Stop Bleeding Research Articles

Efficacy of palliative hemostatic radiotherapy for tumor bleeding and pain relief in locally advanced pelvic gynecological malignancies.

The appearance of symptomatic tumor-related vaginal bleeding and pain in advanced incurable cancer patients with pelvic gynecological malignancies remains atherapeutic challenge in oncological treatment. The aim of our analysis was to evaluate the efficacy and safety of palliative hemostatic radiotherapy. We retrospectively identified patients who had received palliative hemostatic radiotherapy (RT) at our institution between 2011 and 2023 and evaluated acute toxicity, local control, cessation of bleeding, and pain relief. In total, 40patients with amedian planning target volume of 804 cm3 were treated with amedian total dose of 39 Gy in 13fractions, resulting in 6‑month and 1‑year local control rates of 66.9 and 60.8%, respectively. No higher-grade (>gradeIII) acute RT-induced toxicity appeared. Complete cessation of bleeding was achieved in 80.0% of all patients after amedian of 16days and pain relief was documented in 60.9% at first follow-up. 37.5% of the women required ablood transfusion and 25% an additional tamponade with local hemostatic agents. Successful stopping of bleeding was significantly less frequent in patients receiving anticoagulation concurrently with radiation and in the case of infield re-irradiation. Patients with ahigher total RT dose had cessation of bleeding significantly more often, with acut-off value of at least EQD2 (α/β = 10) = 36 Gy. The applied RT technique and planning target volume had no significant influence on the occurrence of bleeding cessation. Palliative hemostatic radiotherapy for locally advanced pelvic gynecological malignancies is safe and effective in achieving high control rates of hemostasis in tumor bleeding and pain relief.

A versatile natural gelatin-based hydrogel for emergency wound treatment through hemostasis, antibacterial, and anti-inflammation

Emergency wounds are often accompanied by bacterial infection, oxidative stress, and excessive inflammation due to the inability to quickly close and stop bleeding, resulting in chronic wounds that are difficult to heal. Clinically, surgical suturing is the fastest method for wound closure, but it is only suitable for wounds with small bleeding volumes and causes unsightly scar formation. Consequently, there is a critical need for hemostatic dressings versatile enough to address a spectrum of diverse and intricate wounds, especially in emergency scenarios. In this study, we constructed a unique versatile natural gelatin-based hydrogel with hemostasis, antibacterial, and anti-inflammation properties. The hydrogel was composed of 4-(4-(hydroxymethyl)-2-methoxy-5-nitrophenoxy) butyrylethylenediamine-modified methacrylated gelatin (GelMA-NB) and epigallocatechin gallate-grafted polylysine (EPL-EGCG), which imparts adhesion, antibacterial and antioxidant properties to the hydrogel. Simultaneously, the hydrogel was loaded with GelMA microspheres encapsulating natural resveratrol (RES@GM). This combination not only exhibited outstanding hemostatic capabilities but also preserved the anti-inflammatory potential of RES. In different animal models, the hydrogel exhibited outstanding hemostatic and wound healing effects, down-regulated the expression of IL-1βto promote inflammatory regulation and potential for angiogenesis and anti-scar. In conclusion, unique versatile natural gelatin-based hydrogel suitable for various complex wounds provides a promising strategy for emergency wound dressing applications.

Advancements in Vascular Closure Devices for Effective Hemostasis in Femoral Artery Interventions.

With medical technology development, endovascular intervention has been widely used in clinical practice, and the establishment of surgical access through the femoral artery, where most vascular interventions are performed, is a common method. Postoperative hemostasis at the femoral artery puncture site is a key part of interventional procedures and is particularly important to ensure the safety and effectiveness of hemostasis. Some patients undergoing interventional therapy also use anticoagulant and antiplatelet drugs preoperatively and undergo systemic heparin session intraoperatively, which leads to abnormal coagulation, thus increasing the difficulty of hemostasis at the puncture point postoperatively. Certain patients with specific conditions, such as combined vascular calcification, obesity, diabetes mellitus, and renal impairment, present more challenging cases for postoperative puncture point hemostasis. Femoral artery puncture site hemostasis methods include manual compression, arterial compression devices, and vascular closure devices, which are a kind of equipment that helps interventional doctors stop bleeding quickly at the femoral artery puncture site. From the 1990s to the present, vascular occluders with many different concepts and mechanisms have emerged. Based on different hemostatic principles and materials, the mechanisms and principles of action are varied and include sealant occlusion, collagen patch embolization, polyester suture closure, absorbable polyethanol embolic agents, nickel-titanium alloy clips, polydiethanol sealant embolization, and suture bioabsorbable patches. Many studies have compared the hemostatic effect of vascular closure devices with those of manual compression. In this article, we review the hemostatic effects of the 2 modalities and the advances in the use of vascular closure devices in vascular intervention.

