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Valavi E, Amoori P, Mohtasham N, Ziaei Kajbaf T, Taheri M, Cheraghian B, Hooshmandi S. Beneficial effect of fresh frozen plasma in reducing renal complications in Hemiscorpius lepturus scorpion envenomated children with severe hemoglobinuria: an open label randomized clinical trial. TOXIN REV 2022. [DOI: 10.1080/15569543.2022.2068031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Ehsan Valavi
- Division of Pediatric Nephrology, Abuzar Children’s Hospital, Chronic Renal Failure Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Parisa Amoori
- Division of Pediatric Nephrology, Abuzar Children’s Hospital, Chronic Renal Failure Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Neda Mohtasham
- Abuzar Children’s Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Tahereh Ziaei Kajbaf
- Abuzar Children’s Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mehri Taheri
- Abuzar Children’s Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Bahman Cheraghian
- Department of Biostatistics and Epidemiology, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Soodeh Hooshmandi
- Abuzar Children’s Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Butt SA, Tahir HM, Ali S, Tariq M, Hassan A, Summer M, Raza C, Khan SY. Evaluation of anti-scorpion ( Hottentota tamulus) venom potential of native plants extracts using mice model. TOXIN REV 2021. [DOI: 10.1080/15569543.2021.1933533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Samima Asad Butt
- Applied Entomology and Toxicology Laboratory, Department of Zoology, Government College University Lahore, Lahore, Pakistan
| | - Hafiz Muhammad Tahir
- Applied Entomology and Toxicology Laboratory, Department of Zoology, Government College University Lahore, Lahore, Pakistan
| | - Shaukat Ali
- Applied Entomology and Toxicology Laboratory, Department of Zoology, Government College University Lahore, Lahore, Pakistan
| | - Muniba Tariq
- Applied Entomology and Toxicology Laboratory, Department of Zoology, Government College University Lahore, Lahore, Pakistan
| | - Ali Hassan
- Applied Entomology and Toxicology Laboratory, Department of Zoology, Government College University Lahore, Lahore, Pakistan
| | - Muhammad Summer
- Applied Entomology and Toxicology Laboratory, Department of Zoology, Government College University Lahore, Lahore, Pakistan
| | - Chand Raza
- Applied Entomology and Toxicology Laboratory, Department of Zoology, Government College University Lahore, Lahore, Pakistan
| | - Shafaat Yar Khan
- Department of Zoology, University of Sargodha, Sargodha, Pakistan
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Enjeti AK, de Malmanche T, Chapman K, Ziolkowski A. Genomic investigation of inherited thrombotic microangiopathy-aHUS and TTP. Int J Lab Hematol 2021; 42 Suppl 1:33-40. [PMID: 32543063 DOI: 10.1111/ijlh.13201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/16/2020] [Accepted: 03/19/2020] [Indexed: 12/12/2022]
Abstract
Thrombotic microangiopathies (TMA) are a heterogeneous group of red cell fragmentation syndromes characterized by a tendency for thrombosis and pathognomonic red cell fragments in peripheral blood, which results in thrombosis in the microvasculature due to endothelial damage. Genomic investigations into inherited TMAs are of diagnostic, prognostic and therapeutic value. Here, we present two cases that capture the importance of performing genomic testing in rare disorders. Treatment options for these conditions, such as plasma exchange and monoclonal antibodies against complement factors, are intensive and expensive health care interventions. The results of genomic investigation into rare TMAs can better inform the clinicians and their patients of prognosis and suitable personalized treatment options.
