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1.
Medicine (Baltimore) ; 99(15): e19788, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32282742

RESUMO

RATIONALE: Idiopathic thrombocytopenic purpura (ITP) is the condition of having a low platelet count of unknown causes and is a poorly understood acquired hemorrhagic disease involving destruction of platelets in the reticuloendothelial system induced by antiplatelet antibodies. Patients with ITP can have traumatic intra-articular, intraosseous or soft tissue hemorrhage which may present as a rare intraosseous pseudotumor on medical imaging. PATIENT CONCERNS: A 30-year old male patient had complaint of pain in the right leg for 1 year. Laboratory test revealed a much lower platelet count (3-12 × 10/L). DIAGNOSES: Radiography and computed tomography showed expansive bone destruction in the distal segment of the right femur, and magnetic resonance imaging revealed heterogeneous signal intensity in the lesion. Lesion curettage and pathology showed an expansion cyst with a really thin cortical bone shell containing serum-like red liquid and some sediment-like deposit. Consequently, the diagnosis of a pseudotumor was confirmed. INTERVENTIONS: Lesion curettage and bone graft surgery were performed, and 8 units of platelet were transfused to the patient. Giant cell reaction was found on the shell of the lesion, but no tumor cell was found on pathological examination. OUTCOMES: The platelet count was 308 × 10/L 5 days after operation, and the clotting time was normal. At 6 month follow-up after lesion curettage, the patient remained normal with no deterioration in the lesion site. CONCLUSION: The diagnosis of a pseudotumor of ITP relies mainly on imaging findings of the lesion and, in particular, knowledge of the underlying bleeding disorders. Radiologist and pathologist should be aware of the characteristics of this rare complication of ITP and other bleeding disorders like hemophilia in order to avoid misinterpretation of the lesion as a tumor or infection disease.


Assuntos
Fêmur/patologia , Granuloma de Células Plasmáticas/diagnóstico por imagem , Púrpura Trombocitopênica Idiopática/complicações , Ferimentos e Lesões/complicações , Adulto , Transplante Ósseo/métodos , Curetagem/métodos , Fêmur/diagnóstico por imagem , Granuloma de Células Plasmáticas/patologia , Granuloma de Células Plasmáticas/cirurgia , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Dor/diagnóstico , Dor/etiologia , Contagem de Plaquetas/estatística & dados numéricos , Transfusão de Plaquetas/métodos , Púrpura Trombocitopênica Idiopática/patologia , Radiografia/métodos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
3.
J Surg Res ; 246: 284-291, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31622885

RESUMO

BACKGROUND: Platelet-rich plasma (PRP) improves the healing of refractory wounds, and its application is receiving more attention in the field of wound repair. However, when a patient's condition is very poor, it may be difficult to provide whole blood to harvest autologous PRP. METHODS: We evaluated the efficacy and safety of allogeneic PRP in the field of chronic refractory wound repair. Sixty patients (39 males and 21 females, 57 ± 10 y old) with chronic wounds were enrolled in this prospective, randomized, single-center study during January 2014 to January 2018. Their wounds were treated by standard care. The patients with chronic refractory wounds were divided into allogeneic PRP treatment and control groups on the basis of the presence or absence of allogeneic PRP in wounds after debridement, respectively. Allogeneic PRP was prepared by collecting whole blood from healthy individuals and two-step centrifugation. Clinical effects were evaluated by visually observing wound conditions and objectively assessing wound surfaces. RESULTS: After 30 d of treatment, the allogeneic PRP-treated group showed bright red granulation that bled easily with reduced inflammatory exudation. No rejection reactions were observed. The rate of chronic wound healing was much faster in the allogeneic PRP-treated group than that in the control group. CONCLUSIONS: The present study shows that combined treatment of chronic wounds by standard care and allogeneic PRP significantly shortens healing time, suggesting that allogeneic PRP is an effective, safe adjuvant treatment for chronic wounds.


