RESUMO
INTRODUCTION: Liver is most commonly affected in dengue often resulting in changes in the liver function test parameters. Alterations in hematological parameters are also reported which could serve as early prognostic markers especially in resource limited settings where serological tests for the diagnosis of dengue is not available. This study aims to analyze liver function test and hematological parameter changes in dengue infected patients. METHODS: A descriptive cross-sectional study was conducted from December 2022 to October 2023 in serologically dengue positive patients. Liver function parameters and blood parameters were analyzed from 220 patients. The purposive sampling technique was employed during the selection of participants. RESULTS: Out of 220 study participants, 113 (51.36%) were males and 107 (49.64%) were females. The median age of the participants was 35 years (IQR: 26 - 48 years). Elevated serum AST and ALT levels were present in 121 (55%) and 80 (36.36%) of the participants respectively. Thrombocytopenia and leukopenia were observed in 92 (41.82%) and 88 (40%) of the study participants respectively. The median hemoglobin level was 14.4 (IQR: 13-15.47) g/dl. Low hemoglobin level was found in 31 (14.09%) participants. The median red blood cell count was 4.91 (IQR: 4.49 - 5.28) millions/mm3 with decreased red blood cell count noted in 27 (12.27%) participants. CONCLUSIONS: Increased serum transaminases levels, thrombocytopenia and leukopenia are common laboratory findings in dengue patients.
Assuntos
Alanina Transaminase , Aspartato Aminotransferases , Dengue , Testes de Função Hepática , Centros de Atenção Terciária , Trombocitopenia , Humanos , Feminino , Dengue/sangue , Dengue/complicações , Dengue/fisiopatologia , Masculino , Estudos Transversais , Adulto , Pessoa de Meia-Idade , Testes de Função Hepática/métodos , Trombocitopenia/sangue , Trombocitopenia/epidemiologia , Alanina Transaminase/sangue , Aspartato Aminotransferases/sangue , Leucopenia/epidemiologia , Leucopenia/etiologia , Leucopenia/sangue , Hemoglobinas/análise , Hemoglobinas/metabolismo , Contagem de Eritrócitos , Fígado/fisiopatologiaRESUMO
Heparin-induced thrombocytopenia (HIT) was widely known as a disease characterized by development of thrombosis with thrombocytopenia after heparin exposure. In addition, vaccine-induced immune thrombotic thrombocytopenia (VITT) has been described as a fatal disease involving simultaneous bleeding and thrombosis after COVID-19 adenovirus vector vaccination. These were caused by HIT antibodies and anti-PF4 antibodies, respectively, but both were autoantibodies that recognized PF4, and were found to have the same pathology with different severities. In recent years, many pathologies in which anti-PF4 antibodies are produced have been reported, and a new concept of anti-PF4 disorder has been proposed. Anti-PF4 disorders are often difficult to identify due to their diverse range of causes, and the prognosis varies greatly depending on whether anti-PF4 antibodies can be measured and early treatment performed after observation of thrombocytopenia of unknown cause or thrombosis at an unusual site. To avoid overlooking anti-PF4 disorders, clinicians should become familiar with the classification of these disorders and accurately select the necessary tests.
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Heparina , Fator Plaquetário 4 , Trombocitopenia , Humanos , Trombocitopenia/terapia , Trombocitopenia/imunologia , Fator Plaquetário 4/imunologia , Heparina/efeitos adversos , Autoanticorpos/imunologia , Vacinas contra COVID-19/efeitos adversos , Vacinas contra COVID-19/imunologia , Vacinas contra COVID-19/administração & dosagem , COVID-19/imunologia , COVID-19/complicações , Trombose/etiologia , Trombose/imunologiaRESUMO
The ubiquitously expressed small GTPase Ras-related protein 1B (RAP1B) acts as a molecular switch that regulates cell signaling, cytoskeletal remodeling, and cell trafficking and activates integrins in platelets and lymphocytes. The residue G12 in the P-loop is required for the RAP1B-GTPase conformational switch. Heterozygous germline RAP1B variants have been described in patients with syndromic thrombocytopenia. However, the causality and pathophysiological impact remained unexplored. We report a boy with neonatal thrombocytopenia, combined immunodeficiency, neutropenia, and monocytopenia caused by a heterozygous de novo single nucleotide substitution, c.35G>A (p.G12E) in RAP1B. We demonstrate that G12E and the previously described G12V and G60R were gain-of-function variants that increased RAP1B activation, talin recruitment, and integrin activation, thereby modifying late responses such as platelet activation, T cell proliferation, and migration. We show that in our patient, G12E was a somatic variant whose allele frequency decreased over time in the peripheral immune compartment, but remained stable in bone marrow cells, suggesting a differential effect in distinct cell populations. Allogeneic hematopoietic stem cell transplantation fully restored the patient's hemato-immunological phenotype. Our findings define monoallelic RAP1B gain-of-function variants as a cause for constitutive immunodeficiency and thrombocytopenia. The phenotypic spectrum ranged from isolated hematological manifestations in our patient with somatic mosaicism to complex syndromic features in patients with reported germline RAP1B variants.
