Abnormalities In Prothrombin Time Research Articles

EFFECTS OF HYPERBARIC OXYGEN THERAPY IN PATIENT WITH ACUTE UPPER LIMB FINGER GANGRENE WITH COVID-19

The COVID-19 pandemic (Corona Virus Diseas) was caused by a new beta coronavirus in early 2020, also called Severe Acute Respiratory Syndrome (SARS-CoV-2). Predilection sites of virus entry are the lungs, intestines, blood vessels, kidney, and adipose tissue cells are the virus reservoir. The virus causes a violent reaction of inammatory cytokines - cytokine storm, activation of coagulation and formation of thrombin. The initial coagulopathy of COVID-19 is manifested by a pronounced disorder of D-dimer and brin/brinogen degradation products, while abnormalities in prothrombin time, partial thromboplastin time and platelet count are relatively rare at the onset of the disease. Later, the phenomenon of thrombotic microangiopathy occurs, which is a consequence of inammation of the blood vessels endothelium. In severe cases of infection, thromboembolism or acute thrombosis of peripheral blood vessels may occur. The paper presents a case of a patient with COVID-19 infection in whom, in addition to the usual clinical picture of the disease with changes in lung parenchyma (bilateral pneumonia), thrombosis of the a. radialis and a. ulnaris of the left hand developed, and fteen days after the infection development, the development of gangrene of the distal articles II, III and IV of the nger occurs. In addition to therapy used according to the national guide to COVID-19, hyperbaric oxygen therapy (HBOT) was used. The effect of this therapy was used to increase vascular permeability and create factors that affect angiogenesis and improve blood ow in the ischemic region. HBOT also affected the demarcation of necrotic from healthy tissue, and stimulated wound healing. After two sessions of HBOT treatment, there was a complete restitution of blood ow with full function of the left hand and all its ngers.

COVID-19 Associated Coagulopathy and Implications for its Treatment

Abstract The SARS-CoV-2 coronavirus (COVID-19) pandemic is due to lack of prior immunity and there is no certain management, regarding the complications of this viral illness. The target organ for COVID-19 infection are the lungs. Patients may develop acute lung injury that can be complicated by acute respiratory failure, as well as multiorgan failure. The pathophysiology of COVID-19 infection is characterized with inflammatory changes, associated with coagulopathy. Recent data suggests diffuse bilateral pulmonary inflammation observed in COVID-19 infection that is related to a novel pulmonary-specific vasculopathy, defined as pulmonary intravascular coagulopathy (PIC), distinct from disseminated intravascular coagulopathy (DIC). The coagulopathy associated with COVID-19 is distinguished by initial elevation of D-dimer and fibrin/fibrinogen degradation products. Abnormalities in prothrombin time (PT), partial thromboplastin time (APTT) and platelet counts are not common in the early stages of the infection. This suggests the early screening measurement of D-dimer and fibrinogen. The implications for COVID-19-associated-coagulopathy is the established thromboembolic prophylaxis and standard management for sepsis-induced coagulopathy or DIC. High levels of D-dimer are a marker of higher mortality risk. However, current studies do not show the common use of full therapeutical doses of anticoagulants, unless there are other clinical indications. Bleeding in COVID-19 infection is uncommon, even when a laboratory constellation for DIC is present. However, if it occurs, standard guidelines for DIC management should be followed.

