RESUMEN
Diagnosis of SARS-CoV-2 infections is mostly based on the nasopharyngeal swabs (NPS). However, this collection is invasive and uncomfortable, especially for children and patients with coagulopathies, whose NPS collection often causes bleeding. Thus, the aim of this study was to evaluate the usefulness and accuracy of saliva for the diagnosis of COVID-19 in patients presenting bleeding disorders. Samples of NPS, oropharyngeal swabs (OPS), and saliva were collected simultaneously from 1159 hospitalized patients with hematological diseases and from 524 healthcare workers, both symptomatic and asymptomatic for SARS-CoV-2. All samples were evaluated for SARS-CoV-2 by qRT-PCR. SARS-CoV-2 was detected in NPS, OPS and saliva from 16.9%, 14.4% and 15.6% individuals, respectively. Tests in saliva showed sensitivity, specificity, and overall agreement of 73.3%, 96.9% and 92.7% (=0.74), respectively. Salivary tests had good accuracy (AUC = 0.7) for discriminating negative and positive qRT-PCR for SARS-CoV-2. Higher sensitivity was observed in symptomatic than in non-symptomatic patients, as well as in healthy subjects than in patients with hematological disease, in both OPS and saliva. The mean viral load in NPS was significantly higher than in OPS and in saliva samples (p < 0.001). Saliva is a good diagnostic tool to detect SARS-CoV-2, especially among patients symptomatic for COVID-19, and is a valuable specimen for mass screening of hospitalized patients with hematological diseases, especially for those that with bleeding disorders.
Asunto(s)
Trastornos de la Coagulación Sanguínea/complicaciones , COVID-19/complicaciones , COVID-19/diagnóstico , Trastornos Hemorrágicos/complicaciones , SARS-CoV-2/aislamiento & purificación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , COVID-19/virología , Prueba de COVID-19 , Niño , Preescolar , Estudios de Cohortes , Pruebas Diagnósticas de Rutina , Femenino , Personal de Salud , Humanos , Lactante , Masculino , Persona de Mediana Edad , Saliva , Carga Viral , Adulto JovenRESUMEN
All health care providers should be aware of the impact of bleeding disorders on their patients during any surgical procedures. The knowledge of the mechanisms of hemostasis and optimized management are very important. Initial recognition of a bleeding disorder, in such patients with a systemic pathologic process, may occur in surgical practice. The surgical treatment of those patients might be complicated during the surgery due to the use of anticoagulant and/or antiplatelet medications raises a challenge in the daily practice of surgical professionals. Adequate hemostasis is critical for the success of any surgical procedure because bleeding problems can give rise to complications associated with important morbidity-mortality. Besides, prophylactic, restorative, and surgical care of patients with any bleeding disorders is handled skillfully by practitioners who are well educated regarding the pathology, complications which could arise, and surgical options associated with these conditions. The purpose of this paper is to review common bleeding disorders and their effects on the surgical aspect. Many authors consider that patient medication indicated for the treatment of background disease should not be altered or suspended unless so indicated by the prescribing physician. Local hemostatic measures have been shown to suffice for controlling possible bleeding problems resulting from surgery.
Asunto(s)
Humanos , Procedimientos Quirúrgicos Operativos , Inhibidores de Agregación Plaquetaria/administración & dosificación , Hemorragia/cirugía , Trastornos Hemorrágicos/complicaciones , Hemostasis Quirúrgica/mortalidad , Anticoagulantes/administración & dosificaciónRESUMEN
La hemofilia A adquirida es un trastorno hemorrágico poco frecuente caracterizado por la presencia de autoanticuerpos contra el factor VIII (FVIII) circulante. Se ha observado en un grupo heterogéneo de entidades que incluyen, entre otros, enfermedades malignas; de ellas el 32 por ciento asociada a procesos urológicos, donde el cáncer de próstata tiene la mayor prevalencia. Se presenta un paciente que fue atendido en el servicio de Oncología del Hospital Universitario Celestino Hernández Robau con el diagnóstico de hemofilia A adquirida en la evolución de un adenocarcinoma prostático. Se realizó estudio de coagulación en el Instituto de Hematología e Inmunología donde se comprobó la presencia de inhibidor del factor VIII, lo que confirmó el diagnóstico. Se puso tratamiento inmunosupresor con prednisona 1 mg/kg de peso, con una evolución favorable(AU)