Assuntos
Transfusão de Plaquetas/métodos , Plasma Rico em Plaquetas , Úlcera Cutânea/terapia , Pele/lesões , Cicatrização , Adulto , Idoso , Doença Crônica/terapia , Terapia Combinada/efeitos adversos , Terapia Combinada/métodos , Desbridamento , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Transplante Homólogo/efeitos adversos , Transplante Homólogo/métodos , Resultado do Tratamento
4.
Br J Hosp Med (Lond) ; 80(9): 507-512, 2019 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-31498668

RESUMO

Thrombocytopenia is defined as a platelet count under 150x109/litre. It may be found as a bystander to other pathology or directly related to an underlying haematological condition. Apart from laboratory artefact, it should be treated seriously as it often reflects serious underlying disease. This review uses short case histories to illustrate how to approach thrombocytopenia during the initial presentation of an adult patient to hospital. This article guides the general hospital physician through the narrow but potentially confusing differential diagnoses related to thrombocytopenia, with particular focus on immune thrombocytopenia, disseminated intravascular coagulation and thrombotic thrombocytopenic purpura. Thrombocytopenia in pregnancy deserves special consideration and will not be discussed in this article.


Assuntos
Coagulação Intravascular Disseminada/diagnóstico , Púrpura Trombocitopênica Idiopática/diagnóstico , Púrpura Trombocitopênica Trombótica/diagnóstico , Doença Aguda , Diagnóstico Diferencial , Coagulação Intravascular Disseminada/sangue , Coagulação Intravascular Disseminada/terapia , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Fibrinogênio/metabolismo , Humanos , Coeficiente Internacional Normatizado , Tempo de Tromboplastina Parcial , Transfusão de Plaquetas/métodos , Púrpura Trombocitopênica Idiopática/sangue , Púrpura Trombocitopênica Idiopática/terapia , Púrpura Trombocitopênica Trombótica/sangue , Púrpura Trombocitopênica Trombótica/terapia , Trombocitopenia
5.
Rev. iberoam. fertil. reprod. hum ; 36(3): 3-9, jul.-sept. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-188324

RESUMO

OBJECTIVO: Estudiar la recuperación del crecimiento endometrial en pacientes afectados por el Síndrome de Asherman. DISEÑO: Administración de Plama Rico en Plaquetas (PRP). LUGAR: Clínica IRMO S.L. Santa Cruz de Tenerife. PACIENTES: Presentación de 3 casos. RESULTADOS: El endometrio se midió antes de la aplicación del PRP y a las 48 horas. Durante los seis meses que duró el tratamiento se observó un incremento del grosor endometrial. CONCLUSIONES: El PRP es un procedimiento seguro y económico con muy bajo riesgo de transmisión de enfermedades infecciosas o reacciones inmunológicas, siempre que se haga con una muestra de sangre autóloga. En los tres casos estudiados queda demostrado claramente la mejora del engrosamiento endometrial por acción del PRP. Finalmente, podemos concluir que el PRP es un método efectivo para evitar la aparición de adhesiones y para recuperar un buen engrosamiento endometrial en pacientes con Síndrome de Asherman


OBJECTIVE: To study the recovery of endometrial growth in patients affected by Asherman Syndrome. DESIGN: Administration of Plama Rico in Platelets (PRP). PLACE: Clínica IRMO S.L. Santa Cruz of Tenerife. PATIENTS: Presentation of 3 cases. RESULTS: The endometrium was measured before the application of PRP and at 48 hours. During the six months of the treatment, an increase in endometrial thickness was observed. CONCLUSIONS: PRP is a safe and economical procedure with very low risk of transmission of infectious diseases or immunological reactions, provided it is done with an autologous blood sample. In the three cases studied, the improvement of endometrial thickening by PRP action is clearly demonstrated. Finally, we can conclude that PRP is an effective method to prevent the appearance of adhesions and to recover a good endometrial thickening in patients with Asherman Syndrome


Assuntos
Humanos , Feminino , Gravidez , Adulto , Plasma Rico em Plaquetas , Ginatresia/terapia , Transfusão de Plaquetas/métodos , Endométrio , Resultado do Tratamento , Histeroscopia
6.
Blood Transfus ; 17(4): 321-330, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31385802