Impairments of haemostasis and therapeutic management in patients with COVID-19

The lack of prior immunity to SARS-CoV-2 coronavirus (COVID-19) infection has led to pandemic, where there is no certain management, regarding the complications of this viral illness. The lungs are the target organ for COVID-19 and patients develop acute lung injury that may progress to respiratory and multiorgan failure. Recent data shows the presence of diffuse bilateral pulmonary inflammation in COVID-19 infection. It is associated with a specific pulmonary vasculopathy, defined as pulmonary intravascular coagulopathy (PIC) that is distinct from disseminated intravascular coagulopathy (DIC). The coagulopathy in the early stages of COVID-19 is characterized by initial elevation of D-dimer and fibrin/fibrinogen degradation products, while abnormalities in prothrombin time, partial thromboplastin time and platelet counts are uncommon. That is why screening of D-dimer and fibrinogen levels, are mandatory. COVID-19-associated coagulopathy should be treated, following the guidelines for thromboembolic prophylaxis. Although D-dimer is a marker of mortality, current data does not show routine application of anticoagulants, unless otherwise clinically indicated. Bleeding in COVID-19 is uncommon, even when a laboratory constellation for DIC is present. However, if it occurs, standard guidelines for DIC management should be followed.

A review on coagulopathy in Covid-19 and its Homoeopathic management

Background: Corona Virus disease (Covid-19) rapidly spreading pandemic was initially found as a cluster of severe pneumonia cases in December 2019 reported in Wuhan, Hubei province, China. Infection with the virus, can be asymptomatic or mild to severe symptomatic disease causing Acute viral pneumonia like symptoms leading to fatality in the least possible time if untreated. The pathological cause of this is severe coagulopathies in the microvasculature primarily in the lungs causing hypoxia and later multiorgan failure. Though thrombolytics play an important role, it fail to recover the patient completely, and if so may have thrombolytic effects in other organs too which lead to complications. Selection of Homoeopathic similimum may be practically difficult in such acute condition in an ICU setup but Homoeopathy Remedies which act primarily on thrombosis phenomenon along with affinity on pulmonary organs need to be selected and administered as an adjuvant therapy for beneficial results. Primarily the Tissue remedies like Kali mur, Natsulph, Ferrum phos, and remedies like arnica, Arsenic album, Ammonium Carb, animal Remedies from Ophidia group are found to be effective equally in thrombolysis and prevents further complications. Objectives: The primary focus of this article is on causation of coagulation mechanism in Covid-19 disease, resulting in multiorgan failure and scope of Homoeopathic Medicines as Adjuvant therapy in preventing thromboembolic complications.Methods: Method: Information was obtained from the latest articles on coagulation mechanism in covid-19 research articles and importance of Homoepathic medicines in preventing coagulation. Homoeopathic remedies were chosen from the latest Articles, various original literature and Repertories and their physiological pharmacological and Homoeopathic action on prevention of the formation of thrombus and their role in effective thrombolysis is explained. Conclusion: The COVID-19-associated coagulopathy (CAC) are distinct from those seen with bacterial Sepsis-Induced Coagulopathy (SIC) and disseminated intravascular coagulation (DIC). The CAC usually shows increased D-dimer and fibrinogen levels with minimal abnormalities in Prothrombin time and platelet count. Homoeopathic remedies are proved to be effective in thrombolysis can be thought of primarily as an adjuvant to conventional treatment for an early recovery.

Interpretation of clotting tests in the neonate

There are significant differences between the coagulation system in neonates compared with children and adults. Abnormalities of standard coagulation tests are common within the neonatal population. The laboratory tests of...

Evaluation of a point‐of‐care coagulation analyzer (Abaxis VSPro) for identification of coagulopathies in dogs

