RESUMEN
Background: Dengue fever (DF) is a mosquito-borne illness with substantial economic and societal impact. Understanding laboratory trends of hospitalized Dominican Republic (DR) pediatric patients could help develop screening procedures in low-resourced settings. We sought to describe laboratory findings over time in DR children with DF and DF severity from 2018 to 2020. Methods: Clinical information was obtained prospectively from recruited children with DF. Complete blood count (CBC) laboratory measures were assessed across Days 1-10 of fever. Participants were classified as DF-negative and DF-positive and grouped by severity. We assessed associations of DF severity with demographics, clinical characteristics, and peripheral blood studies. Using linear mixed-models, we assessed if hematologic values/trajectories differed by DF status/severity. Results: A total of 597 of 1101 with a DF clinical diagnosis were serologically evaluated, and 574 (471 DF-positive) met inclusion criteria. In DF, platelet count and hemoglobin were higher on earlier days of fever (p < = 0.0017). Eighty had severe DF. Severe DF risk was associated with thrombocytopenia, intraillness anemia, and leukocytosis, differing by fever day (p < = 0.001). Conclusions: In a pediatric hospitalized DR cohort, we found marked anemia in late stages of severe DF, unlike the typically seen hemoconcentration. These findings, paired with clinical symptom changes over time, may help guide risk-stratified screenings for resource-limited settings.
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Virus del Dengue , Dengue , Humanos , República Dominicana/epidemiología , Dengue/epidemiología , Dengue/sangre , Dengue/virología , Dengue/diagnóstico , Masculino , Femenino , Preescolar , Recuento de Células Sanguíneas , Lactante , Virus del Dengue/aislamiento & purificación , Niño , Epidemias , Anemia/epidemiología , Anemia/sangre , Trombocitopenia/epidemiología , Trombocitopenia/sangre , Trombocitopenia/virología , Estudios ProspectivosRESUMEN
INTRODUCTION: A reduction in platelet count in critically ill patients is a marker of severity of the clinical condition. However, whether this association holds true in acute kidney injury (AKI) is unknown. We analyzed the association between platelet reduction in patients with AKI and major adverse kidney events (MAKE). METHODS: In this retrospective cohort, we included AKI patients at the Hospital Civil of Guadalajara, in Jalisco, Mexico. Patients were divided according to whether their platelet count fell >21% during the first 10 days. Our objectives were to analyze the associations between a platelet reduction >21% and MAKE at 10 days (MAKE10) or at 30-90 days (MAKE30-90) and death. RESULTS: From 2017 to 2023, 400 AKI patients were included, 134 of whom had a > 21% reduction in platelet count. The mean age was 54 years, 60% were male, and 44% had sepsis. The mean baseline platelet count was 194 x 103 cells/µL, and 65% of the KDIGO3 patients met these criteria. Those who underwent hemodialysis (HD) had lower platelet counts. After multiple adjustments, a platelet reduction >21% was associated with MAKE10 (OR 4.2, CI 2.1-8.5) but not with MAKE30-90. The mortality risk increased 3-fold (OR 2.9, CI 1.1-7.7, p = 0.02) with a greater decrease in the platelets (<90 x 103 cells/µL). As the platelets decreased, the incidence of MAKE was more likely to increase. These associations lost significance when accounting for starting HD. CONCLUSION: In our retrospective cohort of patients with AKI, a > 21% reduction in platelet count was associated with MAKE. Our results are useful for generating hypotheses and motivating us to continue studying this association with a more robust design.
A reduction in platelet count in critically ill patients has been associated with a worse prognosis, but it is not yet known whether this relationship also exists in patients with acute kidney injury, who are more susceptible to platelet decrease due to the syndrome or due to the onset of hemodialysis. In our study of acute kidney injury patients, we found that those whose platelet count decreased >21% during the first days were more likely to experience a major kidney event. In addition, the greater the decrease in platelet count was, the more likely these events were to occur. The significance of this association was lost in patients who start hemodialysis. Our conclusions could serve to generate hypotheses about this interesting relationship.
