Реферат
Abstract Background: Twenty-minute whole blood clotting test (20WBCT) and Modified Lee and White (MLW) method are the most routinely employed bedside tests for detecting coagulopathic snake envenomation. Our study compared the diagnostic utility of MLW and 20WBCT for snakebite victims at a tertiary care hospital in Central Kerala, South India. Methods: This single-center study recruited 267 patients admitted with snake bites. 20WBCT and MLW were performed simultaneously at admission along with the measurement of Prothrombin Time (PT). The diagnostic utility of 20WBCT and MLW was determined by comparing the sensitivity (Sn), specificity (Sp), positive and negative predictive values, likelihood ratios, and accuracy at admission with an INR value > 1.4. Results: Out of 267 patients, 20 (7.5%) patients had VICC. Amongst those who had venom-induced consumption coagulopathy (VICC), MLW was prolonged for 17 patients, (Sn 85% 95% confidence interval [CI]: 61.1-96.0) whereas 20WBCT was abnormal for 11 patients (Sn 55%, 95% CI: 32.04-76.17). MLW and 20WBCT were falsely positive for the same patient (Sp 99.6%, 95% CI: 97.4-99.9%). Conclusion: MLW is more sensitive than 20WBCT to detect coagulopathy at the bedside amongst snakebite victims. However, further studies are necessary for standardizing bedside coagulation tests in snakebite cases.
Тема - темы
Prothrombin Time/methods , Snake Bites/diagnosis , Blood Coagulation Disorders/diagnosis , Blood Coagulation Factors/analysisРеферат
Abstract Objective: The main goal of our study was to assess the impact of vascular procedures on the activity of hemostatic and fibrinolytic pathways. Methods: We enrolled 38 patients with ≥ 45 years old undergoing surgery for abdominal aortic aneurysm or peripheral artery disease under general or regional anesthesia and who were hospitalized at least one night after the procedure. Patients undergoing carotid artery surgery and those who had acute bypass graft thrombosis, cancer, renal failure defined as estimated glomerular filtration rate < 30 ml/min/1.73m2, venous thromboembolism three months prior to surgery, or acute infection were excluded from the study. We measured levels of markers of hemostasis (factor VIII, von Willebrand factor:ristocetin cofactor [vWF:CoR], antithrombin), fibrinolysis (D-dimer, tissue plasminogen activator [tPA], plasmin-antiplasmin complexes), and soluble cluster of differentiation 40 ligand (sCD40L) before and 6-12h after vascular procedure. Results: Significant differences between preoperative and postoperative levels of factor VIII (158.0 vs. 103.3, P<0.001), antithrombin (92.1 vs. 74.8, P<0.001), D-dimer (938.0 vs. 2406.0, P=0.005), tPA (10.1 vs. 12.8, P=0.002), and sCD40L (9092.9 vs. 1249.6, P<0.001) were observed. There were no significant differences between pre- and postoperative levels of vWF:CoR (140.6 vs. 162.8, P=0.17) and plasmin-antiplasmin complexes (749.6 vs. 863.7, P=0.21). Conclusion: Vascular surgery leads to significant alterations in hemostatic and fibrinolytic systems. However, the direction of these changes in both pathways remains unclear and seems to be different depending on the type of surgery. A study utilizing dynamic methods of coagulation and fibrinolysis assessment performed on a larger population is warranted.
