Incidence Of Thrombocytopenia Research Articles

A study on effect of phototherapy on platelet count in neonates with unconjugated hyperbilirubinemia: a hospital based prospective observational study

Background: Thrombocytopenia as a side effect of phototherapy has not been mentioned in standard literature and textbooks. Though there are few studies in this regard, but results are conflicting.
 Aims and Objective: Hence, the present study is undertaken to find out whether any significant change in platelet count occurs following phototherapy, and if there be any, to see whether the changes are transient or not.
 Materials and Methods: This prospective and observational study was carried out over a period of one and half years (1st March 2019 to 31st August 2020) on 190 new-borns admitted with idiopathic unconjugated hyperbilirubinemia needing phototherapy through consecutive enrolment. Serum bilirubin (total, conjugated and unconjugated) and platelet count were done before initiation and just after completion of phototherapy, and seven days after completion of phototherapy. Appropriate statistical tests were used to make statistical comparisons with a p-value of < 0.05 taken as significant.
 Results: Among 190 neonates, 108(56.8%) were male and 82(43.2%) were female; 90(47.4%) were preterm and 100(52.6%) were term. Mean birth weight was (2.4725 ± 0.4782) kg. Mean gestational age was (36.4316 ± 2.4802) weeks. Mean haemoglobin level was (17.3816± 1.0784) gm/dl. Mean age at presentation was (4.5737± 1.5811) days. Mean total serum bilirubin (TSB) before initiation, after completion, and 7 days after completion of phototherapy were (17.8595 ± 3.7034) mg/dl, (8.1726 ± 2.2586) mg/dl and (5.7279± 1.5918) mg/dl respectively. The mean duration of phototherapy required was (48.1895 ± 13.6054) hours. Mean platelet count before initiation and just after completion of phototherapy were (2,49,321.0526± 89,460.2101)/μL and (2,22,436.8421 ± 88,538.7173)/μL respectively. Mean platelet count 7days after completion of phototherapy was (2,46,210.5263 ± 87,442.3038)/μL. Decrease in platelet count just after completion of phototherapy was statistically significant. Fifty-nine (31.1%) out of 190 neonates developed mild thrombocytopenia (100000- <150000/μL) just after completion of phototherapy, but none developed moderate or severe thrombocytopenia. None having thrombocytopenia manifested with clinical bleed. Platelet count raised near to pre-phototherapy level 7 days after completion of phototherapy. Fall in platelet count was found to have a positive association with increased duration of phototherapy and lower gestational age (p<0.0001). However, there was no statistically significant association (p>0.05) between reduction in platelet count with gender.
 Conclusions: Though the incidence of thrombocytopenia following phototherapy was significant, but it was mostly mild and transient, and clinically insignificant. There was significant association between decrease of platelet count with duration of phototherapy and lower gestational age.

A systematic review and meta-analysis of myelosuppression in pediatric patients treated with linezolid for Gram-positive bacterial infections

BackgroundThe incidence of linezolid-induced myelosuppression in pediatric patients was reported at large difference among prospective studies, with a range of 0–24%. Additionally, there is little study which evaluated the impact of linezolid administration period on myelosuppression in pediatric patients, while it is one of the most frequent reason that linezolid therapy has to be discontinued in adult patients. Here, we performed a systematic review and meta-analysis to reveal the incidence of linezolid-induced thrombocytopenia and anemia, and impact of the administration period of linezolid on myelosuppression based on individual data analysis of pediatric patients. MethodsWe systematically searched the Scopus, EMBASE, Cochrane Central Register of Controlled Trials, PubMed, and CINAHL until April 2020. We investigated the incidence of linezolid-induced thrombocytopenia and anemia using pooled analysis, and evaluated the impact of linezolid administration period on myelosuppression using meta-analysis. ResultsThirteen studies with 969 pediatric patients were identified. The pooled incidences of thrombocytopenia and anemia were 9% (95% confidence interval (CI), 3–18%) and 4% (95% CI, 0–12%), respectively. Our meta-analysis showed the extension of linezolid administration period (more than 14 days) resulted in higher incidence of thrombocytopenia (OR 4.86, 95% CI 1.10–21.55) and anemia (OR 4.57, 95% CI 0.13–160.49). ConclusionsThe incidence of linezolid-induced myelosuppression in pediatric patients was less than 10%. However, our meta-analysis revealed linezolid administration period for more than 14 days was one of risk factors associated with linezolid-induced myelosuppression. Therefore, especially for pediatric patients treated with linezolid for more than 14 days, careful monitoring of myelosuppression is required.