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Lesión Renal Aguda , Humanos , Masculino , Estudios Retrospectivos , Femenino , Lesión Renal Aguda/sangre , Lesión Renal Aguda/mortalidad , Lesión Renal Aguda/etiología , Persona de Mediana Edad , Recuento de Plaquetas , México/epidemiología , Anciano , Adulto , Diálisis Renal , Enfermedad Crítica , Trombocitopenia/sangre , Factores de RiesgoRESUMEN
Patients bitten by snakes consistently manifest a bleeding tendency, in which thrombocytopenia, consumption coagulopathy, mucous bleeding, and, more rarely, thrombotic microangiopathy, are observed. Von Willebrand factor (VWF) is required for primary hemostasis, and some venom proteins, such as botrocetin (a C-type lectin-like protein) and snake venom metalloproteinases (SVMP), disturb the normal interaction between platelets and VWF, possibly contributing to snakebite-induced bleedings. To understand the relationship among plasma VWF, platelets, botrocetin and SVMP from Bothrops jararaca snake venom (BjV) in the development of thrombocytopenia, we used (a) Wistar rats injected s.c. with BjV preincubated with anti-botrocetin antibodies (ABA) and/or Na2-EDTA (a SVMP inhibitor), and (b) VWF knockout mice (Vwf-/-) injected with BjV. Under all conditions, BjV induced a rapid and intense thrombocytopenia. In rats, BjV alone reduced the levels of VWF:Ag, VWF:CB, high molecular weight multimers of VWF, ADAMTS13 activity, and factor VIII. Moreover, VWF:Ag levels in rats that received BjV preincubated with Na2-EDTA and/or ABA tended to recover faster. In mice, BjV caused thrombocytopenia in both Vwf-/- and C57BL/6 (background control) strains, and VWF:Ag levels tended to decrease in C57BL/6, demonstrating that thrombocytopenia was independent of the presence of plasma VWF. These findings showed that botrocetin present in BjV failed to affect the extent or the time course of thrombocytopenia induced by envenomation, but it contributed to decrease the levels and function of plasma VWF. Thus, VWF alterations during B. jararaca envenomation are an ancillary event, and not the main mechanism leading to decreased platelet counts.
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Bothrops/metabolismo , Venenos de Crotálidos/toxicidad , Mordeduras de Serpientes/complicaciones , Venenos de Serpiente/toxicidad , Trombocitopenia/etiología , Trombocitopenia/metabolismo , Factor de von Willebrand/metabolismo , Animales , Plaquetas/metabolismo , Venenos de Crotálidos/metabolismo , Femenino , Humanos , Masculino , Metaloproteasas/metabolismo , Metaloproteasas/toxicidad , Ratones , Ratones Endogámicos C57BL , Ratones Noqueados , Ratas , Ratas Wistar , Venenos de Serpiente/enzimología , Venenos de Serpiente/metabolismo , Trombocitopenia/sangre , Trombocitopenia/genética , Factor de von Willebrand/genéticaRESUMEN
INTRODUCTION: The multisystem inflammatory syndrome in children associated with SARS-CoV-2 (MIS-C) is cha racterized by a hyperinflammatory state resulting from a cytokine storm, evidenced by alterations in laboratory blood testing and acute-phase proteins. OBJECTIVE: to describe the clinical and labora tory characteristics of patients hospitalized due to MIS-C and identify predictive markers of severity. PATIENTS AND METHOD: Retrospective study of 32 patients. The group was divided into critical and non-critical according to clinical presentation and therapy used. Clinical and laboratory aspects were studied, including complete blood count, coagulation tests, and biomarkers. RESULTS: 18/32 were males, with a median age of 6.8 years. The most frequent manifestations were cardiovascular (84.3%), digestive (84%), and mucocutaneous (59%). The group of critical patients included 15 patients, 12 were males with a median age of 8.9 years, and the non-critical group included 17 patients, 6 were males with a median age of 5.4 years. The laboratory parameters at the admission in the global group showed increased C-reactive protein, D-dimer, leukocytes, neutrophils, ferritin, and fibrinogen. In contrast, albumin and blood sodium levels were decreased. At admission, the critical group was cha racterized by presenting thrombocytopenia, hypoalbuminemia, prolonged prothrombin time, and elevated ferritin. At the time of deterioration, there was an intensification of thrombocytopenia, in creased C-reactive protein together with increased neutrophils level. CONCLUSION: The blood count, C-reactive protein, and albuminemia at admission proved to be significantly important in the identi fication of patients at risk of clinical deterioration.
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COVID-19/complicaciones , SARS-CoV-2 , Índice de Severidad de la Enfermedad , Síndrome de Respuesta Inflamatoria Sistémica/complicaciones , Biomarcadores/sangre , Proteína C-Reactiva/análisis , COVID-19/clasificación , Niño , Deterioro Clínico , Enfermedad Crítica , Femenino , Ferritinas/sangre , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Fibrinógeno/análisis , Humanos , Leucocitos , Masculino , Neutrófilos , Estudios Retrospectivos , Síndrome de Respuesta Inflamatoria Sistémica/clasificación , Trombocitopenia/sangreRESUMEN
BACKGROUND: During hematopoietic stem cell transplantation (HSCT) the patients perform activities of low and moderate intensity because have reduced hematological lineages, leaving them susceptible to hemorrhagic events. The objective of this study was to describe the frequency of bleeding events, severity, and possible association with physical exercise in thrombocytopenic patients. METHODS: A retrospective study with seventy-seven HSCT patients hospitalised, that had a platelet count ≤ 50,000 /µL and received physical exercise during physiotherapy intervention. RESULTS: Regarding bleeding events, only six were related to physical exercise, and bleeding events occurred more frequently at platelet levels ≤ 10,000 /µL. The most frequent bleeding event was epistaxis, considered of low severity, and with the moderate possibility of being related to physical exercise; followed by extremity hematoma, considered of medium severity and highly related to physical exercise. In this study, there was no occurrence of bleeding events considered of high severity. CONCLUSION: Bleeding frequency in supervised physical exercise during physiotherapy in adults with thrombocytopenia undergoing HSCT is minor and relatively rare but occurs more frequently in patients with platelet count ≤10,000 /µL. These results encourage the maintenance of physical activity in this population who is at high risk of developing immobility-related complications.