Тема - темы
Humans , Male , Female , Middle Aged , Aged , Vascular Surgical Procedures/adverse effects , Blood Coagulation/physiology , Aortic Aneurysm, Abdominal/surgery , Peripheral Arterial Disease/surgery , Fibrinolysis/physiology , Postoperative Period , Reference Values , Blood Coagulation Factors/analysis , Enzyme-Linked Immunosorbent Assay , Biomarkers/blood , Pilot Projects , Risk Factors , Treatment Outcome , Statistics, Nonparametric , Preoperative PeriodРеферат
El objetivo de este trabajo fue determinar la efectividad de un rango de la Razón Normalizada Internacional (INR) entre 1,5 y 1,9 en la prevención de la recurrencia de trombosis venosa y de las complicaciones hemorrágicas asociadas al uso de warfarina. Entre enero del 2006 y noviembre del 2009, se estudiaron 39 pacientes, con edades entre 10 y 78 años y diagnóstico de trombosis venosa profunda y/o embolismo pulmonar que recibieron warfarina al menos durante 6 meses. Los sujetos fueron separados aleatoriamente en dos grupos: a 20 pacientes se le ajustó la dosis para mantener el INR entre 1,5 y 1,9 y a 19 pacientes se les mantuvo el INR entre 2 y 3. A cada individuo se le cuantificó la actividad plasmática de los factores II, VII, IX y X a la primera y entre la cuarta y quinta semanas, luego de estabilizado el INR. En ambos grupos, la actividad de los factores se encontró por debajo del valor normal con diferencia significativa entre los grupos (p<0,05). No se detectó recurrencia de trombosis durante el seguimiento. Solo se presentaron manifestaciones hemorrágicas menores en un sujeto con INR entre 1,5 y 1,9 y en cuatro del otro grupo (p = NS). Los resultados del presente trabajo sugieren que un rango de INR entre 1,5 y 1,9, provee un esquema de anticoagulación eficaz para la prevención de recurrencia de trombosis venosa con menor frecuencia de hemorragias. Sin embargo, es necesario seguir incorporando más individuos en el estudio para obtener mayor certeza en el análisis de estos resultados.
The object of this work was to determine the efficacy of a low range International Normalized Ratio (INR) between 1.5 and 1.9, in preventing recurrent venous thrombosis and the hemorrhagic manifestations that can complicate anticoagulation with warfarin. Thirty nine patients, 10 to 78 years of age were studied between January 2006 and November 2009. All of them had been treated with warfarin, for at least 6 months, due to deep venous thrombosis or pulmonary embolism. The subjects were separated, at random, into two groups. In group A (20 patients), the doses of warfarin were adjusted until the INR was stabilized between 1.5 and 1.9; in group B, the INR was maintained between 2 and 3. The coagulant activities of plasma factors II, VII, IX and X were determined in a week and between the fourth and fifth weeks, after stabilization of the INR. Plasma activities of the coagulation factors assayed were abnormally low in both groups, in the two opportunities they were determined, although significantly lower in group B (p<0.05). No thromboembolic episodes occurred during the study, in any of the patients. One of the patients from group A and four from group B, presented minor hemorrhagic manifestations (p N.S.) The above results suggest that a range on INR lower that 2, could be sufficient to prevent recurrent thrombotic episodes while diminishing the frequency of hemorrhagic complications associated with the use of warfarin. However, it is necessary to continue incorporating more individuals in the study to obtain greater certainty in the analysis of these results.
Тема - темы
Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle Aged , Young Adult , Anticoagulants/therapeutic use , International Normalized Ratio , Pulmonary Embolism/drug therapy , Venous Thrombosis/drug therapy , Warfarin/therapeutic use , Anticoagulants/administration & dosage , Anticoagulants/adverse effects , Blood Coagulation Factors/analysis , Dose-Response Relationship, Drug , Drug Monitoring , Hemorrhage/chemically induced , Pulmonary Embolism/blood , Recurrence , Venous Thrombosis/blood , Warfarin/administration & dosage , Warfarin/adverse effectsРеферат
El odontólogo debe comprender qué ocurre cuando se lesiona un vaso o tejido durante procedimientos quirúrgicos o traumáticos que le pueden suceder a un paciente normal ycon trastornos de la hemostasia. Con la elaboración de la historia clínica se pueden detectar antecedentes importantes que permitan tomar acciones preventivas o implementar otras, de tal forma que la atención del paciente sea más segura. La hemostasia es un fenómeno fisiológico complejo por el cual se detiene la hemorragia. Es un mecanismo de defensa que con la respuesta inflamatoria y la reparación ayudan a proteger la integridad vasculardespués de la agresión de los tejidos. El propósito de este artículo es revisar los mecanismos normales de hemostasia, los trastornos más frecuentes que predisponen a eventos hemorrágicos y las herramientas que se disponen para su control, así como las recomendaciones para la evaluación, diagnóstico y tratamiento odontológico en cada paciente...
