Clinical Signs Of Bleeding Research Articles

Rifampin-induced vitamin K deficiency coagulopathy in a patient with brucellosis and rheumatoid arthritis: A clinical case report

Coagulopathy as a reversible dose-dependent side effect of rifampin is rarely observed in patient on rifampin in associate to inducing vitamin K deficiency. We reported a middle-aged man on a brucellosis three-drug regimen (including rifampin) who was admitted to the hospital due to a rheumatoid arthritis flare-up with increased partial thrombin time and international normalized ratio. Abnormal coagulation tests were discovered as an unintentional finding in the absence of clinical signs of bleeding. However, the coagulation tests returned to normal in 48 hours by withdrawing rifampin and administering 2.5 mg of oral vitamin K. The patient was discharged with a new brucellosis regimen including doxycycline and trimethoprim/sulfamethoxazole.

Epistaxis associated with Angiostrongylus vasorum infection in a dog

AbstractA 9‐month‐old, female, entire border collie was presented as an emergency for unilateral epistaxis, rapidly evolving to bilateral, and lethargy of sudden onset. A moderate broncho‐interstitial pattern was present on thoracic radiographs, particularly in the caudo‐dorsal lung lobes. Haematology and coagulation parameters (prothrombin time, partial thromboplastin time, fibrinogen) were within normal range. Multiple larvae (L1) of Angiostrongylus vasorum were identified both on flotation (Ovassay technique) and sedimentation (McKenna technique). The dog was treated with fenbendazole (50 mg/kg) for 15 days. On re‐examination, 4 days after completion of treatment, faecal analysis was negative and thoracic radiographs were improved. This case reports epistaxis as the main clinical finding in a young dog infested with A. vasorum, in the southwest of France, where this parasite is endemic. If bleeding diatheses are increasingly reported in angiostrongylosis, epistaxis is an unusual presentation, especially as the sole clinical sign of bleeding, in a dog with normal coagulation parameters.

RESULTS OF ENDOSCOPIC DIAGNOSIS OF BLEEDING AFTER ABDOMINAL SURGICAL OPERATIONS

The aim of the study is to conduct a comparative analysis of the effectiveness of endovidiosurgical diagnosis techniques to detect gastrointestinal and intra-abdominal bleeding, which may occur after abdominal operations. Materials and methods. The main group included patients (n=408), whose condition was controlled by the endovideosurgical techniques. The control group included patients (n=102) who were controlled by using conventional surgical methods to correct bleeding that may occurred after similar surgical interventions. Gastrointestinal bleeding was observed in 323 patients, and intra-abdominal bleeding was observed in 85 patients. In all cases, endoscopic haemostasis was performed by clipping (n=57), submucosal infiltration (n=32), electrocoagulation (n=29), argon-plasma coagulation (n=74), and combined techniques (n=54). Results and discussion. 408 patients with clinical signs of bleeding in the early postoperative period were examined by endoscopic techniques. Patients with alarming clinical and laboratory findings underwent ultrasound examination, which revealed the presence of free fluid in one or more parts of the abdominal cavity. Laparoscopy was performed in the first hours of the postoperative period in 17 cases (n=17); on the first day of the postoperative period (n=36), on the second day (n=19), on the third (n=8), on the fifth (n=3), and on the sixth day (n=2). Complications were excluded in 7 (16.0%) patients, despite a decrease in blood pressure and haemoglobin levels. The volume of blood found in the abdominal cavity, including clots, ranged from 30 ml to 2000 ml. Signs of ongoing bleeding (the predominance of a large amount of liquid blood with a small number of clots) were found in 49 (57.6%) cases, and signs of arrested bleeding (the presence of a large number of clots with a small amount of liquid blood) was detected in 29 (34.1%) cases. Haemostasis was provided by electrocoagulation (n=35), clipping (n=15), suturing (n=12) and tamponade from a mini-laporatomic incision (n=9). Gastrointestinal bleeding was observed in 323 patients, and intra-abdominal bleeding in 85 patients. In 8.4% (n=27) of cases, the suspicious cases of postoperative complication were excluded by endoscopic examinations. In 91.6% (n=296) of clinical cases, early postoperative bleeding or signs of unstable haemostasis with the risk of repeated bleeding were confirmed. In cases of alarming clinical and laboratory findings indicating intra-abdominal bleeding, diagnostic laparoscopy enables to exclude complications in 16.0% of patients, despite a decrease in blood pressure and haemoglobin levels.