RESUMO

Reports from both adult and paediatric populations indicate that approximately two-thirds of platelet transfusions are used prophylactically to prevent bleeding, while the remaining one-third are used therapeutically to manage active bleeding. These two indications, prophylactic and therapeutic, serve two very distinct purposes and therefore will have two different functional requirements. In addition, disease aetiology in a given patient may require platelets with different functional characteristics. These characteristics can be derived from the various manufacturing methods used in platelet product production, including collection methods, processing methods, and storage options. The iterative combinations of manufacturing methods can result in a number of unique platelet products with different efficacy and safety profiles, which could potentially be used to benefit patient populations by meeting diverse clinical needs. In particular, cold storage of platelet products causes many biochemical and functional changes, of which the most notable characterised to date include increased haemostatic activity and altered expression of molecules inherent to platelet:leucocyte interactions. The in vivo consequences, both short- and long-term, of these molecular and cellular cold-storage-induced changes have yet to be clearly defined. Elucidation of these mechanisms would potentially reveal unique biologies that could be harnessed to provide more targeted therapies. To this end, in this new era of personalised medicine, perhaps there is an opportunity to provide individual patients with platelet products that are tailored to their clinical condition and the specific indication for transfusion.


Assuntos
Plaquetas/citologia , Preservação de Sangue/métodos , Hemostasia , Animais , Plaquetas/imunologia , Plaquetas/metabolismo , Comunicação Celular , Temperatura Baixa , Células Endoteliais/citologia , Células Endoteliais/imunologia , Células Endoteliais/metabolismo , Humanos , Leucócitos/citologia , Leucócitos/imunologia , Leucócitos/metabolismo , Transfusão de Plaquetas/métodos , Medicina de Precisão/métodos
7.
Expert Rev Clin Pharmacol ; 12(9): 859-865, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31352834

RESUMO

Introduction: Thrombocytopenia is a common hematological abnormality in patients with chronic liver disease (CLD), occurring in 64%~84% of patients with cirrhosis or fibrosis. Due to the increased risk of bleeding, thrombocytopenia potentially affects management of CLD, such as surgery or liver biopsy. Avatrombopag is a new oral thrombopoietin (TPO) receptor agonist, activating TPO receptor and increasing megakaryocytic proliferation/differentiation and platelet production. Areas covered: This review summarizes the collected data concerning pharmacokinetics, clinical efficacy, safety and tolerability profiles of avatrombopag for the management of thrombocytopenia in patients with CLD. Expert opinion: Avatrombopag is recently approved by Food and Drug Administration (FDA) for the treatment of thrombocytopenia in patients with CLD who are scheduled to undergo a procedure. Based on the available clinical trials, avatrombopag is superior to placebo in reducing the need for platelet transfusions or rescue procedures for bleeding. Avatrombopag is also recommended as alternative to platelet transfusions.


Assuntos
Hepatopatias/complicações , Tiazóis/uso terapêutico , Tiofenos/uso terapêutico , Trombocitopenia/tratamento farmacológico , Doença Crônica , Hemorragia/etiologia , Hemorragia/prevenção & controle , Humanos , Cirrose Hepática/complicações , Hepatopatias/fisiopatologia , Transfusão de Plaquetas/métodos , Receptores de Trombopoetina/agonistas , Tiazóis/efeitos adversos , Tiazóis/farmacologia , Tiofenos/efeitos adversos , Tiofenos/farmacologia , Trombocitopenia/etiologia
8.
BMJ Case Rep ; 12(7)2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31289158

RESUMO

The Bernard-Soulier syndrome also known as hemorrhagioparous thrombocytic dystrophy, is a rare autosomal recessive bleeding disorder. Macrothrombocytopenia and increased bleeding time are the two main features of this syndrome. There is a reduced adherence of giant platelets to the subendothelium due to a deficiency of glycoprotein GPIb-V-IX complex. Routine dental extraction in a patient with a bleeding disorder can lead to life-threatening complications and there are very few specific protocols for the same. Here, we present a case report describing haemostasis management during dental extraction in a 7-year-old female child, suffering from this syndrome. It was observed that the preoperative and postoperative human leucocyte antigen-matched platelet transfusion, systemic intraoperative tranexamic acid and minimally traumatic procedure improved bleeding control and management.


