Abnormalities Of Coagulation Tests Research Articles

Blood coagulation test abnormalities in trauma patients detected by sonorheometry: a retrospective cohort study

BackgroundTraumatic hemorrhage guidelines include point-of-care viscoelastic tests as a standard of care. Quantra (Hemosonics) is a device based on sonic estimation of elasticity via resonance (SEER) sonorheometry to assess whole blood clot formation. ObjectivesOur study aimed to assess the ability of an early SEER evaluation to detect blood coagulation test abnormalities in trauma patients. MethodsWe conducted an observational retrospective cohort study with data collected at hospital admission of consecutive multiple trauma patients from September 2020 to February 2022 at a regional level 1 trauma center. We performed a receiving operator characteristic curve analysis to determine the ability of the SEER device to detect blood coagulation test abnormalities. Four values on the SEER device were analyzed: clot formation time, clot stiffness (CS), platelet contribution to CS, and fibrinogen contribution to CS. ResultsA total of 156 trauma patients were analyzed. The clot formation time value predicted an activated partial thromboplastin time ratio of >1.5 with an area under the curve (AUC) of 0.93 (95% CI, 0.86-0.99). The AUC of the CS value in detecting an international normalized ratio of prothrombin time of >1.5 was 0.87 (95% CI, 0.79-0.95). The AUC of fibrinogen contribution to CS to detect a fibrinogen concentration of <1.5 g/L was 0.87 (95% CI, 0.80-0.94). The AUC of platelet contribution to CS to detect a platelet concentration of <50 G/L was 0.99 (95% CI, 0.99-1.00). ConclusionOur results suggest that the SEER device may be useful for the detection of blood coagulation test abnormalities at trauma admission.

Association of Abnormal Coagulation Tests in Dengue Fever with Clinical Outcomes of The Patients

Objective: To assess the coagulation test abnormalities (prothrombin time, activated partial thromboplastin time and fibrin degradation products) in dengue fever patients and its impact on clinical outcomes of the patient.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Hematology Department, Pakistan Naval Ship Shifa Hospital, Karachi Pakistan, from Aug 2016 to Feb 2017.&#x0D; Methodology: A total of 135, serologically proven positive dengue-infected IgM cases, based on enzyme-linked immunesorbent assay, were included in the study. Prothrombin time, activated partial thromboplastin time, and fibrin degradation products levels were measured on STA Compact Max® (STAGO) and SysmexCA-1500. Clinical Outcomes of the patient were noted.&#x0D; Results: At the time of admission, elevated prothrombin time was observed in 8(5.6%) cases and remained high at the time of discharge (p-value 0.008). Elevated activated partial thromboplastin time was observed in 57 (42.2%) cases at admission whereas, at discharge, it was observed in 56 (41.5%) cases. Increased level (&gt;5) of fibrin degradation products was seen in 30 (22.2%) cases while at the time of discharge increased level of fibrin degradation products was observed in 25 (18.5%) cases (pvalue 0.007). Out of 135 patients, mortality was observed in two cases and the remaining 133 (98.52%) survived and were discharged.&#x0D; Conclusion: In conclusion, prothrombin time, activated partial thromboplastin time, and fibrin degradation products can be labeled as early predictors of disease severity and their derangements are associated with clinical outcome in dengue infection.

Clinical features of five cases of acquired factor V deficiency

Acquired factor V deficiency is a rare disease that presents with various bleeding symptoms because of the acquired production of factor V inhibitors and decrease in factor V activity. We have experienced five cases of acquired factor V deficiency diagnosed on the basis of abnormalities in coagulation tests in the last 10 years. All five patients were older men, of whom one had no bleeding symptoms, and three had a history of renal failure and malignant tumors. In the cross-mixing test, two of three cases demonstrated an inhibitor pattern, but one case showed a deficient pattern. In all cases, steroid treatment improved factor V activity as well as prothrombin time and activated partial thromboplastin time. However, patients with intracranial hemorrhage had a poor prognosis. Although this disease is rare, careful management is necessary, especially in the absence of bleeding symptoms and where cross-mixing test does not show an inhibitor pattern.

DIC in Pregnancy - Pathophysiology, Clinical Characteristics, Diagnostic Scores, and Treatments.

