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Mumtaz H, Danish R, Yousaf T, Sehgal S, Jawad A, Ali Haider SM. Frequency and Outcome of Pregnant Females Presenting With Thrombocytopenia at a Tertiary Care Hospital. Cureus 2023; 15:e49466. [PMID: 38152787 PMCID: PMC10751517 DOI: 10.7759/cureus.49466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND Platelet-related problems are more frequently discovered in women during pregnancy because screening is carried out as part of the initial clinic examination using automated blood counts. This study was done to find out the frequency and outcomes of pregnant females presenting with thrombocytopenia at a tertiary care hospital. METHODOLOGY This cross-sectional study was conducted at the Department of Obstetrics and Gynecology, Jinnah Hospital, Lahore, Pakistan, from April 2023 to September 2023. This study involved 280 pregnant women presenting in the third trimester. Blood examination was acquired, and a platelet count less than 150x109/L was labeled as thrombocytopenia. Outcome variables were frequency of thrombocytopenia, while post-delivery, frequency of placental abruption, preterm delivery, stillbirth, need for blood transfusion, and poor Apgar score were noted and compared among women with and without thrombocytopenia. RESULTS In a total of 280 pregnant females, the mean age and gestational age at the time of presentation were 29.34±4.38 years and 31.30±2.87 weeks, respectively. The mean BMI of the females was 27.97±4.72 kg/m2. Thrombocytopenia was noted in 34 females (12.1%). Placental abruption, preterm delivery, need for blood transfusion, stillbirth, and poor Apgar score were observed in 1.4%, 4.3%, 8.2%, 1.1%, and 2.1% cases, respectively. Placental abruption (11.8% vs. 0.0%; p<0.001), preterm delivery (29.4% vs. 0.8%; p<0.001), need of blood transfusion (35.3% vs. 4.5%; p<0.001), stillbirth (8.8% vs. 0.0%; p<0.001), and poor Apgar score (17.6% vs. 0.0%; p<0.001) were all significantly higher among pregnant women with thrombocytopenia as compared to those with a normal platelet count. CONCLUSION The frequency of thrombocytopenia was 12.1% among pregnant females. The frequency of placental abruption, preterm delivery, need for blood transfusion, stillbirth, and poor Apgar score were all significantly higher among pregnant women with thrombocytopenia as compared to those with a normal platelet count, irrespective of the patient's age, parity, and BMI.
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Affiliation(s)
- Hira Mumtaz
- Gynaecology and Obstetrics, Basildon University Hospital, National Health Service (NHS) Trust, Basildon, GBR
| | | | - Tayiba Yousaf
- Obstetrics and Gynecology, Salma Khalil Clinic, Narowal, PAK
| | - Shazia Sehgal
- Obstetrics and Gynecology, Fatima Jinnah Medical University, Lahore, PAK
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Point F, Terriou L, Rakza T, Drumez E, Alluin G, Garabedian C, Houfflin‐Debarge V. Risk factors for severe neonatal thrombocytopenia in cases of maternal immune thrombocytopenia. Acta Paediatr 2022; 111:985-991. [PMID: 35028970 DOI: 10.1111/apa.16252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 01/08/2022] [Accepted: 01/10/2022] [Indexed: 11/30/2022]
Abstract
AIM Maternal immune thrombocytopenia (ITP) may induce neonatal thrombocytopenia (nTP), which carries a risk of neonatal haemorrhagic complications. Some risk factors for nTP have reached consensus such as maternal splenectomy and previous severe nTP, while others such as maternal platelet count have not. METHODS We conducted a retrospective cohort study in a university hospital, including 145 neonates of mothers with ITP. We assessed the risk of severe nTP and bleeding complications. RESULTS Severe nTP in the first 24 h after birth was more common in case of maternal splenectomy (OR = 4.4) and a previous severe nTP (OR = 46.9). Severe nTP at nadir (lowest platelet count during the initial postnatal days) was more frequent in cases of a previous neonate with severe nTP (OR = 42), maternal treatment during pregnancy (OR = 2.4) and a low maternal platelet count during pregnancy or at delivery. These risk factors were not significantly associated with an increased risk of neonatal haemorrhagic complications. CONCLUSION In our population, we confirm the risk of severe nTP in case of maternal splenectomy or previous nTP. By monitoring the platelet count to its nadir, we identified three additional risk factors: maternal treatment during pregnancy and low maternal platelet count during pregnancy or low maternal platelet count at delivery.
