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Naser H, Munn K, Lawrence R, Wright R, Grewal E, Williams L, Doak S, Jenkins G. Human plasma can modulate micronucleus frequency in TK6 and OE33 cells in vitro. MUTATION RESEARCH. GENETIC TOXICOLOGY AND ENVIRONMENTAL MUTAGENESIS 2024; 896:503766. [PMID: 38821668 DOI: 10.1016/j.mrgentox.2024.503766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 05/06/2024] [Accepted: 05/13/2024] [Indexed: 06/02/2024]
Abstract
In this paper, we studied the potential genotoxic effects of human plasma from healthy volunteers, as well as patients with gastro-oesophageal reflux disease, Barrett's oesophagus (BO) and oesophageal adenocarcinoma (OAC) using the oesophageal adenocarcinoma cell line (OE33) and the lymphoblastoid cell line (TK6). Both TK6 and OE33 cells were treated with plasma (10 % volume, replacing foetal bovine serum (FBS) or horse serum (HS)) at different time points of 4 h (for the micronucleus (Mn) assay and the invasion assay) and 24 h (for the cell cycle studies). Plasma-induced effects on DNA damage levels, cell viability and the cell cycle were studied by the micronucleus assay, cytokinesis block proliferation index (CBPI) and flow cytometry respectively. The expression of IL-8 in supernatants of TK6 cells and IFN-β in OE33 cells was also analysed by enzyme-linked immunosorbent assay (ELISA). Finally, we carried out an assessment of cellular invasion of OE33 cells following plasma treatment. The results of the micronucleus assay confirmed the genotoxicity of direct plasma treatment from some participants through the increase in DNA damage in TK6 cells. Conversely, some individual patient plasma samples reduced background levels of TK6 cell Mn frequency, in an anti-genotoxic fashion. In TK6 cells, (on average) plasma samples from patients with Barrett's oesophagus induced higher micronucleus levels than healthy volunteers (p= 0.0019). There was little difference in Mn induction when using plasma versus serum to treat the cells in vitro. Cell cycle results showed that direct plasma treatment had a marked impact on OE33 cells at 24 h (p=0.0182 for BO and p=0.0320 for OAC) by decreasing the proportion of cells in the S phase, while plasma exposure was less impactful on the cell cycle of TK6 cells. Invasion of OE33 cells was also seen to be non-significantly affected by plasma treatment of OE33 cells. The addition of N-acetyl cysteine NAC in a dose-dependent matter did not alter the formation of Mn in TK6 cells, suggesting that reactive oxygen species (ROS) are not the root cause of plasma's genotoxicity. The concentration of IL-8 in TK6 cells and IFN-β in OE33 cells was significantly higher in cells treated with OAC-derived plasma than in the untreated negative control. Collectively, our results demonstrate that plasma-specific effects are detectable which helps us better understand some important aspects of the biology of blood-based biomarkers under development.
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Affiliation(s)
- Hamsa Naser
- Institute of Life Science, Faculty of Medicine, Health and Life Science, Swansea University, Singleton Park, Swansea SA2 8PP, UK.
| | - Kathryn Munn
- Institute of Life Science, Faculty of Medicine, Health and Life Science, Swansea University, Singleton Park, Swansea SA2 8PP, UK
| | - Rachel Lawrence
- Barts Cancer Centre, Charterhouse Square, London EC1M6AU, UK
| | - Rhiannon Wright
- Institute of Life Science, Faculty of Medicine, Health and Life Science, Swansea University, Singleton Park, Swansea SA2 8PP, UK
| | - Ethan Grewal
- Institute of Life Science, Faculty of Medicine, Health and Life Science, Swansea University, Singleton Park, Swansea SA2 8PP, UK
| | - Lisa Williams
- Department of Gastroenterology, Singleton Hospital, Swansea Bay University Health Board, Sketty Lane, Swansea SA28QA, UK
| | - Shareen Doak
- Institute of Life Science, Faculty of Medicine, Health and Life Science, Swansea University, Singleton Park, Swansea SA2 8PP, UK
| | - Gareth Jenkins
- Institute of Life Science, Faculty of Medicine, Health and Life Science, Swansea University, Singleton Park, Swansea SA2 8PP, UK
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Díaz Chavarro BC, Molina-Recio G, Assis Reveiz JK, Romero-Saldaña M. Factors Associated with Nutritional Risk Assessment in Critically Ill Patients Using the Malnutrition Universal Screening Tool (MUST). J Clin Med 2024; 13:1236. [PMID: 38592073 PMCID: PMC10931933 DOI: 10.3390/jcm13051236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/31/2024] [Accepted: 02/01/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Malnutrition is an underdiagnosed condition that negatively affects the clinical outcomes of patients, being associated with an increased risk of adverse events, increased hospital stay, and higher mortality. Therefore, nutritional assessment is a required and necessary process in patient care. The objective of this study was to identify the factors associated with nutritional risk by applying the Malnutrition Universal Screening Tool (MUST) scale in a population of critically ill patients. Methods: This was an observational, analytical, and retrospective study. Sociodemographic, clinical, hematological, and biochemical variables and their relationship with nutritional risk and mortality were analyzed. Results: Of 630 patients, the leading cause of admission was pathologies of the circulatory and respiratory system (50%); 28.4% were at high nutritional risk; and mortality was 11.6% and associated with nutritional risk, hemoglobin, and plasma urea nitrogen. Conclusions: The presence of gastrointestinal symptoms and the type of nutritional support received during hospitalization could increase the likelihood of presenting a medium/high nutritional risk, while polycythemia reduced this probability. An associative model was found to determine nutritional risk with an adequate specificity and diagnostic validity index.
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Affiliation(s)
- Blanca Cecilia Díaz Chavarro
- Nursing Program, School of Health, Research Group Genetics, Physiology and Metabolism (GEFIME), Universidad Santiago de Cali, Santiago de Cali 760001, Colombia
- Doctoral Program in Biosciences and Agricultural and Food Sciences, University of Córdoba, 14014 Cordoba, Spain
| | - Guillermo Molina-Recio
- Nursing, Pharmacology and Physiotherapy Department, University of Cordoba, 14004 Cordoba, Spain
- Lifestyles, Innovation and Health (GA-16), Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14014 Cordoba, Spain
| | - Jorge Karim Assis Reveiz
- Department of Research and Education, Clínica de Occidente SA, Santiago de Cali 760001, Colombia
| | - Manuel Romero-Saldaña
- Nursing, Pharmacology and Physiotherapy Department, University of Cordoba, 14004 Cordoba, Spain
- Lifestyles, Innovation and Health (GA-16), Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14014 Cordoba, Spain
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3
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Solhpour A, Kumar S, Koch MJ, Doré S. Impact of blood component transfusions, tranexamic acid and fluids on subarachnoid hemorrhage outcomes. BRAIN HEMORRHAGES 2022. [DOI: 10.1016/j.hest.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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4
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He Y, Liang S, Xu Y, Wan C, Ma F, Wang B. The Analysis of the Effect of Blood Transfusion on Changes of Blood Platelet Parameters in Patients with Leukemia Treated with Chemotherapy. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:2901993. [PMID: 36072416 PMCID: PMC9444399 DOI: 10.1155/2022/2901993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/22/2022] [Accepted: 07/25/2022] [Indexed: 11/18/2022]
Abstract
Objective To study and analyze the effect of blood transfusion on the change of blood platelet parameters in patients with leukemia treated with chemotherapy. Methods Ninety-eight patients with leukemia treated with chemotherapy in the First Affiliated Hospital of Xi'an Jiaotong University from January 2021 to January 2022 were selected to observe the changes of platelet parameters before and after blood transfusion. Results There was significant difference between pre-transfusion and post-transfusion indexes (platelet count, mean platelet volume, and hematocrit) (P < 0.05). After binary logistic regression analysis, the use of antibiotics (OR = 2.235), blood transfusion history (OR = 3.086), abnormal white blood cell count (OR = 1.134), and frozen plasma transfusion (OR = 3.121) were the main factors of blood platelet parameters after transfusion in leukemia patients (P < 0.05). Conclusion Blood transfusion is beneficial to improve blood platelet parameters and prevent bleeding in patients with leukemia treated with chemotherapy. Attention should be paid to patients with risk factors for poor response to blood platelet transfusion and early intervention.
