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1.
Rinsho Ketsueki ; 62(8): 1229-1235, 2021.
Artigo em Japonês | MEDLINE | ID: mdl-34497211

RESUMO

Helicobacter eradication therapy is the first-line therapy for patients with Helicobacter positive idiopathic thrombocytopenic purpura (ITP) in Japan. Indications for treatement in patients with Helicobacter negative, or post-Helicobacter eradicated ITP are platelet counts less than 20×106/l or severe bleeding. The first-line treatment for these patients is corticosteroids. Thrombopoietin receptor agonists (TPO-RAs), rituximab, and splenectomy are second-line treatments for patients with corticosteroid refractory ITP. The choice of a second-line treatment should be determined in consideration of the advantages and disadvantages of each treatment. TPO-RAs are effective in over 80% of patients; however, long-term administration is usually needed. Rituximab treatment ends in four weeks, but its durable response rate is relatively low. The durable response rate of splenectomy is relatively high; however, it causes long-term complications. Effective treatments for patients with ITP who are refractory to second-line treatments have not been established. Some novel drugs are under clinical trials, and a treatment strategy for these patients is expected to be established.


Assuntos
Púrpura Trombocitopênica Idiopática , Corticosteroides , Humanos , Contagem de Plaquetas , Púrpura Trombocitopênica Idiopática/tratamento farmacológico , Rituximab/uso terapêutico , Esplenectomia , Trombopoetina
2.
Rinsho Ketsueki ; 62(8): 1319-1326, 2021.
Artigo em Japonês | MEDLINE | ID: mdl-34497222

RESUMO

Congenital thrombocytopenia is a group of heterogeneous disorders caused by mutations in the responsible genes that play crucial roles in normal megakaryopoiesis and subsequent platelet production. The diagnosis of congenital thrombocytopenia is clinically necessary to distinguish it from immune thrombocytopenia and select the appropriate therapeutic modalities. The number of responsible genes reported so far is up to 56, and data on their targeted sequencing and subsequent exome sequencing analysis are available in Japan. Here, we report the disease outlines, disease classification based on platelet sizes (small, normal, large, and giant platelets), disease descriptions, consultation system, list of responsible genes, therapeutic options, and follow-up system for congenital thrombocytopenia.


Assuntos
Púrpura Trombocitopênica Idiopática , Trombocitopenia , Plaquetas , Humanos , Mutação , Contagem de Plaquetas , Trombocitopenia/diagnóstico , Trombocitopenia/genética , Trombocitopenia/terapia , Trombopoese
3.
JNMA J Nepal Med Assoc ; 59(233): 81-83, 2021 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-34508451

RESUMO

The systemic lupus erythematosus (SLE) is a connective tissue disorder with variable presentations in children. The usual presentation includes arthritis, malar rash, nephritis, hemolytic anemia, and fever. Isolated hematologic abnormality as the only presentation of SLE is rare. Here is a case report of a female child presented to us with superficial and mucosal bleeding with isolated low platelet count and anemia in proportion to blood loss. When platelet count did not go up despite appropriate treatment in lines of ITP, further investigations were done, diagnosis of SLE was established, and management was done accordingly.


Assuntos
Anemia , Artrite , Lúpus Eritematoso Sistêmico , Púrpura Trombocitopênica Idiopática , Criança , Feminino , Humanos , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Contagem de Plaquetas , Púrpura Trombocitopênica Idiopática/complicações , Púrpura Trombocitopênica Idiopática/diagnóstico
5.
J Coll Physicians Surg Pak ; 31(9): 1035-1039, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34500517

RESUMO

OBJECTIVE: The purpose of the present study was to determine the effects of exenatide treatment on platelet function in type 2 diabetes mellitus (DM) patients. STUDY DESIGN: Case-control observational study. PLACE AND DURATION OF STUDY: University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara from October 2016 to October 2018. METHODOLOGY: This study included 50 patients with type 2 DM, who had started exenatide therapy; and age-gender matched 54 control subjects. The biochemical data and BMI of the patients were analysed at the time of admission and after six months of exenatide treatment. RESULTS: PDW (platelet distribution width) and MPV (mean platelet volume) were higher in the diabetic patient group than in the control group (p <0.01 and p=0.036, respectively). Significant positive correlations were determined between PDW and BMI (p<0.001), FPG (p <0.001), and HbA1c (p<0.001). After six months of exenatide treatment, PDW (p = 0.015) values and platelet count (p = 0.003) were significantly decreased. CONCLUSIONS: Exenatide causes a decrease in PDW value and platelet count independent of its positive effect on lipid profile, glycemic regulation, and weight loss, which contributes to explain the effect of treatment on the cardiovascular system through a different mechanism. Key Words: Exenatide, Type 2 diabetes mellitus, Platelet count, Platelet distribution width, Mean platelet volume.