Comparison of Oral Misoprostol with Intravenous Oxtocin in the In the Management of the Third Stage of Labour: A Randomized Controlled Trial

Background: Postpartum haemorrhage (PPH) is defined as the loss of 500ml of blood or more from the vagina following vaginal birth or 1000ml following caesarean delivery. The third stage of labour is the period between the delivery of the baby and the delivery of the placenta and membranes and its management is central to the prevention of postpartum haemorrhage (PPH). There are basically two methods of managing the third stage of labour namely active and physiological/expectant. The active management includes the use of uterotonic drugs immediately following delivery of the fetus, early cord clamping and cutting, and controlled umbilical cord traction. The active management of the third stage of labour with oxytocin has been found to reduce the risk of primary PPH significantly; however, the problem of inadequate supply of electricity, high cost and paucity of skilled manpower to administer it has negatively affected its use in developing countries and has made the search for a more suitable alternative expedient. Misoprostol on the other hand has been found to have good uterotonic activities, affordable and stable at room temperature; making its use in the resource-poor countries a veritable alternative. Aims: To determine if there is any difference in the efficacy of intravenous oxytocin over oral misoprostol in the management of the third stage of labour Study Design: This was a prospective, double-blinded, randomized trial of uncomplicated pregnant women who had vaginal delivery in the labour ward of the ESUT Teaching Hospital, Enugu. Sample Size: Two hundred (200) pregnant women who satisfied the inclusion criteria were recruited into the study with each arm accommodating 100 participants. Methodology: The eligible women were recruited on presentation to the labour ward after giving their consent. They were randomly allocated into 2 groups: A and B. Group A received 2 tablets (400µg) of oral misoprostol and 1mililtre(ml) of sterile water intravenously while group B received 2 tablets of white vitamin c and 1ml (10iu) of intravenous oxytocin immediately after cord clamping and cutting following the delivery of the baby. The patient was observed for significant clinical vaginal bleeding or PPH. For the purposes of this study, any bleeding/PPH accompanied with a greater than 30% rise in baseline pulse rate qualified for transfusion. A proforma was used to record the necessary data Statistical Analysis: Data collected from the study was analyzed with the Statistical Package for Social Sciences (SPSS) computer software version 20.0 for Windows. Statistical analysis was both descriptive and inferential at 95% confidence level. The socio-demographic variables were used to categorize the data and this was subjected to comparative statistical evaluation to yield frequencies, means, and percentages. Test of significance between class differences was by Pearson’s Chi-square test for categorical variables and student’s t-test for continuous variables. All P<0.05 at one degree of freedom (df=1) was considered statistically significant. Results and Conclusion: There was no significant difference in the number of women that received blood transfusion, the amount of blood transfused and the need for additional oxytocics on both arms of the study. However, there was a significant difference in the occurrence of side-effects with shivering and vomiting being prominent in the misoprostol and oxytocin arms respectively. Conclusion: There was no difference in the efficacy of oxytocin over misoprostol in the management of the 3rd stage of labour. We therefore, recommend that misoprostol can be adopted as an alternative/substitute to oxytocin in the management of the third stage of labour especially in developing countries.

Coagulation Status in Dogs Naturally Infected with Angiostrongylus vasorum.