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Affiliation(s)
- Yangxin He
- Department of Blood Transfusion, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shannxi, China
| | - Shanshan Liang
- Department of Blood Transfusion, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shannxi, China
| | - Yali Xu
- Department of Blood Transfusion, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shannxi, China
| | - Chunjing Wan
- Department of Blood Transfusion, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shannxi, China
| | - Feng Ma
- Department of Blood Transfusion, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shannxi, China
| | - Baoyan Wang
- Department of Blood Transfusion, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shannxi, China
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Wu K, Duan S, Wang Y, Wang H, Gao X. Convolutional neural network-based automatic classification for incomplete antibody reaction intensity in solid phase anti-human globulin test image. Med Biol Eng Comput 2022; 60:1211-1222. [PMID: 35257292 PMCID: PMC8901095 DOI: 10.1007/s11517-022-02523-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 01/30/2022] [Indexed: 11/25/2022]
Abstract
The precise classification of incomplete antibody reaction intensity (IARI) in hydrogel chromatography medium high density medium solid-phase Coombs test is essential for haemolytic disease screening. However, an automatic and contactless method is required for accurate classification of IARI. Here, we present a deep ensemble learning model that integrates five different convolutional neural networks into a single model for IARI classification. A dataset, including 1628 IARI images and corresponding labels of IARI categories ((-), (1 +), (2 +), (3 +), and (4 +)), was used. We trained our model using 1302 IARIs and validated its performance using 326 IARIs. The proposed model achieved 100%, 99.4%, 99.4%, 100%, and 100% accuracies in the ( −), (1 +), (2 +), (3 +), and (4 +) categories, respectively. The results were compared with those of manual classification by immunologists (average accuracy: 99.8% vs. 88.3%, p < 0.01). Following model assistance, all three immunologists achieved increased accuracy (average accuracy: + 6.1%), with the average accuracy of junior immunologists maximum increasing by 11.3%. The time required for model classification was 0.094 s·image–1, whereas that required manually was 5.528 s·image–1. The proposed model can thus substantially improve the accuracy and efficiency of IARI classification and facilitate the automation of haemolytic disease screening equipment.
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Affiliation(s)
- KeQing Wu
- School of Computer Engineering and Science, Shanghai University, Shanghai, 200444, China
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Science, Suzhou, 215163, China
| | - ShengBao Duan
- CAS Key Lab of Bio-Medical Diagnostics, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Science, Suzhou, 215163, China
| | - YuJue Wang
- CAS Key Lab of Bio-Medical Diagnostics, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Science, Suzhou, 215163, China
| | - HongMei Wang
- CAS Key Lab of Bio-Medical Diagnostics, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Science, Suzhou, 215163, China.
| | - Xin Gao
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Science, Suzhou, 215163, China.
- Jinan Guoke Medical Engineering and Technology Development Co., Ltd., Pharmaceutical Valley New Drug Creation Platform, Jinan, 250109, Shandong, China.
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Muhammad S, Ahmad S, Khan BA, Yousaf A. Cefepime: a novel cause of thrombocytopaenia. BMJ Case Rep 2022; 15:e243749. [PMID: 35039337 PMCID: PMC8767964 DOI: 10.1136/bcr-2021-243749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2021] [Indexed: 11/03/2022] Open
Abstract
Thrombocytopaenia is a commonly encountered finding in hospitalised patients. Many antibiotics, especially beta-lactams, are well known to cause thrombocytopaenia by an immune-mediated mechanism. We present a 55-year-old woman who was admitted to the hospital with a complicated urinary tract infection resulting in right-sided pyonephrosis and pararenal abscess. She was observed to develop thrombocytopaenia after initiation of cefepime therapy. Following an extensive work-up for her new-onset thrombocytopaenia, she was diagnosed as a case of a drug (cefepime)-induced thrombocytopaenia. Her platelet count recovered back to normal levels after cessation of cefepime therapy. Based on our PubMed search, there are only a few cases of cefepime-induced thrombocytopaenia published in the literature. This paper illustrates that physicians should include cefepime among the possible aetiologies of thrombocytopaenia. Additionally, this article outlines the currently available approaches to the diagnosis and management of drug-induced thrombocytopaenia.
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Affiliation(s)
| | - Soban Ahmad
- Emergency Medicine, Department of Medical Education, Hamad Medical Corporation, Doha, Qatar
| | | | - Amman Yousaf
- Internal Medicine, McLaren Health Care Corporation, Flint, Michigan, USA
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Mukhopadhyay T, Kumar N, Pandey S, Subramanian A, Madaan N, Malhotra R. Variation in Laboratory Utilization and Correlation with Hospital Bed Utilization: Experience of a Trauma-Care Hospital during the COVID-19 Pandemic. J Lab Physicians 2021; 14:210-217. [PMID: 35982878 PMCID: PMC9381313 DOI: 10.1055/s-0041-1739540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objectives
The present study was planned with the following objectives: (i) to calculate the difference in frequency of laboratory test ordered and use of consumables between the prepandemic and pandemic phases, (ii) to determine and compare the monthly average number of tests ordered per patient between the prepandemic and pandemic phases, and (iii) to correlate the monthly test ordering frequency with the monthly bed occupancy rate in both phases.
Materials and Methods
Records of laboratory tests ordered and use of consumables were collected for the prepandemic phase (1.8.2019 to 31.3.2020) and the pandemic phase (1.4.2020 to 31.10.2020). The absolute and relative differences were calculated. Monthly average number of tests ordered per patient and bed occupancy rate between prepandemic and pandemic phases was determined, compared, and correlated.
Statistical Analysis
The absolute and the relative differences between the two periods were calculated. The continuous variables were analyzed between groups using Mann–Whitney U test. Spearman correlation was used to correlate the monthly test ordering frequency with the monthly bed occupancy rate in both phases.
Results
A total of 946,421 tests were ordered, of which 370,270 (39%) tests were ordered during the pandemic period. There was a decrease in the number of the overall laboratory tests ordered (12%), and in the use of blood collection tubes (34%), and an increase in the consumption of sanitizers (18%), disinfectants (3%), masks (1633%), and gloves (7011%) during the pandemic period. Also, the monthly average number of tests ordered per patients significantly reduced (
p
-value < 0.001). Test ordering frequency had strong positive correlation with bed occupancy rate during pandemic (Spearman co-efficient = 0.73,
p
-value = 0.03).
Conclusions
An overall decline in laboratory utilization during pandemic period was observed. Understanding and correlating the trends with hospital bed utilization can maximize the productivity of the laboratory and help in better preparedness for the challenges imposed during similar exigencies.
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Affiliation(s)
- Tapasyapreeti Mukhopadhyay
- Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Narinder Kumar
- Department of Hospital Administration, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Shivam Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Arulselvi Subramanian
- Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Nirupam Madaan
- Department of Hospital Administration, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Malhotra
- Department of Orthopedics, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
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Dutta SR, Passi D, Singh P, Atri M, Mohan S, Sharma A. Risks and complications associated with dental implant failure: Critical update. Natl J Maxillofac Surg 2020; 11:14-19. [PMID: 33041571 PMCID: PMC7518499 DOI: 10.4103/njms.njms_75_16] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 02/27/2017] [Accepted: 09/09/2019] [Indexed: 11/25/2022] Open
Abstract
Risks and complications have been identified with dental implant failure though there is continuous innovation in implant systems and various interceptive treatment modalities. The success rate of dental implants has increased over a period of years as a treatment option for the rehabilitation of missing teeth. The dental implants are designed that best suits the various types of bone. Endosseous implants fail due to many reasons. Different reasons for the implant failure and their contributing factors have been discussed in this review article. A better understanding of the factors responsible for the implant failure will provide clinical decision-making and may enhance the field of implant dentistry. This article summarizes the factors causing implant failure. This paper presents the results of a survey of dentists practicing implant dentistry and updates regarding their knowledge of risk factors that they consider to be important for predicting dental implant failure.
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Affiliation(s)
- Shubha Ranjan Dutta
- Department of Oral and Maxillofacial Surgery, MB Kedia Dental College, Birgunj, Nepal
| | - Deepak Passi
- Department of Dentistry, Sub-Divisional Hospital, Ranchi, Jharkhand, India
| | - Purnima Singh
- Department of Physiology, MB Kedia Dental College, Birgunj, Nepal
| | - Mansi Atri
- Department of Public Health Dentistry, E.S.I.C. Dental College and Hospital, Delhi, India
| | - Stuti Mohan
- Department of Orthodontics, Subharti Dental College and Hospital, Meerut, Uttar Pradesh, India
| | - Abhimanyu Sharma
- Department of Oral and Maxillofacial Surgery, E.S.I.C. Dental College and Hospital, Delhi, India
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Salvagno GL, Demonte D, Poli G, Favaloro EJ, Lippi G. Impact of low volume citrate tubes on results of first-line hemostasis testing. Int J Lab Hematol 2019; 41:472-477. [PMID: 30985988 DOI: 10.1111/ijlh.13028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 03/16/2019] [Accepted: 03/20/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Pediatric tubes are increasingly used for drawing blood for hemostasis testing. This study has investigated the potential impact of low volume citrate tubes on results of first-line hemostasis testing. METHODS The study population comprised 34 patients on warfarin therapy and 17 ostensibly healthy volunteers. Blood was collected into five different evacuated blood tubes from each subject. On right arm, blood was drawn directly into two standard evacuated blood tubes (3-mL Vacuette and 2-mL Vacutest) and one evacuated low volume blood tube (1-mL Vacuette) by straight needle venipuncture. On left arm, blood was drawn using a 5-mL syringe and then transferred within two nonevacuated microtubes (0.5 mL MiniCollect and 0.5 mL Micro Test). Prothrombin time (PT), activated partial thromboplastin time (APTT), and fibrinogen were assayed on ACL TOP 700. RESULTS Spearman's correlation of PT, APTT, and fibrinogen values obtained using different tubes was always satisfactory (ie, ≥0.93). A statistically significant bias was frequently found by comparing values obtained in different tubes. Nevertheless, the minimum quality specifications for bias were exceeded only by comparing data of Vacuette 1 mL with those of all other blood tubes for PT, by comparing data of Micro Test 0.5 mL with those of all other blood tubes for APTT, and by comparing data of Micro Test 0.5-mL blood tubes with those of Vacuette 3 mL and Vacuette 1. CONCLUSION First-line hemostasis testing using low volume citrate tubes may display differences sometimes exceeding the minimum quality specifications.