To evaluate the ability of the Abaxis VSPro, a point-of-care analyzer that measures prothrombin time (PT) and activated partial thromboplastin time (aPTT), to identify dogs with coagulopathies caused by administration of anticoagulants. Veterinary teaching hospital. Six healthy adult dogs that are part of a preexisting research colony. One dog was not included in the warfarin portion of the study. Unfractionated heparin (UFH, 50 U/kg i.v. once then 300 U/kg s.q. q 8 h) was administered to prolong aPTT. Citrated whole blood was used for PT and aPTT analyses with the VSPro and were run in duplicate. The VSPro results were compared to PT and aPTT measured in plasma with a standard benchtop coagulometer (AMAX Destiny). A washout period of at least 24 hours followed. Once dogs had normal PT and aPTT values, warfarin was administered (0.25-0.30 mg/kg p.o.) once then (0.15 mg/kg p.o.) as needed up to every 12 hours to prolong PT values. Seventy separate samples were evaluated for PT and 73 samples for aPTT. Pearson correlation coefficients (PCC) for replicate VSPro measures of PT and aPTT were 0.941 and 0.891, respectively (P < 0.001). The PCC between VSPro and AMAX was 0.578 for PT and of 0.865 for PTT (P < 0.001). Receiver operating characteristic (ROC) analysis indicated a maximum sensitivity and specificity for diagnosis of coagulopathy (by AMAX) at VSPro PT value of 21.6 seconds (sensitivity 72%, specificity 86%) and a maximum sensitivity and specificity at VSPro aPTT of 105.3 seconds (sensitivity 93%, specificity 89%). The positive predictive value for PT and aPTT were 84% and 89%, respectively. The Abaxis VSPro showed acceptable correlation with clinical laboratory tests, and is a useful POC device for identification of animals with abnormalities in PT or aPTT.

The Prevalence of Abnormal Coagulation Parameters in Patients with Newly Diagnosed Primary Systemic Amyloidosis and Its Impact on Outcome

Background: Primary systemic amyloidosis (AL) is an incurable plasma cell disorder associated with varying degree of organ infiltration with light chain derived amyloid protein and consequent organ dysfunction. Various acquired coagulopathies, predominantly Factor X (FX) deficiency have been previously described in AL. The factor deficiencies are thought to be due to the direct binding of blood coagulation proteins to amyloid fibrils. Little is known regarding the prognostic significance of abnormal coagulation parameters in AL patients (pts).Methods: After Institutional Review Board approval, we performed a retrospective review of the medical records of 625 consecutive pts who had presented within 3 months of a diagnosis of AL to be evaluated at Mayo Clinic from June 2001 to June 2006. 540 pts had coagulation studies performed within 2 months of presentation. 51 of those pts were on oral anticoagulation and were excluded from the analysis.Results: Of the 489 pts included in the analysis, the median age was 62 years and 61% were male. The median overall survival (OS) of the entire cohort was 26.8 months. Table 1 lists the prevalence of abnormal coagulation tests in the remaining 489 patients. Prothrombin time (PT) was available in the majority of pts. 61 pts (12.6%) had elevated PT, and 63 pts (20.4%) had a decreased FX. 37 of the 61 pts with elevated PT had available FX levels, of which 31 (84%) of those had a decreased FX, suggesting that the cause of elevated PT was mostly due to a low FX. Indicators of hepatic involvement such as alkaline phosphatase and bilirubin levels were higher among the patients with prolonged PT and low FX. An elevated PT (more than 12.4 seconds) was strongly predictive of an adverse outcome, with a median OS of 8.7 months compared to a median OS of 29 months (p<0.0001) in pts with normal PT (Figure 1). Similarly, pts with decreased FX (less than 60% activity), was associated with significantly worse outcomes with a median OS of 14.9 months versus a median OS of 33 months (p<0.0001) in pts with normal FX (Figure 2). In a Cox proportional hazards model containing cardiac troponin (cTnT), NT-Pro BNP, serum alkaline phosphatase, and free light chain difference (involved minus uninvolved), prolonged PT or FX deficiency were independently prognostic for overall survival.Conclusion: Abnormalities of PT and FX are seen in a sizable proportion of pts with newly diagnosed AL. An elevated PT and or FX deficiency appear to adversely affect the outcome of these patients. It is likely that the elevated PT in these patients relate to FX deficiency in the majority which in turn may reflect the amyloid ‘burden’. The effect of other organ involvement like the hepatic involvement may also have an impact on FX and PT.Table 1. Prevalence of abnormal coagulation testing in patients with newly diagnosed primary systemic amyloidosis.Coagulation studyN (Test results available)N of abnormal results(%)Elevated prothrombin time4866112.6Elevated activated partial thromboplastin time3124815.4Elevated thrombin time3158426.7Elevated fibrinogen14011884.3Decreased Factor II activity622641.9Decreased Factor V activity63914.3Decreased Factor VII activity631727Decreased Factor X activity3096320.4Elevated D-dimer1307255.4 [Display omitted] [Display omitted]

