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1.
Praxis (Bern 1994) ; 109(2): 65-70, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-32019448

RESUMO

CME:Heparin-Induced Thrombocytopenia Abstract. Heparin-induced thrombocytopenia (HIT) is a dangerous, potentially fatal, immunologically mediated side effect of heparin. Typically, five to ten days after heparin exposure there is a decrease in platelet count with a mean of 60 x 109/l. Due to an activation of thrombocytes by HIT antibodies, venous or more rarely arterial thromboses may occur. The diagnosis of HIT includes the calculation of the probability of a HIT using the 4T Score and the laboratory detection of HIT antibodies. The HIT therapy represents the immediate discontinuation of the heparin therapy as well as the beginning of an alternative therapeutic anticoagulation.


Assuntos
Anticoagulantes , Heparina , Trombocitopenia , Trombose , Anticorpos , Anticoagulantes/efeitos adversos , Heparina/efeitos adversos , Humanos , Trombocitopenia/induzido quimicamente
4.
Toxicol Lett ; 318: 92-98, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31678399

RESUMO

Sulfur mustard (SM) is a vesicant chemical warfare agent. Recent studies reported alleged use of SM by non-state actors in Syria and Iraq. It has been shown that SM induced immunological and hematological complications. The aim of this study was to determine acute toxic effects of SM exposure on hematological parameters. Blood samples from a group of Syrian exposed to SM in 2016 were taken daily during the follow-up of the patients in intensive care unit. Initial leukocytosis was observed in all patients (100%) on the first 48 h after exposure. Following leukocytosis, isolated lymphopenia was observed in all patients (100%) between 2nd and 4th days. A decrease in hemoglobin level was noted in five patients (62.5%) between 4th and 5th days. Thrombocytopenia was observed in 75% of patients between 4th and 6th days for mild cases and between 9th and 11th days for severe cases. Three patients (37.5%) developed distinct leucopenia/neutropenia on 11th and 12th days. It was observed that human exposure to high dose of SM has direct toxic effect on hematological cells and bone marrow. New strategies on treatment of SM-induced myelosuppression could reduce the effects of hematological complications and could increase the survival rate in these patients.


Assuntos
Medula Óssea/efeitos dos fármacos , Terrorismo Químico , Substâncias para a Guerra Química/envenenamento , Leucocitose/induzido quimicamente , Leucopenia/induzido quimicamente , Linfopenia/induzido quimicamente , Gás de Mostarda/envenenamento , Trombocitopenia/induzido quimicamente , Adolescente , Adulto , Biomarcadores/sangue , Medula Óssea/patologia , Feminino , Hemoglobinas/metabolismo , Humanos , Leucocitose/sangue , Leucocitose/patologia , Leucopenia/sangue , Leucopenia/patologia , Linfopenia/sangue , Linfopenia/patologia , Masculino , Síria , Trombocitopenia/sangue , Trombocitopenia/patologia , Adulto Jovem
5.
Am J Surg ; 219(1): 54-57, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31400811

RESUMO

BACKGROUND: The Warkentin 4-T scoring system for determining the pretest probability of heparin-induced thrombocytopenia (HIT) has been shown to be inaccurate in the ICU and does not take into account body mass index (BMI). METHODS: Prospectively collected data on patients in the surgical and cardiac ICU between January 2007 and February 2016 who were presumed to have HIT by clinical suspicion were reviewed. Patients were categorized into 3 BMI groups and assigned scores: Normal weight, overweight, and obese. Multivariate analyses were used to identify independent predictors of HIT. RESULTS: A total of 523 patients met inclusion criteria. Multivariate analysis showed that only BMI, Timing, and oTher variables were independently associated with HIT. This new 3-T model was better than a five-component model consisting of the entire 4-T scoring system plus BMI (AUC = 0.791). CONCLUSIONS: Incorporating patient 'T'hickness into a pretest probability model along with platelet 'T'iming and the exclusion of o'T'her causes of thrombocytopenia yields a simplified "3-T" scoring system that has increased predictive accuracy in the ICU.


