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1.
Biomolecules ; 11(7)2021 07 13.
Artigo em Inglês | MEDLINE | ID: mdl-34356644

RESUMO

Two adenovirus-based vaccines, ChAdOx1 nCoV-19 and Ad26.COV2.S, and two mRNA-based vaccines, BNT162b2 and mRNA.1273, have been approved by the European Medicines Agency (EMA), and are invaluable in preventing and reducing the incidence of coronavirus disease-2019 (COVID-19). Recent reports have pointed to thrombosis with associated thrombocytopenia as an adverse effect occurring at a low frequency in some individuals after vaccination. The causes of such events may be related to SARS-CoV-2 spike protein interactions with different C-type lectin receptors, heparan sulfate proteoglycans (HSPGs) and the CD147 receptor, or to different soluble splice variants of the spike protein, adenovirus vector interactions with the CD46 receptor or platelet factor 4 antibodies. Similar findings have been reported for several viral diseases after vaccine administration. In addition, immunological mechanisms elicited by viral vectors related to cellular delivery could play a relevant role in individuals with certain genetic backgrounds. Although rare, the potential COVID-19 vaccine-induced immune thrombotic thrombocytopenia (VITT) requires immediate validation, especially in risk groups, such as the elderly, chronic smokers, and individuals with pre-existing incidences of thrombocytopenia; and if necessary, a reformulation of existing vaccines.


Assuntos
Vacinas contra COVID-19/efeitos adversos , COVID-19/prevenção & controle , Trombose/etiologia , COVID-19/imunologia , Humanos , Fatores de Risco , SARS-CoV-2/imunologia , Fumantes , Glicoproteína da Espícula de Coronavírus/imunologia , Trombocitopenia/etiologia , Trombocitopenia/imunologia , Trombose/imunologia , Vacinação/efeitos adversos
3.
Sci Rep ; 11(1): 16290, 2021 08 11.
Artigo em Inglês | MEDLINE | ID: mdl-34381066

RESUMO

To reveal if coagulopathies relate to the course of COVID-19, we examined 255 patients with moderate and severe COVID-19, receiving anticoagulants and immunosuppressive drugs. Coagulopathy manifested predominantly as hypercoagulability that correlated directly with systemic inflammation, disease severity, comorbidities, and mortality risk. The prolonged clotting tests in about » of cases were associated with high levels of C-reactive protein and antiphospholipid antibodies, which impeded coagulation in vitro. Contraction of blood clots was hindered in about ½ of patients, especially in severe and fatal cases, and correlated directly with prothrombotic parameters. A decrease in platelet contractility was due to moderate thrombocytopenia in combination with platelet dysfunction. Clots with impaired contraction were porous, had a low content of compressed polyhedral erythrocytes (polyhedrocytes) and an even distribution of fibrin, suggesting that the uncompacted intravital clots are more obstructive but patients could also be prone to bleeding. The absence of consumption coagulopathy suggests the predominance of local and/or regional microthrombosis rather than disseminated intravascular coagulation. The results obtained (i) confirm the importance of hemostatic disorders in COVID-19 and their relation to systemic inflammation; (ii) justify monitoring of hemostasis, including the kinetics of blood clot contraction; (iii) substantiate the active prophylaxis of thrombotic complications in COVID-19.


Assuntos
Transtornos da Coagulação Sanguínea/etiologia , Transtornos Plaquetários/etiologia , COVID-19/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/uso terapêutico , Transtornos da Coagulação Sanguínea/tratamento farmacológico , Plaquetas/ultraestrutura , COVID-19/tratamento farmacológico , Feminino , Humanos , Inflamação/etiologia , Masculino , Pessoa de Meia-Idade , Gravidade do Paciente , Trombocitopenia/etiologia , Resultado do Tratamento , Adulto Jovem
5.
S Afr Med J ; 111(6): 535-537, 2021 04 20.
Artigo em Inglês | MEDLINE | ID: mdl-34382561

RESUMO

There have recently been safety concerns regarding an increased risk of vaccine-induced immune thrombotic thrombocytopenia (VITT) following administration of SARS-CoV-2 adenoviral vector vaccines. The Southern African Society of Thrombosis and Haemostasis reviewed the emerging literature on this idiosyncratic complication. A draft document was produced and revised by consensus agreement by a panel of professionals from various specialties. The recommendations were adjudicated by independent international experts to avoid local bias. We present concise, practical guidelines for the clinical management of VITT.


