Costs of haematological adverse events in chronic myeloid leukaemia patients: a retrospective cost analysis of the treatment of anaemia, neutropenia and thrombocytopenia in patients with chronic myeloid leukaemia

OBJECTIVE

The study aim was to assess costs of haematological adverse events (AE) related to pharmacologic treatment of chronic myeloid leukaemia (CML) patients.

METHODS

This was a retrospective cohort study using patient records of adults (n=91) with chronic-phase CML treated at a single university medical centre in the Netherlands. Occurrence of grade III/IV haematological AEs, defined according to CTC-NCI guidelines criteria, was derived from the laboratory registration. Mean age at time of diagnosis was 48 years; 56% male. A healthcare perspective was adopted. Cost estimates are presented in 2006 euros.

RESULTS

Average cost of an episode of anaemia was 1,572 euro, of thrombocytopenia 2,955 euro, and of neutropenia 1,152 euro. The mean cost of febrile neutropenia amounted to 2,462 euro.

CONCLUSIONS

Treatment costs of AEs varied considerably. However, apart from the cost of anaemia, the results presented seem to be in line with information from the international literature. The key limitations of the study concern the relatively small cohort of patients at a single centre, the retrospective design and the various treatment regimens of CML during the follow-up.

Drug-related blood dyscrasias in a Swedish reporting system, 1985-1994

Drug-related blood dyscrasias as reported in Sweden during a 10-yr period have been analysed in relation to sales and prescription data. The number of cases reported were as follows: agranulocytosis 390, thrombocytopenia 391, pancytopenia 50 and aplastic anaemia 36. The annual incidence rates per 10(6) inhabitants were: agranulocytosis 4.8, thrombocytopenia 5.6, pancytopenia 1.1 and aplastic anaemia 0.5. Incidences in the elderly were higher for all dyscrasias except aplastic anaemia. The most commonly reported drugs for all dyscrasias were sulphonamides and diuretics, but when related to sales data the risk of agranulocytosis was high for clozapine, dapsone, mianserin and sulphasalazine, while the risk did not seem to be increased for furosemide. For thrombocytopenia, furosemide, co-trimoxazole and the measles, mumps and rubella vaccine were most commonly reported. The risk for pancytopenia and aplastic anaemia was increased for acetazolamide and co-trimoxazole. As spontaneous reporting systems are primarily set up for signalling purposes, such data must always be interpreted with utmost care.

Incidence and cause of aplastic anemia, hemolytic anemia, agranulocytosis and thrombocytopenia

A total of 745 patients with cytopenia (aplastic anemia 157, hemolytic anemia 101, agranulocytosis 136, thrombocytopenia 351) were diagnosed during a 5-year period in a health care region comprising 16% of the Swedish population. The total incidence was for aplastic anemia 24.6, hemolytic anemia 15.8, agranulocytosis 21.3 and thrombocytopenia 55.0 cases per 10(6) and year. Compared to 10 years earlier, aplastic anemia and agranulocytosis have become more common, thrombocytopenia occurs with unchanged frequency while hemolytic anemia is rarer. The overall incidence is 5 times higher in elderly (greater than 65 y.) than in younger patients and 1.3 times higher in women than in men, figures that make total incidence figures rather meaningless. The most common cause is "unknown" (45%), the next drug-induced (25-36% including cytostatic drugs). Disregarding cytostatics, the drugs most often encountered are oral diuretics, analgesics, antiphlogistics and sulfonamides.

