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https://www.readbyqxmd.com/read/27860293/thrombocytopenia-in-chronic-liver-disease
#1
Markus Peck-Radosavljevic
Thrombocytopenia is a common haematological disorder in patients with chronic liver disease (CLD). It is multifactorial and severity of liver disease is the most influential factor. Due to the increased risk of bleeding, thrombocytopenia may impact upon medical procedures, such as surgery or liver biopsy. The pathophysiology of thrombocytopenia in CLD has long been associated with the hypothesis of hypersplenism, where portal hypertension causes pooling and sequestration of all corpuscular elements of the blood, predominantly thrombocytes, in the enlarged and congested spleen...
November 17, 2016: Liver International: Official Journal of the International Association for the Study of the Liver
https://www.readbyqxmd.com/read/27848915/heparin-monitoring-clinical-outcome-and-practical-approach
#2
Noémie Despas, Anne-Sophie Larock, Hugues Jacqmin, Jonathan Douxfils, Bernard Chatelain, Marc Chatelain, François Mullier
Traditional anticoagulant agents such as unfractionated heparin (UFH), low molecular weight heparins (LMWHs), fondaparinux, danaparoid and bivalirudine are used in the prevention and treatment of thromboembolic diseases. However, these agents have limitations: their constraining parenteral route of administration and the need for regular coagulation monitoring for HNF. The LMWHs, with their more predictable anticoagulant response, don't require a systematic monitoring. The usefulness of LMWHs monitoring in several clinical situations such as pregnancy, obesity and renal insufficiency is a matter of debate...
December 1, 2016: Annales de Biologie Clinique
https://www.readbyqxmd.com/read/27823643/an-overview-of-hematopoietic-stem-cell-transplantation-related-thrombotic-complications
#3
REVIEW
Ugur Sahin, Pinar Ataca Atilla, Erden Atilla, Selami Kocak Toprak, Taner Demirer
Thrombotic episodes are far less common than bleeding complications after hematopoietic stem cell transplantation (HSCT). However, they lead to significant morbidity and mortality. These complications are classified into four groups, including venous thromboembolic events (VTE), catheter-induced thrombosis (CIT), transplant-associated thrombotic microangiopathy (TA-TMA) and sinusoidal obstruction syndrome (SOS) or veno-occlusive disease (VOD). The frequency of VTE is increased among patients undergoing HSCT due to some acquired conditions including underlying malignancy, infections, administration of myeloablative conditioning regimens and/or total body irradiation, prolonged hospitalizations leading to immobility and presence of central venous catheters...
November 2016: Critical Reviews in Oncology/hematology
https://www.readbyqxmd.com/read/27814839/adult-acute-lymphoblastic-leukemia
#4
REVIEW
Shilpa Paul, Hagop Kantarjian, Elias J Jabbour
Conventional cytotoxic chemotherapy used to treat acute lymphoblastic leukemia (ALL) results in high cure rates in pediatric patients but is suboptimal in the treatment of adult patients. The 5-year overall survival is approximately 90% in children and 30% to 40% in adults and elderly patients. Adults with ALL tend to have higher risk factors at diagnosis, more comorbidities, and increasing age that often requires dose reductions. Major advancements have been made in redefining the pathologic classification of ALL, identifying new cytogenetic-molecular abnormalities, and developing novel targeted agents in order to improve survival...
November 2016: Mayo Clinic Proceedings
https://www.readbyqxmd.com/read/27754896/thrombotic-microangiopathies-a-general-approach-to-diagnosis-and-management
#5
REVIEW
Donald M Arnold, Christopher J Patriquin, Ishac Nazy
No abstract text is available yet for this article.
October 17, 2016: CMAJ: Canadian Medical Association Journal, Journal de L'Association Medicale Canadienne
https://www.readbyqxmd.com/read/27824218/coagulopathy-in-sepsis-a-new-look-at-an-old-problem
#6
Małgorzata Lipinska-Gediga
Sepsis is a life-threatening condition characterized by a systemic response to microbial infection. Despite considerable progress in intensive care medicine, the incidence of sepsis and the number of sepsis-related deaths are increasing world-wide. There is a complex relationship between the coagulation, immune and inflammatory systems in sepsis. Activation of the coagulation cascade in sepsis is a result of a pathogen invasion and is a part of a immuno-inflammatory host response. In sepsis, the close cooperation of the immune and coagulation systems through cross signalling results in immunothrombosis...