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Terapia por Ejercicio , Trasplante de Células Madre Hematopoyéticas , Hemorragia , Adulto , Anciano , Aloinjertos , Femenino , Hemorragia/sangre , Hemorragia/etiología , Hemorragia/terapia , Humanos , Masculino , Persona de Mediana Edad , Recuento de Plaquetas , Estudios Retrospectivos , Trombocitopenia/sangre , Trombocitopenia/terapiaAsunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Neoplasias Colorrectales/terapia , Oxaliplatino/efectos adversos , Trombocitopenia/inducido químicamente , Quimioterapia Adyuvante/efectos adversos , Colectomía , Neoplasias Colorrectales/sangre , Neoplasias Colorrectales/patología , Femenino , Fluorouracilo/efectos adversos , Humanos , Leucovorina/efectos adversos , Persona de Mediana Edad , Compuestos Organoplatinos/efectos adversos , Trombocitopenia/sangre , Trombocitopenia/diagnóstico , Trombocitopenia/inmunologíaRESUMEN
Bleeding is a common hemostatic disorder that occurs in Bothrops envenomations. We evaluated the changes in coagulation, fibrinolysis components, and platelets in Bothrops atrox envenomations with bleeding. This is an observational study with B. atrox snakebite patients (n = 100) treated in Manaus, Brazilian Amazon. Bleeding was recorded on admission and during hospitalization. We found that the platelet count in our patients presented a weak correlation to tissue factor, factor II, and plasminogen. Tissue factor presented weak correlation to factor V, II, D-dimer, plasminogen, alpha 2-antiplasmin, and moderate correlation to fibrinogen and fibrin/fibrinogen degradation product (FDP). Patients with systemic bleeding (n = 20) presented low levels of factor V, II, fibrinogen, plasminogen, and alpha 2-antiplasmin, and high levels of tissue factor and FDP compared to those without bleeding. Patients with only local bleeding (n = 41) and without bleeding showed similar levels of hemostatic factors. Thrombocytopenia was observed mainly in patients with systemic bleeding and increased levels of serum venom. No association was found between venom levels and systemic bleeding, or between venom levels and clinical severity of envenomation. This is the first report that shows the participation of the extrinsic coagulation pathway in the consumption coagulopathy of B. atrox envenomations with systemic bleeding due to tissue factor release.
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Factores de Coagulación Sanguínea/metabolismo , Coagulación Sanguínea , Plaquetas/metabolismo , Bothrops , Venenos de Crotálidos/metabolismo , Hemorragia/sangre , Mordeduras de Serpientes/sangre , Tromboplastina/metabolismo , Adolescente , Adulto , Anciano , Animales , Antivenenos/uso terapéutico , Pruebas de Coagulación Sanguínea , Estudios de Casos y Controles , Femenino , Fibrinólisis , Hemorragia/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Recuento de Plaquetas , Mordeduras de Serpientes/diagnóstico , Mordeduras de Serpientes/tratamiento farmacológico , Trombocitopenia/sangre , Trombocitopenia/diagnóstico , Adulto JovenRESUMEN
INTRODUCTION: Hemophagocytic lymphohistiocytosis (HLH) is a condition characterized by a hyperinflammatory state and persistent macrophage activation, resulting in reactive phagocytosis of the hematopoietic elements. In children, it is usually a hereditary disorder, while in adults it is usually acquired secondary to viral infections, collagenoses, or tumors. Although accounting for 10% of hematologic malignancies, HLH is rarely associated with multiple myeloma (MM) and other plasmacytic dyscrasias. PATIENT CONCERNS: A 64-year-old Brazilian man seeked medical care with a 3-month history of intermittent fever, weight loss, night sweats, and progressive anemic symptoms. DIAGNOSIS: Total blood count showed severe bicytopenia (normocytic-normochromic anemia and thrombocytopenia), biochemical exams showed elevation of creatinine, as well as monoclonal peak in serum protein electrophoresis, high IgA dosage, and serum immunofixation with IgA kappa paraprotein. Bone marrow biopsy showed 30% of monoclonal and phenotypically anomalous plasmocytes, confirming the diagnosis of MM. Diagnosis of HLH was established by the presence of clinical and laboratory criteria: fever, splenomegaly, cytopenias, hypofibrinogenemia, hyperferritinemia, elevation of triglycerides, and several figures of erythrophagocytosis in bone marrow aspirate. INTERVENTIONS: The patient experienced pulse therapy with methylprednisolone for hemophagocytic lymphohistiocytosis, followed by initial therapy for multiple myeloma with cyclophosphamide and dexamethasone. OUTCOMES: Once the diagnosis of MM and secondary hemophagocytic syndrome was established, the patient had a rapid clinical deterioration despite the established therapeutic measures, evolving with cardiovascular failure, acute liver failure, acute disseminated intravascular coagulation, worsening renal dysfunction requiring dialysis support, respiratory dysfunction, and lowering of consciousness, characterizing rapid multiple organ dysfunction, ultimately leading to the death of the patient. INNOVATION: Here, we aimed to describe the sixth reported case of HLH associated with MM, according to cases cataloged in the PubMed database, and the first case evaluated by 18-fluordeoxyglucose positron emission tomography (18-FDG-PETCT). CONCLUSION: Our case report seeks to provide support for a better clinical and laboratory characterization of this rare paraneoplastic entity associated with MM, and aims to call the attention of hematologists and intensivists to this condition that falls within the scope of the differential diagnosis of rapid onset multiple organ failure in patients with plasmacytic neoplasms.