Acquired hemophilia A is a rare bleeding disorder characterized by the presence of autoantibodies against circulating factor VIII (FVIII). It has been observed in a heterogeneous group of entities that include, among others, malignant diseases; 32 percent associated with urological processes, where prostate cancer has the highest prevalence. We present a patient who was treated at the Oncology Service of the Celestino Hernández Robau University Hospital with the diagnosis of acquired hemophilia A in the course of a prostatic adenocarcinoma. A coagulation study was carried out at the Institute of Hematology and Immunology where the presence of factor VIII inhibitor was confirmed, confirming the diagnosis. Immunosuppressive treatment was given with prednisone 1 mg/kg of weight, with a favorable evolution(AU)
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Prednisona/uso terapéutico , Hemofilia A/complicaciones , Hemofilia A , Hiperplasia Prostática/complicaciones , Hemofilia A/diagnóstico , Trastornos Hemorrágicos/complicacionesRESUMEN
La hemofilia A adquirida es un trastorno hemorrágico poco frecuente caracterizado por la presencia de autoanticuerpos contra el factor VIII (FVIII) circulante. Se ha observado en un grupo heterogéneo de entidades que incluyen, entre otros, enfermedades malignas; de ellas el 32 por ciento asociada a procesos urológicos, donde el cáncer de próstata tiene la mayor prevalencia. Se presenta un paciente que fue atendido en el servicio de Oncología del Hospital Universitario Celestino Hernández Robau con el diagnóstico de hemofilia A adquirida en la evolución de un adenocarcinoma prostático. Se realizó estudio de coagulación en el Instituto de Hematología e Inmunología donde se comprobó la presencia de inhibidor del factor VIII, lo que confirmó el diagnóstico. Se puso tratamiento inmunosupresor con prednisona 1 mg/kg de peso, con una evolución favorable(AU)
Acquired hemophilia A is a rare bleeding disorder characterized by the presence of autoantibodies against circulating factor VIII (FVIII). It has been observed in a heterogeneous group of entities that include, among others, malignant diseases; 32 percent associated with urological processes, where prostate cancer has the highest prevalence. We present a patient who was treated at the Oncology Service of the Celestino Hernández Robau University Hospital with the diagnosis of acquired hemophilia A in the course of a prostatic adenocarcinoma. A coagulation study was carried out at the Institute of Hematology and Immunology where the presence of factor VIII inhibitor was confirmed, confirming the diagnosis. Immunosuppressive treatment was given with prednisone 1 mg/kg of weight, with a favorable evolution(AU)
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Prednisona/uso terapéutico , Hemofilia A/complicaciones , Hemofilia A/tratamiento farmacológico , Hiperplasia Prostática/complicaciones , Hemofilia A/diagnóstico , Trastornos Hemorrágicos/complicacionesRESUMEN
INTRODUCTION AND OBJECTIVES: The management of urolithiasis in patients on anticoagulants presents a challenge to the endourologist. Due to multiple comorbidities, it may be impossible to safely discontinue the anticoagulant treatment. Other modalities such as shock wave lithotripsy and PCNL are contraindicated in these patients, so ureteroscopic treatment may be the only option. We conducted a systematic review of the literature to look at the safety and efficacy of ureteroscopic management in these patients. METHODS: Systematic review and quantitative meta-analysis was performed using studies identified by a systematic electronic literature search from January 1990 to August 2011. All articles reporting on treatment for stones in patients with a bleeding diathesis using ureteroscopy and a Holmium:YAG laser were included. Two reviewers independently extracted the data from each study. The data was included into a meta-analysis and discussed. RESULTS: Three studies were identified reporting on 70 patients (73 procedures). All patients had stone fragmentation using Holmium laser. The mean stone size was 13.2mm with a range of 5-35 mm. The quality of the included studies was modest. Stone free status was achieved in sixty-four patients (87.7%). There were no major complications and only 11% of the patients developed minor complications with only 4% rate of minor bleeding. CONCLUSIONS: Retrograde stone treatment using ureteroscopy and holmium laser lithotripsy can be safely performed in patients with bleeding diathesis with a low complication rate.
