Prothrombin Time Values Research Articles

How to Generate a More Accurate Laboratory-Based International Normalized Ratio: Solutions to Obtaining or Verifying the Mean Normal Prothrombin Time and International Sensitivity Index.

Although the landscape of anticoagulation therapy is evolving, vitamin K antagonists (VKAs) such as warfarin remain an anticoagulant of choice for many clinicians and their patients. Nevertheless, management of VKA therapy remains challenging, largely because of patient variability and drug and food interactions; thus, VKA dosing has to be personalized. This is achieved by regular monitoring using a test called the prothrombin time (PT), mathematically converted to an international normalized ratio (INR). The INR system is meant to harmonize laboratory test results by taking into account reagent and instrumentation variability that is otherwise expected to give rise to variable PT values, but which should accordingly lead to less variable INR values. Of clinical importance, too low an INR is suggestive of increased thrombotic risk and typically means the VKA dose should be increased, whereas too high an INR is suggestive of increased bleeding risk and typically means the VKA dose should be temporarily withheld and/or decreased. However, evidence continues to show that variability in INR values between laboratories remains unacceptably high. Given that modern instrumentation provides for robust analytical values-meaning highly reproducible intralaboratory clotting times or PTs in this case-the most likely cause of high INR variability is inconsistency in the INR test components-meaning the MNPT (mean normal PT) and ISI (international sensitivity index) values used by laboratories to generate a given INR. In other words, there are doubts as to the accuracy of some INR values because there are corresponding doubts about the accuracy of MNPT and/or ISI values that have been assigned by some laboratories for their reagent/instrument combination. The current report is intended to provide some solutions around the problems of inaccurate INRs, ISIs, and MNPTs, thus aiming to drive laboratory INRs closer to "truth," and thus promote better patient management. The novel strategies include a primary process of transference to obtain/verify MNPT and/or ISI values for a new reagent using an existing reagent as reference, and a secondary process whereby external quality assessment data can be used to correct bias or existing errors in assigned MNPT and/or ISI values.

The prothrombin time does not predict the risk of recurrent venous thromboembolism or major bleeding in rivaroxaban-treated patients

IntroductionFor treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE), rivaroxaban is given in fixed doses without routine coagulation monitoring. Patients and methodsTo determine whether monitoring would enhance its benefit-risk profile, we examined whether peak and trough prothrombin time (PT) values measured in 3797 rivaroxaban-treated patients included in the EINSTEIN DVT and PE studies correlated with subsequent recurrent VTE and major bleeding. In addition, we examined the stability of PT values over time and the impact of clinical variables on PT values. ResultsThe mean peak PT values at months 3 and 6 or 12 were 21.9 ± 5 and 21.7 ± 6.0 s, respectively, while the mean trough PT values at months 2 and 6 were 15.1 ± 5.1 and 15.3 ± 2.9 s, respectively. Although peak and through PT values were higher in females, and with older age, frailty, active cancer, low body weight, impaired renal function and use of moderate to strong inhibitors of CYP3A4 and/or P-glycoprotein, and were lower in patients taking strong CYP 3A4 inducers, the differences were small and results were overlapping. Neither peak nor trough PT values correlated with recurrent VTE or major bleeding. ConclusionsPT monitoring is unlikely to improve the benefit-risk profile of rivaroxaban in patients with DVT or PE.The study was registered at www.clinicaltrials.gov as #NCT00440193 (EINSTEIN-DVT) and #NCT00439777 (EINSTEIN-PE).

Perkütan Koroner Girişim Yapılan Akut Koroner Sendromlu Hastalarda Protrombin Zamanın Prognostik Değeri

Perkütan Koroner Girişim Yapılan Akut Koroner Sendromlu Hastalarda Protrombin Zamanın Prognostik Değeri

Value of gadoxetate disodium-enhanced magnetic resonance on hepatobiliary phase T1 mapping for predicting liver injury