Assuntos
Índice de Massa Corporal , Fibrinolíticos/efeitos adversos , Heparina/efeitos adversos , Modelos Teóricos , Trombocitopenia/induzido quimicamente , Adulto , Idoso , Feminino , Previsões , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
6.
Am J Hematol ; 95(1): 38-47, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31621093

RESUMO

Heparin-induced thrombocytopenia (HIT) is a prothrombotic drug reaction caused by platelet-activating anti-platelet factor 4 (PF4)/heparin antibodies. Pathogenic HIT antibodies can be detected by the serotonin-release assay (SRA), a platelet activation test. We have regarded the SRA performed in our medical community ("McMaster" SRA) as having high sensitivity and specificity. Recently, the concept of "SRA-negative HIT" has been proposed for enzyme-immunoassay (EIA)-positive/SRA-negative patients with a HIT-compatible clinical picture, who test positive in a PF4-enhanced platelet activation assay. After identifying an index case of SRA-negative HIT, we estimated the frequency of this condition by performing the "PF4-SRA" (modified SRA using high concentrations of added PF4 rather than heparin) in EIA-positive patients from a cohort study evaluating clinical and laboratory diagnosis of HIT. We defined SRA-negative HIT as patients meeting three criteria: clinical picture compatible with HIT (4Ts ≥ 4 points); EIA-positive (≥1.00 units); and PF4-SRA-positive. Among 430 patients, 35 were EIA-positive/SRA-positive and 27 were EIA-positive/SRA-negative. Among these 27 SRA-negative patients, three were found to have subthreshold levels of platelet-activating antibodies by PF4-SRA, of whom one met clinical criteria for SRA-negative HIT. Thus, based on identifying one patient with SRA-negative HIT within a cohort study that found 35 SRA-positive HIT patients, we estimate the sensitivity of the McMaster SRA for diagnosis of HIT to be 35/36 (97.2%; 95% CI, 85.8-99.9%). Although the McMaster SRA is highly sensitive for HIT, occasional SRA-negative but EIA-positive patients strongly suspected of having HIT can have this diagnosis supported by a PF4-enhanced activation assay such as the PF4-SRA.


Assuntos
Técnicas de Laboratório Clínico/normas , Heparina/efeitos adversos , Serotonina/metabolismo , Trombocitopenia/induzido quimicamente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos/sangue , Bioensaio , Técnicas de Laboratório Clínico/métodos , Feminino , Humanos , Imunoensaio , Masculino , Pessoa de Meia-Idade , Fator Plaquetário 4/imunologia , Sensibilidade e Especificidade , Trombocitopenia/diagnóstico
7.
Anticancer Res ; 39(12): 6895-6901, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31810959

RESUMO

BACKGROUND: Lenvatinib, a newly developed oral multi-tyrosine kinase inhibitor, has amazing potential in the multidisciplinary treatment of advanced or metastatic hepatocellular carcinoma. Thrombocytopenia is a serious adverse event that causes drug dose reduction or withdrawal. Partial splenic embolization is currently being used as a non-surgical treatment for thrombocytopenia caused by various pharmacotherapies. CASE REPORT: Partial splenic embolization was performed for three patients with hepatocellular carcinoma receiving lenvatinib therapy with/without transarterial chemoembolization. Partial splenic embolization was advantageous for various situations, including the induction of lenvatinib for patients with thrombocytopenia, application of lenvatinib after multiple transarterial chemoembolization using cisplatin and radiotherapy, and re-administration of lenvatinib after lenvatinib therapy-induced thrombocytopenia. In all cases, lenvatinib therapy was completed without need for cessation due to thrombocytopenia. CONCLUSION: We strongly recommend the new concept of combining partial splenic embolization and lenvatinib therapy for hepatocellular carcinoma.


Assuntos
Carcinoma Hepatocelular/tratamento farmacológico , Neoplasias Hepáticas/tratamento farmacológico , Compostos de Fenilureia/efeitos adversos , Quinolinas/efeitos adversos , Trombocitopenia/terapia , Idoso , Embolização Terapêutica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Baço , Trombocitopenia/induzido quimicamente , Resultado do Tratamento
8.
Rinsho Ketsueki ; 60(11): 1544-1549, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31839632