P48.08 Phase IV Clinical Study on the Safety and Efficacy of Lobaplatin-Based Regimen With Small Cell Lung Cancer

Previous phase III studies have confirmed a similar efficacy of lobaplatin /etoposide (EL) to that of cisplatin /etoposide (EP) and more favorable safety profile including less gastrointestinal toxicity and nephrotoxicity as first-line treatment for extensive-stage SCLC(ED-SCLC). Based upon the evidence of this study, Chinese Society Of Clinical Oncology (CSCO) guidelines for SCLC have added EL regimen as an option for the first line treatment of ED-SCLC. We further carried out a phase IV study to systematically evaluate the safety and effectiveness of lobaplatin (LBP)-based regimen for widespread use in SCLC population. Patients diagnosed with SCLC were enrolled without therapeutic history limitation. The chemotherapy regimen was decided by the investigator with LBP administration required. The primary end point was safety and the secondary study endpoints included PFS, OS, ORR, and DCR. 1211 patients were enrolled from 30 centers in China. 780 patients were newly diagnosed with 96.18% treated with LBP plus etoposide; 431 were relapsed patients with 46.27% treated with LBP plus etoposide, 31.33% with LBP plus irinotecan and 21.69% with LBP alone. The average treatment cycle of treatment-naïve patients and relapsed patients were 3.9 and 3.6 cycles, respectively. The median follow-up period was 36 months. The efficacy of LBP-based treatment was similar to previous studies. The ORR, DCR, mPFS and mOS were shown in the table below. The overall and grade III/IV incidence of AE were 90.22% and 48.46%, respectively. The highest incidence of AE were leukopenia, neutropenia, thrombopenia, and anemia, with incidences of 66.7%, 61.7%, 42.3%, and 55.1%, and grade III/IV incidences were 24.1%, 36.0%, 14.8%, and 11.5%. The incidence of SAE was 8.04%, mainly because of myelosuppression which prolonged the hospital stays. There was no treatment-related death and no significant difference in the overall and grade III/IV incidence of AE between newly treated and relapsed patients. Besides, the total and grade III/IV incidence of thrombocytopenia were lower in both treatment-naïve and relapsed patients whose creatinine clearance > 80 ml/min.Tabled 1Treatment-naïve patientsRelapsed patientsOverall (n=780)LS-SCLC (n=322)ED-SCLC (n=458)Overall (n=431)LS-SCLC (n=122)ED-SCLC (n=309)ORR(%)66.1%69.1%64.0%33.438.731.1DCR(%)89.5%92.4%87.5%70.974.569.3mPFS(m)676453mOS(m)12.113.311.39.212.07.6 Open table in a new tab The LBP regimen is effective and safe for Chinese patients with SCLC. Clinical trial information: ChiCTR-ONC-13003470.

Type 2B von Willebrand Disease in Pregnancy: A Systematic Literature Review.

Our objective was to review the maternal characteristics and obstetric complications in women with type 2B von Willebrand disease (VWD). A systematic literature search was conducted using PubMed, Scopus, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov. We included all publications that addressed type 2B VWD in pregnancy. Our primary and secondary outcomes were incidence of postpartum hemorrhage (PPH) and incidence of thrombocytopenia in pregnancy. Two reviewers independently identified eligible studies and abstracted data including maternal characteristics, hematologic characteristics, treatment, and delivery outcomes. Twenty studies met inclusion criteria. There were 27 women (32 pregnancies) with type 2B VWD. Primary PPH was reported in 9/20 women (45%) and secondary PPH was reported in 6/13 women (46%). Thrombocytopenia in pregnancy was present in 27/28 women (96%); 23/27 women (85%) had platelet count <100 × 109/L, mean 33.7 ± 22.7 × 109/L. Factor concentrate treatment was administered before delivery (n = 16) and postpartum (n = 18), some women received both. Seventeen deliveries required blood products postpartum with 13/17 (76%) platelet transfusions and 6/17 (35%) red blood cell transfusions. No maternal mortality was reported. Women with type 2B VWD have significant morbidity in pregnancy related to high incidence of severe thrombocytopenia and primary and secondary PPH.

Comparison of outcomes of thrombocytopenic and non-thrombocytopenic culture proven neonatal sepsis