Objective: To evaluate the measured value of gadoxetic disodium - enhanced T1-weighted magnetic resonance for the prediction of liver damage (LD) including liver fibrosis and inflammation. Methods: Retrospectively analyzed laboratory data of 115 patients with pathological results including prothrombin time (PT), albumin, serum total bilirubin level (TBil), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and magnetic resonance measurements (T1 measurement before and after enhancement and hepatobiliary specific phase T1pre, T1post, and changes in T1 relaxation time before and after enhancement were measured). The correlation between LD and magnetic resonance measurements was assessed by Spearman's correlation. All cases were divided into two groups: LD < 1 and LD≥1 (n1 = 26, n2 = 89), and the mean value of both groups was compared by t-test or Mann-Whitney U test. The independent influence factors of LD were obtained by binary logistic regression model. The area under receiver operating characteristics (AUROC) curve was performed on T1pre, T1post, and variation values. Results: Spearman's correlation test showed that T1post and variation values ​​were significantly associated with LD, and the correlation coefficients were 0.435, -0.353 and P < 0.05, respectively. The mean values ​​of T1post, variation values, PT, albumin, ALT and AST were statistically significant (P < 0.05). Binary logistic regression model showed T1post (P = 0.006), PT (P = 0.003), and AST (P = 0.032) were independent influencing factors of LD. T1- post contrast was good predictor of liver damage (AUC = 0.800). Conclusion: T1-post contrast predicts the existence of liver damage and provides useful information for clinical diagnosis and treatment.

Predictive Value of Prothrombin Time for All-cause Mortality in Acute Myocardial Infarction Patients.

Acute myocardial infarction (AMI) is a serious cardiovascular disease caused by acute or persistent ischemic and anoxia of the coronary artery. A more practical and effective risk model is still remained to be established for AMI patients. This study aims to investigate the predictive value of prothrombin time (PT) in AMI patients. In this study, 2734 AMI patients available in the public MIMIC III clinical database were investigated, with 629 deaths occurring within 2-year follow-up. More than 20 risk factors including demographics, clinical disease history, laboratory test information, surgery history, and mediation information were analyzed as potential predictors for all-cause mortality in AMI patients. After adjustment for other covariates, PT was showed to be a significant risk factor for all-cause mortality in AMI patients (adjusted hazard ratio, 4.04; 95% confidence interval, 2.83 to 5.75) from Cox regression analysis. We also developed a comprehensive risk model for AMI mortality using multivariate Cox proportional hazards model based on the above 20 risk factors. Combined with PT, the model achieved a good accuracy with an AUC (area under ROC curve) of 0.843. Overall, PT is an independent predictor for 2-year mortality in AMI, and it might be useful in identifying AMI patients with a high risk for mortality.

Hyperfibrinolysis Is an Important Cause of Early Hemorrhage in Patients with Acute Promyelocytic Leukemia.

BackgroundThe objective of the current study was to guide the early clinical treatment strategies by assessing the recovery of abnormal coagulation in acute promyelocytic leukemia (APL) patients during induction therapy.Material/MethodsRetrospective analysis was performed in 112 newly-diagnosed patients with APL during induction treatment.ResultsThe early death (ED) rate in our study was 5.36% and the main cause was fetal hemorrhage. The presence of bleeding symptoms was significantly correlated with low platelet and fibrinogen levels. The values of white blood cell (WBC), lactate dehydrogenase (LDH), prothrombin time (PT), fibrinogen, and bone marrow leukemic promyelocyte in the high-risk group were significantly different from those in the low/intermediate-risk groups. Coagulation variables significantly improved after dual induction therapy. No significant difference was found in changes of platelet (PLT), prothrombin time (PT), activated partial thromboplastin time (APTT), D-dimers, and fibrinogen among different risk groups after induction therapy. D-dimer levels were initially high and remained well above normal after 4 weeks of induction therapy.ConclusionsAggressive prophylactic transfusion to maintain high platelet and fibrinogen transfusion thresholds could reduce hemorrhage in APL patients. Immediately starting induction therapy effectively alleviated coagulopathy in APL patients. Hyperfibrinolysis was a more important event in the APL hemorrhagic diathesis.

