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Ayub TH, Strizek B, Poetzsch B, Kosian P, Gembruch U, Merz WM. Placenta Accreta Spectrum Prophylactic Therapy for Hyperfibrinolysis with Tranexamic Acid. J Clin Med 2023; 13:135. [PMID: 38202142 PMCID: PMC10780074 DOI: 10.3390/jcm13010135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 12/18/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND To report on prophylactic therapy for hyperfibrinolysis with tranexamic acid (TXA) during expectant management (EM) in the placenta accreta spectrum (PAS). METHODS This is a monocentric retrospective study of women with PAS presenting at our hospital between 2005 and 2021. All data were retrospectively collected through the departmental database. RESULTS 35 patients with PAS were included. EM was planned in 25 patients prior to delivery. Complete absorption of the retained placenta was seen in two patients (8%). Curettage was performed in 14 patients (56%). A hysterectomy (HE) was needed in seven (28%) patients; 18 patients (72%) underwent uterus-preserving treatment without severe complications. The mean duration of EM was 107 days. The mean day of onset of hyperfibrinolysis and beginning of TXA treatment was day 45. The mean nadir of fibrinogen level before TXA was 242.4 mg/dL, with a mean drop of 29.7% in fibrinogen level. CONCLUSIONS Our data support EM as a safe treatment option in PAS. Hyperfibrinolysis can be a cause of hemorrhage during EM and can be treated with TXA. To our knowledge, this is the first cohort of patients with EM of PAS in whom coagulation monitoring and use of TXA have been shown to successfully treat hyperfibrinolysis.
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Affiliation(s)
- Tiyasha Hosne Ayub
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Brigitte Strizek
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Bernd Poetzsch
- Institute for Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Philipp Kosian
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Ulrich Gembruch
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Waltraut M. Merz
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
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2
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Shaikh N, Alhammad MF, Nahid S, Umm E A, Fatima I, Ummunnisa F, Yaqoub SA. Amniotic fluid embolism causing multiorgan embolisms and reinforces the need for point-of-care ultrasound. Qatar Med J 2023; 2023:13. [PMID: 37521090 PMCID: PMC10376761 DOI: 10.5339/qmj.2023.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 04/02/2023] [Indexed: 08/01/2023] Open
Abstract
INTRODUCTION Pregnant patients are at risk of several possible complications during the peripartum period. Amniotic fluid embolism (AFE) is a peripartum complication with high mortality and morbidity. The sudden entry of amniotic fluid into the maternal circulation causes a rapid and dramatic sequence of clinical events called AFE. The reported incidence of AFE after a cesarean section is around 19%, and after a normal delivery, it is 11%. AFE causing multiple embolisms is not reported in the literature, nor is the use of point-of-care ultrasound (POCUS) in the diagnosis of AFE. We report a case of AFE causing pulmonary and ovarian embolisms. CASE A 34-year-old pregnant lady had an elective lower section cesarean section (LSCS) for transverse lying and placenta previa under combined spinal and epidural anesthesia. She was gravida 3 para 2 and had regular antenatal check-ups, and she presented for her LSCS at 36 weeks of gestation. Immediately after delivery of the fetus, the patient had convulsions, cardiac arrest, and disseminated intravascular coagulopathy (DIC). Immediately, cardiopulmonary resuscitation started, and the team achieved a return of spontaneous circulation (ROSC) in 3 minutes. DIC was corrected with blood and blood products during this maneuver, and POCUS of the inferior vena cava and heart showed multiple small particles floating, thus confirming the diagnosis of AFE in this patient. The patient was transferred to the intensive care unit (ICU), intubated, and ventilated, necessitating a vasopressor infusion. Computed tomographic pulmonary angiography (CTPA) showed pulmonary embolism and ovarian vein embolism, which were managed with heparin infusion. She was hemodynamically stable and weaned from vasopressors, and the ventilator was then extubated on day 13 of ICU admission. She remained awake and in stable condition. The patient was transferred to the ward and subsequently discharged to go home on the 20th-day post-delivery. CONCLUSION AFE can be quickly diagnosed using clinical manifestations and POCUS, and it can be managed early for better patient outcomes. POCUS will show multiple smaller and a few larger amniotic fluid emboli in the heart and vena cava. These larger AFE emboli can migrate and cause multiple embolisms, requiring systemic anticoagulation.
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Affiliation(s)
- Nissar Shaikh
- Department of Anesthesia, ICU and Perioperative Medicine, Hamad Medical Corporation, Doha, Qatar. E-mail: ORCID ID: https://orcid.org/0000-0002-8241-7939
| | - Muhammad Fras Alhammad
- Department of Anesthesia, ICU and Perioperative Medicine, Hamad Medical Corporation, Doha, Qatar. E-mail: ORCID ID: https://orcid.org/0000-0002-8241-7939
| | - Seema Nahid
- Department of Anesthesia, ICU and Perioperative Medicine, Hamad Medical Corporation, Doha, Qatar. E-mail: ORCID ID: https://orcid.org/0000-0002-8241-7939
| | - Amara Umm E
- Apollo Medical College Hyderabad, Telangana, India
| | - Ifrah Fatima
- The University of Missouri-Kansas City (UMKC), Missouri, USA
| | | | - Slawa Abu Yaqoub
- Women's Wellness & Research Center, Hamad Medical Corporation, Doha, Qatar
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3
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Perry JC, Pindek RL, Sur A, Kc N, Zeibeq J. Alcohol Abuse as a Silent Risk Factor for Purpura Fulminans and the Importance of Pneumococcal Vaccination. Cureus 2023; 15:e39522. [PMID: 37378100 PMCID: PMC10292072 DOI: 10.7759/cureus.39522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2023] [Indexed: 06/29/2023] Open
Abstract
Purpura fulminans (PF) is a rare presentation of disseminated intravascular coagulopathy (DIC) and a life-threatening complication of septic shock. DIC can present with bleeding and thrombosis in acute settings, making its management exceptionally challenging. Common causative organisms include Neisseria meningitidis, Streptococcus pneumoniae, andHaemophilus influenzae. We report a case of a 47-year-old patient with a history of alcohol abuse and marijuana use with a bizarre presentation of copious diarrhea and altered mental status. The patient was subsequently admitted to the intensive care unit (ICU) for acute respiratory failure and septic shock secondary to Streptococcus pneumoniae bacteremia complicated by DIC. Unfortunately, the patient's condition worsened with multiorgan failure and purpura fulminans, leading to extensive necrosis of all his extremities, with the involvement of his lips, nose, and genitals. Unfortunately, despite aggressive interventions, he continued to deteriorate and ultimately was transitioned to comfort care before he expired. In the literature, there is only one reported case of PF in an individual with alcohol abuse. However, the frequency and severity of pneumococcal infections in individuals with a history of alcohol abuse are much higher than in the general population. PF is a devastating complication of Streptococcus pneumoniae, with a mortality of 43%. We hope that this case will continue highlighting the importance of vaccinating patients with a history of alcohol abuse with the pneumococcal vaccine.