Laporan Pendidikan Kesehatan Kebutuhan Nutrisi Untuk Proses Penyembuhan Luka Post OP di Bangsal Mawar RSUD Dr Soehadi Prijonegoro Sragen

: Background: Nutrients are obtained from food and fluids which are then assimilated by the body. Nutrition itself is one of the factors that can support the wound healing process, there are things that are no less important that must be considered as well, namely the nutrients from the food we eat during the wound healing process. Objective: The purpose of postoperative diet is to strive for the patient's nutritional status to return to normal immediately to accelerate the healing process and increase the patient's immune system, by providing basic needs (fluids, energy, protein), replacing the loss of protein, glycogen, iron, and other nutrients, correcting electrolyte and fluid imbalances, preventing and stopping bleeding. Methods: The media used in health education activities is leaflets. Through leaflets we hope that the delivery of material can be understood by participants and can be delivered well.Results: The results of observations from this health education activity, that the majority of participants are active in asking questions and answering questions given by the health education team and can explain the essence of the material that has been delivered by the speaker Conclusion: Of the 20 patient families who attended 15 people had understood the fulfillment of nutritional needs for the correct post op wound healing process.

Freestanding Hydrogen-Bonded Organic Framework Membrane for Efficient Wound Healing.

Hydrogen-bonded organic frameworks (HOFs) are emerging as multifunctional materials with exceptional biocompatibility, abundant active sites, and tunable porosity, which are highly beneficial for advanced wound care. However, a significant challenge involves transforming pristine HOFs powders into lightweight, ultrathin, freestanding membranes compatible with soft biological systems. Herein, the study successfully develops shape-adaptive HOF-based matrix membranes (HMMs) using a polymer-assisted liquid-air interface technique. The HMMs conform seamlessly to tissues of different sizes and shapes, effectively stopping bleeding, and provide high water-vapor permeability. Notably, both in vitro and in vivo studies with mice wound models demonstrated that these tissue-conformable HMMs significantly accelerate wound healing by modulating the inflammatory environment of the injured tissue and promoting rapid re-epithelialization. Furthermore, RNA-seq analysis and mechanistic studies revealed that HMMs effectively reduce inflammation and facilitate the tissue transition from the proliferative stage to the remodeling stage of skin development. This work not only opens up new avenues for advanced wound care materials but also establishes a foundation for hybridizing HOFs with polymers for a wide range of potential applications.

Blood-responsive mussel-inspired hydrogels for hemostasis, antibacterial action, and wound healing

Rapid hemostasis, potent antimicrobial activity, and efficient wound management are critical factors in enhancing the survival of trauma patients. Chitosan, as a green and sustainable biomaterial with low cost, degradability and biocompatibility, is widely used in the biomedical field. However, chitosan dissolves in an acidic environment, which is not conducive to wound healing. In this study, chitosan was chemically modified to address this limitation. A mussel-inspired hydrogel composed of caffeic acid-grafted chitosan, gallic acid-grafted chitosan, and oxidized microcrystalline cellulose (CHI-C/CSG/OMCC) was designed. This hydrogel exhibits blood-responsive gelation behavior and offers a synergistic combination of tissue adhesion, antimicrobial properties, and tissue repair capabilities. The carboxyl, hydroxyl, phenolic hydroxyl and aldehyde groups within the hydrogel system endowed the hydrogel with excellent adhesion properties (53.1 kPa adhesion strength to porcine skin-adherent tissues), biocompatibility, and excellent antimicrobial properties. Surprisingly, this hydrogel not only achieved rapid and effective hemostasis, but also effectively promoted wound healing in a mouse skin injury model. In addition, its remarkable efficacy in stopping bleeding within approximately 2 min without rebleeding was demonstrated in a porcine model of acute gastrointestinal hemorrhage in the esophagus, stomach, and intestines. This blood-responsive ternary hydrogel offers a promising alternative to wound management materials due to its excellent overall performance and superior efficacy in all phases of wound healing.