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Linfohistiocitosis Hemofagocítica/tratamiento farmacológico , Linfohistiocitosis Hemofagocítica/etiología , Mieloma Múltiple/complicaciones , Mieloma Múltiple/tratamiento farmacológico , Anemia/sangre , Anemia/etiología , Antineoplásicos Alquilantes/administración & dosificación , Antineoplásicos Alquilantes/uso terapéutico , Médula Ósea/patología , Brasil/epidemiología , Ciclofosfamida/administración & dosificación , Ciclofosfamida/uso terapéutico , Dexametasona/administración & dosificación , Dexametasona/uso terapéutico , Quimioterapia Combinada , Resultado Fatal , Fiebre/diagnóstico , Fiebre/etiología , Glucocorticoides/administración & dosificación , Glucocorticoides/uso terapéutico , Humanos , Linfohistiocitosis Hemofagocítica/sangre , Linfohistiocitosis Hemofagocítica/diagnóstico , Masculino , Metilprednisolona/administración & dosificación , Metilprednisolona/uso terapéutico , Persona de Mediana Edad , Mieloma Múltiple/metabolismo , Insuficiencia Multiorgánica/complicaciones , Paraproteinemias/sangre , Células Plasmáticas/patología , Esplenomegalia/diagnóstico , Esplenomegalia/etiología , Trombocitopenia/sangre , Trombocitopenia/etiología , Pérdida de PesoAsunto(s)
Azacitidina , Bases de Datos Factuales , Síndromes Mielodisplásicos , Anciano , Azacitidina/administración & dosificación , Azacitidina/efectos adversos , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Humanos , América Latina/epidemiología , Masculino , Persona de Mediana Edad , Síndromes Mielodisplásicos/tratamiento farmacológico , Síndromes Mielodisplásicos/mortalidad , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Tasa de Supervivencia , Trombocitopenia/sangre , Trombocitopenia/inducido químicamente , Trombocitopenia/mortalidadRESUMEN
BACKGROUND: Thrombocytopenia in malaria involves platelet destruction and consumption; however, the cellular response underlying this phenomenon has still not been elucidated. OBJECTIVE: To find associations between platelet indices and unbalanced Th1/Th2/Th17 cytokines as a response to thrombocytopenia in Plasmodium vivax infected (Pv-MAL) patients. METHODS: Platelet counts and quantification of Th1/Th2/Th17 cytokine levels were compared in 77 patients with uncomplicated P. vivax malaria and 37 healthy donors from the same area (endemic control group - ENCG). FINDINGS: Thrombocytopenia was the main manifestation in 55 patients, but was not associated with parasitaemia. The Pv-MAL patients showed increases in the mean platelet volume (MPV), which may be consistent with larger or megaplatelets. Contrary to the findings regarding the endemic control group, MPV and platelet distribution width (PDW) did not show an inverse correlation, due the increase in the heterogeneity of platelet width. In addition, the Pv-MAL patients presented increased IL-1ß and reduced IL-12p70 and IL-2 serum concentrations. Furthermore, the reduction of these cytokines was associated with PDW values. MAIN CONCLUSIONS: Our data demonstrate that an increase in MPV and the association between reductions of IL-2 and IL-12 and PDW values may be an immune response to thrombocytopenia in uncomplicated P. vivax malaria.
