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2.
Cardiovasc Ther ; 2021: 8836450, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33519970

RESUMO

Background: Thrombocytopenia was intuitively considered to be associated with higher risk of bleeding and multiple comorbidities after percutaneous coronary intervention (PCI). However, controversial results exist, and the real-world clinical impact of thrombocytopenia in patients undergoing PCI is largely unknown. The aim of this study was to evaluate the influence of baseline thrombocytopenia on the prognosis of patients undergoing PCI. Methods: Using the West China Hospital Inpatient Sample database, patients who underwent PCI were identified from August 2012 to January 2019. Baseline thrombocytopenia was defined as a preprocedural platelet count of 100 × 109/L or less obtained from a routine blood sample taken within 48 hours before coronary PCI. The clinical effect of the advanced thrombocytopenia group (≤85 × 109/L), according to the median value of platelet count in the thrombocytopenia cohort, was further assessed. The primary outcome was a composite of in-hospital death, bleeding events, and post-PCI transfusion. Results: Of 9531 patients enrolled in our study, 936 had baseline thrombocytopenia and 8595 patients did not have. There were no significant differences in the primary outcome between the two groups. However, advanced thrombocytopenia was independently associated with higher risk of primary outcome (OR 1.67, 95% CI 1.06 to 2.65, p = 0.029). Acute coronary syndrome (ACS) patients with thrombocytopenia were associated with higher odds of major bleeding (BARC ≥ 2) (OR 2.56, 95% CI 1.24 to 5.44, p = 0.011). Compared with the nonthrombocytopenia group, the thrombocytopenia group with ticagrelor use had higher odds of major bleeding (OR 9.7, 95% CI 1.57 to 60.4 versus OR 0.22, 95% CI 0.03 to 1.69, interaction p = 0.025). Conclusions: It seems feasible for patients with thrombocytopenia to receive PCI, but close attention should be paid to advanced thrombocytopenia, the risk of postprocedure bleeding in ACS patients, and the use of more potent P2Y12 inhibitor.


Assuntos
Síndrome Coronariana Aguda/terapia , Doença da Artéria Coronariana/terapia , Intervenção Coronária Percutânea , Trombocitopenia/complicações , Síndrome Coronariana Aguda/complicações , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/mortalidade , Idoso , China , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/mortalidade , Bases de Dados Factuais , Feminino , Hemorragia/induzido quimicamente , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/efeitos adversos , Inibidores da Agregação de Plaquetas/administração & dosagem , Inibidores da Agregação de Plaquetas/efeitos adversos , Antagonistas do Receptor Purinérgico P2Y/administração & dosagem , Antagonistas do Receptor Purinérgico P2Y/efeitos adversos , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Trombocitopenia/diagnóstico , Trombocitopenia/mortalidade , Fatores de Tempo , Resultado do Tratamento
3.
Ital J Pediatr ; 47(1): 7, 2021 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-33436048

RESUMO

BACKGROUND: Neonatal thrombocytopenia (NT) (platelet count < 150 × 109/L) is a common finding in the neonatal intensive care unit (NICU). The main aim of this study was to assess the prevalence, risk factors, and outcomes of severe NT in full term (FT) infants. METHODS: During the study period, all FT infants who met the inclusion criteria for NT on two occasions were included. Maternal data, such as maternal age, weight, gestational age, mode of delivery, and history of systemic diseases, including diabetes mellitus, pre-eclampsia, systemic lupus erythematosus, and immune thrombocytopenic purpura, were recorded. Furthermore, neonatal data, such as gender, neonatal weight, causes/duration of admission, types of respiratory support used, complete blood count measurements, and outcomes for neonates admitted to the NICU, were recorded. RESULTS: In total, 55 FT infants with NT met the inclusion criteria, and 29 (52.73%) cases had severe NT. The most common cause of NT was neonatal sepsis (20 cases, 36.35%), followed by a postoperative state (5 cases, 9.09%). Moreover, in cases of positive blood cultures, the most commonly isolated organism was Escherichia coli (6 cases, 10.90%), followed by Klebsiella (5 cases, 9.09%). Cases of severe NT needed more platelet transfusions (P = 0.001) and had higher rates of mortality (P = 0.001) when compared to cases of mild/moderate NT associated with signs of bleeding and pulmonary/intraventricular hemorrhage (IVH) (P = 0.001). CONCLUSION: Severe NT compared to mild/moderate NT, associated with signs of bleeding and pulmonary/IVH, needed more platelet transfusions, and had increased mortality. Further research is needed to explain which of these complications related to severity of thrombocytopenia or were associated with original disease of the babies.