RESUMO

A 51-year-old man with a 9-month history of narrowing of visual fields and papilledema was admitted to the Department of Neurosurgery. Upon admission, glycerol was intravenously administered and heparin flushes were initiated to maintain intravenous access. Brain MRI revealed right transverse and sigmoid sinus thrombosis on hospital day 2, and the patient was treated with unfractionated heparin. On hospital day 9, the patient had a seizure and impaired mental status. Moreover, on hospital day 10, the platelet count decreased to less than half compared with that documented upon admission. The patient was then switched from heparin to argatroban because thrombosis exacerbation due to heparin-induced thrombocytopenia (HIT) was suspected. Despite negative IgG-specific chemiluminescent immunoassay for anti-platelet factor 4 (PF4) /heparin antibodies, positive functional assay led to the diagnosis of HIT. Warfarin was initiated and the platelet count was restored. Because maintaining the patient's PT-INR within the therapeutic range was difficult probably due to concomitant antimicrobial administration for complicating pneumonia, anticoagulation was switched to rivaroxaban. No bleeding or thrombotic complications developed. Thus, the presentation and clinical course should be considered for an accurate diagnosis of HIT. This is particularly important when the immunological assay is negative for anti-PF4/heparin antibodies. Furthermore, anticoagulation with rivaroxaban can be useful in the management of the subacute phase of HIT.


Assuntos
Fator Plaquetário 4 , Trombocitopenia , Anticoagulantes , Heparina , Humanos , Imunoensaio , Imunoglobulina G , Masculino , Pessoa de Meia-Idade , Trombocitopenia/induzido quimicamente
9.
Neurology ; 93(19): e1799-e1806, 2019 11 05.
Artigo em Inglês | MEDLINE | ID: mdl-31586022

RESUMO

OBJECTIVE: To determine the efficacy of the thrombopoietin receptor agonist romiplostim for the prevention of temozolomide-induced thrombocytopenia in newly diagnosed glioblastoma. METHODS: In the PLATUM phase II open-label, multicenter, single-arm trial, patients diagnosed with Common Terminology Criteria for Adverse Events grade 3 or 4 thrombocytopenia during chemoradiotherapy received weekly subcutaneous romiplostim injections. PLATUM aimed at demonstrating that the percentage of thrombocytopenic patients treated with romiplostim able to complete 6 cycles of maintenance temozolomide chemotherapy exceeded 10% (p0 = 0.10; pA = 0.35). Using type I error equal to 0.05% and 95% power, 31 patients had to be recruited. According to a Fleming 2-step design with a preplanned interim analysis after recruitment of 20 patients (step 1), the trial was terminated early for success. RESULTS: Twenty patients were enrolled in step 1. Median age was 61 years (range 33-73). Twelve patients received 6 temozolomide cycles, corresponding to a success rate of 60% (95% confidence interval 36%-81%). Four patients discontinued temozolomide because they did not respond to romiplostim, 2 for progression, and 2 for adverse events unrelated to romiplostim. CONCLUSION: The thrombopoietin receptor agonist romiplostim improves exposure to chemotherapy in patients with glioblastoma experiencing temozolomide-induced thrombocytopenia. CLINICALTRIALSGOV IDENTIFIER: NCT02227576. CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that for patients with glioblastoma and thrombocytopenia, romiplostim is effective for the secondary prophylaxis of temozolomide-induced thrombocytopenia.


Assuntos
Antineoplásicos Alquilantes/efeitos adversos , Neoplasias Encefálicas/terapia , Glioblastoma/terapia , Receptores Fc/uso terapêutico , Proteínas Recombinantes de Fusão/uso terapêutico , Temozolomida/efeitos adversos , Trombocitopenia/prevenção & controle , Trombopoetina/uso terapêutico , Adulto , Idoso , Quimiorradioterapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Receptores de Trombopoetina/agonistas , Trombocitopenia/induzido quimicamente , Trombocitopenia/tratamento farmacológico
10.
Medicine (Baltimore) ; 98(39): e17147, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574817