Assuntos
Mutação com Ganho de Função , Trombocitopenia , Proteínas rap de Ligação ao GTP , Humanos , Masculino , Substituição de Aminoácidos , Transplante de Células-Tronco Hematopoéticas , Síndromes de Imunodeficiência/genética , Mutação de Sentido Incorreto , Proteínas rap de Ligação ao GTP/genética , Proteínas rap de Ligação ao GTP/metabolismo , Trombocitopenia/genética , Trombocitopenia/patologia , Recém-Nascido , Lactente , Pré-Escolar , CriançaRESUMO
OBJECTIVE: To analyze the influencing factors of postoperative thrombocytopenia in critically ill patients with heart disease and construct a nomogram prediction model. METHODS: From October 2022 to October 2023, 319 critically ill patients with heart disease who visited our hospital were collected and separated into postoperative thrombocytopenia group (n = 142) and no postoperative thrombocytopenia group (n = 177) based on their postoperative thrombocytopenia, Logistic regression analysis was applied to screen risk factors for postoperative thrombocytopenia in critically ill patients with heart disease; R software was applied to construct a nomogram for predicting postoperative thrombocytopenia in critically ill patients with heart disease, and ROC curves, calibration curves, and Hosmer-Lemeshow goodness of fit tests were applied to evaluate nomogram. RESULTS: A total of 142 out of 319 critically ill patients had postoperative thrombocytopenia, accounting for 44.51%. Logistic regression analysis showed that gender (95% CI 1.607-4.402, P = 0.000), age ≥ 60 years (95% CI 1.380-3.697, P = 0.001), preoperative antiplatelet therapy (95% CI 1.254-3.420, P = 0.004), and extracorporeal circulation time > 120 min (95% CI 1.681-4.652, P = 0.000) were independent risk factors for postoperative thrombocytopenia in critically ill patients with heart disease. The area under the ROC curve was 0.719 (95% CI: 0.663-0.774). The slope of the calibration curve was close to 1, and the Hosmer-Lemeshow goodness of fit test was χ2 = 6.422, P = 0.491. CONCLUSION: Postoperative thrombocytopenia in critically ill patients with heart disease is influenced by gender, age ≥ 60 years, preoperative antiplatelet therapy, and extracorporeal circulation time > 120 min. A nomogram established based on above multiple independent risk factors provides a method for clinical prediction of the risk of postoperative thrombocytopenia in critically ill patients with heart disease.
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Estado Terminal , Cardiopatias , Nomogramas , Complicações Pós-Operatórias , Trombocitopenia , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Fatores de Risco , Cardiopatias/cirurgia , Medição de Risco/métodos , Idoso , Estudos Retrospectivos , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Curva ROCRESUMO
BACKGROUND: Thrombocytopenia is commonly observed in patients with sepsis and is an independent risk factor for poor prognosis. However, the changes of platelet count caused by different pathogens can vary significantly. Our study aims to evaluate the quantitative changes in platelet count in response to various pathogens. MATERIAL AND METHODS: We retrospectively analysed data of 3044 patients with sepsis from Medical Information Mart for Intensive Care (MIMIC, 2008-2019) database and prospectively collected data of 364 patients with sepsis from our local cohort of the Shandong Bloodstream Infection and Sepsis Collaboration Study (SBISC, 2020-2022). Propensity score matching (PSM) was employed to control for baseline differences in variables, except for the causative pathogen. RESULTS: Multivariate logistic analyses of both original and PSM populations identified Candida, Escherichia, Klebsiella, and Serratia species posing a higher risk for thrombocytopenia compared to others. Restricted cubic spline (RCS) curves showed L- or U-shaped associations between platelet count and 28-mortality with various cut-off values among different pathogens: ranging from 96 × 109/L in Candida species - 190 × 109/L in Klebsiella species. CONCLUSION: Our present findings indicate a pathogen-specific effect on platelet count, highlighting the importance of monitoring thrombocytopenia in patients infected with above microorganisms. Clinicians need to consider pathogen-specific thresholds when intervene on platelet count.