Assuntos
Trombocitopenia/diagnóstico , Trombocitopenia/epidemiologia , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Tempo de Internação , Masculino , Idade Materna , Prevalência , Respiração Artificial , Fatores de Risco , Índice de Gravidade de Doença , Taxa de Sobrevida , Trombocitopenia/terapia
4.
Ther Umsch ; 77(8): 379-384, 2020.
Artigo em Alemão | MEDLINE | ID: mdl-33054644

RESUMO

Thrombocytopenia as an incidental finding Abstract. Platelets play an important role in normal hemostasis and their number in the periphereal blood is normally very stable. Thrombocytopenia is frequently encountered in the clinic. As a first step, one has to exclude so called pseudothrombocytopenia due to preanalytic (EDTA as an anticoagulant) conditions. This can be done by determination of platelet counts in citrate or alternative (e. g. Thrombo-Exact) tubes or by performing a blood smear, where platelets are seen clumped. A blood smear is also the mainstay of further work-up as the differential diagnosis is very broad. In bleeding patients early therapeutic interventions have to be considered. Further work-up should be done stepwise and in collaboration with a hematologist. A definite diagnosis is essential in order to define specific therapeutic interventions, mainly in bleeding patients, in patients scheduled for surgery or patients taking antiaggregation and / or anticoagulation therapy.


Assuntos
Achados Incidentais , Trombocitopenia , Anticoagulantes/uso terapêutico , Ácido Edético , Humanos , Contagem de Plaquetas , Trombocitopenia/diagnóstico
5.
Rev Bras Ginecol Obstet ; 42(10): 669-671, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33129222

RESUMO

The present report describes the case of a 31-year-old primigravida, with dichorionic twins at 31 weeks. She presented with history of myalgia, jaundice, and abdominal discomfort. No flu-like symptoms as fever or cough. She was not aware of exposure to COVID-19. Normal blood pressure and O2 saturation. Laboratory tests showed platelet count of 218,000 mm3, alanine aminotransferase (ALT) 558 IU and serum creatinine 2.3 mg/dl. Doppler ultrasound in one twin was compatible with brain sparing. Partial hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome was the hypothesis, and a cesarean section was performed. On day 2, the white-cell count reached 33,730, with decreased consciousness and mild respiratory distress. Tomography revealed both lungs with ground-glass opacities. Swab for COVID-19 polymerase chain reaction (PCR) was positive. Thrombocytopenia in patients with COVID-19 appears to be multifactorial, similar to what occurs in preeclampsia and HELLP syndrome. We assume that the synergism of these pathophysiological mechanisms could accelerate the compromise of maternal conditions and could be a warning to the obstetric practice.


Assuntos
Infecções por Coronavirus/diagnóstico , Síndrome HELLP/diagnóstico , Pneumonia Viral/diagnóstico , Complicações Infecciosas na Gravidez/diagnóstico , Resultado da Gravidez , Adulto , Cesárea/métodos , Técnicas de Laboratório Clínico , Diagnóstico Diferencial , Feminino , Idade Gestacional , Humanos , Pandemias , Gravidez , Gravidez de Gêmeos , Trombocitopenia/diagnóstico , Ultrassonografia Pré-Natal
7.
Medicine (Baltimore) ; 99(39): e21941, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991402

RESUMO

INTRODUCTION: Diffuse pulmonary lymphangiomatosis (DPL) is a rare condition. Most patients with DPL present dyspnea, cough, expectoration, and hemoptysis. There are few reports of DPL accompanied by thrombocytopenia, whose cause remains unknown. PATIENT CONCERNS: An 18-year-old male patient presented with recurrent cough, expectoration, and dyspnea for 5 years, and thrombocytopenia was observed during a 2-month follow-up. DIAGNOSIS: Chest computed tomography showed diffuse patchy shadows in both lungs, and pleural and pericardial effusions. Immunohistochemical lung tissue staining showed lymphatic and vascular endothelial cells positive for D2-40, CD31 and CD34. Routine blood test revealed platelets at 62 × 10 cells/L during follow-up. Bone marrow biopsy was normal. Ultrasound revealed no hepatosplenomegaly. Finally, the patient was diagnosed with DPL accompanied by thrombocytopenia. INTERVENTIONS: He was treated by subtotal pericardial resection, thoracocentesis, and anti-infective therapy. Oral prednisone was administered for 2 months. OUTCOMES: The symptoms of cough and shortness of breath were improved, but thrombocytopenia persisted. We investigated the cause of thrombocytopenia. Whole-exome sequencing identified a mutation in exon 3 of the TNFRSF13B gene in this patient. CONCLUSION: DPL may present with thrombocytopenia and DIC. Patients with thrombocytopenia but not DIC and splenomegaly should be screened for gene mutations.