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Affiliation(s)
- Jamal C Perry
- Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Rachel L Pindek
- Osteopathic Medicine, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, USA
| | - Avtar Sur
- Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Nabin Kc
- Critical Care Medicine, One Brooklyn Health System-Interfaith Medical Center, New York, USA
| | - John Zeibeq
- Pulmonary and Critical Care Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA
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4
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Hakobyan N, Ilerhunmwuwa N, Wasifuddin M, Tasnim A, Boris A. COVID-19-Associated Disseminated Intravascular Coagulopathy Presenting As Inferior ST-Segment Elevation Myocardial Infarction. Cureus 2023; 15:e39308. [PMID: 37346198 PMCID: PMC10281741 DOI: 10.7759/cureus.39308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2023] [Indexed: 06/23/2023] Open
Abstract
Disseminated intravascular coagulopathy (DIC) is infrequently associated with COVID-19 infection. COVID-19 infection can predispose to thrombotic events through inflammation and microvascular injury. DIC is rarely associated with coronary artery disease, especially myocardial infarction (MI). In this case report, we present an uncommon case of a patient with concurrent DIC and MI in the setting of COVID-19 infection. A 73-year-old male patient with no known cardiovascular risk factor presented with syncope. Assessment in the field by emergency medical service (EMS) showed the patient had a third-degree atrioventricular block and a heart rate of 40 beats per minute. He was given atropine and transcutaneously paced. Upon admission, he was found to have an inferior wall ST-elevation myocardial infarction (STEMI) and tested positive for COVID-19. Cardiac catheterization was performed urgently and revealed triple vessel disease. Attempts to revascularize the vessels were unsuccessful. He subsequently developed cardiogenic shock. He was started on multiple pressor support. Laboratory workup was suggestive of DIC, and he later developed multiorgan failure. Continuous renal replacement therapy was initiated but failed due to persistent thrombosis of the dialysis access. Despite all measures, the patient developed cardiac arrest and passed away on the third day of hospitalization. Our understanding of COVID-19 and its complications has grown exponentially since the beginning of the pandemic. The pro-inflammatory state induced by the disease creates a hypercoagulable state that may result in thrombotic complications, including MI. In severe cases, a consumptive coagulopathy may develop, leading to DIC. This unique case report seeks to highlight the importance of staying vigilant about the potential complications of MI and DIC induced by COVID-19 so that prompt diagnosis can be made to reduce morbidity and mortality in these patients.
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Affiliation(s)
- Narek Hakobyan
- Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA
| | | | - Mustafa Wasifuddin
- Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Anika Tasnim
- Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Avezbakiyev Boris
- Hematology/Oncology, Brookdale University Hospital Medical Center, Brooklyn, USA
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5
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Zaaqoq A, Sallam T, Merley C, Galloway LA, Desale S, Varghese J, Alnababteh M, Kriner E, Kitahara H, Shupp J, Dalton H, Molina E. The interplay of inflammation and coagulation in COVID-19 Patients receiving extracorporeal membrane oxygenation support. Perfusion 2023; 38:384-392. [PMID: 35000466 PMCID: PMC9931882 DOI: 10.1177/02676591211057506] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Bleeding and thrombosis are common complications during Extracorporeal Membrane Oxygenation (ECMO) support for COVID-19 patients. We sought to examine the relationship between inflammatory status, coagulation effects, and observed bleeding and thrombosis in patients receiving venovenous (VV) ECMO for COVID-19 respiratory failure. STUDY DESIGN Cross-sectional cohort study. SETTINGS Quaternary care institution. PATIENTS The study period from April 1, 2020, to January 1, 2021, we included all patients with confirmed COVID-19 who received VV ECMO support. INTERVENTION None. MEASUREMENTS AND MAIN RESULTS Thirty-two patients were supported with VV ECMO during the study period, and 17 patients (53%) survived to hospital discharge. The ECMO nonsurvivors mean lactate dehydrogenase (LDH) levels were markedly elevated in comparison to survivors (1046 u/L [IQR = 509, 1305] vs 489 u/L [385 658], p = 0.003). Platelet/fibrinogen dysfunction, as reflected by the low Maximum Amplitude (MA) on viscoelastic testing, was worse in nonsurvivors (65.25 mm [60.68, 67.67] vs 74.80 mm [73.10, 78.40], p = 0.01). Time-group interaction for the first seven days of ECMO support, showed significantly lower platelet count in the nonsurvivors (140 k/ul [103, 170] vs 189.5 k/ul [ 146, 315], p < 0.001) and higher D-dimer in (21 μg/mL [13, 21] vs 14 μg/mL [3, 21], p < 0.001) in comparison to the survivors. Finally, we found profound statistically significant correlations between the clinical markers of inflammation and markers of coagulation in the nonsurvivors group. The ECMO nonsurvivors experienced higher rate of bleeding (73.3% vs 35.3%, p = 0.03), digital ischemia (46.7% vs 11.8%, p = 0.02), acute renal failure (60% vs 11.8%, p = 0.01) and bloodstream infection (60% vs 23.5%, p = 0.03). CONCLUSION The correlation between inflammation and coagulation in the nonsurvivors supported with VV ECMO could indicate dysregulated inflammatory response and worse clinical outcomes.
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Affiliation(s)
- Akram Zaaqoq
- Department of Critical Care
Medicine, MedStar Washington Hospital
Center, Georgetown University, Washington, DC, USA,Department of Medicine, MedStar Washington Hospital
Center, Georgetown University, Washington, DC, USA,Akram Zaaqoq, MD Department of Critical
Care Medicine Georgetown University 110 Irving St NW, suite 4B65 Washington, DC
20010, USA. E-mail:
| | - Tariq Sallam
- Department of Medicine, MedStar Washington Hospital
Center, Georgetown University, Washington, DC, USA
| | - Caitlin Merley
- Department of Medicine, University of
Pennsylvania, Philadelphia, PA, USA
| | - Lan Anh Galloway
- Department of Urology, Vanderbilt University, Nashville, TN, USA
| | - Sameer Desale
- MedStar Health Research
Institute, Hyattsville, MD, USA
| | - Jobin Varghese
- Department of Medicine, MedStar Washington Hospital
Center, Georgetown University, Washington, DC, USA
| | - Muhtadi Alnababteh
- Department of Medicine, MedStar Washington Hospital
Center, Georgetown University, Washington, DC, USA
| | - Eric Kriner
- Department of Critical Care
Medicine, MedStar Washington Hospital
Center, Georgetown University, Washington, DC, USA
| | - Hiroto Kitahara
- Department of Cardiac Surgery, MedStar Washington Hospital
Center, Georgetown University, Washington, DC, USA
| | - Jeffrey Shupp
- Department of Biochemistry and
Molecular & Cellular Biology, MedStar Washington Hospital
Center, Georgetown University Medical Center, Washington, DC,
USA,Department of Surgery, MedStar Washington Hospital Center
and MedStar Georgetown University Hospital, Washington, DC, USA
| | - Heidi Dalton
- Department of Pediatrics, Inova Fairfax Hospital, Virginia, USA, USA
| | - Ezequiel Molina
- Department of Cardiac Surgery, MedStar Washington Hospital
Center, Georgetown University, Washington, DC, USA
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6
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Latona A, Hill K, Connelly A, Stuart K, Wood P. Prothrombinex®-VF in chronic liver disease: Friend or foe? Emerg Med Australas 2023; 35:89-96. [PMID: 35993256 PMCID: PMC10087488 DOI: 10.1111/1742-6723.14058] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 05/11/2022] [Accepted: 07/28/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Management of coagulopathy in chronic liver disease (CLD) poses a challenge for critical care physicians. Prothrombinex®-VF is a low-volume product with rapid onset of action. Evidence for its efficacy and safety in CLD is limited and cases of acute intravascular coagulation and fibrinolysis (AICF) and/or disseminated intravascular coagulation (DIC) have been reported. Our objective was to evaluate the role of Prothrombinex®-VF in reversal of coagulopathy and the incidence AICF/DIC, thromboembolic events and mortality. METHODS This was a retrospective, multi-centre study of Prothrombinex®-VF use in CLD across 11 hospitals over a 2-year period, excluding those on therapeutic anticoagulation. Patients were subclassified into acute on chronic liver failure (ACLF), acute decompensation (ADC) and compensated cirrhosis. Reversal of coagulopathy was defined as international normalised ratio (INR) <1.5× upper limit normal (ULN), prothrombin time <1.5× ULN, activated partial thromboplastin time <1.5× ULN and fibrinogen >1 g/L. Markers of AICF/DIC were recorded. RESULTS Thirty CLD patients were included, and the median model for end-stage liver disease score was 23.5. Acute bleeding was the most common indication for Prothrombinex®-VF (60%). All had baseline coagulopathy and the majority did not achieve reversal. Key indicators of AICF/DIC were mainly observed in those with ACLF; bleeding from mucosa or lines (53%), worsening hypofibrinogenaemia (60%), worsening thrombocytopaenia (60%). The ADC and compensated cirrhosis groups were relatively unaffected. Incidence of venous thromboembolism was 6%. Overall mortality was 43% and 70% in ACLF. CONCLUSION Prothrombinex®-VF did not lead to meaningful reversal of coagulopathy and should be used with caution in CLD. Patients with ACLF were more likely to develop AICF/DIC following Prothrombinex®-VF, although the association is uncertain. Further studies are needed to evaluate the safety and efficacy of Prothrombinex®-VF use in CLD.
