Thrombocytopenia and anaphylaxis secondary to heparin in a hemodialysis patient.

AIMS: We describe a rare case of anaphylaxis and thrombocytopenia whose cause was heparin used during hemodialysis sessions. CASE REPORT: A 77-year-old woman suffered five consecutive episodes of vomiting, tachypnea, wheezing or rales, immediately after initiating hemodialysis. In the first of these episodes, arterial pressure was undetectable. In all of the episodes there was evidence of the presence of hypoxia (always below 60 mmHg) and thrombocytopenia (always below l00,000/microl,, with partial platelets recovery among episodes. The episodes started immediately after hemodialysis sessions and heparin infusion; either sodium heparin or enoxaparin was used. Utilization of different filters was not able to stop the episodes. These were stopped when a switch from heparin to hirudin was tested. Tryptase levels, as a marker of mast cells activation and anaphylaxis, were not increased in two of the episodes which were assessed. IgG antibodies against heparin-PF4 complex was detected at high levels. DISCUSSION: A diagnosis of concomitant anaphylaxis and thrombocytopenia caused by sodium heparin and a low-molecular weight heparin (enoxaparin) were assumed.

Iron depletion by phlebotomy with recombinant erythropoietin prior to allogeneic transplantation to prevent liver toxicity.

Iron overload may induce liver toxicity after hematopoietic stem cell transplantation (HSCT), but it is not known if iron depletion prior to HSCT can reduce the risk of severe toxicity in this setting. We used subcutaneous recombinant erythropoietin (EPO) (25 UI/kg) three times a week and phlebotomy once a week, to prevent liver toxicity in a patient with advanced acute leukemia and liver disease due to severe iron overload, previous drug toxicity and hepatitis C viral infection. Over the 9 months prior to allogeneic HSCT, 34 phlebotomies were carried out. Serum ferritin dropped from 2964 to 239 microg/l and the ALT dropped to near normal values. At allogeneic HSCT no liver toxicity was observed, suggesting that iron depletion in the pretransplant period may contribute to reducing transplant-related toxicity in selected cases.

[Vascular risk factors in patients with ischaemic stroke. Distribution according to age, sex and stroke subtype]. / Factores de riesgo vascular en pacientes con ictus isquémico. Distribución según edad, sexo y subtipo de ictus.

INTRODUCTION: Cardiovascular diseases are one of the leading health problems in developed countries. This term covers conditions such as coronary vascular disease, cerebrovascular diseases and peripheral vascular disease. Ischaemic cerebrovascular disease accounts for 80% of all cerebrovascular diseases. From a clinical point of view it is interesting to distinguish between modifiable and non-modifiable vascular risk factors. AIM: To analyse the prevalence of modifiable vascular risk factors and their different combinations in a case-control study on ischaemic cerebrovascular disease in the Spanish population, and also the differences in the distribution of the risk factors according to the type of stroke (TOAST classification), age and sex. SUBJECTS AND METHODS: The study was conducted on 308 patients with ischaemic stroke who were paired by age (+/- 5 years) and sex, with 307 controls with no prior history of thrombosis. The statistical analysis was performed using the software application SAS v. 9.1. RESULTS: The results suggest that the risk factors are subject to an adding effect, as well as pointing to the presence of a specific profile of these factors depending on the subtype of stroke that is developed. CONCLUSION: The addition of cardiovascular risk factors is associated with an increased risk of vascular events. The distribution of the modifiable vascular risk factors differs according to the type of stroke and the patient's sex and age.

Factores de riesgo vascular en pacientes con ictus isquémico. Distribución según edad, sexo y subtipo de ictus / Vascular risk factors in patients with ischaemic stroke distribution according to age, sex and stroke subtype

Las enfermedades cardiovasculares constituyen uno de los principales problemas de salud en los paísesdesarrollados. Esta entidad engloba la patología vascular coronaria, las enfermedades cerebrovasculares y la patología vascular periférica. La enfermedad cerebrovascular isquémica supone el 80% de las enfermedades cerebrovasculares. Desdeun punto de vista clínico, es interesante diferenciar los factores de riesgo vascular modificables de los no modificables. Objetivo. Analizar la prevalencia de factores de riesgo vascular modificables y sus distintas combinaciones en un estudio de casos y controles en enfermedad cerebrovascular isquémica en población española, así como las diferencias en la distribución de los factores de riesgo según el tipo de ictus (clasificación TOAST), edad y sexo. Sujetos y métodos. El estudio se llevó a cabo en 308 pacientes con ictus isquémico emparejados por edad (± 5 años) y sexo con 307 controles sin historia trombótica previa.El análisis estadístico se realizó con el programa SAS v. 9.1. Resultados. Los resultados sugieren un efecto aditivo de los factores de riesgo, así como la presencia de un determinado perfil de estos factores en función del subtipo de ictus que se desarrolle. Conclusión. La adición de factores de riesgo cardiovascular se asocia a un aumento de riesgo de acontecimientos vasculares. Existen diferencias en la distribución de los factores de riesgo vascular modificables en función del tipo de ictus, el sexo y la edad del paciente

Cardiovascular diseases are one of the leading health problems in developed countries. This termcovers conditions such as coronary vascular disease, cerebrovascular diseases and peripheral vascular disease. Ischaemic cerebrovascular disease accounts for 80% of all cerebrovascular diseases. From a clinical point of view it is interesting to distinguish between modifiable and non-modifiable vascular risk factors. Aim. To analyse the prevalence of modifiablevascular risk factors and their different combinations in a case-control study on ischaemic cerebrovascular disease in the Spanish population, and also the differences in the distribution of the risk factors according to the type of stroke (TOAST classification), age and sex. Subjects and methods. The study was conducted on 308 patients with ischaemic stroke who werepaired by age (± 5 years) and sex, with 307 controls with no prior history of thrombosis. The statistical analysis was performed using the software application SAS v. 9.1. Results. The results suggest that the risk factors are subject to an adding effect, as well as pointing to the presence of a specific profile of these factors depending on the subtype of stroke that isdeveloped. Conclusion. The addition of cardiovascular risk factors is associated with an increased risk of vascular events. The distribution of the modifiable vascular risk factors differs according to the type of stroke and the patient’s sex and age