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Affiliation(s)
- Florian Point
- Department of Obstetrics Lille University Hospital Lille France
| | - Louis Terriou
- Department of Internal Medicine and Clinical Immunology Referral Center for Rare Systemic Autoimmune Diseases North and Northwest of France Lille University Hospital Lille France
- Lille University Inserm U995‐LIRIC‐Lille Inflammation Research International Center Lille France
| | - Thameur Rakza
- Department of Obstetrics Lille University Hospital Lille France
| | - Elodie Drumez
- Department of Biostatistics Lille University Hospital Lille France
- Lille University ULR 2694 ‐ METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales Lille France
| | - Gauthier Alluin
- Etablissement Français du Sang Hauts‐de‐France‐Normandie Loos France
| | - Charles Garabedian
- Department of Obstetrics Lille University Hospital Lille France
- Lille University ULR 2694 ‐ METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales Lille France
| | - Véronique Houfflin‐Debarge
- Department of Obstetrics Lille University Hospital Lille France
- Lille University ULR 2694 ‐ METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales Lille France
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Janssens A, Selleslag D, Depaus J, Beguin Y, Lambert C. Primary immune thrombocytopenia in adults: Belgian recommendations for diagnosis and treatment anno 2021 made by the Belgian Hematology Society. Acta Clin Belg 2022; 77:470-483. [PMID: 33635747 DOI: 10.1080/17843286.2021.1876310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The Belgian Hematology Society (BHS) updated the 2013 guidelines for diagnosis and treatment of primary immune thrombocytopenia (ITP) [1]. As knowledge about ITP pathophysiology is increasing, the mode of action of old therapies is better understood and novel drugs are introduced to target more specific pathways.Corticosteroids with or without intravenous immunoglobulins (IgIV) remain the first-line treatment. According to the updated international guidelines a short course of corticosteroids rather than a prolonged treatment has to be recommended. The same guidelines stress that consequent therapies as thrombopoietic agents (TPO-RAs) and rituximab should be available independent of duration of ITP.Although the majority of recommendations is based on very low-quality evidence, it is strongly advised to individualize the ITP management taking patient values. and preferences in account. The main treatment goal in all ITP patients must be to maintain a safe platelet count to prevent or stop bleeding with a minimum of toxicity and not to normalize the platelet count.
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Affiliation(s)
- A. Janssens
- Department of Hematology, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - D. Selleslag
- Department of Hematology, AZ Sint-Jan Brugge, Brugge, Belgium
| | - J. Depaus
- Department of Hematology, CHU UCL Namur, Yvoir, Belgium
| | - Y. Beguin
- Department of Hematology, Centre Hospitalier Universitaire Liège, Liège, Belgium
| | - C. Lambert
- Department of Hematology, Cliniques Universitaire St Luc, Bruxelles, Belgium
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Bouldouyre MA, Dauphin H, Cherradou N, Gros H. [Establishment and one-year evaluation of an internal medicine consultation in a maternity]. SANTE PUBLIQUE 2019; 30:671-677. [PMID: 30767482 DOI: 10.3917/spub.186.0671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE In the obstetric medicine movement and in response to requests for appointments in internal medicine by obstetricians and midwives, we created an internal medicine consultation within the maternity ward of our General Hospital, and provide feedback after 1 year. METHODS This retrospective descriptive study took place at the Robert Ballanger Intercommunal Hospital Center in Aulnay-sous-Bois in Seine-Saint-Denis (France) between 3rd March 2016 and 9th March 2017, the first year of the internal medicine consultation, one afternoon every 15 days, in the maternity level 2b. RESULTS Out of 121 appointments, 93 consultations were conducted for 63 patients. The main reasons were: thromboembolism (n=2), placental vascular disease (n=14), anemia (n=9), HIV infection (n=8), fetal deaths in utero (n=6), thrombocytopenia (n=6) and autoimmune biological abnormalities (n=3). Although none etiology was found for 16 patients (including 11 seen for placental vascular disease), a diagnosis was made in 75% of cases with a suitable therapeutic attitude. The diagnoses were varied: antiphospholipid syndrom, hypertension, but also discovery of a primary biliary cirrhosis, of a veritable pregnancy-induced immune thrombocytopenia induced by the pregnancy and of a lymphoma-associated on anemia. CONCLUSIONS This consultation provides satisfaction in terms of interdisciplinary organization and collaboration. It appears useful to patients, leading to prevention advice, various diagnoses and sometimes long-term follow-up.
