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By Ronald Lands Benign hematologist
C M Hull, C L Hopkins, N J Purdy, R C Lloyd, J A Harris
Marathon runners are exposed to multiple thrombogenic risk factors including dehydration and hemoconcentration, injury and inflammation, long-distance travel between events, and contraceptive usage. However, despite awareness about thromboembolism and several case reports detailing life-threatening hypercoagulopathies in athletes, the prevalence of venous thromboembolism in marathon runners remains uncharted. There is a lack of data and evidence-based guidelines for these athletes and for healthcare providers, including general medical practitioners and sports physicians...
October 2015: Scandinavian Journal of Medicine & Science in Sports
M Sanz de la Garza, A Lopez, M Sitges
Intense endurance exercise could be associated with multiple thrombogenic risk factors, including dehydration, hemoconcentration, inflammation, and injuries. Despite an increasing number of reported cases of deep venous thrombosis (DVT) in athletes that is raising awareness in the medical community, the prevalence is not well established and evidenced-based guidelines for management of this clinical scenario are lacking. We present an episode of unprovoked DVT and multiple pulmonary embolisms with severe right ventricular dysfunction in a male runner...
May 2017: Scandinavian Journal of Medicine & Science in Sports
Christopher Meyering, Thomas Howard
Risk factors for thromboembolism are well known, and athletes are placed under conditions that can result in exposure to several of these risk factors, which include travel, trauma, immobilization, hemoconcentration, and polycythemia. Presence of a genetic hypercoagulable disorder adds additional risk. Overall management is no different than in nonathletes. Thrombolysis is strongly recommended for upper extremity deep venous thrombosis (DVT) coupled with surgical decompression of obstructive structures if indicated...
April 2004: Current Sports Medicine Reports
Gregory Grabowski, William K Whiteside, Michael Kanwisher
Because deep vein thrombosis (DVT) can occur following orthopaedic procedures, knowledge of hereditary and acquired risk factors for DVT is essential. Hereditary forms of thrombophilia include factor V Leiden and prothrombin G20210A mutations, and deficiencies of antithrombin III, protein C, and protein S. Acquired risk factors include but are not limited to trauma, immobilization, and surgical procedures. In general, athletes have a low risk of venous thrombosis; however, this population is exposed to many acquired thrombogenic risk factors, including hemoconcentration, trauma, immobilization, long-distance travel, and the use of oral contraceptives...
February 2013: Journal of the American Academy of Orthopaedic Surgeons
Ralph Green
B12 deficiency is the leading cause of megaloblastic anemia and though more common in the elderly, can occur at any age. Clinical disease caused by B12 deficiency usually connotes severe deficiency, resulting from a failure of the gastric or ileal phase of physiological B12 absorption, best exemplified by the autoimmune disease pernicious anemia. There are many other causes of B12 deficiency which range from severe to mild. Mild deficiency usually results from failure to render food B12 bioavailable or from dietary inadequacy...
March 30, 2017: Blood
Saskia Middeldorp
Thrombophilia is found in many patients presenting with venous thromboembolism (VTE). However, whether the results of such tests help in the clinical management of such patients has not been determined. Thrombophilia testing in asymptomatic relatives may be useful in families with antithrombin, protein C, or protein S deficiency or homozygosity for factor V Leiden, but is limited to women who intend to become pregnant or who would like to use oral contraceptives. Careful counseling with knowledge of absolute risks helps patients in making an informed decision in which their own preferences can be taken into account...
2011: Hematology—the Education Program of the American Society of Hematology
R E J Roach, W M Lijfering, F M Helmerhorst, S C Cannegieter, F R Rosendaal, A van Hylckama Vlieg
BACKGROUND: Oral contraception (OC) and postmenopausal hormone therapy (HT) can be used to alleviate menopausal symptoms. However, the risk of venous thrombosis (VT) associated with OC use in women over 50 years old has never been assessed and the two preparations have not been directly compared. OBJECTIVES: To determine and compare the risk of VT associated with OC and HT use. METHODS: From a large case-control study, 2550 women aged over 50 years old, 1082 patients with a first VT and 1468 controls, were included...
January 2013: Journal of Thrombosis and Haemostasis: JTH
E F W van Vlijmen, S Wiewel-Verschueren, T B M Monster, K Meijer
UNLABELLED: Essentials We performed a meta-analysis on thrombosis risk in thrombophilic oral contraceptive (COC)-users. The results support discouraging COC-use in women with a natural anticoagulant deficiency. Contrary, additive risk of factor V Leiden (FVL) or prothrombin-G20210A (PT) mutation is modest. Women with a FVL/PT-mutation as single risk factor can use COCs if alternatives are not tolerated. SUMMARY: Background Combined oral contraceptives (COCs) are associated with an increased risk of venous thromboembolism (VTE), which is shown to be more pronounced in women with hereditary thrombophilia...
