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1.
Zhongguo Shi Yan Xue Ye Xue Za Zhi ; 29(5): 1577-1581, 2021 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-34627443

RESUMO

OBJECTIVE: To investigate the effect of enhanced autophagy in megakaryocyte to proplatelet formation in children with immune thrombocytopenia(ITP). METHODS: Giemsa staining and immunofluorescence staining were used to observe megakaryocyte morphology and proplatelet formation, Western blot was used to determine the expression of cytoskeleton protein and autophagy related protein. Autophagr regulation drugs Rap or 3-MA was used to regulate autophagy of megakaryocytes. RESULTS: Some vacuole-like structures was found in ITP megakaryocytes of the children, the expression of LC3II/I (ITP 1.32±0.18; Ctrl 0.49±0.16,P<0.05) and Atg5-Atg12 (ITP 0.69±0.17; Ctrl 0.12±0.08,P<0.05) was significantly higher in ITP children as compared with those in control group. The immu- nofluorescence staining showed that the cytoskeleton arrangement in megakaryocytes of ITP children was abnormal, and the phosphorylation of myosin light chain was also increased(ITP 0.74±0.09, Ctrl 0.05±0.02,P<0.05). In vitro, inducer or inhibitor of autophagy could regulate the production of proplatelet and the expression of cell cycle related protein, including CyclinD1(Veh 1.08±0.12; Rap 0.46±0.04; Rap+3-MA 0.70±0.03), CyclinD2(Veh 0.47±0.04; Rap 0.27±0.04; Rap+3-MA 0.41±0.03), P21(Veh 0.15±0.01; Rap 0.04±0.01; Rap+3-MA 0.05±0.01). CONCLUSION: Enhanced autophagy is the key factor of poor proplatelet formation in megakaryocytes of ITP children.


Assuntos
Púrpura Trombocitopênica Idiopática , Trombocitopenia , Autofagia , Plaquetas , Humanos , Megacariócitos
2.
PLoS One ; 16(10): e0258236, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34597333

RESUMO

BACKGROUND: All healthcare workers (HCWs) in Yongin Severance Hospital were allocated to receive the ChAdOx1 nCov-19 vaccine according to national policy. A report of thrombosis and thrombocytopenia syndrome (TTS) associated with ChAdOx1 nCoV-19 led to hesitancy about receiving the second dose among HCWs who had received the first dose. METHODS: From 7 to 14 May, 2021, we performed a survey to identify the factors associated with hesitancy about receiving the second vaccine dose among HCWs at the hospital who had received the first dose of the vaccine. Based on survey results, a hospital-wide campaign was implemented on 18 May 2021 to improve vaccine coverage. HCWs who completed the second dose completed a self-administered questionnaire to evaluate the effect of the campaign. FINDINGS: Of 1,171 HCWs who had received the first dose of the vaccine, 71.5% completed the online survey, of whom 3.7% refused to take the second dose and 22.3% showed hesitancy. Hesitancy to receive a second dose was significantly associated with age under 30 years and concerns about TTS, and was less common among those who trusted effectiveness and safety of the vaccine. Among HCWs who received the first dose, 96.2% completed vaccination with the second dose between 27 May and 4 June, 2021. Of those who answered the questionnaire asked about the timing of their decision to receive the second dose, 57.1% reported that they were motivated by the hospital-wide campaign. CONCLUSION: A tailored intervention strategy based on a survey can improve COVID-19 vaccination uptake among HCWs.


Assuntos
Vacinas contra COVID-19/administração & dosagem , COVID-19/prevenção & controle , Pessoal de Saúde/psicologia , Adulto , COVID-19/virologia , Vacinas contra COVID-19/efeitos adversos , Feminino , Política de Saúde , Hospitais , Humanos , Internet , Masculino , Pessoa de Meia-Idade , República da Coreia , SARS-CoV-2/isolamento & purificação , Inquéritos e Questionários , Trombocitopenia/etiologia , Trombose/etiologia
4.
Int J Mol Sci ; 22(19)2021 Oct 06.
Artigo em Inglês | MEDLINE | ID: mdl-34639132

RESUMO

Novel coronavirus SARS-CoV-2 has resulted in a global pandemic with worldwide 6-digit infection rates and thousands of death tolls daily. Enormous efforts are undertaken to achieve high coverage of immunization to reach herd immunity in order to stop the spread of SARS-CoV-2 infection. Several SARS-CoV-2 vaccines based on mRNA, viral vectors, or inactivated SARS-CoV-2 virus have been approved and are being applied worldwide. However, the recent increased numbers of normally very rare types of thromboses associated with thrombocytopenia have been reported, particularly in the context of the adenoviral vector vaccine ChAdOx1 nCoV-19 from Astra Zeneca. The statistical prevalence of these side effects seems to correlate with this particular vaccine type, i.e., adenoviral vector-based vaccines, but the exact molecular mechanisms are still not clear. The present review summarizes current data and hypotheses for molecular and cellular mechanisms into one integrated hypothesis indicating that coagulopathies, including thromboses, thrombocytopenia, and other related side effects, are correlated to an interplay of the two components in the vaccine, i.e., the spike antigen and the adenoviral vector, with the innate and immune systems, which under certain circumstances can imitate the picture of a limited COVID-19 pathological picture.


