Platelet aggregation abnormalities in end-stage renal disease; a possible cause of hemorrhagic diathesis

End-stage renal disease patients [ESRD] are at risk of hematological complications. Hypercoagulability and paradoxically hemorrhagic tendency have been described in uremic patients. Hemorrhagic complications are primarily due to uremic platelet dysfunction and intermittent anticoagulation therapy used in hemodialysis. The aim of this study was to investigate the effect of hemodialysis [HDD] on platelet aggregation abnormalities and hence its role in bleeding in ESRD patients on maintenance hemodialysis. Forty two patients with ESRD on maintenance HD, in the hemodialysis unit at Sohag University Hospital utilizing polysulphon memrance and using Fresenius machines 94008 B] were included in this study and compared with a control group; of fourteen healthy adult volunteers. Blood samples were obtained for laboratory investigations form patients and controls before HD session and after the session from patients only the following laboratory investigations were performed; Complete blood cont [CBC]. serum urea, creatinine, Bilirubin, AST, ALT and hepatitis markers [HBsAg and anti HCV antibody]. tests for coagulation screening; PT and PTT, Study of platelet aggregation with ADP and Ristocetin. For all patients and controls bleeding time [BT] was performed at the time of sample taking. Bleeding time is significantly prolonged after the HD session comparing to results before the HD session and that of controls, platelet aggregation with ADDP and Ristocetin were significantly decreased in HD patients before and after session comparing to controls and also statistically significant comparing the results of patients before and after HD session. There is no statistically significant difference in the results of INR and PTT when comparing results of patients before and after sessions and when comparing the results of patients to controls, HD sessions in ESRD patients lead to platelet aggregation abnormalities which may resulted in hemorrhagic disorders in HD dependent patients

Anemia in systemic lupus erythematosus [SLE] patients; types, simple diagnosis and role of erythropoietin [EPO]

Anemia is a common hematological abnormality in Systemic lupus erythematosus and can easily be categorized with simple laboratory tests; the aim of this study was to investigate types and causes of anemia in SLE patients and to evaluate the role of EPO in different types of SLE anemia. Patients and methods; forty three male and female patients with SLE were investigated for types and possible causes of anemia among the follow up patients of the rheumatology outpatient clinic of Sohag university hospital in one year, blood and urine samples were obtained for laboratory investigations, patients with hemoglobin level less than 14 gm/dl for male and 12.3 gm/dl for female were consider anemic and enrolled in the study. Thirty nine patients [90.7%- 1 male and 38 females] were anemic, with mean age of 31 +/- 10 years, the types and incidence of anemia were; iron deficiency anemia [IDA] n = 22 [56.4%], anemia of chronic disease [ACD] n = 12 [30.8%] and autoimmune hemolytic anemia [AIHA] n=5 [12.8%], mean levels of hemoglobin were 10.4 +/- 1.3, 9.6 +/- 1.1 and 7.7 +/- 0.8, in the three groups respectively, low levels of complement C3 and C4 were observed in AIHA, and ACD, but not in patients with IdA. Anti-dsDNA antibodies were seen in all patients with AIHA, and in 10 patients with IDA, CRP concentrations were not related to severity of anemia in the three groups, higher levels of serum creatinine and proteinuria were detected in the three was no difference in the mean levels of EPO among different groups. Anemia in SLE can be easily diagnosed by simple methods, IDA is very common among SLE patients in our community, Erythropoietin [EPO] may have no role in SLE anemia and the presence of Anti Erythropoietin antibodies [AEA] and its role can not be ruled out

Outcome of surgical repair of iatrogenic injuries of major bile ducts

Bile duct injury is a severe and potentially life-threatening complication of open cholecystectomy [OC] or laparoscopic cholecystectomy [LC]. The management of bile duct injuries remains a challenge for most surgeons. The purpose of this study was to evaluate the presentation, characteristics, related investigation, and outcome of patents who underwent immediate or late repair of iatrogenic major bile duct injuries [MBDI]. Twenty three patients with post-cholecystectomy [OC or LC], and postoperative abdominal surgery presented with manifestation of biliary tract strictures or injuries between January 2000 and March 2005 in Sohag university hospital were included in this study. Those patients either underwent their primary surgery in the university hospital or were referred to the university hospital after their primary surgery was performed in other hospitals in our locality. Patients were subjected to clinical examination and to the following; laboratory investigations [blood picture, blood sugar, liver function test, serum urea and creatinine], abdominal ultrasound examination, CT scan, PTC, ERCP, and MRCP in selected cases. These patients then subjected to endoscopic and/or open surgical treatment. This study included 23 patients, 21[91.3%] after cholecystectomy [14 OC and 7 LC], and 2 patients after other abdominal surgeries. Bile duct injuries were recognized immediately in 5 patients [21.7%] [2 after OC and 3 after LC], and 18 patients [78.3%] presented later after the primary surgery. Their clinical presentations were obstructive jaundice in 13 patients [56.5%], external biliary fistula in 5 patients [21.7%], and biliary collection in 3 patients [13%]. The level of obstruction or injury was classified as Bismuth type 1 in 14 cases [61%], Bismuth type 11 in 6 cases [26%], and Bismuth type III in 3 cases [13%]. Bismuth IV and V types were not recorded among the studied cases. End-to-end anastomosis was done for 5 cases [21.7%]. The 5 patients [21.7%] to whom end-to-end anastomosis was done; failure was seen in 4 of these 5 cases [80%] and was corrected by re-exploration and reaired by hepaticojejunostomy. Choledochojejunostomy and hepaticojejunostomy were performed in majority of cases and showed no failures. Cholecystojejunostomy was done for the 2 cases [8.7%] that presented with bile duct obstruction after other abdominal operations. Postoperative complications includes, minor leakage in 5 [21.8%] patients was managed conservatively. Wound sepsis was seen in 8 [34.8%] with burst abdomen occurred in 3 [13%] of them. No operative mortality encountered in our patients. Late stricture encountered on long-term follow up [3 years] in 3 cases [13%]. The overall success after repair by Roux-en-Y hepaticojejunostomy was 78.3%. Major bile duct injuries after cholecystectomy and other abdominal surgeries are a considerable surgical challenge. Surgical reconstruction using Roux-en-Y hepaticojejunostomy mucosa to mucosa repair remains the golden standard procedure of choice for treating these injuries with successful outcome and better long-term result. Early recognition and adequate treatment at socialized institutions account for the key of prognostic parameters. Finally, as always, the true key to successful treatment of these injuries remains prevention