November 8, 2016: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/27788992/catheter-related-infections-in-patients-with-haematological-malignancies-novel-preventive-and-therapeutic-strategies
#7
REVIEW
Ramia Zakhour, Anne-Marie Chaftari, Issam I Raad
Central venous catheters are essential for the treatment of patients with haematological malignancies and the recipients of stem-cell transplant. This patient population is, however, at high risk for catheter-related bloodstream infections that can result in substantial morbidity, mortality, and health-care-associated costs. Efficient prevention, early diagnosis, and effective treatment are essential to providing the best care to these patients. Although confirming the catheter as a source of infection remains challenging, the Infectious Diseases Society of America definition of catheter-related bloodstream infection remains the most precise definition to use in these patients...
November 2016: Lancet Infectious Diseases
https://www.readbyqxmd.com/read/27755116/blood-products-and-procoagulants-in-traumatic-bleeding-use-and-evidence
#8
Henna Wong, Nicola Curry, Simon J Stanworth
PURPOSE OF REVIEW: Death from uncontrolled haemorrhage is one of the leading causes of trauma-related mortality and is potentially preventable. Advances in understanding the mechanisms of trauma-induced coagulopathy (TIC) have focused attention on the role of blood products and procoagulants in mitigating the sequelae of TIC and how these therapies can be improved. RECENT FINDINGS: A host of preclinical and clinical studies have evaluated blood product availability and efficacy in trauma...
December 2016: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/27732721/clinical-practice-guidelines-from-the-aabb-red-blood-cell-transfusion-thresholds-and-storage
#9
Jeffrey L Carson, Gordon Guyatt, Nancy M Heddle, Brenda J Grossman, Claudia S Cohn, Mark K Fung, Terry Gernsheimer, John B Holcomb, Lewis J Kaplan, Louis M Katz, Nikki Peterson, Glenn Ramsey, Sunil V Rao, John D Roback, Aryeh Shander, Aaron A R Tobian
Importance: More than 100 million units of blood are collected worldwide each year, yet the indication for red blood cell (RBC) transfusion and the optimal length of RBC storage prior to transfusion are uncertain. Objective: To provide recommendations for the target hemoglobin level for RBC transfusion among hospitalized adult patients who are hemodynamically stable and the length of time RBCs should be stored prior to transfusion. Evidence Review: Reference librarians conducted a literature search for randomized clinical trials (RCTs) evaluating hemoglobin thresholds for RBC transfusion (1950-May 2016) and RBC storage duration (1948-May 2016) without language restrictions...
November 15, 2016: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/27686346/intravenous-iron-or-placebo-for-anaemia-in-intensive-care-the-ironman-multicentre-randomized-blinded-trial-a-randomized-trial-of-iv-iron-in-critical-illness
#10
Edward Litton, Stuart Baker, Wendy N Erber, Shannon Farmer, Janet Ferrier, Craig French, Joel Gummer, David Hawkins, Alisa Higgins, Axel Hofmann, Bart De Keulenaer, Julie McMorrow, John K Olynyk, Toby Richards, Simon Towler, Robert Trengove, Steve Webb
PURPOSE: Both anaemia and allogenic red blood cell transfusion are common and potentially harmful in patients admitted to the intensive care unit. Whilst intravenous iron may decrease anaemia and RBC transfusion requirement, the safety and efficacy of administering iron intravenously to critically ill patients is uncertain. METHODS: The multicentre, randomized, placebo-controlled, blinded Intravenous Iron or Placebo for Anaemia in Intensive Care (IRONMAN) study was designed to test the hypothesis that, in anaemic critically ill patients admitted to the intensive care unit, early administration of intravenous iron, compared with placebo, reduces allogeneic red blood cell transfusion during hospital stay and increases the haemoglobin level at the time of hospital discharge...