Angiostrongylus vasorum infection has been associated with coagulopathies including hyperfibrinolysis. We compared coagulation status including thromboelastometry (ROTEM) parameters in dogs naturally infected with A. vasorum versus healthy dogs to determine clinicopathological parameters associated with bleeding, hypocoagulopathy, and hyperfibrinolysis. Clinical signs, white blood cell count, platelet count, hematocrit, plasmatic coagulation tests (PT, aPTT, fibrinogen concentration), D-dimer, and ROTEM S parameters (Ex-tem, In-tem, Fib-tem, Ap-tem) were analysed and compared between bleeding, nonbleeding, and control dogs and between hypo- and normocoagulable animals. Clinical signs of bleeding were present in 6/9 (67%) hypocoagulable and 1/9 (11%) normocoagulable dogs. PT, fibrinogen concentration, and several ROTEM parameters were significantly different between hypocoagulable and normocoagulabe A. vasorum infected dogs. Hyperfibrinolysis was identified in 44% of infected dogs and was significantly more common in bleeding and hypocoagulable dogs. Hyperfibrinolysis was significantly associated with low MCFFib-tem but not with low fibrinogen concentration or increased D-dimers. CFTEx-tem > 248 swas 100% sensitive and 89% specific to predict hyperfibrinolysis. Hyperfibrinolysis, hypocoagulability and bleeding are common in A. vasorum infected dogs. Only Ex-tem and Fib-tem parameters and potentially PT were associated with bleeding or hypocoagulability. Ex-tem analysis enables detection of bleeding, hypocoagulability and hyperfibrinolysis within minutes.

Mild Traumatic Brain Injury in Older Adults: Are Routine Second cCT Scans Necessary?

Fall-related hospitalizations among older adults have been increasing in recent decades. One of the most common reasons for this is minimal or mild traumatic brain injury (mTBI) in older individuals taking anticoagulant medication. In this study, we analyzed all inpatient stays from January 2017 to December 2019 of patients aged > 75 years with a mTBI on anticoagulant therapy who received at least two cranial computer tomography (cCT) scans. Of 1477 inpatient stays, 39 had primary cranial bleeding, and in 1438 the results of initial scans were negative for cranial bleeding. Of these 1438 cases, 6 suffered secondary bleeding from the control cCT scan. There was no significance for bleeding related to the type of anticoagulation. We conclude that geriatric patients under anticoagulant medication don’t need a second cCT scan if the primary cCT was negative for intracranial bleeding and the patient shows no clinical signs of bleeding. These patients can be dismissed but require an evaluation for need of home care or protective measures to prevent recurrent falls. The type of anticoagulant medication does not affect the risk of bleeding.

ITP Patients in the Asia Pacific: Are They Different?

BackgroundImmune thrombocytopenia (ITP) is an autoimmune disorder characterized by auto-antibody induced platelet (PLT) destruction and reduced PLT production, leading to a low PLT count. The availability of robust epidemiological and clinical data on ITP in regions outside Europe and the United States is limited. The International ITP Registry is a prospective cohort study which seeks to collect epidemiological and clinical data of recently diagnosed primary ITP adult patients, predominantly from the Asia-Pacific region. The International Registry has been established for > 6 years.AimsTo contrast and compare the International ITP Registry population with the Intercontinental Cooperative Immune Thrombocytopaenia Study Group Pediatric and Adult Intercontinental Registry on Chronic ITP (PARC-ITP Registry) adult population. The PARC - ITP Registry was selected as it represents a prospective cohort including newly diagnosed ITP patients, with a comparably sized adult cohort which is well established (>5 years) across the regions in which epidemiological data is already available1.MethodClinical and laboratory data from the International ITP Registry 2016 data analysis were compared with clinical and laboratory data reported for adults enrolled in the PARC-ITP registry.ResultsThe PARC Registry had 340 adult patients enrolled in 31 countries across Europe, Canada, United States, Latin America, the Middle East, and Asia. As at 31 August 2016 514 patients had data available for the International ITP Registry from 44 sites across 10 countries. Patient characteristics are presented in Table 1.The International ITP Registry has a predominance of patients of Asian origin whereas the PARC- ITP Registry population is principally Caucasian (55% v 63%). A female predominance is seen in both cohorts.Comorbidities are reported more often in the International Registry group (34% vs 30% in PARC). Hypertension is the most often reported comorbidity in both groups. Of the comorbidities related to ITP diagnosis that are available for comparison, diabetes occurs more often in the International Registry group and gastrointestinal disease is reported at similar rates in both groups (Table 1).Mean PLT count at baseline was 32 x 109/L (range 0-99 x 109/L) in the International Registry group and 25.4 x 109/L (range 0-133 x 109/L) in the PARC Registry adults.Corticosteroids are the most frequently used first-line treatment in both groups - 76% in the International Registry and 59% in the PARC-ITP Registry adults. IVIg is used in both populations at much lower rates - 26 % in the International Registry and 6% in the PARC-ITP Registry adults. Splenectomy is uncommon, with 40 patients in our group having splenectomy, splenectomy is not reported on in the PARC-ITP Registry publication. TPO-receptor agonist use is reported in the International Registry group (n = 48) but not reported on in the PARC-ITP Registry group. Anti-D is reported both groups at rates <5%, and both groups have similar rates of not treated patients with approximately one-third of patients untreated in each group (Table 1).Clinical signs of bleeding were assessed by location in both Registries. The International Registry also records severity of bleeding. Bleeding at any site was seen in 39% of patients in the International Registry whereas PARC -ITP Registry reports manifestations of bleeding in 69% of adults.Summary/ConclusionComparative data showed similarities in gender distribution, presenting platelet counts, and diagnostic testing, whereas differences occurred in ethnicity, co-morbidity, bleeding, and first and second line therapies.ReferencesKühne T, et al on behalf of the Intercontinental Cooperative ITP Study Group. Newly diagnosed immune thrombocytopenia in children and adults: a comparative prospective observational registry of the Intercontinental Cooperative Immune Thrombocytopenia Study Group. Haematologica 2011;96(12):1831-1837. doi:10.3324/haematol.2011.050799 [Display omitted] DisclosuresLee:Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Member of advisory Boards for Novartis on Revolade ;involved in the Novartis sponsored Phase IV multicenter, observational study in Chronic Immune Thrombocytopenia patients on Revolade treatment in emerging markets (CITE Study)“, Research Funding. Ilhan:Novartis: Consultancy.

