Deep venous thrombosis in children with sickle cell disease.

BACKGROUND: Deep venous thrombosis (DVT) is rare in children compared to adults. Its incidence and risk factors in children are not well known. This study determined these aspects of DVT in children with sickle cell disease (SCD). PROCEDURE: A retrospective, observational and descriptive study was performed. Patients born between October 2000 and October 2012 with SCD and registered in HEMORIO, including those who died in HEMORIO, were included in this study. Patients whose medical records were inaccessible, who died in institutions other than HEMORIO, who died with implanted deep venous catheters, and those who were not monitored in HEMORIO for a period of 1 year or more were excluded from the study. Of a total of 1,519 patients, 456 were excluded and 1,063 patients were included in the study. Data were obtained from the computer system and the medical records at HEMORIO. RESULTS: Of the 1,063 patients, 2 (0.2%) developed DVT with both cases being related to central venous catheters (CVCs) (P-value <0.001). Of the patients who required CVCs, the prevalence of DVT was 10%. No other variable was clinically or statistically significant with respect to DVT. CONCLUSION: The establishment of CVCs in children with SCD poses a high risk for DVT. If this procedure is necessary, the internal jugular vein should be utilized instead of the subclavian and femoral veins. The identification of associated risk factors may justify antithrombotic prophylaxis.

Trombocitopenia na sepse: um importante marcador prognóstico / Thrombocitopenia in sepsis: an important prognosis factor

OBJETIVO: Demonstrar associação da trombocitopenia e do comportamento das plaquetas, com a mortalidade em pacientes sépticos. MÉTODOS: Foram selecionados os pacientes que apresentaram critérios de sepse na admissão ou em qualquer momento no curso da internação e excluídos os que ficaram menos de 24h internados. A trombocitopenia foi definida como contagem plaquetária abaixo de 150.000/mm³ e a recuperação, definida como retorno da contagem para níveis acima de 150.000/mm³ após trombocitopenia. Observaram-se variáveis de prognóstico na admissão (APACHE II), contagem plaquetária durante os dias de internação e desfecho. RESULTADOS: Dos 56 pacientes, 34 desenvolveram trombocitopenia no curso da sepse (Grupo 1). A mortalidade nesse grupo foi de 76,4%, e entre os não trombocitopênicos (Grupo 2) de 40,9%, (RR 1,87; IC 95% 1,12 - 3,12; p = 0,0163). Em 44,1% dos pacientes do Grupo 1, houve queda > 50% das plaquetas em relação à admissão, e desses, 93,3% evoluíram para óbito (RR 1,48; IC 95% 0,93 - 2,36; p = 0,0528). Entre os pacientes do Grupo 1 que apresentaram recuperação na contagem plaquetária, 53,3% sobreviveram, e dos que mantiveram trombocitopenia sem recuperação, 100% evoluíram para óbito (RR 2,14; IC 95% 1,35 - 3,39; p = 0,0003). Entre os pacientes com APACHE II > 22, os trombocitopênicos apresentaram mortalidade de 81,8% (p = 0,25) contra nenhuma morte entre os não trombocitopênicos, enquanto no grupo com APACHE II ≤ 22, a mortalidade dos trombocitopênicos foi de 74% (p = 0,0741) contra 42,8% dos não trombocitopênicos. CONCLUSÃO: A trombocitopenia, bem como seu comportamento evolutivo com queda >50% ou não recuperação, mostraram-se fatores de mau prognóstico no grupo de pacientes sépticos estudado.

OBJECTIVE: To demonstrate an association between thrombocytopenia and platelet behavior in predicting mortality in septic patients. METHODS: Patients with criteria for sepsis at admission or at any time during hospitalization were selected; patients hospitalized for less than 24 hours were excluded. Thrombocytopenia was defined as a platelet count lower than 150.000/mm³, and recovery was defined as returning to levels above 150.000/mm³ after showing thrombocytopenia. We assessed the admission prognosis variables (APACHE II), platelet counts during the hospitalization and outcomes. RESULTS: Of the 56 patients included, 34 developed thrombocytopenia during sepsis (Group 1) and had a 76.4% mortality rate. The mortality rate among patients not showing thrombocytopenia (Group 2) was 40.9% (RR 1.87; 95% CI 1.12 - 3.12; p = 0.0163). In 44.1% of Group 1 patients, the platelet counts drops by >50% compared with the admission counts; 93.3% of these patients eventually died (RR 1.48; 95% CI 0.93 - 2.36; p = 0.0528). Among the Group 1 patients showing recovered platelet counts, 53.3% survived; 100% of the patients with unrecovered thrombocytopenia died (RR 2.14; 95% CI 1.35 - 3.39; p = 0.0003). Among the patients with APACHE II scores > 22, the thrombocytopenic patients had an 81.8% mortality rate (p = 0.25), while no deaths occurred among the non-thrombocytopenic patients. For the patients with APACHE II scores ≤ 22, the mortality rate of the thrombocytopenic patients was 74% (p = 0.0741), versus 42.8% for the non-thrombocytopenic patients. CONCLUSION: For this sample of septic patients, thrombocytopenia and its progression, defined as a >50% drop or failure to recover platelet count, were shown to be markers of poor prognosis.

Thrombocitopenia in sepsis: an important prognosis factor. / Trombocitopenia na sepse: um importante marcador prognóstico.

OBJECTIVE: To demonstrate an association between thrombocytopenia and platelet behavior in predicting mortality in septic patients. METHODS: Patients with criteria for sepsis at admission or at any time during hospitalization were selected; patients hospitalized for less than 24 hours were excluded. Thrombocytopenia was defined as a platelet count lower than 150.000/mm³, and recovery was defined as returning to levels above 150.000/mm³ after showing thrombocytopenia. We assessed the admission prognosis variables (APACHE II), platelet counts during the hospitalization and outcomes. RESULTS: Of the 56 patients included, 34 developed thrombocytopenia during sepsis (Group 1) and had a 76.4% mortality rate. The mortality rate among patients not showing thrombocytopenia (Group 2) was 40.9% (RR 1.87; 95% CI 1.12 - 3.12; p = 0.0163). In 44.1% of Group 1 patients, the platelet counts drops by >50% compared with the admission counts; 93.3% of these patients eventually died (RR 1.48; 95% CI 0.93 - 2.36; p = 0.0528). Among the Group 1 patients showing recovered platelet counts, 53.3% survived; 100% of the patients with unrecovered thrombocytopenia died (RR 2.14; 95% CI 1.35 - 3.39; p = 0.0003). Among the patients with APACHE II scores > 22, the thrombocytopenic patients had an 81.8% mortality rate (p = 0.25), while no deaths occurred among the non-thrombocytopenic patients. For the patients with APACHE II scores ≤ 22, the mortality rate of the thrombocytopenic patients was 74% (p = 0.0741), versus 42.8% for the non-thrombocytopenic patients. CONCLUSION: For this sample of septic patients, thrombocytopenia and its progression, defined as a >50% drop or failure to recover platelet count, were shown to be markers of poor prognosis.