Clinical and laboratory features of disseminated histoplasmosis in HIV patients from Brazil

To identify the main clinical and laboratory features of disseminated histoplasmosis (DH) in human immunodeficiency virus (HIV) patients and compare them with those of HIV patients with other opportunistic diseases. Retrospective study of HIV patients comparing the clinical and laboratory data of patients with and without DH. Univariate and multivariate analyses were performed to verify the risk factors related to DH. In total, 378 HIV patients were included, 164 with DH and 214 with other opportunistic diseases. Acute renal failure, respiratory insufficiency and septic shock were more frequent in DH patients, who also had a higher mortality (32%vs. 14%, P < 0.001). Independent risk factors for DH were: acute renal failure [odds ratio (OR) 5.2; 95% confidence interval (CI) 3.2-8.5; P < 0.001], splenomegaly (OR 3.4; 95% CI 1.19-9.9; P < 0.001), respiratory insufficiency (OR 2.7 95% CI 1.5-5.0; P < 0.001), proteinuria (OR 2.7; 95% CI 1.3-5.2; P = 0.03), hypotension (OR 2.5; 95% CI 1.2-5.0; P = 0.008), hepatomegaly (OR 2.4; 95% CI 1.2-4.8; P = 0.01), cutaneous lesions (OR, 1.9; 95% CI 1.0-3.3; P = 0.02) and weight loss (OR 1.8; 95% CI 1.0-3.1; P = 0.03). Our results suggest that DH is a severe opportunistic disease with high mortality rate, which should be promptly recognized in order to provide early specific treatment.

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.

Reducing unnecessary coagulation testing in hypertensive disorders of pregnancy

Objective: To estimate the magnitude of laboratory testing for hypertension in pregnancy and determine whether abnormalities in prothrombin time (PT), activated partial thromboplastin time (aPTT), and fibrinogen can be predicted by results of common, less expensive tests. Materials and Methods: Laboratory records were searched and charts were reviewed to identify gravidas tested for hypertension and to exclude conditions producing coagulopathy. Contingency tables were constructed to assess the ability of the platelet count, lactate dehydrogenase, and transaminases to predict coagulation test results. Results: Preliminary data on 73 gravidas found that a platelet count plus a lactate dehydrogenase test best predicted coagulation abnormalities. Results on another 732 gravidas indicated that coagulation tests were obtained in about 30%. No patient had a PT greater than 18 seconds, two had an aPTT greater than 40 seconds, and three had fibrinogen levels less than 200 mg/dL. The combination of a normal platelet count plus a normal lactate dehydrogenase had a negative predictive value of 100% for clinically significant abnormalities of PT and aPTT, and 99% for significant abnormalities of fibrinogen. Conclusions: Substantial coagulation testing was done on gravidas evaluated for a hypertensive disorder even though the prevalence of clinically significant abnormalities was low. Laboratory evaluation of patients suspected of having preeclampsia need not include a PT, aPTT, or fibrinogen test when there is no evidence of bleeding or of a condition that could produce coagulopathy and when the platelet count and lactate dehydrogenase level are both normal.

Reducing unnecessary coagulation testing in hypertensive disorders of pregnancy.