Assuntos
Vacinas contra COVID-19/efeitos adversos , COVID-19/prevenção & controle , SARS-CoV-2/imunologia , Glicoproteína da Espícula de Coronavírus/imunologia , Trombocitopenia/etiologia , Trombose/etiologia , Adenoviridae/imunologia , Animais , COVID-19/imunologia , Vacinas contra COVID-19/imunologia , Vetores Genéticos/efeitos adversos , Vetores Genéticos/imunologia , Humanos , Púrpura Trombocitopênica Idiopática/etiologia , Púrpura Trombocitopênica Idiopática/imunologia , Glicoproteína da Espícula de Coronavírus/efeitos adversos , Trombocitopenia/imunologia , Trombose/imunologia , Vacinação/efeitos adversos
5.
Zhonghua Gan Zang Bing Za Zhi ; 29(9): 896-899, 2021 Sep 20.
Artigo em Chinês | MEDLINE | ID: mdl-34638215

RESUMO

Chronic liver disease causes bleeding and coagulation system abnormalities through a variety of mechanisms. Thrombocytopenia is a common complication of chronic liver disease. Patients with chronic liver disease, especially liver cirrhosis, often face more invasive examinations or surgeries, which brings great challenges to clinical diagnosis and treatment. Traditional platelet transfusion is the main clinical intervention. With the approval of thrombopoietin receptor agonists, the current management standards for chronic liver disease-related thrombocytopenia may face changes. This article reviews the current main non-pharmacological and pharmacological interventions for chronic liver disease-related thrombocytopenia, and put forwards the corresponding clinical management improvement strategies based on the efficacy and limitations of these interventions.


Assuntos
Hepatopatias , Trombocitopenia , Hemorragia , Humanos , Cirrose Hepática , Hepatopatias/complicações , Hepatopatias/terapia , Trombocitopenia/etiologia , Trombocitopenia/terapia
8.
Gan To Kagaku Ryoho ; 48(10): 1255-1257, 2021 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-34657058

RESUMO

The patient was a 61-year-old woman who presented to the hospital with the chief complaints of anemia and thrombocytopenia. There was a mass in her left breast, and a needle biopsy with pathology revealed invasive ductal carcinoma, which was HR-positive and HER2-negative. A PET scan revealed multiple bone metastases, which were confirmed on bone marrow biopsy, leading to the diagnosis of bone marrow carcinomatosis. As the patient was in good general condition, an aromatase inhibitor(AI)therapy was selected. Rapid improvements in her hemoglobin level and platelet count were observed. At 19 months after the start of treatment, we were able to perform a left mastectomy with left axillary lymph node dissection. The histological evaluation of her response to treatment was Grade 2a, and severe lymph node metastasis was observed. The patient continued to receive the AI postoperatively. Thirty-two months after the start of treatment, there was no evidence of cancer on clinical imaging. Although it is rare for bone marrow carcinomatosis to occur, as in the present case, it is also notable that the patient had been in long-term remission with consistent AI therapy.


Assuntos
Anemia , Neoplasias da Mama , Neoplasias Peritoneais , Trombocitopenia , Anemia/tratamento farmacológico , Anemia/etiologia , Inibidores da Aromatase , Medula Óssea , Neoplasias da Mama/complicações , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/cirurgia , Feminino , Humanos , Mastectomia , Pessoa de Meia-Idade , Trombocitopenia/tratamento farmacológico , Trombocitopenia/etiologia
9.
Zhongguo Shi Yan Xue Ye Xue Za Zhi ; 29(5): 1667-1670, 2021 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-34627459

RESUMO

Autoimmune cytopenia is a general term for all hemocytopenia diseases caused by humoral or cellular immunity abnormalities, and its common immune mechanism determines the importance of immunosuppressive therapy. Sirolimus, as an immunosuppressant against of mTOR, induces immune tolerance by adjusting Treg cells, which has application prospect in the treatment of refractory autoimmune cytopenia. This article reviews the mechanism, application, and possible adverse reactions of sirolimus in the treatment of idiopathic autoimmune cytopenia.