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Harde M, Bhadade R, deSouza R, Jhingan M. Thrombocytopenia in Pregnancy Nearing Term: A Clinical Analysis. Indian J Crit Care Med 2019; 23:503-508. [PMID: 31911740 PMCID: PMC6900888 DOI: 10.5005/jp-journals-10071-23277] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background and aim Thrombocytopenia in pregnancy varies from benign to severe with fetomaternal complications. We aimed to evaluate thrombocytopenia in pregnant Indian females in third trimester mainly during labor and delivery. Materials and methods It was a prospective observational study done in a tertiary care teaching public hospital over 1 year. Consecutive 150 pregnant patients admitted to labor ward with thrombocytopenia were analyzed for etiology of thrombocytopenia, severity, mode of delivery, type of anesthesia, and fetomaternal complications. SPSS version 17 was used for the analysis. Results Most common cause of thrombocytopenia was preeclampsia 50 (33.3%) and preeclampsia with hemolysis, elevated liver enzyme, and low platelet count syndrome (HELLP syndrome) 31 (20.7%) together followed by gestational 42 (28%). Infectious causes such as malaria, dengue, and leptospirosis were found in 19 patients (12.7%). Moderate to severe thrombocytopenia was seen in preeclampsia, preeclampsia with HELLP syndrome, and infectious etiology. Eleven patients (7.3%) developed antepartum hemorrhage (APH), 24 (16%) postpartum hemorrhage (PPH), 12 (8%) required ICU admission, and 3 (2%) mortalities were noted. Fifteen neonates (10%) needed ICU admission. Complications were observed in preeclampsia with HELLP syndrome (82%) and infectious causes (18%) and none in gestational. Sixty-eight patients underwent lower segment cesarean section (LSCS), among them 41 (27.3%) were given spinal anesthesia (SA) and none of them developed any neurological complications. Conclusion Study widened the spectrum of causes for thrombocytopenia in pregnant patients. Preeclampsia with or without HELLP syndrome and vector-borne infections such as malaria, dengue, and leptospirosis were found to be very important causes of moderate to severe thrombocytopenia and were associated with complications. Spinal anesthesia is safe in parturients with mild thrombocytopenia. Awareness and vigilance about thrombocytopenia is vital to reduce maternal morbidity and mortality. How to cite this article Harde M, Bhadade R, deSouza R, Jhingan M. Thrombocytopenia in Pregnancy Nearing Term: A Clinical Analysis. IJCCM 2019;23(11):503–508.