Background: Due to high incidence of sepsis as a main cause of neonatal mortality, early detection and proper treatment are important in reducing neonatal mortality. Thrombocytopenia is a common hematological problem encountered during neonatal period, particularly in neonatal sepsis. This study was done to know the incidence of thrombocytopenia in neonatal sepsis and to compare clinical outcome in patients with thrombocytopenic and non-thrombocytopenic neonatal sepsis.Methods: This was a prospective study carried out at neonatal intensive care unit of a tertiary care teaching hospital of western Gujarat, India, from October 2018 to August 2020. 2739 neonates were admitted with probable sepsis during study period. 299 neonates with positive blood cultures were recruited for the study. They were divided into two groups; group-1 had patients with thrombocytopenia, while group-2 included patients without thrombocytopenia. Severity of thrombocytopenia was assessed in group-1. Micro-organisms isolated and outcome of sepsis were compared in both the groups. Results: There were 208 neonates in group-1 (thrombocytopenic) and 91 in group-2 (non-thrombocytopenic). There was no significant difference in demographic profiles of neonates in both groups. Klebsiella pneumonia was the most common organism isolated from 79 patients of group-1 and 19 patients of group-2 (p=0.033). Coagulase negative Staphylococci and Candida were the second and third most common micro-organisms isolated from 30.2% and 15.1% of blood cultures respectively. In group-1, 85 (40.8%), 72 (34.6%) and 51 (24.5%) neonates had severe, moderate and mild thrombocytopenia respectively. Klebsiella pneumoniae (45.9%) was the commonest organism isolated in severe thrombocytopenic neonates, followed by Candia (22.4%) and Enterococcus (14.1%).Conclusions: Thrombocytopenia is a specific marker of neonatal sepsis. The platelet count is a simple test that facilitates diagnostic orientation and the establishment of an early empirical treatment. Klebsiella pneumoniae was the commonest organism isolated in severe thrombocytopenic neonates.

The incidence of thrombocytopenia in adult patients receiving chemotherapy for solid tumors or hematologic malignancies.

ObjectivesTo estimate the risk of thrombocytopenia in various cancers and chemotherapy regimens.MethodsStructured patient‐level data from the Flatiron Health Electronic Health Record database were used to identify adult patients who received chemotherapy for a solid tumor or hematologic malignancy from 2012 to 2017. Three‐month cumulative incidence of thrombocytopenia was assessed based on platelet counts, overall and by grade of thrombocytopenia. Co‐occurrence of anemia, neutropenia, and leukopenia was evaluated.ResultsOf 15,521 patients with solid tumors, 13% had thrombocytopenia within 3 months (platelet count < 100 × 109/L); 4% had grade 3 (25 to < 50 × 109/L), and 2% grade 4 (<25 × 109/L) thrombocytopenia. Of 2537 patients with hematologic malignancies, 28% had any thrombocytopenia, 16% with grade 3, and 12% with grade 4. Among patients with thrombocytopenia, it occurred without another cytopenia in 18% of solid tumors and 7% of hematologic malignancies.ConclusionsIn a large, US‐representative sample of patients undergoing chemotherapy in clinical practice, thrombocytopenia incidence varied across tumor and regimen types. Despite recommendations to alter chemotherapy to avoid severe thrombocytopenia, 4% of patients with solid tumors and 16% with hematologic malignancies experienced grade 3 thrombocytopenia. Prediction and prevention of thrombocytopenia may help oncologists avoid dose modifications and their adverse effects on survival.

Mediterranean Diet Maintained Platelet Count within a Healthy Range and Decreased Thrombocytopenia-Related Mortality Risk: A Randomized Controlled Trial.

There is little information on the dietary modulation of thrombosis-related risk factors such as platelet count. We aimed to assess the effects of Mediterranean diet (MedDiet) on platelet count and related outcomes in an older population at high cardiovascular risk. In participants of the PREDIMED (PREvención con DIeta MEDiterránea) study, we assessed whether an intervention with a MedDiet enriched with extra-virgin olive oil or nuts, relative to a low-fat control diet, modulated platelet count (n = 4189), the risk of developing thrombocytosis and thrombocytopenia (n = 3086), and the association between these alterations and all-cause mortality (median follow-up time: 3.0 years). Although platelet count increased over time (+0.98·109 units/L·year [95% confidence interval: 0.12; 1.84]), MedDiet interventions moderated this increase, particularly in individuals with near-high baseline count (both MedDiets combined: −3.20·109 units/L·year [−5.81; −0.59]). Thrombocytopenia incidence was lower in the MedDiet interventions (incidence rates: 2.23% in control diet, 0.91% in MedDiets combined; hazard ratio: 0.44 [0.23; 0.83]). Finally, thrombocytopenia was associated with a higher risk of all-cause mortality (hazard ratio: 4.71 [2.69; 8.24]), but this relationship was attenuated in those allocated to MedDiet (p-interaction = 0.018). In brief, MedDiet maintained platelet counts within a healthy range and attenuated platelet-related mortality in older adults at high cardiovascular risk.