Assuntos
Diabetes Mellitus Tipo 2 , Glicemia , Diabetes Mellitus Tipo 2/tratamento farmacológico , Exenatida , Humanos , Volume Plaquetário Médio , Contagem de Plaquetas
6.
J Coll Physicians Surg Pak ; 31(9): 1064-1068, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34500522

RESUMO

OBJECTIVE: To determine the effect of vitamin D treatment on platelet counts according to age groups in patients with vitamin D deficiency. STUDY DESIGN: An observational study. PLACE AND DURATION OF STUDY: Outpatient Clinics, Department of Internal Medicine, Faculty of Medicine, Lokman Hekim University Hospital, Ankara, Turkey from January 1st to December 31st, 2020. METHODOLOGY: A total of 1,230 participants, who were treated for vitamin D deficiency after admission to hospital for various reasons, were enrolled. Patients under 18 years of age, having chronic diseases, using medicines affecting platelets and who had 25-hydroxyvitamin D levels above 74.88 nmol/L were excluded from study. Participants were divided into three groups according to ages: 18 to 30 (Group 1), 30 to 50 (Group 2), and greater than 50 years (Group 3). Complete blood count parameters and vitamin D level data before and after vitamin D replacement treatment were compared. RESULTS: Platelet counts and mean platelet volume levels were found to be significantly lower in participants after vitamin D treatment. Changes in hemoglobin and neutrophil counts were insignificant. Although there was no difference between mean platelet counts and age groups before treatment, significant differences were noted after vitamin D treatment (p=0.004). Correlation between vitamin D levels and changes in platelet levels compared to treatment beginning was found to be significant (r=-0.159, p<0.001). CONCLUSION: Vitamin D treatment lowered platelet counts. This may be beneficial in medical conditions such as essential thrombocythemia in which platelet counts are higher than normal, and may help decrease platelet counts. Key Words: Complete blood count, Blood platelet count, Vitamin D.


Assuntos
Deficiência de Vitamina D , Vitamina D , Adolescente , Adulto , Humanos , Contagem de Leucócitos , Volume Plaquetário Médio , Contagem de Plaquetas , Deficiência de Vitamina D/tratamento farmacológico , Adulto Jovem
7.
N Engl J Med ; 385(10): 885-895, 2021 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-34469646

RESUMO

BACKGROUND: Immune thrombocytopenia is a rare autoimmune disorder with associated bleeding risk and fatigue. Recommended first-line treatment for immune thrombocytopenia is high-dose glucocorticoids, but side effects, variable responses, and high relapse rates are serious drawbacks. METHODS: In this multicenter, open-label, randomized, controlled trial conducted in the United Kingdom, we assigned adult patients with immune thrombocytopenia, in a 1:1 ratio, to first-line treatment with a glucocorticoid only (standard care) or combined glucocorticoid and mycophenolate mofetil. The primary efficacy outcome was treatment failure, defined as a platelet count of less than 30×109 per liter and initiation of a second-line treatment, assessed in a time-to-event analysis. Secondary outcomes were response rates, side effects, occurrence of bleeding, patient-reported quality-of-life measures, and serious adverse events. RESULTS: A total of 120 patients with immune thrombocytopenia underwent randomization (52.4% male; mean age, 54 years [range 17 to 87]; mean platelet level, 7×109 per liter) and were followed for up to 2 years after beginning trial treatment. The mycophenolate mofetil group had fewer treatment failures than the glucocorticoid-only group (22% [13 of 59 patients] vs. 44% [27 of 61 patients]; hazard ratio, 0.41; range, 0.21 to 0.80; P = 0.008) and greater response (91.5% of patients having platelet counts greater than 100×109 per liter vs. 63.9%; P<0.001). We found no evidence of a difference between the groups in the occurrence of bleeding, rescue treatments, or treatment side effects, including infection. However, patients in the mycophenolate mofetil group reported worse quality-of-life outcomes regarding physical function and fatigue than those in the glucocorticoid-only group. CONCLUSIONS: The addition of mycophenolate mofetil to a glucocorticoid for first-line treatment of immune thrombocytopenia resulted in greater response and a lower risk of refractory or relapsed immune thrombocytopenia, but with somewhat decreased quality of life. (Funded by the U.K. National Institute for Health Research; FLIGHT ClinicalTrials.gov number, NCT03156452; EudraCT number, 2017-001171-23.).


