- Hemostatic responses to exercise, dehydration, and simulated bleeding in heat-stressed humans. [Journal Article]
- AJAm J Physiol Regul Integr Comp Physiol 2018 Sep 19
- Heat stress followed by an accompanying hemorrhagic challenge may influence hemostasis. We tested the hypothesis that hemostatic responses are increased by passive heat stress, and exercise-induced h...
Heat stress followed by an accompanying hemorrhagic challenge may influence hemostasis. We tested the hypothesis that hemostatic responses are increased by passive heat stress, and exercise-induced heat stress, each with accompanying central hypovolemia to simulate a hemorrhagic insult. In Aim 1, subjects were exposed to passive heating or normothermic time control, each followed by progressive lower-body negative pressure (LBNP) to pre-syncope. In Aim 2 subjects exercised in hyperthermic environmental conditions, with and without accompanying dehydration, each also followed by progressive LBNP to pre-syncope. At baseline, pre-LBNP and post-LBNP, hemostatic activity of venous blood was evaluated by plasma markers of hemostasis and thrombelastography. For Aim 1, both hyperthermic and normothermic LBNP (H-LBNP and N-LBNP, respectively) resulted in higher levels of Factor V, Factor VIII, and vWF antigen compared to the time control trial (all P<0.05), but these responses were temperature independent. Hyperthermia increased fibrinolysis (LY30) to 5.1% post-LBNP, compared to 1.5% (time control) and 2.7% in N-LBNP (P=0.05 for main effect). Hyperthermia also potentiated increased platelet counts post-LBNP: 274(k/µL) for H-LBNP, 246(k/µL) for N-LBNP, 196(k/µL) for time control (P<0.05 for the interaction). For Aim 2, hydration status during exercise in the heat did not affect the hemostatic activity, but fibrinolysis (LY30) was increased to 6-10% when subjects were dehydrated compared to an increase to 2-4% when hydrated (P=0.05 for treatment). Central hypovolemia is a primary driver of hemostasis when compared to hyperthermia and dehydration. However, hyperthermia induces significant thrombocytosis and by itself causes an increase in clot lysis. Dehydration associated with exercise-induced heat stress increases clot lysis but does not affect exercise-activated or hypovolemia-activated hemostasis in hyperthermic humans. Clinical implications of these findings are that quickly restoring a hemorrhaging hypovolemic trauma patient with cold, non-coagulant fluids (crystalloids) can have serious deleterious effects on the body's ability to form essential clots.
- Hemolytic anemia potentially associated with Aripiprazole - a case report. [Letter]
- PCPsychiatry Clin Neurosci 2018 Sep 18
- We report a case of a female patient, 48yo, medicated for depressive features with Clomipramine 75mg 1id and Bromazepam 6mg 3id, with the recent addition (8 weeks at admission time) of Aripiprazole 1...
We report a case of a female patient, 48yo, medicated for depressive features with Clomipramine 75mg 1id and Bromazepam 6mg 3id, with the recent addition (8 weeks at admission time) of Aripiprazole 10mg 1id. She started experiencing fatigue, tachycardia, and paleness (symptoms suggestive of anemia) as well as weight loss and dark coloured urine. She presented with macrocytic anemia (Hb 7.7 g/dL, MGV 108.1 fL), leucocytosis (17.160/L), thrombocytosis (612 x109/L) and hyperbilirubinemia (total 1.86mg/dL, direct 0.46mg/dL). This article is protected by copyright. All rights reserved.
- Thrombocytosis as a Marker for Postoperative Complications in Colorectal Surgery. [Journal Article]
- GRGastroenterol Res Pract 2018; 2018:1978639
- CONCLUSIONS: In this retrospective study, thrombocytosis was shown to have a positive correlation with postoperative medical and surgical complications. An elevated platelet count in the postoperative period should alert the clinician to a developing complication. We recommend that further studies with a larger sample size would test the specific associations with individual complications.
- Progressive splenomegaly and mild thrombocytosis in beta-thalassaemia trait and coexisting hereditary hemochromatosis: possible confounders for a subsequent hematological diagnosis. [Journal Article]
- IEIntern Emerg Med 2018 Sep 14
- [Cytopenia under topical imiquimod in two patients treated with oral hydroxyurea]. [Journal Article]
- ADAnn Dermatol Venereol 2018 Sep 11
- CONCLUSIONS: . The literature review identified reports of dose-dependent lymphopenia under oral imiquimod but not under Aldara®. The National Pharmacovigilance Database listed 10 cases of hematological disorders most likely caused by Aldara®. Hydroxyurea may induce cytopenia, and while it was not considered the sole causative agent in this case, it is likely to have had a triggering role in these patients with blood dyscrasias. Our findings show that misuse of imiquimod carries a potential risk of hematologic abnormality in patients receiving concomitant hydroxyurea, a commonly combined drug.
