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1.
Nephrology (Carlton) ; 25(11): 845-849, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32776624

RESUMO

COVID-19 remains a global pandemic with more than 10 million cases and half a million deaths worldwide. The disease manifestations in patients with chronic kidney disease and especially those on haemodialysis are still being understood, with only a few overseas case series, and small observational trials thus far. It appears that the disease is more severe in this patient cohort. Part of the pathophysiology of severe COVID-19 is related to accompanying cytokine release syndrome (CRS). Tocilizumab, an interleukin-6 inhibitor, has been trialled for treatment of CRS in COVID-19, but not yet approved. We present a case of an Australian patient on long-term haemodialysis with severe COVID-19 who was successfully treated with Tocilizumab. The peak of her illness was on day 7, with a C-reactive protein of 624 mg/L (reference < 5 mg/L), ferritin of 5293 ng/mL (reference 30-500 ng/mL), and interleukin-6 level 1959.7 pg/mL, consistent with CRS. She was severely hypoxic on a ventilator, with rising inotropic requirements. With the use of Tocilizumab, there was a significant and immediate response in her inflammatory markers, and she made a steady recovery. The patient was discharged home 6 weeks after presentation.


Assuntos
Anemia , Anticorpos Monoclonais Humanizados/administração & dosagem , Infecções por Coronavirus , Síndrome da Liberação de Citocina , Interleucina-6 , Falência Renal Crônica , Pandemias , Pneumonia Viral , Idoso , Anemia/etiologia , Anemia/terapia , Transfusão de Sangue/métodos , Proteína C-Reativa/análise , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/terapia , Síndrome da Liberação de Citocina/sangue , Síndrome da Liberação de Citocina/terapia , Síndrome da Liberação de Citocina/virologia , Feminino , Humanos , Fatores Imunológicos/administração & dosagem , Interleucina-6/antagonistas & inibidores , Interleucina-6/sangue , Falência Renal Crônica/complicações , Falência Renal Crônica/terapia , Monitorização Imunológica/métodos , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/imunologia , Pneumonia Viral/terapia , Diálise Renal/métodos , Respiração Artificial/métodos , Resultado do Tratamento
2.
Am J Perinatol ; 37(12): 1280-1282, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32791537

RESUMO

INTRODUCTION: Data regarding transplacental passage of maternal coronavirus disease 2019 (COVID-19) antibodies and potential immunity in the newborn is limited. CASE REPORT: We present a 25-year-old multigravida with known red blood cell isoimmunization, who was found to be COVID-19 positive at 27 weeks of gestation while undergoing serial periumbilical blood sampling and intrauterine transfusions. Maternal COVID-19 antibody was detected 2 weeks after positive molecular testing. Antibodies were never detected on cord blood samples from two intrauterine fetal cord blood samples as well as neonatal cord blood at the time of delivery. CONCLUSION: This case demonstrates a lack of passive immunity of COVID-19 antibodies from a positive pregnant woman to her fetus, neither in utero nor at the time of birth. Further studies are needed to understand if passage of antibodies can occur and if that can confer passive immunity in the newborn. KEY POINTS: · Passive immunity should not be assumed in COVID-19 infection in pregnancy.. · Isoimmunization may impair passive immunity of certain antibodies.. · Vaccination to or maternal infection of COVID-19 may not be protective for the fetus..


Assuntos
Anemia/terapia , Anticorpos Antivirais/imunologia , Transfusão de Sangue Intrauterina , Infecções por Coronavirus/imunologia , Sangue Fetal/imunologia , Imunidade Materno-Adquirida/imunologia , Imunoglobulina G/imunologia , Pneumonia Viral/imunologia , Complicações Infecciosas na Gravidez/imunologia , Adulto , Anemia/etiologia , Betacoronavirus , Incompatibilidade de Grupos Sanguíneos/complicações , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Feminino , Humanos , Pandemias , Gravidez , Segundo Trimestre da Gravidez
3.
Am J Cardiol ; 128: 161-162, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32650913

RESUMO

We describe an 84-year-old man who presented with hemoptysis and acute blood loss anemia due to a pulmonary artery pseudoaneurysm (PAP). The etiology of his PAP was thought to be an abandoned epicardial defibrillator patch that was implanted at age 55. To our knowledge, PAP has never been reported as a possible complication of an abandoned epicardial defibrillator patch.