Assuntos
Vacinas contra COVID-19/efeitos adversos , COVID-19/prevenção & controle , Trombocitopenia/terapia , Trombose/terapia , Vacinas contra COVID-19/administração & dosagem , Humanos , SARS-CoV-2/imunologia , África do Sul , Trombocitopenia/diagnóstico , Trombocitopenia/etiologia , Trombose/diagnóstico , Trombose/etiologia
6.
Molecules ; 26(16)2021 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-34443589

RESUMO

The thrombotic thrombocytopenia syndrome (TTS), a complication of COVID-19 vaccines, involves thrombosis (often cerebral venous sinus thrombosis) and thrombocytopenia with occasional pulmonary embolism and arterial ischemia. TTS appears to mostly affect females aged between 20 and 50 years old, with no predisposing risk factors conclusively identified so far. Cases are characterized by thrombocytopenia, higher levels of D-dimers than commonly observed in venous thromboembolic events, inexplicably low fibrinogen levels and worsening thrombosis. Hyper fibrinolysis associated with bleeding can also occur. Antibodies that bind platelet factor 4, similar to those associated with heparin-induced thrombocytopenia, have also been identified but in the absence of patient exposure to heparin treatment. A number of countries have now suspended the use of adenovirus-vectored vaccines for younger individuals. The prevailing opinion of most experts is that the risk of developing COVID-19 disease, including thrombosis, far exceeds the extremely low risk of TTS associated with highly efficacious vaccines. Mass vaccination should continue but with caution. Vaccines that are more likely to cause TTS (e.g., Vaxzevria manufactured by AstraZeneca) should be avoided in younger patients for whom an alternative vaccine is available.


Assuntos
Vacinas contra COVID-19/efeitos adversos , Trombocitopenia/induzido quimicamente , Trombocitopenia/terapia , Trombose/induzido quimicamente , Trombose/terapia , Anticorpos/sangue , Diagnóstico Diferencial , Heparina/efeitos adversos , Humanos , Fator Plaquetário 4/sangue , Trombocitopenia/etiologia , Trombose/etiologia
7.
Arch. argent. pediatr ; 119(4): e303-e314, agosto 2021. tab, ilus
Artigo em Inglês, Espanhol | LILACS, BINACIS | ID: biblio-1280999

RESUMO

Las trombocitopenias de causa no inmunológica son ocasionadas por múltiples patologías; las más frecuentes son las debidas a infecciones extra- o intrauterinas y las secundarias a otras patologías involucradas en la interrelación niño-placenta-madre. En este segundo artículo, se enumeran sus causas y se describen en detalle las distintas patologías. La transfusión de plaquetas es ampliamente utilizada en neonatología, tanto para tratamiento como para profilaxis de hemorragias. Sin embargo, no hay aún consenso generalizado sobre el umbral de recuento plaquetario conveniente para indicar la transfusión ni sobre sus reales indicaciones. Se comentan artículos recientes sobre las distintas estrategias propuestas. Se enfatiza la discusión sobre los múltiples efectos adversos de las transfusiones de plaquetas, cuyo conocimiento está cambiando el paradigma relativo a sus indicaciones, lo que sugiere que se debe aplicar una política mucho más restrictiva al respect


Non-immune thrombocytopenia is caused by multiple pathologies; the most common causes are extra- or intrauterine infections, whereas secondary cases result from other pathologies involved in the fetal-placental-maternal interface. This second article lists its causes and provides details of the different pathologies. Platelet transfusion is widely used in neonatology, both as treatment and as bleeding prophylaxis. However, there is no general consensus about the platelet count threshold that is convenient to indicate a transfusion or actual indications. Recent articles are commented regarding the different proposed strategies. The emphasis is on discussing the multiple adverse effects of platelet transfusions because knowledge about them is changing the paradigm for indications, suggesting that a much more restrictive policy is required


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Trombocitopenia/etiologia , Trombocitopenia/patologia , Transfusão de Plaquetas/efeitos adversos , Hemorragia
10.
Am J Case Rep ; 22: e931478, 2021 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-34285180