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Affiliation(s)
- Akmez Latona
- Department of Emergency Medicine, Ipswich Hospital, Ipswich, Queensland, Australia.,Department of Emergency Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Department of Emergency Medicine, St Vincent's Private Hospital, Toowoomba, Queensland, Australia.,The University of Queensland, Brisbane, Queensland, Australia
| | - Kate Hill
- Department of Haematology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Griffith University, Brisbane, Queensland, Australia
| | - Aurelia Connelly
- Department of Emergency Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Katherine Stuart
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Peter Wood
- Department of Haematology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Department of Haematology, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, England
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7
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Tuculeanu G, Barbu EC, Lazar M, Chitu-Tisu CE, Moisa E, Negoita SI, Ion DA. Coagulation Disorders in Sepsis and COVID-19-Two Sides of the Same Coin? A Review of Inflammation-Coagulation Crosstalk in Bacterial Sepsis and COVID-19. J Clin Med 2023; 12. [PMID: 36675530 DOI: 10.3390/jcm12020601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/27/2022] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
Sepsis is a major cause of morbidity and mortality worldwide. Sepsis-associated coagulation disorders are involved in the pathogenesis of multiorgan failure and lead to a subsequently worsening prognosis. Alongside the global impact of the COVID-19 pandemic, a great number of research papers have focused on SARS-CoV-2 pathogenesis and treatment. Significant progress has been made in this regard and coagulation disturbances were once again found to underlie some of the most serious adverse outcomes of SARS-CoV-2 infection, such as acute lung injury and multiorgan dysfunction. In the attempt of untangling the mechanisms behind COVID-19-associated coagulopathy (CAC), a series of similarities with sepsis-induced coagulopathy (SIC) became apparent. Whether they are, in fact, the same disease has not been established yet. The clinical picture of CAC shows the unique feature of an initial phase of intravascular coagulation confined to the respiratory system. Only later on, patients can develop a clinically significant form of systemic coagulopathy, possibly with a consumptive pattern, but, unlike SIC, it is not a key feature. Deepening our understanding of CAC pathogenesis has to remain a major goal for the research community, in order to design and validate accurate definitions and classification criteria.
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8
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Čápová I, Salaj P, Hrachovinová I. Hereditary antithrombin deficiency in pregnancy - severe thrombophilic disorder as a danger for mother and foetus. Ceska Gynekol 2021; 86:175-182. [PMID: 34167310 DOI: 10.48095/cccg2021175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
SETTING In the article, we remember the role of antithrombin (AT) in hemostasis, escalation of AT-potential with heparin and difficulties with monitoring the effectiveness of LMWH therapy (low molecular weight heparin) in patients with AT deficiency. We pay most of our attention to hereditary AT deficiency and its thromboembolic risk in pregnancy. METHODS In the introduction, the principle of AT function, its two main domains and the regulation of synthesis are cleared. We describe the causal mutations of hereditary AT deficiency in SERPINC1 gen and the relation to a thromboembolic risk. The general recommendations for patients with hereditary AT deficiency and pregnant women are mentioned. As the risk of thromboembolic disease is escalated in pregnancy, the LMWH should always be considered. There has been frequently observed that patients with AT deficiency do not elevate anti-Xa-levels when standard prophylactic LMWH doses are used. This fact well illustrates that heparin without AT may not inhibit the active coagulant factors efficiently enough. Therefore, if a high thromboembolic risk in the patient’s anamnesis is present, the LMWH dosing should be escalated. In individual cases, concomitant administration of an antithrombin concentrate to the heparin treatment is recommended at the time of delivery or in the case of deep venous thrombosis. In this article, three cases of unusual pregnancy in patients with different types of AT deficiency are reported. The case reports are summarized from the Department of Hematology at Hospital Kolín, the Centre of Hemostasis and Thrombosis at Institute of Hematology and Blood Transfusion in Prague and from cooperating obstetrical departments in the Czech Republic. RESULTS We demonstrated the threat of hereditary AT deficiency in three case reports. In one case, the estimated risk of thromboembolism – type I of AT-deficiency (quantitative) – was in a good correlation with real peripartal complications. In the next two cases with different types of AT deficiency, we showed surprising courses of complicated pregnancies. CONCLUSION As it has been shown, it is not safe to estimate the risk of thromboembolism on the base of causal mutation for AT deficiency. For present clinical practice, we should still remember AT deficiency as a potentially very dangerous thromboembolic disorder for mother and fetus; thus, excellent cooperation of an obstetrician and a hematologist is necessary.
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9
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Abstract
Hemostatic derangement is a hallmark in severe COVID-19. Markedly elevation of D-dimer and fibrinogen degradation product levels were observed in patients with severe COVID-19 higher and 71.4% of nonsurvivors met the International Society of Thrombosis and Haemostasis criteria of disseminated intravascular coagulation (DIC). Although the clinical and epidemiological features of COVID-19 have been well-described, the underlying mechanism influencing disease severity remains to be elucidated. Herein, the aim of this review article is to evaluate hemostasis in the pathogenesis of COVID-19 and its role in the management of this unprecedented pandemic.
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Affiliation(s)
- Ka U Lio
- Medical student, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Parth Rali
- Division of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, Pennsylvania, USA
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10
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Fresa A, Autore F, Innocenti I, Piciocchi A, Tomasso A, Morelli F, Sorà F, Sica S, De Stefano V, Laurenti L. Non-overt disseminated intravascular coagulopathy associated with the first obinutuzumab administration in patients with chronic lymphocytic leukemia. Hematol Oncol 2021; 39:423-427. [PMID: 33462837 DOI: 10.1002/hon.2837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Infusion-related reactions are among the worst complications of obinutuzumab (G) administration and occur predominantly during the first infusion. We reported another adverse event related to the first G infusion, a subclinical coagulopathy. We retrospectively analyzed a cohort of 13 pts with chronic lymphocytic leukemia treated with a frontline G-chlorambucil regimen. Six pts developed non-overt disseminated intravascular coagulopathy (DIC) (46%) after the first administration of G. The coagulopathy was subclinical and self-limited in all pts, not requiring any intervention apart from the suspension of anticoagulant therapy in one pt. We observed a drop in the platelet count, an elevation of D-dimer levels, and an elongation of activated partial thromboplastin time. We found a significant difference in the platelet count between the pts with DIC and those withouts; in fact, all the six pts with non-overt DIC had a platelet count greater than 100 × 109 /L, while in the other group only one (p = 0.019). A trend towards a lower lymphocyte count and a higher CD20 expression was found in the pts with DIC. No other correlation between the DIC complication and the clinical or laboratory characteristics of the patients was found. The pathogenesis of the G-related non-overt DIC could be related to the consumption of the platelets after the lysis of lymphocytes, probably triggered by the damage associated molecular patterns. Despite its limitations, this study describes a new adverse event and identifies a specific subgroup of patients whose clinical management at the time of the infusion of G may need to be refined.