Hemostatic state augmented with platelet indices among Sudanese diabetic septic foot

BackgroundDiabetes mellitus is a very rampant metabolic disorder, particularly type II. It has many complications such as the septic foot. Diabetic septic foot (DSF) patients are at high risk for coagulation abnormalities as well as surgical hazards. Owing to the potential sequelae of coagulation and vascular abnormalities, this work aimed at studying the hemostatic state and platelet indices in diabetes type II patients with septic foot.MethodsA case-control study was conducted during the period from July to September 2017 at Dr. Awaad medical center, Red Sea State, Sudan. 57 diabetic patients with septic foot, aged between 17 and 78 years along with 57 non-diabetic subjects as control were enrolled. Sociodemographic data were collected using a structured questionnaire. Venipuncture blood was taken with necessary safety measures. Diabetes profile, coagulation studies as well as platelet indices were estimated. Data was analyzed using SPSS version 24.0 for windows. Ethical approval was considered and written consent from each participant was obtained.ResultsThe mean age of diabetic patients with septic foot and healthy controls were 48.49 ± 15.8 and 32.77 ± 14.0, respectively. The duration of the diabetes onset was 10.43 ± 9.5 years. Plasma prothrombin time (PT) value (12.61 ± 2.6 vs 13.67 ± 1.5, P < 0.009) was found to be significantly shorter in DSF compared to control. Plasma activated partial thromboplastin time (APTT) value was significant in diabetic septic foot (32.64 ± 5.2 vs 28.49 ± 4.13, P < 0.000), and thrombin time (TT) did not changed in DSF. Mean platelet volume (MPV), platelet distribution width (PDW), and platelet large cell ratio (P-LCR) values were significantly decreased in DSF compared to control (P < 0.013, 0.034, and 0.020, respectively). PDW values were positively correlated with PT, APTT, and D-Dimer (DD) (r = 0.28/p < 0.003, r = 0.29/p < 0.029, and r = 0.32/p < 0.016, respectively). FVIII activity (121.86 ± 174.4 vs 98.66 ± 31.83, P < 0.951) was insignificant with DSF, as the DD was also insignificant (P < 0.081).ConclusionDiabetes mellitus is associated with prothrombotic tendency. Hypercoagulable state in DSF is indicated by shortened PT finding. PDW is a manifesting evidence that proves the presence of more reactive and aggregable platelets in DSF patients.

Correlation of prothrombin time and activated partial thromboplastin time with serum immunoglobulins in newly diagnosed patients with plasma cell dyscrasias: an experience from tertiary care centre

Background: Plasma cell dyscrasia (PCD) is the term used to describe the disorders characterized by neoplastic proliferation of plasma cells with the abnormal production of immunoglobulins (Ig). Patients with multiple myeloma frequently have abnormal coagulation tests. Aim of the present study were to correlate prothrombin time (PT) and Activated Partial Thromboplastin time (aPTT) with Ig concentrations in patients with newly diagnosed with PCD and to compare PT and aPTT values in untreated and treated patients diagnosed with PCDMethods: This study was conducted in the department of clinical hematology of SKIMS, a tertiary care hospital in northern India from 2015 to 2016. Patients diagnosed with PCD were advised for coagulogram (PT, aPTT) as a base line investigation. A total of 72 patients were included in the study.Results: 37% of multiple myeloma cases (newly diagnosed) and 22% of light chain disease patients presented with prolonged PT whereas none of the patients in treated cases of PCD had prolonged PT. The mean Ig concentration was significantly higher in patients with prolonged PT and aPTT compared to that of patients with normal PT and aPTT values. In IgA myeloma, the mean immunoglobulin concentration was 3643 mg/dL with a mean PT and aPTT values of 18.8s and 36.6 (p value: 0.006). The mean free light chain concentration in kappa (k) light chain myeloma was 1727 mg/L with a mean PT value of 20.5 s, mean aPTT value of 37.4 s (p-value: 0.026).Conclusions: Patients with newly diagnosed myeloma presented with prolonged PT as compared to the treated cases. Also, mean Ig concentration was significantly higher in patients with prolonged PT and aPTT compared to that of patients with normal PT and aPTT values.

Proposed diagnostic criteria for acute-on-chronic liver failure in Japan.