The dentist must understand the events that occur when vessels or tissues are damaged during surgical or traumatic procedures that can happen to a healthy patient or one withhemostatic disorders. The elaboration of the clinical history is important to identify this kind of disorders, so the dentist can plan and implement safer preventive and other type ofprocedures for the patient. Hemostasis is a complex physiological phenomenon that causes the bleeding process to stop. It is a defense mechanism that, along with the inflammatory response and healing, protects vascular integrity after tissue aggression. The purpose of this article is to review the normal hemostatic mechanisms, the most frequent disorders that predispose bleeding events, and the available resources to control them, as well as the recommendations for an effective evaluation, diagnosis and dental treatment for each patient...
Тема - темы
Dental Care , Blood Coagulation Factors/analysis , Blood Coagulation Factors , Hemostasis , Oral Medicine , Pediatric DentistryРеферат
FUNDAMENTO: A relação entre atividade inflamatória e pró-trombótica na cardiomiopatia chagásica e em outras etiologias é obscura. OBJETIVO: Estudar o perfil de marcadores pró-trombóticos e pró-inflamatórios em pacientes com insuficiência cardíaca chagásica e compará-los com os de etiologia não chagásica. MÉTODOS: Coorte transversal. Critérios de inclusão: fração de ejeção do VE (FEVE) < 45 por cento e tempo de início de sintomas > um mês. Os pacientes foram divididos em dois grupos: grupo 1 (G1) - sorologias positivas para Chagas - e grupo 2 (G2) - sorologias negativas para Chagas. Fator pró-inflamatório: PCR ultrassensível. Fatores pró-trombóticos: fator trombina-antitrombina, fibrinogênio, antígeno do fator de von Willebrand, P-selectina plasmática e tromboelastograma. Amostra calculada para poder de 80 por cento, assumindo-se diferença de 1/3 de desvio-padrão; p significativo se < 0,05. Análise estatística: teste exato de Fischer para variáveis categóricas; teste t de Student não pareado para variáveis contínuas paramétricas e teste de Mann-Whitney para variáveis contínuas não paramétricas. RESULTADOS: Entre janeiro e junho de 2008, foram incluídos 150 pacientes, 80 no G1 e 70 no G2. Ambos os grupos mantinham médias de PCR ultrassensível acima dos valores de referência, porém, sem diferença significativa (p=0,328). Os níveis de fibrinogênio foram maiores no G2 do que no G1 (p=0,015). Entre as variáveis do tromboelastograma, os parâmetros MA (p=0,0013), G (p=0,0012) e TG (p=0,0005) foram maiores no G2 em comparação ao G1. CONCLUSÃO: Não há indícios de maior status pró-trombótico entre chagásicos. A dosagem de fibrinogênio e dos parâmetros MA, G e TG do tromboelastograma apontam para status pró-trombótico entre não chagásicos. Ambos os grupos tinham atividade inflamatória exacerbada.