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Affiliation(s)
- Anoop K Enjeti
- NSW Health Pathology North, John Hunter Campus, New Lambton Heights, NSW, Australia.,Calvary Mater Newcastle, Waratah, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Theo de Malmanche
- NSW Health Pathology North, John Hunter Campus, New Lambton Heights, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Kent Chapman
- NSW Health Pathology North, John Hunter Campus, New Lambton Heights, NSW, Australia
| | - Andrew Ziolkowski
- NSW Health Pathology North, John Hunter Campus, New Lambton Heights, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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Protective efficacy and pharmacokinetics of human/mouse chimeric anti-Stx1 and anti-Stx2 antibodies in mice. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2015; 22:448-55. [PMID: 25716230 DOI: 10.1128/cvi.00022-15] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In the United States, Shiga toxin (Stx)-producing Escherichia coli (STEC) is the most frequent infectious cause of hemorrhagic colitis. Hemolytic uremic syndrome (HUS) is a serious sequela that may develop after STEC infection that can lead to renal failure and death in up to 10% of cases. STEC can produce one or more types of Stx, Stx1 and/or Stx2, and Stx1 and Stx2 are responsible for HUS-mediated kidney damage. We previously generated two monoclonal antibodies (MAbs) that neutralize the toxicity of Stx1 or Stx2. In this study, we evaluated the protective efficacy of human/mouse chimeric versions of those monoclonal antibodies, named cαStx1 and cαStx2. Mice given an otherwise lethal dose of Stx1 were protected from death when injected with cαStx1 either 1 h before or 1 h after toxin injection. Additionally, streptomycin-treated mice fed the mouse-lethal STEC strain B2F1 that produces the Stx2 variant Stx2d were protected when given a dose of 0.1 mg of cαStx2/kg of body weight administered up to 72 h post-oral bacterial challenge. Since many STEC strains produce both Stx1 and Stx2 and since either toxin may lead to the HUS, we also assessed the protective efficacy of the combined MAbs. We found that both antibodies were required to protect mice from the presence of both Stx1 and Stx2. Pharmacokinetic studies indicated that cαStx1 and cαStx2 had serum half-lives (t1/2) of about 50 and 145 h, respectively. We propose that cαStx1 and cαStx2, both of which have been tested for safety in humans, could be used therapeutically for prevention or treatment early in the development of HUS.
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Huang H, Sun W, Liang Y, Long XD, Peng Y, Liu Z, Wen X, Jia M. CD(+)(4)CD(+)(25) Treg cells in thrombotic thrombocytopenic purpura associated with systemic lupus erythematosus patients. Ren Fail 2014; 36:1263-7. [PMID: 24990576 DOI: 10.3109/0886022x.2014.934649] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
AIM CD(+)(4)CD(+)(25) Treg cells are of critical importance for maintenance of tolerance. The purpose of the this study was to observe the number of CD(+)(4)CD(+)(25) Treg cells in the patients with thrombotic thrombocytopenic purpura (TTP) associated with systemic lupus erythematosus (SLE), and to study pathogenesis of TTP with SLE. METHODS Seven patients with TTP associated with SLE and seven healthy volunteers were studied. The CD(+)(4)CD(+)(25) Treg cells were examined by flow cytometry. Clinical and laboratory data, such as urinary protein, serum creatinine, endothelial markers and immunologic serologics, were obtained from each patient and healthy volunteer. Glomerular injury was assessed by histopathology. Serum IL-2, IL-4, IL-6 and anti-endothelial cell antibody were analyzed by ELISA and anti-ADAMTS13 antibody were detected by Western blotting. RESULTS CD(+)(4)CD(+)(25) Treg cells significantly decreased in TTP with SLE patients compared with controls (p < 0.05). CD(+)(4)CD(+)(25) Treg cells are negatively correlated with blood urea nitrogen, serum uric acid, supernatant IL-4, and proteinuria, and positively with estimated glomerular filtration rate (eGFR) in TTP with SLE patients. [Formula: see text] Treg cells gradually decreased as the severity of renal histology increased. Serum IL-2, IL-6, supernatant IL-4, anti-endothelial cell antibody, and anti-ADAMTS13 antibody significantly increased in TTP with SLE patients compared to those of the control groups (all p < 0.05). In contrast, serum levels of C3 were significantly decreased in TTP with SLE patients compared to those of the control groups (p < 0.05). CONCLUSIONS CD(+)(4)CD(+)(25) Treg cells are not only lower in TTP with SLE patients, but also are correlated with disease severity in TTP with SLE patients.CD(+)(4)CD(+)(25)Treg cells may play an important role in the pathogenesis of TTP with SLE.
