Severity Of Thrombocytopenia In Patients Research Articles

Prevalence and severity of thrombocytopenia in patients with hyperferritinemia

ABSTRACTBackgroundIn patients with tumors, inflammation, and blood disorders, hyperferritinemia has been associated with the severity of the underlying disease and is frequently accompanied by a co-occurring low platelet count or thrombocytopenia. Despite this, no established correlation has been identified between hyperferritinemia and platelet count. In this retrospective, double-center study, we sought to describe the prevalence and severity of thrombocytopenia in patients with hyperferritinemia.Study and designA total of 901 samples were enrolled in this study, all of which had significantly high ferritin levels (>2000 μg/L) between January 2019 and June 2021. We analyzed the general distribution, incidence of thrombocytopenia in patients with hyperferritinemia, and the relationship between ferritin level and platelet count. p-values < 0.05 were considered statistically significant.ResultsThe total incidence of thrombocytopenia in patients with hyperferritinemia was 64.7%. Hematological diseases were the most frequent cause of hyperferritinemia (43.1%), followed by solid tumors (29.5%) and infectious diseases (11.7%). Patients with thrombocytopenia (<150 × 109/L) had significantly higher ferritin levels than those with platelet counts exceeding 150 × 109/L, with median ferritin levels of 4011 and 3221 μg/L, respectively (P < 0.001). Additionally, the results showed that the incidence of thrombocytopenia was higher in hematological patients with chronic transfusion than in those without chronic blood transfusions (93% vs 69%).ConclusionsIn conclusion, our results suggest that hematological diseases are the most common cause of hyperferritinemia and that patients with chronic blood transfusions are more susceptible to thrombocytopenia. Elevated ferritin levels may act as a trigger for thrombocytopenia.

Safety of temozolomide use in adult patients with renal dysfunction.

Temozolomide (TMZ), a cytotoxic DNA alkylating agent, is the main chemotherapy used for the treatment of high grade astrocytomas. The active alkylator, methylhydrazine, is not recovered in urine and thus renal function is not expected to affect clearance. Prescribing information for TMZ states pharmacokinetics have not been studied in adults with poor renal function, eGFR < 36mL/min/1.73 m2. We reviewed our clinical experience with TMZ in patients with impaired renal function to evaluate safety of administering full dose TMZ. The primary endpoint was to characterize the incidence and severity of thrombocytopenia in patients with eGFR < 60mL/min/1.73 m2 who received TMZ for treatment of high grade gliomas (HGG) or primary CNS lymphoma (PCNSL). Secondary endpoints included incidence and severity of neutropenia, lymphopenia hepatotoxicity, and number of TMZ cycles administered. Medical records of patients with HGG or PCNSL treated with TMZ from October 1, 2016-September 30, 2019 were accessed to identify cases for this study. Thirty-two patients were eligible for this study. Of the seven patients with eGFR < 36mL/min/1.73m2, 38/39 cycles (97%) were completed without grade 3-4 thrombocytopenia. No patients experienced grade 3-4 neutropenia, and grade 3-4 lymphopenia occurred in 5 cycles (15%). One patient discontinued TMZ 7days prior to completion of radiation due to thrombocytopenia. Hematologic toxicity in patients with severe renal dysfunction, eGFR < 36mL/min/1.73m2, is similar to that of patients with normal renal function. Severe renal impairment does not preclude use of temozolomide, but cautious monitoring of blood counts is warranted.