Obstetrical hemorrhage and especially DIC (disseminated intravascular coagulation) is a leading cause for maternal mortality across the globe, often secondary to underlying maternal and/or fetal complications including placental abruption, amniotic fluid embolism, HELLP syndrome (hemolysis, elevated liver enzymes and low platelets), retained stillbirth and acute fatty liver of pregnancy. Various obstetrical disorders can present with DIC as a complication; thus, increased awareness is key to diagnosing the condition. DIC patients can present to clinicians who may not be experienced in a variety of aspects of thrombosis and hemostasis. Hence, DIC diagnosis is often only entertained when the patient already developed uncontrollable bleeding or multi-organ failure, all of which represent unsalvageable scenarios. Beyond the clinical presentations, the main issue with DIC diagnosis is in relation to coagulation test abnormalities. It is widely believed that in DIC, patients will have prolonged prothrombin time (PT) and partial thromboplastin time (PTT), thrombocytopenia, low fibrinogen, and raised D-dimers. Diagnosis of DIC can be elusive during pregnancy and requires vigilance and knowledge of the physiologic changes during pregnancy. It can be facilitated by using a pregnancy specific DIC score including three components: 1) fibrinogen concentrations; 2) the PT difference – relating to the difference in PT result between the patient’s plasma and the laboratory control; and 3) platelet count. At a cutoff of ≥26 points, the pregnancy specific DIC score has 88% sensitivity, 96% specificity, a positive likelihood ratio (LR) of 22, and a negative LR of 0.125. Management of DIC during pregnancy requires a prompt attention to the underlying condition leading to this complication, including the delivery of the patient, and correction of the hemostatic problem that can be guided by point of care testing adjusted for pregnancy.

Timeliness of postnatal surgery in newborns with open neural tube defects: a single center experience.

This study aims to evaluate the experience of a tertiary health center on the timeliness of postnatal management in newborns with open neural tube defects (NTDs). This is a retrospective review of 38 neonates with NTDs who were treated surgically at a tertiary health care center between January 2009 and January 2019. Five neonates with genetic syndromes were excluded. Twenty-six neonates with NTD underwent surgery on the first postnatal day while 12 neonates with NTD had surgery after the first postnatal day. The reasons for the latency in operative treatment were the delay in the referral of the affected newborn from other health care centers (n=8) and the transient abnormalities in coagulation tests (n=4). Rural residence was significantly more frequent, gestational age at delivery was significantly lower, preterm delivery was significantly more frequent and prenatal diagnosis was significantly less frequent in neonates that underwent surgery for NTD repair after the first postnatal day (p=0.001, p=0.048, p=0.024 and p=0.003 respectively). Postoperative motor dysfunction was significantly more severe (p=0.002), postoperative complications were significantly more frequent (p=0.008), the reoperation and postoperative mortality rates were significantly higher (p=0.009 and p=0.048 respectively) and the duration of hospital stay was significantly longer (p=0.033) for the neonates who underwent surgery after the first postnatal day. Our study appears to favor the early repair of NTD`s within the first 24 hours of life. Such an approach may reduce the risk of infectious and neurological complications significantly.

Comparative study of coagulation profile in liver disease in tertiary care hospital

Introduction: The liver is the corner stone of the coagulation system and patients with liver disease are at a substantially increase risk of both thrombosis and haemorrhage. Liver acts as a reticulo endothelial system and regulates coagulation and fibrinolysis by removing these coagulation factors from the circulation. Coagulation disorders in liver disease are usually measured by the prolongation of global screening tests such as the prothrombin time and the activated partial thromboplastin time. Ingeneral, PT determines vitamin K dependent extrinsic factors VII, X, II, V and fibrinogen. The aPTT measures the activities of intrinsic and common pathways of coagulation cascade most sensitive to factor VIII, IX, XI, XII and those of the contact system. Aims and Objectives: To study the alteration in coagulation profile in various liver diseases, to evaluate the risk of bleeding in patients with liver disease and to study the association of coagulation abnormality with the extent of liver disease. Material and Methods: The study included 100 patients with liver diseases attending Medicine and Paediatric department clinics in a teaching tertiary care hospital. These patients were divided into three groups: (1) 40 cases of cirrhosis, (2) 40 cases of viral hepatitis and (3) 20 cases of obstructive jaundice. All these patients were screened for different coagulation tests like Prothrombin time (PT), Activated Partial Thromboplastin Time (APTT), Fibrinogen and Platelet count. Conclusion: Various abnormalities of coagulation tests vary greatly with different liver disorders, duration of the disorders, and their severity. There are more chances of bleeding when coagulation parameters are altered in cases of cirrhosis but more studies are required in this field to evaluate the thrombotic events seen in patients with liver diseases. Keywords: Bleeding time, Coagulation, Cirrhosis, Hepatitis, Obstructive jaundice.