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Affiliation(s)
- Hongdong Huang
- Division of Nephrology, Beijing Shijitan Hospital, Capital Medical University , P.R. China
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Deng MY, Zhang GS, Zhang Y, Xiao H, Dai CW, Xu YX, Zheng WL, Peng HL, Shen JK. Analysis of clinical and laboratory characteristics in 42 patients with thrombotic thrombocytopenic purpura from a single center in China. Transfus Apher Sci 2013; 49:447-52. [PMID: 23973730 DOI: 10.1016/j.transci.2013.07.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Revised: 06/30/2013] [Accepted: 07/26/2013] [Indexed: 01/02/2023]
Abstract
Thrombotic thrombocytopenic purpura (TTP) is a life-threatening disease characterized by microvascular platelet deposition and thrombus formation with resulting microangiopathic hemolytic anemia. Deficiency of the von Willebrand factor cleavage protease, also known as ADAMTS 13, has been implicated as an important etiological factor in TTP. Little studies were obtained on Chinese patients with TTP until now. Our aim was to analyze the clinical features, outcome and laboratory characteristics of Chinese TTP patients, and determine whether plasma ADAMTS 13 activity is decreased in TTP and its diagnostic value for TTP. Forty-two TTP patients (29 females; 13 males) admitted to our hospital from 1998 to 2010 were analyzed. There were 34 patients (81%) with the triad of TTP, including hemolytic anemia, thrombocytopenia and neurologic abnormalities; 7 (16.7%) had the classical pentad of TTP. Major etiologic factors were acquired autoimmunological abnormalities (31%); no familial TTP was identified in this series. The schistocytes of peripheral blood smears were present in all cases with a mean frequency of 4.6% (range from 0.3% to 13.4%). Plasma ADAMTS 13 activity was determined in 22 patients with the FRET-vWF86 assay. Only 4 idiopathic TTP patients (18.2%) had severe ADAMTS 13 deficiency (activity<10%); 9 (40.9%) had moderate decrease of ADAMTS 13 activity (activity: 10-40%); another 9 (40.91%) had normal ADAMTS 13 activity (>40%). T lymphocyte subpopulation was measured in 23 TTP patients with FACS Calibur; 14 of the 23 (60.9%) had significantly decreased CD4 cells count and CD4/CD8 ratio, suggesting cellular immune dysfunction may be involved in the pathogenesis of TTP. In the studies, plasmapheresis is the main therapeutic method. 26 of 31 patients (83.9%) accepting plasmapheresis achieved complete remission; those patients who only underwent plasma infusion had low remission rate (18.2%) and high mortality (9/11; 81.8%). Four patients with packed RBC infusion manifested transient exacerbation of neurologic or psychiatric symptoms. In conclusion, the diagnosis of TTP in China is still based on clinical features including evidence of microangiopathic hemolysis. Severe ADAMTS 13 activity deficiency might be a valuable indicator for idiopathic TTP diagnosis. Further studies are needed to determine the real value of ADAMTS 13 activity for TTP diagnosis and whether T lymphocytes subset dysregulation plays important role in TTP pathogenesis.
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Affiliation(s)
- Ming-yang Deng
- Department of Hematology, The Second Xiang-Ya Hospital, Central South University, Changsha, Hunan 410011, PR China
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Salmenniemi U, Remes K. Thrombotic microangiopathy associated with bortezomib treatment in a patient with relapsed multiple myeloma. Hematol Rep 2012; 4:e13. [PMID: 22826795 PMCID: PMC3401134 DOI: 10.4081/hr.2012.e13] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Revised: 04/21/2012] [Accepted: 06/12/2012] [Indexed: 01/23/2023] Open
Abstract
Thrombotic thrombocytopenic purpura (TTP) and hemolytic-uremic syndrome (HUS) describe microvascular occlusive disorders characterized by thrombocytopenia due to increased platelet aggregation and fragmentation hemolysis. We report here what to our knowledge is the second case of TTP/HUS associated with bortezomib treatment.
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Seltz LB, Bakel LA, Tiehen J, Gao D, Cadnapaphornchai MA, Lum G, Ford D. Efficacy and safety of clopidogrel in children with diarrhea associated hemolytic uremic syndrome. Thromb Res 2012; 130:e26-30. [PMID: 22683020 DOI: 10.1016/j.thromres.2012.05.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Revised: 05/09/2012] [Accepted: 05/16/2012] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Hemolytic uremic syndrome is a thrombotic microangiopathy. Clopidogrel, a recently developed platelet aggregation inhibitor, has not been previously reported as a treatment for this illness. Our study's objective was to explore the efficacy and safety of clopidogrel in children with diarrhea associated hemolytic uremic syndrome. MATERIALS AND METHODS We performed a retrospective chart review of all children (≤ 18 years) hospitalized with diarrhea associated hemolytic uremic syndrome. Outcomes in clopidogrel treated children were described. In subgroup analysis, outcomes were compared to those untreated with platelet aggregation inhibitors. RESULTS Of 72 children with diarrhea associated hemolytic uremic syndrome, 88% were treated with platelet aggregation inhibitors (clopidogrel 56%, sulfinpyrazone 19%, dipyridamole 13%). The median age of clopidogrel treated children was 5 years; 40% were male. Initial median hemoglobin, platelet count, and serum creatinine were 10.1g/dL, 53 × 10(3)/μL, and 2.3mg/dL respectively. Clopidogrel (median dose 1mg/kg/d) was given for a median of 4 days (range 1-15). Other therapies included erythropoietin (98%), red blood cell transfusions (80%), diuretics (58%), anti-hypertensive agents (45%), and dialysis (33%). The median hospital length of stay was 9 days (range 3-26). Three children had bleeding complications (epistaxis/hematemesis). The risk of chronic kidney disease was 5% and death 2.5%. In subgroup analysis, median duration of dialysis was 11 days in thirteen clopidogrel treated children compared to 21 days in five untreated patients (P=0.04). CONCLUSIONS Children with diarrhea associated hemolytic uremic syndrome treated with clopidogrel have outcomes comparable to untreated patients. Bleeding complications may occur.