To establish diagnostic criteria for acute-on-chronic liver failure (ACLF) in Japan, the Intractable Hepato-Biliary Disease Study Group of Japan undertook a multicenter pilot survey for patients fulfilling the Asian Pacific Association for the Study of the Liver (APASL), Association for the Study of the Liver-Chronic Liver Failure (EASL-Clif) Consortium, or Chinese Medical Association (CMA) diagnostic criteria for ACLF. The APASL criteria were suitable for screening Japanese patients with ACLF when patients whose conditions were triggered by gastrointestinal bleeding were included within the disease entity, and the EASL-Clif Consortium criteria were useful for classifying the severity of the patients' conditions. Based on these observations, the Study Group proposed the following diagnostic criteria for ACLF in Japan: patients with cirrhosis and a Child-Pugh score of 5-9 should be diagnosed as having ACLF when a deterioration of liver function (serum bilirubin level ≥5.0mg/dL and prothrombin time value ≤40% of the standardized values and/or international normalization rate ≥1.5) caused by severe liver damage develops within 28days after acute insults, such as alcohol abuse, bacterial infection, gastrointestinal bleeding, or the exacerbation of underlying liver diseases. The severities of the patients can be classified into four grades depending on the extent of the deterioration in organ functions, including kidney, cerebral, blood coagulation, circulatory and respiratory functions, as well as liver function. The usefulness of these novel criteria should be validated prospectively in a large-scale cohort in the future.

Clinical profile and outcome of children admitted with dengue fever in a tertiary care hospital in South India

Objective: The objective is to study the clinical profile and outcome of patients admitted with dengue fever and to identify the risk factors for severe dengue (SD). Materials and Methods: This is a descriptive study of children admitted with a diagnosis of dengue fever from January 2013 to June 2014 in a tertiary care Medical College Hospital in South India. Results: A total of 306 children were admitted with dengue fever during the study period with a mean age of 7.8±3.2 years and male:female ratio of 1.06:1. The most common symptoms apart from fever were vomiting (54.9%) and abdominal pain (36.3%). Tender hepatomegaly and narrow pulse pressure were the most common signs. 131 (42.8%) were classified as dengue fever without warning signs, 119 (38.8%) as dengue fever with warning signs (DWS), and 56 (18.4%) as severe dengue (SD) according to the WHO guidelines 2012. A significant difference in aspartate aminotransferase’ and alanine aminotransferase elevation was noted among dengue fever without warning signs, DWS, and SD. Hemoconcentration, thrombocytopenia, hypoproteinemia, hypoalbuminemia, hypocalcemia, hypoglycemia, hypokalemia, hepatic derangement, elevated urea, and creatinine were significantly associated with SD. The mean values of prothrombin time, international normalized ratio, and activated partial thromboplastin time in SD were 19±3.7 s, 1.5±0.3 s, and 46±7 s, respectively. The finding of thalamic hypodensity in one patient with dengue encephalopathy was only rarely described in literature. Conclusion: Bleeding manifestations altered coagulation profile as well as deranged liver functions can be used as predictors of severe dengue fever.

A comparative study of the variation in coagulation profile between different blood groups in ischemic heart disease patients and normal subjects

Background: A positive association of coagulation factors has been implicated with the risk of ischemic heart disease (IHD), and so have the associations of the ABO blood groups. Aims and Objectives: This study was done in IHD patients and normal individuals to assess the variations of coagulation factors among the different ABO blood groups. Materials and Methods: This study included 50 IHD male patients taken as cases and 50 age-matched and sex-matched, apparently healthy males taken as controls. Blood samples were collected from subjects for the analysis of prothrombin time (PT), activated partial thromboplastin time (aPTT), and fibrinogen levels and also for the determining the ABO blood group. Results: Majority of the cases belonged to blood group A (36%) while a majority of the controls belonged to blood group O (44%). Among the cases, individuals with blood group A were found to have significantly higher fibrinogen levels, and blood group O individuals had the least fibrinogen levels. Similar pattern was also observed among the controls. The PT and aPTT values were minimum in individuals of blood group A while maximum values were observed in blood group O individuals; both in cases and controls. Conclusion: PT and aPTT indirectly assess the coagulant activity of the different factors of the extrinsic and intrinsic pathways, respectively. Shortened levels of PT and aPTT and higher levels of fibrinogen are seen in blood group A individuals. Thus, it can be said that among the various risks associated with the development of IHD, ABO blood group is also one of them wherein blood group A individuals are more likely to the develop the disease while blood group O confers protection against IHD.