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Affiliation(s)
| | - Davide Demonte
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - Giovanni Poli
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - Emmanuel J Favaloro
- Department of Haematology, Sydney Centres for Thrombosis and Haemostasis, Institute of Clinical Pathology and Medical Research, NSW Health Pathology, Westmead Hospital, Westmead, NSW, Australia
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
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Abstract
There are few absolute contraindications to dental implant placement. Relative contraindications include cognitive decline, American Society of Anesthesiology patient status IV or higher categories, or medical conditions that may jeopardize the life or lifespan of the patient. Precautions for placing dental implants should be viewed with respect to the evidence-based exposures that can contribute to risk of failure, including but not limited to local, behavioral, and medical factors. Risk for dental implant failure increases in association with (1) past history of periodontal disease, (2) bruxism, (3) smoking, and (4) radiation therapy.
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Affiliation(s)
- Amritpal S Kullar
- Division of Oral Diagnosis, Oral Medicine, Oral Radiology, MN324 College of Dentistry, University of Kentucky, 800 Rose Street, Lexington, KY 40356-0297, USA
| | - Craig S Miller
- Division of Oral Diagnosis, Oral Medicine, Oral Radiology, MN324 College of Dentistry, University of Kentucky, 800 Rose Street, Lexington, KY 40356-0297, USA.
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Elbedewy TA, Elsebaey MA, Elshweikh SA, Elashry H, Abd-Elsalam S. Predictors for eltrombopag response in patients with hepatitis C virus-associated thrombocytopenia. Ther Clin Risk Manag 2019; 15:269-274. [PMID: 30804674 PMCID: PMC6375108 DOI: 10.2147/tcrm.s186106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background and aims Thrombocytopenia is a common hematological abnormality observed in patients infected with hepatitis C virus (HCV). The use of eltrombopag has been approved for HCV-associated thrombocytopenia. This is the first study aiming to determine the predictive factors of response to eltrombopag therapy in patients with HCV-associated thrombocytopenia. Patients and methods This prospective study was carried out on 130 patients with chronic HCV-associated thrombocytopenia (<50,000×109/L) that precludes the initiation of HCV therapy. Eltrombopag was initiated at a dose of 25 mg once daily; the dose was adjusted with 25 mg increments every 2 weeks to achieve the target platelet count. The primary end point was to achieve stable target platelet count (50,000-100,000×109/L) required to initiate antiviral therapy. Results Treatment response was achieved in 111 (85.38%) patients. This prospective study showed that megakaryocyte hypoplasia or aplasia and splenectomy were independent risk factors for eltrombopag nonresponse in chronic HCV-associated thrombocytopenic patients. Conclusion Eltrombopag is safe and effective for patients with HCV-associated thrombocytopenia. Bone marrow examination should be considered before initiating treatment with eltrombopag in chronic HCV-associated thrombocytopenic patients, especially in patients with splenectomy.
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Affiliation(s)
- Tamer A Elbedewy
- Internal Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mohamed A Elsebaey
- Internal Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Samah A Elshweikh
- Internal Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Heba Elashry
- Tropical Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt,
| | - Sherief Abd-Elsalam
- Tropical Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt,
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12
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Lippi G, Da Rin G. Advantages and limitations of total laboratory automation: a personal overview. ACTA ACUST UNITED AC 2019; 57:802-811. [DOI: 10.1515/cclm-2018-1323] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 01/14/2019] [Indexed: 11/15/2022]
Abstract
Abstract
Automation is considered one of the most important breakthroughs in the recent history of laboratory diagnostics. In a model of total laboratory automation (TLA), many analyzers performing different types of tests on different sample matrices are physically integrated as modular systems or physically connected by assembly lines. The opportunity to integrate multiple diagnostic specialties to one single track seems effective to improve efficiency, organization, standardization, quality and safety of laboratory testing, whilst also providing a significant return of investment on the long-term and enabling staff requalification. On the other hand, developing a model of TLA also presents some potential problems, mainly represented by higher initial costs, enhanced expenditure for supplies, space requirements and infrastructure constraints, staff overcrowding, increased generation of noise and heat, higher risk of downtime, psychological dependence, critical issues for biospecimen management, disruption of staff trained in specific technologies, along with the risk of transition toward a manufacturer’s-driven laboratory. As many ongoing technological innovations coupled with the current scenario, profoundly driven by cost-containment policies, will promote further diffusion of laboratory automation in the foreseeable future, here we provide a personal overview on some potential advantages and limitations of TLA.
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Affiliation(s)
- Giuseppe Lippi
- Section of Clinical Biochemistry , University Hospital of Verona , Piazzale LA Scuro , 37134 Verona , Italy
| | - Giorgio Da Rin
- Laboratory Medicine , San Bassiano Hospital , Bassano del Grappa , Italy
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Sharma B, Sharma M, Majumder M, Steier W, Sangal A, Kalawar M. Thrombocytopenia in Septic Shock Patients—A Prospective Observational Study of Incidence, Risk Factors and Correlation with Clinical Outcome. Anaesth Intensive Care 2019; 35:874-80. [DOI: 10.1177/0310057x0703500604] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The objectives of the study were to study the incidence of various degrees of severity of thrombocytopenia in septic shock, the risk factors for its development and the correlation with clinical outcome. Complete blood counts, chemistry panel, arterial lactate, serum cortisol, APACHE II score, logistic organ dysfunction score and SOFA score were determined in 69 septic shock patients within 24 hours of admission or onset of septic shock. We followed the patients until they died or for six months to determine the mortality rate. The incidence of thrombocytopenia in our study group was 55%. Patients with thrombocytopenia had significantly higher serum creatinine, SOFA score, vasopressor requirement, lower PaO2/FiO2 ratio and higher mortality than those without thrombocytopenia (P <0.05). Higher SOFA score, low PaO2/FiO2 ratio and high vasopressor dose were independent risk factors for development of thrombocytopenia. The presence of thrombocytopenia had significant correlation with SOFA score (P=0.008). On receiver-operator characteristic curve analysis, platelet count was found to be predictive of increased mortality (area under curve=0.56). Thrombocytopenic patients had 1.4 times the risk of mortality and lower survival probability at six months (log rank test P=0.03). In conclusion, thrombocytopenia is common in septic shock and is associated with worse clinical outcome. Higher SOFA score, low PaO2/FiO2 ratio and high vasopressor dose are independent risk factors for development of thrombocytopenia in septic shock.
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Affiliation(s)
- B. Sharma
- Departments of Pulmonary and Critical Care Medicine and Hematology-Oncology, Brookdale University Hospital and Medical Center, State University of New York, Brooklyn, New York, United States of America
| | - M. Sharma
- Departments of Pulmonary and Critical Care Medicine and Hematology-Oncology, Brookdale University Hospital and Medical Center, State University of New York, Brooklyn, New York, United States of America
| | - M. Majumder
- Departments of Pulmonary and Critical Care Medicine and Hematology-Oncology, Brookdale University Hospital and Medical Center, State University of New York, Brooklyn, New York, United States of America
- Pulmonary and Critical Care Medicine
| | - W. Steier
- Departments of Pulmonary and Critical Care Medicine and Hematology-Oncology, Brookdale University Hospital and Medical Center, State University of New York, Brooklyn, New York, United States of America
- Hematology and Oncology and Program Director, Hematology and Oncology Fellowship Program
| | - A. Sangal
- Departments of Pulmonary and Critical Care Medicine and Hematology-Oncology, Brookdale University Hospital and Medical Center, State University of New York, Brooklyn, New York, United States of America
| | - M. Kalawar
- Departments of Pulmonary and Critical Care Medicine and Hematology-Oncology, Brookdale University Hospital and Medical Center, State University of New York, Brooklyn, New York, United States of America
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14
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Abstract
How to cite this article: Aluru N, Samavedam S. Thrombocytopenia in Intensive Care Unit. Indian J Crit Care Med 2019;23(Suppl 3):S185–S188.
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Affiliation(s)
- Narmada Aluru
- Department of Internal Medicine and Critical Care, Virinchi Hospitals, Hyderabad, Telangana, India
| | - Srinivas Samavedam
- Department of Internal Medicine and Critical Care, Virinchi Hospitals, Hyderabad, Telangana, India
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15
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Abstract
Anemia is a common condition and is diagnosed on laboratory assessment. It is defined by abnormally low hemoglobin concentration or decreased red blood cells. Several classification systems exist. Laboratory markers provide important information. Acute anemia presents with symptoms owing to acute blood loss; chronic anemia may present with worsening fatigue, dyspnea, lightheadedness, or chest pain. Specific treatments depend on the underlying anemia and etiology. Iron is an alternative treatment for patients with microcytic anemia owing to iron deficiency. Hyperbaric oxygen is an option for alternative rescue therapy. Most patients with chronic anemia may be discharged with follow-up if hemodynamically stable.