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Affiliation(s)
- L Barry Seltz
- Department of Pediatrics, Section of Hospital Medicine, Children's Hospital Colorado and the University of Colorado School of Medicine. 13123 E 16th Ave, Aurora, CO 80045, USA.
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Ye Z, Smith C, Kullo IJ. Usefulness of red cell distribution width to predict mortality in patients with peripheral artery disease. Am J Cardiol 2011; 107:1241-5. [PMID: 21296321 DOI: 10.1016/j.amjcard.2010.12.023] [Citation(s) in RCA: 134] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Revised: 12/17/2010] [Accepted: 12/17/2010] [Indexed: 01/06/2023]
Abstract
Increased red blood cell distribution width (RDW), a marker of anisocytosis, has been associated with adverse outcomes in multiple settings. Whether RDW is predictive of mortality in patients with peripheral artery disease (PAD) is unknown. We studied 13,039 consecutive outpatients (69.5 ± 12.0 years of age, 60.9% men, 97.6% white) with PAD identified by noninvasive lower-extremity arterial testing at the Mayo Clinic from January 1997 through December 2007, with follow-up through September 2009. We defined PAD as a low (≤ 0.9) or high (≥ 1.4) ankle-brachial index (ABI). Cardiovascular risk factors and co-morbidities were ascertained using electronic medical record-based algorithms. RDW was obtained from the complete blood cell count drawn around the time of arterial evaluation. Mortality was ascertained using the Mayo electronic medical record and Accurint databases. Association of RDW with all-cause mortality was analyzed by multivariable Cox proportional hazards regression. During a median follow-up of 5.5 years, 4,039 (31.0%) deaths occurred (28.7% in low and 38.9% in high ABI subsets). After adjustment for age, gender, cardiovascular risk factors, and co-morbidities, patients in the highest quartile of RDW (> 14.5%) had a 66% greater risk of mortality compared to the lowest quartile (< 12.8%, p < 0.0001); a 1% increment in RDW was associated with a 10% greater risk of all-cause mortality (hazard ratio 1.10, 95% confidence interval 1.08 to 1.12, p < 0.0001). The adjusted hazard ratio was similar in the low (1.10, 1.08 to 1.12) and high (1.09, 1.06 to 1.12) ABI subsets. In conclusion, RDW, a routinely available measurement, is an independent prognostic marker in patients with PAD.
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Affiliation(s)
- Zi Ye
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota; Gonda Vascular Center, Mayo Clinic, Rochester, Minnesota, USA
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Abstract
Shiga toxin-producing Escherichia coli is a contaminant of food and water that in humans causes a diarrheal prodrome followed by more severe disease of the kidneys and an array of symptoms of the central nervous system. The systemic disease is a complex referred to as diarrhea-associated hemolytic uremic syndrome (D+HUS). D+HUS is characterized by thrombocytopenia, microangiopathic hemolytic anemia, and acute renal failure. This review focuses on the renal aspects of D+HUS. Current knowledge of this renal disease is derived from a combination of human samples, animal models of D+HUS, and interaction of Shiga toxin with isolated renal cell types. Shiga toxin is a multi-subunit protein complex that binds to a glycosphingolipid receptor, Gb3, on select eukaryotic cell types. Location of Gb3 in the kidney is predictive of the sites of action of Shiga toxin. However, the toxin is cytotoxic to some, but not all cell types that express Gb3. It also can cause apoptosis or generate an inflammatory response in some cells. Together, this myriad of results is responsible for D+HUS disease.