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Subgrupos Linfocitarios/inmunología , Malaria Vivax/inmunología , Malaria Vivax/patología , Plasmodium vivax/inmunología , Trombocitopenia/sangre , Trombocitopenia/patología , Humanos , Interleucina-12/sangre , Interleucina-2/sangre , Malaria Vivax/sangre , Malaria Vivax/parasitología , Trombocitopenia/parasitologíaAsunto(s)
Anestésicos Intravenosos/efectos adversos , Fentanilo/administración & dosificación , Trombocitopenia/inducido químicamente , Anestésicos Intravenosos/administración & dosificación , Bronquiolitis Obliterante/cirugía , Femenino , Fentanilo/efectos adversos , Humanos , Trasplante de Pulmón/efectos adversos , Persona de Mediana Edad , Dolor Postoperatorio/etiología , Dolor Postoperatorio/prevención & control , Recuento de Plaquetas , Trombocitopenia/sangre , Trombocitopenia/diagnósticoRESUMEN
INTRODUCTION AND OBJECTIVES: Non-alcoholic fatty liver disease (NAFLD) is the most common liver disorder in western countries. It is often related to metabolic syndrome, presenting an increased risk of advanced liver disease and cardiovascular-related death. In some etiologies of chronic liver disease, thrombocytopenia has been associated not only with advanced stages of fibrosis but also with autoimmune disease. In NAFLD, however, its prevalence and related factors are still unknown. The aim of this study is to evaluate the prevalence of thrombocytopenia in NAFLD patients without cirrhosis and to investigate its related risk factors. PATIENTS AND METHODS: This was a retrospective study carried out in two tertiary hospitals in the South and Southeast regions of Brazil. Patients diagnosed with NAFLD by liver biopsy were included. Those with other causes of liver disease and/or cirrhosis were excluded. For analysis, patients were divided into two groups, with and without thrombocytopenia. Data was analyzed using a significance level of 5%. RESULTS: 441 non-cirrhotic patients with NAFLD (evaluated by liver biopsy) were included in the study. The prevalence of thrombocytopenia was 3.2% (14/441 patients). In the comparative analysis between groups, thrombocytopenia was associated with male sex (p=0.007) and level of hemoglobin (p=0.023). CONCLUSION: Thrombocytopenia is an infrequent event in NAFLD patients without cirrhosis and is related with male sex and higher hemoglobin levels.
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Enfermedad del Hígado Graso no Alcohólico/epidemiología , Trombocitopenia/epidemiología , Adulto , Anciano , Brasil/epidemiología , Femenino , Hemoglobinas/metabolismo , Humanos , Hígado/patología , Masculino , Persona de Mediana Edad , Enfermedad del Hígado Graso no Alcohólico/sangre , Enfermedad del Hígado Graso no Alcohólico/patología , Prevalencia , Estudios Retrospectivos , Factores Sexuales , Trombocitopenia/sangreRESUMEN
Introducción: la pseudotrombocitopenia inducida por EDTA (ácido etilendiamino tetraacético) es un fenómeno de aglutinación de plaquetas que se presenta in vitro, mediado por anticuerpos anti-plaquetarios de tipo IgG, IgA o IgM dirigidos contra el complejo glucoproteínico IIb/IIIa de la membrana plaquetaria. Caso clínico: presentamos un caso clínico de una paciente de 59 años de edad sometida a recambio valvular aórtico; clínicamente con evolución favorable durante el periodo posquirúrgico, sin embargo, en estudios de control se registra trombocitopenia severa, lo que llevo a cuestionar el uso de anticoagulantes y la necesidad de transfusión de plaquetas. Al realizar estudios complementarios se encontró agregados plaquetarios en el frotis de sangre periférica, posteriormente se realizó recuento seriado de plaquetas y comparación del histograma plaquetario, catalogando el caso como pseudotrombocitopenia. Conclusión: La trombocitopenia por agregados plaquetarios es una condición de baja incidencia (0.07% a 0.1%). Se debe a la agregación de plaquetas in vitro asociada al uso de anticoagulantes, frecuentemente etilendiaminotetraacético (EDTA), en el presente caso también se asoció al uso de citrato de sodio. Este problema no se asocia a sangrado, sin embargo su desconocimiento pudo haber llevado a realizar procedimientos diagnósticos y terapéuticos innecesarios
Introduction: EDTA (ethylenediamine tetraacetic acid) induced by pseudothrombocytopenia is a platelet agglutination phenomenon that occurs in vitro, which are mediated by anti-platelet antibodies of the IgG, IgA or IgM type directed against the glycoprotein complex IIb / IIIa of the platelet membrane . Clinical case: This is a clinical case of a 59-yearsold patient undergoing aortic valve replacement, clinically with a favorable evolution during the postoperative period, however, in control studies, severe thrombocytopenia was recorded, which led to questioning the use of anticoagulants and the need for platelet transfusion. When carrying out complementary studies, aggregated platelet were found in the peripheral blood smear, later, a serial platelet count and comparison of the platelet histogram were performed, classifying the case as pseudotrombocytopenia. Conclusion: Thrombocytopenia due to aggregated platelet is a low incidence condition (0.07% to 0.1%). It is due to the aggregation of platelets in vitro associated with the use of anticoagulants [frequently ethylenediamine tetra acetic (EDTA)]; in the present case it was also associated with the use of sodium citrate. This problem is not associated with bleeding; however its lack of knowledge leads to unnecessary diagnostic and therapeutic procedures.