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Affiliation(s)
- Alberto Fresa
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Autore
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Idanna Innocenti
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Annamaria Tomasso
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesca Morelli
- Haematology Unit, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | - Federica Sorà
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy.,Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Simona Sica
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy.,Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Valerio De Stefano
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy.,Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luca Laurenti
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy.,Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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11
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Iida Y, Asano R, Hachiya T. Successful treatment of chronic type B aortic dissection complicated by disseminated intravascular coagulopathy with recombinant human soluble thrombomodulin after thoracic endovascular aortic repair. Vascular 2021; 30:38-41. [PMID: 33522457 DOI: 10.1177/1708538121990123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES We report a case of successful thoracic endovascular aortic repair (TEVAR) of chronic type B aortic dissection complicated by disseminated intravascular coagulopathy. METHODS The patient suffered from chronic type B aortic dissection coexisting with a large false lumen and an intimal tear. He underwent TEVAR with left common carotid-left subclavian artery bypass. RESULTS The following day, the patient exhibited a bleeding tendency and marked subcutaneous hemorrhage. He had a low fibrinogen level, a low platelet count, and high levels of fibrin dimer product and D-dimer. We diagnosed the condition as disseminated intravascular coagulopathy and administered recombinant human soluble thrombomodulin (rhTM). The patient recovered successfully from disseminated intravascular coagulopathy and was discharged on postoperative day 6. CONCLUSIONS We successfully treated a patient with chronic type B aortic dissection with a large intimal tear complicated by postoperative disseminated intravascular coagulopathy using TEVAR followed by rhTM administration. rhTM may be considered in patients with large intimal tear and false lumen.
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Affiliation(s)
- Yasunori Iida
- Department of Cardiovascular Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Ryota Asano
- Department of Cardiovascular Surgery, Ogikubo Hospital, Tokyo, Japan
| | - Takashi Hachiya
- Department of Cardiovascular Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
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12
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Jawaid T, Gangat N, Weister T, Kashyap R. An Electronic Search Algorithm for Early Disseminated Intravascular Coagulopathy Diagnosis in the Intensive Care Unit: A Derivation and Validation Study. Cureus 2020; 12:e10972. [PMID: 33209530 PMCID: PMC7667609 DOI: 10.7759/cureus.10972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Aim: We aim to create and validate an electronic search algorithm for accurate detection of disseminated intravascular coagulopathy (DIC) from medical records. Methods: Patients with DIC in Mayo Clinic’s intensive care units (ICUs) from Jan 1, 2007, to May 4, 2018, were included in the study. An algorithm was developed based on clinical notes and ICD diagnosis codes. A cohort of 50 patients was included with DIC diagnosis, its variations, and no diagnosis of DIC. Then, the next set of 50 patients was used to refine the algorithm. Results were compared with a manual reviewer and the disagreements were resolved by the third reviewer. The same process was repeated with 'revised clinical note search' for the first and second derivation cohort with additional exclusion terms. The obtained sensitivity and specificity were reported. The generated algorithm was applied to another set of 50 patients for validation. Results: In the first derivation cohort- DIC search by clinical notes and diagnosis codes had 92% sensitivity and 100% specificity. Sensitivity dropped to 71% in the second cohort although specificity remains the same. Therefore, the algorithm was refined to clinical notes search only. The revised search was reapplied to first and second derivation cohorts and results obtained for the first derivation were the same but 91.3% sensitive and 100% specific for the second derivation. The search was locked and applied in the validation cohort with 95.8% sensitivity and 100% specificity, respectively. Conclusion: The revised clinical note based electronic search algorithm was found to be highly sensitive and specific for DIC during the corresponding ICU duration.
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13
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Schizas N, Salem A, Lama N, Leventi E, Argiriou M, Patris V. Delayed disseminated intravascular coagulopathy post thoracic endovascular aortic repair (TEVAR). J Card Surg 2020; 35:3610-3613. [PMID: 33032361 DOI: 10.1111/jocs.15057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 09/08/2020] [Accepted: 09/10/2020] [Indexed: 11/30/2022]
Abstract
Disseminated intravascular coagulopathy (DIC) is a very rare outcome post endovascular repair of aortic aneurysm dissections. We present a case of a 70-year-old male who presented with DIC post a thoracic endovascular aortic repair (TEVAR) procedure due to a type 1A endoleak. Initially, the patient was treated with red blood cells and blood products; however, when failing to improve, he underwent a hybrid arch replacement. In this study, we will analyze the management of DIC post TEVAR and look at its presentation more extensively, as it is currently a topic that is poorly studied.
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Affiliation(s)
- Nikolaos Schizas
- Department of Cardiothoracic and Vascular Surgery, Evangelismos General Hospital, Athens, Greece
| | - Agni Salem
- Department of Cardiovascular Surgery, Heart and Chest Surgery Hospital, Liverpool, UK
| | - Niki Lama
- Research Unit of Radiology and Medical Imaging, Kapodistrian University of Athens, Athens, Greece
| | - Eleni Leventi
- Department of Anesthesiology, Evangelismos General Hospital, Athens, Greece
| | - Michail Argiriou
- Department of Cardiothoracic and Vascular Surgery, Evangelismos General Hospital, Athens, Greece
| | - Vasilios Patris
- Department of Cardiothoracic and Vascular Surgery, Evangelismos General Hospital, Athens, Greece
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14
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Vlachodimitropoulou Koumoutsea E, Vivanti AJ, Shehata N, Benachi A, Le Gouez A, Desconclois C, Whittle W, Snelgrove J, Malinowski AK. COVID-19 and acute coagulopathy in pregnancy. J Thromb Haemost 2020; 18:1648-1652. [PMID: 32302459 PMCID: PMC9770955 DOI: 10.1111/jth.14856] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/14/2020] [Indexed: 01/17/2023]
Abstract
We present a putative link between maternal COVID-19 infection in the peripartum period and rapid maternal deterioration with early organ dysfunction and coagulopathy. The current pandemic with SARS-CoV-2 has already resulted in high numbers of critically ill patients and deaths in the non-pregnant population, mainly due to respiratory failure. During viral outbreaks, pregnancy poses a uniquely increased risk to women due to changes to immune function, alongside physiological adaptive alterations, such as increased oxygen consumption and edema of the respiratory tract. The laboratory derangements may be reminiscent of HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome, and thus knowledge of the COVID-19 relationship is paramount for appropriate diagnosis and management. In addition to routine measurements of D-dimers, prothrombin time, and platelet count in all patients presenting with COVID-19 as per International Society on Thrombosis and Haemostasis (ISTH) guidance, monitoring of activated partial thromboplastin time (APTT) and fibrinogen levels should be considered in pregnancy, as highlighted in this report. These investigations in SARS-CoV-2-positive pregnant women are vital, as their derangement may signal a more severe COVID-19 infection, and may warrant pre-emptive admission and consideration of delivery to achieve maternal stabilization.