Comparison of irinotecan and oxaliplatin as the first-line therapies for metastatic colorectal cancer: a meta-analysis

BackgroundIrinotecan (IRI) and oxaliplatin (Ox) are standard therapeutic agents of the first-line treatments for metastatic colorectal cancer (mCRC). Previous meta-analyses of randomized controlled trials (RCTs) showed that treatment with Ox-based compared with IRI-based regimens was associated with better overall survival (OS). However, these reports did not include trials of molecular targeting agents and did not take methods for the administration of concomitant drugs, such as bolus or continuous infusion of 5-fluorouracil, into account. A systematic literature review was performed to compare the efficacy and toxicity profiles between IRI- and Ox-based regimens as the first-line treatments for mCRC.MethodsThis meta-analysis used data from the Cochrane Central Register of Controlled Trials, PubMed, and SCOPUS. The primary endpoint was OS, and the secondary endpoints were progression-free survival (PFS), objective response rate (ORR), and adverse events (AEs).ResultsNineteen trials involving 4571 patients were included in the analysis. No statistically significant difference was observed between the two groups in terms of OS, PFS, and ORR. There was no significant heterogeneity. Regarding ≥ grade 3 AEs, IRI-based regimens were associated with a high incidence of leukopenia, febrile neutropenia, and diarrhea. Moreover, there was a high incidence of thrombocytopenia and peripheral sensory neuropathy in patients who received Ox-based regimens. In a subgroup analysis, IRI combined with bevacizumab was correlated with a better PFS (HR = 0.90, 95% CI = 0.82–0.98, P = 0.02), but not with OS (pooled HR = 0.91, 95% CI = 0.80–1.03, P = 0.15).ConclusionAlthough the safety profiles of IRI- and Ox-based regimens varied, their efficacy did not significantly differ. The combination of anti-VEGF antibody and IRI was associated with better PFS compared with anti-VEGF antibody and Ox. Both regimens could be used as the first-line treatments for mCRC with consideration of the patients’ condition or toxicity profiles.

Incidence and Risk Factors of Thrombocytopenia in Neonates Admitted With Surgical Disorders to Neonatal Intensive Care Unit of Tikur Anbessa Specialized Hospital; A One-Year Observational Prospective Cohort Study From a Low-Income Country

Background: Thrombocytopenia is one of the most common hematologic disorders affecting neonates who are admitted to the neonatal intensive care unit with a reported incidence of 18-35%. Several maternal, neonatal and perinatal factors contribute to the development of thrombocytopenia. This study is aimed to determine the incidence and associated risk factors of neonatal thrombocytopenia. Methods: An observational prospective cohort study was conducted and all neonates admitted to the neonatal intensive care unit of Tikur Anbessa Specialized Hospital with surgical disorders in the study period were included. Data was collected using a checklist and analysed by SPSS version 23. Chi square test and independent sample T- test were used to asses the association among different variables. Findings: A total of 210 neonates were included in the study out of which 56.2% were males. The incidence of thrombocytopenia in the study period was 55.8%. Among neonates with thrombocytopenia, 90.9% had a late onset thrombocytopenia and half of them were in the severe range (<50,000/µl). The presence of sepsis(P=0.000) and atresia (P=0.000) were found to be significantly associated with the development of thrombocytopenia. The mean non feeding hours were found to be significantly longer for patients with thrombocytopenia (t (199), 5.81, P= 0.000). Interpretation: The incidence of thrombocytopenia in neonates admitted with surgical disorders was high in our institution. Preventive methods towards neonatal sepsis including antenatal and postnatal measures should be given due emphasis. Initiation of oral feedings in neonates as early as feasible is recommended. Funding Statement: Addis Ababa University has granted the fund for this study. Declaration of Interests: None. Ethics Approval Statement: Written informed consent was taken from parents of enrolled neonates and each neonate’s clinical data was kept in confidential manner using a coding system. Ethical clearance for this study was obtained from ethical board of the medical college.

Thrombocytopenia and Bloodstream Infection: Incidence and Implication on Length of Stay in the Pediatric Intensive Care Unit.

The incidence and prognosis of thrombocytopenia in critically ill patients with bloodstream infection (BSI) is not well delineated in the pediatric intensive care unit (PICU) setting. We assessed these variables in our PICU and sought to determine whether thrombocytopenia could serve as a prognostic marker for length of stay (LOS). The study was conducted at the medical PICU of a university hospital, on all critically ill pediatric patients consecutively admitted during a 3-year period. Patient surveillance and data collection have been used to identify the risk factors during the study period. The main outcomes were BSI incidence and implication on morbidity and LOS. Data from 2,349 PICU patients was analyzed. The overall incidence of BSI was 3.9% (93/2,349). Overall, 85 of 93 patients (91.4%) with BSI survived and 8 patients died (8.6% mortality rate). The overall incidence of thrombocytopenia among these 93 patients was 54.8% (51/93) and 100% (8/8) for the nonsurvivors. Out of the 85 survivors, 27 thrombocytopenic patients were hospitalized for >14 days versus 14 of nonthrombocytopenic patients ( p = 0.007). Thrombocytopenia was associated with borderline significance with an increased LOS (adjusted odds ratio = 3.00, 95% confidence interval: 0.93-9.71, p = 0.066). Thrombocytopenia is common in critically ill pediatric patients with BSI and constitutes a simple and readily available risk marker for PICU LOS.