September 30, 2016: Intensive Care Medicine
https://www.readbyqxmd.com/read/27553919/emergency-medicine-management-of-sickle-cell-disease-complications-an-evidence-based-update
#11
Erica Simon, Brit Long, Alex Koyfman
BACKGROUND: Sickle cell disease (SCD) affects approximately 100,000 individuals in the United States. Due to alterations in the structural conformation of hemoglobin molecules under deoxygenated conditions, patients with SCD are predisposed to numerous sequelae, many of which require acute intervention. OBJECTIVE: Our aim was to provide emergency physicians with an evidence-based update regarding the diagnosis and management of SCD complications. DISCUSSION: SCD patients experience significant morbidity and mortality secondary to cerebrovascular accident, acute chest syndrome, acute vaso-occlusive pain crises, SCD-related multi-organ failure, cholecystitis, acute intrahepatic cholestasis, acute sickle hepatic crisis, acute hepatic sequestration, priapism, and renal disease...
October 2016: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27566811/management-of-bleeding-in-vascular-surgery
#12
REVIEW
Y E Chee, S E Liu, M G Irwin
Management of acute coagulopathy and blood loss during major vascular procedures poses a significant haemostatic challenge to anaesthetists. The acute coagulopathy is multifactorial in origin with tissue injury and hypotension as the precipitating factors, followed by dilution, hypothermia, acidemia, hyperfibrinolysis and systemic inflammatory response, all acting as a self-perpetuating spiral of events. The problem is confounded by the high prevalence of antithrombotic agent use in these patients and intraoperative heparin administration...
September 2016: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/27543264/management-of-bleeding-in-patients-treated-with-direct-oral-anticoagulants
#13
REVIEW
Marcel Levi
BACKGROUND: Recently, a new generation of direct-acting oral anticoagulants (DOACs) with a greater specificity towards activated coagulation factors was introduced based on encouraging results for efficacy and safety in clinical studies. An initial limitation of these new drugs was the absence of an adequate strategy to reverse the effect if a bleeding event occurs or an urgent invasive procedure has to be carried out. MAIN TEXT: Specific reversing agents for DOACs have become available, however, and are now evaluated in clinical studies...
August 20, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27481757/investigation-of-hemophagocytic-lymphohistiocytosis-in-severe-sepsis-patients
#14
Burcin Halacli, Nese Unver, Sevil Oskay Halacli, Hande Canpinar, Ebru Ortac Ersoy, Serpil Ocal, Dicle Guc, Yahya Buyukasik, Arzu Topeli
PURPOSE: Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening condition characterized by uncontrolled inflammation and has common clinical and laboratory features with sepsis. The aim of this study was to investigate patients treated with severe sepsis who had bicytopenia for the presence of HLH. MATERIALS AND METHODS: Patients with severe sepsis who were non-responsive to treatment and developed at least bicytopenia were included. Peripheral blood samples were collected and stored for later evaluation for natural killer (NK) activity and soluble interleukin-2 receptor levels...
October 2016: Journal of Critical Care
https://www.readbyqxmd.com/read/27230048/heparin-induced-thrombocytopenia-a-comprehensive-clinical-review
#15
REVIEW
Benjamin S Salter, Menachem M Weiner, Muoi A Trinh, Joshua Heller, Adam S Evans, David H Adams, Gregory W Fischer
Heparin-induced thrombocytopenia is a profoundly dangerous, potentially lethal, immunologically mediated adverse drug reaction to unfractionated heparin or, less commonly, to low-molecular weight heparin. In this comprehensive review, the authors highlight heparin-induced thrombocytopenia's risk factors, clinical presentation, pathophysiology, diagnostic principles, and treatment. The authors place special emphasis on the management of patients requiring procedures using cardiopulmonary bypass or interventions in the catheterization laboratory...
May 31, 2016: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/27380536/plasma-transfusion-history-current-realities-and-novel-improvements
#16
Justin J J Watson, Shibani Pati, Martin A Schreiber
Traumatic hemorrhage is the leading cause of preventable death after trauma. Early transfusion of plasma and balanced transfusion have been shown to optimize survival, mitigate the acute coagulopathy of trauma, and restore the endothelial glycocalyx. There are a myriad of plasma formulations available worldwide, including fresh frozen plasma, thawed plasma, liquid plasma, plasma frozen within 24 h, and lyophilized plasma (LP). Significant equipoise exists in the literature regarding the optimal plasma formulation...