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MESH Headings
- Adult
- Betacoronavirus/pathogenicity
- Blood Coagulation
- Blood Coagulation Tests
- COVID-19
- COVID-19 Testing
- Clinical Laboratory Techniques
- Coronavirus Infections/blood
- Coronavirus Infections/diagnosis
- Coronavirus Infections/virology
- Disseminated Intravascular Coagulation/blood
- Disseminated Intravascular Coagulation/diagnosis
- Disseminated Intravascular Coagulation/therapy
- Disseminated Intravascular Coagulation/virology
- Female
- Host-Pathogen Interactions
- Humans
- Pandemics
- Pneumonia, Viral/blood
- Pneumonia, Viral/diagnosis
- Pneumonia, Viral/virology
- Pregnancy
- Pregnancy Complications, Hematologic/blood
- Pregnancy Complications, Hematologic/diagnosis
- Pregnancy Complications, Hematologic/therapy
- Pregnancy Complications, Hematologic/virology
- Pregnancy Complications, Infectious/blood
- Pregnancy Complications, Infectious/diagnosis
- Pregnancy Complications, Infectious/therapy
- Pregnancy Complications, Infectious/virology
- Pregnancy Trimester, Third/blood
- SARS-CoV-2
- Treatment Outcome
- Young Adult
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Affiliation(s)
- Evangelia Vlachodimitropoulou Koumoutsea
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
- Division of Hematology, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Alexandre J Vivanti
- Department of Obstetrics and Gynecology, Antoine-Béclère Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Saclay, Clamart, France
| | - Nadine Shehata
- Division of Hematology, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Alexandra Benachi
- Department of Obstetrics and Gynecology, Antoine-Béclère Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Saclay, Clamart, France
| | - Agnes Le Gouez
- Anaesthesia and Critical Care Department, Antoine-Béclère Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Saclay, Clamart, France
| | - Celine Desconclois
- Biological Hematology, Antoine-Béclère Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Saclay, Clamart, France
| | - Wendy Whittle
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - John Snelgrove
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Ann Kinga Malinowski
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
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15
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Stafford IA, Moaddab A, Dildy GA, Klassen M, Berra A, Watters C, Belfort MA, Romero R, Clark SL. Amniotic fluid embolism syndrome: analysis of the Unites States International Registry. Am J Obstet Gynecol MFM 2020; 2:100083. [PMID: 33345954 PMCID: PMC8500673 DOI: 10.1016/j.ajogmf.2019.100083] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 12/20/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Incidence, risk factors, and perinatal morbidity and mortality rates related to amniotic fluid embolism remain a challenge to evaluate, given the presence of differing international diagnostic criteria, the lack of a gold standard diagnostic test, and a significant overlap with other causes of obstetric morbidity and mortality. OBJECTIVE The aims of this study were (1) to analyze the clinical features and outcomes of women using the largest United States-based contemporary international amniotic fluid embolism registry, and (2) to investigate differences in demographic and obstetric variables, clinical presentation, and outcomes between women with typical versus atypical amniotic fluid embolism, using previously published and validated criteria for the research reporting of amniotic fluid embolism. MATERIALS AND METHODS The AFE Registry is an international database established at Baylor College of Medicine (Houston, TX) in partnership with the Amniotic Fluid Embolism Foundation (Vista, CA) and the Perinatology Research Branch of the Division of Intramural Research of the NICHD/NIH/DHHS (Detroit, MI). Charts submitted to the registry between August 2013 and September 2017 were reviewed, and cases were categorized into typical, atypical, non-amniotic fluid embolism, and indeterminate, using the previously published and validated criteria for the research reporting of AFE. Demographic and clinical variables, as well as outcomes for patients with typical and atypical AFE, were recorded and compared. Student t tests, χ2 tests, and analysis of variance tables were used to compare the groups, as appropriate, using SAS/STAT software, version 9.4. RESULTS A total of 129 charts were available for review. Of these, 46% (59/129) represented typical amniotic fluid embolism and 12% (15/129) atypical amniotic fluid embolism, 21% (27/129) were non-amniotic fluid embolism cases with a clear alternative diagnosis, and 22% (28/129) had an uncertain diagnosis. Of the 27 women misclassified as an amniotic fluid embolism with an alternative diagnosis, the most common actual diagnosis was hypovolemic shock secondary to postpartum hemorrhage. Ten percent (6/59) of the women with typical amniotic fluid embolism had a pregnancy complicated by placenta previa, and 8% (5/61) had undergone in vitro fertilization to achieve pregnancy. In all, 66% (49/74) of the women with amniotic fluid embolism reported a history of atopy or latex, medication, or food allergy, compared to 34% of the obstetric population delivered at our hospital over the study period (P < .05). CONCLUSION Our data represent a series of women with amniotic fluid embolism whose diagnosis has been validated by detailed chart review, using recently published and validated criteria for research reporting of amniotic fluid embolism. Although no definitive risk factors were identified, a high rate of placenta previa, reported allergy, and conceptions achieved through in vitro fertilization was observed.
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Affiliation(s)
- Irene A Stafford
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, Houston, TX.
| | - Amirhossein Moaddab
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, Houston, TX
| | - Gary A Dildy
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, Houston, TX
| | | | - Alexandra Berra
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, Houston, TX
| | - Christine Watters
- Biostatistics Program, School of Public Health, LSU Health, New Orleans, LA
| | - Michael A Belfort
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, Houston, TX
| | - Roberto Romero
- Perinatology Research Branch, Program for Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, University of Michigan Health System, Ann Arbor, MI; Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI; Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI; Detroit Medical Center, Detroit, MI; Department of Obstetrics and Gynecology, Florida International University, Miami, FL
| | - Steven L Clark
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, Houston, TX
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16
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Jeon YJ, Kim JW, Park S, Shin DW. Risk factor, monitoring, and treatment for snakebite induced coagulopathy: a multicenter retrospective study. Acute Crit Care 2019; 34:269-275. [PMID: 31743633 PMCID: PMC6895465 DOI: 10.4266/acc.2019.00591] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 08/28/2019] [Indexed: 12/28/2022] Open
Abstract
Background Snakebite can cause various complications, including coagulopathy. The clinical features of snakebite-associated coagulopathy differ from those of disseminated intravascular coagulation (DIC) caused by other diseases and its treatment is controversial. Methods We retrospectively reviewed the medical records of patients hospitalized for snakebite between January 2006 and September 2018. Results A total of 226 patients were hospitalized due to snakebite. Their median hospital stay was 4.0 days (interquartile range, 2.0 to 7.0 days). Five patients arrived at hospital with shock and one patient died. Twenty-one patients had overt DIC according to the International Society of Thrombosis and Hemostasis scoring system. Two patients developed major bleeding complications. Initial lower cholesterol level at presentation was associated with the development of overt DIC. International normalization ratio (INR) exceeding the laboratory’s measurement limit was recorded as late as 4 to 5 days after the bite. Higher antivenom doses (≥18,000 units) and transfusion of fresh frozen plasma (FFP) or cryoprecipitate did not affect prolonged INR duration or hospital stay in the overt DIC patients without bleeding. Conclusions Initial lower cholesterol level may be a risk factor for overt DIC following snakebite. Although patients lack apparent symptoms, the risk of coagulopathy should be assessed for at least 4 to 5 days following snakebite. Higher antivenom doses and transfusion of FFP or cryoprecipitate may be unbeneficial for coagulopathic patients without bleeding.
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Affiliation(s)
- Yong Jun Jeon
- Department of Surgery, Chinjujeil Hospital, Jinju, Korea
| | - Jong Wan Kim
- Department of Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - SungGil Park
- Department of Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Dong Woo Shin
- Department of Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
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17
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Ichiki T, Kohda F, Hiramatsu T, Saiki R, Sakai A, Furue M. Early pathology in venom-induced consumption coagulopathy by Rhabdophis tigrinus (Yamakagashi snake) envenomation. Clin Toxicol (Phila) 2019; 57:668-671. [PMID: 30689439 DOI: 10.1080/15563650.2018.1540045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: Rhabdophis tigrinus (Yamakagashi in Japanese) is a venomous non-front-fanged colubroid snake capable of inflicting envenoming with life-threatening defibrinating coagulopathy. However, because of the uncommon incidence of bites and tendency for late development of symptoms/signs, the early effects of the venom on the coagulation system are poorly known. Case report: We describe a boy bitten by a wild R. tigrinus and report his clinical course starting at 30 min after the bite. Results: At 30 min after envenomation, only the thrombin-antithrombin complex (TAT) level was elevated. At 90 min after envenomation, laboratory data revealed a prolonged activated partial thromboplastin time (APTT) and increased prothrombin time international normalized ratio (PT-INR) with elevated fibrinogen degeneration product (FDP). At 5.5 h after envenomation, APTT and PT-INR increased beyond a measurable range, and fibrinogen levels dropped below the detection limit. We administered recombinant human soluble thrombomodulin and antivenom prepared against R. tigrinus antivenom. Venom-induced consumption coagulopathy (VICC), which is sometimes reported as disseminated intravascular coagulation (DIC), subsequently improved rapidly. Discussion: We found that TAT is the earliest marker to detect R. tigrinus envenomation and subsequent VICC occurrence. Although rTM was effective in this case, further studies are necessary to prove its safety and efficacy.