To estimate the magnitude of laboratory testing for hypertension in pregnancy and determine whether abnormalities in prothrombin time (PT), activated partial thromboplastin time (aPTT), and fibrinogen can be predicted by results of common, less expensive tests. Laboratory records were searched and charts were reviewed to identify gravidas tested for hypertension and to exclude conditions producing coagulopathy. Contingency tables were constructed to assess the ability of the platelet count, lactate dehydrogenase, and transaminases to predict coagulation test results. Preliminary data on 73 gravidas found that a platelet count plus a lactate dehydrogenase test best predicted coagulation abnormalities. Results on another 732 gravidas indicated that coagulation tests were obtained in about 30%. No patient had a PT greater than 18 seconds, two had an aPTT greater than 40 seconds, and three had fibrinogen levels less than 200 mg/dL. The combination of a normal platelet count plus a normal lactate dehydrogenase had a negative predictive value of 100% for clinically significant abnormalities of PT and aPTT, and 99% for significant abnormalities of fibrinogen. Substantial coagulation testing was done on gravidas evaluated for a hypertensive disorder even though the prevalence of clinically significant abnormalities was low. Laboratory evaluation of patients suspected of having preeclampsia need not include a PT, aPTT, or fibrinogen test when there is no evidence of bleeding or of a condition that could produce coagulopathy and when the platelet count and lactate dehydrogenase level are both normal.

Central Venous Catheter Placement in Patients With Disorders of Hemostasis

To define the incidence of bleeding complications from central venous access procedures performed by a critical care service in patients with disorders of hemostasis. Prospective, consecutive sample, collection of clinical data. University teaching hospital. Seventy-six consecutive patients with disorders of hemostasis who required central venous access for clinical management between October 1992 and October 1993. Age, sex, clinical diagnosis, most recent platelet count, prothrombin time (PT), and activated partial thromboplastin time (aPTT) were recorded from the medical record of patients with known coagulation or platelet abnormalities. The site of central venous catheter placement, the number of needle passes necessary to complete the procedure, and the occurrence of complications were reported by the critical care attending physician performing or supervising the procedure. One hundred four central venous access procedures were performed on 76 patients with disorders of hemostasis. Seventy-three percent of catheters were placed in patients with platelet counts less than 100,000/mL and 40% of catheters were placed in patients with abnormalities of PT, aPTT, or both. Thirteen percent of patients had abnormalities of both platelets and coagulation profile. There were no serious complications. Bleeding complicated 7 (6.5% of the procedures; 5 patients had bleeding from the skin (from the suture sites in four), and 2 patients developed small periosteal hematomas. All patients with bleeding complications had thrombocytopenia with mean platelet counts of 22,000/mL and a range of 6,000 to 37,000/mL. Most patients with platelet counts in this range did not have clinically evident bleeding. Central venous access procedures can be done safely in patients with disorders of hemostasis by skilled physicians who frequently perform these procedures. Patients most likely to experience bleeding from these procedures are patients with severe thrombocytopenia. In this series, only a single patient, with a platelet count of 6,000/mL, required therapeutic blood product administration.

Perirenal Hemorrhage in Ureter Ligated Dogs Receiving Phthalyl-sulfathiazole

SummaryThe ureters were ligated in 6 dogs, and phthalylsulfathiazole was administered orally in doses of 0.5 to 0.75 g/kg/day for 3-6 days pre-operatively and postoperatively until death. Two of these animals showed at autopsy an increased vascularity of the fascial sheath covering the perirenal fat, 5 animals showed perirenal sheath hemorrhage, and 3 animals had fresh free blood in the abdominal cavity.The ureters were ligated in 6 control dogs, and they received no phthalylsulfathiazole. Four of these animals showed at autopsy an increased vascularity of the perirenal sheath. None of the animals showed perirenal hemorrhage.It was found that both ureter ligation and phthalylsulfathiazole administration are necessary for production of the perirenal lesions. It appears that the perirenal hemorrhage is due to vascular changes since no abnormalities in prothrombin time, bleeding, clotting, and clot retraction time, red blood cell counts or platelet counts were demonstrated. The average total blood sulfathiaz...