Thrombocytopenia among HIV infected patients attending a tertiary care hospital in India

Thrombocytopenia is a frequent hematological complication of human immunodeficiency virus infection which can occur at any stage of HIV infection. The various cytopenias correlate directly with the degree of immunosuppression. However, isolated thrombocytopenia, may be the initial presentation of HIV infection. Incidence of thrombocytopenia is around 10% - 40% and in some patient only thrombocytopenia may be the first sign of HIV infection or AIDS. Since few studies are available from Asian countries we decide to study thrombocytopenia in HIV infection or AIDS from India.The study was conducted at a teaching hospital in India after obtaining ethical permission from the institute. Subjects were recruited after taking written informed consent. Two hundred subjects of both sex and in the age group 18-60 years were recruited for study. Blood samples were collected and analysed on same day within two hours. Platelet count of &amp;#60; 1.5 lakh/mm was defined as thrombocytopenia. Data analysis was carried out using Statistical Package for Social Science (SPSS) version 16.0. p value &amp;#60; 0.05 considered as significant and p value &amp;#62; 0.05 non-significant. The mean platelet count was 2.06935lakh/ mmand highest and lowest platelet count were 4.1lakh/mm and 0.63lakh/mmrespectively. Out of two hundred, 8.5% subjects had thrombocytopenia. Females had a slightly higher prevalence as compared to males but it was not statistically significant (p=0.22). Likewise more of younger age group patients had thrombocytopenia. No significant relation was found between platelet count and ART status (p=0.773). Thrombocytopenia is a common finding in HIV infection. Peripheral destruction of platelets and ineffective platelet production leads to thrombocytopenia among HIV patients. ART improves platelet count and must be started as soon as possible.

Low arterial oxygen partial pressure induces pulmonary thrombocytopenia in patients and a mouse model

BackgroundRecent basic studies demonstrate that the lung is a primary organ of platelet biogenesis. However, whether the pathophysiological state of the lung affect the platelets is little known. We aim to investigate the incidence of thrombocytopenia in patients with pulmonary infection (PIN) and risk factors associated with pulmonary thrombocytopenia.MethodsIn total, 11,941 patients with pulmonary infection (PIN) were enrolled, and patients with other three infectious diseases were collected as controls. The incidence of thrombocytopenia was compared, and the risk factors associated with thrombocytopenia in PIN patients were investigated by multivariate analysis. To explore the mechanism of thrombocytopenia, hypoxic model was constructed. Blood platelet counts from the angular vein (PLTs), left ventricle (PLTpost) and right ventricle (PLTpre) were determined. Megakaryocytes identified by anti-CD41 antibody were detected through flow cytometry and immunofluorescence.ResultsThe incidence of thrombocytopenia in PIN was higher than that in other three infectious diseases (9.8% vs. 6.4% ~ 5.0%, P < 0.001). Low arterial oxygen partial pressure (PaO2) was an important risk factor for thrombocytopenia (OR = 0.88; P < 0.001). In a hypoxic mouse model, PLTs decreased (518.38 ± 127.92 vs 840.75 ± 77.30, P < 0.05), which showed that low PaO2 induced thrombocytopenia. The difference between the PLTpost and PLTpre (∆PLTpost-pre), representing the production of platelets in the lungs, was significantly attenuated in hypoxic mice when compared with normoxic mice (F = 25.47, P < 0.05). Additionally, proportions of CD41-positive megakaryocytes in the lungs, marrow, spleen all decreased in hypoxic mice.ConclusionThere is a high incidence for thrombocytopenia in PIN patients. Low PaO2-induced thrombocytopenia is associated with impaired generation of platelet in the lungs.