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Affiliation(s)
- Tom G Obrig
- Department of Microbiology and Immunology, School of Medicine, University of Maryland, 685 W. Baltimore St., HSF I Suite 380, Baltimore, MD 21201, USA; ; Tel.: +1-410-706-6917
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Valavi E, Ansari MJA. Hemolytic uremic syndrome following Hemiscorpius lepturus (scorpion) sting. Indian J Nephrol 2010; 18:166-8. [PMID: 20142930 PMCID: PMC2813541 DOI: 10.4103/0971-4065.45293] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Scorpion envenomations are a public health problem in many countries. Scorpions are second only to snakes in causing human fatalities from envenomation. Species of scorpions capable of inflicting fatal stings are living in North and South Africa, the Middle East, India, America, Trinidad, and Tobago. Hemiscorpius lepturus (from the Hemiscorpiidae family) is the most medically important scorpion in Iran which accounts for 92% of all hospitalized scorpion sting cases. The venom from H. lepturus is primarily a cytotoxic agent and has hemolytic, nephrotoxic, and to some extent, hepatotoxic activities. We found a combination of microangiopatic hemolytic anemia, thrombocytopenia, and acute renal failure in a seven year-old female child who was referred to us with a 12 h history of bloody urine following a H. lepturus sting. Her blood smear showed fragmented erythrocytes and burr cells, leading us to a diagnosis of hemolytic uremic syndrome (HUS). This report highlights the importance of acceptable prophylaxis and therapeutic protocols for HUS in these patients.
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Affiliation(s)
- E Valavi
- Department of Nephrology, Abuzar Pediatric Hospital, Ahwaz, Iran
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Saltzman DJ, Chang JC, Jimenez JC, Carson JG, Abolhoda A, Newman RS, Milliken JC. Postoperative Thrombotic Thrombocytopenic Purpura After Open Heart Operations. Ann Thorac Surg 2010; 89:119-23. [DOI: 10.1016/j.athoracsur.2009.09.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2009] [Revised: 09/09/2009] [Accepted: 09/10/2009] [Indexed: 10/20/2022]
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Zheng T, Chunlei L, Zhen W, Ping L, Haitao Z, Weixin H, Caihong Z, Huiping C, Zhihong L, Leishi L. Clinical-pathological features and prognosis of thrombotic thrombocytopenic purpura in patients with lupus nephritis. Am J Med Sci 2009; 338:343-7. [PMID: 19745703 DOI: 10.1097/maj.0b013e3181b0c872] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND We investigated the clinical-pathological features and the prognosis of thrombotic thrombocytopenic purpura (TTP) in patients with lupus nephritis (LN). METHODS A retrospective analysis was performed on the clinical-pathological data and prognosis in 8 patients with LN complicating with TTP. RESULTS Thrombocytopenia and hemolytic anemia, neurologic symptoms, and renal dysfunction were the clinical manifestations in 8 patients. Six patients had fever. Eight patients presented with rapid progressive glomerulonephritis, and 1 patient with continuous gross hematuria. The histologic features of the 8 patients were thrombotic microangiopathy lesions. Immune-suppressive therapies were administrated in all patients, and blood purification therapy was applied in 7 patients. Three cases involved plasma exchange and/or immunoabsorption. Seven patients received a median follow-up of 12 months. One patient died, 3 cases received peritoneal dialysis, and 1 case failed to follow-up. During follow-up, 1 case was able to stop peritoneal dialysis, and 1 case changed to hemodialysis. The other 3 patients continued with stable renal function. CONCLUSION The patients with LN with TTP have severe clinical-pathological changes. Active treatment including renal replacement therapy, plasma exchange, and immunoabsorption are promising.
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Affiliation(s)
- Tang Zheng
- Research Institute of Nephrology, Jinling Hospital, Nanjing, People's Republic of China.
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Sucker C, Kurschat C, Farokhzad F, Hetzel GR, Grabensee B, Maruhn-Debowski B, Loncar R, Scharf RE, Zotz RB. The TT genotype of the C677T polymorphism in the methylentetrahydrofolate reductase as a risk factor in thrombotic microangiopathies: results from a pilot study. Clin Appl Thromb Hemost 2009; 15:283-8. [PMID: 19448163 DOI: 10.1177/1076029607308865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
In this study, we assessed the potential role of the TT genotype of the gene of the methylenetetrahydrofolate reductase for the manifestation of thrombotic microangiopathies, enrolling 40 affected patients (mean age [+/- standard deviation] 35 +/- 11 years). As a result, the methylenetetrahydrofolate reductase 677TT genotype was more prevalent in patients with thrombotic microangiopathies compared with controls (adjusted odds ratio = 2.58, 95% confidence interval = 1.2-5.7, P = .018), particularly in those suffering from the hemolytic uremic syndrome. A hemolytic more severe clinical course of thrombotic microangiopathies in carriers of the methylenetetrahydrofolate reductase 677TT genotype was not observed. In summary, our findings suggest a significant influence of the methylenetetrahydrofolate reductase genotype on the manifestation of thrombotic microangiopathies. The 677 TT genotype of this polymorphism appears to be a risk factor for manifestation of these rare thrombotic disorders, possibly explained by endothelial activation and increased oxidative stress.