Assuntos
Síndrome de Bernard-Soulier/complicações , Hemostasia/efeitos dos fármacos , Extração Dentária/efeitos adversos , Administração Oral , Síndrome de Bernard-Soulier/diagnóstico , Plaquetas/patologia , Criança , Diagnóstico Diferencial , Feminino , Humanos , Transfusão de Plaquetas/métodos , Cuidados Pré-Operatórios , Ácido Tranexâmico/administração & dosagem , Ácido Tranexâmico/uso terapêutico , Resultado do Tratamento
9.
J Trauma Acute Care Surg ; 87(2): 342-349, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31349348

RESUMO

BACKDROP: Clinicians intuitively recognize that faster time to hemostasis is important in bleeding trauma patients, but these times are rarely reported. METHODS: Prospectively collected data from the Pragmatic Randomized Optimal Platelet and Plasma Ratios trial were analyzed. Hemostasis was predefined as no intraoperative bleeding requiring intervention in the surgical field or resolution of contrast blush on interventional radiology (IR). Patients who underwent an emergent (within 90 minutes) operating room (OR) or IR procedure were included. Mixed-effects Poisson regression with robust error variance (controlling for age, Injury Severity Score, treatment arm, injury mechanism, base excess on admission [missing values estimated by multiple imputation], and time to OR/IR as fixed effects and study site as a random effect) with modified Bonferroni corrections tested the hypothesis that decreased time to hemostasis was associated with decreased mortality and decreased incidence of acute kidney injury (AKI), acute respiratory distress syndrome (ARDS), multiple-organ failure (MOF), sepsis, and venous thromboembolism. RESULTS: Of 680 enrolled patients, 468 (69%) underwent an emergent procedure. Patients with decreased time to hemostasis were less severely injured, had less deranged base excess on admission, and lower incidence of blunt trauma (all p < 0.05). In 408 (87%) patients in whom hemostasis was achieved, every 15-minute decrease in time to hemostasis was associated with decreased 30-day mortality (RR, 0.97; 95% confidence interval [CI], 0.94-0.99), AKI (RR, 0.97; 95% CI, 0.96-0.98), ARDS (RR, 0.98; 95% CI, 0.97-0.99), MOF (RR, 0.94; 95% CI, 0.91-0.97), and sepsis (RR, 0.98; 95% CI, 0.96-0.99), but not venous thromboembolism (RR, 0.99; 95% CI, 0.96-1.03). CONCLUSION: Earlier time to hemostasis was independently associated with decreased incidence of 30-day mortality, AKI, ARDS, MOF, and sepsis in bleeding trauma patients. Time to hemostasis should be considered as an endpoint in trauma studies and as a potential quality indicator. LEVEL OF EVIDENCE: Therapeutic/care management, level III.


Assuntos
Hemorragia/terapia , Técnicas Hemostáticas/mortalidade , Ferimentos e Lesões/terapia , Adulto , Hemorragia/sangue , Hemorragia/mortalidade , Humanos , Escala de Gravidade do Ferimento , Pessoa de Meia-Idade , Transfusão de Plaquetas/métodos , Distribuição de Poisson , Indicadores de Qualidade em Assistência à Saúde , Ressuscitação/métodos , Fatores de Tempo , Ferimentos e Lesões/sangue , Ferimentos e Lesões/mortalidade , Adulto Jovem
10.
Vox Sang ; 114(5): 517-522, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31056742

RESUMO

BACKGROUND AND OBJECTIVES: Platelet dosing has been studied in adult oncology inpatients, but there is almost no published evidence to guide platelet dosing for adult outpatients. We evaluated transfusion indices after 1 unit and 2 unit apheresis platelet transfusions at our hospital to determine whether a benefit to 2-unit transfusions could be detected. MATERIALS AND METHODS: A retrospective chart review was conducted of all adult oncology patients who received an outpatient platelet transfusion over a 16-month period (July 2016-November 2017). Pre- and post-transfusion platelet count, and chronology of subsequent platelet transfusions were compared. RESULTS: A total of 8467 platelet transfusions were administered to 602 patients during the study period. 59·8% of patients (n = 360) were transfused interchangeably with one or two platelets throughout the study period. The primary study population were comprised of these patients. On average, a 2-unit platelet transfusions resulted in a higher immediate post-transfusion platelet count (43 vs. 37 x 103 /µl, P < 0·001) and a lower corrected count increment (9707 vs. 14 060, P < 0·001). Transfusion with 2 platelets did not increase the number of days between outpatient transfusions (median; 4 vs. 4, P = 0·959) or the platelet count at the time of next transfusion (11 vs. 11 x 103 /µl, P = 0·147). CONCLUSION: Among adult, oncology outpatients that were transfused interchangeably with one or two units of platelets, transfusion with two platelets did not offer a durable improvement in platelet count or impact the subsequent transfusion schedule.