RESUMO

BACKGROUND Immune thrombocytopenic purpura (ITP) is an immune response that destroys platelets and increases the risk of bleeding, which can range from bruising to intracranial hemorrhage. ITP is a known complication of coronavirus disease 2019 (COVID-19). In the first studies of the BNT162b2 messenger RNA (mRNA) COVID-19 vaccine, there were no reports of ITP and the incidence of serious adverse events (AEs) was low overall. Here, we present a case of ITP as a complication of the BNT162b2 mRNA COVID-19 vaccine. CASE REPORT Three days after receiving a second dose of the BNT162b2 mRNA COVID-19 vaccine, a 39-year-old woman presented with a petechial rash on her trunk, legs, and arms, and fatigue and muscle aches. At the time of her hospital admission, her platelet count was 1000/µL. A peripheral smear showed profound thrombocytopenia. During the course of the patient's hospitalization, she was treated with 2 units of platelets, 2 infusions of i.v. immunoglobulin, and i.v. methylprednisolone. Her platelet count increased to 92 000/µL on the day of discharge and she was prescribed a tapered dose of oral prednisone. One day later, her rash had resolved and her platelet count was 243 000/µL. The patient recovered completely with no complications. CONCLUSIONS ITP should be considered a severe AE of the BNT162b2 mRNA COVID-19 vaccine. Knowing the early signs and symptoms of ITP will become increasingly important as more of the population receives this vaccine. Quick diagnosis and management are essential to avoid life-threatening bleeding.


Assuntos
COVID-19 , Púrpura Trombocitopênica Idiopática , Trombocitopenia , Adulto , Vacinas contra COVID-19 , Feminino , Humanos , RNA Mensageiro/genética , SARS-CoV-2 , Trombocitopenia/etiologia , Vacinação/efeitos adversos
12.
Medicine (Baltimore) ; 100(28): e26651, 2021 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-34260567

RESUMO

RATIONALE: Hypersplenism causes thrombocytopenia, which may lead to the reduction or discontinuation of chemotherapy. Partial splenic embolization (PSE) is an effective treatment for thrombocytopenia associated with hypersplenism. However, there have been no reports of patients with gastric cancer who have resumed and continued chemotherapy after PSE for splenic hypersplenism associated with tumor infiltration.Here, we report two cases in which we performed PSE for hypersplenism associated with gastric cancer that had invaded the splenic vein. Chemotherapy was continued in both cases. PATIENT CONCERNS: Both patients developed thrombocytopenia with splenomegaly due to advanced gastric cancer that required discontinuation of chemotherapy. DIAGNOSIS: Upper gastrointestinal endoscopy and computed tomography showed advanced gastric cancer with invasion of the splenic vein and splenomegaly. Both patients developed thrombocytopenia. INTERVENTIONS: Patients were treated with PSE. OUTCOMES: PSE produced an increase in thrombocyte count, and chemotherapy could be resumed. LESSONS: PSE seems to be a useful treatment for thrombocytopenia with splenomegaly associated with advanced gastric cancer and may allow continuation of chemotherapy.


Assuntos
Embolização Terapêutica/métodos , Hiperesplenismo/etiologia , Hiperesplenismo/terapia , Neoplasias Gástricas/patologia , Trombocitopenia/etiologia , Trombocitopenia/terapia , Idoso , Antineoplásicos/uso terapêutico , Feminino , Humanos , Pessoa de Meia-Idade , Veia Esplênica , Neoplasias Gástricas/tratamento farmacológico
13.
JAMA ; 326(4): 332-338, 2021 07 27.
Artigo em Inglês | MEDLINE | ID: mdl-34213527