BACKGROUND: The relationship between inflammatory and prothrombotic activity in chagas cardiomyopathy and in other etiologies is unclear. OBJECTIVE: To study the profile of pro-thrombotic and pro-inflammatory markers in patients with Chagas' heart failure and compare them with patients of non-chagas etiology. METHODS: Cross-sectional cohort. Inclusion criteria: left ventricle ejection fraction (LVEF) < 45 percent and onset time to symptoms > one month. The patients were divided into two groups: group 1 (G1) - seropositive for Chagas - and group 2 (G2) - seronegative for Chagas. Pro-inflammatory factor: Ultra-sensitive CRP. Pro-thrombotic factors: thrombin-antithrombin factor, fibrinogen, von Willebrand factor antigen, plasma P-selectin and thromboelastography. Sample calculated for 80 percent power, assuming a standard deviation difference of 1/3; significant p if it is < 0.05. Statistical analysis: Fisher's exact test for categorical variables; unpaired Student's t-test for parametric continuous variables and Mann-Whitney test for nonparametric continuous variables. RESULTS: Between January and June 2008, 150 patients were included, 80 in G1 and 70 in G2. Both groups maintained the averages of high sensitivity CRP above baseline values, however, there was no significant difference (p = 0.328). The fibrinogen levels were higher in G2 than in G1 (p = 0.015). Among the thromboelastography variables, the parameters MA (p=0.0013), G (p=0.0012) and TG (p =0.0005) were greater in G2 than in G1. CONCLUSION: There is no evidence of greater pro-thrombotic status among patients with Chagas disease. The levels of fibrinogen and the MA, G and TG parameters of the thromboelastography point to pro-thrombotic status among non-chagas patients. Both groups had increased inflammatory activity.
Тема - темы
Female , Humans , Male , Middle Aged , Blood Coagulation Factors/analysis , Chagas Cardiomyopathy/blood , Biomarkers/blood , Epidemiologic Methods , Inflammation/blood , Polymerase Chain Reaction , Risk Factors , Thrombelastography/methods , Thrombosis/bloodРеферат
Es necesario investigar drogas naturales nuevas que aporten principios farmacológicos activos para ser utilizadas como una alternativa terapéutica. Por este motivo nos propusimos estudiar a Ficus insipida, cuyo látex ha sido usado como antihelmíntico durante muchos años en la amazonía, pero se investigó solo superficialmente su efecto anticoagulante in vitro. Objetivo: Comprobar el efecto anticoagulante in vitro y determinar la vía de la coagulación sobre la que actúa el látex de Ficus insípida. Material y métodos: Se obtuvo el látex de Ficus insipida y se prepararon diferentes concentraciones del mismo. Se obtuvieron muestras de sangre venosa periférica de 5 donantes voluntarios, anticoagulándolas con citrato de sodio. Luego, éstas se mezclaron con las diluciones del látex, se centrifugaron y se extrajo el plasma. Posteriormente, se obtuvo un pool de plasma para cada concentración del látex y se procedió a determinar el Tiempo de Protrombina (TP) y el Tiempo de Tromboplastina Parcial activada (TTPa), respectivamente. Resultados: Se encontró que el látex de Ficus insipida prolongó el TP a una concentración mayor o igual a 0,03125% (V/V), y ambos, el TP y TTPa a una concentración mayor o igual a 0,15% (V/V). Conclusiones: Los resultados obtenidos nos permiten afirmar que el látex de Ficus insipida posee un efecto anticoagulante in vitro dosis dependiente sobre la vía extrínseca de la coagulación sanguínea a una concentración igual o mayor a 0,03125% (V/V) y que a una concentración igual o mayor a 0,15% (V/V) posee un potente efecto anticoagulante sobre ambas vías de la coagulación.
We need to search for new natural drugs yielding pharmacological active principles to be used as an alternative to conventional therapies. For this reason, we proposed to study Ficus insipida, an amazonian plant that its latex has been used for years as an Antihelmintic agent but its anticoagulant effect has been only superficially studied. Objective: To corroborate the in vitro anticoagulant effect and to determine upon which of the coagulation pathways acts the latex of Ficus insipida. Material and methods: The latex of Ficus insipid was obtained and prepared at different concentrations. Then, samples of peripheral blood from 5 donors were taken using sodium citrate to avoid blood clotting; the samples were mixed with the latex dilutions and centrifuged, after that, the plasma was extracted to form a plasma pool from each latex concentration. Finally, the Prothrombin Time (PT) and the Partial Thromboplastin Time (PTT) were determined, respectively. Results: The results obtained demonstrated that the latex of Ficus insipida delays the PT at concentrations equal or higher than 0.03125% (V/V), and both the PT and PTT at concentrations equal or higher than 0.15% (V/V). Conclusions: This data allow us to affirm that the latex of Ficus insipida has a dose-dependent in vitro anticoagulant effect upon the extrinsic coagulation pathway at concentrations equal or higher than 0.03125% (V/V). Additionally, at concentrations equal or higher than 0.15% (V/V) it has a potent anticoagulant effect over both coagulation pathways.