This study validated the differential incidence of thrombocytopenia among various pathogens within two distinct populations.Candida, Escherichia, Klebsiella, and Serratia species were identified as having a notably higher risk of causing thrombocytopenia compared to other pathogens.We observed L- or U-shaped relationships between platelet counts and 28-day mortality in Candida species, Enterococcus species, Escherichia species, Enterobacter species, Staphylococcus species, and Klebsiella species with platelet count cutoff values of 96 × 109/L, 100 × 109/L, 100 × 109/L, 146 × 109/L, 152 × 109/L, and 190 × 109/L, respectively.
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Sepse , Trombocitopenia , Humanos , Masculino , Feminino , Sepse/sangue , Sepse/microbiologia , Estudos Retrospectivos , Contagem de Plaquetas , Pessoa de Meia-Idade , Trombocitopenia/sangue , Trombocitopenia/microbiologia , Idoso , Estudos Prospectivos , Klebsiella/isolamento & purificação , Fatores de Risco , Candida/isolamento & purificação , Serratia/isolamento & purificação , Pontuação de PropensãoRESUMO
BACKGROUND: Chimeric antigen receptor (CAR)-T therapy has emerged as a promising treatment for hematologic malignancies. However, cytopenia remains one of the most frequent and challenging adverse effects of this therapy. METHODS: We conducted a retrospective analysis of 26 patients with relapsed/refractory aggressive B-cell lymphoma who received CAR-T therapy at our center. Subsequently, to investigate measures to address cytopenias following CAR-T therapy, we isolated and generated murine CAR-T cells and bone marrow-derived mesenchymal stem cells (MSCs), establishing a murine syngeneic CAR-T therapy model. We assessed the impact of MSC infusion on hematopoietic recovery post-CAR-T therapy by evaluating complete blood count, bone marrow hematopoietic stem cells and their subpopulations, bone marrow histomorphology, and hematopoiesis-related genes. RESULTS: All patients experienced cytopenias to varying degrees, with complete lineage involvement in half of the patients. Grade ≥ 3 cytopenias were observed in 88.46% of the patients. CAR-T therapy was associated with a higher incidence of biphasic, late-onset, or prolonged cytopenias. Survival analysis indicated that neutropenia and lymphopenia tended to be associated with better prognosis, whereas thrombocytopenia tended to be related to poorer outcomes. Through animal experiments, we discovered that MSCs infusion boosted HSCs and their long-term subpopulations, enhancing hematopoietic recovery, particularly in the megakaryocyte lineage, and mitigating bone marrow damage. Importantly, both in vitro and in vivo experiments demonstrated that MSCs did not compromise the activity or antitumor efficacy of CAR-T cells. CONCLUSIONS: Our findings propose MSCs infusion as a promising strategy to address cytopenias, particularly thrombocytopenia, after CAR-T therapy. This approach could help overcome certain limitations of cellular immunotherapy by enhancing hematopoietic recovery without compromising the efficacy of CAR-T cells. HIGHLIGHTS: 1 Cytopenia is a frequently observed adverse effect following CAR-T therapy, and it is often characterized by biphasic and prolonged patterns. 2 MSCs play a critical role in promoting hematopoietic recovery and mitigating bone marrow damage in a murine model of CAR-T therapy 3 The activity and antitumor efficacy of CAR-T cells were not impaired by MSCs.
Assuntos
Imunoterapia Adotiva , Transplante de Células-Tronco Mesenquimais , Células-Tronco Mesenquimais , Receptores de Antígenos Quiméricos , Animais , Humanos , Camundongos , Masculino , Feminino , Pessoa de Meia-Idade , Imunoterapia Adotiva/métodos , Imunoterapia Adotiva/efeitos adversos , Células-Tronco Mesenquimais/citologia , Células-Tronco Mesenquimais/metabolismo , Adulto , Transplante de Células-Tronco Mesenquimais/métodos , Receptores de Antígenos Quiméricos/metabolismo , Idoso , Estudos Retrospectivos , Trombocitopenia/terapia , Hematopoese , Linfoma de Células B/terapia , Células-Tronco Hematopoéticas/metabolismo , Células-Tronco Hematopoéticas/citologia , Neutropenia/terapia , CitopeniaRESUMO
BACKGROUND: Malaria is an intravascular parasitic-related blood disease that causes bleeding, coagulopathy, and thrombocytopenia. However, limited data shows the effect of Plasmodium species infection on basic coagulation parameters and platelet count. Thus, this study aimed to assess basic coagulation parameters and platelet count among malaria patients. METHOD: A cross-sectional study was conducted among 240 study participants (120 cases and 120 controls) from June 1, 2021, to February 30, 2022. A convenient sampling technique was employed to select study participants. The blood sample was collected by a trained laboratory technologist for platelet counts, prothrombin time (PT), partial thromboplastin time (PTT), international normalization ratio (INR), blood film, and serological testing. The collected data were analyzed in SPSS version 23. Data were analyzed by the Mann-Whitney U test, Kruskal Wallis H, and Spearman's rank-order correlation tests. Descriptive findings were presented through median, tables, and chart. In all cases, a P-value < 0.05 was considered statistically significant. RESULTS: The percentage of mild, moderate, and high malaria parasitemia levels per microliter of blood was 21.7%, 20%, and 58.3%, respectively. The overall median malaria parasitemia was 10,304 per microliter of blood. Among malaria patients, 77.5%, 61.7%, and 51.7% had prolonged PT, INR, and APTT, respectively as compared to control. Moreover, 26.7% of Plasmodium-infected participants had mild thrombocytopenia as compared to the control group (P < 0.001). CONCLUSION: The value of PT, APTT, and INR were significantly elevated, whereas the level of platelet count was inversely reduced when the malaria parasitemia level increased as compared to controls (p < 0.001).