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Humanos , Femenino , Persona de Mediana Edad , Trombocitopenia/diagnóstico , Trombocitopenia/etiología , Trombocitopenia/sangre , Agregación Plaquetaria/efectos de los fármacos , Ácido Edético/efectos adversos , Citrato de Sodio/efectos adversos , Anticoagulantes/efectos adversosRESUMEN
BACKGROUND Thrombocytopenia in malaria involves platelet destruction and consumption; however, the cellular response underlying this phenomenon has still not been elucidated. OBJECTIVE To find associations between platelet indices and unbalanced Th1/Th2/Th17 cytokines as a response to thrombocytopenia in Plasmodium vivax infected (Pv-MAL) patients. METHODS Platelet counts and quantification of Th1/Th2/Th17 cytokine levels were compared in 77 patients with uncomplicated P. vivax malaria and 37 healthy donors from the same area (endemic control group - ENCG). FINDINGS Thrombocytopenia was the main manifestation in 55 patients, but was not associated with parasitaemia. The Pv-MAL patients showed increases in the mean platelet volume (MPV), which may be consistent with larger or megaplatelets. Contrary to the findings regarding the endemic control group, MPV and platelet distribution width (PDW) did not show an inverse correlation, due the increase in the heterogeneity of platelet width. In addition, the Pv-MAL patients presented increased IL-1β and reduced IL-12p70 and IL-2 serum concentrations. Furthermore, the reduction of these cytokines was associated with PDW values. MAIN CONCLUSIONS Our data demonstrate that an increase in MPV and the association between reductions of IL-2 and IL-12 and PDW values may be an immune response to thrombocytopenia in uncomplicated P. vivax malaria.
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Humanos , Plasmodium vivax/inmunología , Trombocitopenia/patología , Trombocitopenia/sangre , Subgrupos Linfocitarios/inmunología , Malaria Vivax/inmunología , Malaria Vivax/patología , Trombocitopenia/parasitología , Interleucina-2/sangre , Malaria Vivax/parasitología , Malaria Vivax/sangre , Interleucina-12/sangreRESUMEN
OBJECTIVE: To analyze the behavior of platelets after transcatheter valve-in-valve implantation for the treatment of degenerated bioprosthesis and how they correlate with adverse events upon follow-up. METHODS: Retrospective analysis of 28 patients who received a valve-in-valve implant, 5 in aortic, 18 in mitral and 5 in tricuspid positions. Data were compared with 74 patients submitted to conventional redo valvular replacements during the same period, and both groups' platelet curves were analyzed. Statistical analysis was conducted using the IBM SPSS Statistics(r) 20 for Windows. RESULTS: All patients in the valve-in-valve group developed thrombocytopenia, 25% presenting mild (<150.000/µL), 54% moderate (<100.000/µL) and 21% severe (<50.000/µL) thrombocytopenia. The platelet nadir was on the 4th postoperative day for aortic ViV, 2nd for mitral and 3rd for tricuspid patients, with the majority of patients recovering regular platelet count. However, the aortic subgroup comparison between valve-in-valve and conventional surgery showed a statistically significant difference from the 7th day onwards, where valve-in-valve patients had more severe and longer lasting thrombocytopenia. This, however, did not translate into a higher postoperative risk. In our study population, postoperative thrombocytopenia did not correlate with greater occurrence of adverse outcomes and only normal preoperative platelet count could significantly predict a postoperative drop >50%. CONCLUSION: Although thrombocytopenia is an extremely common finding after valve-in-valve procedures, the degree of platelet count drop did not correlate with greater incidence of postoperative adverse outcomes in our study population.
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Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Complicaciones Posoperatorias/sangre , Complicaciones Posoperatorias/etiología , Trombocitopenia/sangre , Trombocitopenia/etiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Bioprótesis/efectos adversos , Femenino , Prótesis Valvulares Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/métodos , Humanos , Masculino , Persona de Mediana Edad , Válvula Mitral/cirugía , Recuento de Plaquetas/métodos , Valor Predictivo de las Pruebas , Valores de Referencia , Reoperación , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Estadísticas no Paramétricas , Factores de Tiempo , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversos , Resultado del Tratamiento , Válvula Tricúspide/cirugía , Adulto JovenRESUMEN
INTRODUCTION AND AIM: EVBL is a procedure frequently performed in cirrhotic patients for primary prophylaxis of bleeding. Patients with cirrhosis display various degrees of alteration of common coagulation parameters, and it is not known whether these alterations may predict post-EVBL bleeding. To evaluate factors predictive of post-endoscopic variceal band ligation (EVBL) bleeding in cirrhotic patients with thrombocytopenia. METHODS: We included 109 patients with cirrhosis undergoing EVBL for primary prophylaxis of variceal bleeding. Common coagulation parameters (INR, fibrinogen levels) and complete haemogram were obtained in all patients and evaluated subdividing patients in bleeders and non bleeders following EVBL. RESULTS: The incidence of post-EVBL bleeding was 5.5% (6 patients). INR and platelet counts, considered as continuous or dichotomous variables according to common cut-offs (i.e., INR>1.5, platelet count <50x109/L) were not predictors of post-EVBL bleeding. Patients who bled had significantly lower fibrinogen levels [146 mg/dL (98 - 262) versus 230 mg/dL (104 - 638), P=0.009], and no other biochemical or clinical predictors of bleeding were identified. A fibrinogen cut-off of 179 mg/dL had 98.6% negative predictive value for bleeding. CONCLUSION: low fibrinogen levels are associated with an increased risk of bleeding following prophylactic EVBL in cirrhotic patients, and might be used to stratify patients' risk. However, due to their preliminary nature, these findings need to be confirmed in larger populations.