Assuntos
Pneumopatias/congênito , Linfangiectasia/congênito , Trombocitopenia/complicações , Adolescente , Criança , Humanos , Pneumopatias/complicações , Pneumopatias/diagnóstico por imagem , Pneumopatias/genética , Pneumopatias/patologia , Linfangiectasia/complicações , Linfangiectasia/diagnóstico por imagem , Linfangiectasia/genética , Linfangiectasia/patologia , Masculino , Mutação de Sentido Incorreto , Trombocitopenia/diagnóstico , Tomografia Computadorizada por Raios X , Proteína Transmembrana Ativadora e Interagente do CAML , Sequenciamento Completo do Exoma
8.
Yonsei Med J ; 61(10): 851-859, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32975059

RESUMO

PURPOSE: Thrombocytopenia (platelet count <150×10³/µL) is associated with poor outcomes in various critical illness settings. However, the prognostic value of platelet count in patients with cardiogenic shock (CS) remains unclear. MATERIALS AND METHODS: We enrolled 1202 patients between January 2014 and December 2018 from a multicenter retrospective-prospective cohort registry of CS. Clinical characteristics and treatment outcomes were compared between the patients with and without thrombocytopenia. RESULTS: At presentation with CS, 244 (20.3%) patients had thrombocytopenia. The patients with thrombocytopenia had lower blood pressure, hemoglobin level, and worse liver and renal functions compared to the patients without. During hospitalization, the patients with thrombocytopenia had more frequent gastrointestinal bleeding (10.5% vs. 3.8%, p=0.009), sepsis (8.3% vs. 2.6%, p=0.013), requirement of renal replacement therapy (36.5% vs. 18.9%, p<0.001), requirement of mechanical ventilation (65.2% vs. 54.4%, p=0.003), longer intensive care unit stay (8 days vs. 4 days, p<0.001), and thirty-day mortality (40.2% vs. 28.5%, p<0.001) compared to those without. In addition, the platelet count was an independent predictor of 30-day mortality (per 103/µL decrease; adjusted hazard ratio: 1.002, 95% confidence interval: 1.000-1.003, p=0.021). CONCLUSION: Thrombocytopenia at CS presentation was associated with worse clinical findings, higher frequencies of complications, and longer stay at the intensive care unit. Also, thrombocytopenia was independently associated with increased 30-day mortality. (Clinical trial registration No. NCT02985008).


Assuntos
Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Sistema de Registros/estatística & dados numéricos , Choque Cardiogênico , Trombocitopenia , Adulto , Idoso , Estudos de Casos e Controles , Estudos de Coortes , Estado Terminal , Feminino , Hemorragia Gastrointestinal/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Contagem de Plaquetas , Prevalência , Prognóstico , Estudos Prospectivos , Respiração Artificial/estatística & dados numéricos , Estudos Retrospectivos , Sepse/sangue , Sepse/epidemiologia , Choque Cardiogênico/diagnóstico , Choque Cardiogênico/mortalidade , Choque Cardiogênico/terapia , Trombocitopenia/diagnóstico , Trombocitopenia/mortalidade , Trombocitopenia/terapia , Resultado do Tratamento
9.
Vnitr Lek ; 66(4): 242-248, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32972188

RESUMO

Heparin-induced thrombocytopenia (HIT) is an immunologically-mediated complication, which usually follows heparin exposition, less frequently exposition to other drugs or even occurs spontaneously. The type of heparin, its dose and mode of application as well as the exposition time, major trauma or operation, and obesity represent the main risk factors for HIT. The probability of HIT correlates with so-called 4T-score. A confirmatory laboratory diagnostic should be exclusively reserved for patients with a medium to a high probability of HIT development (more than 3 points in 4T-score). The screening method is based on serological detection of antibodies against heparin-platelet factor-4 complexes; confirmation tests aim to identify the activation of platelets. The treatment of HIT requires an immediate interruption of heparin application and rigorous antithrombotic treatment with an alternative agent. Herein authors describe a clinical case of HIT manifested as an extreme urticarial reaction in the location of nadroparin application as well as thrombosis of deep subcutaneous veins in a polymorbid obese patient with an extensive and infected burn. Due to timely diagnosis and fondaparinux treatment, no more severe thrombotic events occurred in this patient.