Epidemiology of thrombocytopenia in HIV inlection

Thrombocytopenia is a known complication of human immunodeficiency virus Type-1 (HIV-1) infection, and more data need to be collected on its frequency, severity, and clinical sequelae. We determined the frequency of thrombocytopenia and its relationship to other HIV infection characteristics from a review of records of 1004 HIV-infected patients attending two outpatient clinics in Washington, D.C. The self-reported sources of HIV-1 exposure were male homosexual activity (68%), bisexual activity (10%), heterosexual activity (6%), and intravenous drug use (15%). Fifty-nine percent of the individuals were white, 37% were black and 94% were male. Fifteen percent had AIDS. Thrombocytopenia occurred more frequently in subjects with AIDS (21.2%) than in HIV-infected individuals who did not fit clinical criteria for AIDS (9.2%) (p less than 0.001). Patients with few CD4-positive cells and an advanced stage of disease were more likely to have low platelet counts: 30% with an absolute CD4 cell count lower than 200/mm3 vs 8% with CD4 counts between 200 and 500 (p less than 0.00001), and 18.5% with Stage IV disease compared to 7.6% in Stage II (p less than 0.001) had platelet counts less than 150,000/mm3. Thrombocytopenia was more frequent in white males and older subjects. Although subjects infected by heterosexual exposure had a lower frequency of thrombocytopenia, intravenous drug users and homosexual men exhibited similar frequencies of thrombocytopenia. Of all subjects with platelet counts less than 50,000/mm3, 40% reported bleeding and 1 died of an intracranial hemorrhage. Thrombocytopenia occurs frequently in HIV-infected people, primarily in those with AIDS, low CD4 cell numbers, and advanced stages of diseases.

Rituximab-associated acute thrombocytopenia: an under-diagnosed phenomenon

Acute infusion reactions are the most common documented adverse reactions reported with rituximab, with overt cytokine release syndrome, and hematological adverse events being much rarer. The clinical course of a patient with mantle cell lymphoma, who developed acute thrombocytopenia and leukopenia following rituximab administration, is described and the literature reviewed. Serum complement and the levels of three cytokines--TNF-alpha, IL-6, and IL-1, were measured 2 days after the infusion of rituximab by using ELISA assay. Drug-dependent antibodies against platelets were evaluated by two procedures as follows: an immunofluorescence test applying flow cytometry and Monoclonal Antibody Immobilization of Platelet Antigen (MAIPA). Serum levels of TNF-a were significantly increased compared with normal, whereas those of IL-6 and IL-1 were not increased significantly. Flow cytometry assay and the MAIPA assay failed to detect rituximab-dependent antibodies against platelets. Complement levels were decreased compared with normal. Literature search yielded 10 publications reporting on another 15 patients. The most common type of lymphoma was mantle cell lymphoma, six patients had bone marrow involvement, and 10 patients had splenomegaly. In 10 patients, acute cytopenia was preceded by cytokine release syndrome or infusion-related symptoms. Usually, thrombocytopenia was not associated with bleeding manifestations. Thrombocytopenia was the most commonly acute cytopenia reported. The postulated pathogenesis is associated with cytokine release syndrome and complement activation. Patients with potential risk factors like splenomegaly and bone marrow involvement, who develop clinical manifestations compatible with cytokine release syndrome, should be closely monitored for rituximab-associated cytopenia.

Clinical and laboratory findings in acute malaria caused by various plasmodium species

OBJECTIVE

To find out clinical and laboratory findings in acute malaria caused by various plasmodium species.

METHODS

This study was conducted in Department of Medicine and Pathology, Combined Military Hospital, Quetta, Balochistan, from August 2006 to December 2006. Five hundred and two subjects with positive malarial parasite slide were included in the study. Frequencies of alterations in clinical and laboratory parameters were determined in various plasmodium species and reported in percentage.

RESULTS

Of 502 patients, 311 were Plasmodium (P.) falciparum, 100 were P. vivax and 91 were mixed infection. Triad of fever, chills and sweating was present in 91% of subjects with all three varieties of P. infection. Splenomegaly was detected in 59-73% individuals with malaria. Thrombocytopenia was the leading haematological alteration associated with various P. species, seen in almost 80% of infected patients. Anaemia and Jaundice were more common in P. falciparum and mixed infection as compared to P. vivax. Serum urea, creatinine and plasma glucose were within normal limits in all the patients with malaria.