COVID-19-associated pseudothrombocytopenia.

COVID-19-associated pseudothrombocytopenia.

Accidental apixaban intoxication in a 23-month-old child: a case report

BackgroundDirect oral anticoagulants, such as apixaban, are increasingly used in everyday practice in order to treat or prevent thromboembolic diseases. To date, there is no available data about apixaban pharmacokinetics in children, and no intoxication has previously been described.Case presentationA 23-month-old boy, with no medical history, was admitted to the emergency department 2 h after accidentally ingesting 40 mg apixaban and 0.75 mg digoxin. No adverse event was observed. Digoxin trough level was within therapeutic values. Apixaban blood concentration increased up to 1712 μg/L at H + 6 (1000–2750 μg/L using 2–5 mg/kg of apixaban in adults). The terminal half-life was 8.2 h (6–15 h in adults). The rapid elimination may explain the absence of bleeding despite high concentrations.ConclusionsDespite an important intake of apixaban and a real disturbance in routine coagulation assays, no clinical sign of bleeding was observed, perhaps due to wide therapeutic range of apixaban. It may also be explained by its rapid elimination. Considering the high Cmax and a possible enteroenteric recycling, the use of activated charcoal should be considered in such situations in order to prevent eventual bleeding.

A Prospective Analysis of Potential and Observed Drug-Drug Interactions, Adverse Events and its Associated Risk Factors in Hospitalized Cardiology Patients in Benin.