Assuntos
Parasitemia , Humanos , Etiópia/epidemiologia , Masculino , Estudos Transversais , Feminino , Contagem de Plaquetas , Adulto , Adolescente , Parasitemia/sangue , Parasitemia/parasitologia , Adulto Jovem , Pessoa de Meia-Idade , Coagulação Sanguínea , Malária/sangue , Malária/epidemiologia , Tempo de Tromboplastina Parcial , Trombocitopenia/sangue , Trombocitopenia/epidemiologia , Criança , Tempo de Protrombina , Estudos de Casos e ControlesRESUMO
BACKGROUND: Nintedanib is a primary antifibrosing medication available for idiopathic pulmonary fibrosis, systemic sclerosis-interstitial lung disease, and progressive pulmonary fibrosis, with scattered report of drug-induced thrombocytopenia. CASE REPORT: A 60-year-old Asian male with no history of thrombocytopenia was administered with nintedanib to treat progressive pulmonary fibrosis. The platelet count dropped rapidly after introduction of nintedanib and resolved gradually by withdrawal of the medication along with thrombopoietin receptor agonist. CONCLUSION: Based on experience from the limited reports, nintedanib-induced thrombocytopenia is typically reversible and manageable. Close monitoring of platelet counts in patients receiving this medication should be warranted.
Assuntos
Indóis , Trombocitopenia , Humanos , Masculino , Indóis/efeitos adversos , Indóis/uso terapêutico , Trombocitopenia/induzido quimicamente , Pessoa de Meia-Idade , Fibrose Pulmonar/induzido quimicamente , Fibrose Pulmonar/tratamento farmacológico , Contagem de Plaquetas , Fibrose Pulmonar Idiopática/tratamento farmacológicoRESUMO
The present study evaluated the rational prescription of linezolid, the prevalence of thrombocytopenia, and major drug interactions in patients with cardiovascular diseases. We conducted a retrospective cross-sectional study on linezolid-treated patients at Shahid Chamran Heart Hospital in Isfahan from March 21, 2021, to March 20, 2022. Our research involved 132 patients who received linezolid. We reported 43.18% of linezolid prescriptions as irrational. Linezolid-induced thrombocytopenia is more common than previous studies, with a prevalence of 47.9%. We found a significant relationship between thrombocytopenia and the concomitant use of aspirin. The duration of treatment was identified as predicting factor for linezolid-induced thrombocytopenia. Moreover, the prevalence of interactions in the X and D categories was determined. Serotonergic and catecholamine medications were associated with 56.1% and 47.7% medication interactions, respectively. Our study found a high prevalence of linezolid-induced thrombocytopenia among patients with cardiovascular diseases. Based on this study, physicians should focus more closely on prescribing linezolid to patients with cardiovascular diseases. In addition to following rational antibiotic use, this susceptible group is also at an elevated risk of side effects (thrombocytopenia) and medication interactions.