Reliability of Thrombocytopenia in Sepsis as a Predicting Tool for ICU Mortality

Introduction: There are many easy reproducible scores used in Intensive Care Unit (ICU) to predict mortality. But these need to be reassessed on a regular basis. There are many variables used to calculate these scores. But there can be some loss of data as the scores are repeated 24-48 hours apart and have many parameters which may make the process less user friendly. Aim: To study the predictive value of new onset thrombocytopenia as an effective tool in predicting mortality in septic patients. Materials and Methods: In this prospective observational study, 200 patients with thrombocytopenia at admission or at any time during ICU hospitalisation between 1st February 2015 to 1st November 2016 were selected; patients hospitalised for less than 24 hours were excluded. Thrombocytopenia is defined as a platelet count lower than 150,000/mm3, and recovery is defined as returning to levels above 150,000/mm3 after showing thrombocytopenia. Admission prognosis variables Acute Physiology, Age and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA) Score and platelet counts during the hospitalisation and outcomes were assessed using descriptive statistics, Chi-square test and One-way Analysis of Variance (ANOVA). Results: Out of 200 patients included, overall incidence of thrombocytopenia was 29.83%. The mean age was 49 (SD 18.24) years and mean duration of stay was 8.85 (SD 6.58) days. Maximum patients belonged to the age group of 18-30 years and 51-60 years. Total 89 (44.5%) of the 200 had sepsis and out of them 24 patients died, therefore, mortality rate among those in sepsis with thrombocytopenia was 27%. Mean SOFA score and APACHE II scores were 6.32 (SD 3.44) and 14 (SD 7.89), respectively. In the patients with thrombocytopenia and poor outcomes in the form of death or Discharge Against Medical Advice (DAMA), the SOFA scores were 9.04 and 6.96, respectively (p=0.0438). Similarly, patients with sepsis and thrombocytopenia who had either died or given DAMA the mean APACHE II scores were 18.66 and 17.96, respectively (p-value 0.0492). Conclusion: There was a significant association between, APACHE II and SOFA scores with new onset thrombocytopenia. Therefore, it can be used as an independent individual variable to predict mortality in patients of sepsis with thrombocytopenia.

FREQUENCY OF THROMBOCYTOPENIA IN PATIENT WITH MALARIA PRESENTED TO KHYBER TEACHING HOSPITAL PESHAWAR, PAKISTAN

Background: Malaria is a fatal infectious disease which is associated with numerous complications and has a profound effects on the blood indices. Thrombocytopenia is frequently reported among the patients with malaria though it is not an indication of the severity of the disease.&#x0D; &#x0D; Objective: &#x0D; The aim of the current study is to observe the hematological changes particularly the incidence of thrombocytopenia among the patients with malaria presented to the Khyber Teaching Hospital, Peshawar.&#x0D; Methodology: &#x0D; A descriptive cross-sectional study was conducted at the Medicine Department of Khyber Teaching Hospital, Peshawar from August 2018 to February 2019. A total of 95 malaria parasite (MP) positive cases were included in the study. The patients’ demographic details and the hematological variables were recorded. Data was analyzed using SPSS Version 20.0.&#x0D; Results: &#x0D; Among 95 MP positive patients, 88 had Plasmodium vivax infection while 7 patients were suffering from Plasmodium falciparum malaria. Moreover, 89 (93.6%) were found to have thrombocytopenia with majority having grade 1 thrombocytopenia (52.6%). while leukopenia was seen among 29.5% of the cases and only 5.3% presented with leukocytosis. The level of Hb&#x0D; was normal in majority of the cases and only 27.4% had Hb&lt;11.5g/dl.&#x0D; &#x0D; Conclusion: &#x0D; Thrombocytopenia is a common hematological finding among the patients suffering from malaria. Our study findings favor the diagnostic implications of thrombocytopenia as an indicator of acute malaria.

Clinical Analysis of Thrombocytopenia following Transcatheter Occlusion of a Patent Ductus Arteriosus

Background: Our aim is to analyze the correlation between severe thrombocytopenia and the diameter of patent ductus arteriosus (PDA) and residual shunt after PDA closure. Methods: The patients with severe thrombocytopenia (platelet count <50 × 10⁹/L) following transcatheter occlusion of a PDA from January 2010 to December 2018 in the Children’s Hospital of Chongqing Medical University were collected. And the high-risk factors, diagnosis, treatment, and prognosis of severe thrombocytopenia were analyzed. Results: A total of 1,581 children with transcatheter occlusion of a PDA were collected; 22 (1.39%) of the enrolled patients had severe thrombocytopenia. Further data analysis showed that the median diameter of PDA (6.7 [IQR: 1.63]) mm in children with severe thrombocytopenia was significantly larger than that in children without severe thrombocytopenia (3.6 ± 1.7 mm, p < 0.001). Furthermore, the incidence of thrombocytopenia in children with residual shunt after operation (10.9%) was significantly higher than that in children without residual shunt (0.2%, p < 0.001). The mean time of thrombocytopenia was found to be 2.4 ± 1.3 days after intervention. All patients with thrombocytopenia were treated by methylprednisolone with or without platelet transfusion and recovered without major organ hemorrhage. Conclusions: Severe thrombocytopenia following transcatheter occlusion of a PDA may be related to the larger diameter of PDA and residual shunt. If early detection of severe thrombocytopenia is obtained, our study supports a good prognosis if appropriate measures are implemented.

Blood Management in Total Knee Arthroplasty: A Nationwide Analysis from 2011 to 2018.