Assuntos
Glucocorticoides/uso terapêutico , Imunossupressores/uso terapêutico , Ácido Micofenólico/uso terapêutico , Púrpura Trombocitopênica Idiopática/tratamento farmacológico , Adolescente , Adulto , Idoso , Quimioterapia Combinada , Fadiga/induzido quimicamente , Feminino , Glucocorticoides/efeitos adversos , Hemorragia/etiologia , Hemorragia/prevenção & controle , Humanos , Imunossupressores/efeitos adversos , Masculino , Pessoa de Meia-Idade , Ácido Micofenólico/efeitos adversos , Contagem de Plaquetas , Púrpura Trombocitopênica Idiopática/complicações , Qualidade de Vida , Adulto Jovem
8.
Zhongguo Shi Yan Xue Ye Xue Za Zhi ; 29(4): 1231-1235, 2021 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-34362507

RESUMO

OBJECTIVE: To evaluate the diagnostic value of peripheral blood cell parameters for early recognition of myelodysplastic syndrome (MDS) patients. METHODS: The clinical and laboratory data of 86 patients with MDS and 72 patients with non-malignant clonal anemia treated in first diagnosed in the Second Hospital of Hebei Medical University from January 1, 2015 to December 31, 2017 was retrospectively analyzed. The peripheral blood cell parameters of the patients in two groups were analyzed, generated the receiver operator characteristic curve (ROC curve) from the statistically significant parameters, the binary logistic model was build to calculate and compare the area under the ROC curve (AUC) combined with multiple indicators and individual indicators, sensitivity, specificity, positive and negative likelihood ratio, and diagnostic accuracy, the diagnostic efficacy of the patients was analyzed. RESULTS: Compared with patients in the non-malignant clonal anemia group ,white blood cell count (WBC), neutrophil percentage (NE%), eosinophil percentage (E%), eosinophil absolute value (E#), platelet count (PLT), platelet specific volume (PCT%) in the MDS patients were significantly reduced; while percentage of lymphocytes (LY%), basophilic percentage (B%), and the width of platelet distribution (PDW) significantly increased. The several ROC curves with the above indicators were established, which showed that AUCLY%%=0.718 (P=0.040); AUCPDW=0.674 (P=0.044); AUCB%=0.650 (P=0.044) were >0.5. After established a binary logistic regression model, the AUCPRE-4 obtained by combining the three indicators of LY%, PDW and B% was 0.777 (P=0.037), which was significantly higher than the AUC of any indicator alone. When the sensitivity was 77.91% and the specificity was 61.11%, the corresponding threshold value was 0.47, the positive likelihood ratio was 2.00, the negative likelihood ratio was 0.36, and the case ratio of correct classification was 54.40%. CONCLUSION: PDW, B% and LY% in peripheral blood cell parameters have certain diagnostic value for early recognition of MDS.


Assuntos
Linfócitos , Síndromes Mielodisplásicas , Humanos , Contagem de Leucócitos , Síndromes Mielodisplásicas/diagnóstico , Contagem de Plaquetas , Estudos Retrospectivos
9.
Georgian Med News ; (315): 108-113, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34365435

RESUMO

Fibromyalgia is a chronic disease with undefined aetiology which commonly results in muscle sensitivity, pain, and sensitivity at certain anatomical points. The pathogenesis and aetiology of fibromyalgia are not yet fully understood. The objective of this study was to assess the diagnostic value of neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and lymphocyte/ monocyte ratio (LMR) as simple systemic inflammatory response biomarker sin patients with fibromyalgia. A total of 489 patients with fibromyalgia (group1) and 227 healthy controls (group2) were included in the study. Demographic data, Body Mass Index (BMI) neutrophil, lymphocyte and platelet counts, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were recorded. Baseline NLR, PLR, and LMR were calculated by dividing the absolute neutrophil, platelet and lymphocyte counts by the respective divisor absolute values. The NLR, PLR, and LMR levels of the two groups were then compared. There were no significant differences in gender and age between the two groups (p>0,05). BMI levels (29.6 vs 24.8 kg/m2), mean NLR (3.63 vs. 2.11) and PLR (222.55 vs. 114.28) values were found to be statistically higher (p <0.001), and mean LMR (2.73 vs. 3.85) values were found to be statistically lower, in the patient group (p <0.001). The present study showed that NLR, PLR, AND LMR levels can be used in the diagnosis of fibromyalgia and systemic inflammation may play a role in fibromyalgia.


Assuntos
Fibromialgia , Fibromialgia/diagnóstico , Humanos , Contagem de Leucócitos , Linfócitos , Neutrófilos , Contagem de Plaquetas , Estudos Retrospectivos
10.
Medicine (Baltimore) ; 100(33): e26942, 2021 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-34414954