Assuntos
Antibacterianos , Doenças Cardiovasculares , Interações Medicamentosas , Linezolida , Trombocitopenia , Humanos , Linezolida/efeitos adversos , Trombocitopenia/induzido quimicamente , Trombocitopenia/epidemiologia , Doenças Cardiovasculares/tratamento farmacológico , Masculino , Feminino , Estudos Retrospectivos , Estudos Transversais , Pessoa de Meia-Idade , Idoso , Prevalência , Antibacterianos/efeitos adversos , AdultoRESUMO
Congenital thrombocytopenia/platelet disorders are heterogeneous disorders of platelet number and/or function. Pathogenic variants in the genes implicated in megakaryocyte differentiation and platelet formation cause thrombocytopenia in these patients. Recent advances have elucidated several causative genes for these disorders, but identifying the underlying causative genes remains challenging. Patients with these disorders often receive inappropriate treatments, including glucocorticoids and splenectomy, for chronic immune thrombocytopenia (ITP). In Japan, we have developed a diagnostic system using high-throughput DNA sequencing with a multigene panel and established a registry. Between 2018 and 2023, 245 patients were enrolled and analyzed. Pathogenic variants in 17 genes (42 MYH9, 19 ANKRD26, 17 ITGA2B/ITGB3, 8 ACTN1, 8 WAS, 6 ETV6, 6 VWF, 5 CYCS, and 14 others) were identified in 125 patients (51.0%). An additional 29 patients (11.8%) had suspected pathogenic variants under investigation. We also found that immature platelet fraction (IPF%) is useful in the differential diagnosis because the median IPF% in MYH9 disorders, 48.7%, was significantly higher than in all other groups (chronic ITP, 13.4%; controls, 2.6%). The results of this study provide new insight into congenital thrombocytopenia/platelet disorders.
Assuntos
Sequenciamento de Nucleotídeos em Larga Escala , Sistema de Registros , Trombocitopenia , Humanos , Trombocitopenia/genética , Trombocitopenia/diagnóstico , Trombocitopenia/congênito , Transtornos Plaquetários/genética , Transtornos Plaquetários/diagnóstico , Transtornos Plaquetários/congênito , PlaquetasRESUMO
INTRODUCTION: This single-center, observational cohort study aimed to investigate the risk factors associated with linezolid-induced hematological toxicity by analyzing the linezolid trough concentration (Cmin) obtained from patients undergoing treatment between January 2020 and December 2021. METHODOLOGY: A total of 111 eligible individuals were included in the study, of which 47 were diagnosed with linezolid-induced thrombocytopenia and 18 were diagnosed with linezolid-induced hemoglobin decrease. RESULTS: Binary logistic regression analysis revealed that creatinine clearance level (Ccr) < 50 mL/min/1.73 m2 (OR, 5.463; 95% CI, 1.249-23.888, p = 0.024) and Cmin > 7 mg/L (OR, 62.660; 95% CI, 14.293-274.708, p = 0.001) were risk factors associated with linezolid-induced thrombocytopenia. Area under the ROC curve for Cmin was 0.955, with a maximum Youden index of 0.837. The corresponding critical value was 6.94 mg/L (sensitivity 91.5%; specificity 92.2%). Ccr < 50 mL/min/1.73 m2 (OR, 7.282; 95% CI, 1.765-30.048, p = 0.006) and Cmin > 7mg/L (OR, 6.364; 95% CI, 1.937-20.910, p = 0.020) were found to be associated with linezolid-induced hemoglobin reduction. The area under the ROC curve for Cmin was 0.755, Youden index was 0.477 at the maximum, and the corresponding critical value was 7.53 mg/L (sensitivity 77.8%; specificity 69.9%). CONCLUSIONS: Renal insufficiency is a related risk factor for linezolid-induced hematological toxicity. Patients receiving linezolid treatment should be closely monitored with blood routine and plasma concentration, particularly in patients with moderate or severe renal insufficiency. The plasma trough concentration of linezolid could be a suitable predictor for linezolid-induced thrombocytopenia and anemia.
Assuntos
Antibacterianos , Linezolida , Trombocitopenia , Humanos , Linezolida/efeitos adversos , Masculino , Estudos Retrospectivos , Feminino , Pessoa de Meia-Idade , Fatores de Risco , Trombocitopenia/induzido quimicamente , Antibacterianos/efeitos adversos , Idoso , Adulto , Idoso de 80 Anos ou maisRESUMO
INTRODUCTION: This work aim to evaluate the association of procalcitonin (PCT) levels with disease severity and prognosis in severe fever with thrombocytopenia syndrome (SFTS) patients. METHODOLOGY: The medical records of 158 confirmed SFTS patients at two hospitals were reviewed. The patients were divided into survival group and nonsurvival group according to outcomes. Additionally, to assess mortality rates at different PCT levels, patients were divided into two groups, PCT < 0.25 ng/mL and PCT ≥ 0.25 ng/mL. RESULTS: Among the 158 confirmed SFTS patients, 26 died; the case fatality rate was 16.46%. PCT data were available for 132 of these patients; 66 were in the PCT < 0.25 ng/mL group, and 66 were in the PCT ≥ 0.25 ng/mL group. The SFTS patients had abnormal results on routine blood tests, indicating varying degrees of thrombocytopenia and leukopenia, and most patients presented with multiple organ dysfunction. The PCT level of the nonsurvival group was significantly higher than that of the survival group (p < 0.01). Additionally, the mortality of the PCT ≥ 0.25 ng/mL group was significantly higher than that of the PCT < 0.25 ng/mL group (p < 0.01); mortality increased sharply ( ≥ 25%) when the PCT level exceeded 0.1 ng/mL. CONCLUSIONS: PCT levels in SFTS patients are closely related to the severity and prognosis of their illness. The serum PCT level is a promising predictor of mortality and severity in SFTS patients when considered in combination with clinical data and other laboratory tests.