INNV-28. TEMOZOLOMIDE IN RENAL DYSFUNCTION

Abstract BACKGROUND Temozolomide (TMZ) is a cytotoxic DNA alkylating agent. It is the only chemotherapy known to improve survival in patients with high grade astrocytomas. The active alkylating species, methylhydrazine, is not recovered in the urine and thus renal function is not expected to affect clearance of this agent. It has never been formally evaluated in adults with eGFR &amp;lt; 36 mL/min/1.73 m2, and it is often recommended to administer with caution, dose reduce, or withhold therapy. However, lacking other effective therapies, we have elected to administer TMZ at full dose to these patients. This IRB approved retrospective study was conducted to evaluate the safety of this practice. METHODS The primary endpoint was to characterize the incidence and severity of thrombocytopenia in patients with renal impairment defined as eGFR &amp;lt; 60 mL/min/1.73 m2 who received TMZ for the treatment of their high grade gliomas (HGG) or primary CNS lymphoma (PCNSL). Secondary endpoints included incidence and severity of neutropenia, lymphocytopenia, hepatotoxicity, and number of cycles administered. Medical records were reviewed for adult patients with HGG or PCNSL treated with TMZ from October 1, 2016-September 30, 2019. RESULTS Thirty-four patients met criteria for inclusion. Of the 7 patients with eGFR &amp;lt; 36 mL/min/1.73m2, 33/34 cycles (97%) were completed successfully without grade 3–4 thrombocytopenia. No patients experienced grade 3–4 neutropenia, and grade 3–4 lymphocytopenia occurred in 5 cycles (15%). One patient required discontinuation of TMZ 7 days prior to completion of radiation due to thrombocytopenia. CONCLUSION The side effect profile from TMZ administered to patients with eGFR &amp;lt; 36 mL/min/1.73 m2 appears to be similar to that of patients with normal renal function. This is not an unanticipated finding given what is known about the metabolism of the drug.

Тромбоцитопения в реальной клинической практике врача-кардиолога: результаты многолетнего обсервационного исследования

Цель исследования: оценить частоту встречаемости тромбоцитопении (ТП) в реальной практике врача-кардиолога и характеризовать ее в зависимости от тяжести состояния пациента (варианта оказания специализированной кардиологической помощи). Материалы и методы: Проведено многолетнее ретроспективное обсервационное исследование на базе крупного кардиологического центра, оказывающего специализированную кардиологическую помощь как в плановом, так и в экстренном порядке, а также в условиях консультационно-поликлинического отделения. Анализировались данные 31430 пациентов. Под ТП понималось патологическое состояние, характеризующееся снижением количества тромбоцитов, циркулирующих в периферической крови, &lt; 150×109/л. Результаты: У 2,69% пациентов кардиологического профиля был выявлен уровень тромбоцитов в периферической крови &lt; 150×109/л. Среди пациентов, госпитализированных по неотложным и экстренным показаниям, частота ТП составила 9,41%. У пациентов, нуждающихся в экстренной и неотложной кардиологической помощи, ТП была более тяжелая (LQ 7×103/мм3; p = 0,012), сопровождалась анемией (гемоглобин LQ 13 г/л; р = 0,003) и лейкоцитозом (лейкоциты UQ 16,3×103/мм3; р = 0,000). Нарастание степени тяжести ТП у больных, госпитализированных в экстренном порядке, было ассоциировано со значимым снижением степени тромбоцитарного анизоцитоза — PDW = 8,7 [6,6; 12,4]% (p = 0,001) и минимальными изменениями размера тромбоцитов (MPV). Заключение: В реальной клинической практике тромбоцитопения выявляется у 2,7% пациентов кардиологического профиля, частота ее встречаемости увеличивается с нарастанием тяжести клинического состояния больных. Установлены цитоморфологические различия тромбоцитопении у пациентов кардиологического профиля в зависимости от тяжести состояния. Полученные данные свидетельствуют об угнетении тромбоцитопоэза в качестве ведущего механизма снижения количества тромбоцитов у кардиологических пациентов с тромбоцитопенией, госпитализированных в ургентном порядке. Objectives: to evaluate the frequency of thrombocytopenia in the real cardiological clinical practice, and to characterize it according to the severity of the patient’s condition. Patients/Methods: A long-term retrospective observational study was performed in the large cardiological center providing specialized cardiological care: planned and emergency hospitalizations as well as outpatient consultation. We analyzed data from 31,430 patients. Thrombocytopenia (TP) was considered as a pathological condition characterized by abnormally low levels of platelets &lt; 150×109/L. Results: Platelets levels &lt; 150×109/L were detected in 2.69% of patients with cardiovascular disorders. Among critically ill patients the incidence of TP was 9.41%. In patients requiring urgent admission to intensive cardiovascular care unit (ICU), TP was more severe (LQ 7×103/mm3; p = 0.012) and accompanied by anemia (hemoglobin LQ 13 g/L; p = 0.003) and leukocytosis (leukocytes UQ 16.3×103/mm3; p = 0.000). An increase in the severity of TP in patients admitted to ICU was associated with a significant decrease of platelet anisocytosis — PDW = 8.7 [6.6; 12.4]% (p = 0.001) and minimal changes in platelet volume (MPV). Conclusions: In real clinical practice, thrombocytopenia was detected in 2.7% of patients with cardiovascular disorders; and its frequency increased with worsening of the patients’ clinical state. Thrombocytopenia characterized by cytomorphological differences according to the clinical severity in cardiovascular patients. Received data suggest an inhibition of platelet production as a leading mechanism for platelet count reducing in critically ill patients with cardiovascular disorders.