RESUMO

Importance: Cases of cerebral venous sinus thrombosis in combination with thrombocytopenia have recently been reported within 4 to 28 days of vaccination with the ChAdOx1 nCov-19 (AstraZeneca/Oxford) and Ad.26.COV2.S (Janssen/Johnson & Johnson) COVID-19 vaccines. An immune-mediated response associated with platelet factor 4/heparin antibodies has been proposed as the underlying pathomechanism. Objective: To determine the frequencies of admission thrombocytopenia, heparin-induced thrombocytopenia, and presence of platelet factor 4/heparin antibodies in patients diagnosed with cerebral venous sinus thrombosis prior to the COVID-19 pandemic. Design, Setting, and Participants: This was a descriptive analysis of a retrospective sample of consecutive patients diagnosed with cerebral venous sinus thrombosis between January 1987 and March 2018 from 7 hospitals participating in the International Cerebral Venous Sinus Thrombosis Consortium from Finland, the Netherlands, Switzerland, Sweden, Mexico, Iran, and Costa Rica. Of 952 patients, 865 with available baseline platelet count were included. In a subset of 93 patients, frozen plasma samples collected during a previous study between September 2009 and February 2016 were analyzed for the presence of platelet factor 4/heparin antibodies. Exposures: Diagnosis of cerebral venous sinus thrombosis. Main Outcomes and Measures: Frequencies of admission thrombocytopenia (platelet count <150 ×103/µL), heparin-induced thrombocytopenia (as diagnosed by the treating physician), and platelet factor 4/heparin IgG antibodies (optical density >0.4, in a subset of patients with previously collected plasma samples). Results: Of 865 patients (median age, 40 years [interquartile range, 29-53 years], 70% women), 73 (8.4%; 95% CI, 6.8%-10.5%) had thrombocytopenia, which was mild (100-149 ×103/µL) in 52 (6.0%), moderate (50-99 ×103/µL) in 17 (2.0%), and severe (<50 ×103/µL) in 4 (0.5%). Heparin-induced thrombocytopenia with platelet factor 4/heparin antibodies was diagnosed in a single patient (0.1%; 95% CI, <0.1%-0.7%). Of the convenience sample of 93 patients with cerebral venous sinus thrombosis included in the laboratory analysis, 8 (9%) had thrombocytopenia, and none (95% CI, 0%-4%) had platelet factor 4/heparin antibodies. Conclusions and Relevance: In patients with cerebral venous sinus thrombosis prior to the COVID-19 pandemic, baseline thrombocytopenia was uncommon, and heparin-induced thrombocytopenia and platelet factor 4/heparin antibodies were rare. These findings may inform investigations of the possible association between the ChAdOx1 nCoV-19 and Ad26.COV2.S COVID-19 vaccines and cerebral venous sinus thrombosis with thrombocytopenia.


Assuntos
Vacinas contra COVID-19/efeitos adversos , Heparina/imunologia , Fator Plaquetário 4/imunologia , Trombose dos Seios Intracranianos/complicações , Trombocitopenia/etiologia , Adulto , Anticorpos/sangue , Feminino , Heparina/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Trombose dos Seios Intracranianos/imunologia , Trombocitopenia/epidemiologia
14.
Int J Lab Hematol ; 43 Suppl 1: 96-102, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34288442

RESUMO

Heparin-induced thrombocytopenia (HIT) is a prothrombotic condition resulting from pathogenic antibodies to complexes of heparin and platelet factor 4 (PF4). The diagnosis of HIT can be challenging due to the widespread use of heparin and the frequency of thrombocytopenia in hospitalized patients. Laboratory testing for HIT typically includes an immunoassay to detect antibodies to PF4-heparin and a functional assay. Current HIT diagnostic algorithms recommend using the 4Ts score to determine the need for HIT laboratory testing. Automated calculation of HIT clinical prediction scores in the electronic health record may improve the identification of patients who should undergo HIT testing. Another challenge in the management of patients with suspected HIT is the turnaround time of the laboratory testing needed to confirm the diagnosis. Due to the high daily thrombotic risk of HIT, clinicians must treat patients with intermediate to high pretest likelihood of HIT empirically while awaiting the test results. Treatment for HIT often involves alternative anticoagulants that lack reversal agents, which may increase bleeding risk, prolong hospital stays, and increase costs for patients suspected of having HIT. Rapid immunoassays hold promise to improve the speed of HIT diagnosis. These assays must retain a very high sensitivity for this "can't miss" diagnosis, yet have sufficient specificity to be of diagnostic value. A Bayesian approach has been proposed using two rapid immunoassays in succession, which decreased analytic turnaround time to 60 minutes. Such an approach has the potential to be a much-needed clinical advance in improving accuracy and speed in the diagnosis of HIT.


Assuntos
Anticoagulantes/efeitos adversos , Testes Hematológicos/métodos , Heparina/efeitos adversos , Trombocitopenia/diagnóstico , Trombocitopenia/etiologia , Algoritmos , Biomarcadores , Gerenciamento Clínico , Suscetibilidade a Doenças , Ensaio de Imunoadsorção Enzimática , Humanos , Imunoensaio , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Fatores de Tempo
15.
Intern Emerg Med ; 16(5): 1113-1119, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34191218