Predictive formula of coma onset and prothrombin time to distinguish patients who recover from acute liver injury.

Acute liver failure (ALF) is defined as acute liver injury (ALI) associated with coagulopathy. A follow-up strategy for ALI and characterization of ALI patients with a risk of progressing to ALF have never been established. To establish predictive markers for progression from ALI to ALF, this study compared the clinical characteristics and laboratory data on the day of registration to data from a regional referral system of patients with ALI. This prospective, observational study enrolled 365 consecutive patients with ALI/ALF between 2007 and 2016. We evaluated 109 ALI patients, 27 of whom satisfied the ALF criteria during observation and another 82 patients who recovered without progression to ALF. Four patients died; all were in the ALF group. The variables of age, incidence of autoimmune hepatitis, model of end-stage liver disease score, values for total bilirubin and prothrombin time (PT)-international ratio, and Japan Hepatic Encephalopathy Prediction Model (JHEPM) probability at registration were significantly higher in ALF patients than in ALI patients. In multivariate analysis, PT and JHEPM were identified as risk factors for progression to ALF. The cut-off values of 13%, 4.9%, 65%, and 1.32% for the model of end-stage liver disease score, JHEPM probability, PT, and PT-international ratio values, respectively, had high negative predictive values. Furthermore, among patients whose JHEPM was underestimated, none died due to ALF. The JHEPM probability is a predictive parameter that can be used to decide a follow-up treatment strategy for ALI patients.

Interpretation of Coagulation Tendency Contributing to Thrombosis in Vector-Borne Diseases (Ehrlichiosis, Anaplasmosis, Leishmaniosis, and Dirofilariasis) among Dogs

Background: Vector-borne infectious and zoonotic diseases are an important health problem that directly affects human and animal health negatively. Results through evaluation of coagulation disorders among vector-borne diseases should be of beneficial for both human and dogs studies. According to the present author’s knowledge reports regarding changes in platelet (PLT) count, prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB) and D-dimer levels in dogs naturally infected with one or more vector-borne pathogens are lacking. Therefore, the present study was aimed to detecting those parameters for relation between diagnosis and prognosis of vector-borne diseases among dogs.Materials, Methods &amp; Results: The material of this study was 46 dogs (36 were naturally infected with vector-borne diseases and 10 were healthy) from different breed, age and of both sexes. Venous blood samples were obtained to detect PLT counts, antibodies of ehrlichiosis, anaplasmosis, borreliosis, leishmaniosis and antigens of Dirofilaria immitis. The diagnosis of vector-borne diseases was performed by using a commercial ELISA assay kits. PLT count was performed with an automated blood cell counter analyser. In addition, PT, APTT and FIB concentrations were measured using a microcoagulometer. D-dimer concentrations were determined using fluorescence immunoassay rapid quantitave test analyser. Subgroups were formed according to the number of cases and the distribution of vector-borne agent. Statistically significant decreased PLT count was found in dogs mono infected with ehrlichiosis compared to healthy dogs (P &lt; 0.001). Changes in mean PT value in the studied animals did not show statistically significant differences among the groups (P &gt; 0.05). APTT values in the ehrlichiosis mono infection group were significantly higher than that of the healthy control (P &lt; 0.01). A significant increase in FIB levels were detected for ehrlichiosis mono infection and ehrlichiosis - leishmaniosis co infection versus healthy control (P &lt; 0.001). Plasma D-dimer concentrations were found to be higher in all groups infected with vector borne diseases compared to healthy group (P &lt; 0.001) and the differences between infected groups were not statistically significant.Discussion: Bleeding disorders such as epistaxis, haematuria and haemorrhagic diarrhoea has been reported in dogs with vector-borne diseases. These disorders represent the main cause of death in dogs. In the present study, thrombocytopenia was observed in dogs mono infected with ehrlichiosis compared to healthy. This finding is in agreement with those reported in dogs with ehrlichiosis. Plasma FIB is one of the most important factors in the coagulation cascade. In the present study, a significant difference between dogs with ehrlichiosis mono infection and ehrlichiosis - leishmaniosis co infection versus healthy controls group was observed. PT and APTT are commonly used in evaluating dogs with bleeding tendencies. In the present study, a significant difference between dogs with ehrlichiosis and with healthy control was observed in APTT values, however, differences in PT values compared to healthy dogs were insignificant. No statistical difference in PT values might be related to the lower sensitivity of the commercial PT assays. In dogs, D-dimer concentrations can be elevated due to disseminated intravascular coagulopathy, infections, metabolic disorders, neoplasia and post-surgically. In the present study, a significant increase in D-dimer concentration was observed in all dogs with vector-borne diseases. This finding points to the activation of the fibrinolysis system in consequence of thrombophilia. In conclusion, elevations presented in coagulation biomarkers such as APTT, FIB and D-dimer in the present study were interpreted as with the effects of vector-borne diseases. It may be briefly suggested that D-dimer levels as a marker of pro-coagulatory activity, as well as fibrinolysis, indicates the highly active and excessive coagulation, and all through are risk factors for thromboembolic disorders. Therefore, these findings should be considered in the diagnosis, treatment and prognosis of the vector-borne diseases in dogs.