Etamsylate-loaded hydrogel composed of carboxymethyl chitosan and oxidized tannic acid for improved wound healing

Proper wound dressing is essential to facilitate skin wound healing, stop bleeding, and prevent infections. Herein, carboxymethyl chitosan (CMC) was crosslinked with oxidized tannic acid (OTA) to form an adhesive and self-healing OTA/CMC hydrogel, and etamsylate was loaded to enhance the hemostatic effect of the hydrogel dressing. The resultant OTA/CMC/E hydrogel exhibited a spectrum of noteworthy attributes including excellent cell compatibility, high antioxidant activity, effective anti-bacterium, and excellent hemorrhage control. Functionally, it mitigated intracellular ROS levels, hindered the proliferation of Staphylococcus aureus, while also significantly reducing hemostasis duration and total blood loss. In vivo full-thickness skin incision results showed that the OTA/CMC/E hydrogel could efficiently accelerate in vivo wound closure and healing, promising as an advanced wound healing material.

Clinical evolution of bladder carcinosarcoma: A case report and literature review.

Bladder carcinosarcoma (BC) is a malignant tumor composed of a mixture of malignant epithelial and stromal components. Carcinosarcoma mostly occurs in the upper respiratory tract and upper gastrointestinal tract and is less common in the urinary system. The incidence of malignant tumors of the urinary system is <3%. It rarely occurs in the bladder and accounts for approximately 0.31% of all malignant bladder tumors. A literature review and this report will help to further improve our understanding, diagnosis, and treatment of bladder carcinosarcoma (BC). We describe the case of an 80-year-old female patient who was admitted to the hospital with a history of intermittent hematuria for 3 years. Furthermore, total cystectomy was refused when a BC was diagnosed. Palliative resection surgery was necessary because of the recurrent hematuria and abdominal pain. Pathologically confirmed BC after surgery. The patient's first transurethral resection of bladder tumor (TURBT) was diagnosed as BC. However, the patient refused a total cystectomy. Two months after intravesical treatment with epirubicin, bladder tumor recurrence was observed during follow-up cystoscopy. The patient underwent a second TURBT for hemostatic treatment due to persistent hematuria. Due to hematuria and abdominal pain, a third TURBT was performed to reduce tumor size and stop bleeding. Finally, tumor recurrence resulted in bilateral hydronephrosis, and the patient underwent bilateral renal catheter drainage guided by B-ultrasound. Bladder carcinosarcoma caused uremia, electrolyte imbalance, and sepsis. Approximately 19 months after the discovery of the tumor, the patient died. Radical bladder resection is recommended once a BC is diagnosed. By reporting the cases and reviewing the literature in the database, we will summarize the epidemiology, origin, etiology, clinical features, existing treatments, and prognostic factors of BC, and propose new prospects for BC therapy.

Advances in research on the main nutritional quality of daylily, an important flower vegetable of Liliaceae.

Daylily (Hemerocallis citrina) is a perennial herb of the genus Hemerocallis of Liliaceae. It is also an economically important crop and is widely cultivated. Daylily has nutritional, medicinal and ornamental values. The research literature shows that daylily is a high-quality food raw material rich in soluble sugars, ascorbic acid, flavonoids, dietary fiber, carotenoids, mineral elements, polyphenols and other nutrients, which are effective in clearing heat and diuresis, resolving bruises and stopping bleeding, strengthening the stomach and brain, and reducing serum cholesterol levels. This article reviews the main nutrients of daylily and summarizes the drying process of daylily. In addition, due to the existence of active ingredients, daylily also has a variety of biological activities that are beneficial to human health. This article also highlights the nutritional quality of daylily, the research progress of dried vegetable rehydration technology and dried daylily. In the end, the undeveloped molecular mechanism and functional research status of daylily worldwide are introduced in order to provide reference for the nutritional quality research and dried processing industry of daylily.