Both advances in perioperative blood management, anesthesia, and surgical technique have improved transfusion rates following primary total knee arthroplasty (TKA), and have driven substantial change in preoperative blood ordering protocols. Therefore, blood management in TKA has seen substantial changes with the implementation of preoperative screening, patient optimization, and intra- and postoperative advances. Thus, the purpose of this study was to examine changes in blood management in primary TKA, a nationwide sample, to assess gaps and opportunities. The American College of Surgeons National Surgical Quality Improvement Program database was used to identify TKA (n = 337,160) cases from 2011 to 2018. The following variables examined, such as preoperative hematocrit (HCT), anemia (HCT <35.5% for females and <38.5% for males), platelet count, thrombocytopenia (platelet count < 150,000/µL), international normalized ration (INR), INR > 2.0, bleeding disorders, preoperative, and postoperative transfusions. Analysis of variances were used to examine changes in continuous variables, and Chi-squared tests were used for categorical variables. There was a substantial decrease in postoperative transfusions from high of 18.3% in 2011 to a low of 1.0% in 2018, (p < 0.001), as well as in preoperative anemia from a high of 13.3% in 2011 to a low of 9.5% in 2016 to 2017 (p < 0.001). There were statistically significant, but clinically irrelevant changes in the other variables examined. There was a HCT high of 41.2 in 2016 and a low of 40.4 in 2011 to 2012 (p < 0.001). There was platelet count high of 247,400 in 2018 and a low of 242,700 in 201 (p < 0.001). There was a high incidence of thrombocytopenia of 5.2% in 2017 and a low of low of 4.4% in 2018 (p < 0.001). There was a high INR of 1.037 in 2011 and a low of 1.021 in 2013 (p < 0.001). There was a high incidence of INR >2.0 of 1.0% in 2012 to 2015 and a low of 0.8% in 2016 to 2018 (p = 0.027). There was a high incidence of bleeding disorders of 2.9% in 2013 and a low of 1.8% in 2017 to 2018 (p < 0.001). There was a high incidence of preoperative transfusions of 0.1% in 2011 to 2014 and a low of <0.1% in 2015 to 2018 (p = 0.021). From 2011 to 2018, there has been substantial decreases in patients receiving postoperative transfusions after primary TKA. Similarly, although a decrease in patients with anemia was seen, there remains 1 out 10 patients with preoperative anemia, highlighting the opportunity to further improve and address this potentially modifiable risk factor before surgery. These findings may reflect changes during TKA patient selection, optimization, or management, and emphasizes the need to further advance multimodal approaches for perioperative blood management of TKA patients. This is a Level III study.

Efficacy and safety of S-1 maintenance therapy in advanced non-small-cell lung cancer patients.

BACKGROUNDPrevious reports have demonstrated that S-1 has remarkable effects in the maintenance treatment of advanced non-small-cell lung cancer (NSCLC), and has less toxic and side effects than conventional drugs.AIMTo investigate the efficacy and safety of S-1 maintenance therapy in patients with advanced NSCLC.METHODSNinety-four patients with NSCLC admitted to our hospital from September 2015 to April 2018 were included in the study and divided into the S-1 group (47 cases) and the gemcitabine group (47 cases) by random digital table method. The S-1 group was treated with S-1, while the gemcitabine group received gemcitabine treatment. The clinical efficacy and quality of life of the patients after treatment in the two groups were evaluated.RESULTSThere was no significant difference in the total effectiveness rate between the two groups (P = 0.519). The quality-of-life scores indicated that there was no significant difference between the two groups in terms of four dimensions of the GQOLI-74 questionnaire (P = 0.518, 0.094, 0.338, 0.418). The incidence of nausea and vomiting, granulocytopenia and diarrhea in the S-1 group was significantly lower than that in the gemcitabine group (P = 0.001, 0.001 and 0.001, respectively). There was no significant difference in the incidence of thrombocytopenia (P = 0.366), the progression-free survival (P = 0.064), and the survival between the two groups (P = 0.050). CONCLUSIONS-1 maintenance therapy shows a significant therapeutic effect in patients with advanced NSCLC. It has the same clinical efficacy as gemcitabine, but with less toxic and side effects than conventional drugs.

Thrombocytopenia and Anemia Among Patients with Cerebral Palsy: A Big-Data Analysis