CONCLUSION

Malaria must be considered as a leading differential diagnosis in an acutely febrile patient with one or more of abnormalities like splenomegaly, fall in blood counts or rise in bilirubin and serum alanine aminotransferase levels.

The prevalence of intolerance for low-dose acetylsalicylacid in the secondary prevention of atherothrombosis

Daily low-dose acetylsalicylacid (ASA) is prescribed to patients with atherothrombosis frequently to prevent vascular complications. In reports on complications and side effects of low-dose ASA use in the literature there is a range of definitions. We explored the incidence, characteristics and consequences of symptoms suggestive of ASA intolerance in patients on low-dose ASA. General practitioners and specialists in 105 centres were asked to review their patient files for the last 10 consecutive patients who were prescribed ASA. Participating patients completed a questionnaire about their current ASA use (doctors completed the questionnaire together with the patients), use of co-medication and symptoms suggestive of ASA intolerance. A total of 947 patients were included in this study. Sixty patients (6.6%) had ceased ASA treatment, predominantly because of the occurrence of side effects suspected to be caused by ASA use. A quarter of the patients concomitantly used an anti-acid agent. Of the 947 patients, 271 (30.6%) indicated symptoms during ASA intake. The most common symptoms were related to the gastrointestinal tract (25.1%). In patients prescribed a low-dose of ASA monotherapy, side effects suggestive of intolerance are common. More awareness should be created to detect and treat these symptoms, because the occurrence of side effects is the most important reason for patients to discontinue ASA treatment.

Clinical description of intracranial hemorrhage associated with bleeding disorders

BACKGROUND

Intracerebral hemorrhage (ICH) is an unusual but serious complication of bleeding disorders. ICH is believed to follow thrombocytopenia, alterations in coagulation, and vascular fragility. Information regarding its distribution is nonconclusive, and the mechanism of bleeding is not fully understood. The aim of this study was to examine the clinical and neuroimaging features of ICH in patients with bleeding disorders to predict risk factors for this condition.

METHODS

All cases of ICH diagnosed from 1987 to 2004 were retrospectively identified using the centralized database of our institution. Cases were included whenever ICH was caused by a primary hematologic disorder. The clinical characteristics, neuroimages, and outcome were analyzed.

RESULTS

A total of 31 patients were identified. ICH was the initial presentation of the bleeding disorder in 9 patients. Overall, 71% had systemic bleeding concurrent to the ICH. All patients had altered mental status. In 45.2% of the patients simultaneous intracranial hemorrhages were found. Eight patients had recurrent ICH. Severe thrombocytopenia (platelet count < 10,000/mm(3)) was present in 41% and very low platelets (</=1000/mm(3)) in 3%. Death occurred in 71%.

CONCLUSIONS

Multiple ICH is not an unusual presentation in patients with primary bleeding disorders developing brain hemorrhage. Although low platelet counts can be blamed for the bleeding, factors different from thrombocytopenia should be considered as the principal mechanism. The best predictor of cerebral bleeding is the presence of systemic bleeding.

A national study of the complications of lupus in pregnancy

OBJECTIVE

This study was undertaken to determine the risk of rare complications during pregnancy for women with systemic lupus erythematosus.

STUDY DESIGN

By using the Nationwide Inpatient Sample from 2000-2003, we compared maternal and pregnancy complications for all pregnancy-related admissions for women with and without systemic lupus erythematosus.

RESULTS

Of more than 16.7 million admissions for childbirth over the 4 years, 13,555 were to women with systemic lupus erythematosus. Maternal mortality was 20-fold higher among women with systemic lupus erythematosus. The risks for thrombosis, infection, thrombocytopenia, and transfusion were each 3- to 7-fold higher for women with systemic lupus erythematosus. Lupus patients also had a higher risk for cesarean sections (odds ratio: 1.7), preterm labor (odds ratio: 2.4), and preeclampsia (odds ratio: 3.0) than other women. Women with systemic lupus erythematosus were more likely to have other medical conditions, including diabetes, hypertension, and thrombophilia, that are associated with adverse pregnancy outcomes.

