Dosing and monitoring of enoxaparin therapy in children: experience in a tertiary care hospital.

Pediatric deep vein thrombosis (DVT) is an emerging problem in tertiary care hospitals, recent reviews shows a rate of 40.2/10,000 admissions. Experts affirm that enoxaparin has become in the drug of choice for DVT therapy. Despite this, there is a little information regarding the optimal dose schedule for enoxaparin therapy in children and the therapeutic guidelines for enoxaparin use in children are extrapolated from adult guidelines. Monitoring by antifactor Xa (anti-Xa) measurement and target concentrations between 0.5-1 U/ml at 4-6 h postdose are recommended. This study was designed to analyse our experience in paediatric-specific dosage requirements for enoxaparin therapy. A retrospective study was performed with patients less than 16 years old, who were treated with enoxaparin for DVT and monitored by anti-Xa concentration, between January 2005 and March 2012. Demographic and clinical characteristics and outcomes were obtained. Fourteen patients were analyzed: boy/girl ratio, 8/4; median age, 3.5 months. Cerebral venous sinus thrombosis was the most common indication for therapy. All patients presented thrombosis risks factors. Dose increases were necessary only in patients less than 6 years old. Target anti-Xa concentrations were achieved in 12 (85%) patients. Children younger than 1 year required a higher dose of enoxaparin/kg (1.5-2.7 mg/kg per 12 h). Complete resolutions of DVT were registered in all cases. The mean number of dose increases was three and a median of 11 days to achieve target anti-Xa concentration. This study indicates that an initial higher enoxaparin dose may be necessary in neonates and infants, but other factors must be considered to improve management.

[Comparison between phlebotomy and erythrocytapheresis of iron overload in patients with HFE gene mutations]. / Comparación de la flebotomía con eritrocitaféresis en la sobrecarga de hierro en portadores de mutaciones del gen HFE.

BACKGROUND AND OBJECTIVE: Large-volume erythrocytapheresis (EA) is an useful and speedy method to treat iron overload (IO). We assesed the efficacy of EA in patients with HFE gene mutations and IO compared to the classical phlebotomies. PATIENTS AND METHOD: Data from 9 patients with IO treated with EA, using a discontinuous flow cell separator as a single needle procedure, for a period of 2 years, were compared to 9 matched patients who underwent conventional phlebotomies. RESULTS: The mean volume of red blood cells removed in each EA was 275 ml, with a median reduction of 23 g/l for haemoglobin and 55 microg/l for serum ferritin levels (vs. 17 microg/l between phlebotomies). The liver function test returned to normal values in 4 out of 5 patients undergoing EA, but none of the phlebotomies. The time required to achieve iron depletion was 3 times shorter in EA group. CONCLUSIONS: EA is an effective and safe procedure that achieves iron depletion more quickly than manual phlebotomies. Nevertheless, to determine its cost-effectiveness, economical, prospective, randomized studies are warranted.

Comparación de la flebotomía con eritrocitaféresis en la sobrecarga de hierro en portadores de mutaciones del gen HFE / Comparison between phlebotomy and erythrocytapheresis of iron overload in patients with HFE gene mutations

Fundamento y objetivo: Aunque la sangría terapéutica se considera el tratamiento de elección de la sobrecarga férrica (SF), la eritrocitaféresis (EA) se presenta como un método seguro y rápido para retirar el exceso de hierro, sin pérdida asociada de volumen, plasma ni plaquetas. En este estudio se compara la eficacia de la EA con la del método clásico. Pacientes y método: Se revisaron los datos de 9 pacientes con SF tratados con EA, mediante separador celular automático de flujo discontinuo por unipunción, en 24 meses, y se compararon con los de 9 pacientes apareados tratados con sangrías. Resultados: En cada EA se retiraron 275 ml de eritrocitos, con reducción de 23 g/l de la hemoglobina y de 55 µg/l de la ferritina, frente a los 17 µg/l de la sangría, lo que redujo a un tercio el tiempo requerido para la depleción férrica. Las pruebas hepáticas se normalizaron en el 80% de los pacientes con EA, y en ninguno de los tratados con sangría. Conclusiones: La EA es segura, efectiva y más rápida que las sangrías para eliminar la SF, aunque se necesitan estudios económicos aleatorizados para determinar si es además una alternativa coste-efectiva

Background and objective: Large-volume erythrocytapheresis (EA) is an useful and speedy method to treat iron overload (IO). We assesed the efficacy of EA in patients with HFE gene mutations and IO compared to the classical phlebotomies. Patients and method: Data from 9 patients with IO treated with EA, using a discontinuous flow cell separator as a single needle procedure, for a period of 2 years, were compared to 9 matched patients who underwent conventional phlebotomies. Results: The mean volume of red blood cells removed in each EA was 275 ml, with a median reduction of 23 g/l for haemoglobin and 55 µg/l for serum ferritin levels (vs. 17 µg/l between phlebotomies). The liver function test returned to normal values in 4 out of 5 patients undergoing EA, but none of the phlebotomies. The time required to achieve iron depletion was 3 times shorter in EA group. Conclusions: EA is an effective and safe procedure that achieves iron depletion more quickly than manual phlebotomies. Nevertheless, to determine its cost-effectiveness, economical, prospective, randomized studies are warranted

Scedosporium prolificans: infección diseminada en un paciente inmunodeprimido / Scedosporium prolificans: diseminated infection in immunocompromised patient

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