Assuntos
Falso Aneurisma/diagnóstico por imagem , Desfibriladores Implantáveis , Corpos Estranhos/diagnóstico por imagem , Artéria Pulmonar/diagnóstico por imagem , Idoso de 80 Anos ou mais , Anemia/etiologia , Anemia/terapia , Falso Aneurisma/etiologia , Falso Aneurisma/cirurgia , Angiografia Digital , Transfusão de Sangue , Procedimentos Endovasculares , Corpos Estranhos/complicações , Hemoptise/etiologia , Hemoptise/cirurgia , Humanos , Masculino , Artéria Pulmonar/cirurgia , Tomografia Computadorizada por Raios X
5.
Can J Cardiol ; 36(9): 1550-1553, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32599018

RESUMO

Severe acute respiratory distress syndrome (ARDS) can complicate novel pandemic coronavirus disease (COVID-19). Extracorporeal life support (ECLS) represents the final possible rescue strategy. Variations in practice, combined with a paucity of rigourous guidelines, may complicate blood-product resource availability and allocation during a pandemic. We conducted a literature review around venovenous extracorporeal membrane oxygenation (VV-ECMO) transfusion practices for platelets, packed red blood cells, fresh frozen plasma, prothrombin complex concentrate, and antithrombin. Pertinent society guidelines were examined, and the practice of Canadian ECLS experts was sampled through an environmental scan. This paper represents a synthesis of these explorations, combined with input from the Canadian Cardiovascular Critical Care (CANCARE) Society, Canadian Society of Cardiac Surgeons, and the Canadian Critical Care Society. We offer a pragmatic guidance document for restrictive transfusion thresholds in nonbleeding patients on VV-ECMO, which may attenuate transfusion-related complications and simultaneously shield national blood product inventory from strain during pandemic-induced activation of the National Plan for the Management of Shortages of Labile Blood Components.


Assuntos
Anticoagulantes , Transfusão de Componentes Sanguíneos/métodos , Infecções por Coronavirus/complicações , Oxigenação por Membrana Extracorpórea , Pneumonia Viral/complicações , Síndrome do Desconforto Respiratório do Adulto , Adulto , Anemia/sangue , Anemia/etiologia , Anemia/terapia , Anticoagulantes/classificação , Anticoagulantes/uso terapêutico , Betacoronavirus , Testes de Coagulação Sanguínea/métodos , Canadá , Consenso , Oxigenação por Membrana Extracorpórea/efeitos adversos , Oxigenação por Membrana Extracorpórea/métodos , Humanos , Pandemias , Síndrome do Desconforto Respiratório do Adulto/sangue , Síndrome do Desconforto Respiratório do Adulto/etiologia , Síndrome do Desconforto Respiratório do Adulto/terapia , Trombose/sangue , Trombose/etiologia , Trombose/prevenção & controle
6.
Am J Gastroenterol ; 115(8): 1283-1285, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32516204

RESUMO

Gastrointestinal symptoms are common and frequently reported in Coronavirus Disease-2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It is unclear if SARS-CoV-2 is associated with increased risk of gastrointestinal bleeding (GIB). Nevertheless, GIB in COVID-19 patients poses unique challenges to patients due to high-risk of concomitant respiratory failure and to endoscopy personnel due to risk of airborne transmission during endoscopic procedures. Many management issues related to COVID-19 are still being studied. In this case series, we attempt to discuss the important clinical implications related to the management of GIB in COVID-19 patients.


Assuntos
Anemia/terapia , Infecções por Coronavirus/terapia , Hemorragia Gastrointestinal/terapia , Pneumonia Viral/terapia , Idoso de 80 Anos ou mais , Anastomose em-Y de Roux , Anemia/etiologia , Betacoronavirus , Tratamento Conservador , Infecções por Coronavirus/complicações , Transfusão de Eritrócitos , Feminino , Hemorragia Gastrointestinal/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Úlcera Péptica Hemorrágica/complicações , Úlcera Péptica Hemorrágica/terapia , Pneumonia Viral/complicações , Complicações Pós-Operatórias/terapia , Inibidores da Bomba de Prótons/uso terapêutico , Índice de Gravidade de Doença , Úlcera/complicações , Úlcera/terapia
7.
Br J Haematol ; 189(4): 635-639, 2020 05.
Artigo em Inglês | MEDLINE | ID: covidwho-116400