Assuntos
Neoplasias , Pacientes Ambulatoriais , Transfusão de Plaquetas/métodos , Adulto , Idoso , Relação Dose-Resposta a Droga , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Estudos Retrospectivos
11.
Platelets ; 30(6): 799-801, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31068031

RESUMO

The efficacy of 30 platelet concentrate (PC) products transfused to a patient with myelodysplastic syndrome (MDS) was evaluated by calculating the 1-hour post-transfusion corrected count increment (1h-CCI). Of the 30 transfusions, all HLA-A/B-matched, the cross-match (CM) test was negative in 23 (CM(-)-PC) and weakly positive (CM(+)-PC) in 2, and the CM test was not conducted in 5 (non-CM-PC). The effective rate was higher with CM(-)-PC compared to non-CM-PC (82.6% vs 60%), but statistical significance was not achieved, which suggested that the CM test of PC may still be a not satisfactorily effective predictor of PC refractoriness. Studies are ongoing in Japan to confirm on the importance of CM test of PC.


Assuntos
Antígenos HLA/uso terapêutico , Transfusão de Plaquetas/métodos , Idoso , Feminino , Antígenos HLA/farmacologia , Humanos
12.
Int J Surg ; 67: 37-46, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31128316

RESUMO

OBJECTIVE: To compare the clinical efficacy of platelet-rich plasma (PRP) injections with that of corticosteroids in patients with lateral epicondylitis (LE). METHODS: We searched for relevant studies on the comparison of PRP and corticosteroids in the management of lateral epicondylitis in electronic databases, including PubMed, Embase, Ovid, Cochrane Library, Web of Science, Wan Fang and China National Knowledge Internet, up to March 2019. The outcomes were pain score, elbow joint function and adverse effects after local injection. For continuous data, the weighted mean difference (WMD) and 95% confidence intervals (CIs) was used. Risk difference (RD) with a 95% CI were calculated for dichotomous outcomes. Cochrane Collaboration's tool was used to assess the risk of bias. The data were collected and input into the STATA software. RESULTS: A total of seven randomized controlled trials (RCTs) involving 515 patients were finally included in our study. The present meta-analysis indicated that PRP injection yielded statistically significant superior in pain scores and elbow joint function at a 6-month follow up compared with local corticosteroid injection. No significant difference was identified between two groups regarding the post-injection adverse events. CONCLUSION: Local PRP injections was associated with superior outcomes for reducing pain and improving elbow joint function compared with local corticosteroids treatment for LE at a follow-up of 6 months.


Assuntos
Corticosteroides/uso terapêutico , Transfusão de Plaquetas/métodos , Plasma Rico em Plaquetas , Cotovelo de Tenista/terapia , Artralgia/etiologia , Artralgia/fisiopatologia , Artralgia/terapia , Articulação do Cotovelo/fisiopatologia , Humanos , Injeções , Medição da Dor , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica , Cotovelo de Tenista/complicações , Cotovelo de Tenista/fisiopatologia , Resultado do Tratamento
13.
Pediatrics ; 143(5)2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30940676

RESUMO

BACKGROUND AND OBJECTIVES: Thrombocytopenia is associated with late closure of patent ductus arteriosus (PDA). There are few studies evaluating platelet transfusions to treat PDA. We compared liberal platelet-transfusion criteria (to maintain a platelet count >100 000 per µL) versus standard criteria achieve earlier PDA closure among thrombocytopenic preterm neonates (<35 weeks' gestation) with hemodynamically significant PDA (hs-PDA) presenting within the first 2 weeks of life. METHODS: Thrombocytopenic (<100 000 per µL) preterm neonates with hs-PDA were enrolled and randomly allocated to the liberal and standard transfusion groups: 22 in each arm. They underwent echocardiography daily until closure of PDA, completion of 120 hours follow-up, or death. All subjects received standard cotreatment with nonsteroidal antiinflammatory drugs. Primary outcome of time to PDA closure was compared by survival analysis. Multivariate Cox proportional hazard regression was performed with randomization group, baseline platelet count, gestational age, and age at enrollment as predictor variables. RESULTS: Median time to PDA closure was 72 (95% confidence interval [CI] 55.9-88.1) versus 72 (95% CI 45.5-98.4) hours in the liberal versus restrictive transfusion groups, respectively (unadjusted hazard ratio 0.88 [95% CI 0.4-1.9]; P = .697). Despite adjusting for potential confounders, there was no significant difference in time to PDA closure. In the liberal transfusion group, 41% of infants had any grade of intraventricular hemorrhage compared with 4.5% in the restrictive group (P = .009). CONCLUSIONS: Attempting to maintain a platelet count >100 000 per µL by liberally transfusing platelets in preterm thrombocytopenic neonates with hs-PDA does not hasten PDA closure.