RESUMO

ABSTRACT: The aim of this study was to investigate the predictive value of the platelet-to-lymphocyte ratio (PLR) and the China Acute Myocardial Infarction registry-ST segment elevation myocardial infarction (CAMI-STEMI) score for major adverse cardiovascular events (MACE) in ST-segment elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI) within 6 months.We enrolled STEMI patients who received emergency PCI in the First Hospital of Lianyungang from January 2016 to December 2019. The clinical characteristics of the patients, the PLR, and the CAMI-STEMI score were recorded. The MACE included heart failure, nonfatal re-infarction, recurrent angina pain, re-hospitalization for cardiovascular-related illness, repeat PCI, coronary artery bypass grafting, and all-cause mortality. According to the incidence of MACE during the follow-up the patients were divided into the MACE group (96 cases, 24.8%) and the non-MACE group (291 cases, 75.2%).The PLR, 147.62 (121.13-205.20) in MACE group, was 111.19 (90.23-146.42) in the non-MACE group in comparison, the PLR was higher in MACE group than that in non-MACE group (P < .01). Multivariate regression analysis showed that PLR (odds ratio (OR) = 1.007, 95% confidence interval (CI) 1.002-1.012, P < .01) and CAMI-STEMI score (OR = 1.575, 95% CI: 1.311-1.892, P < .01) were independent predictors of MACE. Besides, I-BIL was also an independent predictor of MACE (OR = 1.007, 95% CI: 1.011-1.146, P = .021). Reciever-operating characteristic curve showed that the area under curve of PLR was 0.704 (95%CI 0.644-0.763, P < .001). The cutoff value was 112.6, the sensitivity and specificity were 84.4% and 51.9%, respectively.PLR and CAMI-STEMI scores were independent risk factors of MACE after PCI in STEMI patients.


Assuntos
Contagem de Linfócitos , Intervenção Coronária Percutânea , Contagem de Plaquetas , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Idoso , Ecocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/estatística & dados numéricos , Prognóstico , Estudos Prospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Infarto do Miocárdio com Supradesnível do Segmento ST/patologia , Índice de Gravidade de Doença
11.
PLoS One ; 16(8): e0254073, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34351940

RESUMO

INTRODUCTION: Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 virus, is a major public health concern spanning from healthy carriers to patients with life-threatening conditions. Although most of COVID-19 patients have mild-to-moderate clinical symptoms, some patients have severe pneumonia leading to death. Therefore, the early prediction of disease prognosis and severity is crucial in COVID-19 patients. The main objective of this study is to evaluate the haemocytometric parameters and identify severity score associated with SARS-CoV-2 infection. METHODS: Clinical and laboratory records were retrospectively reviewed from 97 cases of COVID-19 admitted to hospitals in Istanbul, Turkey. The patient groups were subdivided into three major groups: Group 1 (Non-critical): 59 patients, Group 2 (Critical-Survivors): 23 patients and Group 3 (Critical-Non-survivors):15 patients. These data was tested for correlation, including with derived haemocytometric parameters. The blood analyses were performed the Sysmex XN-series automated hematology analyser using standard laboratory protocols. All statistical testing was undertaken using Analyse-it software. RESULTS: 97 patients with COVID-19 disease and 935 sequential complete blood count (CBC-Diff) measurements (days 0-30) were included in the final analyses. Multivariate analysis demonstrated that red cell distribution width (RDW) (>13.7), neutrophil to lymphocyte ratio (NLR) (4.4), Hemoglobin (Hgb) (<11.4 gr/dL) and monocyte to neutrophil ratio (MNR) (0.084) had the highest area under curve (AUC) values, respectively in discrimination critical patients than non-critical patients. In determining Group 3, MNR (<0.095), NLR (>5.2), Plateletcount (PLT) (>142 x103/L) and RDW (>14) were important haemocytometric parameters, and the mortality risk value created by their combination had the highest AUC value (AUC = 0.911, 95% CI, 0886-0.931). Trend analysis of CBC-Diff parameters over 30 days of hospitalization, NLR on day 2, MNR on day 4, RDW on day 6 and PLT on day 7 of admission were found to be the best time related parameters in discrimination non-critical (mild-moderate) patient group from critical (severe and non-survivor) patient group. CONCLUSION: NLR is a strong predictor for the prognosis for severe COVID-19 patients when the cut-off chosen was 4.4, the combined mortality risk factor COVID-19 disease generated from RDW-CV, NLR, MNR and PLT is best as a mortality haematocytometric index.


Assuntos
COVID-19/sangue , COVID-19/mortalidade , Adulto , Idoso , Área Sob a Curva , Contagem de Células Sanguíneas/métodos , Feminino , Hemoglobinas , Humanos , Laboratórios , Linfócitos , Masculino , Pessoa de Meia-Idade , Monócitos , Neutrófilos , Contagem de Plaquetas , Prognóstico , Curva ROC , Estudos Retrospectivos , Fatores de Risco , SARS-CoV-2/patogenicidade , Índice de Gravidade de Doença , Turquia
12.
Lancet Haematol ; 8(9): e658-e665, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34450103