RESUMO

The amazing effort of vaccination against COVID-19, with more than 2 billion vaccine doses administered all around the world as of 16 June 2021, has changed the history of this pandemic, drastically reducing the number of severe cases or deaths in countries were mass vaccination campaign have been carried out. However, the people's rising enthusiasm has been blunted in late February 2021 by the report of several cases of unusual thrombotic events in combination with thrombocytopenia after vaccination with ChAdOx1 nCov-19 (Vaxzevria), and a few months later also after Ad26.COV2. S vaccines. Of note, both products used an Adenovirus-based (AdV) platform to deliver the mRNA molecule - coding for the spike protein of SARS-CoV-2. A clinical entity characterized by cerebral and/or splanchnic vein thrombosis, often associated with multiple thromboses, with thrombocytopenia and bleeding, and sometimes disseminated intravascular coagulation (DIC), was soon recognized as a new syndrome, named vaccine-induced immune thrombotic thrombocytopenia (VITT) or thrombosis with thrombocytopenia syndrome (TTS). VITT was mainly observed in females under 55 years of age, between 4 and 16 days after receiving only Adenovirus-based vaccine and displayed a seriously high fatality rate. This prompted the Medicine Regulatory Agencies of various countries to enforce the pharmacovigilance programs, and to provide some advices to restrict the use of AdV-based vaccines to some age groups. This point-of view is aimed at providing a comprehensive review of epidemiological issues, pathogenetic hypothesis and treatment strategies of this rare but compelling syndrome, thus helping physicians to offer an up-to dated and evidence-based counseling to their often alarmed patients.


Assuntos
Vacinas contra COVID-19/efeitos adversos , Trombocitopenia/etiologia , Vacinação/estatística & dados numéricos , Biomarcadores/análise , Vacinas contra COVID-19/farmacocinética , Vacinas contra COVID-19/uso terapêutico , Correlação de Dados , Prova Pericial , Humanos , Trombocitopenia/fisiopatologia , Vacinação/efeitos adversos , Vacinação/métodos
16.
Transfus Apher Sci ; 60(4): 103174, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34088601

RESUMO

Vaccine-induced immune thrombotic thrombocytopenia (VITT) is associated with high titers of immunoglobulin G class antibodies directed against the cationic platelet chemokine platelet factor 4 (PF4). These antibodies activate platelets via FcγIIa receptors. VITT closely resembles heparin-induced thrombocytopenia. Inflammation and tissue trauma substantially increase the risk for forming pathogenic PF4 antibodies. We therefore propose the use of therapeutic plasma exchange as rescue therapy in VITT to deplete antibodies plus factors promoting inflammation such as excess cytokines in the circulation as well as extracellular vesicles derived from activated platelets.


Assuntos
Vacinas contra COVID-19/efeitos adversos , Troca Plasmática , Fator Plaquetário 4/imunologia , Púrpura Trombocitopênica Trombótica/terapia , Terapia de Salvação , Albuminas , Especificidade de Anticorpos , Anticoagulantes , Autoanticorpos/imunologia , Vacinas contra COVID-19/farmacologia , Citratos , Contraindicações de Procedimentos , Citocinas/sangue , Vesículas Extracelulares , Humanos , Imunoglobulina G/imunologia , Imunossupressão , Inflamação , Troca Plasmática/efeitos adversos , Troca Plasmática/métodos , Ativação Plaquetária , Transfusão de Plaquetas/efeitos adversos , Púrpura Trombocitopênica Trombótica/etiologia , Púrpura Trombocitopênica Trombótica/imunologia , Sistema de Registros , Trombocitopenia/etiologia , Trombose/etiologia
18.
N Engl J Med ; 385(8): 720-728, 2021 08 19.
Artigo em Inglês | MEDLINE | ID: mdl-34107198

RESUMO

The use of high-dose intravenous immune globulin (IVIG) plus anticoagulation is recommended for the treatment of vaccine-induced immune thrombotic thrombocytopenia (VITT), a rare side effect of adenoviral vector vaccines against coronavirus disease 2019 (Covid-19). We describe the response to IVIG therapy in three of the first patients in whom VITT was identified in Canada after the receipt of the ChAdOx1 nCoV-19 vaccine. The patients were between the ages of 63 and 72 years; one was female. At the time of this report, Canada had restricted the use of the ChAdOx1 nCoV-19 vaccine to persons who were 55 years of age or older on the basis of reports that VITT had occurred primarily in younger persons. Two of the patients in our study presented with limb-artery thrombosis; the third had cerebral venous and arterial thrombosis. Variable patterns of serum-induced platelet activation were observed in response to heparin and platelet factor 4 (PF4), indicating the heterogeneity of the manifestations of VITT in serum. After the initiation of IVIG, reduced antibody-induced platelet activation in serum was seen in all three patients. (Funded by the Canadian Institutes of Health Research.).