Assuntos
Trombocitopenia , Trombose , Anticoagulantes/efeitos adversos , Fondaparinux , Heparina/efeitos adversos , Humanos , Trombocitopenia/induzido quimicamente , Trombocitopenia/diagnóstico
11.
Int J Hematol ; 112(6): 878-882, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32712863

RESUMO

A 66-year-old woman had experienced abnormal bleeding since the age of 7. Thrombocytopenia was not detected until she was 48, and immune thrombocytopenia was diagnosed at age 66. She also reported experiencing hearing disturbance since the age of 30 and acute renal failure since the age of 61 but reported no visual disturbance. Her younger son, who was 40 years old, also experienced abnormal bleeding since the age of 6, but immune thrombocytopenia was diagnosed as late as age 35. He had no other associated disorders. Laboratory examinations of both mother and son revealed a low platelet count (8000 and 29,000 µL, respectively), giant platelets and Döhle body-like granulocyte inclusion bodies. The mother had a high creatinine level (15.4 mg/dL) and normal liver enzyme levels. MYH9 genetic analysis identified a heterozygous mutation, c.101T>A, p.Val34Glu at exon 2 in both patients. These clinical and laboratory findings were consistent with a diagnosis of an MYH9-related disorder with different phenotypes observed in the same family. MYH9-related disorders were recognised in 2003, but were often misdiagnosed as immune thrombocytopenia, and hence, they have rarely been reported in Taiwan.


Assuntos
Perda Auditiva Neurossensorial/diagnóstico , Perda Auditiva Neurossensorial/genética , Mutação , Cadeias Pesadas de Miosina/genética , Púrpura Trombocitopênica Idiopática , Trombocitopenia/congênito , Adulto , Idoso , Biomarcadores/sangue , Plaquetas/patologia , Creatinina/sangue , Diagnóstico Diferencial , Feminino , Granulócitos/citologia , Granulócitos/patologia , Perda Auditiva Neurossensorial/sangue , Humanos , Corpos de Inclusão/patologia , Masculino , Pessoa de Meia-Idade , Relações Mãe-Filho , Fenótipo , Contagem de Plaquetas , Taiwan , Trombocitopenia/sangue , Trombocitopenia/diagnóstico , Trombocitopenia/genética
12.
Zhonghua Nei Ke Za Zhi ; 59(7): 498-510, 2020 Jul 01.
Artigo em Chinês | MEDLINE | ID: mdl-32594683

RESUMO

Thrombocytopenia is the main clinical manifestation or common complication of multiple diseases, but there is still a lack of systematic understanding of pathogenesis, underlying diseases and treatment strategies of thrombocytopenia. Based on evidence-based medicine, this consensus summarizes seven aspects related to thrombocytopenia, including definition, epidemiology, pathogenesis, clinical manifestations, laboratory examination, diagnosis and treatment. This consensus provides an important reference for the diagnosis and treatment of thrombocytopenia.


Assuntos
Trombocitopenia , China/epidemiologia , Consenso , Medicina Baseada em Evidências , Humanos , Trombocitopenia/diagnóstico , Trombocitopenia/terapia
13.
Microbes Infect ; 22(9): 500-503, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32574789

RESUMO

COVID-19 patients (n = 34) suffering from ARDS were treated with tocilizumab (TCZ). Outcome was classified in two groups: "Death" and "Recovery". Predictive factors of mortality were studied. Mean age was 75.3, mean oxygen (O2) requirements 10.4 l/min. At baseline, all patients had multiple biological abnormalities (lymphopenia, increased CRP, ferritin, fibrinogen, D-dimer and liver enzymes). 24 patients (70.5%) recovered after TCZ therapy and 10 died (29.5%). Deceased subjects differed from patients in whom treatment was effective with regard to more pronounced lymphopenia (0.6 vs 1.0 G/l; p = 0.037), lower platelet number (156 vs 314 G/l; p = 0.0001), lower fibrinogen serum level (0.6 vs 1.0 G/l; p = 0.03), higher aspartate-amino-transferase (108 vs 57 UI/l; p = 0.05) and greater O2 requirements (11 vs 8 l/min; p = 0.003).