RESUMO

With the developing COVID-19 pandemic, patients with inherited anaemias require specific advice regarding isolation and changes to usual treatment schedules. The National Haemoglobinopathy Panel (NHP) has issued guidance on the care of patients with sickle cell disease, thalassaemia, Diamond Blackfan anaemia (DBA), congenital dyserythropoietic anaemia (CDA), sideroblastic anaemia, pyruvate kinase deficiency and other red cell enzyme and membrane disorders. Cascading of accurate information for clinicians and patients is paramount to preventing adverse outcomes, such as patients who are at increased risk of fulminant bacterial infection due to their condition or its treatment erroneously self-isolating if their fever is mistakenly attributed to a viral cause, delaying potentially life-saving antibiotic therapy. Outpatient visits should be minimised for most patients, however some, such as first transcranial dopplers for children with sickle cell anaemia should not be delayed as known risk of stroke will outweigh the unknown risk from COVID-19 infection. Blood transfusion programmes should be continued, but specific changes to usual clinical pathways can be instituted to reduce risk of patient exposure to COVID-19, as well as contingency planning for possible reductions in blood available for transfusions. Bone marrow transplants for these disorders should be postponed until further notice. With the current lack of evidence on the risk and complications of COVID-19 infection in these patients, national data collection is ongoing to record outcomes and eventually to identify predictors of disease severity, particularly important if further waves of infection travel through the population.


Assuntos
Anemia/complicações , Anemia/terapia , Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/complicações , Pneumonia Viral/prevenção & controle , Transfusão de Sangue , Transplante de Medula Óssea , Infecção Hospitalar/prevenção & controle , Humanos
9.
Anaesthesia ; 75(8): 1105-1113, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32339260

RESUMO

As COVID-19 disease escalates globally, optimising patient outcome during this catastrophic healthcare crisis is the number one priority. The principles of patient blood management are fundamental strategies to improve patient outcomes and should be given high priority in this crisis situation. The aim of this expert review is to provide clinicians and healthcare authorities with information regarding how to apply established principles of patient blood management during the COVID-19 pandemic. In particular, this review considers the impact of the COVID-19 pandemic on blood supply and specifies important aspects of donor management. We discuss how preventative and control measures implemented during the COVID-19 crisis could affect the prevalence of anaemia, and highlight issues regarding the diagnosis and treatment of anaemia in patients requiring elective or emergency surgery. In addition, we review aspects related to patient blood management of critically ill patients with known or suspected COVID-19, and discuss important alterations of the coagulation system in patients hospitalised due to COVID-19. Finally, we address special considerations pertaining to supply-demand and cost-benefit issues of patient blood management during the COVID-19 pandemic.


Assuntos
Betacoronavirus , Doadores de Sangue/provisão & distribução , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Anemia/complicações , Anemia/diagnóstico , Anemia/terapia , Transtornos da Coagulação Sanguínea/diagnóstico , Transtornos da Coagulação Sanguínea/tratamento farmacológico , Transtornos da Coagulação Sanguínea/virologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Procedimentos Cirúrgicos Eletivos , Emergências , Humanos , Recuperação de Sangue Operatório , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Cuidados Pré-Operatórios/métodos
10.
Radiol Med ; 125(10): 1008-1011, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32306200

RESUMO

PURPOSE: This manuscript reports on a preliminary experience concerning emborrhoid in patients affected by cirrhotic portal hypertension; furthermore, a novel customized technique of coils release, named "Spaghetti technique," is described. MATERIALS AND METHODS: Five patients with chronic anemia due to internal hemorrhoidal bleeding and cirrhotic portal hypertension were treated. Clinics and hemoglobin values were evaluated to objectively assess clinical conditions up to 3 months follow-up. Embolizations were performed with fibered coils, oversized, released stretched and not packed. RESULTS: Technical success, intended as occlusion of all superior hemorrhoidal artery branches, was 100%. In two patients, inferior hemorrhoidal arteries were embolized too. No patients reported major or minor complications. At 3-month follow-up, clinical improvement was obtained in four of the five patients; hemoglobin values improved or remained stable in the whole sample. CONCLUSIONS: Based on this limited experience, emborrhoid seems to be safe and effective at 3-month follow-up to improve symptoms in patients with cirrhotic portal hypertension and chronic anemia due to hemorroidal bleeding; the stretched fashion to release oversized coils provides effective embolization.