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Affiliation(s)
- Minal Harde
- Department of Anaesthesiology, Topiwala National Medical College and BYL Nair Ch. Hospital, Mumbai, Maharashtra, India
| | - Rakesh Bhadade
- Department of Medicine, Topiwala National Medical College and BYL Nair Ch. Hospital, Mumbai, Maharashtra, India
| | - Rosemarie deSouza
- Department of Medicine, Topiwala National Medical College and BYL Nair Ch. Hospital, Mumbai, Maharashtra, India
| | - Mrida Jhingan
- Department of Anaesthesiology, Topiwala National Medical College and BYL Nair Ch. Hospital, Mumbai, Maharashtra, India
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Loustau V, Pourrat O, Mandelbrot L, Godeau B. Purpura thrombopénique immunologique et grossesse : état des connaissances actuelles et questions encore sans réponse. Rev Med Interne 2015; 36:167-72. [DOI: 10.1016/j.revmed.2014.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 07/30/2014] [Indexed: 11/28/2022]
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Fournet-Fayard A, Lebreton A, Ruivard M, Storme B, Godeau B, Bonnin M, Delabaere A, Gallot D. Prise en charge anténatale des patientes à risque d’hémorragie du post-partum (hors anomalies de l’insertion placentaire). ACTA ACUST UNITED AC 2014; 43:951-65. [DOI: 10.1016/j.jgyn.2014.09.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Ankichetty SP, Chin KJ, Chan VW, Sahajanandan R, Tan H, Grewal A, Perlas A. Regional anesthesia in patients with pregnancy induced hypertension. J Anaesthesiol Clin Pharmacol 2014; 29:435-44. [PMID: 24249977 PMCID: PMC3819834 DOI: 10.4103/0970-9185.119108] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Pregnancy induced hypertension is a hypertensive disorder, which occurs in 5% to 7% of all pregnancies. These parturients present to the labour and delivery unit ranging from gestational hypertension to HELLP syndrome. It is essential to understand the various clinical conditions that may mimic preeclampsia and the urgency of cesarean delivery, which may improve perinatal outcome. The administration of general anesthesia (GA) increases morbidity and mortality in both mother and baby. The provision of regional anesthesia when possible maintains uteroplacental blood flow, avoids the complications with GA, improves maternal and neonatal outcome. The use of ultrasound may increase the success rate. This review emphasizes on the regional anesthetic considerations when such parturients present to the labor and delivery unit.
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Affiliation(s)
- Saravanan P Ankichetty
- Department of Anesthesia, Toronto Western Hospital, University Health Network, McL 2 405, Toronto, ON, M5T 2S8, Canada
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Pourrat O. [Obstetric medicine: Its relevance in the French health system]. Rev Med Interne 2014; 36:147-50. [PMID: 24704324 DOI: 10.1016/j.revmed.2014.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 03/01/2014] [Indexed: 11/16/2022]
Affiliation(s)
- O Pourrat
- Consultation de médecine interne, service de réanimation médicale et médecine interne, CHU de Poitiers, université de Poitiers, 2, rue de la Milétrie, BP 577, 86021 Poitiers, France.
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Puyade M, Badin J, Quéron B, Christiaens L, Varroud-Vial N, Pierre F, Pourrat O. Purpura thrombotique thrombocytopénique : ne pas méconnaître l’atteinte cardiaque. Rev Med Interne 2014; 35:264-7. [DOI: 10.1016/j.revmed.2013.02.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 02/11/2013] [Accepted: 02/13/2013] [Indexed: 01/30/2023]
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Dikman D, Elstein D, Levi GS, Granovsky-Grisaru S, Samueloff A, Gozal Y, Ioscovich A. Effect of thrombocytopenia on mode of analgesia/anesthesia and maternal and neonatal outcomes. J Matern Fetal Neonatal Med 2013; 27:597-602. [DOI: 10.3109/14767058.2013.836483] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Harde M, Dave S, Vasave RR, Gujjar P, Bhadade R. Lower segment cesarean section in a patient with severe thrombocytopenia and pregnancy induced hypertension. J Anaesthesiol Clin Pharmacol 2013; 29:387-9. [PMID: 24106368 PMCID: PMC3788242 DOI: 10.4103/0970-9185.117110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Thrombocytopenia in pregnancy carries a major risk of feto-maternal morbidity and mortality. We present a case of hypocellular bone marrow with severe thrombocytopenia with pregnancy induced hypertension (PIH) for emergency lower segment cesarean section (LSCS). This disease is characterized by pancytopenia and hypocellular bone marrow with impaired morphology and maturation. Causes of death due to this disease include hemorrhage and infection secondary to thrombocytopenia and neutropenia especially following surgery. We report successful management of emergency LSCS with severe thrombocytopenia with severe PIH.