RESUMO

Recommendations regarding management of essential thrombocythaemia rely on studies done before the discovery of the CALR mutation. On May 20, 2020, the European LeukemiaNet annual meeting was held with the goal to identify unmet clinical needs in myeloproliferative neoplasms. Because patients with a CALR mutation have specific clinical characteristics, treatment of CALR-mutated essential thrombocythaemia was considered an unmet clinical need by the European LeukemiaNet. The elaboration of a consensus document with recommendations according to current evidence was proposed as a solution for resolving uncertainties in the treatment of CALR-mutated essential thrombocythaemia. A steering committee comprising four European LeukemiaNet members was then formed and a panel of ten experts in the field was recruited. The experts proposed 51 potential unmet clinical needs in the management of CALR-mutated essential thrombocythaemia and were asked to score the relevance of each topic. Those topics that obtained the highest scores as relevant unmet clinical needs were identified, including antiplatelet therapy in patients at low risk, definition of extreme thrombocytosis and its management in patients at low risk, indications of cytoreduction and targets of therapy, first-line treatment of choice in young patients (<60 years), and management of pregnancy. After the steering committee revised the available evidence for each topic, a consensus on management and proposal for improving knowledge was achieved by use of an email-based, two round, Delphi approach. Consensus was achieved when 90% of the panellists agreed with a statement and included 14 recommendations and six solution proposals. Key recommendations included careful observation for asymptomatic patients with classical, low-risk, CALR-mutated essential thrombocythaemia without cardiovascular risk factors; caution in the use of antiplatelet therapy for symptomatic patients at low risk with platelet counts of 1000-1500 × 109 platelets per L, in such cases cytoreduction is an adequate option, especially if adquired Von Willebrand disease is present; cytoreduction is recommended for extreme thrombocytosis (platelet count >1500 × 109 platelets per L) with pegylated interferon alfa being the preferred option for younger patients; both hydroxycarbamide and anagrelide might be given to patients ineligible for pegylated interferon alfa; and treatment algorithms for patients with high-risk pregnancies should not be changed according to genotype. The European LeukemiaNet proposes to use these recommendations in the routine management of patients with CALR-mutated essential thrombocythaemia, and designing new clinical studies in this field might be useful.


Assuntos
Inibidores da Agregação Plaquetária/uso terapêutico , Trombocitemia Essencial/tratamento farmacológico , Fatores Etários , Calreticulina/genética , Feminino , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Contagem de Plaquetas , Gravidez , Índice de Gravidade de Doença , Trombocitemia Essencial/genética , Trombocitemia Essencial/patologia
13.
J Clin Lab Anal ; 35(9): e23935, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34390017

RESUMO

BACKGROUND: Neutral-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) are associated with coronavirus disease 2019 (COVID-19) and many diseases, but there are few data about the reference interval (RI) of NLR, LMR, and PLR. METHODS: The neutrophil count, lymphocyte count, monocyte count, and platelet count of 404,272 Chinese healthy adults (>18 years old) were measured by Sysmex XE-2100 automatic hematology analyzer, and NLR, LMR, and PLR were calculated. According to CLSI C28-A3, the nonparametric 95% percentile interval is defined as the reference interval. RESULTS: The results of Mann-Whitney U test showed that NLR (p < .001) in male was significantly higher than that in female; LMR (p < .001) and PLR (p < .001) in male were significantly lower than that in female. Kruskal-Wallis H test showed that there were significant differences in NLR, LMR, and PLR among different genders and age groups (p < .001). The linear graph showed that the reference upper limit of NLR and PLR increased with age and the reference upper limit of LMR decreases with age in male population. In female population, the reference upper limit of NLR in 50-59 group, LMR in >80 group, and PLR in 70-79 group appeared a trough; the reference upper limit of NLR in >80 group, LMR in 50-59 group, and PLR in 40-49 group appeared peak. CONCLUSION: The establishment of RI for NLR, LMR, and PLR in Chinese healthy adults according to gender and age will promote the standardization of clinical application.


Assuntos
Contagem de Leucócitos/estatística & dados numéricos , Contagem de Linfócitos/estatística & dados numéricos , Monócitos , Neutrófilos , Contagem de Plaquetas/estatística & dados numéricos , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , COVID-19/sangue , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valores de Referência , SARS-CoV-2 , Fatores Sexuais
14.
BMC Pregnancy Childbirth ; 21(1): 567, 2021 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-34407793

RESUMO

BACKGROUND: Coronavirus disease 2019 (COVID-19) still is a global emergency. According to the studies, pregnant women are of the at risk populations and any underlying disease(s) might even worsen their condition. The aim of this study is reporting a complex case of immune thrombocytopenic purpura (ITP) during pregnancy who has been diagnosed with COVID-19 as well as suspicion of HELLP syndrome. CASE PRESENTATION: A 24-year-old woman with a platelet count of 6000/mL and resistance to conventional therapies was referred. A day after starting 0.5 g/day of methylprednisolone for her, fever and a decrease in SpO2 presented. According to the paraclinical investigations, COVID-19 was diagnosed and the conventional COVID-19 treatments started for her (the methylprednisolone pulse stopped). Due to the increased liver enzymes and low platelet count, with suspicion of HELLP syndrome, cesarean section surgery was performed which resulted in a healthy neonate. Then, the methylprednisolone pulse was restarted for and she developed an increase in the platelet count. CONCLUSION: It is not clear how COVID-19 and pregnancy affected the patient's condition and the underlying disease; however, it seems the delivery and/or restarting the methylprednisolone pulses caused improvement in her condition.