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Affiliation(s)
- Christoph Sucker
- Department of Hemostasis and Transfusion Medicine, Heinrich Heine University Medical Center, Dusseldorf, Germany.
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Sucker C, Kurschat C, Hetzel GR, Grabensee B, Maruhn-Debowski B, Loncar R, Ostojic L, Scharf RE, Zotz RB. The G1691A Mutation of the Factor V Gene (Factor V Leiden) and the G20210A Mutation of the Prothrombin Gene as Risk Factors in Thrombotic Microangiopathies. Clin Appl Thromb Hemost 2009; 15:360-3. [DOI: 10.1177/1076029607311778] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Factor V Leiden (FVL) mutation and prothrombin G20210A mutation are common hereditary risk factors for venous thrombosis. In the current study, 40 patients (mean age ± standard deviation, 35 ± 11 years) and 764 healthy control subjects (mean age ± standard deviation, 37 ± 14 years) were enrolled to assess the potential role of these mutations in the manifestation of thrombotic microangiopathies. Compared with controls, neither the heterozygous FVL mutation (7.5% vs 8.5%; P = 1) nor the heterozygous prothrombin mutation (2.5% vs 2.8%; P = 1) was more prevalent in the patients. The findings do not support a significant role of FVL and prothrombin mutations as risk factors for the manifestation of thrombotic microangiopathies. Thus, screening for these mutations does not allow the identification of individuals at increased risk for these rare thrombotic disorders.
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Affiliation(s)
- Christoph Sucker
- Department of Hemostasis and Transfusion Medicine Heinrich Heine University Medical Center, Düsseldorf, Germany,
| | - Christine Kurschat
- Department of Nephrology, Heinrich Heine University Medical Center, Düsseldorf, Germany
| | - Gerd R. Hetzel
- Department of Nephrology Heinrich Heine University Medical Center, Düsseldorf, Germany
| | - Bernd Grabensee
- Department of Nephrology Heinrich Heine University Medical Center, Düsseldorf, Germany
| | - Beate Maruhn-Debowski
- Department of Nephrology Heinrich Heine University Medical Center, Düsseldorf, Germany
| | - Robert Loncar
- Department of Nephrology Heinrich Heine University Medical Center, Düsseldorf, Germany
| | - Ljerka Ostojic
- University Medical Center, Mostar, Bosnia and Herzegovina
| | - Ruediger E. Scharf
- Department of Hemostasis and Transfusion Medicine Heinrich Heine University Medical Center, Düsseldorf, Germany
| | - Rainer B. Zotz
- Department of Hemostasis and Transfusion Medicine Heinrich Heine University Medical Center, Düsseldorf, Germany
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Sucker C, Farokhzad F, Kurschat C, Grabensee B, Scharf RE, Zotz RB, Maruhn-Debowski B, Hetzel GR. The Homozygous Leu Variant of the Factor XIII Val34Leu Polymorphism as a Risk Factor for the Manifestation of Thrombotic Microangiopathies. Clin Appl Thromb Hemost 2009; 15:197-200. [PMID: 17895511 DOI: 10.1177/1076029607304723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The 34 Leu (100T) variant of the factor XIII Val34Leu (G100T-) polymorphism slows down fibrinolysis and has been proposed as a thrombotic risk factor. In this pilot study, we enrolled 40 patients (mean age ± SD = 38 ± 11 years) and 728 controls to assess the role of this genetic variant for the manifestation of thrombotic microangiopathies. From the genotype prevalences, an increased manifestation risk for carriers of the TT genotype (homozygous Leu variant) of the factor XIII Val34Leu (G100T-) polymorphism was calculated (odds ratio [OR] = 2.44; 95% confidence interval [CI] = 0.8-7.6; P = .11). This association was statistically significant for patients with thrombotic thrombocytopenic purpura—hemolytic-uremic syndrome (TTP-HUS) (OR = 6.6; 95% CI = 1.7-25.9; P = .006). Our data suggest a role of the homozygous Leu variant of the factor XIII Val34Leu polymorphism in the manifestation of thrombotic microangiopathies. Decreased fibrinolysis in the presence of this genetic variant provides a plausible explanation for this association.
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Affiliation(s)
- Christoph Sucker
- Department of Hemostasis and Transfusion Medicine, Heinrich Heine University Medical Center, Düsseldorf, Germany.