Asunto(s)
Anticoagulantes/administración & dosificación , Trastornos Hemorrágicos/complicaciones , Litotripsia por Láser/métodos , Ureteroscopía/métodos , Cálculos Urinarios/terapia , Anticoagulantes/efectos adversos , Susceptibilidad a Enfermedades , Humanos , Láseres de Estado Sólido/uso terapéutico , Litotripsia por Láser/efectos adversos , Resultado del Tratamiento , Ureteroscopía/efectos adversosRESUMEN
INTRODUCTION AND OBJECTIVES: The management of urolithiasis in patients on anticoagulants presents a challenge to the endourologist. Due to multiple comorbidities, it may be impossible to safely discontinue the anticoagulant treatment. Other modalities such as shock wave lithotripsy and PCNL are contraindicated in these patients, so ureteroscopic treatment may be the only option. We conducted a systematic review of the literature to look at the safety and efficacy of ureteroscopic management in these patients. METHODS: Systematic review and quantitative meta-analysis was performed using studies identified by a systematic electronic literature search from January 1990 to August 2011. All articles reporting on treatment for stones in patients with a bleeding diathesis using ureteroscopy and a Holmium:YAG laser were included. Two reviewers independently extracted the data from each study. The data was included into a meta-analysis and discussed. RESULTS: Three studies were identified reporting on 70 patients (73 procedures). All patients had stone fragmentation using Holmium laser. The mean stone size was 13.2mm with a range of 5-35mm. The quality of the included studies was modest. Stone free status was achieved in sixty-four patients (87.7%). There were no major complications and only 11% of the patients developed minor complications with only 4% rate of minor bleeding. CONCLUSIONS: Retrograde stone treatment using ureteroscopy and holmium laser lithotripsy can be safely performed in patients with bleeding diathesis with a low complication rate.
Asunto(s)
Humanos , Anticoagulantes/administración & dosificación , Trastornos Hemorrágicos/complicaciones , Litotripsia por Láser/métodos , Ureteroscopía/métodos , Cálculos Urinarios/terapia , Anticoagulantes/efectos adversos , Susceptibilidad a Enfermedades , Láseres de Estado Sólido/uso terapéutico , Litotripsia por Láser/efectos adversos , Resultado del Tratamiento , Ureteroscopía/efectos adversosRESUMEN
Inherited deficiencies of blood coagulation factors are usually associated with lifelong bleeding tendency. In addition to Haemophilias A and B and von Willebrand disease, congenital deficiencies of such factors as fibrinogen, prothrombin (FII)), FV, FVII, FX, FXI, FXIII, and combined deficiencies occur and can lead to a diversity of clinical conditions. Paradoxically, for some of these disorders associated with significant bleeding tendency there are reports of thrombotic events, both arterial and venous. Thrombosis in hemophilia patients has a multifactorial pathogenesis and the main conditions associated with this complication are the use of long-term central venous catheters, intensive replacement therapy usually in the setting of surgical procedures, the use of bypassing agents or the coexistence of acquired or inherited prothrombotic risk factors. Regarding other rare bleeding disorders, thrombotic phenomena has been described particularly in patients with afibrinogenemia, FXI and FVII deficiency and the events can occur even in young patients, in the presence of concomitant risk factors or spontaneously. Replacement therapy must be individualized and should take into account past history of haemostatic challenges, family history of bleeding and thrombosis, just like the level of factor. For mild deficiencies when patients are asymptomatic the use of antithrombotic prophylaxis must be considered with or without concomitant use of replacement therapy. In patients with history of thrombosis it may be helpful to perform a thrombophilia screening to exclude coexisting prothrombotic defects and for all patients it is recommended to control known cardiovascular disease risk factors.
Asunto(s)
Hemorragia/complicaciones , Trastornos Hemorrágicos/complicaciones , Enfermedades Raras/complicaciones , Trombosis/complicaciones , Trastornos de la Coagulación Sanguínea Heredados/complicaciones , Trastornos de la Coagulación Sanguínea Heredados/metabolismo , Deficiencia del Factor VII/complicaciones , Deficiencia del Factor VII/metabolismo , Deficiencia del Factor XI/complicaciones , Deficiencia del Factor XI/metabolismo , Fibrinógeno/metabolismo , Hemorragia/metabolismo , Trastornos Hemorrágicos/metabolismo , Humanos , Enfermedades Raras/metabolismo , Trombosis/metabolismoRESUMEN
BACKGROUND AND OBJECTIVES: Mucocutaneous bleeding (MCB) is the main expression of inherited disorders of primary hemostasis. However, the relative prevalence of these disorders, their clinical differential diagnosis, and the proportion of patients with MCB of unknown cause (BUC) after an initial comprehensive laboratory testing are unknown. DESIGN AND METHODS: We studied prospectively 280 consecutive patients with MCB and 299 matched controls, using strict inclusion and exclusion criteria. A single physician recorded the clinical data in a bleeding score and estimated the severity of bleeding in clinical categories. Laboratory criteria for the diagnosis of von Willebrand's disease (VWD) and platelet function defects were established from reference values derived from controls. RESULTS: Fifty patients (17.9%) had VWD (type 1VWD=45, type 2=5). Platelet function defects and mild clotting factor deficiencies were found in 65 (23.2%) and 11 (3.9%) patients, respectively. Thirteen (11.5%) patients had combined defects. The remaining 167(59.6%) patients had BUC, with prolonged bleeding time in 18.6% as their only abnormality. All these disorders, including BUC, were clinically undistinguishable. Moreover, no relationship was found between the severity of bleeding and VWF/platelet function variables. INTERPRETATION AND CONCLUSIONS: The diagnostic efficacy of a first laboratory testing in patients with hereditary MCB is 40.4%. Most patients have a disease(s) of high prevalence but unknown pathogenesis. Concurrent bleeding disorders in the same patient are frequent. Our results support the proposal that low plasma VWF levels, but also platelet function defects, should be considered risk factors rather than unequivocal causes of hemorrhages.