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Affiliation(s)
- Toshio Ichiki
- a Department of Dermatology , Aso Iizuka Hospital , Iizuka , Japan
| | - Futoshi Kohda
- a Department of Dermatology , Aso Iizuka Hospital , Iizuka , Japan
| | - Toshiki Hiramatsu
- b Department of Intensive Care Medicine , Aso Iizuka Hospital , Iizuka , Japan
| | - Reo Saiki
- c Department of Paediatrics , Aso Iizuka hospital , Iizuka , Japan
| | | | - Masutaka Furue
- e Department of Dermatology, Graduate School of Medical Science , Kyushu University , Fukuoka , Japan
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18
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Hatzl S, Uhl B, Hinterramskogler M, Leber S, Eisner F, Haring M, Jud P. Acute myeloid leukemia with severe coagulation disorder and concomitant central nervous system bleeding - a clinical diagnostic case report. EJIFCC 2018; 29:146-151. [PMID: 30050398 PMCID: PMC6053813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
We report a case of severe central nervous system bleeding in a patient with acute monocytic leukemia. The patient was admitted to our emergency department because of massive back pain and positive meningeal signs. MR imaging yielded a spontaneous epidural hematoma of the thoracic vertebral column. Coagulation studies revealed fibrinogen levels below the linear measuring range and blood smears showed myeloid blast cells in the peripheral blood. The diagnosis of acute monocytic leukemia was confirmed by flow cytometric analysis. Despite of substitution with more than 12 g fibrinogen per day over 3 days plasma fibrinogen levels couldn't be stabilized. After starting the induction chemotherapy with cytarabine, laboratory coagulation test results were improved. Despite all intensive medical efforts, the patient died due to cerebral epidural hematoma.
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Affiliation(s)
- S. Hatzl
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Austria,Corresponding author: Stefan Hatzl Division of Hematology Department of Internal Medicine Medical University of Graz Austria E-mail:
| | - B. Uhl
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Austria
| | - M. Hinterramskogler
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Austria
| | - S. Leber
- Department of Radiology, Medical University of Graz, Austria
| | - F. Eisner
- Intensive Care Unit, Department of Internal Medicine, Medical University of Graz, Austria
| | - M. Haring
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Austria
| | - P. Jud
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Austria
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19
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Chen W, He Y, Su Y. Multifocal cerebral infarction as the first manifestation of occult malignancy: Case series of trousseau's syndrome and literature review. Brain Circ 2018; 4:65-72. [PMID: 30276339 PMCID: PMC6126242 DOI: 10.4103/bc.bc_1_18] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 04/22/2018] [Accepted: 05/09/2018] [Indexed: 12/21/2022] Open
Abstract
Ischemic stroke as an initial presentation of malignancy is extremely rare and the underlying etiology is often ignored. The aim of this study is to outline the clues to occult malignancy in patients presenting with cerebral infarction initially. The clinical characteristics of total 19 patients with Trousseau's Syndrome presenting with cerebral infarction initially were analyzed. Among those patients, no conventional vascular risk factors were detected in 68% (13/19) of patients, and infarction occurring in multiple vascular distributions was found in 84% (16/19). Blood test showed thrombophilia in 79% (15/19) of patients with significantly elevated D-dimer, disseminated intravascular coagulopathy (DIC) in 59% (11/19), and elevated levels of tumor makers in 47% (9/19). The prognosis of the 19 patients was poor, with 68% (13/19) of patients undergoing a relapse of stroke in short interval, and 84% (16/19) being reportedly to die in 6 months. In patients, who developed unexplained recurrent brain infarction involving multiple arterial territory, with laboratory evidence suggesting hypercoagulability (higher level of D-dimer, or DIC), Trousseau's Syndrome should be considered, and investigation for an occult malignancy was required.
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Affiliation(s)
- Weibi Chen
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yanbo He
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Department of Neurology, The Beijing Moslem People Hospital, Beijing, China
| | - Yingying Su
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
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20
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Koizumi K, Hoshiai M, Toda T, Nakane T, Sugita K. Marked pleural effusion after i.v. immunoglobulin therapy for Kawasaki disease. Pediatr Int 2018; 60:307-308. [PMID: 29480538 DOI: 10.1111/ped.13489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 08/25/2017] [Accepted: 12/11/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Keiichi Koizumi
- Department of Pediatrics, Graduate School of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Minako Hoshiai
- Department of Pediatrics, Graduate School of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Takako Toda
- Department of Pediatrics, Graduate School of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Takaya Nakane
- Department of Pediatrics, Graduate School of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Kanji Sugita
- Department of Pediatrics, Graduate School of Medicine, University of Yamanashi, Yamanashi, Japan
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21
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Ando T, Akiyama D, Okada H, Date K, Furukawa H, Takeda M. Helicobacter pylori Eradication Therapy for Thrombocytopenia after Surgery for Abdominal Aortic Aneurysm with Disseminated Intravascular Coagulation. Ann Vasc Dis 2016; 9:334-337. [PMID: 28018509 DOI: 10.3400/avd.cr.16-00081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 09/08/2016] [Indexed: 11/13/2022] Open
Abstract
Abdominal aortic aneurysm (AAA) is known to be rarely accompanied by disseminated intravascular coagulation (DIC). We report a case of AAA with DIC. An 81-year-old man with abdominal pain referred to our hospital. Computed tomography demonstrated an AAA (maximum diameter: 90 mm). The patient underwent a laparotomy, and an abdominal aorta replacement was performed. At the 3-month follow-up, the patient underwent Helicobacter pylori eradication treatment for 1 week. After treatment, the platelet count dramatically increased. The mechanism by which H. pylori eradication therapy improves hematological parameters has not been elucidated; however, this noninvasive treatment effectively resolved DIC associated with AAA.
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Affiliation(s)
- Takashi Ando
- Department of Cardiovascular Surgery, Yokohama Rosai Hospital, Yokohama, Kanagawa, Japan
| | - Daichi Akiyama
- Department of Cardiovascular Surgery, Yokohama Rosai Hospital, Yokohama, Kanagawa, Japan
| | - Hiroshi Okada
- Department of Cardiovascular Surgery, Yokohama Rosai Hospital, Yokohama, Kanagawa, Japan
| | - Kazuma Date
- Department of Cardiovascular Surgery, Yokohama Rosai Hospital, Yokohama, Kanagawa, Japan
| | - Hiroshi Furukawa
- Department of Cardiovascular Surgery, Yokohama Rosai Hospital, Yokohama, Kanagawa, Japan
| | - Makoto Takeda
- Department of Cardiovascular Surgery, Yokohama Rosai Hospital, Yokohama, Kanagawa, Japan
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22
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Hasegawa A, Murakoshi T, Otsuki Y, Torii Y. Clinical course of disseminated intravascular coagulopathy-type amniotic fluid embolism: A report of three cases. J Obstet Gynaecol Res 2016; 42:1881-1885. [PMID: 27650060 DOI: 10.1111/jog.13142] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 06/26/2016] [Accepted: 07/17/2016] [Indexed: 11/26/2022]
Abstract
Amniotic fluid embolism (AFE) is a rare complication of pregnancy and its mortality rate is high. There have been few reports of AFE with presence of severe coagulopathy and incoagulable bleeding, and absence of cardiopulmonary symptoms or limited cardiopulmonary symptoms, followed by massive blood loss during delivery. Such cases have been referred to as disseminated intravascular coagulopathy-type AFE, and the characteristics of this condition have been presented previously. Here we report three cases that fulfilled the diagnostic characteristics of disseminated intravascular coagulopathy-type AFE.