Hemostatic biomarkers in occult cancer and cancer risk prediction

Cancer patients present with abnormalities of coagulation tests, reflecting a hypercoagulable state, often asso- ciated with a high incidence of thrombotic complications and poor disease prognosis. Different degrees of blood clotting abnormalities are described in diverse cancers, depending on tumor types and stage. The mechanisms of hemostasis that are critically involved in thrombosis are also implicated in tumor progression, angiogenesis, and metastatic spread. In this review, we summarize the results of published studies and focus on ongoing research and future directions of clotting factors and clotting activation bioproducts as biomarkers for cancer disease diagnosis and in cancer risk prediction.

Prophylactic plasma transfusion for patients without inherited bleeding disorders or anticoagulant use undergoing non-cardiac surgery or invasive procedures.

Prophylactic plasma transfusion for patients without inherited bleeding disorders or anticoagulant use undergoing non-cardiac surgery or invasive procedures.

Coagulation Profile in Liver Diseases: A Study of 300 Cases in a Tertiary Care Hospital in Uttarakhand, India

ABSTRACT Background The liver is the cornerstone of the coagulation system. The physiology of blood coagulation is closely linked to liver function as the liver synthesizes most of the factors of the coagulation cascade and fibrinolytic proteins. Objective The objective of this study was to evaluate coagulation abnormalities associated with chronic liver diseases and determine the coagulation abnormalities using various coagulation studies [prothrombin time (PT), activated partial thromboplastin time (APTT), bleeding time (BT), clotting time (CT), and platelet count]. Materials and methods This study included 300 patients clinically diagnosed with liver disease and who were divided into three categories – cirrhosis, hepatitis, and other liver diseases. The coagulation tests PT, APTT, BT, CT, and platelet count were performed and the results were evaluated in groups. Results Out of the 300 patients, 156 were diagnosed with cirrhosis, 75 were of viral hepatitis, and 69 were of other liver diseases. About 62% (186/300) had prolonged PT. About 39.3% (118/300) had prolonged APTT. The BT was prolonged in 34% (102/300), while CT was prolonged in 10.6% (32/300). Thrombocytopenia was seen in 46% (138/300) patients. Conclusion We concluded that various abnormalities of coagulation tests vary greatly with different liver disorders, duration of the disorders, and their severity. Prolongation of PT and APTT in advancing liver cirrhosis indicates damage to the liver parenchyma resulting in decreased production of coagulation proteins with increased risk of bleeding tendencies, which can be detected before these ensue. How to cite this article Bhatia G, Kaushik S, Kumar R, Kishore S, Bhatia U. Coagulation Profile in Liver Diseases: A Study of 300 Cases in a Tertiary Care Hospital in Uttarakhand, India. Int J Adv Integ Med Sci 2017;2(2):61-64.

Gerinnungsstörungen auf der Intensivstation

Coagulation disorders are frequently encountered in the intensive care unit (ICU) and are challenging due to a variety of potential etiologies. Critically ill patients with coagulation abnormalities may present with an increased risk of bleeding, show coagulation activation resulting in thromboembolism, or have no specific symptoms. Hemostatic abnormalities observed in ICU patients range from isolated thrombocytopenia or prolonged global clotting tests to complex and life-threatening coagulation defects. Successful management of coagulation disorders requires prompt and accurate identification of the underlying cause. This review describes the most frequently occurring diagnoses found in intensive care patients with thrombocytopenia and coagulation test abnormalities and summarizes appropriate diagnostic interventions and current approaches to differential diagnosis.