Assuntos
COVID-19/diagnóstico , Metilprednisolona/administração & dosagem , Complicações Hematológicas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/diagnóstico , Púrpura Trombocitopênica Idiopática/tratamento farmacológico , Antivirais/uso terapêutico , COVID-19/complicações , COVID-19/tratamento farmacológico , COVID-19/virologia , Cesárea , Resistência a Medicamentos , Feminino , Síndrome HELLP/diagnóstico , Humanos , Recém-Nascido , Masculino , Contagem de Plaquetas , Gravidez , Complicações Hematológicas na Gravidez/sangue , Complicações Hematológicas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/virologia , Pulsoterapia , Púrpura Trombocitopênica Idiopática/sangue , Púrpura Trombocitopênica Idiopática/complicações , Púrpura Trombocitopênica Idiopática/diagnóstico , SARS-CoV-2/isolamento & purificação , Resultado do Tratamento , Adulto Jovem
15.
BMJ Open ; 11(8): e044885, 2021 08 27.
Artigo em Inglês | MEDLINE | ID: mdl-34452956

RESUMO

INTRODUCTION: Immune thrombocytopaenia (ITP) is an acquired disorder of low platelets and risk of bleeding. Although many children can be observed until spontaneous remission, others require treatment due to bleeding or impact on health-related quality of life. Standard first-line therapies for those who need intervention include corticosteroids, intravenous immunoglobulin and anti-D globulin, though response to these agents may be only transient. Eltrombopag is an oral thrombopoietin receptor agonist approved for children with chronic ITP who have had an insufficient response to corticosteroids, intravenous immunoglobulin or splenectomy. This protocol paper describes an ongoing open-label, randomised trial comparing eltrombopag to standard first-line management in children with newly diagnosed ITP. METHODS AND ANALYSIS: Randomised treatment assignment is 2:1 for eltrombopag versus standard first-line management and is stratified by age and by prior treatment. The primary endpoint of the study is platelet response, defined as ≥3 of 4 weeks with platelets >50×109/L during weeks 6-12 of therapy. Secondary outcomes include number of rescue therapies needed during the first 12 weeks, proportion of patients who do not need ongoing treatment at 12 weeks and 6 months, proportion of patients with a treatment response at 1 year, and number of second-line therapies used in weeks 13-52, as well as changes in regulatory T cells, iron studies, bleeding, health-related quality of life and fatigue. A planned sample size of up to 162 randomised paediatric patients will be enrolled over 2 years at 20 sites. ETHICS AND DISSEMINATION: The study has been approved by the centralised Baylor University Institutional Review Board. The results are expected to be published in 2023. TRIAL REGISTRATION NUMBER: NCT03939637.


Assuntos
Púrpura Trombocitopênica Idiopática , Benzoatos/uso terapêutico , Criança , Ensaios Clínicos Fase III como Assunto , Humanos , Hidrazinas/uso terapêutico , Contagem de Plaquetas , Púrpura Trombocitopênica Idiopática/tratamento farmacológico , Pirazóis , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
16.
Medicine (Baltimore) ; 100(29): e26202, 2021 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-34397999

RESUMO

INTRODUCTION: Previous research indicates that the platelet-to-lymphocyte ratio (PLR) may be an indicator of poor prognosis in many tumor types. However, the PLR is rarely described in patients undergoing neoadjuvant chemotherapy (NAC) for solid tumors. Thus, we performed a meta-analysis to investigate the prognostic value of this ratio for patients with solid tumors treated by NAC. METHODS: A comprehensive search of the literature was conducted using the PubMed, EMBASE, Cochrane Library, and Web of Science databases, followed by a manual search of references from the retrieved articles. Pooled hazard ratios (HRs) with 95% confidence interval (CIs) were used to evaluate the association between PLR and 3 outcomes, namely, overall survival, disease-free survival, and pathological complete response rate after NAC. RESULTS: Eighteen studies published no earlier than 2014 were included in our study. A lower PLR was associated with better overall survival (HR = 1.46, 95% CI, 1.11-1.92) and favorable disease-free survival (HR = 1.81, 95% CI, 1.27-2.59). A PLR that was higher than a certain cutoff was associated with a lower pathological complete response rate in patients with cancer who received NAC (Odds ratio = 1.93, 95% CI, 1.40-2.87). CONCLUSION: Elevated PLR is associated with poor prognosis in various solid tumors. PLR may be a useful biomarker in delineating those patients with poorer prognoses who may benefit from neoadjuvant therapies.