Asunto(s)
Hemorragia/etiología , Trastornos Hemorrágicos/diagnóstico , Membrana Mucosa , Enfermedades de la Piel/etiología , Adolescente , Adulto , Tiempo de Sangría , Trastornos de las Plaquetas Sanguíneas/sangre , Trastornos de las Plaquetas Sanguíneas/complicaciones , Trastornos de las Plaquetas Sanguíneas/diagnóstico , Trastornos de las Plaquetas Sanguíneas/epidemiología , Plaquetas/efectos de los fármacos , Plaquetas/metabolismo , Manejo de Caso , Estudios de Casos y Controles , Niño , Preescolar , Trastornos de las Proteínas de Coagulación/sangre , Trastornos de las Proteínas de Coagulación/complicaciones , Trastornos de las Proteínas de Coagulación/diagnóstico , Trastornos de las Proteínas de Coagulación/epidemiología , Epinefrina/farmacología , Femenino , Hemoglobinas/análisis , Hemorragia/sangre , Trastornos Hemorrágicos/sangre , Trastornos Hemorrágicos/complicaciones , Trastornos Hemorrágicos/epidemiología , Trastornos Hemorrágicos/genética , Humanos , Masculino , Anamnesis , Persona de Mediana Edad , Fenotipo , Pruebas de Función Plaquetaria/instrumentación , Pruebas de Función Plaquetaria/métodos , Valor Predictivo de las Pruebas , Prevalencia , Estudios Prospectivos , Serotonina/metabolismo , Índice de Severidad de la Enfermedad , Transducción de Señal , España/epidemiología , Encuestas y Cuestionarios , Enfermedades de von Willebrand/sangre , Enfermedades de von Willebrand/clasificación , Enfermedades de von Willebrand/complicaciones , Enfermedades de von Willebrand/diagnóstico , Enfermedades de von Willebrand/epidemiologíaRESUMEN
Introdução: A prevalência da embolia pulmonar(EP)aumenta com a idade, porém pouco se conhece a respeito dos fatores associados ao óbito no idoso.Objetivo: Identificar as características clínicas e os fatores que se associam com a mortalidade por EP confirmada, internados, entre Março de 2000 a Maio de 2004. A associação com a mortalidade foi analisada pelo teste exato de Fisher e pelo teste t, considerando-se 5 por cento como nível de significância estatística.Resultados: A média de idade foi de 80 anos(máximo 98 anos, mínimo 65 anos) e do Escore APACHE 13, seno 72 por cento do sexo feminino. O seguimento foi de 6 meses. A mortalidade diretamente relacionada à EP foi de 21 por cento. Os demais óbitos foram por choque séptico ou diátese hemorrágica. Houve associação significtiva com mortalidade por EP com: neoplasia (p igual 0,024), acidente vascular encefálico(p igual 0,024), pressão sistólica inferior a 100mmhg(p igual 0,005), e com o intervalo entre o início dos sintomas e a internação(p igual 0,0001).Conclusão: Conclui-se que na EP, fatores associados como a neoplasia, acidente vascular encefálico, hipotensão e intervalo entre o início dos sintomas e a internação correlacionaram-se com a mortalidade
Asunto(s)
Humanos , Masculino , Femenino , Anciano , Choque Séptico/mortalidad , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/fisiopatología , Embolia Pulmonar/prevención & control , Trastornos Hemorrágicos/complicaciones , Trastornos Hemorrágicos/mortalidad , Tromboembolia/complicaciones , Tromboembolia/fisiopatología , Infarto Encefálico , Hipotensión , Factores de RiesgoRESUMEN
Objetivos: determinar quais as doencas que ocasionaram morte materna por ordem de frequencia, estabelecer as razoes de mortalidade materna para...