The objective is to ascertain the pattern of potential drug-drug interactions (pDDIs) and record any observed DDIs and adverse events (AEs) in hospitalized Beninese cardiology patients from Sub-Saharan Africa and analyze all risk factors associated with DDIs and AEs. It was a prospective study in which data including AEs were assessed from medical files and interview of patients and their relatives. Patients who were treated with more than two drugs and who remained in the hospital for at least 48 hours were included. A computerized database system Pharma IAM- VIDAL version 2011 was used to identify the pattern for potential DDIs. 156 patients were included in this study. The prevalence of potential DDIs was estimated at 93 % (145/156). Forty (5.1%) among 804 potential DDIs identified were observed clinically. The observed DDIs were attributable to low blood pressure (27.5%), hyponatremia (22.5%), hemorrhage (20.0%), hyperkalemia (17.5%) and nephrotoxicity (7.5%). The combination of spironolactone and furosemide resulted in hyponatremia while the combination of enoxaparin and potassium resulted in hyperkalemia. ACE inhibitor (or ARAII) in combination with furosemide resulted in the nephrotoxicity cases observed. Enoxaparin, Acetyl salicylic acid, Acenocoumarol and Clopidogrel were decreasingly involved in the pairs of drugs responsible for observed hemorrhages. 29 patients out of 156 (18.6%) had at least one AE. AEs were mainly (34.2%) of metabolic type. Severe AEs, which represented 18.4% was mostly from nephrotoxicity and metabolic disorders. More than 14 active substances multiplied the risk factor for AEs occurrence by 42, while more than 14 days hospitalization increased this risk by 42. This study highlights the need to optimize treatments by strictly regulating blood pressure, serum sodium and potassium levels, coagulation parameters and looking for clinical signs of hemorrhage. Physician should be aware of certain drug associations that may carry a risk of severe adverse events.

Hematologic Parameters and Blood Cultures from the Gingival Vein Compared with the Cranial Vena Cava in Guinea Pigs.

Blood collection methods in guinea pigs are limited due to the animals' compact neck, short limbs, and lack of a tail. Gingival venipuncture is a recently described blood sampling technique that is minimally traumatic with no significant alterations in hematologic parameters when multiple blood samples were collected weekly for 6 wk. The purpose of this study was to determine whether the gingival vein can be used as an alternative blood collection site in guinea pigs, such that: (1) hematologic parameters would be consistent with samples collected from the cranial vena cava; and (2) no contaminants from the oral cavity would be introduced into the sample. Blood samples were obtained from both the gingival vein and cranial vena cava of anesthetized Dunkin Hartley guinea pigs for CBC (n = 9) and aerobic blood cultures (n = 10). Only MCV was significantly different between sampling sites. Bland-Altman analyses calculated a small mean bias for all hematologic parameters, indicating clinical interpretation is unlikely to be affected by the sampling site. Bacterial growth occurred in all 5 gingival vein blood samples prepared by using saline and 2 of the 5 prepared with dilute chlorhexidine. Bacteria did not grow from any cranial vena caval blood samples prepared with dilute chlorhexidine. No clinical signs of hemorrhage or trauma were detected at either site. These results provide evidence that gingival venipuncture can be used as an alternative blood collection method for guinea pigs for hematologic analysis but should not be used for blood culture.

THROMBOCYTOSIS: A RETROSPECTIVE STUDY OF 573 DOGS (2016-2017)

Abstract Thrombocytosis refers to the increase in number of platelets per microliter (µL) of blood. Platelet counts greater than 1,000,000/µL may be associated with clinical signs of bleeding or thrombosis. Previous studies on underlying causes of thrombocytosis have aroused the interest of researchers about its clinical importance in dogs. The objective of this study was to analyze the blood cell counts in dogs in order to define the main diseases or clinical conditions that were associated with thrombocytosis, from 2016 to 2017. This was done to determine the incidence of thrombocytosis, and categorize the increase in platelet count with respect to severity. Of the 12,676 blood samples analyzed, 4.5% presented thrombocytosis (n = 573). Similar mean platelet counts were observed in all diagnosis or different categories of clinical conditions (neoplasms; gastrointestinal, endocrine, and ophthalmological diseases; trauma and surgery; dermatological, cardiac, neurological, infectious, respiratory, genitourinary, idiopathic, and multiple diseases; and pregnancy) with no significant difference (P ≥ 0.05). The disorders most commonly associated with thrombocytosis were gastrointestinal diseases, followed by neoplasms. Furthermore, increased platelet counts were observed in dogs treated with glucocorticoids and vincristine drugs. As for the degree of severity, extreme thrombocytosis occurred more frequently in the presence of gastrointestinal diseases.

Correlation of plasma coagulation tests and fibrinogenClauss with rotational thromboelastometry parameters and prediction of bleeding in dogs.