Assuntos
Contagem de Linfócitos/normas , Terapia Neoadjuvante/métodos , Neoplasias/patologia , Contagem de Plaquetas/normas , Prognóstico , Plaquetas/classificação , Plaquetas/patologia , Humanos , Contagem de Linfócitos/métodos , Linfócitos/classificação , Linfócitos/patologia , Neoplasias/fisiopatologia , Neoplasias/terapia , Contagem de Plaquetas/métodos
17.
Am J Clin Dermatol ; 22(5): 693-707, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34406619

RESUMO

BACKGROUND: Pivotal phase III studies demonstrated that abrocitinib, an oral, once-daily, JAK1-selective inhibitor, is effective treatment for moderate-to-severe atopic dermatitis (AD) as monotherapy and in combination with topical therapy. OBJECTIVE: The aim of this study was to evaluate the long-term safety of abrocitinib 200 mg and 100 mg in an integrated analysis of a phase IIb study, four phase III studies, and one long-term extension study. METHODS: Two cohorts were analyzed: a placebo-controlled cohort from 12- to 16-week studies and an all-abrocitinib cohort including patients who received one or more abrocitinib doses. Adverse events (AEs) of interest and laboratory data are reported. RESULTS: Total exposure in the all-abrocitinib cohort (n = 2856) was 1614 patient-years (PY); exposure was ≥ 24 weeks in 1248 patients and ≥ 48 weeks in 606 (maximum 108 weeks). In the placebo-controlled cohort (n = 1540), dose-related AEs (200 mg, 100 mg, placebo) were nausea (14.6%, 6.1%, 2.0%), headache (7.8%, 5.9%, 3.5%), and acne (4.7%, 1.6%, 0%). Platelet count was reduced transiently in a dose-dependent manner; 2/2718 patients (200-mg group) had confirmed platelet counts of < 50 × 103/mm3 at week 4. Incidence rates (IRs) were 2.33/100PY and 2.65/100 PY for serious infection, 4.34/100PY and 2.04/100PY for herpes zoster, and 11.83/100PY and 8.73/100PY for herpes simplex in the 200-mg and 100-mg groups, respectively. IRs for nonmelanoma skin cancer, other malignancies, and major adverse cardiovascular events were < 0.5/100PY for both doses. Five venous thromboembolism events occurred (IR 0.30/100PY), all in the 200-mg group. There were three deaths due to gastric carcinoma (diagnosed at day 43), sudden death, and COVID-19. CONCLUSION: Abrocitinib, with proper patient and dose selection, has a manageable tolerability and longer-term safety profile appropriate for long-term use in patients with moderate-to-severe AD. TRIAL REGISTRIES: ClinicalTrials.gov: NCT02780167, NCT03349060, NCT03575871, NCT03720470, NCT03627767, NCT03422822.


Assuntos
Dermatite Atópica/tratamento farmacológico , Infecções/epidemiologia , Inibidores de Proteínas Quinases/efeitos adversos , Pirimidinas/efeitos adversos , Neoplasias Cutâneas/epidemiologia , Sulfonamidas/efeitos adversos , Acne Vulgar/induzido quimicamente , Adolescente , Adulto , Idoso , Doenças Cardiovasculares/epidemiologia , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Feminino , Cefaleia/induzido quimicamente , Herpes Simples/epidemiologia , Herpes Zoster/epidemiologia , Humanos , Incidência , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Náusea/induzido quimicamente , Contagem de Plaquetas , Inibidores de Proteínas Quinases/administração & dosagem , Pirimidinas/administração & dosagem , Fatores de Risco , Sulfonamidas/administração & dosagem , Fatores de Tempo , Tromboembolia Venosa/epidemiologia , Adulto Jovem
18.
Beijing Da Xue Xue Bao Yi Xue Ban ; 53(4): 647-652, 2021 Aug 18.
Artigo em Chinês | MEDLINE | ID: mdl-34393222

