- An Outpatient, Dose-Intense, Intravenous Cisplatin and Oral Etoposide Regimen for the Treatment of Advanced, Platinum-Resistant Ovarian Cancer. [Journal Article]
- IJInt J Gynecol Cancer 2018; 28(3):448-452
- CONCLUSIONS: Our shorter, within-day regimen for delivering dose-intense weekly cisplatin and oral etoposide to treat platinum-resistant metastatic ovarian cancer is safe and efficacious.
- Atypical microdeletion in 22q11 deletion syndrome reveals new candidate causative genes: A case report and literature review. [Journal Article]
- MMedicine (Baltimore) 2018; 97(8):e9936
- CONCLUSIONS: Although none of the previous reported causative genes were affected in the patient, her clinical manifestations were typical of 22q11 deletion syndrome, apart from her progressive splenomegaly. This case indicated 8 new candidate pathogenic genes for 22q11 deletion syndrome. Given that the loss of these genes was sufficient to induce 22q11DS defects, whether these genes directly influence the pathogenesis of 22q11DS or through interactions with known hotspot mutations is worthy of research.
- The presentation and management of platelet disorders in pregnancy. [Journal Article]
- EJEur J Haematol 2018 Feb 21
- Thrombocytopenia, defined as a platelet count less than 150,000 per microlitre, occurs in 7-12% of all pregnancies. Aside from anaemia, it is the most common haematological disorder in pregnancy. Des...
Thrombocytopenia, defined as a platelet count less than 150,000 per microlitre, occurs in 7-12% of all pregnancies. Aside from anaemia, it is the most common haematological disorder in pregnancy. Despite its frequent occurrence, thrombocytopenia often leads to difficulties of diagnosis and management in pregnancy. Typically, a pregnant woman will have platelet counts of 150,000 to 450,000 per microlitre and platelet counts may be slightly lower than those of healthy, non-pregnant controls. Approximately 8% of pregnant women will develop mild thrombocytopenia (100,000-150,000 per microlitre) and while 65% of these women will have no underlying pathology, all pregnant women with platelet counts of less than 100,000 per microlitre should undergo further clinical and laboratory assessment. Thrombocytopenia in pregnancy occurs as a result of multiple distinct conditions, we present four cases of thrombocytopenia in pregnancy encountered in our unit over a 12 month period. These include gestational thrombocytopenia, immune thrombocytopenic purpura (ITP), thrombotic thrombocytopenic purpura (TTP) and thrombocytopenia absent radius (TAR) syndrome. The literature review of these cases highlights the significance of identification, understanding pathophysiology and a multidisciplinary approach to these conditions. We refresh knowledge on these conditions and emphasise the importance of thrombocytopenia in pregnancy. This article is protected by copyright. All rights reserved.
- High proportion of TAFRO syndrome in Thai adult Castleman's disease patients: a 10-year experience. [Journal Article]
- AHAnn Hematol 2018 Feb 20
- Castleman's disease (CD) is a rare lymphoproliferative disorder, and its prevalence in Thailand is not known. This 10-year period study investigated the prevalence of CD in Thailand, and the clinical...
Castleman's disease (CD) is a rare lymphoproliferative disorder, and its prevalence in Thailand is not known. This 10-year period study investigated the prevalence of CD in Thailand, and the clinical characteristics and outcomes of Thai CD patients, with special focus on the existence and prevalence of TAFRO syndrome. TAFRO syndrome is defined as CD with thrombocytopenia, anasarca, fever, reticulin fibrosis, and organomegaly. Thirty-three CD patients diagnosed and treated at Siriraj Hospital during January 2007 to December 2016 were included. The prevalence of CD was 1.4 per 1,000,000 patients/10 years. Median age was 46 years, with slight female predominance. Six patients were assigned to the TAFRO group. A high proportion of TAFRO syndrome (18.2%) was found among Thai adult CD patients. In addition to routine TAFRO diagnostic criteria, significantly lower hemoglobin and albumin levels were observed in the TAFRO group than in the non-TAFRO group. Treatment outcomes of CD patients were complete remission (52%), stable disease (30%), and death (13%). Three-year overall survival in the non-TAFRO group and TAFRO group was 88 and 50%, respectively. While most CD patients had a good prognosis, severe cases with TAFRO syndrome had poor outcome.
- A Case Report of Recombinant Tissue Plasminogen Activator Use in a SPAN-100-Positive Geriatric Patient with Thrombocytopenia. [Journal Article]
- CCureus 2017 Dec 11; 9(12):e1933
- Thrombocytopenia (platelet count: < 100,000/mm3) is considered a contraindication in the use of intravenous thrombolysis for acute ischemic stroke. Little literature exists regarding tissue plasminog...