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Affiliation(s)
- Brit Long
- Department of Emergency Medicine, San Antonio Military Medical Center, 3841 Roger Brooke Drive, Fort Sam Houston, TX 78234, USA.
| | - Alex Koyfman
- Department of Emergency Medicine, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
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Use of four-factor prothrombin complex concentrate in the reversal of warfarin-induced and nonvitamin K antagonist-related coagulopathy. Blood Coagul Fibrinolysis 2018; 28:564-569. [PMID: 28604569 DOI: 10.1097/mbc.0000000000000643] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
: To evaluate the efficacy of international normalized ratio (INR) reversal using four-factor prothrombin complex concentrate (4F-PCC) in nonmedication-induced coagulopathy. We performed a single-site, retrospective cohort study of patients receiving off-label use of 4F-PCC. Cohorts included liver dysfunction if they had acute liver decompensation or cirrhosis without other causative factors of liver failure such as sepsis, coagulopathy of acute sepsis (CAS) if they had documentation of sepsis and no underlying liver disorder, known factor deficiencies, or medication-induced coagulopathy, or warfarin if they were taking warfarin. Patients with unknown medication or direct oral anticoagulant usage were excluded. 4F-PCC was administered 32 times in 26 patients for nonvitamin-K antagonist related coagulopathy (11 CAS and 21 liver dysfunction) and 47 administrations were in warfarin patients. Liver dysfunction patients had a mean model for end-stage liver disease score of 28 ± 10. CAS and warfarin patients had significant INR reductions (ΔINR 1.9, P < 0.01; ΔINR 3.9, P < 0.01, respectively). Liver dysfunction patients mean change in INR trended toward significance (ΔINR 0.7, P = 0.09). Patients who received 4F-PCC based upon previously established dosing guidelines for moderate elevations in INR (20-30 IU/kg) doing demonstrated similar reductions in INR between CAS and warfarin patients (ΔINR 1.3, P = 0.03, ΔINR 1.0 P < 0.01, respectively). 4F-PCC significantly reduces the INR in CAS patients and trended toward significant reductions in liver dysfunction patients. Adequately powered, prospective trials are needed to demonstrate 4F-PCC efficacy in reversal of these coagulopathies.
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Sengul D, Sengul I. Is there any link between a kind of thyrocyte dysfunction, hypothyroidism and inflammatory hematologic parameters in the cases having the benign thyroid nodules? A 5-year single-center experience. SANAMED 2018. [DOI: 10.24125/sanamed.v13i1.211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objective: Microscopically, the thyroid gland is composed of spherical follicles and thyroid parenchyma includes two major cell types, the thyrocytes releasing thyroid hormones and C cells secreting mature calcitonin. Hypothyroidism has been known as being associated with the various abnormalities of the coagulation system. In the present study, it had been purposed to investigate the relationship between inflammatory hematological parameters, RBC, Hb, Htc, RDW, WBC, neutrophil, lymhocyte, N/L, Plt, MPV, PCT, PDW and hypothyroid hormonal status in the cases possessing the benign thyroid nodules. Material and Methods: A total of 313 cases, 202 with hypothyroidism and 111 with euthyroidism possesing the benign thyroid nodules, that was verified with the cytological evaluation after one-endocrine surgeon performed ultrasonography (US) guided fine needle aspiration (FNA) (US-g-FNA), at the Division of Endocrine Surgery, Department of General Surgery, Giresun University Faculty of Medicine, Giresun, Turkey, in conformity with the criteria, were enrolled into the study during the period, from April 2010 to April 2015. The documents that were used to follow consisted of laboratory tests of the cases including both the thyroid hormones, free T3, Free T4, and TSH, and the inflammatory hematological parameters were reviewed and scanned retrospectively. The upper limit of the normal Thyrotropin (TSH) reference range was determined as 4 mU/L in the present study. Results: No statistically significant difference was found between the inflammatory hematological parameters, RBC, Hb, Htc, RDW, WBC, neutrophil, lymhocyte, N/L, Plt, MPV, PCT, PDW, and hypothyroidism (p > 0.05). Conclusion: Inflammatory hematological parameters may not be useful for estimating the hormonal status of the thyroid gland in the cases with the benign thyroid nodules verified with the cytological evaluation, TBSRTC.
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18
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Russell L, Holst LB, Kjeldsen L, Stensballe J, Perner A. Risks of bleeding and thrombosis in intensive care unit patients with haematological malignancies. Ann Intensive Care 2017; 7:119. [PMID: 29230562 PMCID: PMC5725397 DOI: 10.1186/s13613-017-0341-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 11/28/2017] [Indexed: 02/14/2023] Open
Abstract
Background Patients with malignant haematological disease and especially those who require intensive care have an increased risk of bleeding and thrombosis, but none of these data were obtained in ICU patients only. We assessed the incidence of bleeding and thrombotic complications, use of blood products and risk factors for bleeding in an adult population of ICU patients with haematological malignancies. Methods We screened all patients with acute leukaemia and myelodysplastic syndrome admitted to a university hospital ICU during 2008–2012. Bleeding in ICU was scored according to the WHO grading system, and risk factors were evaluated using unadjusted and adjusted analyses. Results In total, 116 of 129 ICU patients were included; their median length of stay was 7 (IQR 2–16) days. Of these, 66 patients (57%) had at least one bleeding episode in ICU; they bled for 3 (2–6) days and most often from lower and upper airways and upper GI tract. Thirty-nine (59%) of the 66 patients had severe or debilitating (WHO grade 3 or 4) bleeding. The median platelet count on the day of grade 3 or 4 bleeding was 23 × 109 per litre (IQR 13–39). Nine patients (8%) died in ICU following a bleeding episode; five of these had intra-cerebral haemorrhage. Platelet count on admission was associated with subsequent bleeding (adjusted odds ratio 1.18 (95% CI 1.03–1.35) for every 10 × 109 per litre drop in platelet count, p = 0.016). Eleven of the 116 patients (9%) developed a clinically significant thrombosis in ICU, which was the cause of death in four patients. The median platelet count was 20 × 109 per litre (15–48) at the time of thrombosis. The patients received a median of 6 units of red blood cells, 1 unit of fresh frozen plasma and 8 units of platelet concentrates in ICU. Conclusions Severe and debilitating bleeding complications were frequent in our ICU patients with haematological malignancies, but thrombosis also occurred in spite of low platelet counts. Platelet count on ICU admission was associated with subsequent bleeding. Electronic supplementary material The online version of this article (10.1186/s13613-017-0341-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lene Russell
- Department of Intensive Care 4131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark. .,Copenhagen Academy for Medical Education and Simulation, University of Copenhagen and The Capital Region of Denmark, Copenhagen, Denmark.
| | - Lars Broksø Holst
- Department of Intensive Care 4131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Lars Kjeldsen
- Department of Haematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jakob Stensballe
- Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Anders Perner
- Department of Intensive Care 4131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
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19
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20
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Patient Blood Management in the Intensive Care Unit. Transfus Med Rev 2017; 31:264-271. [DOI: 10.1016/j.tmrv.2017.07.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 07/14/2017] [Accepted: 07/25/2017] [Indexed: 01/28/2023]
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21
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Rotational thromboelastometry significantly optimizes transfusion practices for damage control resuscitation in combat casualties. J Trauma Acute Care Surg 2017; 83:373-380. [PMID: 28846577 DOI: 10.1097/ta.0000000000001568] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Up to 40% of combat casualties with a truncal injury die of massive hemorrhage before reaching a surgeon. This hemorrhage can be prevented with damage control resuscitation (DCR) methods, which are focused on replacing shed whole blood by empirically transfusing blood components in a 1:1:1:1 ratio of platelets:fresh frozen plasma:erythrocytes:cryoprecipitate (PLT:FFP:RBC:CRYO). Measurement of hemostatic function with rotational thromboelastometry (ROTEM) may allow optimization of the type and quantity of blood products transfused. Our hypothesis was that incorporating ROTEM measurements into DCR methods at the US Role 3 hospital at Bagram Airfield, Afghanistan would change the standard transfusion ratios of 1:1:1:1 to a product mix tailored specifically for the combat causality. METHODS This retrospective study collected data from the Department of Defense Trauma Registry to compare transfusion practices and outcomes before and after ROTEM deployment to Bagram Airfield. Over the course of six months, 134 trauma patients received a transfusion (pre-ROTEM) and 85 received a transfusion and underwent ROTEM testing (post-ROTEM). Trauma teams received instruction on ROTEM use and interpretation, with no provision of a specific transfusion protocol, to supplement their clinical judgment and practice. RESULTS The pre and post groups were not significantly different in terms of mortality, massive transfusion protocol activation, mean injury severity score, or coagulation measurements. Despite the difference in size, each group received an equal total number of transfusions. However, the post-ROTEM group received a significant increase in PLT and CRYO transfusions ratios, 4× and 2×, respectively. CONCLUSION The introduction of ROTEM significantly improved adherence to DCR practices. The transfusion differences suggest that aggressive DCR without thromboelastometry data may result in reduced hemostatic support and underestimate the need for PLT and CRYO. Thus, future controlled trials should include ROTEM-guided coagulation management in trauma resuscitation. LEVEL OF EVIDENCE Therapeutic, level IV.
