RESUMEN
D-Dimer measurements are being increasingly used for negative prediction of deep vein thrombosis (DVT). At our institution, clinical score, D-Dimer assay, plethysmography and, if necessary, Doppler ultrasound are used to secure the diagnosis. We collected the data from 100 consecutive patients proven to have DVT. We examined their medical case notes at diagnosis for concurrent clinical conditions and one year later to look for documented evidence of malignancy. Twenty-two of the 66 patients with D-Dimers greater than 1000 ng/ml were diagnosed with a cancer compared with only 2 of the 34 patients with a presenting D-Dimer score of less than 1000 ng/ml. We propose that a D-Dimer score of less than 1000 ng/ml in proven DVT is a strong negative predictor for malignancy (p = 0.0025).
Asunto(s)
Productos de Degradación de Fibrina-Fibrinógeno/análisis , Neoplasias/diagnóstico , Valor Predictivo de las Pruebas , Trombosis de la Vena/complicaciones , Anciano , Anciano de 80 o más Años , Humanos , Persona de Mediana Edad , Neoplasias/sangre , Neoplasias/complicaciones , Pronóstico , Estudios Retrospectivos , Trombosis de la Vena/sangre , Trombosis de la Vena/diagnósticoRESUMEN
Chronic myelomonocytic leukaemia is an atypical myeloproliferative disorder with a natural history of progression to acute myeloid leukaemia, a complex and poorly understood response by the bone marrow to stress. Cardiac surgery activates many inflammatory cascades and may precipitate a systemic inflammatory response syndrome. We present a case of undiagnosed chronic myelomonocytic leukaemia who developed rapidly fatal multi-organ dysfunction following cardiac surgery due to an acute leukaemoid reaction.