Assuntos
Permeabilidade do Canal Arterial/diagnóstico por imagem , Permeabilidade do Canal Arterial/terapia , Recém-Nascido Prematuro , Transfusão de Plaquetas/métodos , Trombocitopenia/diagnóstico por imagem , Trombocitopenia/prevenção & controle , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro/fisiologia , Masculino , Contagem de Plaquetas/métodos
14.
Transfusion ; 59(S2): 1467-1473, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30980736

RESUMO

BACKGROUND: Platelet (PLT) transfusion is a widely used therapy in treating or preventing bleeding and hemorrhage in patients with thrombocytopenia or trauma. Compared to the relative ease of PLT transfusion, current practice for PLT storage at room temperature (RT) for up to 5 to 7 days is inefficient, costly, wasteful, and relatively unsafe. STUDY DESIGN AND METHODS: This study was a review of major advances in PLT derivative products with improved hemostatic potential and safety feature. RESULTS: Recent progress in understanding the PLT activation and host clearance mechanisms has led to reassessments of current and new storage conditions that employ refrigeration and/or cryopreservation to overcome storage lesions and significantly extend shelf life of PLTs with reduced risk of pathogen contamination. DISCUSSION: It is anticipated that future PLT preservation involving cold, frozen, and/or pathogen reduction strategies in proper PLT additive solutions will enable longer term and safer PLT storage.


Assuntos
Plaquetas , Preservação de Sangue , Segurança do Sangue , Criopreservação , Transfusão de Plaquetas , Coagulação Sanguínea , Preservação de Sangue/métodos , Preservação de Sangue/tendências , Segurança do Sangue/métodos , Segurança do Sangue/tendências , Criopreservação/métodos , Criopreservação/tendências , Hemorragia/sangue , Hemorragia/terapia , Humanos , Transfusão de Plaquetas/métodos , Transfusão de Plaquetas/tendências , Trombocitopenia/sangue , Trombocitopenia/terapia , Ferimentos e Lesões/sangue , Ferimentos e Lesões/terapia
16.
Innovations (Phila) ; 14(2): 134-143, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30885089

RESUMO

OBJECTIVE: Although the morbidity associated with red blood cell transfusion in cardiac surgery has been well described, the impacts of platelet transfusion are less clearly understood. Given the conflicting results of prior studies, we sought to investigate the impact of platelet transfusion on outcomes after cardiac surgery across institutions in Maryland. METHODS: Using a multiinstitutional statewide database created by the Maryland Cardiac Surgery Quality Initiative, we retrospectively analyzed data from 10,478 patients undergoing isolated coronary artery bypass across 10 centers. Platelet transfusion practices were compared between institutions. Multivariate logistic regression model was used to analyze the association between platelet transfusion and 30-day mortality and postoperative complications. RESULTS: Rates of platelet transfusion varied between institutions from 4.4% to 24.7% ( P < 0.001), a difference that remained statistically significant in propensity score-matched cohorts. Among patients on preoperative antiplatelet therapy, transfusion rates varied from 8.5% to 46.4% ( P < 0.001). There was no statistically significant relationship between case volume and transfusion rates ( P = 0.815). In multivariate logistic regression, platelet transfusion was associated with increased risk of 30-day mortality (OR 2.43, P = 0.008), postoperative pneumonia (OR 2.21, P = 0.004), prolonged intubation (OR 2.05, P < 0.001), and readmission (OR 1.43, P = 0.039). CONCLUSIONS: Significant variation existed in platelet transfusion rates between institutions, even after controlling for various risk factors. This variation may be associated with increased mortality and length of stay. Further study is warranted to better understand risks associated with platelet transfusion. Standardizing practice may help reduce risk and conserve resources.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Ponte de Artéria Coronária/mortalidade , Transfusão de Eritrócitos/efeitos adversos , Transfusão de Plaquetas/efeitos adversos , Idoso , Perda Sanguínea Cirúrgica/prevenção & controle , Procedimentos Cirúrgicos Cardíacos/mortalidade , Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Transfusão de Eritrócitos/métodos , Transfusão de Eritrócitos/estatística & dados numéricos , Feminino , Humanos , Tempo de Internação , Masculino , Maryland/epidemiologia , Pessoa de Meia-Idade , Mortalidade , Transfusão de Plaquetas/métodos , Transfusão de Plaquetas/tendências , Complicações Pós-Operatórias/etiologia , Melhoria de Qualidade/normas , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
17.
Int J Mol Sci ; 20(5)2019 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-30841510