RESUMO

The study aims to examine the treatment effect and adverse reactions of patients with newly diagnosed MM receiving different bortezomib-based regimens.This was a retrospective study of patients with newly diagnosed MM and who were treated with bortezomib-based combined chemotherapy at the Department of Hematology of the 2 affiliated hospitals of Wenzhou Medical University between July 2009 and May 2016. Cox proportion hazard multivariate analyses were carried out to assess the differences in treatment effect and adverse events between standard (1.3 mg/m on days 1, 4, 8, 11) and weekly (1.6 mg/m on days 1, 8, 15) cohorts, as well as the differences between intravenous injection and subcutaneous injection therapy. Progression-free survival (PFS) and overall survival (OS) were assessed using Kaplan-Meier method and the log-rank test.Among the 117 patients, 78 patients were treated with bortezomib standard therapy and 39 patients were treated with bortezomib weekly therapy (all with intravenous injection). In all patients, the treatment strategy was not independently associated with PFS or OS. The patients in the weekly therapy group had less thrombocytopenia events than those in the standard therapy group. The subcutaneous route had similar treatment effect as the intravenous route, but the incidence of peripheral neuropathy was lower.The once-weekly bortezomib regimen was similar in effectiveness to standard therapy in treating patients with newly diagnosed MM, but the incidence of thrombocytopenia was lower with the weekly regimen compared with the standard regimen.


Assuntos
Antineoplásicos/administração & dosagem , Bortezomib/administração & dosagem , Mieloma Múltiplo/tratamento farmacológico , Trombocitopenia/induzido quimicamente , Idoso , Antineoplásicos/efeitos adversos , Bortezomib/efeitos adversos , China , Intervalo Livre de Doença , Esquema de Medicação , Feminino , Humanos , Injeções Intravenosas , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/mortalidade , Estudos Retrospectivos , Resultado do Tratamento
11.
J Coll Physicians Surg Pak ; 29(10): 986-992, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31564275

RESUMO

Heparin-induced thrombocytopenia (HIT) is an immune-mediated response to heparin administration. HIT following cardiopulmonary bypass (CPB) procedures has not been clearly delineated in pediatric populations. By comprehensive retrieval of the pertinent literature published since 2000, 19 reports were collected with 33 pediatric patients recruited into this study. A female predominance was noted in this patient setting. HIT occurred after a mean heparin exposure of 2.8 times. Pediatric HIT following CPB showed different features from that with no CPB, by a longer span on postoperative day 1-16, and a significant negative correlation between the platelet count and time of occurrence of thrombocytopenia on postoperative day 1-8. The thrombus formation developed on postoperative day 13. Heparin discontinuation and use of coganulant substitute are the important treatments of choice. In HIT patients, continued heparin use may cause patient death or recurrence of HIT. HIT-related thrombosis was present in 69.6% of the patients with similar incidence rates of arterial and venous thrombosis; and the thrombosis could be managed by medical, surgical or device explant methods. The direct thrombin inhibitors lepirudin, argatroban and bivalirudin as well as the factor Xa inhibitor danaparoid can be used safely in most of the pediatric patients. The event-free survival rate of this patient setting was 69.7%.


Assuntos
Anticoagulantes/efeitos adversos , Ponte Cardiopulmonar , Heparina/efeitos adversos , Trombocitopenia/induzido quimicamente , Criança , Humanos
12.
J Med Case Rep ; 13(1): 316, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31647029

RESUMO

BACKGROUND: Immune checkpoint inhibitor therapy has changed the standard drug therapy for relapsed or advanced non-small cell lung cancer; its efficacy is well-recognized by pulmonary physicians, oncologists, and thoracic surgeons. Nivolumab, one of the anti-programmed cell death 1 antibodies, was the first immune checkpoint inhibitor to be approved and is used as a standard second-line regimen for patients with non-small cell lung cancer irrespective of the expression of programmed cell death ligand 1. Programmed cell death 1 antibodies have been generally confirmed to be less toxic than conventional cytotoxic chemotherapy, although unusual immune-related adverse events such as type I diabetes mellitus, adrenal failure, and myasthenia gravis may occur with a very low incidence. A case of severe grade V immune-related thrombocytopenia after two courses of nivolumab as second-line therapy for relapsed non-small cell lung cancer is reported. CASE PRESENTATION: An 82-year-old Japanese woman with relapsed lung adenocarcinoma was treated with nivolumab as second-line systemic therapy at our institute. Her laboratory data indicated thrombocytopenia suspected to be an immune-related adverse event following two courses of nivolumab. Subsequently, she developed a massive pulmonary hemorrhage and left cerebral infarction despite intensive treatment including systemic steroid therapy. Although there have been a few reports of thrombocytopenia caused by nivolumab, this is the first report of grade V thrombocytopenia following administration of nivolumab for relapsed non-small cell lung cancer. CONCLUSION: A very difficult case of grade V immune-related thrombocytopenia after the administration of nivolumab as second-line therapy for relapsed lung adenocarcinoma was described. Immune-related thrombocytopenia is a rare adverse event, but it must be considered a possible complication because it may become critical once it has occurred.