Assuntos
Calcitonina , Pró-Calcitonina , Febre Grave com Síndrome de Trombocitopenia , Humanos , Masculino , Feminino , Estudos Retrospectivos , Febre Grave com Síndrome de Trombocitopenia/sangue , Febre Grave com Síndrome de Trombocitopenia/mortalidade , Febre Grave com Síndrome de Trombocitopenia/diagnóstico , China/epidemiologia , Pessoa de Meia-Idade , Pró-Calcitonina/sangue , Idoso , Calcitonina/sangue , Adulto , Prognóstico , Idoso de 80 Anos ou mais , Índice de Gravidade de Doença , Precursores de Proteínas/sangue , Análise de Sobrevida , Trombocitopenia/sangue , Peptídeo Relacionado com Gene de CalcitoninaRESUMO
The study aims to evaluate the prognosis and risk factors of sepsis-associated thrombocytopenia (SAT) among patients with coagulopathy, and to provide evidence of the relationship between adverse outcomes and potential risks. Patients with sepsis-associated coagulopathy were included in the study from January 2014 to December 2022. The primary outcome was sepsis-associated thrombocytopenia (platelet count less than 100 *109/L), which was evaluated by logistic regression models adjusted for demographic characteristics and comorbidities. Among patients in the SAT group, 54% developed severe SAT, while 16% of these patients recovered from thrombocytopenia. The in-hospital mortality rate was significantly higher in the SAT group compared to the non-SAT group (31% in SAT group vs 23.9% in non-SAT group, p = 0.029). Even after adjusting for age, gender, Charlson comorbidity, white blood cell, and Sequential Organ Failure Assessment score, the differences in mortality rate persisted (Odds Ratio 0.72, [95% Confidence Interval 0.52-0.92]). Correlation analyses revealed that prothrombin time (r = 0.08, p = 0.50), international normalized ratio (r = 0.08, p = 0.42), prothrombin activity (r = -0.06, p > 0.999), D-dimer (r = -0.02, p > 0.999), and inflammatory parameters such as C-reactive protein (r = -0.11, p = 0.37) were not significantly correlated with platelet counts. According to subgroup analyses, patients with lung infection complicated by SAT had slightly higher mortality (OR 0.66, [95% CI, 0.46 to 0.94]). Sepsis-associated coagulopathy indicates a subset of critical ill patients, with those experiencing thrombocytopenia at greater risk for in-hospital death compared to those without it.
Assuntos
Transtornos da Coagulação Sanguínea , Sepse , Trombocitopenia , Humanos , Sepse/complicações , Sepse/mortalidade , Sepse/sangue , Masculino , Feminino , Fatores de Risco , Trombocitopenia/sangue , Idoso , Pessoa de Meia-Idade , Transtornos da Coagulação Sanguínea/etiologia , Transtornos da Coagulação Sanguínea/sangue , Transtornos da Coagulação Sanguínea/mortalidade , Mortalidade HospitalarRESUMO
Gastric cancer primarily metastasizes to the peritoneum, liver and lungs, with bone marrow involvement being a rare occurrence, found in less than 1% of cases. Disseminated carcinomatosis of the bone marrow (DCBM) is characterised by widespread infiltration of cancer cells into the bone marrow, leading to haematological disorders such as disseminated intravascular coagulation and thrombocytopenia. We present a unique case of a man in his late 50s with acute thrombocytopenia as the initial symptom, subsequently diagnosed with gastric cancer on bone marrow examination. Despite receiving chemotherapy, the patient's condition deteriorated rapidly, emphasising the challenging management and poor prognosis associated with DCBM. This case underscores the need for improved diagnostic strategies and therapeutic approaches to enhance patient outcomes in DCBM associated with gastric cancer.