Micro-Arc Oxidation Enhances the Blood Compatibility of Ultrafine-Grained Pure Titanium.

Ultrafine-grained pure titanium prepared by equal-channel angular pressing has favorable mechanical performance and does not contain alloy elements that are toxic to the human body. It has potential clinical value in applications such as cardiac valve prostheses, vascular stents, and hip prostheses. To overcome the material’s inherent thrombogenicity, surface-coating modification is a crucial pathway to enhancing blood compatibility. An electrolyte solution of sodium silicate + sodium polyphosphate + calcium acetate and the micro-arc oxidation (MAO) technique were employed for in situ oxidation of an ultrafine-grained pure titanium surface. A porous coating with anatase- and rutile-phase TiO2 was generated and wettability and blood compatibility were examined. The results showed that, in comparison with ultrafine-grained pure titanium substrate, the MAO coating had a rougher surface, smaller contact angles for distilled water and higher surface energy. MAO modification effectively reduced the hemolysis rate; extended the dynamic coagulation time, prothrombin time (PT), and activated partial thromboplastin time (APTT); reduced the amount of platelet adhesion and the degree of deformation; and enhanced blood compatibility. In particular, the sample with an oxidation time of 9 min possessed the highest surface energy, largest PT and APTT values, smallest hemolysis rate, less platelet adhesion, a lesser degree of deformation, and more favorable blood compatibility. The MAO method can significantly enhance the blood compatibility of ultrafine-grained pure titanium, increasing its potential for practical applications.

THE RISKS OF USING TRANEXAMIC ACID AND VITAMIN K FOR DECREASING PROTHROMBIN TIME AND ACTIVATED PARTIAL THROMBOPLASTIN TIME VALUES IN INTRACRANIAL HEMORRHAGIC PATIENTS AT RUMAH SAKIT UMUM PUSAT FATMAWATI JAKARTA

Objective: Intracranial hemorrhaging is a life-threatening condition that requires intensive treatment. Such hemorrhaging can happen spontaneously and may be caused by vascular malformations, trauma, or the administration of anticoagulant medications. The purpose of this study was to evaluate the risks of using tranexamic acid and Vitamin K for decreasing prothrombin time (PT) and activated partial thromboplastin time (aPTT) values in intracranial hemorrhagic patients.Methods: This study used a retrospective cohort design, and data were taken from patients’ medical records at the medical record installation of Rumah Sakit Umum Pusat Fatmawati in Jakarta. A total of 125 medical records were selected based on the inclusion criteria. The first group included patients receiving only tranexamic acid, and the second group consisted of patients receiving both tranexamic acid and Vitamin K.Results: Statistical analysis using Chi-squared testing for the first group showed a significant decrease in aPTT values, with p=0.000 (p&lt;0.05), but there was no significant decrease in PT values, with p=0.314 (p&lt;0.05). Statistical analysis using Chi-squared testing in the second group showed a significant decrease in aPTT values, with p=0.000 (p&lt;0.05), and a significant decrease in PT values, with p=0.034 (p&lt;0.05). Patients that used tranexamic acid and Vitamin K decreased the PT and aPTT values 2.7 times and 1, 6 times greater than patients without tranexamic acid and Vitamin K. Patients that used tranexamic acid decreased the PT and aPTT values 2.5 times and 1.2 times greater than patients without tranexamic acid.Conclusions: The combination of tranexamic acid and Vitamin K is potentially more effective in decreasing of hemorrhaging.