Frequency of thrombocytopenia and its severity in patients of Malaria.

Pakistan is an endemic area for malaria. Malaria is considered to be associated with thrombocytopenia. The frequency of thrombocytopenia varies in different studies. This study was done to determine the frequency of thrombocytopenia among patients with malaria. Objectives: To determine the frequency and severity of thrombocytopenia in patients of malaria. Study Design: Cross-sectional survey. Setting: Pathology Department, Nishtar Medical University, Multan. Period: Eight months; (04-03-2018 to 03-11-2018). Materials &amp; Methods: One hundred and fifty patients with malaria were included in the study. Platelet count of all the patients was done on Sysmex-K167. The patients were categorized according to the presence of thrombocytopenia (yes or no) and the severity of thrombocytopenia (mild, moderate or severe). The data was described as frequency distribution table. Results: The mean age of the patients was 31.81 + 15.31 years. There were 46 (30.7%) female patients and 104 (69.3%) male patients. Thrombocytopenia was present among 103 (68.7%) patients. Mild, moderate and severe thrombocytopenia was found in 60 (58.3%), 24 (23.3%) and 19 (18.4%) patients, respectively. Conclusion: This study concludes that frequency of thrombocytopenia is very high among patients with malaria. Severity of thrombocytopenia is mild to moderate, with few patients presenting with severe thrombocytopenia. This finding signifies that malaria is an important cause of thrombocytopenia. So the platelet count should be monitored closely in patients of malaria to avoid possible complications of thrombocytopenia. Moreover, it is suggested that malaria is an important differential diagnosis of thrombocytopenia with fever but needs confirmation by thick and thin smears for malarial parasite. In case of viral infections like dengue fever, smears will be negative for malarial parasite and patients will present with leucopenia and thrombocytopenia and majority of peripheral blood leucocytes will be reactive lymphocytes.

LIVER CIRRHOSIS

Objectives: To determine the frequency and severity of thrombocytopenia inpatients with liver cirrhosis. Study Deisgn: Cross sectional study. Period: 01-03-2013 to 31-08-2013. Setting: Liaquat University Hospital, Hyderabad. Methods: The cirrhotic patients wereassessed for thrombocytopenia and its severity. The data was analyzed in SPSS version 11.00and frequency and percentage was computed. The chi-square test was applied and p -value≤0.05 was considered as statistically significant. Results: Total one hundred patients wereevaluated for thrombocytopenia, 70% males and 30% females. The mean ± SD for age incirrhotic subjects was 41.16±14.24 whereas the mean ±SD for age in male and female cirrhoticpatients was 42.81±10.96 and 40.63±9.85. The thrombocytopenia was detected in 68%, ofwhich 43(63.2%) were males and 25(36.8%) were females. Mean±SD for platelet in all subjectswas 130.85±8.33 whereas it was 68.82±6.52 in thrombocytopenic cirrhotic patients. Mean±SDplatelet count in male and female thrombocytopenic patients was 70.94±7.42 and 64.72±5.84.Out of sixty eight thrombocytopenic cirrhotic subjects 23 had mild thrombocytopenia, 25had moderate thrombocytopenia and 20 had severe thrombocytopenia while in relation toChild-Pugh class B (p&lt;0.01) predominant. Regarding the duration of the liver cirrhosis, thethrombocytopenia was predominant in patients between 6-12 months. The common presentingfeature observed in relation to gender were malaise 21%, fatigue 17, nausea / vomiting 14%and combine feature in 21 cirrhotic patients (p=0.04). Conclusions: The thrombocytopeniawas detected in patients with liver cirrhosis, therefore frequent platelet assessment is one of themost important step to monitor platelet count and reduce severe and life threatening episodesof bleeding.