Assuntos
Sirolimo , Trombocitopenia , Humanos , Imunossupressores , Linfócitos T Reguladores
11.
Zhongguo Shi Yan Xue Ye Xue Za Zhi ; 29(5): 1671-1675, 2021 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-34627460

RESUMO

Chronic lymphocytic leukemia (CLL) patients usually show immune dysfunction, which often leads to autoimmune hemocytopenia. Immune thrombocytopenia (ITP) is one of the common complications. The pathogenesis of CLL-related ITP is complex and has not been fully elucidated. At present, the researches mainly focus on humoral immunity, cellular immunity and innate immune disorders. Recent studies suggest that genomic abnormalities and microRNAs are also involved in CLL-related ITP. Traditional ITP standard therapy has a poor effect on CLL-related ITP. Chemotherapy or monoclonal antibody therapy against the primary pathogenesis of CLL can effectively treat thrombocytopenia, and the emergence of new targeted drugs also provides new treatment options for the disease. In this paper, the progresses of CLL-related ITP pathogenesis, prognosis and treatment in recent years are reviewed.


Assuntos
Leucemia Linfocítica Crônica de Células B , MicroRNAs , Púrpura Trombocitopênica Idiopática , Trombocitopenia , Anticorpos Monoclonais , Humanos , Leucemia Linfocítica Crônica de Células B/complicações
12.
Andes Pediatr ; 92(3): 382-388, 2021 Jun.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-34479244

RESUMO

INTRODUCTION: The multisystem inflammatory syndrome in children associated with SARS-CoV-2 (MIS-C) is cha racterized by a hyperinflammatory state resulting from a cytokine storm, evidenced by alterations in laboratory blood testing and acute-phase proteins. OBJECTIVE: to describe the clinical and labora tory characteristics of patients hospitalized due to MIS-C and identify predictive markers of severity. PATIENTS AND METHOD: Retrospective study of 32 patients. The group was divided into critical and non-critical according to clinical presentation and therapy used. Clinical and laboratory aspects were studied, including complete blood count, coagulation tests, and biomarkers. RESULTS: 18/32 were males, with a median age of 6.8 years. The most frequent manifestations were cardiovascular (84.3%), digestive (84%), and mucocutaneous (59%). The group of critical patients included 15 patients, 12 were males with a median age of 8.9 years, and the non-critical group included 17 patients, 6 were males with a median age of 5.4 years. The laboratory parameters at the admission in the global group showed increased C-reactive protein, D-dimer, leukocytes, neutrophils, ferritin, and fibrinogen. In contrast, albumin and blood sodium levels were decreased. At admission, the critical group was cha racterized by presenting thrombocytopenia, hypoalbuminemia, prolonged prothrombin time, and elevated ferritin. At the time of deterioration, there was an intensification of thrombocytopenia, in creased C-reactive protein together with increased neutrophils level. CONCLUSION: The blood count, C-reactive protein, and albuminemia at admission proved to be significantly important in the identi fication of patients at risk of clinical deterioration.


Assuntos
COVID-19/complicações , SARS-CoV-2 , Índice de Gravidade de Doença , Síndrome de Resposta Inflamatória Sistêmica/complicações , Biomarcadores/sangue , Proteína C-Reativa/análise , COVID-19/classificação , Criança , Deterioração Clínica , Estado Terminal , Feminino , Ferritinas/sangue , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Fibrinogênio/análise , Humanos , Leucócitos , Masculino , Neutrófilos , Estudos Retrospectivos , Síndrome de Resposta Inflamatória Sistêmica/classificação , Trombocitopenia/sangue
13.
Rinsho Ketsueki ; 62(8): 1195-1204, 2021.
Artigo em Japonês | MEDLINE | ID: mdl-34497207

RESUMO

Many patients who require consultations for thrombocytopenia and coagulation test abnormalities are referred to hematology outpatient clinics. In this article, we provide information that would guide you through the differential diagnosis of these relatively common abnormalities that physicians encounter in their daily clinical practice.


Assuntos
Transtornos da Coagulação Sanguínea , Hemostáticos , Trombocitopenia , Hemostasia , Humanos , Encaminhamento e Consulta , Trombocitopenia/diagnóstico
14.
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
17.
F1000Res ; 10: 469, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34394916