Low platelet count is potentially the most important contributor to severe bleeding in patients newly diagnosed with acute promyelocytic leukemia.

The objective of the current study was to provide more appropriate therapeutic strategies for reducing severe hemorrhaging by assessing the recovery of abnormal coagulation indexes in patients with acute promyelocytic leukemia (APL) during induction therapy. Retrospective analyses of 112 patients newly diagnosed with APL were performed during initial treatment. In our study, the early death rate was 5.36%. Hemorrhage was the leading cause of death during the induction period (4/6). The values of white blood cell count, lactate dehydrogenase, prothrombin time (PT), fibrinogen (Fbg), hemoglobin, and bone marrow leukemic promyelocytes were significantly different in the high-risk group compared to the low/intermediate-risk groups. There were significant differences in the white blood cell count, bone marrow leukemic promyelocytes, platelet (PLT) count, and the levels of lactate dehydrogenase, d-dimer, PT, and Fbg, as well as in FLT3-ITD mutations between patients with major bleeding and those with minor bleeding. Hemostatic variables significantly improved over time during induction therapy. The recovery times of the PLT, PT, and Fbg values were significantly slower in patients with major bleeding than in those with minor bleeding. Specifically, the PLT level in patients with major bleeding was not similar to that in the minor bleeding group until after 4 weeks of treatment. Hemorrhages were the most common cause of induction death in this study. High-risk patients were more prone to serious clinical bleeding symptoms. Patients with major bleeding had more rapid proliferation characteristics and an increased incidence of FLT3-ITD mutations compared to patients with minor bleeding. Hemostatic variables recovered significantly more slowly in patients with major bleeding than in those with minor bleeding. Active induction therapy and blood product infusion are effective in preventing severe bleeding. Our results suggested that low PLT count might be the leading cause of fatal bleeding in patients newly diagnosed with APL.

ASSOCIATION OF POSTPRANDIAL BLOOD SUGAR WITH HYPERCOAGULABILITY IN COMPARISON TO FASTING BLOOD SUGARS IN DIABETIC AND HEALTHY PATIENTS: A CROSS-SECTIONAL STUDY

Objective: The aim of this study was to find the association of postprandial blood glucose with hypercoagulability in comparison to fasting blood sugars(FBS) in diabetic and healthy patients.Methods: The present study involved a total of 156 patients, of which 78 were taken as cases (diabetics) and other 78 as controls (non-diabetics). Laboratory analysis included prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen assay done along with fasting, and postprandial sugars.Results: Platelets in diabetics and healthy controls were in normal range. Decrease in PT and partial thromboplastin time was noted in diabetics compared to non-diabetic controls. Fibrinogen levels were increased in cases compared to controls. Changes in PT values were more significant with postprandial blood sugar (PPBS) levels when compared to FBS levels, and APTT follows the same pattern with more in PPBS levels and FBS levels in diabetics. PPBS showed elevated fibrinogen when compared to FBS in diabetics as well as non-diabetics.Conclusion: Type 2 diabetes mellitus is a hypercoagulable state as proven by the following results of our study.