Assuntos
Vacinas contra COVID-19/efeitos adversos , Imunoglobulinas Intravenosas , Trombocitopenia/terapia , Trombose/terapia , Idoso , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Fibrinogênio/análise , Heparina/farmacologia , Humanos , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Fator Plaquetário 4/farmacologia , Serotonina/sangue , Trombocitopenia/sangue , Trombocitopenia/etiologia , Trombose/etiologia , Trombose/imunologia
19.
J Autoimmun ; 122: 102685, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34174723

RESUMO

The involvement of viruses and SARS-CoV-2 in autoimmune diseases is well known. The recent demonstration that ChAdOx1 nCoV-19 Covid-19 (AstraZeneca) vaccine (ChA) favors the production of anti-platelet factor 4 (anti-PF4) antibodies, blood clots, and thrombocytopenia raises the question of whether other anti-CoViD-19 vaccines favor the same patterns of events. We assessed the frequency of severe adverse events (SAEs) documented in the EudraVigilance European database up to April 16, 2021 related to thrombocytopenia, bleeding, and blood clots in recipients of ChA compared to that of recipients of the BNT162b2 Covid-19 (Pfizer/BioNTech) vaccine (BNT). ChA administration was associated with a much higher frequency of SAEs in each AE Reaction Group as compared with that elicited by BNT. When considering AEs caused by thrombocytopenia, bleeding and blood clots, we observed 33 and 151 SAEs/1 million doses in BNT and ChA recipients, respectively. When considering patients with AEs related to cerebral/splanchnic venous thrombosis, and/or thrombocytopenia, we documented 4 and 30 SAEs and 0.4 and 4.8 deaths/1 million doses for BNT and ChA recipients, respectively. The highest risk following ChA vaccination is in young people and, likely, women of reproductive age, as suggested by hypothesized scenarios. In conclusion, the immune reaction promoted by ChA vaccine may lead to not only thrombocytopenia and cerebral/splanchnic venous thrombosis but also other thrombotic and thromboembolic SAEs. These events are not favored by BNT vaccine. Our study may help in the evaluation of the benefit/risk profile of the ChA vaccine considering the epidemic curve present in a country.


Assuntos
Vacinas contra COVID-19/efeitos adversos , COVID-19/prevenção & controle , Hemorragia/etiologia , Trombose/etiologia , Adolescente , Adulto , Europa (Continente) , Feminino , Hemorragia/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , SARS-CoV-2 , Trombocitopenia/epidemiologia , Trombocitopenia/etiologia , Trombose/epidemiologia , Adulto Jovem
20.
Cancer Radiother ; 25(5): 469-475, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34120853

RESUMO

PURPOSE: In patients with right-sided breast cancer (BC) the liver might be partially irradiated during adjuvant radiotherapy (RT). Thus, we performed a prospective observational study to evaluate the dose delivered to the liver, and its potential biological impact. PATIENTS AND METHODS: We enrolled 34 patients with right-sided BC treated with adjuvant RT. The RT schedules were either the Canadian (42.5Gy in 16 fx) or standard fractionated (50Gy in 25 fx) regimen respectively with 9 (26.5%) and 25 (73.5%) patients each, ± a boost of 10-16Gy. Each patient had a complete blood count and liver enzymes analysis, before starting and during the last week of treatment. RESULTS: A significant decrease in white blood cells and thrombocytes counts was observed during RT. We observed a significant correlation between certain hepatic parameters and the volume of the irradiated liver and/or the mean liver dose. A significant correlation between the volume of the right lung and the liver mean dose was found (P=0.008). In the bivariate analysis, a significant correlation between fatigue and the white blood cell count's evolution was observed (P<0.025). CONCLUSION: With the standard RT technique, incidental irradiation of the liver was documented in a large number of patients, and some significant hepatic parameters alterations were observed, without an apparent clinical impact, but this study cannot exclude them. The liver mean dose was correlated with the right lung volume suggesting that deep inspiration breath hold (DIBH) techniques may represent a way to decrease the liver dose. These findings need to be evaluated in further larger studies.


Assuntos
Fígado/efeitos da radiação , Neoplasias Unilaterais da Mama/radioterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Alanina Transaminase/sangue , Aspartato Aminotransferases/sangue , Fracionamento da Dose de Radiação , Fadiga/etiologia , Feminino , Humanos , Leucopenia/etiologia , Pulmão/efeitos da radiação , Pessoa de Meia-Idade , Órgãos em Risco , Estudos Prospectivos , Dosagem Radioterapêutica , Radioterapia Adjuvante , Trombocitopenia/etiologia
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