Title: Thrombocytopenia and Anemia among patients with Cerebral Palsy: A big-data analysis Introduction : The incidence of thrombocytopenia and anemia in patients with cerebral palsy (CP) is not well reported in the medical literature . Patients with CP, particularly those with the most severe phenotypes, may be repeatedly exposed to medications and infections associated with blood dyscrasias. The aim of this study was to assess the the prevalence of thrombocytopeniaand anemia in patients with CP comparing it to the general population. We also compared the prevalence of hospitalizations between patients with CP, with and without these blood dyscrasias. Methods: Utilizing a commercial database (Explorys Inc, IBM), we identified a cohort of patients diagnosed with CP based on the Systematized Nomenclature of Medicine-Clinical Terms. We calculated the overall prevalence rate of diagnosis of CP, described age, and gender-based prevalence rates of CP, and identified associated diagnoses of thrombocytopenia and anemia associated with CP. Explorys is a largereservoir of de-identified, HIPAA-compliant aggregated data of more than 63 million unique patients. First we compared the incidence of thrombocytopenia and anemia between patients with CP and the general population. To generate a cohort of patients representative of the general population, a cohort of patients with any coded disease was pooled except for CP. Moreover, relevant covariates including hospitalization, use of antiepileptic drugs (AED), infections, age, and gender were recorded and will be included in a multivariate analysis. We further sub-grouped patients with CP based on diagnoses of wheelchair dependency and AED exposure as markers of morbidity and risk for blood dyscrasias respectively. Results: We identified 49,492,350 unique patients of whom 93,850 were patients with CP. The prevalence of thrombocytopenia was higher in patients with CP than in the general population (Table 1; 4.91% vs 1.76%, RR 2.8, p&amp;lt;0.0000001). The same case was also noted for anemia (24,4% vs 11,4%, RR 2.1, p&amp;lt;0.0000001). When comparing the baseline characteristics of the two populations it seems that patients with CP are less aged compared to the general population (prevalence of patients &amp;gt;65 yoa , 53% vs 28%). Moreover, the infection rate in patient with CP surpasses that of the general population (infectious disease prevalence 93% vs 77%). On subgroup analysis, wheelchair dependence,AED exposure and any infectious process in patients with CP are risk factors for both anemia and thrombocytopenia. Nonetheless, an infectious process seems to be a stronger risk factor for both thrombocytopenia and anemia compared to AED exposure and wheelchair dependence (WD). More specifically the RR for thrombocytopenia in patients with CP is 7.4 compared to 4.8 and 2.4 for AED exposure and WD respectively. The same pattern is noticed for anemia (RR 4.7 vs 2.6 vs 1.8, p&amp;lt;0.001).Finally, we compared the total hospitalization rate in the past 5 years between patients with CP and with or withoutthrombocytopenia, anemia and cytopenia (defined as thrombocytopenia and anemia). Higher hospitalizations rates were found for patients with CP and with any of the above defined blood cell dyscrasias (Relative risk for hospitalization for patients with CP and thrombocytopenia/anemia/cytopenia vs without, RR 10/9/12.5, P&amp;lt;0.001). Discussion: Our study using large, aggregated data from Explorys demonstrates there is a higher prevalence of thrombocytopenia and anemia in patients with CP. In our cohort, patients with CP with thrombocytopenia and/or anemia were more likely to be hospitalized. Further research is needed to confirm this observed association and to clarify the mechanism of the relationship between CP and cytopenias. Disclosures Ahuja: Genentech: Consultancy, Honoraria; Sanofi Genzyme: Consultancy, Honoraria; XaTek, Inc.: Consultancy, Patents &amp; Royalties, Research Funding.

S0627 Incidence of Thrombocytopenia Between Proton Pump Inhibitors and Histamine-2 Receptor Antagonists in Critically Ill, Mechanically Ventilated Patients Receiving Stress-Ulcer Prophylaxis

S0627 Incidence of Thrombocytopenia Between Proton Pump Inhibitors and Histamine-2 Receptor Antagonists in Critically Ill, Mechanically Ventilated Patients Receiving Stress-Ulcer Prophylaxis

Thrombocytopenia in intensive care unit patients: A scoping review.

Thrombocytopenia is frequent in intensive care unit (ICU) patients and may be associated with adverse outcomes. We aimed to assess the incidence, risk factors, and outcomes associated with thrombocytopenia in adult ICU patients. We conducted a scoping review in accordance with the Preferred Reporting Items for Systematic Review and Meta-analyses extension for Scoping Reviews (PRISMA-ScR) and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. We included study reports on adult ICU patients with thrombocytopenia and assessed patient-important outcomes, including mortality and health-related quality-of-life. We included a total of 70 studies comprising a total of 215098 patients; 57 were cohort studies. The incidence of thrombocytopenia varied from 8 to 56 per 100 admissions (very low quality of evidence). We identified several risk factors including age, sepsis, and higher disease severity (low quality of evidence). Thrombocytopenia was associated with bleeding, use of life support, length of stay in the ICU, and increased mortality (low/very low quality of evidence). Data on platelet transfusion before invasive procedures and transfusion thresholds were limited. No studies assessed the benefits and harms of thromboprophylaxis in ICU patients with thrombocytopenia. Thrombocytopenia is common and associated with increased morbidity and mortality in adult ICU patients. Several risk factors for thrombocytopenia exists, but the evidence-base on management strategies, including transfusion thresholds and thromboprophylaxis in ICU patients is very limited.