Epidural analgesia in pregnant with deficit of factor VII.

The congenital deficit of FVII of coagulation it's an anomaly of genetic transmission autosomal recessive type, it can occur with clinical manifestations like hematomas and spontaneous bleeding or not. The normal levels of FVII it's found between 70%-130% of the laboratory reference value. For unknown reasons there is a poor correlation between levels of FVII and bleeding risk. During pregnancy coagulation can be significantly altered, there is a no clear consensus and a very few information about how to act during labor in a patient with a FVII deficit. The case of a 35-year-old patient with 35 weeks of gestation and congenital deficit of the coagulation FVII (36%) is presented, epidural analgesia is performed during labor previously administering activated recombinant FVII (rFVIIa) without complications (Spinal hematoma, postpartum bleeding, thrombosis).

Epidural analgesia in pregnant with deficit of factor VII. / Analgesia epidural en gestante con déficit del factor VII.

The congenital deficit of FVII of coagulation it's an anomaly of genetic transmission autosomal recessive type, it can occur with clinical manifestations like hematomas and spontaneous bleeding or not. The normal levels of FVII it's found between 70%-130% of the laboratory reference value. For unknown reasons there is a poor correlation between levels of FVII and bleeding risk. During pregnancy coagulation can be significantly altered, there is a no clear consensus and a very few information about how to act during labor in a patient with a FVII deficit. The case of a 35-year-old patient with 35 weeks of gestation and congenital deficit of the coagulation FVII (36%) is presented, epidural analgesia is performed during labor previously administering activated recombinant FVII (rFVIIa) without complications (Spinal hematoma, postpartum bleeding, thrombosis).

[Parvovirus B19 infection in patients with congenital blood coagulation disorders]. / Infección por Parvovirus B19 en pacientes afectados de coagulopatías congénitas.

BACKGROUND: The aim of this study is to assess the prevalence of Parvovirus B19 infection in a group of patients affected by congenital coagulation disorders and its association with epidemiological aspects. PATIENTS AND METHODS: We have analyzed a group of 50 patients (median age 28) diagnosed with haemophilia or any other congenital coagulation disorder and 111 healthy non-transfused controls (median age 30) for IgG and IgM antibodies to Parvovirus B19 (Dako A/S, Glostrup, Dinamarca). Other issues analysed were HIV coinfection, the use of virally inactivated or non-inactivated plasma products and clinical symptoms of the infection. RESULTS: 84% of the patients (93.3% of those previously transfused) and 60.3% of the controls subjects showed IgG antibodies against Parvovirus B19. None of them had specific IgM antibodies. Five patients (all of them seronegative) had never been exposed to any plasma derivative and 11 were HIV-positive. The differences found between the prevalence of parvoviral infection in patients and controls are statistically significant, but those differences are only confirmed in younger patients (< 30) when age groups are compared. However, the severity of the haemostatic disorder, the type of plasma products infused or HIV coinfection had no influence on prevalence rates. The infection was clinically asymptomatic in all the cases. CONCLUSIONS: Haemophilic patients of any age are exposed to a higher risk of Parvovirus B19 infection than general population, although this infection had no clinical relevance in our study. The use of virally inactivated factor concentrates or the severity of the haemostatic disorder has no influence on this infectious risk.

[Antiphospholipid antibodies in asymptomatic pediatric patients]. / Anticuerpos antifosfolípido en población pediátrica asintomática.

BACKGROUND: Findings of prolonged activated partial thromboplastin time (APTT) and lupus anticoagulant are rare in asymptomatic children and are often preceded by certain types of surgery. Clinical behaviour is usually favorable. PATIENTS AND METHODS: We assessed the biological and clinical features of antiphospholipid antibodies found in 13 children diagnosed between January 1996 and September 2000 (mean age at diagnosis: 5 years). The patients were prospectively followed-up for a median of 16 months (range: 15-60). The diagnosis of lupus anticoagulant was based on the guidelines of the International Society of Thrombosis and Hematosis and included coagulation-based assays as well as enzyme-linked immunosorbent assay for anticardiolipin and anti-beta 2 glycoprotein I. RESULTS: In all patients lupus anticoagulant was detected after investigation of prolonged APTT prior to surgery (adenoidectomy in eight patients, orchidopexy in one and eye surgery in one). The antibody was associated with infectious mononucleosis in one patient and was detected during routine laboratory investigations in two. All antibodies were primary and 53.6% of events were transient. In all patients lupus anticoagulant IgG and anti-beta 2 glycoprotein I were negative. Slightly reduced factor XII:C plasma concentrations (mean: 38.2 UI/dl) were found in 30.7% of the patients. No clinical manifestations of antiphospholipid symptoms were associated with the diagnosis of antiphospholipid antibodies and none of the patients experienced bleeding after surgery. CONCLUSIONS: Primary antiphospholipid antibodies were infrequent in asymptomatic pediatric patients and were typically associated with certain types of surgery (adenoidectomy, tonsillectomy) or viral infections. They were usually transient and clinically irrelevant. These antibodies may be associated with slightly reduced plasma concentrations of factor XII and consequently a differential diagnosis with a mild factor XII deficiency should be considered.

[Major thromboembolic complications during oral anticoagulant therapy. Importance of level of anticoagulation]. / Complicaciones tromboembólicas mayores durante el tratamiento con anticoagulantes orales. Importancia del nivel de anticoagulación.

PURPOSE: The incidence of major thromboembolic complications in patients on oral anticoagulant therapy (OAT) and the correlation of this with the intensity of the OAT and the INR level at the time of the episode have been assessed in our study. PATIENTS AND METHODS: We have carried out a retrospective study including 1350 patients with an overall follow-up period of 6432 patient-years. The mean INR level throughout OAT and at the time of the mayor thromboembolic event were considered. The statistical analysis was performed by means of a survival analysis test. RESULTS: The incidence of major thromboembolic complications found in our study was 1.18/100 patient-years. Those patients with a mean INR below the therapeutic range showed significantly a higher risk (3.31 times higher) of suffering from some sort of major thromboembolic complication. Mean INR level at the time of the event was 1.9 and 47% of those patients had an INR level < 2 at the time of the thromboembolic complication. CONCLUSIONS: The probability of suffering a major thromboembolic complication for those subjects on OAT increases as the INR falls below the therapeutic range; therefore we must pay special attention to this factor in order to avoid any further recurrences.