RESUMO

Wrist osteoarthritis (OA) is one of the most common conditions encountered by hand surgeons with limited efficacy of non-surgical treatments. The purpose of this study is to describe the Platelet-Rich Plasma (PRP) mixed-microfat biological characteristics of an experimental Advanced Therapy Medicinal Product (ATMP) needed for clinical trial authorization and describe the clinical results obtained from our first three patients 12 months after treatment (NCT03164122). Biological characterization of microfat, PRP and mixture were analysed in vitro according to validated methods. Patients with stage four OA according to the Kellgren Lawrence classification, with failure to conservative treatment and a persistent daily painful condition >40 mm according to the visual analog scale (VAS) were treated. Microfat-PRP ATMP is a product with high platelet purity, conserved viability of stromal vascular fraction cells, chondrogenic differentiation capacity in vitro and high secretion of IL-1Ra anti-inflammatory cytokine. For patients, the only side effect was pain at the adipose tissue harvesting sites. Potential efficacy was observed with a pain decrease of over 50% (per VAS score) and the achievement of minimal clinically important differences for DASH and PRWE functional scores at one year in all three patients. Microfat-PRP ATMP presented a good safety profile after an injection in wrist OA. Efficacy trials are necessary to assess whether this innovative strategy could delay the necessity to perform non-conservative surgery.


Assuntos
Tecido Adiposo/citologia , Articulações do Carpo/patologia , Transplante de Células-Tronco Mesenquimais/métodos , Osteoartrite/terapia , Transfusão de Plaquetas/métodos , Adolescente , Adulto , Idoso , Células Cultivadas , Condrócitos/citologia , Feminino , Humanos , Masculino , Transplante de Células-Tronco Mesenquimais/efeitos adversos , Células-Tronco Mesenquimais/citologia , Pessoa de Meia-Idade , Transfusão de Plaquetas/efeitos adversos , Plasma Rico em Plaquetas/citologia
18.
Med Hypotheses ; 125: 10-15, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30902133

RESUMO

Modern massive transfusion protocols call for early plasma and platelets to patients presenting with hemorrhagic shock. The packed red blood cell (PRBC):plasma:platelet ratio generally ranges from 1:1:1 to 3:1:1, but the ideal ratio remains controversial. We aimed to determine the effects of different resuscitation strategies and blood product ratios on hematocrit, platelet and fibrinogen concentrations (FC) during resuscitation. Assuming: pre-insult blood volume 5 L; hematocrit 0.4, FC = 100%, platelet count 400 × 109/L; predetermined constant values for each blood product unit (volume, hematocrit, FC, platelet number); and transfusion rate to maintain euvolemia, we simulated different resuscitation strategies using a computer-based hemorrhage model. When crystalloids are administered to restore an acute 30% blood loss, the initial hematocrit, platelets and FC are adequate, and remain physiologic when further resuscitation is carried out with 1:1:1. Higher transfusion ratios increase the hematocrit at the expense of proportional drops in FC and platelets. When crystalloids and PRBCs (1500 mL) are administered to restore an acute 60% blood loss, the FC drops to 39%. Further resuscitation with 1:1:1 (but not with 2:1:1 or 3:1:1) increases the FC while maintaining the hematocrit and platelets within physiologic range. When blood products (1-3:1:1) are administered to restore an acute 60% blood loss, the initial hematocrit, platelets and FC are at adequate levels, but remain within physiologic range only when 1:1:1 (but not 2:1:1 or 3:1:1) is implemented for further resuscitation. Notably, platelet concentration consistently drops in all simulated scenarios reaching dangerously low levels particularly with high blood loss/transfusion rates and with higher transfusion ratios. The FC does not always drop by the same proportion with higher ratios probably because it is based on plasma concentration and is thus "cushioned" by the reduction in plasma volume as the hematocrit rises with higher transfusion ratios. In summary, computer simulation suggests that in non-severe shock hemorrhage, the differences between 1-3:1:1 transfusion ratios during initial resuscitation may be small. In severe shock, however, 1:1:1 results in the most physiologic hematocrit, FC and platelet concentration and is, therefore, desirable.


