Value Of Thrombocytopenia Research Articles

#580 Pitfalls in valganciclovir prophylaxis dose adjustment based on renal function in kidney transplant recipients

Abstract Background Clinically significant cytomegalovirus infection (csCMVi) is the most frequent viral infection in kidney transplant recipients (KTR). A daily dose of 900 mg valganciclovir (VGC) as primary antiviral prophylaxis (PAP) is frequently administered to KTR at risk for csCMVi, including CMV donor (D)+/recipient (R)− and CMV R+ patients after induction immunosuppression with thymoglobulin (R+/TG) until 6- and 3-months post-transplant, respectively. Dose adjustments for VGC are recommended based on renal function to reduce potential myelotoxicity. There is paucity of real-life data on VGC dose adjustment as PAP and association with clinical outcomes. Method and Aims Bicentric and retrospective Swiss Transplant Cohort Study (STCS)-embedded observational study including all consecutive adult D+/R− and R+/TG KTR between 2010 and 2020, who received PAP with VGC. The primary objective was to describe the proportion of VGC weekly entries, that was inappropriately (either under- or over-) dosed based on the associated renal function. Secondary objectives included the incidence of breakthrough csCMVi, potential associations between breakthrough-csCMVi and cytopenias with VGC dosing. Results Among 178 KTR included in both centres, 131 (73.6%) patients had at least two week entries for the longitudinal data of interest and were included in the outcome analysis. There were 1032 weekly VGC dose entries for 131 patients. Overall, 460 (44.6%) were appropriately dosed, while 234 (22.7%) and 338 (32.8%) were under- and over-dosed, respectively (Table 1). Inappropriate dosing was more frequent among R+/TG (133/214, 62.1%) than D+/R− (92/176, 52.3%, p = 0.05) during the first four weeks post-transplant. Nineteen (14.5%) patients had a breakthrough-csCMVi, without any association between breakthrough-csCMVi and VCG dosing (p = 0.44). Among cytopenias, there was no statistically significant difference in the proportion of weekly leucopenia, neutropenia, or thrombocytopenia values. In contrast, lymphopenia was more frequently observed when VGC was overdosed (p = 0.005, Table 2). Conclusion VGC as PAP in KTR is frequently inappropriately dosed, albeit without meaningful clinical associations, neither in terms of efficacy nor safety.

ROLE OF PLATELET PARAMETERS IN DENGUE FEVER IN CHILDREN

Aim: To evaluate the role of platelet parameters in dengue fever and also to determine relationship of platelet parameters with platelet count and the severity of the disease. The platelet para Materials and methods: meters [platelet count, plateletcrit, mean platelet volume (MPV), platelet distribution width (PDW)] of 50 dengue infected children were calculated using BC 3000 plus Mindray Automated Hematology Analyzer. Normal range of MPV is 7.5-11.5 . Plateletcrit cut off value in thrombocytopenia is 0.2-0.36%. The PDW reported varies with reference intervals ranging from 8.3 to 56.6%. Subjects were divided into four groups according to their platelet count on day 3 of illness (<20,000 cells/cumm, 20,000 to 50,000 cells/cumm, 50,000 to 100,000 cells/cumm and >100,000 cells/cumm). Platelet indices were studied among these groups and also the indices were evaluated with respect to the severity of disease as group A (dengue without warning signs), group B (dengue with warning signs and group C (severe dengue). Results: Male: female ratio was 28:22. Mean age of presentation was 7.8 + 2.2 years. Thirty-ve patients belonged to Group A, 26 to group B and 2 belonged to group C. PLT (cells/cumm) on Day 3 and Day 7 was 91,828 ±33,532 vs 195,371 + 70,586 in Group A patients (p<0.0001), 69,076 ±45,904 vs 163,230 + 85,053 in Group B patients (p=0.0018) 38,500 + 38,890 vs 86,000 + 28,284 in Group C patients (p=0.29). PCT (%) on Day 3 and Day 7 was 0.09 + 0.04 vs 0.18 + 0.06 in Group A patients (p<0.0001), 0.07 + 0.04 vs 0.15 + 0.07 in Group B patients (p=0.0009) and 0.04 + 0.04 vs 0.08 + 0.28 in Group C patients (p=0.84). MPV () on Day 3 and Day 7 was 10.73 + 1.07 vs 11.34 + 1.09 in Group A patients (p=0.0212), 10.41 + 1.39 vs 10.87 + 0.99 in Group B patients (p=0.3389), 9.35 + 1.62 vs 10.3±1.41 in Group C patients (p=0.59). PDW () on Day 3 and Day 7 was 14.46 ± 1.35 vs 13.22 + 1.10 in Group A patients (p=0.0001), 14.61 + 1.36 vs 13.0 + 0.76 in Group B patients (p=0.0011) and 14.5 + 1.84 vs 13.5 + 0.71 in Group C (p=0.54). Though MPV was lower in patients with platelet count <20,000 cells/cumm (8.57 + 0.5 ) as compared to other groups, it was not statistically signicant (p=0.325). PCT increases with increase in platelet count on Day 3 and Day 7 (p=0.000). Though PDW was lower on Day 3 in patients with platelet count <20,000 cells/cumm as compared to the other 3 groups, it was not statistically signicant (p=0.0740). Conclusion: Lower platelet count and low PCT are seen with severe dengue, increasing platelet count and PCT suggest recovery phase of dengue. MPV had no correlation with severity of dengue or level of thrombocytopenia suggestive that there is no role to predict severity of dengue. PDW does not uctuate with severity of dengue or level of thrombocytopenia