Тема - темы
Humans , Male , Female , Anticoagulants , Blood Coagulation Factors/analysis , Ficus , Prothrombin Time , Partial Thromboplastin TimeРеферат
Se presentan 37 casos de trombosis, en su mayoría jóvenes, con antecedentes trombóticos familiares y con diagnóstico de trombofilia primaria o hereditaria además de cuatro familiares de primer grado de estos pacientes en los cuales se confirmó la portación familiar de trombofilia. La anamnesis reveló que el 82 por ciento presentó la primera trombosis antes de los 45 años; tuvo más de una trombosis en un 59 por ciento y tenía antecedentes familiares en 49 por ciento. Los defectos trombofílicos determinantes encontrados fueron: deficiencia de proteína S (27 por ciento); resistencia a proteína C activada por factor V Leiden (24,3 por ciento); deficiencia proteína C (21,6 por ciento) y antotrombina III (16,2 por ciento); mutación G20210 A del gen protrombina (8,1 por ciento). Entre los defectos adquiridos estudiados simultáneamente, un 27,2 por ciento de los casos presentaron anticoagulante lupico y ninguno hiperhomocisteína. La existencia de mas de un factor de riesgo trombofílico se observó en el 24.3 por ciento de los pacientes. En el estudio de los 4 parientes de primer grado se encontró factor V Leiden en uno; factor V Leiden mas anticoagulante lupico en uno y deficiencia proteína S en dos. El trabajo anterior publicado en 2004 motivó a los pacientes que no se hicieron el estudio a tomar conciencia de su situación y de la necesidad de controlarse, lo que demuestra la importancia de difundir esta patología aún poco conocida.
Тема - темы
Male , Female , Adult , Humans , Blood Coagulation Factors/analysis , Thrombophilia/complications , Thrombophilia/diagnosis , Thrombosis/diagnosis , Thrombosis/etiology , Age Factors , Factor V/analysis , Genetic Predisposition to Disease , Homocysteine/analysis , Lupus Coagulation Inhibitor/analysis , Mutation , C-Reactive Protein/antagonists & inhibitors , Protein C/analysis , Protein S/analysis , Prothrombin/genetics , Risk FactorsРеферат
Thromboembolic events are reported to occur with a high frequency in the setting of malignancy. However, reports on an association between cholangiocarcinoma and pulmonary thromboembolism, thus far, are almost lacking. We present here an unusual case of a 56-yr-old patient presenting cholangiocarcinoma and unexplained pulmonary thromboembolism. The patient had been quite healthy before the diagnosis. Coagulation tests showed elevated levels of fibrinogen, fibrinogen degradation product (FDP), D-dimer, and IgM anticardiolipin antibody (aCL Ab). The thromboemboli were resolved 3 weeks after anticoagulant therapy using lowmolecular-weight-heparin. Then, follow-up coagulation tests showed a marked decrease to normal in aCL Ab titer as well as the normalization of FDP and D-dimer levels. In this case, we describe pulmonary thromboembolism caused by hypercoagulable state associated with cholangiocarcinoma and speculate that such a thrombotic phenomenon could be regressed by anticoagulant therapy.
