Gemcitabine-associated thrombotic thrombocytopenic purpura and hemolytic uremic syndrome.

A patient being treated for metastatic adenocarcinoma of the pancreas presents to the clinic for a routine appointment. A complete blood count reveals hemoglobin of 6.5 g/dl and a platelet count of 30,000 K/mm3 thought to be from the last of many doses of gemcitabine. On assessment, the only complaint was fatigue with no evidence of bleeding or other abnormal physical findings other than pallor. Past medical history includes hypertension managed with three antihypertensive agents. Additional laboratory tests reveal elevated blood urea nitrogen (69 mg/dl), creatinine (2.76 mg/dl), and lactic dehydrogenase (LDH), was well as indirect bilirubin (2.1 mg/dl). The patient is admitted and transfused with packed red blood cells (pRBCs). The next day, the platelet count drops to 9,000 K/mm3 and the hemoglobin increases, appropriately, to 8.9 g/dl. Urinalysis is positive for hemoglobin (+ 3). The peripheral blood smear is positive for schistocytes (fragmented RBCs). A pheresis catheter is placed after the patient was evaluated by a hematologist and a nephrologist. A presumptive diagnosis of thrombotic thrombocytopenic purpura (TTP) with hemolytic uremic syndrome (HUS) was made.

Escherichia coli O157:H7: local epidemiology and disease spectrum in Brazil

Escherichia coli O157: H7 is one of the most important foodborne pathogens nowadays, since it has been responsible for severe outbreaks worldwide. Event hough this food pathogen has been isolated in many countries, Brazilian foods were considered E. coli O157:H7-free until recently. However, the presence of E. coli O157:H7 has been reported in diverse foods produced in Brazil and an increasing number of isolation from cattle feces has been observed, demonstrating that this pathogen is present in different parts of Brazil, and severe foodborne outbreaks mayoccur in the near future if adequate control measures are not implemented

Hemolytic uremic syndrome: a case review.

Hemolytic uremic syndrome is a complex disease that impacts multiple body systems. Knowledge gained from cases has increased understanding of etiologic factors, presenting symptoms, diagnostic laboratory findings, and the disease process. In rare cases, severe neurological symptoms are evident. This 20-year-old woman presented with bloody diarrhea that progressed quickly to respiratory distress requiring intubation and to the development of status epilepticus, controlled only by a barbiturate coma. Ongoing nursing care in the critical care unit was vital in preventing complications and promoting a positive outcome.

Pediatric case study: hemolytic uremic syndrome.

The nursing interventions necessary to care for this critically ill child were professionally challenging. Meeting the psychosocial, educational, and supportive needs of the family during this period of uncertainty, as well as, providing the dialysis therapy and support for this fragile child demonstrated the unique contributions of professional nursing. All outcomes were met, but the patient's extremely poor myocardial function made dialysis treatments and volume control difficult. The use of CVVHD was instrumental to providing dialysis in a safe, effective manner. The nursing care for S.B.K. and her family was physically and emotionally draining, but seeing her neurological status return was the great reward for all of our efforts.

Multisystem failure in a child with HUS.

HUS is a complex multisystem disease. Research has increased our understanding of etiologic factors, presenting symptoms, lab findings, and course of the disease and has had an impact on treatment plans. As children present to community hospitals with symptomatology of dehydration, more careful analysis of electrolytes, BUN, creatinine, and hematologic smears have supported earlier diagnosis and directly impacted the morbidity and mortality of HUS. Astute ongoing nursing assessment and care in the critical care unit are crucial to promoting a favorable outcome.