High Prevalence of Prothrombotic Abnormalities in Multifocal Osteonecrosis

Multifocal or multiple osteonecrosis (ON), defined by the involvement of 3 or more anatomic sites, is unusual, being observed in only 3%–10% of patients diagnosed with ON. We report the clinical characteristics of a cohort of 29 patients with multifocal ON from a single center and evaluate the prevalence of associated prothrombotic abnormalities in 26 of these patients. We conducted a retrospective study of all patients diagnosed with multifocal ON evaluated in our institution during the last 20 years. We recorded clinical manifestations and underlying diagnoses. A wide thrombophilic profile was performed, including antithrombin, protein C, protein S, lupus anticoagulant, anticardiolipin antibodies, activated protein C resistance, factor V Leiden, mutation G-20210-A of the prothrombin gene, and factor VIII. Coagulation test results were compared with those in a healthy control group and a group of patients with history of lower-extremity deep venous thrombosis.The mean age of the patients was 49.2 ± 15 years (range, 28–81 yr). The mean number of ON localizations per patient was 5.2 ± 2.3 (range, 3–11). Hips were the most commonly affected joint (82%), followed by knees (58%), shoulders (37%), and ankles (13%). Most patients had an underlying disease process, and 12 of 25 (48%) patients had coagulation test abnormalities. The most common alterations were high factor VIII levels and antiphospholipid antibody (aPL) positivity in 24% and 20% of cases, respectively. These abnormalities were more prevalent in patients with multifocal ON compared with patients in the control groups.Sixty-one percent of patients had a history of corticosteroid treatment. Patients with coagulation abnormalities had a higher number of ON localizations per patient (6.5 ± 2.7 vs. 3.88 ± 0.8; p = 0.002) and a higher prevalence of atypical ON localizations (25% vs. 0%; p = 0.05).In conclusion, in the present cohort of patients with multifocal ON, 48% of the patients had at least 1 prothrombotic factor, especially high levels of factor VIII and aPL. These findings have major implications for the diagnosis and treatment of multifocal ON and clearly indicate the need to perform a thrombophilic profile in these patients.

Risk Factors for Bleeding and Clinical Implications in Patients Undergoing Liver Transplantation

IntroductionAdvanced liver disease is characterized by prolonged global coagulation tests such as prothrombin time (PT). Using Model of End-stage Liver Disease (MELD) score-based allocation, many current transplant recipients show advanced end-stage liver disease with an elevated international normalized ratio (INR). The relationship between abnormalities in coagulation tests and the risk of bleeding has been recently challenged among liver disease patients. In this study we reassessed risk factors for bleeding and the clinical implications for patients who underwent orthotopic liver transplantation (OLT). MethodsWe studied OLT patients between 2005 and 2011 excluding combined transplantations, retransplantations, or cases due to acute liver failure. We collected prospectively pre-OLT, during OLT, and post-OLT clinical and biochemical data to assess the risk for bleeding using linear regression models. ResultsThe strongest predictor of overall survival among 286 patients with a mean follow-up of 32 months was the number of blood transfusions (P = .005). The risk factor for bleeding during surgery investigated by multivariate analysis only showed the INR (P < .001) and the presence of ascites (P = .003) to independently correlate with the amount of blood transfusion. Receiver operation characteristics (ROC) analysis performed to determine the risk for massive blood transfusion (more than 6 units) revealed a cut-off value for INR ≥1.6. Appreciation of the operative field by the surgeon during the intervention as “wet” versus “dry”, amounts of blood transfusion and fresh frozen plasma, and stay in the intensive care unit (ICU) and in the hospital were all significantly different (P < .001) for patients with INR <1.6 versus INR ≥1.6. ConclusionsBleeding during OLT affects the outcome. The risk is independently influenced by the presence of ascites (probably reflecting the degree portal hypertension) and an INR ≥1.6. To improve survival after OLT therapeutic interventions should be further explored to reduce the need for blood transfusions.

Acute pulmonary embolus in the course of cancer

Risk of pulmonary embolism (PE) is relatively high in patients with advanced chronic diseases, particularly with malignancies. Most patients with cancer have blood coagulation test abnormalities indicative of up-regulation of the coagulation cascade, increased platelet activation and aggregation. Pulmonary thromboembolism is common in patients with any cancer and incidence is increased by surgery, chemotherapy, radiotherapy and disease progression. Manifestations range from small asymptomatic to life-threatening central PE with subsequent hypotension and cardiogenic shock. Diagnostic algorithms utilizing various noninvasive tests have been developed to determine the pretest probability of PE results of D-dimer assay, chest radiography ECG and computed tomography. The mortality in untreated PE is high (30%) but appropriate treatment may decrease it to 2–18%. The current recommended treatment for massive pulmonary embolus is either thrombolytic therapy or surgical embolectomy.