BackgroundCorrelation of plasma fibrinogen concentration (fibrinogenClauss) with rotational thromboelastometry (ROTEM) parameters has not been investigated in dogs.ObjectivesTo determine the correlation between plasma coagulation tests and fibrinogenClauss with ROTEM parameters and to evaluate their ability to predict bleeding in dogs.AnimalsNinety‐seven dogs with concurrent determination of fibrinogenClauss and fibrin polymerization test (FIBTEM) analysis.MethodsSignalment, pretreatment, clinical signs of bleeding, fibrinogenClauss, plasma coagulation test results, hematocrit, platelet count, FIBTEM, extrinsic (EXTEM) and intrinsic (INTEM) activated ROTEM assays were retrieved retrospectively. Correlations between fibrinogenClauss and FIBTEM maximum clot firmness (MCFFIBTEM) and between prothrombin time (PT) or activated partial thromboplastin time (aPTT) and ROTEM parameters were determined. Dogs were further assigned to groups with or without clinical signs of bleeding. The prognostic significance of significantly different parameters to predict bleeding was evaluated.ResultsFibrinogenClauss showed strong correlation with MCFFIBTEM (r = 0.860, n = 97, P < .001). PT showed strong correlation with EXTEM clotting time (CTEXTEM) (r = 0.839, n = 53, P < .001), and aPTT was strongly correlated with INTEM CT (CTINTEM) (r = 0.664, n = 31, P < .001). Platelet count, PT/aPTT, EXTEM clot formation time (CFTEXTEM), MCFEXTEM, EXTEM maximum clot elasticity (MCEEXTEM), and CTINTEM were significantly different between groups. A CTINTEM >149 seconds was 100% sensitive to detect bleeding.Conclusions and Clinical ImportanceThe MCFFIBTEM can be used to evaluate the effect of fibrinogen on hemostasis as an alternative to determination of fibrinogenClauss. In addition, CTEXTEM and CTINTEM are strongly correlated with PT and aPTT, respectively.

Outbreak of Crimean-Congo haemorrhagic fever with atypical clinical presentation in the Karak District of Khyber Pakhtunkhwa, Pakistan

BackgroundCrimean-Congo haemorrhagic fever (CCHF) is a potentially fatal disease endemic in Pakistan. The causative virus is transmitted by the bite of Hyalomma ticks or by contact with infected blood or tissue. First cases of the disease were reported in Pakistan in 1976 but regular outbreaks have been observed since the year 2000. A huge agricultural base with more than 175 million livestock, the concomitant presence of Hyalomma ticks and a lack of precautionary measures to prevent transmission lead to a considerable risk for exposed populations to contract CCHF in Pakistan. At the same time, secondary cases contracted by nosocomial transmission are reported from hospitals.Case presentationHere we present an outbreak of CCHF with four of six patients succumbing to the disease before the suspicion for CCHF was raised. Importantly, the main clinical features of these cases were gastrointestinal symptoms without any clinical signs of bleeding. Only the last two patients in this outbreak presented with typical signs of bleeding disorder and were then confirmed being infected by CCHF. Confirmation of diagnosis was done at the National Institute of Health by real-time RT-PCR.ConclusionsThis case series highlights the importance of early clinical suspicion for CCHF in exposed individuals and the need for improved precautionary measures against the spread of CCHF within the Pakistani population and hospitals.

Excessive Hypocoagulation in Therapy with Warfarin within Polypharmacy: Using online database Multi-Drug Interaction Checker and Graphic “Time-Effect-Drug Administration” to Eliminate Adverse Drug Event (Case Report)

The purpose of this article is to demonstrate a new approach to polypharmacy management in ambulatory practice using as example a case report of adverse drug event (ADE) in patient with atrial fibrillation and comorbidity. The patient had excessive polypharmacy level (11 drugs). Minor bleeding developed when using these drugs (INR – 6.70). The analysis of drug interactions was performed at patient’s home by online database Multi-Drug Interaction Checker and Time-effect-drug graphic. As a result of analysis, it was described two drug interactions led to minor bleeding: warfarin+rosuvastatin, warfarin+amiodarone. It was found that the patient had not taken rosuvastatin before and it was first-time administration of rosuvastatin. Therapy was corrected, the causes and effects of ADE are eliminated. The drugs without proven benefit and known drug interactions were cancelled. There were no clinical signs of bleeding after correction and the last INR was 2.54. Combined using of Multi-Drug Interaction Checker and Time-effect-drug graphic allowed to detect causal relationship between ADE and drugs initiating it and then to make a rational decision right at the patient’s home in a short time.