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Affiliation(s)
- Akihiro Hasegawa
- Division of Perinatology, Fetal Diagnosis and Therapy, Maternal and Perinatal Care Center, Shizuoka, Japan
| | - Takeshi Murakoshi
- Division of Perinatology, Fetal Diagnosis and Therapy, Maternal and Perinatal Care Center, Shizuoka, Japan
| | - Yoshiro Otsuki
- Department of Pathology, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Yuichi Torii
- Division of Perinatology, Fetal Diagnosis and Therapy, Maternal and Perinatal Care Center, Shizuoka, Japan
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23
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Sarcon A, Liu X, Ton D, Haywood J, Hitchcock T. Advanced Congestive Heart Failure Associated With Disseminated Intravascular Coagulopathy. J Investig Med High Impact Case Rep 2016; 3:2324709615623298. [PMID: 26788528 PMCID: PMC4710112 DOI: 10.1177/2324709615623298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 11/23/2015] [Indexed: 12/16/2022] Open
Abstract
Background. Disseminated intravascular coagulopathy (DIC) is a complication of an underlying disease and not a primary illness. It is most commonly associated with sepsis, trauma, obstetrical complications, and malignancies. There are very few cases in the literature illustrating the association between DIC and congestive heart failure. Findings. In this report, we present a case of severe congestive heart failure, leading to biventricular thrombi and subsequently DIC. Conclusion. We suggest that the association between congestive heart failure and DIC is an underrecognized one. Congestive heart failure continues to remain a major cause of morbidity and mortality despite advances in medical therapies. Thus far, the precise role of coagulation factors in congestive heart failure is unknown. Further investigations are needed to elucidate the pathophysiology of congestive heart failure and coagulation factors.
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Affiliation(s)
| | - Xiaoli Liu
- Scripps Green Hospital, La Jolla, CA, USA
| | - David Ton
- Scripps Green Hospital, La Jolla, CA, USA
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24
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Başaranoğlu S, Sıddık Evsen M, Ağaçayak E, Tunç SY, Yılmaz Z, Yıldırım Y, Deregözü A, Sak ME, Yıldırım ZB, Kavak GÖ, Gül T. Evaluation of obstetrical patients with disseminated intravascular coagulopathy - tertiary center experience. J Matern Fetal Neonatal Med 2015; 29:2929-33. [PMID: 26513693 DOI: 10.3109/14767058.2015.1108403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The purpose of the present study is twofold: (a) to investigate the etiology of disseminated intravascular coagulopathy (DIC) caused by obstetrical conditions and (b) to present parameters that can be used in predicting DIC-related mortality in obstetrical patients. MATERIAL AND METHOD Obstetrical patients who had a delivery at or were referred (after delivery) to Obstetrics and Gynecology Clinic of Dicle University between July 2006 and December 2013 were retrospectively analyzed in this study. Those patients diagnosed with DIC were included in the study. RESULTS Fifty-six obstetrical patients carrying the diagnosis of DIC were included in this study. The overall mortality rate was 25% among these patients. More specifically, the mortality rate was 10.7% among patients with a DIC score ≤5 and 40.7% among those with a DIC score > 5. Multiple logistic regression analysis resulted in the finding that international normalized ratio (INR) and urea were among those factors affecting mortality in obstetrical DIC [OR: 8.44 (CI: 1.9-36.8), OR: 1.05 (CI: 1.0-1.1), respectively]. CONCLUSION DIC is a syndrome that might be caused by obstetrical conditions. It is associated with high mortality and morbidity rates. In obstetrical DIC, urea is the most important factor affecting mortality. In addition, we are of the opinion that DIC score might guide mortality predictions as a determinant of prognosis.
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Affiliation(s)
- Serdar Başaranoğlu
- a Department of Obstetrics and Gynecology , School of Medicine, Fatih University , Istanbul , Turkey
| | - Mehmet Sıddık Evsen
- b Department of Obstetrics and Gynecology , School of Medicine, Dicle University , Diyarbakir , Turkey
| | - Elif Ağaçayak
- b Department of Obstetrics and Gynecology , School of Medicine, Dicle University , Diyarbakir , Turkey
| | - Senem Yaman Tunç
- b Department of Obstetrics and Gynecology , School of Medicine, Dicle University , Diyarbakir , Turkey
| | - Zülfikar Yılmaz
- c Department of Nephrology , School of Medicine, Dicle University , Diyarbakir , Turkey , and
| | - Yaşar Yıldırım
- c Department of Nephrology , School of Medicine, Dicle University , Diyarbakir , Turkey , and
| | - Avşeqüi Deregözü
- a Department of Obstetrics and Gynecology , School of Medicine, Fatih University , Istanbul , Turkey
| | - Muhammet Erdal Sak
- b Department of Obstetrics and Gynecology , School of Medicine, Dicle University , Diyarbakir , Turkey
| | - Zeynep Baysal Yıldırım
- d Department of Anesthesiology , School of Medicine, Dicle University , Diyarbakir , Turkey
| | - Gönül Ölmez Kavak
- d Department of Anesthesiology , School of Medicine, Dicle University , Diyarbakir , Turkey
| | - Talip Gül
- b Department of Obstetrics and Gynecology , School of Medicine, Dicle University , Diyarbakir , Turkey
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25
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Todo Y, Tamura N, Itoh H, Ikeda T, Kanayama N. Therapeutic application of C1 esterase inhibitor concentrate for clinical amniotic fluid embolism: a case report. Clin Case Rep 2015; 3:673-5. [PMID: 26273468 PMCID: PMC4527822 DOI: 10.1002/ccr3.316] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 04/06/2015] [Accepted: 05/21/2015] [Indexed: 11/11/2022] Open
Abstract
We present the successful application of C1 esterase inhibitor (C1INH) concentrate to a patient with clinical amniotic fluid embolism (AFE).
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Affiliation(s)
- Yusuke Todo
- Department of Obstetrics & Gynaecology, Hamamatsu University School of Medicine Hamamatsu, Shizuoka, Japan
| | - Naoaki Tamura
- Department of Obstetrics & Gynaecology, Hamamatsu University School of Medicine Hamamatsu, Shizuoka, Japan
| | - Hiroaki Itoh
- Department of Obstetrics & Gynaecology, Hamamatsu University School of Medicine Hamamatsu, Shizuoka, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics & Gynaecology, Mie University School Mie, Japan
| | - Naohiro Kanayama
- Department of Obstetrics & Gynaecology, Hamamatsu University School of Medicine Hamamatsu, Shizuoka, Japan
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26
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Abstract
Thrombotic microangiopathy (TMA) is a complication that can develop directly from certain malignancies, but more often results from anticancer therapy. Currently, the incidence of cancer drug-induced TMA during the last few decades is >15%, primarily due to the introduction of anti-vascular endothelial growth factor (VEGF) agents. It is important for clinicians to understand the potential causes of cancer drug-induced TMA to facilitate successful diagnosis and treatment. In general, cancer drug-induced TMA can be classified into 2 types. Type I cancer drug-induced TMA includes chemotherapy regimens (ie, mitomycin C) that can potentially promote long-term kidney injury, as well as increased morbidity and mortality. Type II cancer drug-induced TMA includes anti-VEGF agents that are not typically associated with cumulative dose-dependent cell damage. In addition, functional recovery of kidney function often occurs after drug interruption, assuming a type I agent was not given prior to or during therapy. There are no randomized controlled trials to provide physician guidance in the management of TMA. However, previously accumulated information and research suggest that endothelial cell damage has an underlying immunologic basis. Based on this, the emerging trend includes the use of immunosuppressive agents if a refractory or relapsing clinical course that does not respond to plasmapheresis and steroids is observed.