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Yazdankhah S, Midtvedt T, Narvhus J, Berstad A, Lassen J, Halvorsen R. The use of probiotics for critically ill patients in hospitals. MICROBIAL ECOLOGY IN HEALTH AND DISEASE 2009. [DOI: 10.3109/08910600903495046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Siamak Yazdankhah
- Norwegian Scientific Committee for Food Safety, Norwegian Institute of Public Health
| | | | - Judith Narvhus
- Department of Chemistry, Biotechnology, and Food Science, Norwegian University of Life Sciences, Ås, Norway
| | - Arnold Berstad
- Institute of Medicine, University of Bergen, Haukeland University Hospital, Bergen, Norway
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Franchini M, Lippi G. The Role Of von Willebrand Factor In Hemorrhagic And Thrombotic Disorders. Crit Rev Clin Lab Sci 2008; 44:115-49. [PMID: 17364690 DOI: 10.1080/10408360600966753] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
von Willebrand factor (VWF) is a multimeric plasma protein that mediates platelet adhesion as well as platelet aggregation at sites of vascular injury and acts as a carrier of factor VIII. Although acquired or inherited VWF deficiency is associated with a bleeding tendency, there is increasing evidence that VWF has a pivotal role in thrombogenesis. In fact, while the presence in the plasma of unusually large VWF multimers, due to a congenital or acquired deficiency of a VWF-cleaving metalloprotease, has been implicated in the pathogenesis of thrombotic thrombocytopenic purpura, high plasma levels of VWF have been associated with an increased risk of both arterial and venous thrombosis. The role of VWF in normal and pathological hemostasis is discussed in this review, and important advances in the pathophysiology, diagnosis, and treatment of VWF-associated disorders are also described.
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Affiliation(s)
- Massimo Franchini
- Servizio di Immunoematologia e Trasfusione, Azienda Ospedaliera di Verona, Verona, Italy.
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19
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Sucker C, Schmitz M, Hetzel GR, Grabensee B, Maruhn-Debowski B, Ostojic L, Scharf RE, Zotz RB. Are prothrombotic variants of platelet glycoprotein receptor polymorphisms involved in the pathogenesis of thrombotic microangiopathies? Clin Appl Thromb Hemost 2008; 15:402-7. [PMID: 18502778 DOI: 10.1177/1076029608316015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Thrombotic microangiopathies are life-threatening disorders characterized by vascular microthromboses, schistocytic hemolytic anemia, and thrombocytopenia. Although recent research has partially explained the pathogenesis of these rare entities, the determinants contributing to the onset and modulating the severity of thrombotic microangiopathies are largely unknown. The present study assessed the putative role of prothrombotic platelet receptor polymorphisms in thrombotic microangiopathies that have been found to be associated with premature onset of myocardial infarction in predisposed individuals. Thirty-four consecutive patients admitted with the diagnosis of thrombotic microangiopathy and 759 healthy subjects were enrolled. Genotyping of the human platelet antigen (HPA) 2 an the Kozak sequence polymorphism of GP Ibalpha of the platelets' von Willebrand factor receptor glycoprotein (GP) Ib-V-IX, the HPA-1 and the HPA-3 polymorphism of the fibrinogen receptor GP IIb-IIIa (integrin alpha(IIb)beta( 3)) and the HPA-5 and GP Ia 807 C/T polymorphism of the collagen receptor GP Ia-IIa (integrin alpha(2)beta(1)) were determined according to standard procedures. As a result, no significant differences in the prevalence of prothrombotic variants of platelet-receptor polymorphisms between patients and healthy control subjects were observed. However, although not significant, the prothrombotic bb genotype of the HPA-1 polymorphism was more prevalent in the patients. The findings do not provide evidence that platelet receptor polymorphisms are determinants for the onset of thrombotic microangiopathies or predispose to a more severe course. Along with this observation, screening for respective platelet-receptor polymorphisms does not appear to contribute to risk stratification of affected patients.
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Affiliation(s)
- Christoph Sucker
- Departments of Hemostasis and Transfusion Medicine Heinrich Heine University Medical Center, Moorenstrasse 5, Düsseldorf, Germany.
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Gefen R, Eshel G, Abu-Kishk I, Lahat E, Youngster I, Rosenbloom E, Kozer E. Hemorrhagic shock and encephalopathy syndrome: clinical course and neurological outcome. J Child Neurol 2008; 23:589-92. [PMID: 18160555 DOI: 10.1177/0883073807309790] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The syndrome of hemorrhagic shock and encephalopathy is associated with an acute onset of diarrhea, followed by shock, disseminated intravascular coagulopathy, multiorgan failure, and encephalopathy. The etiology of this syndrome is unknown, and despite intensive treatment, the outcome is often fatal or associated with severe neurological sequelae. Two infants aged 6 and 9 months were admitted with this syndrome within a 24-hour time interval. The authors hereby present the clinical course and a prospective evaluation of the neurological outcome. A review of the literature regarding this infrequent syndrome is presented.