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22
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Peck-Radosavljevic M. Thrombocytopenia in chronic liver disease. Liver Int 2017; 37:778-793. [PMID: 27860293 DOI: 10.1111/liv.13317] [Citation(s) in RCA: 153] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 11/04/2016] [Indexed: 12/12/2022]
Abstract
Thrombocytopenia is a common haematological disorder in patients with chronic liver disease. It is multifactorial and severity of liver disease is the most influential factor. As a result of the increased risk of bleeding, thrombocytopenia may impact upon medical procedures, such as surgery or liver biopsy. The pathophysiology of thrombocytopenia in chronic liver disease has long been associated with the hypothesis of hypersplenism, where portal hypertension causes pooling and sequestration of all corpuscular elements of the blood, predominantly thrombocytes, in the enlarged and congested spleen. Other mechanisms of importance include bone marrow suppression by toxic substances, such as alcohol or viral infection, and immunological removal of platelets from the circulation. However, insufficient platelet recovery after relief of portal hypertension by shunt procedures or minor and transient recovery after splenic artery embolization have caused many to question the importance and relative contribution of this mechanism to thrombocytopenia. The discovery of the cytokine thrombopoietin has led to the elucidation of a central mechanism. Thrombopoietin is predominantly produced by the liver and is reduced when liver cell mass is severely damaged. This leads to reduced thrombopoiesis in the bone marrow and consequently to thrombocytopenia in the peripheral blood of patients with advanced-stage liver disease. Restoration of adequate thrombopoietin production post-liver transplantation leads to prompt restoration of platelet production. A number of new treatments that substitute thrombopoietin activity are available or in development.
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Affiliation(s)
- Markus Peck-Radosavljevic
- Department of Gastroenterology, Hepatology, Endocrinology and Nephrology, Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria
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23
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Moore JX, Zakai NA, Mahalingam M, Griffin RL, Irvin MR, Safford MM, Baddley JW, Wang HE. Hemostasis biomarkers and risk of sepsis: the REGARDS cohort. J Thromb Haemost 2016; 14:2169-2176. [PMID: 27512924 PMCID: PMC5503746 DOI: 10.1111/jth.13446] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 08/08/2016] [Indexed: 12/16/2022]
Abstract
Essentials Few studies have investigated the risk of sepsis by baseline hemostasis biomarkers measures. Baseline hemostasis biomarkers and risk of sepsis was examined using case-control study design. Increased fibrinogen, factor IX, and factor XI levels may be associated with risk of sepsis. Hemostasis biomarkers may provide a target for sepsis mitigation or prevention. SUMMARY Background Sepsis is a major public health concern, responsible for more than 750 000 hospitalizations and 200 000 annual deaths in the USA. Few studies have investigated the association between baseline measurements of hemostasis biomarkers and the future risk of sepsis. Objective To determine whether hemostasis biomarkers levels measured at baseline in a cohort of community-dwelling participants are associated with the risk of future sepsis events. Methods We performed a nested case-control study within the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. We identified sepsis hospitalizations occurring over a 10-year period. There were 50 incident sepsis cases with baseline measurements of hemostasis (fibrinogen, factor VIII, FIX, FXI, protein C, and D-dimer). Using incidence density sampling, we matched the 50 sepsis cases with 200 controls by age, sex, and race. We used conditional logistic regression to evaluate the association between baseline hemostasis biomarkers and future sepsis events. Results Comparison of 50 sepsis cases with 200 non-sepsis controls showed that sepsis cases had lower education and income, were more likely to live in the stroke belt, had chronic lung disease, and had higher albumin level/creatinine level ratios (ACRs). Individuals with higher baseline fibrinogen levels (adjusted odds ratio [OR] per standard deviation: 1.40, 95% confidence interval [CI] 1.01-1.94), FIX levels ([OR] 1.46, 95% [CI] 1.03-2.07) and FXI levels ([OR]1.52, 95% [CI] 1.04-2.23) were more likely to experience a sepsis event. Conclusion Baseline fibrinogen, FIX and FXI levels are associated with future episodes of sepsis. Hemostasis biomarkers may provide targets for sepsis mitigation or prevention.
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Affiliation(s)
- J X Moore
- Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - N A Zakai
- Departments of Medicine and Pathology, University of Vermont College of Medicine, Colchester Research Facility, Colchester, VT, USA
| | - M Mahalingam
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - R L Griffin
- Departments of Medicine and Pathology, University of Vermont College of Medicine, Colchester Research Facility, Colchester, VT, USA
| | - M R Irvin
- Departments of Medicine and Pathology, University of Vermont College of Medicine, Colchester Research Facility, Colchester, VT, USA
| | - M M Safford
- Department of Medicine, Weill-Cornell Medical Center, New York, NY, USA
| | - J W Baddley
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - H E Wang
- Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Da Silva IRF, Gomes JA, Wachsman A, de Freitas GR, Provencio JJ. Hematologic counts as predictors of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage. J Crit Care 2016; 37:126-129. [PMID: 27718411 DOI: 10.1016/j.jcrc.2016.09.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 09/14/2016] [Accepted: 09/14/2016] [Indexed: 01/13/2023]
Abstract
PURPOSE Aneurysmal subarachnoid hemorrhage (SAH) is associated with high morbidity and mortality, but currently no single clinical method or ancillary test can reliably predict which subset of patients will develop delayed cerebral ischemia (DCI). The aim of this study was to find hematologic derangements and clinical factors present during the first 7 days after bleeding that could help identify patients at risk for development of DCI. MATERIALS AND METHODS Databank analysis of patients with SAH admitted between 2010 and 2012 in a single center. Data from demographics, imaging, laboratory, and clinical factors were collected. Statistical testing was conducted to test for association to the outcome, and multivariate logistic regression was used to design a predictive model. RESULTS Of 55 patients, 14 developed DCI (25%). Anemia and leukocytosis on the third day after bleeding were significantly correlated with the outcome (for anemia: P<.032; confidence interval, 1.12-15.16; odds ratio, 4.12; for leukocytosis: P<.046; confidence interval, 1.03-26.13; odds ratio, 5.18). Anemia and leukocytosis were still statistically significant after adjustment for age, sex, modified Fisher scale, and Hunt-Hess scale. CONCLUSION The presence of leukocytosis and anemia during the third day after SAH was statistically correlated with the occurrence of DCI.
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Affiliation(s)
| | - Joao Antonio Gomes
- Summa Health, Akron City Hospital and Northeast Ohio Medical University, Akron, OH.
| | - Ari Wachsman
- Cleveland Clinic-Akron General Medical Center, Akron, OH.
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25
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Salman SS, Fernández Pérez ER, Stubbs JR, Gajic O. The Practice of Platelet Transfusion in the Intensive Care Unit. J Intensive Care Med 2016; 22:105-10. [PMID: 17469241 DOI: 10.1177/0885066606297969] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The practice of platelet transfusion in the intensive care unit varies, and liberal use may not be associated with improved outcome. This study reviewed the medical records of 117 patients with moderate-to-severe thrombocytopenia and without active bleeding who were admitted to intensive care unit beds during a 6-month period. The primary outcome measures were new bleeding episodes and platelet transfusion complications. Ninety (77%) received a platelet transfusion. Significant new bleeding developed in 1 patient who received a transfusion. Six patients (8%) developed transfusion complications: 2 transfusion-related acute lung injury, 2 allergic, and 2 febrile reactions. Patients who did not receive platelet transfusion had a higher severity of illness than transfused patients. Predictors of platelet transfusion were platelet count and postoperative status, but not invasive procedure. The practice of platelet transfusion in critically ill patients with thrombocytopenia varies. Prospective studies evaluating restrictive versus liberal platelet transfusion strategies are warranted.
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Affiliation(s)
- Salam S Salman
- Pulmonary and Critical Care Medicine, Graduate Hospital, Philadelphia, PA, USA
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26
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Hanafy AS, El Hawary AT, Hamed EF, Hassaneen AM. Impact of Helicobacter pylori eradication on refractory thrombocytopenia in patients with chronic HCV awaiting antiviral therapy. Eur J Clin Microbiol Infect Dis 2016; 35:1171-6. [PMID: 27180243 DOI: 10.1007/s10096-016-2650-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 04/14/2016] [Indexed: 01/06/2023]
Abstract
The possibility of delaying treatment of HCV due to severe thrombocytopenia is challenging. This study aimed to detect the prevalence of active helicobacter infection as a claimed cause of thrombocytopenia in a cohort of Egyptian patients with chronic active HCV awaiting combined anti-viral therapy. The study included 400 chronic HCV patients with thrombocytopenia. Laboratory investigations included liver function tests, real time quantitative PCR, reticulocytic count, ESR, ANA, bone marrow aspiration, measurement of anti-helicobacter antibodies, and helicobacter stool antigen. Positive cases for active H. pylori were given the standard triple therapy for 2 weeks. Helicobacter stool antigen was detected 4 weeks after termination of therapy and the change in platelet count was detected 1 month after eradication. A total of 248 out of 281 seropositive patients for H. pylori (88.3 %) showed positive stool antigen (p = 0.01). Eradication was achieved in 169 (68.1 %) patients with platelet mean count 114.9 ± 18.8 × 10(3)/μl with highly significant statistical difference from pretreatment value (49.7 ± 9.2 × 10(3)/μl, p = 0.000). Seventy-nine patients were resistant to conventional triple therapy and given a 7-day course of moxifloxacin-based therapy; 61 patients responded (77.1 %) with mean platelet improvement from 76.4 ± 17.4 × 10(3)/μl to 104.2 ± 15.2 × 10(3)/μl (p = 0.000). The non-responders showed no improvement in their platelet count (74.6 ± 20.5 vs. 73.6 ± 15.3 × 10(3)/ul, P = 0.5). Eradication of active H. pylori in HCV augments platelet count and enhances the early start of antiviral therapy.