July 2016: Journal of Thrombosis and Haemostasis: JTH
Anne Zufferey, Rick Kapur, John W Semple
Immune thrombocytopenia (ITP) is a complex autoimmune disease characterized by low  platelet counts. The pathogenesis of ITP remains unclear although both antibody-mediated and/or  T cell-mediated platelet destruction are key processes. In addition, impairment of T cells, cytokine  imbalances, and the contribution of the bone marrow niche have now been recognized to be  important. Treatment strategies are aimed at the restoration of platelet counts compatible with  adequate hemostasis rather than achieving physiological platelet counts...
February 9, 2017: Journal of Clinical Medicine
Deepa R J Arachchillage, Mike Laffan
Antiphospholipid antibodies are a heterogeneous group of autoantibodies that have clear associations with thrombosis and pregnancy morbidity, and which together constitute the 'antiphospholipid syndrome' (APS). However, the pathophysiology of these complications is not well understood and their heterogeneity suggests that more than one pathogenic process may be involved. Diagnosis remains a combination of laboratory analysis and clinical observation but there have been significant advances in identifying specific pathogenic features, such as domain I-specific anti-β2-glycoprotein-I antibodies...
March 24, 2017: British Journal of Haematology
Ronald S Go, Jeffrey L Winters, Neil E Kay
Autoimmune hemolytic anemia (AIHA) is an uncommon entity that presents diagnostic, prognostic and therapeutic dilemmas despite being a well-recognized entity for over 150 years. Because of significant differences in the rates of hemolysis as well as associated diseases and cause there is considerable clinical heterogeneity. In addition there is a lack of clinical trials required to refine and update standardized and evidence-based therapeutic approaches. To aid the clinician in AIHA management we present four vignettes that represent and highlight distinct clinical presentations with separate diagnostic and therapeutic pathways that we utilize in our clinical practice setting...
March 30, 2017: Blood
Nichola Cooper
The management of patients with immune thrombocytopenia (ITP) is rapidly evolving. Over the last 15 years, a number of novel treatments have improved practice, with many steroid-sparing agents and a reduction in the progression to splenectomy. Although this has improved clinical care, many therapeutic challenges remain. There is no diagnostic test, no biomarkers to direct treatment and few comparative studies to help management decisions. Development of up to date guidelines is difficult with little high-grade evidence...
April 2017: British Journal of Haematology
Shahzad Raza, Rachael A Safyan, Evan Rosenbaum, Alex S Bowman, Suzanne Lentzsch
Multiple myeloma (MM) is the second most common hematologic malignancy. The diagnosis of MM requires ⩾10% clonal plasma cells in the bone marrow or biopsy-proven plasmacytoma, plus evidence of end-organ damage (hypercalcemia, renal failure, anemia, and lytic bone lesions). The definition of MM has recently been expanded to include a ⩾60% clonal plasma cell burden in the bone marrow, serum involved/uninvolved light chain ratio of ⩾100, or more than one focal lesion on magnetic resonance imaging ⩾5 mm in the absence of end-organ damage...
February 2017: Therapeutic Advances in Hematology
Clara Camaschella
Recent advances in iron metabolism have stimulated new interest in iron deficiency (ID) and its anemia (IDA), common conditions worldwide. Absolute ID/IDA, i.e. the decrease of total body iron, is easily diagnosed based on decreased levels of serum ferritin and transferrin saturation. Relative lack of iron in specific organs/tissues, and IDA in the context of inflammatory disorders, are diagnosed based on arbitrary cut offs of ferritin and transferrin saturation and/or marker combination (as the soluble transferrin receptor/ferritin index) in an appropriate clinical context...
February 13, 2017: Blood Reviews
Cindy N Roy, Peter J Snyder, Alisa J Stephens-Shields, Andrew S Artz, Shalender Bhasin, Harvey J Cohen, John T Farrar, Thomas M Gill, Bret Zeldow, David Cella, Elizabeth Barrett-Connor, Jane A Cauley, Jill P Crandall, Glenn R Cunningham, Kristine E Ensrud, Cora E Lewis, Alvin M Matsumoto, Mark E Molitch, Marco Pahor, Ronald S Swerdloff, Denise Cifelli, Xiaoling Hou, Susan M Resnick, Jeremy D Walston, Stephen Anton, Shehzad Basaria, Susan J Diem, Christina Wang, Stanley L Schrier, Susan S Ellenberg
Importance: In one-third of older men with anemia, no recognized cause can be found. Objective: To determine if testosterone treatment of men 65 years or older with unequivocally low testosterone levels and unexplained anemia would increase their hemoglobin concentration. Design, Setting, and Participants: A double-blinded, placebo-controlled trial with treatment allocation by minimization using 788 men 65 years or older who have average testosterone levels of less than 275 ng/dL...
