Flegmasia cerúlea dolorosa en paciente con trombocitopenia inmune primaria: un gran reto terapéutico / Phlegmasia cerulea dolorosa and primary immune thrombocytopenia: a therapeutic challenge

Introducción: la flegmasia cerúlea dolorosa resulta de una trombosis venosa masiva aguda que provoca unaobstrucción del drenaje venoso de una extremidad y se asocia con un alto grado de morbilidad.Caso clínico: presentamos el caso de un paciente con fl egmasia cerúlea dolorosa y múltiples factores de riesgopara desarrollarla, quien fue llevado a trombólisis dirigida por catéter, con lo que se logró salvar la extremidad.Discusión: la fl egmasia cerúlea dolorosa es una entidad poco frecuente que puede progresar de manera rápiday comprometer la vitalidad de la extremidad afectada o llevar a desenlaces fatales, por lo que requiere una prontasospecha y una intervención emergente. La terapia antitrombótica sigue siendo el manejo de elección.(AU)

Introduction: phlegmasia cerulea dolorosa results from acute massive venous thrombosis that causes obstructionof the venous drainage of an extremity, and it’s associated with a high morbidity.Case report: we present the case of a patient with phlegmasia cerulea dolorosa and multiple risk factors fordeveloping it, who was taken to catheter-directed thrombolysis successfully.Discussion: phlegmasia cerulea dolorosathis is a rare entity that can progress rapidly and compromise the vitalityof the limb or lead to fatal outcomes, which requires early suspicion and emergency intervention. Antithrombotictherapy continues to be the ideal treatment.(AU)

Plasma cell dyscrasia behavior in a referral hospital in southern Colombia: younger, clinically and paraclinically worse than reported

OBJECTIVES: Plasma cell dyscrasias are diseases characterized by clonal proliferation and accumulation of cells producing monoclonal immunoglobulins. These diseases have not been studied in our region and we don't know if their behavior is similar to that reported in the literature. That's why we evaluated multiple characteristics in southern Colombia. METHODS: analytical cross-sectional study of patients with confirmed diagnosis of a plasma cell dyscrasias were included.RESULTS: 60 patients included in our study, 65% were men, with an average age of 58.8 years (CI 96% 55.8 - 61.93). Bone pain was the most frequent symptom (88%). The most frequent dyscrasia was multiple myeloma and in these patients we found a high percentage of hemoglobin less than 10 mg/dl, creatinine greater than 2 mg/dl and serum calcium higher than 11 mg/dl (77%, 38% and 37 %, respectively). Half of the patients had a time course of symptoms greater than 4 months and 43% had plasma cells in bone marrow greater than 60%. 65% of patients had elevated levels of serum B2-microglobulin (> 5.5 mg/L) and in-hospital mortality was 15%. We found a statistically significant association between mortality and gender (PR 6.5) and between mortality and hemoglobin (p = 0.039).CONCLUSION: Patients with plasma cell dyscrasia in southern Colombia are younger, consult late, in an advanced stage of their disease, with greater renal damage, hypercalcemia and anemia than reported in the literature, also a high tumor burden due to high plasma cell infiltration into bone marrow and high values of serum B2-microglobulin

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Submassive Pulmonary Thromboembolism in a Patient with Thrombocytopenia: Therapeutic Challenge.

Venous thromboembolic disease is an important cause of mortality worldwide. A widely recognized risk factor is active neoplasia, mainly hematological tumors, in which associated thrombocytopenia can be a frequent complication. We present the case of a patient with submassive pulmonary thromboembolism associated with severe thrombocytopenia with signs of right heart failure and a requirement for systemic thrombolysis and anticoagulation, however with absolute contraindication for them. The case establishes a therapeutic challenge for the treating group, leading us to carry out an extensive search of the literature and propose a management algorithm in this complex situation.