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Betacoronavirus/patogenicidade , Infecções por Coronavirus/tratamento farmacológico , Linfopenia/tratamento farmacológico , Pneumonia Viral/tratamento farmacológico , Trombocitopenia/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Anticoagulantes/uso terapêutico , Aspartato Aminotransferases/sangue , Betacoronavirus/efeitos dos fármacos , Biomarcadores/sangue , Proteína C-Reativa/metabolismo , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/virologia , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Fibrinogênio/metabolismo , Humanos , Hidroxicloroquina/uso terapêutico , Linfopenia/diagnóstico , Linfopenia/mortalidade , Linfopenia/virologia , Masculino , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/mortalidade , Pneumonia Viral/virologia , Prognóstico , /mortalidade , Estudos Retrospectivos , Análise de Sobrevida , Trombocitopenia/diagnóstico , Trombocitopenia/mortalidade , Trombocitopenia/virologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
14.
Ann Biol Clin (Paris) ; 78(4): 433-437, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32576540

RESUMO

Iron deficiency anemia is frequently associated with thrombocytosis. However, in some rare cases of very severe iron deficiency, a thrombocytopenia may occur. This condition may lead to a misdiagnosis of immune thrombocytopenic purpura and thus to unnecessary tests in this context. Here we report two patients who presented with iron deficiency associated thrombocytopenia rapidly corrected after martial supplementation. We then discuss the value of measuring immature platelet fraction (IPF), which represents the population of newly formed platelets containing a greater amount of residual RNA. For both cases, low IPF values at admission indicated a central origin of thrombocytopenia with decreased platelet production, which is the pathophysiological mechanism of iron deficiency associated thrombocytopenia.


Assuntos
Anemia Ferropriva/diagnóstico , Plaquetas/patologia , Monitorização Fisiológica/métodos , Trombocitopenia/diagnóstico , Adolescente , Adulto , Anemia Ferropriva/sangue , Anemia Ferropriva/complicações , Anemia Ferropriva/tratamento farmacológico , Diagnóstico Diferencial , Feminino , Humanos , Ferro/administração & dosagem , Monitorização Fisiológica/normas , Contagem de Plaquetas/normas , Valor Preditivo dos Testes , Trombocitopenia/sangue , Trombocitopenia/complicações , Trombocitopenia/tratamento farmacológico
16.
Thromb Res ; 193: 110-115, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32535232

RESUMO

Corona Virus Disease 2019 (COVID-19) is caused by the novel coronavirus SARS-CoV-2. Emerging genetic and clinical evidence suggests similarities between COVID-19 patients and those with severe acute respiratory syndrome and Middle East respiratory syndrome. Hematological changes such as lymphopenia and thrombocytopenia are not rare in COVID-19 patients, and a smaller population of these patients had leukopenia. Thrombocytopenia was detected in 5-41.7% of the patients with COVID-19. Analyzing the dynamic decrease in platelet counts may be useful in the prognosis of patients with COVID-19. However, the mechanisms underlying the development of thrombocytopenia remain to be elucidated. This review summarizes the hematological changes in patients infected with SARS-CoV-2 and possible underlying mechanisms of thrombocytopenia development.


Assuntos
Plaquetas/patologia , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Trombocitopenia/etiologia , Animais , Betacoronavirus/isolamento & purificação , Coagulação Sanguínea , Plaquetas/virologia , Infecções por Coronavirus/sangue , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/virologia , Humanos , Pandemias , Contagem de Plaquetas , Pneumonia Viral/sangue , Pneumonia Viral/diagnóstico , Pneumonia Viral/virologia , Prognóstico , Trombocitopenia/sangue , Trombocitopenia/diagnóstico , Trombocitopenia/virologia
18.
J Stroke Cerebrovasc Dis ; 29(7): 104865, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32404288

RESUMO

We present what may be the first case report of acute thrombocytopenia after tissue plasminogen activator (tPA) in the setting of stroke. Early fibrinogen degradation coagulopathy (EFDC) after tPA has been described in the past and acute thrombocytopenia may fall into this spectrum. Further studies are needed to evaluate the bleeding and mortality risk associated with thrombocytopenia after tPA.