CLINICAL CHARACTERISTIC OF ADULT PATIENTS WITH DENGUE HEMORRHAGIC FEVER AT PROF. DR. SULIANTI SAROSO SUNTER INFECTIOUS HOSPITAL 2018

Background: Dengue is a viral disease transmitted by mosquito to humans and becomes a problem for the health of Indonesian people. Dengue Hemorrhagic Fever occurs due to several epidemiological factors. The purpose of this study is to determine the clinical characteristics of adult patients with Dengue Hemorrhagic Fever at Prof. dr. Sulianti Saroso Sunter Infectious Hospital 2018. Method: This Study was an observational descriptive study by taking medical record samples in 49 adult patients Dengue Hemorrhagic Fever in 2018. Results: From the 49 cases of Dengue Haemorrhagic Fever, the highest fender category was male (65,3%), occurred in the 18-25 year age category (38,8%), and the average patient worked as a Private Employee (55,1%). Most patients were hospitalized for the less than 7 days (83,7%). Clinical manifestations were fever (95,9%), nausea (85,7%) and headache (71,4%). Physical examination found was fever (100%) and hepatomegaly (12,2%). Laboratory tests showed normal hematocrit values (71,4%), thrombocytopenia values (87,8%), normal leukocyte values (49%), positive IgG serology tests (83,7%), IgM serology tests (71,4%), Positive IgM and IgG Serology test (69,3%), and NS1 Serology test (2%). Management provided is the administration of intravenous infus fluid drops (100%), PPI (87,8%), H2 Antagonist (4,1%), and Antipiretik (83,7%). The outcome patient is recovered and no complications were found. Conclusion: Dengue Hemorrhagic fever occurs in the age range of 18-25 years with dominant clinical characteristic of fever and thrombocytopenia. And, the most given treatment is Intravena Fluid therapy.

P-119 The prognostic value of thrombocytopenia in patients with primary myelodysplastic syndromes

P-119 The prognostic value of thrombocytopenia in patients with primary myelodysplastic syndromes

OUTCOMES IN SYSTOLIC HEART FAILURE PATIENTS WITH THROMBOCYTOPENIA: MORTALITY AND READMISSIONS

Little is known about the effect of a low platelet count (PC) on mortality of patients (pts) with systolic heart failure (SHF). The aim of this study was to determine the prognostic value of thrombocytopenia (TMPA) in SHF pts by assessing all-cause mortality and hospital readmission rates. 2705 SHF

Systemic lupus erythematosus in a multiethnic US cohort: XLIII. The significance of thrombocytopenia as a prognostic factor