CONCLUSION

Women with systemic lupus erythematosus are at increased risk for serious medical and pregnancy complications during pregnancy.

Neonatal thrombocytopenia associated with maternal pregnancy induced hypertension

OBJECTIVE

To evaluate the prevalence of thrombocytopenia in neonates born to mothers with pregnancy induced hypertension (PIH) and identify the associated material and neonatal characteristics.

METHODS

In the current, prospective study, platelet counts were assessed serially. Maternal and neonatal characteristic were recorded in pre-designed proforma. Primary outcome measures were thrombocytopenia defined as platelet count of <150,000/mm(3) and severe thrombocytopenia if counts were <30,000/mm(3) or <50,000/mm(3) with bleeding.

RESULTS

Of 97 neonates born to PIH mothers 35 (36.1%) had thrombocytopenia. In 20 (20.6%) thrombocytopenia was severe. Higher percentage of thrombocytopenia was associated with male gender (47.7%), low birth weight (71.4%) and prematurity (67.4%). Severe thrombocytopenia was significantly associated with low birth weight (OR: 4.58; 95% CI: 0.98-21.3; p<0.03) and prematurity (OR: 2.52; 95% CI: 0.87-7.24; p<0.05). Material parity, onset of PIH, and medications did not seem to be associated significantly.

CONCLUSION

Premature and low birth weight neonates born to mothers with pregnancy induced hypertension would require scrutiny for thrombocytopenia during early neonatal period.

Therapeutic amenorrhea in patients at risk for thrombocytopenia

To examine the need for and evaluate the method of menses suppression in women at risk for thrombocytopenia. A systematic review of the published literature in MEDLINE using the search terms thrombocytopenia, menorrhagia, therapeutic amenorrhea, progestin intrauterine device, combination oral contraceptive--extended and cyclic, gonadotropin releasing hormone agonist, danazol, and progestins. There are an increased number of reproductive age women at risk for thrombocytopenia who would benefit from menses suppression. A number of effective medical regimens are available. In patients who fail medical therapy, endometrial ablation appears to be effective in women with thrombocytopenia. As a result of the increased number of women at risk for thrombocytopenia, there is a need for therapeutic amenorrhea. The type of regimen selected depends upon the patients need for contraception and the ability to tolerate estrogen-containing medications. For women who fail medical therapy, there are surgical options, which are associated with less morbidity than hysterectomy.

[20-year experience with modified dose fractionation of radiotherapy in primary Hodgkin's disease]

Significantly lower frequency of relapse, incidence of pulmonitis and pericarditis, leukopenia and thrombocytopenia stage IV and longer recurrence-free survival were reported after acceleration of multifractionation of STD of 1.35Gy was used for treatment of patients with primary Hodgkin's disease, as compared with standard fractionation. When STD was reduced to 1.2Gy (modified multifractionation), subtotal exposure of lymph nodes was followed by a significant drop in frequency and severity of leukopenia and thrombocytopenia stage III-IV. The latter complications, rates decreased further, with perspective response to therapy, as irradiation was limited to that of areas exposed during modified multifractionation.