RESUMO

OBJECTIVE: To explore the prognostic value of preoperative platelet parameters in locally advanced renal cell carcinoma for the risk stratification of such patients. METHODS: Clinical data of patients with locally advanced renal cell carcinoma in the Third Hospital of Peking University from January 2015 to December 2017 were collected. The patients were divided into progression group and progression-free group according to follow-up data, and preoperative platelet parameters and clinical data between the two groups were compared. The optimal cut-off value of platelet parameters was determined by receiver operating characteristic curve (ROC) and analyzed by Kaplan-Meier survival curve. Cox proportional hazards model was used to analyze the independent risk factors of PFS. Time dependent ROC curve, net reclassification index (NRI), and integrated discrimination improvement (IDI) were used to evaluate the improvement of SSIGN model by incorporating platelet parameters. RESULTS: Of the 215 patients, 192 (89.3%) were followed up for a median of 36 months. Sixty-four patients (29.8%) had disease progression during the follow-up, and the median PFS was 46 months. In progression group, the platelet count (PLT) was higher [(250.72 ± 88.59)×109/L vs. (227.27 ± 66.94)×109/L, P=0.042] and the platelet distribution width (PDW) was lower [(12.01 ± 2.27)% vs. (13.31 ± 2.74)%, P = 0.001] than that of progression-free groups. 285×109 /L and 12.65% as the best cut-off values of PLT and PDW, the median PFS of PLT≤285×109 /L group was significantly longer than that of PLT>285×109 /L group (53 months vs. 41 months, P=0.033), and the median PFS of PDW>12.65% group was also significantly longer than that of PDW≤12.65% group (56 months vs. 41 months, P < 0.001). Multivariate analysis showed that preoperative PDW (HR=0.735, P < 0.001), nuclear grade Ⅲ to Ⅳ (HR=2.425, P=0.001) and sarcomatoid differentiation (HR=3.101, P=0.008) were independent risk factors for PFS. The area under the curve of PDW combined with SSIGN model was larger than that with the original SSIGN model [0.748 (95%CI: 0.662-0.833) vs. 0.678 (95%CI: 0.583-0.773), P=0.193], NRI was 0.262 (P=0.04), and IDI was 0.085 (P=0.01), indicating that the predictive ability of PDW combined with SSIGN model was improved. CONCLUSION: Preoperative high PLT and low PDW are associated with adverse prognosis of locally advanced renal cell carcinoma, and PDW is an independent risk factor. Therefore, preoperative PDW could serve as biomarker for risk stratification of locally advanced renal cell carcinoma.


Assuntos
Carcinoma de Células Renais , Neoplasias Renais , Carcinoma de Células Renais/cirurgia , Humanos , Neoplasias Renais/cirurgia , Contagem de Plaquetas , Prognóstico , Curva ROC , Estudos Retrospectivos
19.
BMJ Case Rep ; 14(8)2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34389597

RESUMO

Vancomycin is a widely used antibiotic and rarely can cause drug-induced thrombocytopenia. A patient with hospital-acquired meningitis after neurosurgery was treated with systemic and intrathecal vancomycin. On 9th day of antibiotic treatment, the patient's platelets dropped to 0.68×109/L. Multiple platelet transfusions had minimal influence on platelet count. After cessation of vancomycin therapy, platelets returned to normal values without any additional interventions. Diagnosis of vancomycin-induced thrombocytopenia was confirmed by detection of drug-dependent antiplatelet IgG antibodies.


Assuntos
Meningite , Trombocitopenia , Antibacterianos/efeitos adversos , Humanos , Meningite/tratamento farmacológico , Contagem de Plaquetas , Trombocitopenia/induzido quimicamente , Trombocitopenia/tratamento farmacológico , Vancomicina/efeitos adversos
20.
Int J Lab Hematol ; 43 Suppl 1: 36-42, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34288440

RESUMO

The alterations in the hemostatic balance in COVID-19 patients are strongly disturbed and contribute to a high prothrombotic status. The high rate of venous thromboembolism in COVID-19 patients goes along with derangements in coagulation laboratory parameters. Hemostasis testing has an important role in diagnosed COVID-19 patients. Elevated D-dimer levels were found to be a crucial laboratory marker in the risk assessment of thrombosis in COVID-19 patients. The diagnostic approach also includes prothrombin time and platelet count. Fibrinogen might give an indication for worsening coagulopathy. Other markers (activated partial thromboplastin time (aPTT), fibrinolysis parameters, coagulation factors, natural anticoagulants, antiphospholipid antibodies and parameters obtained by thromboelastography or thrombin generation assays) have been described as being deranged. These may help to understand the pathophysiology of thrombosis in COVID-19 patients but have currently no place in diagnosis or management in COVID-19 patients. For monitoring the heparin anticoagulant therapy, the anti-Xa assay is suggested, because the severe acute-phase reaction (high fibrinogen and high factor VIII) shortens the aPTT.


Assuntos
Testes de Coagulação Sanguínea , COVID-19/sangue , SARS-CoV-2 , Trombofilia/etiologia , Anticorpos Antifosfolipídeos/sangue , Biomarcadores/sangue , Fatores de Coagulação Sanguínea/análise , Coagulação Intravascular Disseminada/sangue , Coagulação Intravascular Disseminada/etiologia , Fator Xa/análise , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Fibrinogênio/análise , Fibrinólise , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Tempo de Tromboplastina Parcial , Contagem de Plaquetas , Tempo de Protrombina , Tromboelastografia , Trombina/biossíntese , Trombofilia/sangue , Trombofilia/tratamento farmacológico
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