April 1, 2017: JAMA Internal Medicine
Shehzad Basaria, S Mitchell Harman, Thomas G Travison, Howard Hodis, Panayiotis Tsitouras, Matthew Budoff, Karol M Pencina, Joseph Vita, Connie Dzekov, Norman A Mazer, Andrea D Coviello, Philip E Knapp, Kathleen Hally, Emma Pinjic, Mingzhu Yan, Thomas W Storer, Shalender Bhasin
IMPORTANCE: Testosterone use in older men is increasing, but its long-term effects on progression of atherosclerosis are unknown. OBJECTIVE: To determine the effect of testosterone administration on subclinical atherosclerosis progression in older men with low or low-normal testosterone levels. DESIGN, SETTING, AND PARTICIPANTS: Testosterone's Effects on Atherosclerosis Progression in Aging Men (TEAAM) was a placebo-controlled, double-blind, parallel-group randomized trial involving 308 men 60 years or older with low or low-normal testosterone levels (100-400 ng/dL; free testosterone <50 pg/mL), recruited at 3 US centers...
August 11, 2015: JAMA: the Journal of the American Medical Association
Lukas F Ocias, Thomas S Larsen, Hanne Vestergaard, Lone S Friis, Niels Abildgaard, Henrik Frederiksen
BACKGROUND: The number of hematological malignancies is expected to increase as the Danish population ages within the next few decades. Despite this, data on the course of hematological cancers among the oldest patients are sparse with many intervention studies focusing on younger age groups. The aim of this study is to present Danish incidence and mortality rates among older patients with non-Hodgkin lymphomas (NHL), multiple myeloma (MM), chronic lymphocytic leukemia (CLL), and acute myeloid leukemia (AML)...
2016: Acta Oncologica
Divi Cornec, Valérie Devauchelle-Pensec, Sandrine Jousse-Joulin, Thierry Marhadour, Valérie Ugo, Christian Berthou, Nathalie Douet-Guilbert, Alain Saraux
T-cell large granular lymphocyte leukemia (LGLL) is a rare clonal disease often associated with rheumatoid arthritis (RA) and manifests chiefly as neutropenia and recurrent infections. Immunosuppressive agents are the mainstay of treatment, but long-term remissions are rare. We report 2 cases of LGLL in patients with RA successfully treated with rituximab, a monoclonal antibody specific of B cells and approved for treating RA. The first patient experienced a complete LGLL remission that was sustained during the 8-year follow-up after the first rituximab infusion...
August 29, 2013: Blood
Benoît Bareau, Jérôme Rey, Mohamed Hamidou, Jean Donadieu, Jeff Morcet, Oumedaly Reman, Nicolas Schleinitz, Olivier Tournilhac, Mikael Roussel, Thierry Fest, Thierry Lamy
BACKGROUND: Large granular lymphocyte leukemia is a rare lymphoproliferative disorder associated with autoimmune diseases and impaired hematopoiesis. This study describes the clinical and biological characteristics of 229 patients with T-cell or NK-cell large granular lymphocyte leukemia. DESIGN AND METHODS: The diagnosis was based on a large granular lymphocyte expansion (> 0.5x10(9)/L) lasting more than 6 months. Monoclonal T-cell receptor gamma gene rearrangement was detected in all the cases of T-cell large granular lymphocyte leukemia...
September 2010: Haematologica
Hanna L M Rajala, Thomas Olson, Michael J Clemente, Sonja Lagström, Pekka Ellonen, Tuija Lundan, David E Hamm, Syed Arshi Uz Zaman, Jesus M Lopez Marti, Emma I Andersson, Andres Jerez, Kimmo Porkka, Jaroslaw P Maciejewski, Thomas P Loughran, Satu Mustjoki
T-cell large granular lymphocytic leukemia and chronic lymphoproliferative disorder of natural killer cells are intriguing entities between benign and malignant lymphoproliferation. The molecular pathogenesis has partly been uncovered by the recent discovery of somatic activating STAT3 and STAT5b mutations. Here we show that 43% (75/174) of patients with T-cell large granular lymphocytic leukemia and 18% (7/39) with chronic lymphoproliferative disorder of natural killer cells harbor STAT3 mutations when analyzed by quantitative deep amplicon sequencing...
January 2015: Haematologica
2017-02-09 10:58:02
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