Dengue outbreak in Karachi, Pakistan, 2006: experience at a tertiary care center

This is the first report of the largest epidemic of dengue hemorrhagic fever (DHF) virus infection (2006) with IgM-confirmed cases from Karachi, Pakistan. Medical records of 172 IgM-positive patients were reviewed retrospectively for demographic, clinical and laboratory data. Patients were categorized into dengue fever (DF) and DHF according to the WHO severity grading scale. The mean+/-SD age of the patients was 25.9+/-12.8 years, 55.8% were males and the hemoconcentration was recorded in a small number of patients [10 (7.0%)]. Male gender [odds ratio (OR)=14.7, P=0.003), positive history of vomiting (OR=4.3, P=0.047), thrombocytopenia at presentation (OR=225.2, P<0.001) and monocytosis (OR=5.8, P=0.030) were independently associated with DHF, but not with DF. Five cases (2.9%) had a fatal outcome, with a male-to-female ratio of 1:4. Three were from a pediatric group (<15 years). Pulmonary hemorrhages, disseminated intravascular coagulation and cerebral edema preceded death in these patients. The results have highlighted significant findings, such as adult susceptibility to DHF, pronounced abdominal symptoms and lack of hemoconcentration at time of presentation in the study population. These findings may play an important role in the case definitions of future studies from this part of the world.

Heparin induced thrombocytopenia: pathogenetic, clinical, diagnostic and therapeutic aspects

Heparin induced thrombocytopenia (HIT) in addition to bleeding complications are the most serious and dangerous side effects of heparin treatment. HIT remains the most common antibody-mediated, drug-induced thrombocytopenic disorder and a leading cause of morbidity and mortality. Two types of HIT are described: Type I is a transitory, slight and asymptomatic reduction of platelet count occurring during 1-2 days of therapy. HIT type II, which has an immunologic origin, is characterized by a thrombocytopenia that generally onset after the fifth day of therapy. Despite thrombocytopenia, haemorrhagic complications are very rare and HIT type II is characterized by thromboembolic complications consisting in venous and arterial thrombosis. The aim of this paper is to review new aspects of epidemiology, pathophysiology, clinical features, diagnosis and therapy of HIT type II. There is increasing evidence that platelet factor 4 (PF4) displaced from endothelial cells, heparan sulphate or directly from the platelets, binds to heparin molecule to form an immunogenic complex. The anti-heparin/PF4 IgG immune-complexes activates platelets through binding with the Fcgamma RIIa (CD32) receptor inducing endothelial lesions with thrombocytopenia and thrombosis. Cytokines are generated during this process and inflammation could play an additional role in the pathogenesis of thromboembolic manifestations. The onset of HIT type II is independent from dosage, schedule, and route of administration of heparin. A platelet count must be carried out prior to heparin therapy. Starting from the fourth day, platelet count must be carried out daily or every two days for at least 20 days of any heparin therapy regardless of the route of the drug administration. Patients undergoing orthopaedic or cardiac surgery are at higher risk for HIT type II. The diagnosis of HIT type II should be formulated on basis of clinical criteria and confirmed by in vitro demonstration of heparin-dependent antibodies detected by functional and antigen methods. However, the introduction of sensitive ELISA tests to measure anti-heparin/PF4 antibodies has showed the immuno-conversion in an higher number of patients treated with heparin such as the incidence of anti-heparin/PF4 exceeds the incidence of the disease. If HIT type II is likely, heparin must be immediately discontinued, even in absence of certain diagnosis of HIT type II, and an alternative anticoagulant therapy must be started followed by oral dicumaroids, preferably after resolution of thrombocytopenia. Further studies are required in order to elucidate the pathogenetic mechanism of thrombosis and its relation with inflammation; on the other hand large clinical trials are needed to confirm the best therapeutic strategies for HIT Type II.

Profound thrombocytopenia and survival of hematopoietic stem cell transplant patients without clinically significant bleeding, using prophylactic platelet transfusion triggers of 10 x 10(9) or 20 x 10(9) per L

BACKGROUND

A trigger of 10 x 10(9) per L for prophylactic platelet (PLT) transfusions is generally recommended for stable thrombocytopenic patients who receive chemotherapy, based on studies showing similar incidence, severity, and fatality of bleeding compared with the 20 x 10(9) per L trigger. The outcome of thrombocytopenic nonbleeding patients has not been well described. This retrospective analysis evaluates thrombocytopenia and survival of 381 hematopoietic stem cell transplant (HSCT) patients without clinically significant bleeding, with 10 x 10(9) and 20 x 10(9) per L prophylactic triggers.