Thrombocytopenia (platelet count: < 100,000/mm3) is considered a contraindication in the use of intravenous thrombolysis for acute ischemic stroke. Little literature exists regarding tissue plasminogen activator (tPA) usage in thrombocytopenic patients, especially in older patients. Age and stroke severity are major prognostic indicators of the risk of hemorrhagic transformation. The Stroke Prognostication using Age and NIH Stroke Scale (SPAN) index estimates a patient's risk of intracerebral hemorrhage (ICH) and clinical response to thrombolysis by combining age in years with the National Institutes of Health Stroke Scale (NIHSS) scores. If the total numeric sum is 100 or more, these individuals are considered SPAN-100-positive, while those with a sum less than 100 are considered SPAN-100-negative patients. SPAN-100-positive patients are found to have a greater risk of ICH and poorer long-term outcomes than SPAN-100-negative patients both with and without thrombolysis treatment. SPAN-100-positive patients are found to have a greater risk of ICH and poorer long-term outcomes than SPAN-100-negative patients both with and without thrombolysis treatment. Nonetheless, SPAN-100-positive patients treated with tPA have a reduced relative likelihood of severe disability or death than SPAN-100-positive patients not treated with tPA. We report a case of a SPAN-100-positive, 90-year-old community-dwelling patient who presented with an acute ischemic stroke, an NIHSS score of 14 with near complete left-sided plegia, and a platelet count of 85,000/mm3. Our patient was at increased risk of ICH and poor outcome regardless of tPA administration. However, due to the patient's high functional capacity prior to hospitalization and probable severe morbidity with poor recovery potential at his age, he was treated with tPA and showed a rapid improvement in neurological symptoms with no thrombolytic-associated morbidity. Thrombolytic therapy requires a case-by-case approach. Taking into account the patient's baseline and recovery potential is critical. Even absolute and relative contraindications, as they stand now, may need reconsideration, particularly those with little empiric evidence. More research is indicated to establish if thrombocytopenia should be reclassified as a relative rather than absolute contraindication to tPA.
- Prophylactic platelet transfusion prior to central venous catheter placement in patients with thrombocytopenia: study protocol for a randomised controlled trial. [Journal Article]
- TTrials 2018 Feb 20; 19(1):127
- CONCLUSIONS: This is the first prospective, randomised controlled trial powered to test the hypothesis of whether omitting forgoing platelet transfusion prior to central venous cannulation leads to an equal occurrence of clinical relevant bleeding complications in critically ill and haematologic patients with thrombocytopenia.
- Bivalirudin for Pediatric Procedural Anticoagulation: A Narrative Review. [Journal Article]
- A&AAnesth Analg 2018 Feb 14
- Bivalirudin (Angiomax; The Medicines Company, Parsippany, NJ), a direct thrombin inhibitor, has found increasing utilization as a heparin alternative in the pediatric population, most commonly for th...
Bivalirudin (Angiomax; The Medicines Company, Parsippany, NJ), a direct thrombin inhibitor, has found increasing utilization as a heparin alternative in the pediatric population, most commonly for the treatment of thrombosis secondary to heparin-induced thrombocytopenia. Due to the relative rarity of heparin-induced thrombocytopenia as well as the lack of Food and Drug Administration-approved indications in this age group, much of what is known regarding the pharmacokinetics and pharmacodynamics of bivalirudin in this population has been extrapolated from adult data. This narrative review will present recommendations regarding the use of bivalirudin for procedural anticoagulation in the pediatric population based on the published literature.
- Thrombocytopenia in leukemia: Pathogenesis and prognosis. [Review]
- HHHistol Histopathol 2018 Feb 20; :11976
- Leukemias, a heterogeneous group of hematological disorders, are characterized by ineffective hematopoiesis and morphologic abnormalities of hematopoietic cells. Thrombocytopenia is a common problem ...
Leukemias, a heterogeneous group of hematological disorders, are characterized by ineffective hematopoiesis and morphologic abnormalities of hematopoietic cells. Thrombocytopenia is a common problem among leukemia types that can lead to hemorrhagic complications in patients. The purpose of this review article is to identify the conditions associated with the incidence of thrombocytopenia in leukemias. It can be stated that although translocations have been considered responsible for this complication in many studies, other factors such as bone marrow failure, genes polymorphism, a mutation in some transcription factors, and the adverse effects of treatment could be associated with pathogenesis and poor prognosis of thrombocytopenia in leukemias. Considering the importance of thrombocytopenia in leukemias, it is hoped that the recognition of risk factors increasing the incidence of this complication in leukemic patients would be useful for prevention and treatment of this disorder.
- Acetobacter indonesiensis Pneumonia after Lung Transplantation. [Journal Article]
- EIEmerg Infect Dis 2018; 24(3):598-599
- We report a case of Acetobacter indonesiensis pneumonia in a 51-year-old woman after bilateral lung transplantation. We found 2 other A. indonesiensis pneumonia cases reported in the literature. All ...
We report a case of Acetobacter indonesiensis pneumonia in a 51-year-old woman after bilateral lung transplantation. We found 2 other A. indonesiensis pneumonia cases reported in the literature. All 3 cases involved complex patients exposed to broad-spectrum antimicrobial drugs, suggesting that this pathogen may be opportunistic and highly drug-resistant.
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- Acute haemolysis, DIC and renal failure after transfusion of uncross-matched blood during trauma resuscitation: illustrative case and literature review. [Journal Article]
- TMTransfus Med 2018 Feb 19
- CONCLUSIONS: Although emergency transfusion of uncross-matched blood is commonly practiced at trauma centres worldwide, with low risk of acute HTR (<1/1000), our well-documented patient case demonstrates the potential for acute HTR with severe complications.