Comparison of ultrasound and magnetic resonance imaging for diagnosis and follow-up of joint lesions in patients with haemophilia.

Haematomas and recurrent haemarthroses are a common problem in haemophilia patients from early age. Early diagnosis is critical in preventing haemophilic arthritis, and recent years have seen excellent advances in musculoskeletal ultrasound as a diagnostic tool in soft tissue lesions. In this study, we compared the results of ultrasound imaging for the diagnosis of musculoskeletal injuries in haemophilia patients with scores obtained using magnetic resonance (MRI) scans. A total of 61 haemophilia patients aged 4-82 years were included in this study. Both knees and ankles of each patient were assessed using the Gilbert (clinical assessment) and Pettersson scores (X-ray assessment). Patients with severe haemophilia (n = 30) were examined using ultrasound and MRI (Denver scoring system). Results obtained with ultrasound and MRI in severe patients were correlated using the Pearson test. In patients with severe haemophilia, normal joints were similarly assessed with MRI and ultrasound (κ = 1.000). By component of joint assessment, haemarthrosis was similarly diagnosed with both techniques in all joints (κ = 1.000). A good positive correlation was found between these techniques in detecting and locating synovial hyperplasia (κ = 0.839-1.000, knees and ankles respectively), and erosion of margins (κ = 0.850-1.000). The presence of bone cysts or cartilage loss was better detected with MRI (κ = 0.643-0.552 for knees and ankles, and κ = 0.643-0.462 respectively). Ultrasound is useful in detecting joint bleeds, synovial hyperplasia and joint erosions, with results comparable to those of MRI. A quick and affordable technique, ultrasound imaging may be useful for monitoring joint bleeds and structure normalization and maintenance in routine practice.

Revisión de los antiagregantes plaquetarios y sus indicaciones en atención primaria. Ocho años después / Review of plasma anti-aggregants and their indications in primary care. Eight years later

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Anticuerpos antifosfolípido en población pediátrica asintomática / Antiphospholipid antibodies inasymptomatic pediatric patients

Antecedentes: El hallazgo de alargamientos del tiempo de tromboplastina parcial activado (TTPA) con criterios de anticoagulante lúpico (AL) es un hecho poco frecuente en niños asintomáticos que con frecuencia precede a ciertos tipos de cirugía y posee un comportamiento clínico benigno. Pacientes y métodos: Se ha realizado un análisis de las características biológicas y clínicas de 13 niños con anticuerpos antifosfolípidos (APLA) (media de edad al diagnóstico 5 años) diagnosticados entre enero de 1996 y septiembre de 2000 a los que se realizó un seguimiento prospectivo (mediana, 16 meses; extremos, 15-60). Se realizaron determinaciones de AL por técnicas coagulométricas según los criterios de la International Society for Thrombosis and Haemostasis (ISTH) y anticuerpos anticardiolipina (ACA) y anti-b2-glucoproteínaI por enzimoinmunoanálisis (ELISA). Resultados: Todos los casos de anticoagulante lúpico estudiados se diagnosticaron tras investigación de un alargamiento del TTPA detectado con anterioridad a cirugía (adenoidectomía, 8 casos; orquidopexia, 1 caso; cirugía oftalmológica, 1 caso), asociado a alguna infección vírica (mononucleosis infecciosa, 1caso) o como hallazgo casual en una analítica de rutina (2 casos). Todos ellos eran de tipo primario y un 53,6% tuvieron carácter transitorio. Los ACA-IgG, anti-b2-glucoproteína I fueron negativos en todos los casos. El 30,7% presentaron valores ligeramente reducidos de factor XII: C (media, 38,2 U/dl). El diagnóstico de APLA no se vio acompañado de manifestaciones clínicas relacionadas con éstos ni tampoco se comunicó hemorragia posquirúrgica en ningún caso. Conclusiones: Los APLA primarios representan un hallazgo poco frecuente en la población pediátrica asintomática que se ha descrito con relativa frecuencia en el preoperatorio de determinados tipos de cirugía (adenoidectomía y amigdalectomía) o infecciones víricas. Con frecuencia se trata de fenómenos transitorios, de muy escasa relevancia clínica y que pueden acompañarse de valores ligeramente reducidos de factor XII, por lo que debe establecerse el diagnóstico diferencial con el déficit leve de ese factor (AU)

[Major thromboembolic complications during oral anticoagulant therapy. Importance of level of anticoagulation]. / Complicaciones tromboembólicas mayores durante el tratamiento con anticoagulantes orales. Importancia del nivel de anticoagulación.