Тема - темы
Humans , Male , Middle Aged , Antibodies, Anticardiolipin/blood , Anticoagulants/therapeutic use , Bile Duct Neoplasms/complications , Bile Ducts, Intrahepatic , Blood Coagulation Factors/analysis , Cholangiocarcinoma/complications , Fibrin Fibrinogen Degradation Products/analysis , Fibrinogen/analysis , Heparin, Low-Molecular-Weight/therapeutic use , Pulmonary Embolism/blood , Syndrome , Treatment OutcomeТема - темы
Humans , Chagas Cardiomyopathy/complications , Thrombosis/etiology , Blood Coagulation Factors/analysis , Blood Coagulation Factors/physiology , Clinical Trials as Topic , Chagas Cardiomyopathy/blood , Chagas Cardiomyopathy/physiopathology , Time Factors , Thrombosis/blood , Thrombosis/physiopathologyРеферат
O efeito da infecçäo causada por Actinobacillus pleuropneumoniae no sistema da coagulaçäo do sangue de leitöes foi estudado. 25 leitöes desmamados isentos de organismos patogênicos específicos (IOPES) foram distribuídos de forma aleatória em 2 grupos. 10 leitöes firam infectados com 5x10(6) UFC de Actinobacillus pleuropneumoniae sorotipo 1, e 15 leitöes usados como controles negativos. Reduçöes significativas nas concentraçöes (Pó0.005) dos fatores de coagulaçäo do sangue IX, VIII, VII, X e V foram demonstradas. O tempo parcial ativado da tromboplastina aumentou enquanto que o tempo da protrombina (em porcentagem) diminuiu. A concentraçäo de antitrombina III diminui de forma significativa (Pó0.005). As alteraçöes observadas no tempo de trombina e na quantidade de fibrinogênio estäo relacionadas com a formaçäo de fibrina no processo de coagulaçäo sanguínea. Em consequência disso, a hemorragia pulmonar e a formaçäo de coágulos podem ser observados em pulmöes de leitöes infectados com Actinobacillus pleuropneumoniae
Тема - темы
Blood Coagulation Factors/analysis , Actinobacillus Infections/blood , Swine/microbiology , Pleuropneumonia/microbiologyТема - темы
Humans , Blood Coagulation Factors/analysis , Liver Diseases, Parasitic/blood , Schistosomiasis mansoni/blood , Splenic Diseases/blood , Blood Coagulation Tests , Liver Diseases, Parasitic/complications , Hypertension, Portal/etiology , Hypertension, Portal/blood , Protein C/analysis , Prothrombin/analysis , Schistosomiasis mansoni/complications , Splenic Diseases/complications , Splenomegaly/blood , Splenomegaly/etiology , Blood Coagulation Disorders/bloodРеферат
MARCO TEORICO: En la última década en el Hospital ABC hemos observado un aumento en el número de pacientes que requieren terapia intensiva, se ha incrementado el número de pacientes con padecimientos oncológicos. Adicionalmente se ha iniciado la trombolisis del infarto agudo del miocardio y se ha implementado un programa de cirugía cardiovascular. En consecuencia el laboratorio ha tenido que ampliar sus estrategias para el estudio de los trastornos de la hemostasia. OBJETIVO: Conocer la frecuencia con que se indican las pruebas especiales de la coagulación en el laboratorio clínico del Hospital ABC así como las alteraciones más frecuentes encontradas. TIPO DE ESTUDIO: Investigación clínica, retrosp[ectiva, observacional, comparativa de un período anual de pacientes a quienes se les realizaron estudios especiales de la coagulación en forma integrada como un coagulogama especial (CE). RESULTADOS: Se estudiaron 67 pacientes a los que se les realizaron un total de 98 (CE). La mayoría de los estudios se realizaron en pacientes ambulatorios (63.2 por ciento). A 62 pacientes se les solicitó 1 solo estudio (Grupo 1), a 36 se les indicaron 2 o más (Grupo 2). En el primer grupo la alteración más frecuente fue hipercoagulabilidad (p<0.001). En el segundo grupo se encontró que la alteración más frecuente fue la deficiencia de factores (p<0.025). un 27 por ciento de los estudios fueron completamente normales. CONCLUSIONES: El coagulograma especial es un "perfil" que además de ser costoso para el paciente, resulta muy laborioso para el personal de laboratorio. El haber encontrado que un 27 por iento de los estudios fueron completamente normales nos obliga a insistir que esta batería de estudios solo se debe indicar cuando el coagulograma de rutina o el estado clínico del paciente hagan sospechar alteraciones específicas tales como la hipercoagulabilidad, la presencia de anticoagulante o la deficiencia de factores. Es necesario oncluir un resumen clínico a la solicitud de los estudios para que en el laboratorio se puedan optimizar las estrategias diagnósticas del estudio.