November 2016: Shock
https://www.readbyqxmd.com/read/27272964/activated-partial-thromboplastin-time-monitoring-of-unfractionated-heparin-therapy-issues-and-recommendations
#17
Richard A Marlar, Bernadette Clement, Jana Gausman
When administering unfractionated heparin (UFH), therapeutic levels of anticoagulation must be achieved rapidly and maintained consistently in the therapeutic range. The basic assays for monitoring UFH therapy are the activated partial thromboplastin time (APTT) and/or the chromogenic antifactor Xa or antithrombin assays. For many laboratories, the APTT is the preferred standard of practice; however, the APTT is a surrogate marker that only estimates the heparin concentration. Many factors, including patient variation, reagents of the APTT, UFH composition, and concentration can influence the APTT result...
June 6, 2016: Seminars in Thrombosis and Hemostasis
https://www.readbyqxmd.com/read/27253088/severe-thrombotic-complications-in-congenital-afibrinogenemia-a-pathophysiological-and-management-dilemma
#18
Cristina Santoro, Fulvio Massaro, Salvatore Venosi, Saveria Capria, Erminia Baldacci, Roberto Foà, Maria Gabriella Mazzucconi
Congenital afibrinogenemia (CA) is a disease characterized by a complex pathophysiology, involving both the procoagulant and fibrinolytic systems, as well as platelet activity. Although hemorrhagic diathesis represents the most frequent clinical presentation of this disorder, severe thrombotic events can occur. It is not yet clear if these events are strictly related to the disease itself or to the fibrinogen replacement therapy. Different hypotheses on the pathophysiological mechanisms have been proposed. It is well known that fibrinogen/fibrin has a role in the downregulation of thrombin generation in plasma...
July 2016: Seminars in Thrombosis and Hemostasis
https://www.readbyqxmd.com/read/27124745/coagulation-parameters-and-major-bleeding-in-critically-ill-patients-with-cirrhosis
#19
Andreas Drolz, Thomas Horvatits, Kevin Roedl, Karoline Rutter, Katharina Staufer, Nikolaus Kneidinger, Ulrike Holzinger, Christian Zauner, Peter Schellongowski, Gottfried Heinz, Thomas Perkmann, Stefan Kluge, Michael Trauner, Valentin Fuhrmann
UNLABELLED: Disturbances of coagulation and hemostasis are common in patients with liver cirrhosis. The typical laboratory pattern mimics disseminated intravascular coagulation (DIC). The aim of this study was to assess the impact of routine coagulation parameters in critically ill cirrhosis patients with regard to new onset of major bleeding and outcome. A total of 1,493 critically ill patients were studied prospectively. Routine coagulation parameters were assessed, and the DIC score was calculated based on platelets, fibrinogen, d-dimer, and prothrombin index...
August 2016: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
https://www.readbyqxmd.com/read/27125504/efficacy-of-prothrombin-complex-concentrates-for-the-emergency-reversal-of-dabigatran-induced-anticoagulation
#20
REVIEW
Oliver Grottke, James Aisenberg, Richard Bernstein, Patrick Goldstein, Menno V Huisman, Dara G Jamieson, Jerrold H Levy, Charles V Pollack, Alex C Spyropoulos, Thorsten Steiner, Gregory J Del Zoppo, John Eikelboom
Dabigatran is effective in decreasing the risk of ischaemic stroke in patients with atrial fibrillation. However, like all anticoagulants, it is associated with a risk of bleeding. In cases of trauma or emergency surgery, emergency reversal of dabigatran-induced anticoagulation may be required. A specific reversal agent for dabigatran, idarucizumab, has been approved by the US Food and Drug Administration. Alternative reversal agents are available, such as prothrombin complex concentrates (PCCs) and activated PCCs (aPCCs)...
2016: Critical Care: the Official Journal of the Critical Care Forum
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