Assuntos
Transfusão de Sangue/métodos , Simulação por Computador , Transfusão de Plaquetas/métodos , Adulto , Plaquetas/citologia , Transfusão de Eritrócitos , Fibrinogênio/fisiologia , Fibroblastos/citologia , Hematócrito , Hemorragia , Hemostasia , Humanos , Modelos Biológicos , Plasma , Ressuscitação , Choque Hemorrágico
19.
Transfus Med Rev ; 33(2): 92-97, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30814031

RESUMO

Antiplatelet therapy is extensively used in the primary and secondary prophylaxis of arterial thrombotic disorders. Aspirin, the most commonly used antiplatelet agent, is a cyclooxygenase-1 inhibitor and considered a mild to moderate inhibitor of platelet function. Therefore, often a second antiplatelet agent is necessary in certain clinical conditions requiring greater inhibition of platelet function. An adenosine diphosphate (ADP) receptor, P2Y12, is an important target for this purpose; several agents inhibit this receptor providing potent antiplatelet effect. One of the side effects of these agents is bleeding, which in some patients may require reversal of antiplatelet effect. Similarly, patients undergoing emergent surgeries may benefit from reversal of antiplatelet effect to avoid excessive surgical bleeding. This article reviews current literature on this topic.


Assuntos
Hemorragia/tratamento farmacológico , Inibidores da Agregação de Plaquetas/efeitos adversos , Transfusão de Plaquetas/métodos , Aspirina/uso terapêutico , Perda Sanguínea Cirúrgica , Plaquetas/efeitos dos fármacos , Inibidores de Ciclo-Oxigenase/farmacologia , Hemorragia/induzido quimicamente , Hemostasia/efeitos dos fármacos , Humanos , Inibidores de Fosfodiesterase/farmacologia , Inibidores da Agregação de Plaquetas/uso terapêutico , Testes de Função Plaquetária , Antagonistas do Receptor Purinérgico P2Y/uso terapêutico , Receptores Purinérgicos P2Y12/metabolismo , Tromboembolia/prevenção & controle , Ticagrelor/efeitos adversos
20.
World Neurosurg ; 125: e671-e677, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30735874

RESUMO

BACKGROUND: Antiplatelet therapy is common and complicates the operative management of subdural hematomas (SDH). The risk of reoperation inferred by antiplatelet medication and the ability of platelet transfusion to reduce hemorrhagic complications in patients presenting with antiplatelet associated SDHs are poorly defined. METHODS: We performed a retrospective review of consecutive patients treated with craniotomy or craniectomy for evacuation of an acute or mixed-density SDH between 2012 and 2017 at 2 academic institutions. Exclusion criteria included anticoagulant therapy, thrombocytopenia, and/or international normalized ratio >1.3. Clinical and radiographic data were collected; primary endpoint was reoperation within 30 days. Logistic regression models were used to identify predictors of reoperation. RESULTS: A total of 195 patients were included: 86 patients on antiplatelet medication and 109 with no antithrombotic history. Overall, 24 (12.3%) of patients required a reoperation. Reoperation rate in patients on antiplatelet medication was not significantly different than those not on antithrombotics (14.0% vs. 11.0%, P = 0.53). Patients taking antiplatelet medication were significantly older, more likely to have medical comorbidities, and more likely to receive preoperative platelet transfusion (36.0% vs. 3.7%, P < 0.001). Of patients taking antiplatelet medications, there was no difference in reoperation rate between those patients receiving preoperative platelet transfusion and those not receiving transfusion (16.1% vs. 12.7%, P = 0.75). CONCLUSIONS: Antiplatelet medication was not a significant predictor of reoperation following evacuation of an acute or mixed-density SDH. In patients on antiplatelet medication, preoperative platelet transfusion did not reduce reoperation rates.


Assuntos
Hematoma Subdural Crônico/tratamento farmacológico , Hematoma Subdural Crônico/cirurgia , Inibidores da Agregação de Plaquetas/uso terapêutico , Reoperação/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Craniotomia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transfusão de Plaquetas/métodos , Reoperação/métodos , Estudos Retrospectivos , Cirurgia de Second-Look
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