Significance of Portal Venous Velocity in Short-term Graft Function in Living Donor Liver Transplantation

BackgroundGraft regeneration and functional recovery after reperfusion of transplanted graft are very important for successful living donor liver transplantation (LDLT). The aim of this study was to evaluate the significance of postoperative portal venous velocity (PVV) in short-term recovery of graft function in LDLT. Patients and MethodsFrom February 2007 through December 2015, we performed 17 primary LDLTs, which were included in the present study. The patients ranged in age from 12 to 65 years (mean: 50 years), and 11 were female patients. Postoperatively, Doppler ultrasonography was performed daily to measure PVV (cm/s), and liver function parameters were measured daily. The change in PVV (ΔPVV) was defined as follows: ΔPVV = PVV on postoperative day (POD) 1 − PVV on POD 7. Maximal value of serum aspartate aminotransferase (ASTmax) and maximal value of serum alanine transaminase (ALTmax) at 24 hours after graft reperfusion were used as parameters of reperfusion injury. Correlation analyses were performed as follows: (1) correlation of ΔPVV and PVV on POD 1 (PVV-POD 1) with the values such as ASTmax, ALTmax, other liver function parameters on POD 7 and graft regeneration rate; (2) correlation of ASTmax and ALTmax with other liver function parameters on POD 7. ResultsΔPVV significantly correlated with the values of serum total bilirubin (P < .01), prothrombin time (P < .01), and platelet count (P < .05), and PVV-POD 1 significantly correlated with the values of serum total bilirubin (P < .05) and prothrombin time (P < .05). ConclusionΔPVV and PVV-POD 1 may be useful parameters of short-term functional recovery of the transplant liver in LDLT.

English

BACKGROUND: Laparoscopic cholecystectomy is a common surgical procedure and carbon dioxide pneumoperitoneum created for this purpose may alter the coagulation profile of these patients. This study aims to find the effects of carbon dioxide pneumoperitoneum on coagulation profile and assess if there is an increased risk of thrombosis. MATERIALS AND METHODS: A clinical observational study was conducted with 50 patients who underwent laparoscopic cholecystectomy using carbon di oxide pneumoperitoneum. The prothrombin time and D-dimer values were calculated before and after surgery .using the paired t test data was analyzed. RESULTS: The study showed a decrease in the prothrombin time and increase in the D-dimer value post operatively. The mean of prothrombin time after surgery was 0.13 seconds lower than the preoperative value and D-dimer was found to be elevated three times the pre operative values. The p value calculated for both were highly significant. CONCLUSION: Laparoscopic cholecystectomy using carbon dioxide pneumoperitoneum leads to hypercoagulable states. Hence stringent measures need to be taken to put the patient on prophylaxis for deep vein thrombosis to avoid dire consequences.

Impact of experimental hypercalcemia on routine haemostasis testing.

BackgroundThe blood to anticoagulant ratio is standardized according to the physiological calcium concentration in blood samples conventionally used for hemostasis testing. Specifically, one fixed volume of 0.109 mmol/L sodium citrate is added to 9 volumes of blood. Since little is known about the impact of hypercalcemia on the calcium-binding capacity of citrate, this study was planned to investigate the effect of experimental hypercalcemia on routine hemostasis testing.MethodsFifteen pooled citrated plasmas with matching lithium-heparin pooled plasma from patients with different values of prothrombin time (PT) were divided in three aliquots of 0.6mL each. The first paired aliquots of both citrate and lithium-heparin plasma were supplemented with 60μL of saline, the second paired aliquots with 30μL of saline and 30μL of calcium chloride and the third paired aliquots with 60μL of calcium chloride. Total and ionized calcium was measured in all aliquots of citrate and lithium-heparin plasma, whereas PT, activated partial thromboplastin time (APTT) and fibrinogen were measured in citrate plasma aliquots.ResultsTotal calcium concentration gradually increased in both lithium-heparin and citrate plasma aliquots 2 and 3 compared to baseline aliquot 1. The concentration of ionized calcium also gradually increased in lithium-heparin plasma aliquots 2 and 3, whereas it remained immeasurable (i.e., <0.10 mmol/L) in all citrate plasma aliquots. No significant differences were observed for values of PT, APTT and fibrinogen in citrate plasma aliquots 2 and 3 compared to the baseline aliquot 1, with a mean bias was always comprised within the desirable quality specifications derived from biological variability data.ConclusionHypercalcemia, up to severe hypercalcemia does not generate significant bias in results of first-line coagulations tests, so that hypothetical consideration of adjusting citrate-blood ratio is unjustified in hypercalcemic patients.