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Affiliation(s)
- A S Hanafy
- Internal Medicine Department, Hepatogastroenterology Division, Zagazig University, Zagazig, Egypt.
| | - A T El Hawary
- Internal Medicine Department, Hepatogastroenterology Division, Zagazig University, Zagazig, Egypt
| | - E F Hamed
- Internal Medicine Department, Hepatogastroenterology Division, Zagazig University, Zagazig, Egypt
| | - A M Hassaneen
- Clinical Pathology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.,Clinical Pathology Department, Faculty of Medicine, Sulaiman AlRajhi Colleges, Al Bukayriyah, Saudi Arabia
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Mehta S, Goyal L, Joshi S, Harshvardhan L, Gupta N. Dynamics of platelet count in critically ill medical patients as a prognostic marker and its associated risk factors – Experience at a tertiary care center of North-West India. INDIAN JOURNAL OF MEDICAL SPECIALITIES 2016. [DOI: 10.1016/j.injms.2016.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Russell L, Madsen M, Bonde J, Perner A. Bleeding and thrombosis in leukaemia patients admittet to an intensive care unit. Intensive Care Med Exp 2015. [PMCID: PMC4797408 DOI: 10.1186/2197-425x-3-s1-a252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Predictors of Clinically Significant Postoperative Events after Open Craniosynostosis Surgery. Anesthesiology 2015; 122:1021-32. [DOI: 10.1097/aln.0000000000000612] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Abstract
Background:
Craniosynostosis surgery is associated with clinically significant postoperative events requiring intensive care unit (ICU) admission. The authors investigate specific variables, which might influence the risk for these events, and thereby make recommendations regarding the need for postoperative ICU admission.
Methods:
A retrospective review of 225 children undergoing open craniosynostosis repair at a single center during a 10-yr period is reported. The primary outcome measure was the incidence of predefined clinically relevant postoperative cardiorespiratory and hematological events requiring ICU admission.
Results:
The incidences of postoperative cardiorespiratory and hematological events requiring ICU care were 14.7% (95% CI, 10.5 to 20.1%) and 29.7% (95% CI, 24.0 to 36.3%), respectively. Independent predictors of cardiorespiratory events were body weight less than 10 kg, American Society of Anesthesiologists physical status 3 or 4, intraoperative transfusion of greater than 60 ml/kg packed erythrocytes, and the occurrence of an intraoperative complication. The independent predictors of hematological events were body weight less than 10 kg, American Society of Anesthesiologists physical status 3 or 4, intraoperative transfusion of greater than 60 ml/kg packed erythrocytes, transfusion of hemostatic products (fresh-frozen plasma, platelets, and/or cryoprecipitate), and tranexamic acid not administered.
Conclusions:
Children undergoing craniosynostosis surgery are at increased risk for clinically significant postoperative events requiring ICU admission if they are less than 10 kg body weight, American Society of Anesthesiologists physical status 3 or 4, require intraoperative transfusion of greater than 60 ml/kg of packed erythrocytes, receive hemostatic blood products, or if they develop a significant intraoperative complication. Tranexamic acid administration was associated with fewer postoperative events. A predictive clinical algorithm for pediatric patients having major craniosynostosis surgery was developed and validated to risk stratify these patients.
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Solomon C, Gröner A, Ye J, Pendrak I. Safety of fibrinogen concentrate: analysis of more than 27 years of pharmacovigilance data. Thromb Haemost 2014; 113:759-71. [PMID: 25502954 DOI: 10.1160/th14-06-0514] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 10/22/2014] [Indexed: 11/05/2022]
Abstract
Fibrinogen concentrate use as a haemostatic agent has been increasingly explored. This study evaluates spontaneous reports of potential adverse drug reactions (ADRs) that occurred during postmarketing pharmacovigilance of Haemocomplettan P/RiaSTAP, and reviews published safety data. This descriptive study analysed postmarketing safety reports recorded in the CSL Behring pharmacovigilance database from January 1986 to December 2013. A literature review of clinical studies published during the same period was performed. Commercial data indicated that 2,611,294 g of fibrinogen concentrate were distributed over the pharmacovigilance period, corresponding to 652,824 standard doses of 4 g each, across a range of clinical settings and indications. A total of 383 ADRs in 106 cases were reported (approximately 1 per 24,600 g or 6,200 standard doses). Events of special interest included possible hypersensitivity reactions in 20 cases (1 per 130,600 g or 32,600 doses), possible thromboembolic events in 28 cases (1 per 93,300 g or 23,300 doses), and suspected virus transmission in 21 cases (1 per 124,300 g or 31,000 doses). One virus transmission case could not be analysed due to insufficient data; for all other cases, a causal relationship was assessed as unlikely due to negative polymerase chain reaction tests and/or alternative explanations. The published literature revealed a similar safety profile. In conclusion, underreporting of ADRs is a known limitation of pharmacovigilance. However, the present assessment indicates that fibrinogen concentrate is administered across a range of indications, with few ADRs and a low thromboembolic event rate. Overall, fibrinogen concentrate showed a promising safety profile.
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Affiliation(s)
- C Solomon
- Assoc. Prof. Cristina Solomon, MD, MBA, CSL Behring GmbH, Emil-von-Behring-Strasse 76, 35041 Marburg, Germany, Tel: +49 6421 39 5813, Fax: +49 6421 39 4146, E-mail:
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31
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dos Santos AA, da Silva JP, da Silva LDF, de Sousa AG, Piotto RF, Baumgratz JF. Therapeutic options to minimize allogeneic blood transfusions and their adverse effects in cardiac surgery: a systematic review. Braz J Cardiovasc Surg 2014; 29:606-21. [PMID: 25714216 PMCID: PMC4408825 DOI: 10.5935/1678-9741.20140114] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 09/30/2014] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Allogeneic blood is an exhaustible therapeutic resource. New evidence indicates that blood consumption is excessive and that donations have decreased, resulting in reduced blood supplies worldwide. Blood transfusions are associated with increased morbidity and mortality, as well as higher hospital costs. This makes it necessary to seek out new treatment options. Such options exist but are still virtually unknown and are rarely utilized. OBJECTIVE To gather and describe in a systematic, objective, and practical way all clinical and surgical strategies as effective therapeutic options to minimize or avoid allogeneic blood transfusions and their adverse effects in surgical cardiac patients. METHODS A bibliographic search was conducted using the MeSH term "Blood Transfusion" and the terms "Cardiac Surgery" and "Blood Management." Studies with titles not directly related to this research or that did not contain information related to it in their abstracts as well as older studies reporting on the same strategies were not included. RESULTS Treating anemia and thrombocytopenia, suspending anticoagulants and antiplatelet agents, reducing routine phlebotomies, utilizing less traumatic surgical techniques with moderate hypothermia and hypotension, meticulous hemostasis, use of topical and systemic hemostatic agents, acute normovolemic hemodilution, cell salvage, anemia tolerance (supplementary oxygen and normothermia), as well as various other therapeutic options have proved to be effective strategies for reducing allogeneic blood transfusions. CONCLUSION There are a number of clinical and surgical strategies that can be used to optimize erythrocyte mass and coagulation status, minimize blood loss, and improve anemia tolerance. In order to decrease the consumption of blood components, diminish morbidity and mortality, and reduce hospital costs, these treatment strategies should be incorporated into medical practice worldwide.
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Affiliation(s)
| | - José Pedro da Silva
- Real e Benemérita Associação Portuguesa de Beneficência
de São Paulo, São Paulo, SP, Brasil
| | | | | | - Raquel Ferrari Piotto
- Real e Benemérita Associação Portuguesa de Beneficência
de São Paulo, São Paulo, SP, Brasil
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Jakoi A, Kumar N, Vaccaro A, Radcliff K. Perioperative coagulopathy monitoring. Musculoskelet Surg 2014; 98:1-8. [PMID: 24281819 DOI: 10.1007/s12306-013-0307-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Accepted: 11/07/2013] [Indexed: 06/02/2023]
Abstract
Coagulopathy is common in orthopedic surgery patients either due to acquired factors, such as surgery, trauma, medications, or hemorrhage. Perioperative monitoring of blood coagulation is critical to diagnose the causes of hemorrhage, guide hemostatic therapies, predict the risk of bleeding during surgical procedures, and reduce risk of postoperative cardiac and thromboembolic events. In contrast to previous interventions that measure specific portions of the clotting cascade (such as intrinsic or extrinsic pathways or platelet aggregation), "Point-of-care" coagulation monitoring devices assess the viscoelastic properties of whole blood. These techniques have the potential to measure the entire clotting process, starting with fibrin formation, clot retraction, and fibrinolysis. Furthermore, the coagulation status of patients is assessed in whole blood, allowing the plasmatic coagulation system to interact with platelets and red cells, and thereby providing useful additional information on platelet function. Improved monitoring of coagulopathy is particularly important as new anticoagulant drugs emerge that affect the clotting cascade in novel ways, including the inhibition of intrinsic and extrinsic pathways and platelet function. It is important for orthopedic surgeons to understand the pharmacology and reversal of these drugs in the perioperative setting. The purpose of this review is to review the current techniques to monitoring perioperative coagulopathy and to identify the manner in which novel anticoagulant medications affect the clotting cascade with particular interest in trauma and spine surgery.