Assuntos
Antineoplásicos Imunológicos/efeitos adversos , Nivolumabe/efeitos adversos , Trombocitopenia/induzido quimicamente , Adenocarcinoma de Pulmão/tratamento farmacológico , Idoso de 80 Anos ou mais , Antineoplásicos Imunológicos/administração & dosagem , Infarto Encefálico/etiologia , Evolução Fatal , Feminino , Hemorragia/etiologia , Humanos , Neoplasias Pulmonares/tratamento farmacológico , Recidiva Local de Neoplasia , Nivolumabe/administração & dosagem , Índice de Gravidade de Doença , Trombocitopenia/classificação
13.
Mar Drugs ; 17(9)2019 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-31533230

RESUMO

Protamine sulfate (PS) is a polycationic protein drug obtained from the sperm of fish, and is used to reverse the anticoagulant effect of unfractionated heparin (UFH). However, the interactions between PS, UFH, and platelets are still not clear. We measured the platelet numbers and collagen-induced aggregation, P-selectin, platelet factor 4, ß-thromboglobulin, prostacyclin metabolite, D-dimers, activated partial thromboplastin time, prothrombin time, anti-factor Xa, fibrinogen, thrombus weight and megakaryocytopoiesis in blood collected from mice and rats in different time points.. All of the groups were treated intravenously with vehicle, UFH, PS, or UFH with PS. We found a short-term antiplatelet activity of PS in mice and rats, and long-term platelet-independent antithrombotic activity in rats with electrically-induced thrombosis. The antiplatelet and antithrombotic potential of PS may contribute to bleeding risk in PS-overdosed patients. The inhibitory effect of PS on the platelets was attenuated by UFH without inducing thrombocytopenia. Treatment with UFH and PS did not affect the formation, number, or activation of platelets, or the thrombosis development in rodents.


Assuntos
Anticoagulantes/efeitos adversos , Antagonistas de Heparina/efeitos adversos , Heparina/efeitos adversos , Protaminas/efeitos adversos , Trombocitopenia/diagnóstico , Animais , Anticoagulantes/administração & dosagem , Plaquetas/efeitos dos fármacos , Modelos Animais de Doenças , Hemorragia/sangue , Hemorragia/induzido quimicamente , Hemorragia/prevenção & controle , Heparina/administração & dosagem , Antagonistas de Heparina/administração & dosagem , Humanos , Masculino , Camundongos , Tempo de Tromboplastina Parcial , Agregação Plaquetária/efeitos dos fármacos , Protaminas/administração & dosagem , Ratos , Trombocitopenia/sangue , Trombocitopenia/induzido quimicamente , Fatores de Tempo
14.
BMJ Case Rep ; 12(9)2019 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-31511269

RESUMO

A 2.5-year-old boy with a history of (transient) congenital hyperinsulinism was admitted to the paediatric ward with recurrent hypoglycaemia. Diazoxide 5 mg/kg/day and hydrochlorothiazide 2 mg/kg/day were initiated. After increasing the dose of diazoxide to 10 mg/kg/day, the child developed mild rectal bleeding, petechiae, epistaxis and haematemesis. Blood screening showed severe thrombocytopaenia. Diazoxide and hydrochlorothiazide were stopped, and his platelet count normalised. Drug rechallenge was positive. Drug-induced immune thrombocytopaenia was diagnosed.