Тема - темы
Humans , Male , Female , Blood Coagulation Disorders/diagnosis , Blood Coagulation Disorders/physiopathology , Blood Coagulation Factors/analysis , Blood Coagulation Factors/physiology , Hemostatic Techniques/trends , Hemostatic Techniques , Thrombophlebitis/diagnosis , Laboratories, Hospital/economics , Laboratories, Hospital , Leukemia/diagnosis , AnticoagulantsРеферат
The prevalence of vitamin K deficiency in the newborns delivered at Siriraj Hospital was studied. The prolongation of one stage prothrombin time and the presence of PIVKA-II (non carboxylated prothrombin antigen) in cord blood were interpreted as the secondary change from vitamin K deficiency state. The most reliable method to diagnose vitamin K deficiency is the detection of vitamin K level in plasma which is not yet available in Thailand. Although the prevalence of vitamin K deficiency in the newborns from our data is not high, only 0.6%, it is shown that some of the apparently normal newborn infants may have bleeding problem from vitamin K deficiency in both newborn and early infancy periods. So, the correction of this deficiency by administration of vitamin K to all newborns is appropriate and reasonable decision.
Тема - темы
Biomarkers , Blood Coagulation Factors/analysis , Female , Fetal Blood/chemistry , Vitamin K Deficiency Bleeding/blood , Humans , Infant, Newborn , Male , Predictive Value of Tests , Prevalence , Protein Precursors/analysis , Prothrombin/analysis , Prothrombin Time , Sensitivity and Specificity , Thailand , Vitamin K/analysisРеферат
Eight cases with lupus anticoagulants (LA) were diagnosed over the last five years (1984-88). Of these, three were established cases of systemic lupus erythematosus (SLE), where bad obstetric history (2 cases) and recurrent deep venous thrombosis (DVT--1 case) prompted execution of laboratory tests for LA. In the remaining 5 cases, there was no clinical evidence of SLE. However, one case developed laboratory findings suggestive of SLE at a later date. One of these 5 patients was referred for unexplained abnormality in partial thromboplastin time (K). Three had recurrent abortions (one with additional history of DVT) while one had DVT with raised PTT (K). The clinical findings and laboratory tests by which lupus anticoagulants can be diagnosed have been discussed.
Тема - темы
Adolescent , Adult , Autoantibodies/analysis , Blood Coagulation Disorders/blood , Blood Coagulation Factors/analysis , Female , Humans , Lupus Coagulation Inhibitor , Lupus Erythematosus, Systemic/blood , Male , Middle Aged , Partial Thromboplastin Time , Phospholipids/immunology , Thrombophlebitis/immunologyТема - темы
Humans , Adolescent , Female , Autoantibodies/analysis , Ecchymosis/etiology , Blood Coagulation Factors/immunology , Hyperthyroidism/complications , Thrombosis/etiology , Blood Coagulation Tests , Ecchymosis/immunology , Blood Coagulation Factors/analysis , Necrosis , Phospholipids/immunology , Thrombosis/immunology , Thrombosis/pathologyТема - темы
Humans , Vitamin K/antagonists & inhibitors , Heparin/pharmacology , Enoxaparin/administration & dosage , Anticoagulants/pharmacology , Partial Thromboplastin Time , Prothrombin Time , Thromboembolism/drug therapy , Blood Coagulation Factors/analysis , Heparin/administration & dosage , Injections, SubcutaneousРеферат