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Affiliation(s)
- A Jakoi
- Department of Orthopaedic Surgery, Drexel University, Philadelphia, PA, USA,
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Polastri M, Vianelli N. Active exercise in critically ill adults affected by thrombocytopaenia. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2014. [DOI: 10.12968/ijtr.2014.21.1.41] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Introduction Thrombocytopaenia (TCP), or low platelet count, is a haematological disorder that commonly occurs in critically ill patients and is defined as a platelet count below 100 000/μL. Patients are at higher risk of muscular atrophy and other complications after prolonged bed rest. This literature review aims to clarify the appropriateness of active exercise in critically ill adult patients with TCP. Methods A review of the literature was conducted using the following key words that are PubMed medical subheading (MeSH) terms: ‘critical illness’, ‘exercise therapy’, ‘manual therapy’, ‘physical therapy’, ‘physiotherapy’, ‘postoperative care’, ‘rehabilitation’, ‘thrombocytopenia’, and ‘thrombopenia’. The search was limited by publication date (2000 to 2013) and language (English only) in three main databases: PubMed, SCOPUS, and CINAHL. Results The key word searches found a total of 78 citations. Of these, only those meeting the inclusion criteria were selected after reading the title and abstract. Two studies were included after reading the full-texts. Exercise is used to treat muscular atrophy in critically ill adult patients, and rehabilitation plays an important role in the care pathway. Results of our analysis do not support evidence for or against exercise in critically ill adult patients with TCP; therefore, health professionals must pay close attention to the presence of signs of bleeding in these patients when proposing exercise. Discussion Surprisingly, no study was found that directly covered this issue. Aggressive exercise may not be appropriate in patients with very low platelet counts. On the other hand, critically ill patients are at high risk of muscular atrophy due to the forced bed rest, especially after complex surgery or in prolonged hospitalisation. Physiotherapists and those providing care must share their observations with the rest of the multidisciplinary team before treatment starts. Conclusions Active exercise in critically ill adult patients with severe TCP must be personalised and platelet count carefully monitored before proposing physical activity. Physical recovery can be challenging in critically ill adult patients, and it can be limited by severe TCP, mostly when bleeding is present.
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Affiliation(s)
- Massimiliano Polastri
- Physiotherapist at Bologna University Hospital Authority Sant'Orsola-Malpighi, Italy
| | - Nicola Vianelli
- Haematologist at Bologna University Hospital Authority Sant'Orsola-Malpighi, Italy
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Martin R, Esper A, Martin GS. Hematologic Complications. NON-PULMONARY COMPLICATIONS OF CRITICAL CARE 2014. [PMCID: PMC7121187 DOI: 10.1007/978-1-4939-0873-8_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Critically ill patients are at high risk of developing various hematologic complications that may be present on admission or occur during their stay in the Intensive Care Unit (ICU). Often times the etiology of specific hematologic abnormalities is unclear and the diagnosis may be challenging due to the complexity of critically ill patients. This chapter will focus on diagnosis and management of the most commonly encountered hematologic problems in the critically ill such as anemia, neutropenia, thrombocytopenia, coagulopathy and thrombotic complications, with specific focus on diagnosis and management of these conditions.
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McEvoy MT, Shander A. Anemia, bleeding, and blood transfusion in the intensive care unit: causes, risks, costs, and new strategies. Am J Crit Care 2013; 22:eS1-13; quiz eS14. [PMID: 24186829 DOI: 10.4037/ajcc2013729] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The definition of anemia is controversial and varies with the sex, age, and ethnicity of the patient. Anemia afflicts half of hospitalized patients and most elderly hospitalized patients. Acute anemia in the operating room or intensive care unit is associated with increased morbidity as well as other adverse outcomes, including death. The risks of anemia are compounded by the added risks associated with transfusion of red blood cells, the most common treatment for severe anemia. The causes of anemia in hospitalized patients include iron deficiency, suppression of erythropoietin and iron transport, trauma, phlebotomy, coagulopathies, adverse effects of and reactions to medications, and stress-induced gastrointestinal bleeding. The types and causes of anemia and the increased health care utilization and costs associated with anemia and undetected internal bleeding are described. The potential benefits and risks associated with transfusion of red blood cells also are explored. Last, the strategies and new tools to help prevent anemia, allow earlier detection of internal bleeding, and avoid unnecessary blood transfusions are discussed.
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Affiliation(s)
- Michael T. McEvoy
- Michael T. McEvoy is a critical care registered nurse in the Department of Cardiothoracic Surgery at Albany Medical Center in Albany, New York. Aryeh Shander is an anesthesiologist in the Department of Anesthesiology, Critical Care Medicine, Pain Management, and Hyperbaric Medicine at Englewood Hospital and Medical Center in Englewood, New Jersey
| | - Aryeh Shander
- Michael T. McEvoy is a critical care registered nurse in the Department of Cardiothoracic Surgery at Albany Medical Center in Albany, New York. Aryeh Shander is an anesthesiologist in the Department of Anesthesiology, Critical Care Medicine, Pain Management, and Hyperbaric Medicine at Englewood Hospital and Medical Center in Englewood, New Jersey
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Lambing AY. Unexpected hemorrhage: an unusual and potentially catastrophic clinical challenge. J Am Assoc Nurse Pract 2013; 25:342-50. [PMID: 24170617 DOI: 10.1111/j.1745-7599.2012.00807.x] [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: 11/28/2022]
Abstract
PURPOSE Unexpected bleeding or hemorrhage related to the development of acquired factor VIII inhibitors is an emerging clinical challenge in patients. Symptoms can occur suddenly with bleeding and/or bruising that is excessive relative to the degree of injury or severity of a comorbid condition. Diagnosis is difficult, and bleeding can quickly become life threatening if not treated promptly. This review provides current information, using a patient case scenario, to improve awareness and recognition of patients presenting unexpectedly with excessive bleeding of unknown etiology. DATA SOURCES To complete this review, a search of English-language publications was conducted using Medline and CINAHL databases (1966-2010). CONCLUSIONS Although development of acquired factor VIII inhibitors is rare, its incidence is increasing in many different patient care settings. Improved awareness and recognition is needed to mitigate the significant patient morbidity and mortality that can occur without rapid and timely treatment by experienced hematology specialists. IMPLICATIONS FOR PRACTICE Nurse practitioners, as front-line clinicians treating patients in various therapeutic areas, may be the first healthcare professionals who see patients with this disorder. Increased knowledge and awareness of this rare but potentially catastrophic cause of excessive bleeding can improve prompt treatment and optimize patient outcomes.
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Affiliation(s)
- Angela Y Lambing
- Department of Hematology and Oncology, Hemophilia and Thrombosis Treatment Center, Henry Ford Health System, Detroit, Michigan
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Dou J, Lou Y, Wu J, Lu Y, Jin Y. Thrombocytopenia in patients with hepatitis B virus-related chronic hepatitis: evaluation of the immature platelet fraction. Platelets 2013; 25:399-404. [PMID: 24047408 DOI: 10.3109/09537104.2013.832742] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The immature platelet fraction (IPF) measures the number of reticulated platelets in peripheral blood, and can be used to help determine if thrombocytopenia is secondary to low-platelet production or increased platelet turnover. The aim of this study was to determine whether abnormalities in the IPF were associated with thrombocytopenia in patients with hepatitis B virus-related chronic hepatitis (CHB). One hundred fifty-six patients with chronic hepatitis B, including 80 thrombocytopenia, 76 without thrombocytopenia, and 48 healthy controls were enrolled in the study. The IPF percentages (IPF%) were measured using a XE-2100 multiparameter automatic hematology analyzer. We demonstrated that in the thrombocytopenic group, the IPF% was significantly increased compared with that in healthy controls and the non-thrombocytopenic group (both p < 0.001). Multivariate analysis demonstrated that IPF%, splenomegaly, and the model for end-stage liver disease score were independent predictors for thrombocytopenia (both p < 0.001). High IPF% during the course of thrombocytopenia suggests that platelet destruction/sequestration due to hypersplenism is a major factor contributing to thrombocytopenia in patients with CHB.