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Affiliation(s)
- Minal Harde
- Department of Anesthesia, T.N.M.C. and B.YL. Nair Ch. Hospital, Mumbai, India
| | - Sona Dave
- Department of Anesthesia, T.N.M.C. and B.YL. Nair Ch. Hospital, Mumbai, India
| | - Rahul Ramji Vasave
- Department of Anesthesia, T.N.M.C. and B.YL. Nair Ch. Hospital, Mumbai, India
| | - Pinakin Gujjar
- Department of Anesthesia, T.N.M.C. and B.YL. Nair Ch. Hospital, Mumbai, India
| | - Rakesh Bhadade
- Department of Medicine, T.N.M.C. and B.YL. Nair Ch. Hospital, Mumbai, India
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Erhabor O, Isaac I, Muhammad A, Abdulrahaman Y, Ezimah A, Adias T. Some hemostatic parameters in women with obstetric hemorrhage in Sokoto, Nigeria. Int J Womens Health 2013; 5:285-91. [PMID: 23807863 PMCID: PMC3685449 DOI: 10.2147/ijwh.s43503] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Obstetric hemorrhage is the leading cause of maternal mortality and morbidity worldwide. This study was carried out to investigate the effect of obstetric hemorrhage on the prothrombin time (PT), activated partial thromboplastin time (APTT), and platelet count (PLC). Women with obstetric hemorrhage were divided into two categories, women with antepartum hemorrhage (APH) and those with postpartum hemorrhage (PPH). Pregnant women without hemorrhage were included as controls. Eighty-six pregnant women aged 18–45 years (mean age 36.25 ± 10.50 years) were presented to the Obstetrics and Gynaecology Department of Maryam Abacha Women and Children Hospital in Sokoto Metropolis, Sokoto State, Nigeria with history of obstetric hemorrhage. Forty-three age-matched nonhemorrhaging parturient women were included as controls. The determination of PT and APTT was done by manual methods using commercially prepared Diagen reagent kits, whereas PLC was done by manual methods using a hemocytometer. The results of PT and APTT were significantly higher among women with APH (20.7 ± 4.226 seconds and 46.04 ± 8.689 seconds, respectively) and among women with PPH (23.17 ± 2.708 seconds and 53.78 ± 4.089 seconds, respectively) compared to normal pregnant women (15.85 ± 0.8930 seconds and 36.225 ± 5.010 seconds, respectively) (P = 0.0001). Similarly, the PLC was significantly higher among normal pregnant women compared to those with APH and PPH (291.425 ± 75.980 × 109 compared to 154.83 ± 47.019 × 109 and 136.43 ± 43.894 × 109, respectively) (P = 0.0001). The PT and APTT of women who presented with PPH were significantly higher compared to those who presented with APH (23.17 ± 2.708 seconds and 53.78 ± 4.089 seconds versus 20.7 ± 4.226 seconds and 46.04 ± 8.689 seconds, respectively) (P = 0.02 and P = 0.04, respectively). The PLC was significantly higher among women who presented with APH compared to those who presented with PPH (P = 0.01). The PT and APTT values were higher in the third trimester among women with APH (24.38 ± 2.33 seconds and 52.25 ± 6.71 seconds, respectively), PPH (24.75 ± 2.63 seconds and 58.25 ± 2.53 seconds, respectively), and control women (16.00 ± 0.82 seconds and 34.42 ± 5.59 seconds, respectively) compared to those in first and second trimester. The PLC was significantly lower in the third trimester among APH, PPH, and normal pregnant women (131 ± 23.02 × 109, 99 ± 21.46 × 109, and 192.86 ± 25.44 × 109, respectively). PT and APTT values correlated positively and significantly with trimester (r = 0.52 and 0.65, respectively; P = 0.01). The PLC of women with APH, PPH, and normal control women correlated negatively with trimester (r = −0.36, −0.54, and −0.28, respectively; P = 0.05). Obstetrics hemorrhage compounded the hemostatic status of pregnant women in Sokoto, Nigeria. There is need for the provision of rapid diagnosis of coagulopathy to guide the provision of best therapeutic management options.
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Affiliation(s)
- O Erhabor
- Department of Haematology and Transfusion Medicine, Usmanu Danfodio University, Sokoto, Bayelsa State, Nigeria
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