Frequency of Bleeding Disorders in Women Presenting Menorrhagia in the North of Iran

Abstract 4660 Objectives:Menorrhagia is a common presentation of bleeding disorders, especially VWD in women. We decided to determine the frequency of these disorders in women with menstruation problems. Materials and Methods:208 patients in reproductive age with menorrhagia were investigated for bleeding disorders in two steps. Step one includes CBC, PT, PTT and BT, which performed for all patients, and for patients who had an abnormality in step one, step two was considered. Step two includes VWAg, RCO, factors level, RIPA and platelet aggregometry. Results:Among 208 patients who investigated for bleeding disorders 53 patients (25%) had abnormalities in coagulation tests or platelet count. In our survey frequencies of bleeding disorder was VWD=14(6.73%), thrombocytopenia=13(6.25%), deficiency of factor II= 2(0.96%), factor V=1(0.48%), factor VII=3(1.44%), factor VIII=2(0.96%), Factor XI =4(1.92%), factor XII=4(1.92%), Bernard Soulier=2(0.96%). Furthermore, we found 18 patients (8.65%) who had abnormal PT, PTT or BT with no definite diagnosis. Conclusion:In this study, the most common bleeding disorder was VWD and thrombocytopenia ranked second disorders. Although other bleeding disorders are rare, in our study a number of them were found. So, we recomment the above coagulation test for women with menorrhagia. Disclosures:No relevant conflicts of interest to declare.

Hyperfibrinogenemia and prolonged clotting times in a Turner syndrome patient with hepatocellular carcinoma

Here, we diagnosed a Turner syndrome patient complicated with well differentiated hepatocellular carcinoma. The patient had an extremely high level of plasma fibrinogen. However, her clinical features and coagulation test abnormalities were quite different from those reported cases. We investigated the mechanisms underlying the hyperfibrinogenemia and its effects on coagulation tests. Plasma fibrinogen was analyzed by Clauss, immunoturbidimetry and Western methods. The fibrinogen genes were sequenced. Activated partial thromboplastin time, prothrombin time and thrombin time were measured. Fibrinogen expression in tumor tissues was examined immunohistochemically. Plasma cortisone, interleukin 6 and soluble tissue factor were measured by immunoassays. We found that abundant fibrinogen protein was detected in tumor cells. Plasma fibrinogen activity and antigen were 14.4 +/- 0.8 and 15.1 +/- 0.3 g/l, respectively. On SDS-PAGE, patient and control fibrinogen subunits migrated similarly. No mutations were found in the fibrinogen genes. Activated partial thromboplastin time, prothrombin time and thrombin time were significantly prolonged, but were normalized when fibrinogen was partially absorbed by an antifibrinogen antibody. Plasma interleukin 6, cortisone and soluble tissue factor levels were increased as compared with those of controls. After tumor resection, plasma fibrinogen level and other laboratory tests returned to normal. Our results showed that the hyperfibrinogenemia was caused by hepatocellular carcinoma. High levels of plasma cortisone and interleukin 6 may also contribute to the hyperfibrinogenemia. With the increase of levels of plasma fibrinogen, the values of activated partial thromboplastin time, prothrombin time and thrombin time were gradually prolonged, probably due to the effect of fibrin on thrombin (antithrombin I) and restricted fibrin polymerization by superfluous fibrinogen.

Evidence for indications of fresh frozen plasma

There continues to be a general but unfounded enthusiasm for fresh frozen plasma (FFP) usage across a range of clinical specialties in hospital practice. Clinical use of plasma has grown steadily over the last two decades in many countries. In England and Wales, there has not been a significant reduction in the use of FFP over the last few years, unlike red cells. There is also evidence of variation in usage among countries — use in England and Wales may be proportionately less per patient than current levels of usage in other European countries and the United States. Plasma for transfusion is most often used where there is abnormal coagulation screening tests, either therapeutically in the face of bleeding, or prophylactically in non-bleeding subjects prior to invasive procedures or surgery. Little evidence exists to inform best therapeutic plasma transfusion practice. Most studies have described plasma use in a prophylactic setting, in which laboratory abnormalities of coagulation tests are considered a predictive risk factor for bleeding prior to invasive procedures. The strongest randomised controlled trial (RCT) evidence indicates that prophylactic plasma for transfusion is not effective across a range of different clinical settings and this is supported by data from non-randomised studies in patients with mild to moderate abnormalities in coagulation tests. There are also uncertainties whether plasma consistently improves the laboratory results for patients with mild to moderate abnormalities in coagulation tests. There is a need to undertake new trials evaluating the efficacy and adverse effects of plasma, both in bleeding and non-bleeding patients, to understand whether the “presumed” benefits outweigh the “real risks”. In addition, new haemostatic tests should be validated which better define risk of bleeding.

