RESUMO
A multicentre modified World Health Organization (WHO)-type international sensitivity index (ISI) calibration has been performed at 10 European Concerted Action on Anticoagulation (ECAA) national laboratories using non-citrated whole-blood on two point-of-care test (POCT) prothrombin time (PT) monitor systems, CoaguChek Mini and TAS PT-NC, using single lots of test cards/strips. The relevant species (human and rabbit) WHO international reference preparations (IRPs) were tested with the manual PT technique on citrated plasma from the same blood donations. The ISI was calculated from the slope of the orthogonal regression line relating log PT (POCT) to log PT (IRP). The mean ISI of the CoaguChek Mini system was 1.75 and 1.13 with the prothrombin time non-citrated Thrombolytic Assessment System (TAS PT-NC). With the CoaguChek Mini system, seven out of 10 calibrations exceeded the current 3% WHO recommended limit for the coefficient of variation (CV) of the slope with conventional PT testing, whereas with the TAS PT-NC system, it was eight out of 10. All the POCT calibrations had a CV of the slope <5%. It is suggested that this level of precision be adopted as the limit of acceptability of calibration of these monitor systems. In these circumstances, the modified WHO-type ISI calibration appeared to be satisfactory for the POCT whole-blood monitors.
Assuntos
Monitorização Fisiológica/normas , Sistemas Automatizados de Assistência Junto ao Leito/normas , Tempo de Protrombina , Animais , Calibragem , Humanos , Coeficiente Internacional Normatizado , Monitorização Fisiológica/instrumentação , Coelhos , Kit de Reagentes para Diagnóstico , Análise de Regressão , Sensibilidade e EspecificidadeRESUMO
Mesenteric panniculitis is a rare disease of the bowel mesentery, characterized by tumor-like infiltration by chronic inflammatory cells, fat necrosis, and fibrosis. Reported cases cited clinical presentation ranging from abdominal pain to fever of unknown origin, the majority of which were idiopathic and associated with a benign prognosis. We report the case of a 43-yr-old male who presented with malaise, weight loss, microcytic anemia, and a high erythrocyte sedimentation rate. Radiographic and histological investigations revealed typical features of mesenteric panniculitis. Initial treatment with high-dose oral prednisolone led to rapid and complete resolution of symptomatology, radiographic, and laboratory anomalies. Within 6 months, the patient presented again with anemia, renal failure, and hypercalcemia. A diagnosis of IgA kappa chain myeloma was made. Despite chemotherapy and restoration of normocalcemia, he died from refractory pulmonary edema. This is the first report of a hematological malignancy initially presenting with features of mesenteric panniculitis culminating in an aggressive course and a fatal outcome.
Assuntos
Mieloma Múltiplo/diagnóstico , Paniculite Peritoneal/diagnóstico , Adulto , Biópsia por Agulha , Diagnóstico Diferencial , Progressão da Doença , Evolução Fatal , Humanos , Masculino , Mieloma Múltiplo/patologia , Paniculite Peritoneal/patologia , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios XRESUMO
Cutaneous signs of Günther's disease (congenital erythropoietic porphyria) developing 5 years after the onset of symptomatic thrombocytopenia are described in a 65-year-old man. Persistent thrombocytopenia unresponsive to corticosteroids and immunoglobulin necessitated a splenectomy.
Assuntos
Porfiria Eritropoética/complicações , Trombocitopenia/etiologia , Idoso , Humanos , Masculino , Porfiria Eritropoética/cirurgia , EsplenectomiaAssuntos
Fraturas do Colo Femoral/cirurgia , Fixação Interna de Fraturas , Fraturas Espontâneas/cirurgia , Mieloma Múltiplo/patologia , Neoplasias de Tecidos Moles/patologia , Coxa da Perna/patologia , Feminino , Prótese de Quadril , Humanos , Pessoa de Meia-Idade , Músculo Esquelético/patologia , Invasividade Neoplásica , Inoculação de NeoplasiaRESUMO
Pyoderma Gangrenosum (PG) is often associated with an underlying disease. PG as a paraneoplastic disease is illustrated by the presentation of four patients with malignancy of myeloproliferative origin and PG. An associated malignancy is found in approximately 7% of patients with PG, most commonly haematologic in nature and in particular leukaemia. Clinically the PG is often of the superficial bullous variant and is associated with a poor prognosis.
Assuntos
Síndromes Paraneoplásicas/patologia , Pioderma Gangrenoso/patologia , Idoso , Feminino , Humanos , Leucemia/patologia , Leucemia Mieloide Aguda/patologia , Masculino , Pessoa de Meia-Idade , Síndromes Mielodisplásicas/patologia , Policitemia Vera/patologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/patologiaRESUMO
A patient with long-standing, well-controlled polycythemia rubra vera developed recurrent episodes of bullous pyoderma gangrenosum followed by the transformation of his hematologic disease into a rapidly progressive acute myeloid leukemia. This case, together with previously described patients, indicates that the appearance of bullous pyoderma gangrenosum in a patient with polycythemia rubra vera is often of ominous prognostic significance.
Assuntos
Leucemia Mieloide Aguda/etiologia , Policitemia Vera/complicações , Pioderma Gangrenoso/etiologia , Humanos , Leucemia Mieloide Aguda/diagnóstico , Masculino , Pessoa de Meia-Idade , Policitemia Vera/patologia , Prognóstico , Pioderma Gangrenoso/patologia , RecidivaRESUMO
Pre-deposit autotransfusion has been shown to be an effective method of providing blood for planned surgery. This study discusses preliminary experience with pre-deposit autotransfusion an alternative to homologous blood from those patients considered suitable donors according to established guidelines. In the first 24 weeks, 31 patients pre-donated 59 units of autologous blood for planned surgery. Twenty-nine patients (94%) underwent surgery and 24 (83%) of these did not require additional homologous blood. Two donations (3.6%) were complicated by minor reaction. All donors expressed satisfaction with the service. The authors conclude that in elective orthopaedic surgery pre-deposit autotransfusion is a safe and effective alternative to homologous transfusion.