STUDY DESIGN AND METHODS

A total of 170 patients who received prophylactic PLT transfusions at 20 x 10(9) per L (1997-1998, SP1) and 211 patients who had prophylaxis at 10 x 10(9) per L (1999-2001, SP2) were identified as nonbleeding patients. PLT counts and clinical complications were assessed within 100 days from HSCT.

RESULTS

PLT counts less than or equal to 10 x 10(9) per L were found in 69.2 percent of patients in SP2 and 38.3 percent in SP1 (p < 0.001). Profound thrombocytopenia (4+ PLT counts <or=10 x 10(9)/L) was found in 19.0 percent of patients in SP2 and 7.0 percent in SP1 (p = 0.001). Patients with profound thrombocytopenia had significantly increased early mortality (odds ratio [OR], 3.18; 95% confidence interval [CI], 1.25-8.07) and significantly reduced overall survival (hazard ratio [HR], 1.95; 95% CI, 1.28-2.97) compared to patients with 0 to 3 PLT counts less than or equal to 10 x 10(9) per L. The association of profound thrombocytopenia with early mortality was more notable in SP2.

CONCLUSION

The 10 x 10(9) per L transfusion trigger is associated with significantly greater exposure to low PLT counts. Nonbleeding patients with profound thrombocytopenia were at significantly greater risk of dying compared with nonthrombocytopenic patients. These results suggest that safety of the 10 x 10(9) per L trigger should be more thoroughly evaluated.

No Difference in Risk for Thrombocytopenia During Treatment of Pulmonary Embolism and Deep Venous Thrombosis With Either Low-Molecular-Weight Heparin or Unfractionated Heparin

BACKGROUND

Low-molecular-weight heparin (LMWH) is a popular alternative to unfractionated heparin (UH) for the treatment of pulmonary embolism (PE) and deep vein thrombosis (DVT), in part based on the perception of a lower risk for heparin-induced thrombocytopenia (HIT). To investigate the evidence supporting this perception, we performed a metaanalysis to compare the incidence of thrombocytopenia between LMWH and UH during PE and/or DVT treatment.

METHODS

Randomized trials comparing LMWH with UH for PE and/or DVT treatment were searched for in the MEDLINE database, bibliographies, and by correspondence with published investigators. Two reviewers independently selected high-quality studies and extracted data regarding heparin-associated thrombocytopenia (HAT), HIT confirmed by laboratory testing, and heparin-induced thrombocytopenia with thrombosis (HITT). Outcome rates between LMWH and UH were compared using a binomial, generalized linear mixed model with a logit link and Gaussian random effects for study.

RESULTS

Thirteen studies involving 5,275 patients met inclusion criteria. There were no statistically significant differences in HAT rates between the two treatments (LMWH, 1.2%; UH, 1.5%; p = 0.246). The incidence of documented HIT and HITT was too low to make an adequate comparison between groups.

CONCLUSIONS

Our review disclosed no statistically significant difference in HAT between LMWH and UH and insufficient evidence to conclude that HIT and HITT rates were different between them. There was no evidence from randomized comparative trials to support the contention that patients receiving treatment for PE or DVT with UH are more prone to these complications than those receiving LMWH.

Percutaneous coronary interventions in patients with heparin-induced thrombocytopenia

Accomplishing a successful percutaneous coronary intervention in a patient with a suspected or diagnosed heparin-induced thrombocytopenia (HIT) requires the selection of an appropriate alternative anticoagulant and a thorough assessment of bleeding and thrombotic risks. In this review, we suggest an evidence-based management algorithm that takes into account the clinical phase of HIT (acute, recent, and remote HIT) and the associated risk when patients present with acute coronary syndrome. The algorithm also integrates preventive measures directed at decreasing the bleeding risk associated with the antithrombotic and invasive therapies used for HIT and percutaneous coronary intervention.