PURPOSE: The incidence of major thromboembolic complications in patients on oral anticoagulant therapy (OAT) and the correlation of this with the intensity of the OAT and the INR level at the time of the episode have been assessed in our study. PATIENTS AND METHODS: We have carried out a retrospective study including 1350 patients with an overall follow-up period of 6432 patient-years. The mean INR level throughout OAT and at the time of the mayor thromboembolic event were considered. The statistical analysis was performed by means of a survival analysis test. RESULTS: The incidence of major thromboembolic complications found in our study was 1.18/100 patient-years. Those patients with a mean INR below the therapeutic range showed significantly a higher risk (3.31 times higher) of suffering from some sort of major thromboembolic complication. Mean INR level at the time of the event was 1.9 and 47% of those patients had an INR level < 2 at the time of the thromboembolic complication. CONCLUSIONS: The probability of suffering a major thromboembolic complication for those subjects on OAT increases as the INR falls below the therapeutic range; therefore we must pay special attention to this factor in order to avoid any further recurrences.

[Parvovirus B19 infection in patients with congenital blood coagulation disorders]. / Infección por Parvovirus B19 en pacientes afectados de coagulopatías congénitas.

BACKGROUND: The aim of this study is to assess the prevalence of Parvovirus B19 infection in a group of patients affected by congenital coagulation disorders and its association with epidemiological aspects. PATIENTS AND METHODS: We have analyzed a group of 50 patients (median age 28) diagnosed with haemophilia or any other congenital coagulation disorder and 111 healthy non-transfused controls (median age 30) for IgG and IgM antibodies to Parvovirus B19 (Dako A/S, Glostrup, Dinamarca). Other issues analysed were HIV coinfection, the use of virally inactivated or non-inactivated plasma products and clinical symptoms of the infection. RESULTS: 84% of the patients (93.3% of those previously transfused) and 60.3% of the controls subjects showed IgG antibodies against Parvovirus B19. None of them had specific IgM antibodies. Five patients (all of them seronegative) had never been exposed to any plasma derivative and 11 were HIV-positive. The differences found between the prevalence of parvoviral infection in patients and controls are statistically significant, but those differences are only confirmed in younger patients (< 30) when age groups are compared. However, the severity of the haemostatic disorder, the type of plasma products infused or HIV coinfection had no influence on prevalence rates. The infection was clinically asymptomatic in all the cases. CONCLUSIONS: Haemophilic patients of any age are exposed to a higher risk of Parvovirus B19 infection than general population, although this infection had no clinical relevance in our study. The use of virally inactivated factor concentrates or the severity of the haemostatic disorder has no influence on this infectious risk.

[Infectivity by HIV of different blood products used in Aragon]. / Infectividad para el VIH de diferentes hemoderivados empleados en Aragón.

In our region, prevalence of anti-HIV antibodies among hemophiliacs B (83.3%) is higher than among hemophiliacs A (47%), as reported in other spanish communities and contrary to other countries, were the opposite phenomenon has been observed. This seems to be due to the volume of hemo-derivatives received, rather than to their different infectivity, as it has been suggested sometimes. In order to assess this infectivity, independently of doses, we have studied two groups of patients, hemophiliacs A transfused with factor III and non-hemophiliacs who had received concentrate of prothrombinic complex factors (CPCF), in doses lower than 10,000 units. Both groups were transfused during the period when seroconversions were observed in our area (1981-1985) and we demonstrated that the difference between their prevalences of anti-HIV antibodies was not statistically significant.