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Endoscopía/efectos adversos , Várices Esofágicas y Gástricas/cirugía , Fibrinógeno/metabolismo , Hemorragia Gastrointestinal/prevención & control , Cirrosis Hepática/complicaciones , Hemorragia Posoperatoria/etiología , Trombocitopenia/etiología , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , Coagulación Sanguínea , Regulación hacia Abajo , Endoscopía/métodos , Várices Esofágicas y Gástricas/sangre , Várices Esofágicas y Gástricas/diagnóstico , Várices Esofágicas y Gástricas/etiología , Femenino , Hemorragia Gastrointestinal/sangre , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiología , Humanos , Relación Normalizada Internacional , Ligadura/efectos adversos , Cirrosis Hepática/sangre , Cirrosis Hepática/diagnóstico , Masculino , Persona de Mediana Edad , Recuento de Plaquetas , Hemorragia Posoperatoria/sangre , Hemorragia Posoperatoria/diagnóstico , Medición de Riesgo , Factores de Riesgo , Trombocitopenia/sangre , Trombocitopenia/diagnóstico , Factores de Tiempo , Resultado del TratamientoRESUMEN
Abstract Objective: To analyze the behavior of platelets after transcatheter valve-in-valve implantation for the treatment of degenerated bioprosthesis and how they correlate with adverse events upon follow-up. Methods: Retrospective analysis of 28 patients who received a valve-in-valve implant, 5 in aortic, 18 in mitral and 5 in tricuspid positions. Data were compared with 74 patients submitted to conventional redo valvular replacements during the same period, and both groups' platelet curves were analyzed. Statistical analysis was conducted using the IBM SPSS Statistics(r) 20 for Windows. Results: All patients in the valve-in-valve group developed thrombocytopenia, 25% presenting mild (<150.000/µL), 54% moderate (<100.000/µL) and 21% severe (<50.000/µL) thrombocytopenia. The platelet nadir was on the 4th postoperative day for aortic ViV, 2nd for mitral and 3rd for tricuspid patients, with the majority of patients recovering regular platelet count. However, the aortic subgroup comparison between valve-in-valve and conventional surgery showed a statistically significant difference from the 7th day onwards, where valve-in-valve patients had more severe and longer lasting thrombocytopenia. This, however, did not translate into a higher postoperative risk. In our study population, postoperative thrombocytopenia did not correlate with greater occurrence of adverse outcomes and only normal preoperative platelet count could significantly predict a postoperative drop >50%. Conclusion: Although thrombocytopenia is an extremely common finding after valve-in-valve procedures, the degree of platelet count drop did not correlate with greater incidence of postoperative adverse outcomes in our study population.
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Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Adulto Joven , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/sangre , Trombocitopenia/etiología , Trombocitopenia/sangre , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Recuento de Plaquetas/métodos , Valores de Referencia , Reoperación , Factores de Tiempo , Válvula Tricúspide/cirugía , Bioprótesis/efectos adversos , Prótesis Valvulares Cardíacas/efectos adversos , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento , Estadísticas no Paramétricas , Medición de Riesgo , Implantación de Prótesis de Válvulas Cardíacas/métodos , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversos , Válvula Mitral/cirugíaRESUMEN
OBJECTIVE: to evaluate plasma and salivary uracil (U) to dihydrouracil (UH2) ratios as tools for predicting 5-fluorouracil systemic exposure and drug-related severe toxicity, and clinically validate the use of dried saliva spots (DSS) as an alternative sampling strategy for dihydropyrimidine dehydrogenase (DPD) deficiency assessment. METHODS: Pre-chemotherapy plasma, fresh saliva and DSS samples were obtained from gastrointestinal patients (Nâ¯=â¯40) for measurement of endogenous U and UH2 concentrations by LC-MS/MS. A second plasma sample collected during 5FU infusion was used for 5FU area under the curve (AUC) determination by HPLC-DAD. Data on toxicity was reported according to CTCAE. RESULTS: 15% of the patients developed severe 5FU-related toxicity, with neutropenia accounting for 67% of the cases. U, UH2 and [UH2,]/[U] were highly correlated between fresh and dried saliva samples (rsâ¯=â¯0.960; rsâ¯=â¯0.828; rsâ¯=â¯0.910, respectively). 5FU AUC ranged from 11.3 to 37.31â¯mgâ¯hâ¯L-1, with 46.2% of under-dosed and 10.3% over-dosed patients. The [UH2]/[U] ratios in plasma, fresh saliva and dried saliva samples were moderately correlated with 5FU AUC and adverse events grade, indicating a partial contribution of the variables to drug exposure (râ¯=â¯-0.412, rsâ¯=â¯-0.373, rsâ¯=â¯0.377) and toxicity (râ¯=â¯-0.363, rsâ¯=â¯-0.523, rsâ¯=â¯0.542). Metabolic ratios were lower in patients with severe toxicity (Pâ¯<â¯.01 salivary ratios, and Pâ¯<â¯.5 plasma ratios), and 5FU AUC were in average 47% higher in this group than in moderate toxicity. The diagnostic performance of [UH2]/[U] ratios in fresh saliva and DSS for the identification of patients with severe toxicity were comparable. CONCLUSIONS: The [UH2]/[U] metabolic ratios in plasma, fresh saliva and DSS were significantly associated with 5FU systemic exposure and toxicity degree. This study also demonstrated the applicability of DSS as alternative sampling for evaluating DPD activity.