Effectiveness of platelet transfusion in acute leukemic pediatric patients: a prospective study

Background: In India, leukemia account for 25-35% of hematologic malignancies affecting children. Pediatric patients with acute leukemia have to undergo chemotherapy, which may cause protracted thrombocytopenia due to the cytotoxic effects of the drugs prescribed and due to the primary disease. The aim of the present study was to evaluate the need for platelet transfusion in leukemic children and to assess the effectiveness of platelet transfusion among them. Methods: A prospective observational study was conducted in the Department of transfusion medicine and hematology at a tertiary care teaching hospital for a period of one year. The study population included children diagnosed as acute leukemia in the age group 1-12 years. The transfusion was given depending upon the clinical sign of bleeding and the platelet count. The pre and post transfusion platelet count (24 hours after the transfusion) were estimated using hematology analyzer. Statistical analysis was performed using SPSS software. Results: 198 episodes of platelet transfusion were given to 30 children with acute leukemia. It was found for 95% CI of the mean between the pre and post-transfusion platelet count for single, double units and more than two units platelet transfusion, the rise in platelet count was significant (p&lt;0.0001) and there was no refractoriness. All children were negative for transfusion transmissible infections at the end of the study.Conclusions: In the present study, the clinical management of children with acute leukemia has significantly improved with use of platelet transfusions and thereby, the mortality rate due to bleeding complications has dropped rapidly with remarkable clinical improvement in clinical outcomes.

Comparison of the Hemostatic Efficacy of Pathogen-Reduced Platelets vs Untreated Platelets in Patients With Thrombocytopenia and Malignant Hematologic Diseases

Pathogen reduction of platelet concentrates may reduce transfusion-transmitted infections but is associated with qualitative impairment, which could have clinical significance with regard to platelet hemostatic capacity. To compare the effectiveness of platelets in additive solution treated with amotosalen-UV-A vs untreated platelets in plasma or in additive solution in patients with thrombocytopenia and hematologic malignancies. The Evaluation of the Efficacy of Platelets Treated With Pathogen Reduction Process (EFFIPAP) study was a randomized, noninferiority, 3-arm clinical trial performed from May 16, 2013, through January 21, 2016, at 13 French tertiary university hospitals. Clinical signs of bleeding were assessed daily until the end of aplasia, transfer to another department, need for a specific platelet product, or 30 days after enrollment. Consecutive adult patients with bone marrow aplasia, expected hospital stay of more than 10 days, and expected need of platelet transfusions were included. At least 1 transfusion of platelets in additive solution with amotosalen-UV-A treatment, in plasma, or in additive solution. The proportion of patients with grade 2 or higher bleeding as defined by World Health Organization criteria. Among 790 evaluable patients (mean [SD] age, 55 [13.4] years; 458 men [58.0%]), the primary end point was observed in 126 receiving pathogen-reduced platelets in additive solution (47.9%; 95% CI, 41.9%-54.0%), 114 receiving platelets in plasma (43.5%; 95% CI, 37.5%-49.5%), and 120 receiving platelets in additive solution (45.3%; 95% CI, 39.3%-51.3%). With a per-protocol population with a prespecified margin of 12.5%, noninferiority was not achieved when pathogen-reduced platelets in additive solution were compared with platelets in plasma (4.4%; 95% CI, -4.1% to 12.9%) but was achieved when the pathogen-reduced platelets were compared with platelets in additive solution (2.6%; 95% CI, -5.9% to 11.1%). The proportion of patients with grade 3 or 4 bleeding was not different among treatment arms. Although the hemostatic efficacy of pathogen-reduced platelets in thrombopenic patients with hematologic malignancies was noninferior to platelets in additive solution, such noninferiority was not achieved when comparing pathogen-reduced platelets with platelets in plasma. clinicaltrials.gov Identifier: NCT01789762.

European Guidelines on perioperative venous thromboembolism prophylaxis: Executive summary.