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Affiliation(s)
- Roni Gefen
- Pediatric Division, Assaf Harofeh Medical Center, Zerifin 70300, Israel.
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21
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Dickinson CE, Gould DH, Davidson AH, Avery PR, Legare ME, Hyatt DR, DebRoy C. Hemolytic-uremic syndrome in a postpartum mare concurrent with encephalopathy in the neonatal foal. J Vet Diagn Invest 2008; 20:239-42. [DOI: 10.1177/104063870802000218] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A postpartum mare and foal were presented for evaluation of fever and lethargy in the mare. The mare was diagnosed with endometritis and initially responded well to treatment. On the second day of hospitalization, the mare developed renal insufficiency characterized by oliguria, azotemia, hemolysis, and thrombocytopenia. Concurrently, the foal developed rapidly progressive central nervous system signs culminating in refractory seizures. Both animals failed to respond to treatment and were euthanized. Thrombotic microangiopathy involving glomeruli was evident on microscopic examination of the mare's kidneys. Microscopic evidence of brain edema was the principal postmortem finding in the foal. No specific etiology was confirmed in either case. Notably, Escherichia coli 0103:H2 was isolated from the mare's uterus and the gastrointestinal tracts of both animals. To the authors' knowledge, this is the first report in which an organism implicated as a cause of hemolytic-uremic syndrome was isolated from an animal with clinical signs and postmortem findings consistent with the disease.
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Affiliation(s)
| | | | | | - Paul R. Avery
- Department of Microbiology, Immunology, and Pathology
| | - Marie E. Legare
- Department of Environmental and Radiological Health Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO
| | | | - Chitrita DebRoy
- Gastroenteric Disease Center. Pennsylvania State University, University Park, PA
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Liumbruno GM, Sodini ML, Grazzini G. Recommendations from the Tuscan Transfusion System on the appropriate use of solvent/detergent-inactivated fresh-frozen plasma. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2008; 6:25-36. [PMID: 18661921 PMCID: PMC2626856 DOI: 10.2450/2008.0027-07] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Revised: 06/04/2007] [Accepted: 12/05/2007] [Indexed: 01/14/2023]
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Compostella A, Pasetto LM, Ghiotto C, Stefani M, Monfardini S. Oxaliplatin-Induced Haemolytic Anaemia: A Case Report. Clin Med Oncol 2007. [DOI: 10.1177/117955490700100003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Oxaliplatin plus 5Fluorouracil (5FU) and leucovorin (LV) is the standard treatment of metastatic colorectal cancer (CRC). We describe a rare clinical case of acute renal failure probably oxaliplatin-related at one day from the end of the palliative treatment. A 36 year-old woman developed a stage I CRC. Five months later a liver lesion was detected and treated with FOLFOX4 schedule. Because of progression the patient underwent surgery and she repeated the Oxaliplatin-based therapy for more than one cycle. After many months of therapy, on the second day, the patient noticed urine discoloration. Immediate urinanalysis demonstrated haemoglobinuria. The patient's complete blood count exhibited signs consistent with acute hemolysis, neutrophilic leucocytosis, thrombocytopenia and acute renal failure. She was treated with blood transfusion and hemodialysis and she was managed conservatively with monitored intravenous hydration and loop diuretics. The patient gradually recovered and the results of successive hematological and biochemical tests confirmed the improvement of her condition but a cardiologic evaluation showed a iatrogenic depressed systolic function (ejection fraction of 40%).
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Affiliation(s)
- A Compostella
- Istituto Oncologico Veneto, IRCCS: Medical Oncology 2nd, Via Gattamelata 64, 35128 Padova, Italy
| | - LM Pasetto
- Istituto Oncologico Veneto, IRCCS: Medical Oncology 2nd, Via Gattamelata 64, 35128 Padova, Italy
| | - C Ghiotto
- Istituto Oncologico Veneto, IRCCS: Medical Oncology 2nd, Via Gattamelata 64, 35128 Padova, Italy
| | - M Stefani
- Istituto Oncologico Veneto, IRCCS: Medical Oncology 2nd, Via Gattamelata 64, 35128 Padova, Italy
| | - S Monfardini
- Istituto Oncologico Veneto, IRCCS: Medical Oncology 2nd, Via Gattamelata 64, 35128 Padova, Italy
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