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Antimetabolitos Antineoplásicos/efectos adversos , Deficiencia de Dihidropirimidina Deshidrogenasa/diagnóstico , Dihidrouracilo Deshidrogenasa (NADP)/metabolismo , Fluorouracilo/efectos adversos , Neutropenia/inducido químicamente , Saliva/metabolismo , Uracilo/metabolismo , Adulto , Anciano , Anciano de 80 o más Años , Antimetabolitos Antineoplásicos/administración & dosificación , Antimetabolitos Antineoplásicos/farmacocinética , Biomarcadores/sangre , Biomarcadores/metabolismo , Biotransformación , Deficiencia de Dihidropirimidina Deshidrogenasa/sangre , Deficiencia de Dihidropirimidina Deshidrogenasa/complicaciones , Deficiencia de Dihidropirimidina Deshidrogenasa/metabolismo , Dihidrouracilo Deshidrogenasa (NADP)/sangre , Relación Dosis-Respuesta a Droga , Femenino , Fluorouracilo/administración & dosificación , Fluorouracilo/farmacocinética , Neoplasias Gastrointestinales/complicaciones , Neoplasias Gastrointestinales/tratamiento farmacológico , Humanos , Leucopenia/sangre , Leucopenia/inducido químicamente , Leucopenia/metabolismo , Leucopenia/fisiopatología , Masculino , Persona de Mediana Edad , Neutropenia/sangre , Neutropenia/metabolismo , Neutropenia/fisiopatología , Índice de Severidad de la Enfermedad , Caracteres Sexuales , Trombocitopenia/sangre , Trombocitopenia/inducido químicamente , Trombocitopenia/metabolismo , Trombocitopenia/fisiopatología , Uracilo/análogos & derivados , Uracilo/sangreRESUMEN
The complement system contributes to the pathogenesis of systemic lupus erythematosus (SLE). Mannose-binding lectin (MBL) is a key molecule of the lectin pathway of complement and seems to be related to the clinical manifestations of this disease. We evaluated the serum levels of MBL and its relationship with disease onset and clinical findings in SLE patients. Serum samples were analysed in 195 patients and 145 healthy controls from southern Brazil. Patients with high MBL levels (above 2000 ng/ml) showed a significant increase in the frequency of thrombocytopaenia ( p = 0.007; OR = 2.71; 95% CI = 1.32-5.55); and seizures ( p = 0.034; OR = 2.61; 95% CI = 1.07-6.37). A positive correlation between disease activity and MBL levels (>2000 ng/ml; p = 0.031, rho = 0.279) as well as of MBL concentration with accumulated organ damage ( p = 0.021; rho = 0.232) was observed. Our results suggest a role for MBL in the development of clinical manifestations such as thrombocytopaenia and seizures in SLE patients. These findings corroborate the participation of the lectin pathway of complement in the pathophysiologic mechanisms underlying clinical manifestations of SLE.
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Lupus Eritematoso Sistémico/sangre , Lupus Eritematoso Sistémico/complicaciones , Lectina de Unión a Manosa/sangre , Convulsiones/sangre , Trombocitopenia/sangre , Adulto , Brasil , Estudios de Casos y Controles , Complemento C3/metabolismo , Complemento C4/metabolismo , Femenino , Humanos , Modelos Logísticos , Masculino , Lectina de Unión a Manosa/genética , Persona de Mediana Edad , Convulsiones/etiología , Índice de Severidad de la Enfermedad , Trombocitopenia/etiologíaRESUMEN
The differential diagnosis of immune (ITP) and hereditary macrothrombocytopenia (HM) is key to patient management. The immature platelet fraction (IPF) represents the subset of circulating platelets with higher RNA content, and has been shown to distinguish hypo- from hyperproliferative thrombocytopenias. Here we evaluated the diagnostic accuracy of IPF in the differential diagnosis between HM and other thrombocytopenias in a population of patients with post-chemotherapy thrombocytopenia (n = 56), bone marrow failure (n = 22), ITP (n = 105) and HM (n = 27). TPO levels were also measured in HM and ITP matched for platelet counts. Platelet counts were similar in all patient groups. Higher IPF values were observed in both ITP (12.3%; 2.4-65.6%) and HM (29.8%; 4.6-65.9%) compared to hypoproliferative thrombocytopenias. IPF values were also higher in HM compared to ITP, yielding a diagnostic accuracy of 0.80 (95%CI 0.70-0.90; P < 0.0001) to distinguish these two conditions. Intra- and inter-assays reproducibility of IPF in HM patients revealed that this is a stable parameter. In conclusion, IPF is increased in HM compared to both ITP and other thrombocytopenias and contributes to the differentiation between ITP and HM. Further studies are warranted to understand the biological rationale of these findings and to its incorporation in diagnostic algorithms of HM.