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Affiliation(s)
- JiuFeng Dou
- Department of Traditional Chinese Medicine Pharmacy, First Affiliated Hospital, Zhejiang University School of Medicine , Zhejiang 310003 , China
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Chen YW, Chen YC, Fu TC, Wang CH, Huang SC, Wang JS. Anemic comorbidity reduces capacity of endogenous thrombin generation and is associated with consumptive coagulopathy in patients with heart failure. Int J Cardiol 2013; 168:4965-7. [PMID: 23932866 DOI: 10.1016/j.ijcard.2013.07.140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 07/13/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Yu-Wen Chen
- Centre for Cardiovascular Sciences, University of Birmingham, Birmingham, UK
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Thiele T, Selleng K, Selleng S, Greinacher A, Bakchoul T. Thrombocytopenia in the Intensive Care Unit—Diagnostic Approach and Management. Semin Hematol 2013; 50:239-50. [DOI: 10.1053/j.seminhematol.2013.06.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Nili F, McLeod L, O’Connell C, Sutton E, McMillan D. Maternal and Neonatal Outcomes in Pregnancies Complicated by Systemic Lupus Erythematosus: A Population-Based Study. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2013; 35:323-328. [DOI: 10.1016/s1701-2163(15)30959-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Zampieri FG, Ranzani OT, Morato PF, Campos PP, Caruso P. Effect of intraoperative HES 6% 130/0.4 on the need for blood transfusion after major oncologic surgery: a propensity-matched analysis. Clinics (Sao Paulo) 2013; 68:501-9. [PMID: 23778341 PMCID: PMC3634968 DOI: 10.6061/clinics/2013(04)11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Accepted: 12/21/2012] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES To evaluate the effect of the intraoperative use of hydroxyethyl starch on the need for blood products in the perioperative period of oncologic surgery. The secondary end-points included the need for other blood products, the clotting profile, the intensive care unit mortality and length of stay. METHODS Retrospective observational analysis in a tertiary oncologic ICU in Brazil including 894 patients submitted to oncologic surgery for a two-year period from September 2007. Patients were grouped according to whether hydroxyethyl starch was used during surgery (hydroxyethyl starch and No-hydroxyethyl starch groups) and compared using a propensity score analysis. A total of 385 propensity-matched patients remained in the analysis (97 in the No-hydroxyethyl starch group and 288 in the hydroxyethyl starch group). RESULTS A higher percentage of patients in the hydroxyethyl starch group required red blood cell transfusion during surgery (26% vs. 14%; p = 0.016) and in the first 24 hours after surgery (5% vs. 0%; p = 0.015) but not in the 24- to 48-hour period after the procedure. There was no difference regarding the transfusion of other blood products, intensive care unit mortality or length of stay. CONCLUSION Hydroxyethyl starch use in the intraoperative period of major oncologic surgery is associated with an increase in red blood cell transfusions. There are no differences in the need for other blood products, intensive care unit length of stay or mortality.
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York S, Lichtenberg ES. Characteristics of presumptive idiopathic disseminated intravascular coagulation during second-trimester induced abortion. Contraception 2012; 85:489-95. [DOI: 10.1016/j.contraception.2011.09.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Revised: 09/23/2011] [Accepted: 09/30/2011] [Indexed: 10/15/2022]
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Marco-Schulke C, Sánchez-Casado M, Hortigüela-Martín V, Quintana-Díaz M, Rodríguez-Villar S, Pérez-Pedrero M, Velasco-Ramos A, Canabal-Berlanga A, Arrese-Cosculluela M. Trombocitopenia grave al ingreso en una unidad de cuidados intensivos en pacientes con disfunción multiorgánica. Med Intensiva 2012; 36:185-92. [DOI: 10.1016/j.medin.2011.09.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2011] [Revised: 09/15/2011] [Accepted: 09/27/2011] [Indexed: 11/26/2022]
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Veljkovic D. Use fresh-frozen plasma in newborns, older infants and adolescents on the outcome of bleeding. ACTA ACUST UNITED AC 2011. [DOI: 10.1111/j.1751-2824.2011.01482.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Pradella P, Bonetto S, Turchetto S, Uxa L, Comar C, Zorat F, De Angelis V, Pozzato G. Platelet production and destruction in liver cirrhosis. J Hepatol 2011; 54:894-900. [PMID: 21145808 DOI: 10.1016/j.jhep.2010.08.018] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2009] [Revised: 08/02/2010] [Accepted: 08/09/2010] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Thrombocytopenia is common in liver cirrhosis (LC) but the mechanisms are not fully understood. The purpose of our work was to evaluate platelet kinetics in LC with different etiologies by examining platelet production and destruction. METHODS Ninety-one consecutive LC patients (36 HCV, 49 alcoholics, 15 HBV) were enrolled. As controls, 25 subjects with idiopathic thrombocytopenic purpura, 10 subjects with aplastic anemia, and 40 healthy blood donors were studied. Plasma thrombopoietin (TPO) was measured by ELISA. Reticulated platelets (RP) were determined using the Thiazole Orange method. Plasma glycocalicin (GC) was measured using monoclonal antibodies. Platelet associated and serum antiplatelet antibodies were detected by flow cytometry. B-cell monoclonality in PBMC was assessed by immunoglobulin fingerprinting. RESULTS Serum TPO was significantly lower in LC (29.9±18.1 pg/ml) compared to controls (82.3±47.6 pg/ml). The GC levels were higher in LC (any etiology) than in healthy cases. Conversely, the absolute levels of RP were lower in LC (any etiology) than in healthy controls. The platelet-associated and serum anti-platelet antibodies were higher in HCV+ LC compared to healthy subjects (p<0.0064), alcoholic LC (p<0.018), and HBV+ LC (p<0.0001). B-cell monoclonality was found in 27% of the HCV+LC, while it was not found in HBV+ or alcoholic LC. CONCLUSIONS Patients with LC present decreased plasma TPO, accelerated platelet turnover, and reduced platelet production. This indicates that LC thrombocytopenia is a multifactorial condition involving both increased platelet clearance and impaired thrombopoiesis.
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Affiliation(s)
- Paola Pradella
- Blood Bank Service, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Trieste, Trieste, Italy
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Theusinger O, Baulig W, Seifert B, Emmert M, Spahn D, Asmis L. Relative concentrations of haemostatic factors and cytokines in solvent/detergent-treated and fresh-frozen plasma. Br J Anaesth 2011; 106:505-11. [DOI: 10.1093/bja/aer003] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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Sakr Y. Heparin-induced thrombocytopenia in the ICU: an overview. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2011; 15:211. [PMID: 21457505 PMCID: PMC3219407 DOI: 10.1186/cc9993] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Yasser Sakr
- Department of Anesthesiology and Intensive Care, Friedrich-Schiller-University, Erlanger Allee 103, 07743 Jena, Germany.
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Capri Y, Vanlieferinghen P, Boeuf B, Dechelotte P, Hovnanian A, Lecomte B. [A lethal variant of Netherton syndrome in a large inbred family]. Arch Pediatr 2011; 18:294-8. [PMID: 21255986 DOI: 10.1016/j.arcped.2010.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Revised: 11/06/2010] [Accepted: 12/15/2010] [Indexed: 10/18/2022]
Abstract
Netherton syndrome is a rare autosomal recessive disorder characterized by the triad of ichthyosiform erythrodermia, typical hair dysplasia, and severe atopic features. The broad range of variable expression of this disease is well described and 20% of complications occur during the neonatal period such as hypernatremic dehydration, electrolyte imbalances, recurrent or severe infections, and failure to thrive. Mutation of the SPINK5 gene has been identified as disease-causing in Netherton syndrome, but the pathophysiology still remains unclear. Almost all SPINK5 mutations result in the absence of the serine-protease inhibitor LEKTI protein in both keratinocytes and lymphocytes. In this study, we report on a severe form of Netherton syndrome observed in three patients within a large inbred Rom family. All of them died in the first months of life despite early treatment. They were found to be homozygous for the c.1431-12G>A SPINK5 gene mutation, which has not been associated with a lethal form of the disease thus far. This family illustrates the extreme phenotype of Netherton disease of neonatal onset. Molecular diagnosis allowed further genetic counseling and prenatal testing during other pregnancies.
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Affiliation(s)
- Y Capri
- Service de néonatologie, CHU Estaing, 1, place Lucie-Aubrac, 63000 Clermont-Ferrand, France.
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Sahaya K, Patel NC. Venous sinus thrombosis and consumptive coagulopathy: a role for heparin? Pediatr Neurol 2010; 43:225-7. [PMID: 20691949 DOI: 10.1016/j.pediatrneurol.2010.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2010] [Revised: 03/31/2010] [Accepted: 04/26/2010] [Indexed: 11/18/2022]
Abstract
Cerebral venous sinus thrombosis is a relatively rare but serious condition, more commonly affecting children and pregnant women. It can be precipitated by dehydration. Despite the frequent coexistence of hemorrhage in venous infarcts of patients, clinical trials in adults recommended the use of anticoagulation. No randomized, clinical trials exist in the pediatric age group. Rarely, consumptive coagulopathy is reported to coexist with cerebral venous sinus thrombosis. We report on a child with venous sinus thrombosis and consumptive coagulopathy developing after routine tonsillectomy and its successful management with anticoagulation.
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Affiliation(s)
- Kinshuk Sahaya
- Department of Neurology, University of Missouri-Columbia, Columbia, Missouri 65212, USA.
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