Ayurvedic Management of Multifactorial Female Infertility – A case report

Introduction: Infertility is a medical condition that can cause psychological, physical, mental, spiritual, and medical detriments to the patient. “Infertility is defined as failure to conceive within one or more years having regular unprotected coitus. All types of female Infertility in Ayurveda are described under the heading of Vandhya. According to Acharya Sushruta, there are four factors responsible for creation of Garbha i.e. Ritu (Ovulatory period/ period for copulation), Kshetra (reproductive tract including Uterus, Fallopian tube, Ovary), Ambu (Nutritive fluid for fertilized ovum), Beeja (Shukra &amp; Shonita i.e. Sperm &amp; Ovum). Among these four factors tubal blockage can be considered as the deformity of Kshetra i.e. Kshetradushti and Low level of Anti mullerian hormone can be compared to Dhatukshayajanya Vandhyatav. Aim and Obejctive: This case study was done to treat multifactorial female infertility with Ayurvedic treatment protocol and provide better quality of life. Methodology: A female Patient of 28 years of age, came to OPD of Prasuti Tantra Evum Stree roga with complaint of inability to conceive since 2 years of unprotected intercourse. Patient was diagnosed with female infertility due to bilateral tubal blockage, and low AMH level treated by Ayurvedic intervention i.e. - Virechana Karma, Yuktaratha Basti (3 days) along with Uttarabasti with Apamargkshara Taila (6 days) and Nagakesara Choorna orally (after stopping of menstrual bleeding). Result: Female infertility cured after treatment and conception achieved. Discussion: Ayurvedic approach would be beneficial in conservative management of tubal blockage and has an effective result in female infertility.

Research Progress on Quality Control Methods of Donkey-hide Gelatin Preparations

Donkey-hide Gelatin is a solid gum made by decoction and concentration of the dried skin or fresh skin of an equine donkey, which was first published in the The Holy Husbandman s Classic on Roots and Herbs, and listed as the top product. It has the effect of nourishing blood and nourishing yin, moisturizing and stopping bleeding. Through literature search, it was found that Donkey-hide Gelatin mainly used thermogravimetric analysis, gel electrophoresis, infrared spectroscopy, X-ray fluorescence spectroscopy, circular dichromatography [9], liquid chromatography-mass spectrometry, DNA extraction and amplification in authenticity, chemical composition and content analysis. The foundation of the quality control method of Donkey-hide Gelatin preparation is relatively weak, therefore, by combing the quality control methods of Donkey-hide Gelatin preparation in the past ten years, the advantages and disadvantages of the quality control method are discussed and evaluated, which provides reference value for the establishment of a comprehensive multi-faceted quality control system for Donkey-hide Gelatin preparation.

The efficacy and safety of combined therapy with endobronchial tamponade and bronchial artery embolization for massive hemoptysis

BackgroundMassive hemoptysis is characterized by its life-threatening nature, potentially leading to airway obstruction and asphyxia. The objective of this study was to evaluate the clinical effectiveness of combining endobronchial tamponade with bronchial artery embolization (BAE) in the treatment of massive hemoptysis.MethodsBetween March 2018 and March 2022, a total of 67 patients with massive hemoptysis who underwent BAE were divided into two groups: the combination group (n = 26) and the BAE group (n = 41). Technical and clinical success rates were assessed, and adverse events were monitored following the treatment. Blood gas analysis and coagulation function indicators were collected before and after the treatment, and recurrence and survival rates were recorded during the follow-up period.ResultsAll patients achieved technical success. There were no significant differences in the clinical success rate, recurrence rates at 3 and 6 months, and mortality rates at 3 months, 6 months, and 1 year between the combination group and the BAE group. However, the hemoptysis recurrence rate at 1 year was significantly lower in the combination group compared to the BAE group (15.4% vs. 39.0%, P = 0.039). No serious adverse events were reported in either group. After treatment, the combination group showed higher levels of arterial partial pressure of oxygen (PaO2), oxygenation index (PaO2/FiO2), fibrinogen (FIB), and D-dimer (D-D) compared to the BAE group (P < 0.05). Multivariate regression analysis demonstrated a significant correlation between combined therapy and hemoptysis-free survival.ConclusionCombination therapy, compared to embolization alone, exhibits superior efficacy in improving respiratory function, correcting hypoxia, stopping bleeding, and preventing recurrence. It is considered an effective and safe treatment for massive hemoptysis.