Assuntos
Embolização Terapêutica/métodos , Hemorragia/terapia , Hemorroidas/terapia , Hipertensão Portal/complicações , Idoso , Anemia/etiologia , Anemia/terapia , Embolização Terapêutica/instrumentação , Feminino , Hemorragia/complicações , Hemorroidas/complicações , Humanos , Cirrose Hepática/complicações , Masculino , Artérias Mesentéricas , Pessoa de Meia-Idade
11.
Br J Haematol ; 189(4): 635-639, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32330288

RESUMO

With the developing COVID-19 pandemic, patients with inherited anaemias require specific advice regarding isolation and changes to usual treatment schedules. The National Haemoglobinopathy Panel (NHP) has issued guidance on the care of patients with sickle cell disease, thalassaemia, Diamond Blackfan anaemia (DBA), congenital dyserythropoietic anaemia (CDA), sideroblastic anaemia, pyruvate kinase deficiency and other red cell enzyme and membrane disorders. Cascading of accurate information for clinicians and patients is paramount to preventing adverse outcomes, such as patients who are at increased risk of fulminant bacterial infection due to their condition or its treatment erroneously self-isolating if their fever is mistakenly attributed to a viral cause, delaying potentially life-saving antibiotic therapy. Outpatient visits should be minimised for most patients, however some, such as first transcranial dopplers for children with sickle cell anaemia should not be delayed as known risk of stroke will outweigh the unknown risk from COVID-19 infection. Blood transfusion programmes should be continued, but specific changes to usual clinical pathways can be instituted to reduce risk of patient exposure to COVID-19, as well as contingency planning for possible reductions in blood available for transfusions. Bone marrow transplants for these disorders should be postponed until further notice. With the current lack of evidence on the risk and complications of COVID-19 infection in these patients, national data collection is ongoing to record outcomes and eventually to identify predictors of disease severity, particularly important if further waves of infection travel through the population.


Assuntos
Anemia/complicações , Anemia/terapia , Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/complicações , Pneumonia Viral/prevenção & controle , Transfusão de Sangue , Transplante de Medula Óssea , Infecção Hospitalar/prevenção & controle , Humanos
12.
BJOG ; 127(9): 1154-1164, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32175668

RESUMO

OBJECTIVE: Data regarding low maternal haemoglobin concentration and severe maternal morbidity (SMM) are limited and potentially biased. This study evaluated the relation between early maternal haemoglobin concentration and SMM or maternal mortality. DESIGN: Population-based cohort study. SETTING: Ontario, Canada, in a public healthcare system. POPULATION: 737 393 births with a routine outpatient haemoglobin measured at a calculated gestational age of 2-16 weeks. METHODS: The relation between early-pregnancy outpatient blood haemoglobin concentration and each study outcome was expressed as adjusted relative risks (aRR) and absolute risk differences (aRD), with 95% confidence intervals (CI), generated by modified Poisson regression. MAIN OUTCOME MEASURES: The primary outcome was SMM or maternal mortality, from 23 weeks' gestation to 42 days postpartum. RESULTS: The mean (SD) haemoglobin concentration was 126.9 (9.3) g/l. Overall, SMM or death occurred in 13 514 pregnancies (1.8%). Relative to a haemoglobin level of 125-129 g/l, the aRR was 1.07 (95% CI 1.02-1.13) and aRD (0.09%, 95% CI 0.01-0.18) at 120-124 g/l; aRR 1.31 (95% CI 1.17-1.46) and aRD 0.47% (95% CI 0.24-0.69) at 105-109 g/l; and aRR 4.53 (95% CI 3.59-5.72) and aRD 5.94% (95% CI 4.12-7.76) at <90 g/l. In all, 5961 women (0.8%) required red cell transfusion, with significantly higher risks at all haemoglobin concentrations below 125-129 g/l, peaking at a haemoglobin level <90 g/l (aRR 11.82, 95% CI 9.30-15.03). CONCLUSION: There is a gradual increase in the risk of SMM or death, as well as red cell transfusion, starting from the lower level of the normal range of haemoglobin of non-pregnant women. TWEETABLE ABSTRACT: Women with low haemoglobin in early pregnancy are at higher future risk of morbidity, death and blood transfusion.