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Affiliation(s)
- Hassan Izzedine
- Department of Nephrology, Monceau Park International Clinic, Paris, France.
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27
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Kinoshita T, Takeshita N, Takashima A, Yasuda Y, Ishida H, Manrai M. A Case of Life-threatening Obstetrical Hemorrhage Secondary to Placental Abruption at 17 Weeks of Gestation. Clin Pract 2014; 4:605. [PMID: 24847429 PMCID: PMC4019918 DOI: 10.4081/cp.2014.605] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 01/29/2014] [Accepted: 03/24/2014] [Indexed: 11/22/2022] Open
Abstract
A 40-year old woman, gravida 4, para 4, presented with sudden lower abdominal pain and severe vaginal bleeding at 17 weeks of gestation. Clinical symptoms and ultrasonographic finding revealed placental abruption. The volume of bleeding was heavy and led to disseminated intravascular coagulation and hypovolemic shock. We performed blood transfusion and therapy to treat the critical condition. However, the mother’s condition continued to worsen. Therefore, we performed a hysterotomy and aborted the pregnancy to save the mother. Since heavy bleeding caused by placental abruption leading to a life-threatening condition for a mother before the 20 weeks of gestation is very rare, the present case is an important case study.
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Affiliation(s)
- Toshihiko Kinoshita
- Department of Obstetrics and Gynecology, Toho University Medical Center, Sakura Hospital , Chiba, Japan
| | - Naoki Takeshita
- Department of Obstetrics and Gynecology, Toho University Medical Center, Sakura Hospital , Chiba, Japan
| | - Akiko Takashima
- Department of Obstetrics and Gynecology, Toho University Medical Center, Sakura Hospital , Chiba, Japan
| | - Yutaka Yasuda
- Department of Obstetrics and Gynecology, Toho University Medical Center, Sakura Hospital , Chiba, Japan
| | - Hiroaki Ishida
- Department of Obstetrics and Gynecology, Toho University Medical Center, Sakura Hospital , Chiba, Japan
| | - Megumi Manrai
- Department of Obstetrics and Gynecology, Toho University Medical Center, Sakura Hospital , Chiba, Japan
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28
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Yazdi MF, Malekzadeh G. Search for a cause of disseminated intravascular coagulopathy resulted in finding metastatic prostate cancer. Cent European J Urol 2014; 66:172-6. [PMID: 24579022 PMCID: PMC3936144 DOI: 10.5173/ceju.2013.02.art16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 01/28/2013] [Accepted: 03/23/2013] [Indexed: 11/24/2022] Open
Abstract
Disseminated intravascular coagulopathy (DIC) is an acquired disease that occurs secondary to a variety of underlying conditions including solid tumors. Prostate cancer (PCa) is one of these tumors and DIC is the most prevalent coagulopathy related to PCa, but it is rarely reported as the first manifestation of it. This paper is a report of an 85–year–old man who presented with hematuria and vast ecchymoses. Thorough work–up resulted in finding metastatic PCa with DIC as presenting condition. Although DIC is a rare manifestation of metastatic prostate cancer, it should be consider when no other reason can be found to explain it.
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Affiliation(s)
- Mohammad Forat Yazdi
- Internal Medicine Department of Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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29
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Uslu E, Gurbuz S, Erden A, Aykas F, Karagoz H, Karahan S, Karaman H, Cetinkaya A, Avci D. Disseminated intravascular coagulopathy caused by Kikuchi-Fujimoto disease resulting in death: first case report in Turkey. Int Med Case Rep J 2014. [PMID: 24520206 DOI: 10.2147/mcrj.s58891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Kikuchi disease, also called Kikuchi-Fujimoto disease or Kikuchi's histiocytic necrotizing lymphadenitis, is a rare, benign condition of unknown cause, usually characterized by cervical lymphadenopathy and fever. The diagnosis is based on histopathology. Our patient was a woman with bilateral cervical lymphadenopathy, fever, chest and abdominal pain, fatigue, maculopapular rash on her face, trunk, and upper and lower extremities. Immunological and rheumatological tests were negative. We took a cervical lymph node biopsy that showed a proliferative and necrotizing process centered in the paracortex characterized by patchy circumscribed or confluent areas of necrosis associated with karyorrhexis, and was remarkable by the absence of granulocytes and the paucity of plasma cells. These findings confirmed the diagnosis of Kikuchi's disease. The patient's hemoglobin values decreased, and the peripheral blood smear revealed schistocytes. Blood tests showed raised D-dimer, activated partial thromboplastin time, prothrombin time, and international normalized ratio with decreased fibrinogen. The patient's condition quickly worsened and disseminated intravascular coagulopathy eventually developed. Her initial management consisted of a corticosteroid and hydroxychloroquine.
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Affiliation(s)
- Emine Uslu
- Internal Medicine Department, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Sibel Gurbuz
- Infection Disease Department, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Abdulsamet Erden
- Internal Medicine Department, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Fatma Aykas
- Internal Medicine Department, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Hatice Karagoz
- Internal Medicine Department, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Samet Karahan
- Internal Medicine Department, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Hatice Karaman
- Clinical Pathology Department, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Ali Cetinkaya
- Internal Medicine Department, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Deniz Avci
- Internal Medicine Department, Kayseri Training and Research Hospital, Kayseri, Turkey
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30
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Uslu E, Gurbuz S, Erden A, Aykas F, Karagoz H, Karahan S, Karaman H, Cetinkaya A, Avci D. Disseminated intravascular coagulopathy caused by Kikuchi-Fujimoto disease resulting in death: first case report in Turkey. Int Med Case Rep J 2014; 7:19-22. [PMID: 24520206 PMCID: PMC3917920 DOI: 10.2147/imcrj.s58891] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Kikuchi disease, also called Kikuchi–Fujimoto disease or Kikuchi’s histiocytic necrotizing lymphadenitis, is a rare, benign condition of unknown cause, usually characterized by cervical lymphadenopathy and fever. The diagnosis is based on histopathology. Our patient was a woman with bilateral cervical lymphadenopathy, fever, chest and abdominal pain, fatigue, maculopapular rash on her face, trunk, and upper and lower extremities. Immunological and rheumatological tests were negative. We took a cervical lymph node biopsy that showed a proliferative and necrotizing process centered in the paracortex characterized by patchy circumscribed or confluent areas of necrosis associated with karyorrhexis, and was remarkable by the absence of granulocytes and the paucity of plasma cells. These findings confirmed the diagnosis of Kikuchi’s disease. The patient’s hemoglobin values decreased, and the peripheral blood smear revealed schistocytes. Blood tests showed raised D-dimer, activated partial thromboplastin time, prothrombin time, and international normalized ratio with decreased fibrinogen. The patient’s condition quickly worsened and disseminated intravascular coagulopathy eventually developed. Her initial management consisted of a corticosteroid and hydroxychloroquine.
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Affiliation(s)
- Emine Uslu
- Internal Medicine Department, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Sibel Gurbuz
- Infection Disease Department, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Abdulsamet Erden
- Internal Medicine Department, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Fatma Aykas
- Internal Medicine Department, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Hatice Karagoz
- Internal Medicine Department, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Samet Karahan
- Internal Medicine Department, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Hatice Karaman
- Clinical Pathology Department, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Ali Cetinkaya
- Internal Medicine Department, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Deniz Avci
- Internal Medicine Department, Kayseri Training and Research Hospital, Kayseri, Turkey
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