English

INTRODUCTION: Plasmodium Vivax malaria is endemic in the northern and eastern part of India. Although Plasmodium falciparum has been commonly implicated as the cause of complicated malaria but now the trend is changing and vivax is increasingly presenting with severe complications. AIMS AND OBJECTIVES: To study the occurrence and severity of thrombocytopenia in patients of vivax malaria. MATERIAL AND METHODS: A total of 100 patients were included in the study and identified positive for malaria parasites on peripheral smear examination with conventional microscopy. Platelet count was done on a fully automated, quantitative, hematology Counter at the time of presentation of patient. INCLUSION CRITERIA: freshly diagnosed cases of vivax malaria. EXCLUSION CRITERIA: Patients with associated falciparum, dengue, leptospirosis or any other known cause of thrombocytopenia. RESULTS: Platelet count was found to be normal in 32 patients. The mean platelet count in vivax malaria was 1,15,390/μl (SD 64,580) with a range of 8000-5,73,000/μl, Mild thrombocytopenia (50000 to 150000) was found in 36 patients. Moderate thrombocytopenia(20000 to 50000) was found in 20 patients. Severe thrombocytopenia (<20000) was found in 12 patients. Platelet transfusion was given in 9 patients and bleeding manifestations were noted in 4 patients. Thrombocytopenia was found to be more common among males (80.59%) and more common in younger age groups. CONCLUSION: Presence of thrombocytopenia is not a distinguishing feature between Vivax and Falciparum types. Thrombocytopenia less than 20,000/μl can occur in P. vivax malaria. The mechanism of occurrence of complications in vivax malaria is still poorly understood but this study can have therapeutic implications regarding more aggressive treatment of plasmodium vivax which was once considered purely benign and uncomplicated.

English

Background: Thrombocytopenia is commonly seen in patients of Malaria. This study was done to show frequency and severity of thrombocytopenia in patients diagnosed with malaria. Method: The study was carried out on 180 diagnosed cases of Malaria in the Department of Pathology, Dayanand Medical College & Hospital, Ludhiana, Punjab, India from January 2010 to June 2011. Malaria was diagnosed by examination of thick and thin blood films (smears). Patients with peripheral blood smear positive for malarial parasite were included in the study. Platelet count was obtained by using an automated cell counter. Reduced platelet count (thrombocytopenia) was confirmed by manual method and subdivided as mild thrombocytopenia (>50-149 × 103/µL), moderate (>20-49 × 10 3 /µL) and severe (< 20× 10 3 /µL). RESULTS: A total of 180 patients positive for Malaria were included in the study. 99 patients (55%) were positive for Plasmodium vivax, 74 patients (41%) were positive for Plasmodium falciparum and 7 patients (4%) had mixed infection (Plasmodium vivax and Plasmodium falciparum). Out of the total 180 patients, 153 (85%) patients had thrombocytopenia. Mild thrombocytopenia was seen in 100 patients (55%), Moderate thrombocytopenia in 41 patients (23%) and severe thrombocytopenia in 12 patients (7%).The remaining 27 patients (15%) had normal platelet counts. In mild thrombocytopenia, 62% cases were seen in P. Vivax followed by (37%) and (1%) in P. Falciparum and mixed infection (P. Falciparum & P. Vivax), respectively. The age group of the patients ranged from 10-84 years. The highest proportion (48.3%) of different types of malaria was in 20-45 years of age followed by 31.7% in more than 45 years of age. 100 patients (56%) were males and 80 patients (44%) were females. CONCLUSION: In our study, thrombocytopenia was the haematological parameter studied. Thrombocytopenia is quite frequently associated with malaria and has been reported by many

Effect of heparin during extracorporeal detoxification in the severity of thrombocytopenia in patients with severe sepsis

Effect of heparin during extracorporeal detoxification in the severity of thrombocytopenia in patients with severe sepsis