Hypertensive crisis and pulmonary edema following rituximab-induced anaphylaxis.

Rituximab is a monoclonal antibody against the protein CD20. Various lymphomas as well as non-malignant immune disorders are treated with this antibody. Hypersensitivity reactions associated with the use of rituximab include urticaria, hypotension, chest tightness, vomiting, oxygen desaturation and bronchospasm. A very uncommon case of hypertensive crisis and pulmonary edema following rituximab-induced hypersensitivity reaction in an 80-year-old man receiving rituximab for non-Hodgkin lymphoma is reported. Anaphylaxis manifesting as coronary vasospasm following drug treatment, including rituximab, could be proved a serious condition in patients who need specific treatment. In these patients desensitization protocols seem to be mandatory.

Serum Potassium Levels Inversely Correlate with D-Dimer In Patients with Acute-Onset Atrial Fibrillation / Concentrações Séricas de Potássio Encontram-se Inversamente Correlacionadas aos Níveis de D-Dímero em Pacientes com Fibrilação Atrial Aguda

Background: D-dimer values are frequently increased in patients with atrial fibrillation (AF) compared to subjects in sinus rhythm. Hypokalemia plays a role in several cardiovascular diseases, but little is known about the association with AF. Objective: D-dimer values are frequently increased in patients with atrial fibrillation (AF) compared with subjects in sinus rhythm. Hypokalemia plays a role in several cardiovascular diseases, but little is known about the association with AF. The aim of this study was to investigate correlations between D-dimer and serum potassium in acute-onset AF (AAF). Methods: To investigate the potential correlation between the values of serum potassium and D-dimer in patients with AAF, we retrospectively reviewed clinical and laboratory data of all emergency department visits for AAF in 2013. Results: Among 271 consecutive AAF patients with D-dimer assessments, those with hypokalemia (n = 98) had significantly higher D-dimer values than normokalemic patients (139 versus 114 ng/mL, p = 0.004). The rate of patients with D-dimer values exceeding the diagnostic cut-off was higher in the group of patients with hypokalemia than in those with normal serum potassium (26.5% versus 16.2%; p = 0.029). An inverse and highly significant correlation was found between serum potassium and D-dimer (r = −0.21; p < 0.001), even after adjustments for age and sex (beta coefficient −94.8; p = 0.001). The relative risk for a positive D-dimer value attributed to hypokalemia was 1.64 (95% CI, 1.02 to 2.63; p = 0.040). The correlation remained statistically significant in patients free from antihypertensive drugs (r = −0.25; p = 0.018), but not in those taking angiotensin-receptor blockers, angiotensin-converting enzyme inhibitors, or diuretics. Conclusions: The inverse correlation between values of potassium and D-dimer in patients with AAF provides important and complementary information about the thromboembolic ...

Fundamento: Valores de D-dímero são frequentemente aumentada em pacientes com fibrilação atrial (FA) em comparação com indivíduos em ritmo sinusal. A hipocalemia desempenha um papel em várias doenças cardiovasculares, mas pouco se sabe sobre a associação com FA. Objetivo: As concentrações de D-dímero encontram-se frequentemente aumentadas em pacientes com FA, quando comparados com indivíduos em ritmo sinusal. A hipopotassemia desempenha um papel importante nas doenças cardiovasculares, porém, pouco é conhecido sobre sua associação com a FA. O objetivo deste estudo foi investigar a correlação entre os níveis séricos de D-dímero e potássio na FA aguda (FAA). Métodos: Para investigar a existência de uma potencial correlação entre os níveis séricos de potássio e D-dímero em pacientes com FAA, realizamos uma revisão retrospectiva de dados clínicos e laboratoriais relacionados a todas as visitas ao departamento de emergência devido à FAA, no ano de 2013. Resultados: Entre os 271 pacientes com FAA, aqueles com hipopotassemia (n = 98) mostraram aumento significativo nos níveis de D-dímero, quando comparados com pacientes com concentrações normais de potássio (139 versus 114 ng/mL, p = 0,004). A taxa de pacientes com níveis de D-dímero excedendo o valor limiar de diagnóstico foi maior no grupo de pacientes com hipopotassemia, quando comparado com o grupo de pacientes com concentrações normais de potássio (26,5% versus 16,2%; p = 0,029). Detectamos uma correlação inversa e altamente significativa entre os níveis séricos de potássio e D-dímero (r = -0,21; p < 0,001), até mesmo após ajuste para idade e sexo (coeficiente beta –94,8; p = 0,001). O risco relativo de um valor positivo de D-dímero estar relacionado à hipopotassemia foi de 1,64 (95% CI, 1,02 to 2,63; p = 0,040). A correlação permaneceu estatisticamente significativa em pacientes livres de medicamentos hipertensivos (r = -0,25; p = 0,018), porém não nos pacientes em tratamento ...

Causes of elevated D-dimer in patients admitted to a large urban emergency department.

BACKGROUND: Although the request for D-dimer is widespread in emergency departments (EDs), the causes of elevation and their relationship with D-dimer levels in patients with diagnostic values are uncertain. METHODS: In this retrospective investigation, the study population consisted of all patients who visited our large urban ED in the year 2012, for whom a D-dimer test was requested for excluding or diagnosing venous thromboembolism (VTE). Only patients with D-dimer values >243ng/mL were included, regardless of their pre-test clinical probability for VTE. RESULTS: The final study population consisted of 1647 patients. A significant positive correlation was found between age and D-dimer. Infection was the most frequent diagnosis (15.6%), followed by VTE (12.1%), syncope (9.4%), heart failure (8.9%), trauma (8.2%) and cancer (5.8%). D-dimer was higher in patients with VTE than in those with other diagnoses (2541ng/mL vs 1030ng/mL; p<0.001). The frequency of VTE gradually increased from patients with values <1000ng/mL to those with D-dimer >3000ng/mL (4.1 vs 26.7%; p<0.001). As compared with D-dimer values <1000ng/mL, the Odds Ratio for VTE was 8.5 for values >3000ng/mL. CONCLUSIONS: These results show that D-dimer lacks specificity for diagnosing VTE, especially in elderly patients admitted to the ED with significant co-morbidities. In older patients, elevated values (>1000ng/mL) are more frequently associated with VTE, so the use of higher cut-offs may be advantageous.