Assuntos
Transfusão de Sangue Autóloga , Ortopedia , Adolescente , Adulto , Idoso , Feminino , Humanos , Irlanda , Masculino , Pessoa de Meia-Idade , Satisfação do PacienteRESUMO
In a retrospective survey of 85 patients who received chemotherapy as treatment for non-Hodgkin's lymphomas, the authors found that clinically apparent thromboembolic disorders occurred in four of 11 patients receiving weekly chemotherapy, and in none of 74 patients who were treated on less intensive schedules, suggesting that intensive weekly chemotherapy is thrombogenic. The possible mechanisms of this effect are discussed.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Embolia Pulmonar/induzido quimicamente , Tromboembolia/induzido quimicamente , Adolescente , Adulto , Esquema de Medicação , Feminino , Humanos , Linfoma não Hodgkin/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosAssuntos
Leucemia Mielogênica Crônica BCR-ABL Positiva , Infecções por Mycobacterium não Tuberculosas , Infecções por Mycobacterium , Tuberculose Cutânea , Feminino , Humanos , Leucemia Mielogênica Crônica BCR-ABL Positiva/complicações , Pessoa de Meia-Idade , Infecções por Mycobacterium/patologia , Infecções por Mycobacterium não Tuberculosas/patologia , Tuberculose Cutânea/patologia , Tuberculose dos Linfonodos/patologiaRESUMO
Currently there is little information available about the efficacy of heparin during vascular surgery or of the effects of surgical trauma on heparin kinetics. This study was undertaken to evaluate the kinetics of heparin therapy during vascular surgery. Nine patients undergoing major vascular surgery (one carotid, one common iliac and seven aortic operations) were studied both preoperatively and intra-operatively, each patient acting as his own control. Following determination of control activated partial thromboplastin time (APTT) and plasma heparin levels, heparin (100 u/kg body weight) was administered intravenously. Heparin dosage ranged form 4500 units to 8600 units with a mean dose of 6500 units. Plasma heparin and APTT levels were then measured at 10 minute intervals for 1 hour and 20 minute intervals for a second hour. The mean pre-operative and intra-operative APTT levels at ten minutes attained maximal values of 6.6 +/- 3.7 and 8.8 +/- 1.7 times the control respectively. At the end of 2 hours the mean APTT remained greater than 2.5 times the control in both groups. Mean plasma heparin level was 0.83 +/- 0.04 units at 10 minutes and was almost identical in both groups. Heparin level was not a reliable indicator of anticoagulant effect as most patients achieved the same levels but had markedly differing APTT results. The results of this study suggest that excessive doses of heparin may be used in vascular surgery and that surgical trauma does not significantly alter sensitivity to heparin.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Aneurisma Aórtico/cirurgia , Doenças das Artérias Carótidas/cirurgia , Endarterectomia , Heparina/farmacocinética , Artéria Ilíaca/cirurgia , Idoso , Relação Dose-Resposta a Droga , Heparina/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Tempo de Tromboplastina Parcial , Tempo de ProtrombinaRESUMO
We report a 10 year old girl with congenital thrombocytopenia with absent radii (TAR) syndrome. Unusually this patient has shown no abnormal bleeding tendency despite numerous orthopaedic procedures. There is evidence of an associated immune component to the thrombocytopenia which has not been previously documented.
Assuntos
Rádio (Anatomia)/anormalidades , Trombocitopenia/congênito , Autoanticorpos/sangue , Plaquetas/imunologia , Criança , Feminino , Humanos , Imunoglobulina G/análise , Síndrome , Trombocitopenia/imunologiaRESUMO
The quality of blood salvaged at operation and prepared with the Dideco Autotrans BT 795 autotransfusion device was compared with that of donor blood in 41 patients having cardiac surgery involving cardiopulmonary bypass. Saved blood had a higher haemoglobin concentration (17.3 v. 13.1 g dl-1; P less than 0.001), a higher 2,3-diphosphoglycerate concentration (5.3 v. 1.1 mmol litre-1; P less than 0.00001), higher white cell count (17.1 X 10(9) litre-1 v. 4.1; P less than 0.00001), higher pH (7.5 v. 6.6; P less than 0.00001) and a more physiological potassium concentration (5.4 v. 8.8 mmol litre-1; P less than 0.00001) than donor blood. Saved blood platelet count was 34.5 X 10(9) litre-1 compared with 146.24 X 10(9) litre-1 (P less than 0.00001) and its heparin concentration was 0.64 u. ml-1. We conclude that this autotransfusor is a useful aid to blood conservation, producing good quality red cells with relatively normal pH and potassium values. However, modification of the centrifugation and washing is required to lessen the high white cell count and heparin concentrations found in the saved blood.
Assuntos
Transfusão de Sangue Autóloga/normas , Adolescente , Adulto , Idoso , Contagem de Células Sanguíneas , Procedimentos Cirúrgicos Cardíacos , Eritrócitos/fisiologia , Feminino , Heparina/sangue , Humanos , Concentração de Íons de Hidrogênio , Leucócitos/fisiologia , Masculino , Pessoa de Meia-Idade , Potássio/sangueRESUMO
Cardiopulmonary bypass can be expected to cause problems in a patient with sickle cell anaemia (SCA) as such surgery is associated with various factors which may induce sickling and subsequent sickle cell crisis. This patient is only the second with SCA to have valve replacement performed, and is the seventh case reported in the English literature to have cardiopulmonary bypass surgery.