The Evidence-Based Use of FFP and Cryoprecipitate for Abnormalities of Coagulation Tests and Clinical Coagulopathy

There continues to be a general but unfounded enthusiasm for fresh frozen plasma (FFP) or frozen plasma (FP) usage across a range of clinical specialties in hospital practice. Plasma for transfusion is most often used where there are abnormal coagulation screening tests, either therapeutically in the face of bleeding, or prophylactically in nonbleeding patients prior to invasive procedures or surgery. Little evidence exists to inform best therapeutic transfusion practice, and most studies describe plasma use in a prophylactic setting. Laboratory abnormalities of coagulation are considered by many clinicians to be a predictive risk factor for bleeding prior to invasive procedures or in other clinical situations where bleeding risk exists, and plasma for transfusion is presumed to improve the laboratory results and reduce this risk. However, most guideline indications for the prophylactic use of plasma for transfusion are not supported by evidence from good-quality randomized trials. Arguably, the strongest randomized controlled trial (RCT) evidence indicates that prophylactic plasma for transfusion is not effective across a range of different clinical settings, and this is supported by data from nonrandomized studies in patients with mild to moderate abnormalities in coagulation tests. There is a need to undertake new trials evaluating the efficacy and adverse effects of plasma, both in bleeding and non-bleeding patients, to understand whether the presumed benefits outweigh the real risks. In addition, new hemostatic tests that better define the risk of bleeding and monitor the effectiveness of the use of FFP should be validated. Last, there is an opportunity to develop effective educational strategies aimed at addressing understanding and compliance with recommendations in guidelines.

803 Study of Coagulation Factors in Patients with Mild Prolongation of Prothrombin Time: Implications for Neurosurgical Patients

INTRODUCTION: The published data do not provide evidence-based guidance for use of preprocedure plasma therapy in patients with mild to moderate abnormalities of coagulation tests. The international normalized ratio (INR) is calculated from prothrombin time (PT) and is used to monitor coumadin therapy. However, it is frequently used erroneously to assess bleeding risk in patients who are not on coumadin. The purpose of this study was to correlate the levels of relevant clotting factors in patients with mild abnormalities of PT (INR). METHODS: Thirty-six patients with a mild prolongation of PT at 12.5 to 15 seconds (normal = 9–12.5 s; INR = 1.3–1.5) and normal partial thromboplastin time (PTT) (normal = 23–35 s) were treated by the Neurosurgery Service at Parkland Memorial Hospital between September 2003 and January 2004. Plasma levels of Factors (F) II, VII, and VIII (normal hemostatic levels >50%) were measured when requests for fresh-frozen plasma were received. The PT (INR) and PTT were correlated with factor levels. RESULTS: The median PT was 13.6 seconds (mean, 13.8 s), median INR was 1.38 (mean, 1.3), and median PTT was 30.5 seconds (mean, 32.8 s; range, 19.3–37.9 s). The median FII level was 66% (mean, 68%; range, 34 to 107%) The median FVII level was 51% (mean, 53%; range, 28 to 124%). There was no correlation between PT or INR with FVII levels (P ≤0.5). All patients had FVII levels greater than the 15–25% typically recommended as safe for surgery. FII, the precursor of thrombin, was also hemostatically normal, whereas median FVIII levels were elevated at 126% (mean, 156%; range, 55–547%). FVIII is an acute-phase reactant and a strong procoagulant factor, which is associated with shortened PTT in many patients. CONCLUSION: In patients with a mild prolongation of PT (INR), plasma levels of Factor II and VII were hemostatically normal, whereas FVIII was increased. Aggressive correction of mild elevation of PT (INR up to 1.5) may be unnecessary in patients with no evidence of continued bleeding. This may lead to fewer transfusion-related morbidities and help to conserve valuable blood products.

Hemophagocytic Syndrome Associated with CD8 Positive T-cell Chronic Lymphocytic Leukemia

We describe a case of hemophagocytic syndrome (HPS) associated with CD8-positive T-cell chronic lymphocytic leukemia (CD8 + T-CLL). A 68-year-old man with CD8 + T-CLL presented with fever, progressive pancytopenia, and lymphadenopathy. Laboratory findings showed a hyper-ferritinemia, abnormalities of coagulation tests, and liver and renal dysfunction with hypoproteinemia. He did not respond to any treatments and died of respiratory failure 10 days after the admission and 14 months after the onset of CD8 + T-CLL. Pathological findings of the autopsy demonstrated infiltration of CD8 + T-CLL cells in multiple organs along with the increase of histiocytes with prominent hemophagocytosis. Serum concentration levels of IL-6, soluble IL-2 receptor and VEGF were all elevated at admission. These findings revealed that he had a secondary HPS. It was suggested that HPS should be considered in patients with an unexplained cytopenia and a fever during the clinical course of CD8 + T-CLL.

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