Assuntos
Anemia/sangue , Anemia/epidemiologia , Transfusão de Eritrócitos/estatística & dados numéricos , Hemoglobinas/metabolismo , Complicações na Gravidez/sangue , Complicações na Gravidez/epidemiologia , Adulto , Anemia/mortalidade , Anemia/terapia , Feminino , Humanos , Mortalidade Materna , Ontário/epidemiologia , Gravidez , Complicações na Gravidez/mortalidade , Complicações na Gravidez/terapia , Primeiro Trimestre da Gravidez/sangue , Estudos Retrospectivos , Fatores de Risco
13.
Hemodial Int ; 24(2): 252-260, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32052563

RESUMO

INTRODUCTION: Treatment of fluid overload and anemia remains a challenge in patients undergoing hemodialysis. Hypervolemia can be evaluated using a carbon monoxide (CO) rebreathing method by which blood volume (BV), plasma volume (PV), and red blood cell volumes (RBCV) can be determined. We hypothesized that recurrent hypervolemia would cause hemoglobin (Hb) levels to be in the anemic range without a concurrent reduction in RBCV in patients undergoing hemodialysis. METHODS: BV, PV, and RBCV were determined by a CO rebreathing test in 19 patients with type 2 diabetes undergoing chronic hemodialysis. The tests were performed 20 minutes before initiating dialysis, and the measured intravascular volumes were compared with predicted normal intravascular volumes according to Nadler's equation. Before initiating dialysis, Hb and blood pressure were measured, and edema severity was graded. FINDINGS: Measured BV was higher in 17 out of the 19 patients with a median of 71.1 (62.4-76.9) mL/kg and higher than the predicted BV of 58.3 (53.5-59.9) mL/kg (P < 0.001). The measured PV was found to be higher in all patients. RBCV was measured as 25.2 (23.4-28.2) mL/kg with a predicted volume of 25.9 (22.4-26.7) mL/kg (P = 0.56). Eighteen patients were anemic as determined by Hb concentrations (defined as Hb < 13 g/dL for men and <12 g/dL for women), and nine were anemic according to RBCV. DISCUSSION: The CO rebreathing test is a new approach to measuring intravascular volumes in hemodialysis patients. Compared with predicted intravascular volumes, the predialysis BV was expanded in the majority with elevated PV as the main cause. No overall difference in RBCV was found between the measured and predicted volumes. According to predialysis Hb levels, all but one patient was anemic, but according to the measured RBCV, only nine were in the anemic range, indicating dilution of Hb.


Assuntos
Anemia/terapia , Monóxido de Carbono/metabolismo , Volume Plasmático/fisiologia , Diálise Renal/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anemia/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Respiração , Adulto Jovem
14.
J Trauma Acute Care Surg ; 88(6): 803-808, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32102035

RESUMO

BACKGROUND: Anemia in patients who decline transfusion has been associated with increased morbidity and mortality. We hypothesized that the time to death decreases with increasing severity of anemia in patients for whom transfusion is not an option. METHODS: With institutional review board approval, a retrospective review of registered adult blood refusal patients with at least one hemoglobin (Hb) value of 12.0 g/dL or less during hospital admission at a single institution from January 2004 to September 2015 was performed. The association of nadir Hb category and time to death (all-cause 30-day mortality) was determined using Kaplan-Meier plots, log rank tests, and Cox proportional hazard models. We investigated if there was a nadir Hb level between the values of 5.0 and 6.0 g/dL at which mortality risk significantly increased and then categorized nadir Hb by the traditional cut points and the newly identified "critical" cut point. RESULTS: The study population included 1,011 patients. The Cox proportional hazard models showed a more than 50% increase in hazard of death per 1 g/dL decrease in Hb (adjusted hazard ratio [confidence interval], 1.55 [1.40-1.72]; p < 0.001). A Hb value of 5.0 g/dL was identified as defining "critical anemia." We found a strong association between anemia severity level and mortality (p < 0.001). Time to death was shorter (median, 2 days) in patients with critical anemia than in those having higher Hb (median time to death of 4 or 6 days, in severe or moderate anemia). CONCLUSION: In anemic patients unable to be transfused, critical anemia was associated with a significantly and clinically important reduced time to death. LEVEL OF EVIDENCE: Prognostic, level III.