Assuntos
Anti-Hipertensivos/efeitos adversos , Diazóxido/efeitos adversos , Hidroclorotiazida/efeitos adversos , Trombocitopenia/induzido quimicamente , Pré-Escolar , Quimioterapia Combinada/efeitos adversos , Epistaxe/induzido quimicamente , Hematemese/induzido quimicamente , Humanos , Hiperinsulinismo/congênito , Hiperinsulinismo/tratamento farmacológico , Masculino , Doenças Retais/induzido quimicamente
15.
Molecules ; 24(18)2019 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-31505853

RESUMO

Complement (C) activation can underlie the infusion reactions to liposomes and other nanoparticle-based medicines, a hypersensitivity syndrome that can be partially reproduced in animal models. However, the sensitivities and manifestations substantially differ in different species, and C activation may not be the only cause of pathophysiological changes. In order to map the species variation of C-dependent and -independent pseudoallergy (CARPA/CIPA), here we used known C activators and C activator liposomes to compare their acute hemodynamic, hematological, and biochemical effects in rats. These C activators were cobra venom factor (CVF), zymosan, AmBisome (at 2 doses), its amphotericin B-free vehicle (AmBisombo), and a PEGylated cholesterol-containing liposome (PEG-2000-chol), all having different powers to activate C in rat blood. The pathophysiological endpoints measured were blood pressure, leukocyte and platelet counts, and plasma thromboxane B2, while C activation was assessed by C3 consumption using the Pan-Specific C3 assay. The results showed strong linear correlation between C activation and systemic hypotension, pointing to a causal role of C activation in the hemodynamic changes. The observed thrombocytopenia and leukopenia followed by leukocytosis also correlated with C3 conversion in case of C activators, but not necessarily with C activation by liposomes. These findings are consistent with the double hit hypothesis of hypersensitivity reactions (HSRs), inasmuch as strong C activation can fully account for all symptoms of HSRs, but in case of no-, or weak C activators, the pathophysiological response, if any, is likely to involve other activation pathways.


Assuntos
Ativação do Complemento/efeitos dos fármacos , Síndrome de Hipersensibilidade a Medicamentos/tratamento farmacológico , Leucocitose/sangue , Lipossomos/farmacologia , Anfotericina B/química , Anfotericina B/farmacologia , Animais , Colesterol/química , Convertases de Complemento C3-C5/química , Convertases de Complemento C3-C5/farmacologia , Proteínas do Sistema Complemento/química , Proteínas do Sistema Complemento/metabolismo , Síndrome de Hipersensibilidade a Medicamentos/etiologia , Síndrome de Hipersensibilidade a Medicamentos/patologia , Venenos Elapídicos/química , Venenos Elapídicos/farmacologia , Humanos , Hipotensão/sangue , Hipotensão/induzido quimicamente , Leucocitose/induzido quimicamente , Leucopenia/sangue , Leucopenia/induzido quimicamente , Lipossomos/química , Nanopartículas/química , Polietilenoglicóis/química , Ratos , Trombocitopenia/sangue , Trombocitopenia/induzido quimicamente , Zimosan/química , Zimosan/farmacologia
16.
BMJ Case Rep ; 12(9)2019 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-31527216

RESUMO

A middle-aged woman with history of antiphospholipid syndrome, admitted to our hospital for lethargy and persistent chest pain, developed during hospitalisation intracerebral transverse sinus and sigmoid vein thromboses, retinal thromboses, acute renal failure and cardiac involvement associated with thrombocytopaenia. Diagnosis of catastrophic antiphospholipid syndrome was made and treated with IV steroids, heparin infusion and double filtration plasmapheresis (DFPP) without fresh frozen plasma. Heparin-induced thrombocytopaenia was second diagnosed because of persistent severe thrombocytopaenia after 2 weeks of treatment associated with positive conversion of antibodies against platelet factor 4, and a positive functional assay. The clinical course was complicated by cerebellar haematomas that appeared a few days after the last session of DFPP. Heparin-induced thrombocytopaenia was managed by administration of argatroban, a direct thrombin inhibitor with an increase in platelet count. Neurologically, the patient recovered completely and was discharged on vitamin K antagonist treatment and regular dialysis.