Evaluation of composition effects on the tissue-adhesive, mechanical and physical properties of physically crosslinked hydrogels based on chitosan and pullulan for wound healing applications

Tissue adhesion of hydrogels plays an important role in wound healing, which can improve the efficiency of wound treatment, stop bleeding, facilitate tissue growth and wound closure. However, most non-covalent crosslinked hydrogels have weak tissue adhesion and rheological properties. Furthermore, it remains a challenge to synthesize a fully physically crosslinked hydrogel with good rheological properties without compromising its tissue adhesion strength. In this paper, a physically crosslinked hydrogel was developed from a mixture of chitosan and pullulan in different polymer volume ratios using aqueous NaOH. Fourier transform infrared spectroscopy, scanning electron microscopy, thermal analysis, rheological and lap shear tests were used to evaluate the influence of polymer volume ratios on the rheological, and tissue adhesive properties of the hydrogels. It was found that the hydrogels possessed high tissue adhesive strength ranging from 18.0 ± 0.90 to 49.0 ± 2.45 kPa and good storage moduli up to 5.157 ± 1.062 kPa. Gentamicin was incorporated into this polymer matrix and the release profile was investigated. The ratio of chitosan and pullulan to obtain hydrogels with optimum viscoelastic and tissue adhesive properties was identified to be CS/PUL 2:1. These results indicated that the synthesized hydrogels can be potential materials for biomedical applications such as medical adhesives and wound dressings.

ANALYSIS OF METHODS FOR EVALUATION ESSENTIAL PERFORMANCE OF MECHANICAL TOURNIQUETS

The article is devoted to the analysis of methods for evaluating essential performance of mechanical tourniquets to improve their safety in use. According to the legislation of Ukraine and the European Union, a tourniquet is a medical device that, regardless of design, provides relief to a patient in the event of an injury by stopping bleeding in the limb by applying mechanical pressure. Tourniquets are classified as pneumatic and mechanical depending on the method of creating external pressure. The article considers a typical design of mechanical tourniquets and identifies the main structural elements: a pressure generating mechanism, a pressure element, a fixing device, and a place for recording the time of application. The analysis of scientific articles shows a significant number of studies focusing on the characteristics of pneumatic tourniquets, while methods for testing the effectiveness and safety of mechanical tourniquets have been insufficiently investigated. It is noted that the safety of medical devices is defined as the absence of an unacceptable level of risk for the operator and the patient, where risk means the effect of uncertainty in achieving the goals in the process of development, production, design, and use of a medical device. A list of essential performance of mechanical tourniquets is provided: overlapping pressure, pressure loss after application during the time of use, pressure gradient. It has been established that to date, four methods are known for obtaining measurement information on essential performance of mechanical tourniquets: a method based on converting the pressure value generated by the tourniquet during application into an electrical signal using strain sensors; a method based on measuring air pressure in a test cuff; an indirect method for determining pressure using Lamé's equation; a method for directly measuring pressure in the limb under the tourniquet using an invasive pressure sensor. Based on the identified essential performance of mechanical tourniquets, the requirements for methods of their determination are presented: measurement of overlapping pressure, determination of pressure loss after the tourniquet is applied during the time of use, determination of pressure gradient, reproducibility, repeatability, evaluation of metrological uncertainty, and evaluation of the essential performance of mechanical tourniquets based on mathematical models. Ways to improve the existing methods for evaluating essential performance are considered.

