Knee replacement surgery in a patient with acquired von Willebrand disease: a case study with recommendations for patient management.

Introduction and importance: Acquired von Willebrand disease (AvWD) is a rare underdiagnosed bleeding disorder caused by alterations in the levels of the major blood-clotting protein von Willebrand factor (vWF). The clinical and laboratory parameters of AvWD are similar to congenital vWD, but it is found in individuals with no positive family history with no underlying genetic basis. The disease remains multifactorial and incompletely understood. Proposed mechanisms include the development of autoantibodies to vWF, absorption of high molecular weight vWF multimers that impair normal function, shear stress induced vWF cleavage and increased proteolysis.The aetiology of the disease is variable, the most common being hematoproliferation, lymophoproliferation, myeloproliferation and autoimmune and cardiovascular disorders. Consensus and protocols for AvWD patients that require major surgery are currently lacking. Patients with AvWD can experience thrombotic events during surgery as a result of therapeutic interactions with pro-thrombotic risk factors. Case presentation: Here, the authors report a patient with AvWD requiring a knee prosthesis implantation due to chronic pain, limited range of motion and functional impairment. The patient had a high risk of bleeding during surgery and was at risk of thrombosis due to age and obesity. Clinical discussion: Perioperative care required a collaborative approach and the management of bleeding. The patient was administered vWF concentrate Willfact lacking Factor VIII to prevent haemorrhage and to minimize the risk of thrombosis. Conclusion: The treatment was effective and well-tolerated. The authors use this information to provide recommendations for AvWD patients for whom major surgery is indicated.

A 3-Case Series of Autoimmune Haemolytic Anaemia and COVID-19: Is Plasma Exchange an Alternative?

COVID-19 has rarely been associated with immune-mediated phenomena such as autoimmune haemolytic anaemia (AIHA). Both cold hemolysis with cold agglutinin detection and warm haemolysis have been described with variable prognoses. Current treatment regimens are based on experience with other case series and case reports, which still represent a clinical challenge. Corticosteroids, red cell transfusions and rituximab have been successfully employed. We present 3 cases of AIHA in the context of COVID-19 disease, the first case successfully treated with plasma exchange and long-term follow-up of the 3 cases showing complete remission of anaemia.

Managing the front-line treatment for diffuse large B cell lymphoma and high-grade B cell lymphoma during the COVID-19 outbreak.

The COVID-19 pandemic has dramatically challenged care for cancer patients, especially those with active treatment who represent a vulnerable population for SARS-CoV-2 infection. Aggressive lymphoid neoplasms, such as diffuse large B cell lymphoma and high-grade B cell lymphoma, need to be treated without delay in order to get the best disease outcome. Because of that, our clinical practice was changed to minimise the risk of SARS-CoV-2 infection while continuing haematological treatment. In this report, we analyse the management of front-line therapy in 18 patients during the COVID-19 outbreak, as well as the results of the implemented measures in their outcome.

Osteotomía valguizante de tibia proximal en el tratamiento del genu varo artrósico / Valgus Osteotomy of the Proximal Tibia in the Treatment of Arthritic Genu varo

Fundamento: la asimilación de fuerzas en una rodilla mal alineada implica dolor, deformidad y disminución del rango de movimiento. La corrección quirúrgica retarda la progresión de la afección degenerativa articular y la realización de una artroplastia total. Objetivo: evaluar los resultados de la osteotomía valguizante de tibia proximal en el tratamiento del genu varo artrósico. Métodos: estudio descriptivo sobre 21 pacientes atendidos en el Servicio de Ortopedia del Hospital Territorial Docente Julio Aristegui Villamil, entre enero del 2003 y septiembre del 2008, con el diagnóstico de gonartrosis del compartimiento medial y deformidad angular vara secundaria, a los que se les realizó una osteotomía valguizante de tibia proximal con el uso de fijador externo RALCA®. Resultados: predominaron los pacientes masculinos (71,4 %), con edad media de 56,3±2,01 años, el sobrepeso como factor predisponente (57, 1 %) y 52,3 % de lesiones grado II según criterios de Ahlback. Desde el posoperatorio inmediato hasta los dos años, se logró un promedio de corrección quirúrgica del eje femorotibial de 9±1, 13 grados, con una pérdida de corrección de 2 ± 0,34 grados. La osteítis del alambre fue la complicación más frecuente (19, 04 %). A los dos años de evolución los resultados eran buenos en el 80,9 % de los casos. Se retrasó la artroplastia total o parcial de rodilla, disminuyó el dolor, mejoró la capacidad funcional y la calidad de vida en el 95, 2 % de los pacientes. Conclusiones: la osteotomía valguizante de tibia proximal resultó efectiva en el tratamiento del genu varo artrósico.

Background: the assimilation of forces in a misaligned knee involves pain, deformity and decreased range of motion. Surgical correction delays the progression of degenerative joint affection and the performance of a total arthroplasty. Objective: To assess the results of valgus osteotomy of the proximal tibia in the treatment of arthritic genu varo. Methods: A descriptive study was conducted including 21 patients treated at the Orthopedics Service of the Julio Aristegui Villamil Teaching Territorial Hospital from January 2003 to September 2008, with the diagnosis of medial compartment knee osteoarthritis and angular deformity in the secondary rod. These patients underwent valgus osteotomy of the proximal tibia using an external fixator RALCA ®. Results: Male patients predominated (71.4%) with an average age of 56.3 ± 2.01 years old, as well as overweight as a predisposing factor (57, 1%) and 52.3% of grade II lesions according to Ahlback criteria . From the immediate postoperative period up to two years of evolution, we achieved an average femorotibial axis surgical correction of 9 ± 1.13 degrees, with a loss of correction of 2 ± 0.34 degrees. Wire osteitis was the most common complication (19, 04%). After two years of evolution the results were good in 80.9% of cases: partial or total arthroplasty of the knee was delayed, pain was reduced and functional capacities as well as life quality of patients were improved in 95, 2% of cases. Conclusions: Valgus osteotomy of the proximal tibia was effective in the treatment of arthritic genu varo.