Assuntos
Síndrome Antifosfolipídica/complicações , Síndrome Antifosfolipídica/terapia , Heparina/efeitos adversos , Trombocitopenia/induzido quimicamente , Trombocitopenia/terapia , Anticoagulantes/uso terapêutico , Doença Catastrófica , Dor no Peito , Terapia Combinada , Feminino , Glucocorticoides/uso terapêutico , Humanos , Pessoa de Meia-Idade , Plasmaferese
17.
Am J Case Rep ; 20: 1394-1397, 2019 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-31541071

RESUMO

BACKGROUND Rituximab is a chimeric monoclonal antibody to CD20 that is used to treat vasculitis, B-cell lymphoproliferative disorders, and B-cell non-Hodgkin lymphoma (NHL). A report is presented of a case of rituximab-induced acute thrombocytopenia (RIAT) in a woman with splenic marginal zone lymphoma (SMZL) and chronic hepatitis C virus (HCV) infection. CASE REPORT A 46-year-old woman with SMZL complicated by chronic HCV infection presented with worsening B symptoms of fever, night sweats, and loss of weight. The patient had a history of recreational drug use. Intravenous treatment with rituximab (dose, 375 mg/m²) commenced with close monitoring in hospital. On the following day, the complete blood count (CBC) showed that her platelet count had dropped from her admission level of 167,000/µl to 7,000/µl, with no change in hemoglobin or white blood cell (WBC) levels. A diagnosis of RIAT was made. The patient was managed conservatively and monitored for the development of potential clinical complications. CONCLUSIONS RIAT is a rare complication of treatment with rituximab and may be poorly recognized. Further studies are needed to determine the incidence and causes of thrombocytopenia in patients treated with rituximab and the possible association with chronic viral infections, including HCV.


Assuntos
Antineoplásicos Imunológicos/efeitos adversos , Rituximab/efeitos adversos , Trombocitopenia/induzido quimicamente , Feminino , Hepatite C Crônica/complicações , Humanos , Linfoma de Zona Marginal Tipo Células B/tratamento farmacológico , Pessoa de Meia-Idade , Neoplasias Esplênicas/tratamento farmacológico
18.
J Clin Pharm Ther ; 44(5): 809-812, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31486123

RESUMO

WHAT IS KNOWN AND OBJECTIVE: The off-label use of fondaparinux in patients with heparin-induced thrombocytopenia with thrombosis (HITT) has historically been controversial. We present a case of successful fondaparinux use to treat HITT confirmed by the serotonin-release assay in the setting of other significant clotting and bleeding risk factors. CASE SUMMARY: We report a 19-year-old male with a history of Factor V Leiden and recent neurosurgery treated with fondaparinux after developing HITT confirmed by the serotonin-release assay (SRA). The patient achieved full platelet recovery on fondaparinux and was successfully transitioned to warfarin therapy without further thrombotic nor bleeding complications. WHAT IS NEW AND CONCLUSION: This case demonstrates a clear example of success of fondaparinux use to treat SRA-confirmed HITT in the setting of complicating factors and adds to the existing literature supporting the use of fondaparinux for HIT.


Assuntos
Fator V/metabolismo , Inibidores do Fator Xa/uso terapêutico , Fondaparinux/uso terapêutico , Serotonina/metabolismo , Trombocitopenia/tratamento farmacológico , Trombose/tratamento farmacológico , Adulto , Anticoagulantes/uso terapêutico , Coagulação Sanguínea/efeitos dos fármacos , Hemorragia/tratamento farmacológico , Hemorragia/metabolismo , Heparina/efeitos adversos , Humanos , Masculino , Trombocitopenia/induzido quimicamente , Trombocitopenia/metabolismo , Trombose/metabolismo , Adulto Jovem
20.
Med Sante Trop ; 29(2): 175-177, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31379344

RESUMO

Pseudothrombocytopenia or artefactual thrombocytopenia is an abnormally low number of platelets due to their agglutination in a sample tube, with no ex vivo clinical translation. It occurs in ethylene diamine tetraacetic (EDTA) test tubes. Non-EDTA anticoagulants, such as citrate, fluoride oxalate, and heparin lithium, may be responsible for it, alone or in combination. It can occur in patients with autoimmune diseases, neoplasia, atherosclerosis, liver disease, or infections. We report the case of a 5-year-old child, who after falciparum malaria showed persistent thrombocytopenia. Further exploration has led to the conclusion of pseudothrombocytopenia due to three anticoagulants: EDTA, citrate, and fluoride oxalate.


Assuntos
Anticoagulantes/efeitos adversos , Malária Falciparum/complicações , Trombocitopenia/induzido quimicamente , Pré-Escolar , Feminino , Humanos
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