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Adenocarcinoma , Neoplasias da Medula Óssea , Neoplasias Gástricas , Humanos , Masculino , Neoplasias Gástricas/patologia , Neoplasias Gástricas/secundário , Neoplasias da Medula Óssea/secundário , Adenocarcinoma/secundário , Adenocarcinoma/patologia , Pessoa de Meia-Idade , Evolução Fatal , Medula Óssea/patologia , TrombocitopeniaRESUMO
In 2017, diphtheria outbreaks occurred in several provinces in Indonesia; however, the epidemiological data in the country is limited. The aim of this study was to determine the association between clinical findings and laboratory parameters associated with mortality of children with diphtheria. A retrospective cohort study was conducted at Haji Adam Malik General Hospital, Medan, Indonesia, covering diphtheria patients from January 2020 to December 2023. All patients aged 1-18 years clinically diagnosed with diphtheria were considered eligible. The associations between demographic characteristics, clinical features, immunization status, complications, and laboratory profiles with mortality were determined using Fisher's exact test, and the odds ratio (OR) with a 95% confidence interval (95%CI) was calculated. Our data indicated that the clinical characteristics of myocarditis (p=0.005) and airway obstruction (p=0.003) were associated with mortality. There was also a significant association between thrombocytopenia (p=0.020) and mortality in diphtheria patients. Patients with airway obstruction were 13 times more likely to have an increase in mortality compared to patients without airway obstruction. This study highlights that clinical and laboratory characteristics could be associated with in-hospital mortality of diphtheria cases, and therefore, pediatricians should be aware of the presence of those characteristics to prevent the mortality of the patients.
Assuntos
Difteria , Mortalidade Hospitalar , Humanos , Difteria/mortalidade , Difteria/epidemiologia , Masculino , Feminino , Criança , Pré-Escolar , Lactente , Estudos Transversais , Adolescente , Estudos Retrospectivos , Indonésia/epidemiologia , Miocardite/mortalidade , Miocardite/epidemiologia , Obstrução das Vias Respiratórias/mortalidade , Obstrução das Vias Respiratórias/epidemiologia , Trombocitopenia/mortalidade , Trombocitopenia/epidemiologiaRESUMO
BACKGROUND: Immune thrombocytopenia (ITP) and Evans syndrome (ES) are manifestations of immune dysregulation. Genetic variants in immune-related genes have been identified in patients with ITP and especially ES. We aimed to explore familial autoimmunity in patients with ITP and ES to understand possible contributions to chronicity. PROCEDURE: We assessed family history in two ways: via patient report for ITP and ES and by population-based analysis using the Utah Population Database (UPDB) for ITP. A total of 266 patients with ITP and 21 patients with ES were identified via chart review, and 252 of the 266 patients with ITP were also identified in the UPDB. RESULTS: Chart review showed familial autoimmunity in 29/182 (15.9%) and 25/84 (29.8%) of patients with newly diagnosed+persistent (nd+p) ITP and chronic ITP (cITP), respectively, (p = .009). The UPDB analysis revealed that autoimmunity in relatives of patients with nd+pITP was higher than in relatives of controls (odds ratio [OR]: 1.69 [1.19-2.41], p = .004), but was not significantly increased in relatives of patients with cITP (OR 1.10 [0.63-1.92], p = .734). Incomplete family history in medical records likely contributed to the observed discrepancy. CONCLUSIONS: The findings suggest that familial autoimmunity may have a stronger association with the development of ITP rather than its duration. Twelve (57.1%) patients with ES reported autoimmunity in their relatives. UPDB analysis was omitted due to the small number of patients with ES. The use of population databases offers a unique opportunity to assess familial health and may provide clues about contributors to immune dysregulation features within families.
Assuntos
Anemia Hemolítica Autoimune , Autoimunidade , Púrpura Trombocitopênica Idiopática , Trombocitopenia , Humanos , Anemia Hemolítica Autoimune/imunologia , Anemia Hemolítica Autoimune/epidemiologia , Anemia Hemolítica Autoimune/genética , Feminino , Masculino , Púrpura Trombocitopênica Idiopática/imunologia , Púrpura Trombocitopênica Idiopática/genética , Púrpura Trombocitopênica Idiopática/epidemiologia , Criança , Pré-Escolar , Trombocitopenia/imunologia , Trombocitopenia/genética , Adolescente , Lactente , Adulto , Adulto Jovem , Fatores de Risco , Pessoa de Meia-IdadeRESUMO
Chemotherapy-induced thrombocytopenia (CIT) is a common challenge of cancer therapy and can lead to chemotherapy dose reduction, delay, and/or discontinuation, affecting relative dose intensity, and possibly adversely impacting cancer care. Besides changing anticancer regimens, standard management of CIT has been limited to platelet transfusions and supportive care. Use of the thrombopoietin receptor agonist romiplostim, already approved for use in immune thrombocytopenia, has shown promising signs of efficacy in CIT. In a phase 2 prospective randomized study of solid tumor patients with platelet counts <100 × 109/L for ≥4 weeks due to CIT, weekly romiplostim corrected the platelet count to >100 × 109/L in 93% (14/15) of patients within 3 weeks versus 12.5% (1/8) of untreated patients (p < 0.001). Including patients treated with romiplostim in an additional single-arm cohort, 85% (44/52) of all romiplostim-treated patients responded with platelet count correction within 3 weeks. Several retrospective studies of CIT have also shown responses to weekly romiplostim, with the largest study finding that poor response to romiplostim was predicted by tumor invasion of the bone marrow (odds ratio, 0.029; 95% CI: 0.0046-0.18; p < 0.001), prior pelvic irradiation (odds ratio, 0.078; 95% CI: 0.0062-0.98; p = 0.048), and prior temozolomide treatment (odds ratio 0.24; 95% CI: 0.061-0.96; p = 0.043). Elsewhere, lower baseline TPO levels were predictive of romiplostim response (p = 0.036). No new safety signals have emerged from romiplostim CIT studies. Recent treatment guidelines, including those from the National Comprehensive Cancer Network, now support consideration of romiplostim use in CIT. Data are expected from two ongoing phase 3 romiplostim CIT trials.