TRANSFUSION AND INFUSION THERAPY FOR MASSIVE BLOOD LOSS. PART 4. PHYSIOLOGICAL PREREQUISITES AND LIMITATIONS OF PLATELETS TRANSFUSION FOR HAEMOSTATIC RESUSCITATION

Platelets are the main component of primary haemostasis and participate in secondary, coagulation haemostasis. When bleeding from small vessels, primary (platelet) hemostasis can ensure the thrombus's stability, which is sufficient to stop the bleeding. In case of damage to medium and large vessels, stopping bleeding begins with the activation of platelets, but also requires the activation of the coagulation cascade with the involvement of internal and external coagulation pathways. Blood coagulation factors involved in internal, external and general coagulation pathways not only circulate in the blood but are carried by platelets. In addition, actin and myosin contained in platelets, take an active part already in the final phase of thrombus formation – in clot retraction. Platelets also contain growth factors that stimulate the healing of damaged blood vessels. For more than a decade, platelets have been an integral part of haemostatic resuscitation in cases of massive bleeding in trauma and wounds. The optimal ratio of platelets to red blood cells (RBC) and fresh frozen plasma (FFP) in trauma is 1:1:1, that is, to include a considerable number of platelets. With other variants of surgical massive bleeding, the optimal ratio may be different and the proportion of platelets to RBC, and the number of platelets is smaller. Platelets, like clotting factors, are consumed during thrombus formation and are also passively lost with the outflowing blood. The rate of loss of platelets is sometimes not directly proportional to the amount of blood loss and also depends on the haematocrit. Although during a full-scale war, the frequency of the development of massive bleeding in Ukraine is the highest in the world, to date, the logistical problems with the availability of platelets, especially at the stage of initial resuscitation, are still not resolved. Therefore, in this article, we provide ways to solve the situation, depending on the available resources. In civilian settings, the problem with platelets most often occurs because of intraoperative or traumatic bleeding in the background of taking antiplatelet agents, that is, inhibitors of platelet function. Taking antiplatelet agents can increase bleeding, and the physician needs to know how to restore lost platelet functions or how to replace these lost functions with platelet concentrate. In this publication, we will present the pathophysiological rationale for the importance of early recovery of the first phase of haemostasis - platelet aggregation by transfusion of platelet concentrate in case of traumatic massive bleeding. In addition, we present some methods that contribute to the preservation of platelets, as well as improving their functional activity. Other factors that increase the risk of developing MC are thrombocytopenia and thrombocytopenia caused by hereditary and acquired factors. Although haematologists treat such patients and should be involved as consultants, in this article we will briefly outline the most common treatment methods prescribed by haematologists. The factors that lead to platelet deficiency in the blood vary, but life-threatening bleeding treatment by platelet concentrate transfusion can be a common solution in many situations. If it is not possible to transfuse a sufficient number of platelets concentrate during life-threatening bleeding in patients with thrombocytopenia and platelet dysfunction, it may be transfused a fresh whole-blood.

New Monoterpenoid Glycosides from the Fruits of Hypericum patulum Thunb.

The whole Hypericum patulum Thunb. plant is utilized in traditional medicine for its properties of clearing heat, detoxifying, soothing meridians, relaxing the liver, and stopping bleeding. In folk medicine, it is frequently used to treat hepatitis, colds, tonsillitis, and bruises. Phytochemical investigation of a 30% ethanol extract of the fresh ripe fruits of H. patulum has resulted in the isolation of two new pinane-type monoterpenoid glycosides 1-2, named patulumside E-F, and three new chain-shaped monoterpenoid glycosides 3-5, named patulumside G-H, J. Their structures were determined using extensive spectroscopic techniques, such as HR-ESI-MS, 1D and 2D NMR spectroscopy, and electronic circular dichroism (ECD) calculation. The anti-inflammatory activities of these compounds were evaluated in the LPS-induced RAW264.7 cells. This research represents the inaugural comprehensive phytochemical study of H. patulum, paving the way for further exploration of monoterpenoid glycosides.

Optimization design of semi-open impeller based on thrombogenicity in a blood pump.