The prevalence of pantoprazole associated thrombocytopenia in a community hospital

OBJECTIVE

Proton pump inhibitors (PPIs) are widely used in the treatment of gastritis, gastroesophageal reflux disease and peptic ulcer disease. Thrombocytopenia is not listed as one of the main side effects of PPI therapy. However, there have been documented cases of thrombocytopenia with the use of PPIs in the literature. Our objective was to determine whether exposure to PPIs leads to an increased incidence of thrombocytopenia in hospitalized patients.

METHODS

This retrospective cohort study examined the platelet counts of 468 hospitalized patients who were 18 - 80 years of age, were prescribed pantoprazole for a minimum of 3 days and were matched to 468 non-medicated controls. The primary outcome was defined as either a drop in the platelet count by >/= 50% relative to baseline, or a drop to < 150,000/ml. Exclusion criteria were baseline thrombocytopenia and hospitalization for < 3 days.

RESULTS

No difference was found in the occurrence of thrombocytopenia between the two groups (6.2%; 95% CI = 4.1 - 8.7%) in the study group versus (6.6%; 95% CI = 4.5 - 9.2%) in the control group (p = 0.90). Post-hoc analysis revealed a higher incidence of > 20% drop in platelet count in the study group compared with the controls (23%; 95% CI = 19 - 27% versus 11%; 95% CI = 8 - 14%, respectively; p < 0.001).

CONCLUSION

This study failed to demonstrate an increased incidence of thrombocytopenia for patients treated with pantoprazole. Our study adds support to the favorable safety profile of PPI therapy in hospitalized patients. Further investigation is needed to evaluate the effects of PPI use in the outpatient setting.

Impact of thrombocytopenia on outcome of patients admitted to ICU for severe community-acquired pneumonia

OBJECTIVE

To evaluate the prevalence and the prognostic value of thrombocytopenia in patients admitted to ICU for severe community-acquired pneumonia.

METHODS

Multicentre observational study was conducted in 7 ICUs in the north of France over a 19-year period (1987-2005). The primary outcome measure was the ICU mortality.

RESULTS

Eight hundred and twenty-two patients were studied. A platelet count < 150x10(9)/L was observed at ICU admission in 202 (25%) patients. Admission platelet count was between 101 and 149x10(9)/L, 51 and 100x10(9)/L, 21 and 50x10(9)/L, and < or = 20x10(9)/L in 100, 61, 32 and 9 patients, respectively. ICU mortality rate was 35.4%. Classifying patients into 3 categories with the following cut-offs of platelet count, > or = 150x10(9)/L, 51-149x10(9)/L, and < or = 50x10(9)/L, we observed a significant increase in ICU mortality rates which were 30.8% in the first group, 44.1% in the second group and 70.7% in the last one (p<0.0001). In multivariate analysis, thrombocytopenia < or = 50x10(9)/L appeared as an independent predictor of mortality (AOR=4.386).

CONCLUSIONS

In patients admitted to ICU for severe community-acquired pneumonia, thrombocytopenia has a high prevalence and influences the outcome.

Efficacy and safety of abciximab in combination with cilostazol in patients undergoing stenting

OBJECTIVE

To evaluate the short- and long-term efficacy and safety of abciximab and cilostazol in patients with acute MI and unstable angina undergoing intracoronary stenting.

METHODS

Acute-phase (7 and 30 days), 6-month and long-term composite outcomes involving death, myocardial infarction or urgent target vessel revascularization (TVR) together with other outcomes (composite outcomes involving death, MI and elective TVR with restenosis and stroke) were evaluated retrospectively in a total of 175 patients. Safety outcomes were assessed using data on the incidence of bleeding and thrombocytopenia at Day 7 and Day 30.