RESUMO

Background: COVID-19 disease is accompanied by derangement of coagulation with a risk of fatal thromboembolic formation. COVID-19 patients are among those indicative for heparin treatment. Increased heparin administration among COVID-19 patients increased heparin induced-thrombocytopenia's risk with/without thrombocytopenia. Case presentation: We present a 71-year-old male patient who came to the emergency department (ED) with a COVID-19 clinical manifestation that PCR nasopharyngeal swab confirmed. He was assessed to have acute respiratory distress syndrome (ARDS), as shown by rapid progression of hypoxemic respiratory failure and bilateral pulmonary infiltrate. He was then treated with moxifloxacin, remdesivir, dexamethasone, heparin pump, and multivitamins. During admission, his respiratory symptoms got worse, so he transferred to the ICU for NIV support. On the ninth day of admission, he had gross hematuria followed by a rapid fall of platelet count. We used two different scoring systems (4Ts and HEP scoring system) to confirm the diagnosis of heparin-induced thrombocytopenia (HIT). Following the discontinuation of heparin injection, the thrombocyte continued to rise, and hematuria disappeared. Conclusion: Heparin-induced thrombocytopenia is associated with an increased risk of severe disease and mortality among COVID-19 patients. The differential diagnosis of HIT could be difficult among COVID-19 patients as thrombocytopenia can also be caused by infection progression. We use two scoring systems, 4Ts and HEP scoring, that can help us to manage the patient. With good management, we can avoid patient morbidity and mortality.


Assuntos
COVID-19 , Sepse , Trombocitopenia , Idoso , Anticoagulantes/efeitos adversos , Surtos de Doenças , Heparina/efeitos adversos , Humanos , Masculino , SARS-CoV-2 , Sepse/diagnóstico , Trombocitopenia/induzido quimicamente , Trombocitopenia/diagnóstico
18.
BMJ Case Rep ; 14(9)2021 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-34479885

RESUMO

Meropenem is a broad-spectrum carbapenem widely used to treat both Gram-positive and negative bacterial infections, including extended-spectrum beta-lactamase-producing microbes. We describe the occurrence of thrombocytopenia and hypersensitivity in a boy receiving intravenous meropenem for intra-abdominal sepsis secondary to perforated appendicitis. The patient developed a pruritic maculopapular rash with occasional petechiae, associated with severe thrombocytopenia, after 7 days of meropenem administration. Investigations for other causes of thrombocytopenia, including possible line sepsis, were unfruitful, and the thrombocytopenia did not resolve until cessation of meropenem. Drug-induced reactions should be considered in children receiving meropenem who present with a rash and thrombocytopenia.


Assuntos
Infecções Bacterianas , Trombocitopenia , Antibacterianos/efeitos adversos , Infecções Bacterianas/tratamento farmacológico , Criança , Humanos , Masculino , Meropeném/efeitos adversos , Tienamicinas/efeitos adversos , Trombocitopenia/induzido quimicamente , Trombocitopenia/tratamento farmacológico
19.
BMJ Case Rep ; 14(9)2021 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-34489258

RESUMO

A 62-year-old woman with a history of end-stage renal disease on haemodialysis, essential hypertension and type 2 diabetes mellitus was diagnosed with sepsis and placed on 600 mg oral linezolid every 12 hours and 1 g intravenous ceftriaxone every 24 hours. Blood cultures grew Streptococcus dysgalactiae, and she was switched to intravenous ceftriaxone 2 g daily. Platelet counts slowly trended down after starting ceftriaxone reaching 5 K/µL on day 12 of treatment. Ceftriaxone was discontinued and heparin-induced thrombocytopaenia was ruled out. She was switched to vancomycin and her platelet count improved. Given the temporal relationship between changing platelet counts and starting and discontinuing ceftriaxone, a diagnosis of drug-induced thrombocytopaenia was made.


Assuntos
Diabetes Mellitus Tipo 2 , Preparações Farmacêuticas , Trombocitopenia , Ceftriaxona/efeitos adversos , Diabetes Mellitus Tipo 2/tratamento farmacológico , Feminino , Humanos , Pessoa de Meia-Idade , Streptococcus , Trombocitopenia/induzido quimicamente
20.
Clin Appl Thromb Hemost ; 27: 10760296211040110, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34541935

RESUMO

Since the outbreak of Covid-19 in December, 2019, scientists worldwide have been committed to developing COVID-19 vaccines. Only when most people have immunity to SARS-CoV-2, COVID-19 can reduce even wholly overcome. So far, nine kinds of COVID-19 vaccines have passed the phase III clinical trials and have approved for use. At the same time, adverse reactions after COVID-19 vaccination have also reported. This paper focuses on the adverse effects of thrombosis and thrombocytopenia caused by the COVID-19 vaccine, especially the adenovirus-vector vaccine from AstraZeneca and Pfizer, and discusses its mechanism and possible countermeasures.


Assuntos
Adenoviridae/genética , Vacinas contra COVID-19/efeitos adversos , Vetores Genéticos , Trombocitopenia/induzido quimicamente , Trombose/induzido quimicamente , Vacinação/efeitos adversos , Anticorpos/sangue , Vacinas contra COVID-19/genética , Vacinas contra COVID-19/imunologia , Humanos , Fator Plaquetário 4/imunologia , Medição de Risco , Fatores de Risco , Trombocitopenia/sangue , Trombocitopenia/imunologia , Trombose/sangue , Trombose/imunologia
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