European Guidelines on perioperative venous thromboembolism prophylaxis: Executive summary.

Outcome of laparoscopic ovariohysterectomy or ovariectomy in dogs with von Willebrand disease or factor VII deficiency: 20 cases (2012-2014).

OBJECTIVE To describe surgical techniques and perioperative management of dogs with von Willebrand disease (VWD) or factor VII (FVII) deficiency undergoing laparoscopic ovariohysterectomy or ovariectomy and evaluate outcomes. DESIGN Retrospective case series. ANIMALS 20 client-owned dogs with VWD (n = 16) or FVII deficiency (4). PROCEDURES Dogs with VWD or FVII deficiency that underwent laparoscopic ovariohysterectomy or ovariectomy between 2012 and 2014 were retrospectively identified via a multi-institutional review of medical records. RESULTS Median expression of von Willebrand factor was 19% (interquartile range, 18% to 30%). All 16 dogs with VWD were Doberman Pinschers, and all were pretreated with desmopressin; 4 also received cryoprecipitate. One of 4 dogs with FVII deficiency received plasma preoperatively, and 1 was treated with desmopressin; 2 dogs received no preoperative treatment. Laparoscopic ovariectomy was performed in 9 dogs with VWD and 2 dogs with FVII deficiency, laparoscopic ovariectomy with gastropexy was performed in 6 dogs with VWD and 1 dog with FVII deficiency, and laparoscopic-assisted ovariohysterectomy was performed in 1 dog with VWD and 1 dog with FVII deficiency. Iatrogenic splenic laceration requiring conversion to laparotomy occurred during trocar insertion in 1 dog with VWD. No postoperative complications, including signs of hemorrhage, were reported for any dogs. CONCLUSIONS AND CLINICAL RELEVANCE Laparoscopic ovariohysterectomy or ovariectomy in dogs with VWD or FVII deficiency pretreated with desmopressin, cryoprecipitate, or plasma transfusions were not associated with clinical signs of hemorrhage, suggesting that minimally invasive ovariohysterectomy or ovariectomy may be considered in female dogs affected with these coagulopathies.

Hyperfibrinolysis and Hypofibrinogenemia Diagnosed With Rotational Thromboelastometry in Dogs Naturally Infected With Angiostrongylus vasorum.

BackgroundThe pathomechanism of Angiostrongylus vasorum infection‐associated bleeding diathesis in dogs is not fully understood.ObjectiveTo describe rotational thromboelastometry (ROTEM) parameters in dogs naturally infected with A. vasorum and to compare ROTEM parameters between infected dogs with and without clinical signs of bleeding.AnimalsA total of 21 dogs presented between 2013 and 2016.MethodsDogs with A. vasorum infection and ROTEM evaluation were retrospectively identified. Thrombocyte counts, ROTEM parameters, clinical signs of bleeding, therapy, and survival to discharge were retrospectively retrieved from patient records and compared between dogs with and without clinical signs of bleeding.ResultsEvaluation by ROTEM showed hyperfibrinolysis in 8 of 12 (67%; 95% CI, 40–86%) dogs with and 1 of 9 (11%; 95% CI, 2–44%) dogs without clinical signs of bleeding (P = .016). Hyperfibrinolysis was associated with severe hypofibrinogenemia in 6 of 10 (60%; 95% CI, 31–83%) of the cases. Hyperfibrinolysis decreased or resolved after treatment with 10–80 mg/kg tranexamic acid. Fresh frozen plasma (range, 14–60 mL/kg) normalized follow‐up fibrinogen function ROTEM (FIBTEM) maximal clot firmness in 6 of 8 dogs (75%; 95% CI, 41–93%). Survival to discharge was 67% (14/21 dogs; 95% CI, 46–83%) and was not different between dogs with and without clinical signs of bleeding (P = .379).Conclusion and Clinical ImportanceHyperfibrinolysis and hypofibrinogenemia were identified as an important pathomechanism in angiostrongylosis‐associated bleeding in dogs. Hyperfibrinolysis and hypofibrinogenemia were normalized by treatment with tranexamic acid and plasma transfusions, respectively.