Safety and efficacy of total dose infusion of iron dextran in iron deficiency anaemia.

AIMS: Intravenous iron is usually reserved for patients in whom oral administration has failed. Typically the calculated total dose is divided in to several fractions. Total dose infusion (TDI) of iron dextran is not commonly used due to the potential for serious side effects such as anaphylactic reactions. METHODS: We identified 214 patients retrospectively, who were given TDI. Outcomes studied were: immediate side effects, improvement of haemoglobin and haematocrit. RESULTS: The most frequent side effect of TDI was nausea with a rate of 2.2%. Headache, vomiting, chills and backache were seen in 1.1% of patients and about 0.5% of patients experienced fever and diarrhoea. No anaphylactic reaction was noted. Observed mean elevation of haematocrit was 5.3% and haemoglobin of 2.0 gm/dl (p < 0.0001). CONCLUSION: TDI of iron dextran is a safe, potentially efficacious and convenient treatment in iron deficiency anaemia, in patients unresponsive or intolerant to oral iron.

Major arterial occlusion by embolisation of an occult thrombus following thrombolytic therapy for myocardial infarction.

We describe a case in which thrombolytic therapy for acute myocardial infarction resulted in a major arterial embolism from an existing aortic mural thrombus. Clinicians should be alert to this rare complication of thrombolytics, because timely diagnosis and treatment may prevent serious morbidity and mortality.

Complete resolution of refractory immune thrombocytopenic purpura after colectomy for ulcerative colitis.

Immune thrombocytopenia (ITP) is a destructive thrombocytopenia caused by an autoantibody directed to platelet membrane antigens. Various immunological diseases have been associated with ITP, but an association between inflammatory bowel disease (IBD) and ITP is not well recognised. We report a case of refractory immune thrombocytopenia associated with ulcerative colitis that resolved after colectomy. Although the medical treatment of inflammatory bowel disease or splenectomy are usually enough to treat ITP, it may be necessary to do a colectomy in refractory patients.

Spectrum of upper-extremity deep venous thrombosis in a community teaching hospital.

OBJECTIVE: The goal of this study was to characterize the spectrum of upper-extremity deep venous thrombosis in a community teaching hospital. DESIGN AND SETTING: A retrospective analysis was used at a large urban teaching hospital. MATERIAL AND METHODS: We reviewed the records of 90 patients with ultrasound-documented thrombosis of the internal jugular, subclavian, axillary, or brachial veins to determine clinical characteristics, risk factors, and outcome. RESULTS: The most common underlying conditions associated with upper-extremity deep venous thrombosis were the presence of a central venous catheter in 65 patients (72%), infection in 25 (28%), extrathoracic malignancy in 20 (22%), thoracic malignancy in 19 (21%), renal failure in 19 (21%), and a prior lower-extremity deep venous thrombosis in 16 (18%). Pain was noted in 31 (34%) patients, and 76 patients (84%) had edema of the involved extremity. The left subclavian vein was involved in 44 patients (49%), and 35 patients (39%) had a central venous catheter in the left subclavian vein. When a central venous catheter was present, the deep venous thrombosis was usually ipsilateral (P <.001). Heparin and warfarin were administered to 65 (72%) and 53 (59%) of the patients, respectively. Eleven patients (12%) died. Of these patients, 8 (73%) had an underlying infection, whereas only 22% of survivors had an infection (P =.0012). CONCLUSION: Upper-extremity deep venous thrombosis typically occurs in patients with a systemic illness in the presence of a central venous catheter. The left subclavian vein is frequently involved because this is a common site for placement of a central venous catheter. Pain is uncommon, but edema of the involved extremity is noted in the majority of patients. The mortality rate of patients in this study with an upper-extremity deep venous thrombosis was 12%; most patients who died had a central venous catheter and an underlying infection.