Assuntos
Anemia/diagnóstico , Transfusão de Sangue/psicologia , Hemoglobinas/análise , Religião , Recusa do Paciente ao Tratamento/psicologia , Adulto , Idoso , Anemia/sangue , Anemia/mortalidade , Anemia/terapia , Transfusão de Sangue/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , North Carolina/epidemiologia , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Análise de Sobrevida , Fatores de Tempo , Recusa do Paciente ao Tratamento/estatística & dados numéricos
15.
J Oncol Pharm Pract ; 26(5): 1285-1288, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32054413

RESUMO

INTRODUCTION: Polycythemia vera is a myeloproliferative neoplasm (MPN) characterized by increased red blood cell mass. The natural evolution of this MPN is to progress to an anemic/cytopenic phase also known as "spent" phase prior to transformation into an accelerated and/or an overt leukemic phase. CASE REPORT: Herein, we describe a case of a patient with polycythemia vera transitioning though a "spent" phase to an MPN in accelerated phase (MPN-AP). The patient had anemia, thrombocytopenia, neutrophilia and increased blasts in the bone marrow. Management and outcome: Upon treatment with four cycles of 5-azacitidine, the patient's polycythemia vera reversed back to the proliferative phase. Serial phlebotomies were again required. DISCUSSION: Reversal of a "spent" phase by 5-azacitidine back to a proliferative polycythemia vera phase requiring phlebotomies has not been previously reported in the scientific literature. We might witness similar cases in the literature in the future years, which could lead to yet another therapeutic indication of this important pharmacologic agent.


Assuntos
Antimetabólitos Antineoplásicos/uso terapêutico , Azacitidina/uso terapêutico , Flebotomia/métodos , Policitemia Vera/tratamento farmacológico , Idoso de 80 Anos ou mais , Anemia/sangue , Anemia/tratamento farmacológico , Anemia/terapia , Azacitidina/farmacologia , Medula Óssea/efeitos dos fármacos , Medula Óssea/metabolismo , Feminino , Humanos , Transtornos Mieloproliferativos/sangue , Transtornos Mieloproliferativos/tratamento farmacológico , Transtornos Mieloproliferativos/terapia , Policitemia Vera/sangue , Policitemia Vera/terapia
16.
J Vet Emerg Crit Care (San Antonio) ; 30(3): 336-341, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32077204

RESUMO

OBJECTIVE: To describe the diagnosis, management, and outcome of a ferret with spontaneous hemoperitoneum with surgical intervention and xenotransfusion of type A feline packed red blood cells (pRBCs). CASE SUMMARY: A domestic ferret diagnosed with a spontaneous hemoperitoneum secondary to a hepatic mass received isotonic crystalloids, hypertonic saline, and an allogenic blood transfusion perioperatively. Postoperatively, the ferret developed progressive anemia and tachycardia refractory to fluid therapy and, given a lack of additional allogenic blood sources, received a xenotransfusion of feline pRBCs. The ferret was hospitalized for 4 days postoperatively and developed a presumed delayed transfusion reaction characterized by transient hyperbilirubinemia. At a 6-month recheck, the ferret was doing well clinically. NEW OR UNIQUE INFORMATION PROVIDED: This is the first reported case of successful xenotransfusion of feline pRBCs in a ferret. Although xenotransfusion of ferrets with feline blood products is not recommended as a routine procedure, it remains a viable option in critical situations in which ferret blood is unavailable.


Assuntos
Transfusão de Eritrócitos/veterinária , Furões , Hemoperitônio/veterinária , Anemia/terapia , Anemia/veterinária , Animais , Gatos , Hemoperitônio/terapia , Especificidade da Espécie
17.
Z Gerontol Geriatr ; 53(3): 233-238, 2020 May.
Artigo em Alemão | MEDLINE | ID: mdl-32065249

RESUMO

Anemia is frequent in older people with one in two geriatric inpatients being affected. Therefore, in elective surgery, such as endoprosthetic treatment it is very likely that anemia is already present in a preoperative setting. So far there are no particular guidelines about perioperative management of anemia in geriatric patients. The existing recommendations of the Patient Blood Management (PBM) network cooperation and the current Association of the Scientific Medical Societies in Germany (AWMF) S3 guidelines on preoperative anemia refer to all patients aged >18 years but without particular consideration of the growing number of oldest old orthogeriatric patients. This is more problematic as anemia in the aged has been shown to be different from anemia in younger patients in terms of diagnostics and treatment. Based on several interdisciplinary lectures, this year the symposium of the working group on anemia of the German Geriatric Society (DGG) focused on the problems of perioperative PBM in orthogeriatric patients and encouraged the discussion about developing PBM treatment recommendations for this patient group.