RESULTS

Of 175 patients, 83 (47.4%) patients received abciximab. At 7 and 30 days, the composite outcome for the group treated with cilostazol alone and that treated with abciximab in combination with cilostazol did not differ significantly. The composite outcomes at 6 months and 1 year were significantly lower in the abciximab plus cilostazol group (relative risk 0.35, 95% Cl 0.13 - 0.90, relative risk 0.28, 95% CI 0.10 -0.78, respectively). The incidence of major bleeding at the access-site and in the gastrointestinal tract and minor bleeding were significantly higher in the group receiving abciximab plus cilostazol group at 7 days (relative risk 3.33, 95% CI 1.66 - 6.65, relative risk 9.98, 95% CI 1.29 - 77.07, relative risk 1.96, 95% CI 1.06 - 3.62, respectively) and at 30 days (relative risk 3.33, 95% CI 1.66 - 6.65, relative risk 5.54, 95% CI 1.25 - 24.56, relative risk 1.96, 95% CI 1.06 - 3.62, respectively).

CONCLUSION

The combination of abciximab and cilostazol showed an improvement in major cardiac incidents at 6 months and 1 year of the treatment when compared to the group receiving cilostazol alone. However, abciximab did not improve the incidence of death but increased the risk of bleeding complications.

The clinical significance of non-malignant neutropenia in hospitalized children

Neutropenia in non-cancer patients is often discovered in the course of an evaluation for acute infection, and it is usually secondary to the infection itself rather than a predisposing factor of the infection. Although it is not a common finding in hospitalized pediatric patients, it causes a great concern to the treating physicians. The aim of this study was to determine the incidence, the etiology, and the clinical significance of neutropenia in previously healthy children admitted in a general pediatric ward. One thousand five hundred and forty-eight patients admitted during a period of 18 months were included in the study. The clinical characteristics, the complete blood count, and the sedimentation rate were recorded. A total of 143 (9.2%) pediatric patients were identified as neutropenic, with mean absolute neutrophilic count of 0.960 x 10(9)/l (SD 0.341 x 10(9)/l) and ranged from 0.200 to 1.499 x 10(9)/l. The neutropenic patients had lower hemoglobin of 11.2 mg/dl and ranged from 6.2 to 17.2 mg/dl compared to hemoglobin of 11.5 mg/dl, which ranged from 5.2 to 18.0 mg/dl of the individuals with normal neutrophils, p < 0.0001 and lower mean platelet count of 294 x 10(9)/l, which ranged from 122 to 929 x 10(9)/l compared to platelet count of 381 x 10(9)/l, which ranged from 90-165 x 10(9)/l of the individuals without neutropenia, p < 0.001. Additionally, those patients were significantly younger than the non-neutropenic ones. Infection was the most common cause of neutropenia, although none of them developed septicemia. The neutrophil count normalized in most of the patients before discharge. However, 12 (8.3%) of neutropenic patients were discharged with persistent findings. Two of those were finally diagnosed with autoimmune neutropenia. In conclusion, the acquired neutropenia in hospitalized patients without malignancy is mild to moderate. It has no influence on the clinical outcome. Importantly, it has short duration, and it is usually resolved before patient's discharge.

Incidence of antiheparin-platelet factor 4 antibodies and heparin-induced thrombocytopenia in Turkish patients undergoing cardiac surgery

The frequency of antiheparin-platelet factor 4 antibodies by means of antigenic and functional assays ((14) C-serotonin release assay and citrated plasma platelet aggregation) was determined in 115 Turkish patients undergoing cardiac surgery. Blood samples were taken immediately before surgery and on days 5 and 10 +/- 2. Platelet counts were recorded and thrombotic events were determined by clinical methods. Antibody generation measured by enzyme-linked immunosorbent assay before surgery (n = 44) and on days 5 (n = 44) and 10 (n = 115) was 15.9%, 34.1%, and 65.2%, respectively. Positive samples from functional assays were 4.4% on day 0 and 7.0% on day 10. All positive samples had been negative on day 0. A high frequency of antiheparin-platelet factor 4 antibody generation and a low frequency of clinical heparin-induced thrombocytopenia were determined in these patients. These results obtained for Turkish patients are similar to those of other studies of heparin-induced thrombocytopenia.