Assuntos
Antineoplásicos , Receptores Fc , Proteínas Recombinantes de Fusão , Trombocitopenia , Trombopoetina , Humanos , Receptores Fc/uso terapêutico , Trombopoetina/uso terapêutico , Trombopoetina/efeitos adversos , Proteínas Recombinantes de Fusão/uso terapêutico , Proteínas Recombinantes de Fusão/efeitos adversos , Proteínas Recombinantes de Fusão/administração & dosagem , Trombocitopenia/tratamento farmacológico , Trombocitopenia/induzido quimicamente , Antineoplásicos/efeitos adversos , Antineoplásicos/uso terapêutico , Neoplasias/tratamento farmacológico , Contagem de Plaquetas , Receptores de Trombopoetina/agonistas , Resultado do TratamentoRESUMO
Sinusoidal obstruction syndrome (SOS) is a life-threatening complication of hematopoietic stem cell transplantation (HSCT), whose diagnostic criteria changed over time to achieve a timelier diagnosis. Recently, pediatric-specific criteria presented by the European Society for Blood and Marrow Transplantation (pEBMT) incorporated transfusion-refractory thrombocytopenia (RT) as an early indicator of SOS in children. However, a comparison of all individual diagnostic parameters belonging to pEBMT and former SOS diagnostic criteria has never been performed. This retrospective study conducted at a pediatric tertiary care hospital analyzed all pediatric HSCT cases diagnosed with SOS among 170 children transplanted from 2009 to 2023. Eleven patients developed SOS during this period (incidence: 11/170, 6.5%). pEBMT, Seattle, and Baltimore criteria were retrospectively applied to the 11 cases and compared, showing that RT was the earliest fulfilled parameter (median onset: 6 d post-HSCT). pEBMT and Seattle criteria identified 11/11 SOS cases, with pEBMT leading to an earlier diagnosis. RT typically manifested before diagnosis, with significantly higher platelet transfusion requirements before diagnosis than after. RT is the earliest satisfied criterion in pediatric SOS and typically occurs in the initial stages of the disease before diagnosis. Further research is needed to identify additional early indicators of pediatric SOS.
Assuntos
Transplante de Células-Tronco Hematopoéticas , Hepatopatia Veno-Oclusiva , Trombocitopenia , Humanos , Criança , Hepatopatia Veno-Oclusiva/diagnóstico , Hepatopatia Veno-Oclusiva/etiologia , Estudos Retrospectivos , Trombocitopenia/diagnóstico , Trombocitopenia/terapia , Masculino , Feminino , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Pré-Escolar , Adolescente , LactenteRESUMO
Clozapine is the most effective medication for the management of treatment-resistant schizophrenia and schizoaffective disorder, and its discontinuation can pose significant challenges in treatment. We present a patient with a diagnosis of schizoaffective disorder who was stable on clozapine for a decade until discontinuation due to thrombocytopenia. She experienced a relapse of her illness, presenting with psychotic and catatonic features with poor oral intake and physical health complications requiring a lengthy admission to the hospital. There was a poor response to alternative antipsychotics and a full course of electroconvulsive therapy. Intramuscular (IM) clozapine was initiated due to catatonia and refusal to accept oral medications. After receiving 10 doses of IM clozapine, she started accepting oral clozapine and made a full recovery within a few weeks. The low platelet count was persistent, and a bone marrow biopsy showed results consistent with immune thrombocytopenia being the cause of that low platelet count.