- Perspectives on interferon-alpha in the treatment of Polycythemia vera and related Myeloproliferative neoplasms: minimal residual disease and cure? [Review]
- SISemin Immunopathol 2018 Sep 10
- The first clinical trials of the safety and efficacy of interferon-alpha2 (IFN-alpha2) were performed about 30 years ago. Since then, several single-arm studies have convincingly demonstrated that IF...
The first clinical trials of the safety and efficacy of interferon-alpha2 (IFN-alpha2) were performed about 30 years ago. Since then, several single-arm studies have convincingly demonstrated that IFN-alpha2 is a highly potent anti-cancer agent in several cancer types but unfortunately not being explored sufficiently due to a high toxicity profile when using non-pegylated IFN-alpha2 or high dosages or due to competitive drugs, that for clinicians at first glance might look more attractive. Within the hematological malignancies, IFN-alpha2 has only recently been revived in patients with the Philadelphia-negative myeloproliferative neoplasms-essential thrombocytosis, polycythemia vera, and myelofibrosis (MPNs)-and in patients with chronic myelogenous leukemia (CML) in combination with tyrosine kinase inhibitors. In this review, we tell the IFN story in MPNs from the very beginning in the 1980s up to 2018 and describe the perspectives for IFN-alpha2 treatment of MPNs in the future. The mechanisms of actions are discussed and the impact of chronic inflammation as the driving force for clonal expansion and disease progression in MPNs is discussed in the context of combination therapies with potent anti-inflammatory agents, such as the JAK1-2 inhibitors (licensed only ruxolitinib) and statins as well. Interferon-alpha2 being the cornerstone treatment in MPNs and having the potential of inducing minimal residual disease (MRD) with normalization of the bone marrow and low-JAK2V617F allele burden, we believe that combination therapy with ruxolitinib may be even more efficacious and hopefully revert disease progression in many more patients to enter the path towards MRD. In patients with advanced and transforming disease towards leukemic transformation or having transformed to acute myeloid leukemia, "triple therapy" is proposed as a novel treatment modality to be tested in clinical trials combining IFN-alpha2, DNA-hypomethylator, and ruxolitinib. The rationale for this "triple therapy" is given, including the fact that even in AML, IFN-alpha2 as monotherapy may revert disease progression. We envisage a new and bright future with many more patients with MPNs obtaining MRD on the above therapies. From this stage-and even before-vaccination strategies may open a new horizon with cure being the goal for some patients.
- Predictive risk factors for complicated pneumonia in Malaysian children. [Journal Article]
- JPJ Paediatr Child Health 2018 Sep 09
- CONCLUSIONS: This study identifies some modifiable risk to reduce the burden of pneumonia complications.
- An elusive case of digital ischemia in a patient with Rheumatoid Arthritis. [Journal Article]
- PJPak J Med Sci 2018 Jul-Aug; 34(4):1024-1026
- Essential thrombocytosis (ET) has rarely been reported with autoimmune rheumatic disorders. We report a case of young female, diagnosed case of Rheumatoid arthritis (RA), who had been overlooked for ...
Essential thrombocytosis (ET) has rarely been reported with autoimmune rheumatic disorders. We report a case of young female, diagnosed case of Rheumatoid arthritis (RA), who had been overlooked for her raised platelet counts. Later her symptoms of impending digital gangrene led to an active search for her thrombocytosis. JAK2 mutation came out to be positive and she was diagnosed as ET associated with RA. She was treated with Hydroxyurea and Aspirin, in addition to her RA treatment. Patient responded well to the treatment and her platelet counts have been gradually improved, however, she developed gangrene of toe, for which amputation of distal phalanx of toe and nail excision was done, later in the disease course.
- Lenalidomide induced durable remission in a patient with MDS/MPN-with ring sideroblasts and thrombocytosis with associated 5q- syndrome. [Journal Article]
- LRLeuk Res Rep 2018; 10:37-40
- We describe a patient with MDS/MPN with ring sideroblasts and thrombocytosis who had deletions of long arm of chromosome 5 (5q-) and chromosome 20 (20q-). Molecular studies showed an exon 9, frame sh...
We describe a patient with MDS/MPN with ring sideroblasts and thrombocytosis who had deletions of long arm of chromosome 5 (5q-) and chromosome 20 (20q-). Molecular studies showed an exon 9, frame shift mutation in the calreticulin (CALR) gene, and absence of mutations in JAK2, MPL, SETBP1 or SF3B1. Treatment with lenalidomide resulted in durable clinical remission which has lasted 2 years.
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- The Platelet Count and its Implications in Sickle Cell Disease Patients Admitted for Intensive Care. [Journal Article]
- IJIndian J Crit Care Med 2018; 22(8):585-590
- CONCLUSIONS: In severe sickle cell crisis thrombocytopenia is more common than thrombocytosis. In the ICU, day 1 platelet counts correlate inversely with prognostic scores and are significantly reduced in multi-organ failure and nonsurvivors. A platelet count above 175 × 109/L predicts patient survival with high specificity and positive predictive value but lacks sensitivity.