To examine the clinical correlates of thrombocytopenia and the value of thrombocytopenia as a predictor of disease activity, damage accrual, and mortality in patients with systemic lupus erythematosus (SLE). SLE patients participating in a longitudinal multiethnic cohort were studied. Thrombocytopenia was defined as a platelet count <100,000/mm(3) at or before enrollment (baseline). Patients were categorized by the presence and absence of thrombocytopenia. The impact of thrombocytopenia as well as severe thrombocytopenia (platelet count <50,000/mm(3)) on disease activity, damage accrual, and mortality was examined by multivariable analyses. A total of 616 patients were studied; 121 of the patients (20%) had thrombocytopenia, of whom 30 had severe thrombocytopenia. By univariable analyses, those with thrombocytopenia had more pulmonary, neurologic, renal, and hematologic involvement, worse disease activity and damage, and higher mortality rates. By multivariable analyses, thrombocytopenia was associated with higher disease activity over the disease course (P = 0.018), but not with the accrual of damage either at baseline (P = 0.543) or at the last visit (P = 0.086); however, severe thrombocytopenia was associated with damage accrual at the last visit (P = 0.020). When poverty was not included in the models, thrombocytopenia (<100,000/mm(3) or <50,000/mm(3)) was strongly associated with mortality (P < 0.001 for each comparison); however, the level of significance decreased some when poverty was included in the models. Thrombocytopenia early in the course of SLE is indicative of more severe and active disease. Severe thrombocytopenia is an independent predictor of damage accrual at the last visit. Thrombocytopenia is also an independent predictor of mortality, albeit of a lesser magnitude than that predicted by poverty. Patients with thrombocytopenia need close monitoring for possible undesirable outcomes.

Eltrombopag: the emerging evidence of its therapeutic value in thrombocytopenia

Idiopathic (immune) thrombocytopenic purpura (ITP) is an autoimmune disorder characterized by low platelet counts and bleeding episodes. Current therapy options are associated with unwanted side effects, and although patients initially respond to treatment the platelet count is not sustained in many individuals. There is a need for safe and well-tolerated treatments that provide a sustained platelet response. This review summarizes the emerging evidence for the potential use of eltrombopag in the treatment of ITP in adults. Eltrombopag is a nonpeptide, small molecular weight thrombopoietin receptor agonist that is orally administered. It mimics the activity of thrombopoietin, a cytokine that promotes growth and production of platelets, primarily inducing proliferation and differentiation of megakaryocytes from bone marrow progenitor cells. Eltrombopag is still in the early stages of development but initial phase I and phase II results are promising. Potential advantages of eltrombopag may include a sustained platelet response and a good tolerability profile. Its once-daily oral dosing regimen would also be an advantage over many of the existing therapies. It is expected that patients who have failed first-line therapy with corticosteroids and wish to avoid the need for a splenectomy, and patients with chronic refractory ITP, may benefit from eltrombopag treatment.

No Evidence of a Higher Risk of Progression to AIDS in Patients with HIV-1-Related Severe Thrombocytopenia

The prognostic role of platelet (PLT) counts was evaluated in a cohort of 1,533 HIV-1-infected subjects followed for a median of 21 months. Thrombocytopenia (TCP), defined as a PLT count < or = 100 x 10(9)/L was present at enrollment in 11.2% of cases, with counts < or = 50 x 10(9)/L (severe TCP) in 5.3%. With the subjects with normal PLT counts (PLT >150 x 10(9)/L) as the reference group, the relative risk of developing acquired immunodeficiency syndrome (AIDS) was 0.8 [95% confidence interval (CI) 0.5-1.3, p = 0.4] for subjects with severe TCP, 2.1 (95% CI 1.4-3.1, p = 0.002) for those with PLT counts ranging from 51 to 100 x 10(9)/L (moderate TCP), and 1.6 (95% CI 1.2-2.1, p = 0.0004) for those with borderline PLT values (PLT ranging from 101 to 150 x 10(9)/L). Most of the risk increase associated with moderate TCP and borderline PLT values was explained by a higher prevalence of subjects with an older age and lower CD4+ cell counts. However, at multivariable analysis considering age, sex, risk group, and zidovudine (ZDV) treatment, the risk for subjects with severe TCP remained significantly lower than that for subjects with moderate TCP and borderline values. These results suggest the existence of different types of HIV-1-associated TCP and also suggest that severe TCP (which often arises in the early phases of infection) is not related to disease progression.