Asunto(s)
Humanos , Embarazo , Recién Nacido , Eclampsia , Mortalidad Materna , Procedimientos Quirúrgicos Obstétricos , Complicaciones Cardiovasculares del Embarazo , Trastornos Hemorrágicos/complicacionesAsunto(s)
Humanos , Tecnología de Alto Costo/tendencias , Cirugía Bucal/normas , Atención Dental para Enfermos Crónicos/métodos , Trastornos de la Coagulación Sanguínea/complicaciones , Hemofilia A/complicaciones , Leucemia/complicaciones , Terapia de Inmunosupresión , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Trasplante de Médula Ósea/efectos adversos , Anticoagulantes/uso terapéutico , Trastornos Hemorrágicos/complicaciones , Hemostasis , Enfermedades de von WillebrandAsunto(s)
Humanos , Atención Dental para Enfermos Crónicos/métodos , Cirugía Bucal/normas , Tecnología de Alto Costo/tendencias , Anticoagulantes/uso terapéutico , Trastornos de la Coagulación Sanguínea/complicaciones , Hemofilia A/complicaciones , Hemostasis , Terapia de Inmunosupresión , Leucemia/complicaciones , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Trasplante de Médula Ósea/efectos adversos , Trastornos Hemorrágicos/complicaciones , Enfermedades de von WillebrandRESUMEN
La trombofilia es un desorden o trastorno congénito o adquirido del sistema homeostático que predispone a la coagulación intravascular y que debe buscarse en todo paciente joven con o sin factores de riesgo que hace una trombosis venosa profunda. La causa más frecuente de trombofilia congénita es la resistencia a la Proteína C y de trombofilia adquirida es la presencia de anticuerpos antifosfolípidos
Asunto(s)
Humanos , Coagulación Intravascular Diseminada/etiología , Trastornos Hemorrágicos/complicaciones , Anticuerpos Antifosfolípidos/aislamiento & purificación , Proteína C , Tromboflebitis/complicacionesRESUMEN
Grey-platelet syndrome is a rare familial platelet impairment characterised by lack of alpha granules and giant vacuolated platelets. A Mexican family with grey-platelet syndrome associated to Marfan disease is presented. The family was comprised of 22 members, of whom 3 (the propositus and two of his nephews) could be studied. Two of them, with haemorrhagic symptoms since childhood, had moderate prolongation of the Ivy bleeding time which improved after DDAVP administration, plus moderate thrombocytopenia, giant platelets and abnormal platelet aggregation induced by adrenalin, ADP and collagen. Platelet factor 4 was normal. Electron microscope examination of platelets showed lack of alpha granules and increased dense bodies. The rarity of the casual association of two low-frequency genetic diseases, namely Marfan disease and the grey-platelet syndrome, is commented, along with the response attained with DDAVP in the two affected individuals.
Asunto(s)
Plaquetas/ultraestructura , Trastornos Hemorrágicos/complicaciones , Síndrome de Marfan/complicaciones , Adulto , Tiempo de Sangría , Gránulos Citoplasmáticos/ultraestructura , Desamino Arginina Vasopresina/uso terapéutico , Femenino , Trastornos Hemorrágicos/tratamiento farmacológico , Trastornos Hemorrágicos/genética , Humanos , Lactante , Masculino , Síndrome de Marfan/genética , México , Linaje , Agregación Plaquetaria/efectos de los fármacosRESUMEN
A insuficiência renal aguda (IRA), como complicaçäo de diálise hemorrágica generalizada, por contato com lagartas do gênero (Lonomia (Lepidoptera, Saturniidae), é evento rato. Entretanto, atenderam-se dois pacientes, que, na mesma época e em localidades diferentes, após contato com lagartas, desenvolveram diátese hemorrágica e IRA. A identificaçäo da lagarta, sua toxina, os efeitos desta sobre o sistema de coagulaçäo, bem como a IRA, necessitam de estudos mais completos para melhor entendimento de sua patologia
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Lesión Renal Aguda/etiología , Trastornos Hemorrágicos/complicaciones , LepidópterosRESUMEN
Pregnancies in two patients with Hermansky-Pudlak syndrome, oculocutaneous albinism with hemorrhagic diathesis, are presented. Outcomes were good despite prior reports of postpartum hemorrhage in patients with this syndrome. This autosomal recessive disease is relatively common in parts of Puerto Rico. Suspected patients should be screened with platelet aggregation studies.