La incidencia del anticoagulante lúpico (AL), se estudia en 51 pacientes con diagnóstico de Lupus Eritomatoso Sistémico (LES), 15 con Púrpura Trombocitopénica Autoinmune (PTA), y tres con tiempo tromboplastina parcial alargado (TTP), dos de ellas con antecedentes de accidente cerebrovascular y la otra con diagnóstico de hemoglobinuria paroxística nocturna. En cada paciente se investigó el anticoagulante lúpico (AL), mediante el tiempo de recalcificación del plasma y el tiempo de recalcificación del plasma y el tiempo de coagulación con el veneno de Russell (TCVR). Ocho casos (15.6%) con LES y 6 casos (40%) con PTA, mostraron la presencia de AL. También fueron positivos los tres casos con TTP alargado. Con la excepción de dos casos con, todos los pacientes recibían terapia esteroidea. Los 8 casos con LES y Al tenían alargado el TTP y el tiempo de Protrombina (TP), 3 de los pacientes con PTA y AL tenían el TP alargado y los otros 3 tenían alargadas ambas pruebas. Todos los pacientes con AL eran del sexo femenino y de edades comprendidas entre 19 y 59 años. De los casos de LES con AL, en uno había antecedentes de trombosis y en 5 de muerte fetal recurrente. Solo las pacientes con TPA presentaron manifestaciones hemorrágicas y una de ellas sufrió un accidente cerebrovascular agudo. La manifestación clínica más frecuente en todos los pacientes con AL, fué la trombocitopenia, seguida de muerte fetal recurrente. Se estima que la terapia inmunosupresora, haya incidido disminuyendo la frecuencia del anticoagulante lúpico en los pacientes con LES y con PTA crónica
Тема - темы
Child, Preschool , Child , Adolescent , Adult , Middle Aged , Humans , Male , Female , Blood Coagulation Factors/immunology , Lupus Erythematosus, Systemic/blood , Purpura, Thrombocytopenic/blood , Blood Coagulation Factors/analysisРеферат
Una prolongación de las pruebas de coagulación dependientes de fosfolípidos fue detectada en una paciente de 62 años, con una dermatitis linfocítica, pero que no tenía problemas de sangría ni trombóticos. Se detectó una gamapatía monoclonal de tipo IgM lambda con hipoglobulinemia IgG e IgA. La sangre periférica y la médula ósea eran normales inicialmente. La serología fue falsa positiva confirmada por la prueba de anticardiolipina. Todos los estudios para enfermedades infecciosas o autoinmunes fueron negativos. La paciente desarrolló fiebre y esplenomegalia por lo que se le practicó una explenectomía. La histología demostró un neoplasma plasmático. La inmunoperoxidase demostró cadenas lambda en las células anormales y la microscopía electrónica confirmó el origen plasmático del tumor. La citometría de flujo en sangre periférica demostró la mayor parte de células IgM y con marcadores lambda. La coagulación demostró la prolongación del PT y PTT aún con mezcla de plasma normal. La prueba de inhibición de tromboplastina de tejido fue anormal. La prueba de neutralización de plaquetas demostró corrección cuando se usó plaquetas en vez de fosfolípidos como reactivo, confirmando la presencia del anticoagulante de lupus. El lugar de producción de la proteína anormal fue confirmado por estudios inmunohistoquímicos. El anticoagulante de lupus fue neutralizado con un antisuero anti IgM confirmando la naturaleza del anticuerpo. El anticoagulante de lupus se ha descrito en varias enfemedades especialmente el lupus eritematoso, pero también en otras enfermedades autoinmunes, uso de medicamentos, enfermedades neoplásicas, abortos recurrentes, y el síndrome de inmunodeficiencia adquirida. Nuestro paciente tenía un desorden linfoplasmático produciendo hiperglobulinemia M que a su vez era el anticoagulante de lupus
Тема - темы
Middle Aged , Humans , Female , Autoantibodies/analysis , Blood Coagulation Disorders/etiology , Blood Coagulation Factors/immunology , Waldenstrom Macroglobulinemia/complications , Blood Coagulation Factors/analysis , Waldenstrom Macroglobulinemia/blood , Waldenstrom Macroglobulinemia/immunologyРеферат
The clinical features of thirteen Chinese patients with lupus anticoagulant were described. They were noted to conform to those reported among Caucasians and tend to suggest that the term 'lupus anticoagulant' is a double misnomer.