Blood clots are composed of aggregated fibrin and platelets, and thrombosis is the body's natural response to repairing injured blood vessels or stopping bleeding. However, when this process is activated abnormally, such as in a mechanical blood pump, it can lead to excessive thrombus formation. Therefore, how to avoid or reduce the probability of thrombus formation is an important indicator of the stable operation of a blood pump. In this paper, Lagrangian particle tracking trajectories are simulated to study platelet transport in a blood pump. The design of the thrombus blood pump was optimized using an orthogonal design method based on three factors: inlet angle, outlet angle, and blade number. The effect of blood pump pressure, rotational speed, impeller outlet angle, inlet angle, and number of blades on thrombus formation was analysed using Fluent software. The thrombogenic potential was derived by analyzing the trajectory and flow parameters of platelet particles in the blood pump, as well as the statistical parameters of residence time and stress accumulation thrombus in the platelet pump. When the impeller inlet angle is 30°, the outlet angle is 20°, and the number of blades is 6, the probability of thrombus formation is minimized in the orthogonal design method, aligning with the requirements for blood pump performance. These design parameters serve as a numerical guideline for optimizing the geometry of the semi-open impeller in blood pumps and provide a theoretical foundation for subsequent invitro experiments.

Stečena koagulopatija u trogodišnjegdječaka s makrohematurijom– prikaz bolesnika

Acquired coagulopathy is a rare, potentially life-threatening disorder which should be suspected if acute bleeding in patients with a negative previous hemorrhagic diathesis is encountered. This disease arises due to the formation of antibodies against clotting factors in a previously healthy child or adult, which specifically partially or completely neutralize the procoagulant activity of clotting factors or accelerate their removal from the circulating blood, reducing their plasma concentrations and increasing the bleeding tendency. The aforementioned disorder should be confirmed by determining global coagulation times, concentrations of individual clotting factors, and determining the presence of specific or non-specific antibodies. Timely treatment aimed at prompt stopping of bleeding and eradicating the resulting inhibitors will prevent the unfavorable outcome. It is recommended to continue monitoring patients in the outpatient setting with determination of PT and APTT for a year, because in 20% of cases a relapse of the disease occurs, although more often in adults. In this paper, we presented a three-year-old boy in whom we determined prolonged global coagulation times and the presence of non-specific inhibitors of the coagulation factors F II, F IX, F XI and F XII through the diagnostic workup of macrohematuria. The treatment with fresh frozen plasma and corticosteroids resulted in clinical improvement and disease remission. Acquired coagulopathy is a very rare disorder in childhood with scarce literature data. The aim of this paper is to demonstrate the possible causes, clinical course and treatment of this life-threatening disorder in children.

Can We Help Stop Bleeding in Badly Injured People

Serious bleeding, known as major hemorrhage, is the most common cause of death in people with serious injuries. People with major hemorrhage often have a lower amount of an important protein called fibrinogen in their blood, which makes it more difficult to stop the bleeding. In a big randomized controlled trial called CRYOSTAT 2, we looked at whether giving people extra fibrinogen soon after their injury helped stop bleeding and increased the number of people who survived. We were surprised to find that fibrinogen did not help as much as we expected, and that it may even make some people more likely to die. In this article, we talk about the CRYOSTAT-2 experiment and how it shows we cannot treat all bleeding patients in the same way.

Platelets, inflammation, and purinergic receptors in chronic kidney disease

Platelets are anucleated cells that circulate in the bloodstream. Historically, platelets were thought to perform a singular function—stop bleeding via clotting. While platelets do play a key role in hemostasis and thrombosis, recent studies indicate that platelets also modulate inflammation, and this platelet-induced inflammation contributes to the pathophysiology of various diseases such as atherosclerosis and diabetes mellitus. Thus, in recent years, our understanding of platelet function has broadened. In this review, we revisit the classic role of platelets in hemostasis and thrombosis and describe the newly recognized function of platelets in modulating inflammation. We cover the potential use of purinergic receptor antagonists to prevent platelet-modulated inflammation, particularly in patients with chronic kidney disease, and finally, we define key questions that must be addressed to understand how platelet-modulated inflammation contributes to the pathophysiology of chronic kidney disease.