Assuntos
Plaquetas , Fibrinolíticos/efeitos adversos , Acidente Vascular Cerebral/tratamento farmacológico , Trombocitopenia/etiologia , Terapia Trombolítica/efeitos adversos , Ativador de Plasminogênio Tecidual/efeitos adversos , Doença Aguda , Idoso de 80 Anos ou mais , Feminino , Fibrinolíticos/administração & dosagem , Humanos , Contagem de Plaquetas , Acidente Vascular Cerebral/diagnóstico , Trombocitopenia/sangue , Trombocitopenia/diagnóstico , Fatores de Tempo , Ativador de Plasminogênio Tecidual/administração & dosagem , Resultado do Tratamento
19.
Acta Chir Orthop Traumatol Cech ; 87(2): 129-133, 2020.
Artigo em Tcheco | MEDLINE | ID: mdl-32396515

RESUMO

Heparin-induced thrombocytopenia is a rare complication of treatment with both unfractionated heparin (UFH) and low molecular weight heparin (LMWH). Antibodies against the complex heparin-platelet factor 4 are the main cause of pathogenesis, resulting in the activation of thrombocytes, coagulation, endothelium, monocytes, neutrophils and subsequent highly prothrombotic state. The prothrombotic state can result not only in venous but also in arterial thrombosis at different locations (which is manifested apart from venous thromboembolic disease also by acute limb ischemia, acute myocardial infarction, ischemic stroke, skin necrotizing lesion exanthema). If HIT is not adequately treated, it may be fatal in up to 10% of patients. For early diagnosis, a combination of 4T scores and diagnostic lab tests for HIT is required. Immediate discontinuation of heparin therapy (UFH, LMWH) and switching to non-heparin anticoagulants (fondaparinux, bivalirudin, argatroban or in some situations DOACs) are essential in HIT treatment. The case report describes the patient after primary knee replacement, complicated by the development of HIT with no evidence of venous thromboembolic disease. Preoperatively, the patient was administrated nadroparin due to paroxysmal atrial fibrillation, after the development of HIT, anticoagulation was modified to fondaparinux and subsequently to warfarin after the platelet count normalization. Key words: unfractioned heparin, low molecular weight heparin, thrombocytopenia, total knee replacement.


Assuntos
Anticoagulantes/efeitos adversos , Artroplastia do Joelho , Heparina/efeitos adversos , Trombocitopenia/induzido quimicamente , Humanos , Trombocitopenia/diagnóstico , Trombocitopenia/terapia
20.
Pediatrics ; 146(1)2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32366611

RESUMO

The novel severe acute respiratory syndrome coronavirus 2 is a worldwide pandemic. The severe morbidity and mortality associated with coronavirus disease 2019 has mostly affected the elderly or those with underlying medical conditions. We present a case of a 12-year-old girl with no past medical history who presented with fever, cough, and vomiting. Laboratory evaluation revealed severe thrombocytopenia and elevated markers of inflammation. The patient progressed to respiratory failure, and testing results for the severe acute respiratory syndrome coronavirus 2 returned positive. Because of the severity of her thrombocytopenia, she was treated with intravenous immunoglobulin and steroids with prompt improvement in platelets. The patient's severe acute respiratory distress syndrome was managed with mechanical ventilation, inhaled nitric oxide, and then airway pressure release ventilation. After azithromycin and hydroxychloroquine were given without improvement, our patient received tocilizumab, an anti-interleukin-6 receptor antibody, and remdesivir, a broad antiviral agent, with significant clinical benefit soon afterward. Given that severe pediatric coronavirus disease 2019 is rare, we hope to inform pediatric providers on the clinical course and management considerations as this pandemic continues to spread.


Assuntos
Betacoronavirus , Infecções por Coronavirus/diagnóstico , Pneumonia Viral/diagnóstico , Insuficiência Respiratória/diagnóstico , Índice de Gravidade de Doença , Trombocitopenia/diagnóstico , Criança , Infecções por Coronavirus/complicações , Infecções por Coronavirus/terapia , Feminino , Humanos , Imunoglobulinas Intravenosas/administração & dosagem , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/terapia , Respiração Artificial/métodos , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia , Trombocitopenia/etiologia , Trombocitopenia/terapia
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