Assuntos
Anemia/terapia , Transfusão de Sangue , Assistência Perioperatória , Cuidados Pré-Operatórios/métodos , Idoso , Idoso de 80 Anos ou mais , Congressos como Assunto , Procedimentos Cirúrgicos Eletivos , Avaliação Geriátrica , Alemanha , Humanos , Sociedades Médicas
18.
Curr Opin Anaesthesiol ; 33(2): 220-226, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32004168

RESUMO

PURPOSE OF REVIEW: Red cell transfusions are commonly used in management of hemorrhage in trauma patients. The appropriate indications and criteria for transfusion are still debated. Here, we summarize the recent findings on the use of red cell transfusion in trauma setting. RECENT FINDINGS: Recent evidence continues to support the long-established link between allogeneic transfusion and worse clinical outcomes, reinstating the importance of more judicious use of allogeneic blood and careful consideration of benefits versus risks when making transfusion decisions. Studies support restrictive transfusion strategies (often based on hemoglobin thresholds of 7-8 g/dl) in most patient populations, although some argue more caution in specific populations (e.g. patients with traumatic brain injury) and more studies are needed to determine if these patients benefit from less restrictive transfusion strategies. It should be remembered that anemia remains an independent risk factor for worse outcomes and red cell transfusion does not constitute a lasting treatment. Anemia should be properly assessed and managed based on the cause and using hematinic medications as indicated. SUMMARY: Although the debate on hemoglobin thresholds for transfusion continues, clinicians should not overlook proper management of the underlying issue (anemia).


Assuntos
Transfusão de Eritrócitos , Hemorragia/terapia , Ferimentos e Lesões/terapia , Anemia/diagnóstico , Anemia/terapia , Hemoglobinas/análise , Humanos
19.
Ann Hematol ; 99(4): 677-692, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32078008

RESUMO

The development in the therapeutic landscape of myelodysplastic syndromes (MDS) has substantially lagged behind other hematologic malignancies with no new drug approvals for MDS for 13 years since the approval of decitabine in the United States in 2006. While therapeutic concepts for MDS patients continue to be primarily defined by clinical-pathologic risk stratification tools such as the International Prognostic Scoring System (IPSS) and its revised version IPSS-R, our understanding of the genetic landscape and the molecular pathogenesis of MDS has greatly evolved over the last decade. It is expected that the therapeutic approach to MDS patients will become increasingly individualized based on prognostic and predictive genetic features and other biomarkers. Herein, we review the current treatment of lower-risk MDS patients and discuss promising agents in advanced clinical testing for the treatment of symptomatic anemia in lower-risk MDS patients such as luspatercept and imetelstat. Lastly, we review the clinical development of new agents and the implications of the wider availability of mutational analysis for the management of individual MDS patients.


Assuntos
Síndromes Mielodisplásicas/terapia , Anemia/tratamento farmacológico , Anemia/etiologia , Anemia/terapia , Transfusão de Sangue , Terapia por Quelação , Ensaios Clínicos como Assunto , Síndrome do Miado do Gato , Drogas em Investigação/uso terapêutico , Previsões , Hematínicos/uso terapêutico , Transplante de Células-Tronco Hematopoéticas , Humanos , Imunossupressores/uso terapêutico , Sobrecarga de Ferro/tratamento farmacológico , Sobrecarga de Ferro/etiologia , Lenalidomida/uso terapêutico , Terapia de Alvo Molecular , Estudos Multicêntricos como Assunto , Síndromes Mielodisplásicas/complicações , Síndromes Mielodisplásicas/tratamento farmacológico , Síndromes Mielodisplásicas/genética , Medicina de Precisão , Prognóstico , Medição de Risco , Índice de Gravidade de Doença
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