ABSTRACT
OBJETIVO: Pacientes submetidos à cirurgia cardíaca estão mais propensos a desenvolver plaquetopenia. A trombocitopenia induzida por heparina acomete cerca de 5% dos pacientes. O objetivo foi avaliar a importância clínica da trombocitopenia grave em pacientes no pós-operatório de cirurgia cardíaca. MÉTODOS: Estudo prospectivo observacional que incluiu os pacientes de cirurgia cardíaca com plaquetas <150.000 cel/mm³, durante as primeiras 24 h do pós-operatório. Todos os pacientes foram submetidos a avaliação pelo escore dos quatro "Ts" (trombocitopenia, uso de heparina prévia, trombose e queda de plaquetas não relacionada à heparina) e considerado como suspeita de trombocitopenia induzida pela heparina tipo II um escore > 6. A mortalidade na Unidade de Terapia Intensiva (UTI) e hospitalar, o tempo de internação, os escores de gravidade e a incidência de tromboses foram comparados em pacientes com escore e" 6 (grupo 1) e < 6 (grupo 2). RESULTADOS: Foram incluídos 120 pacientes divididos nos dois grupos, não havendo diferença entre os mesmos com relação a idade, prevalência do sexo, tempo de circulação extracorpórea e de cirurgia. Contudo, a incidência de trombose foi mais elevada nos pacientes do grupo 1 (23% vs. 0%, P<0,0001), assim como quanto maior o escore maior a mortalidade hospitalar (P<0,001). CONCLUSÕES: O escore > 6, em pacientes no pós-operatório de cirurgia cardíaca, está associado a maior incidência de trombose, assim como o maior escore está relacionado à elevada mortalidade hospitalar.
OBJECTIVE: Patients undergo to cardiac surgery have more probability to develop thrombocytopenia. The heparin induced thrombocytopenia happens in 5% of the patients. The aim from this study was to evaluate the clinical importance from the severe thrombocytopenia in postoperative cardiac surgical patients. METHODS: It was included cardiac surgical patients with platelets < 150000 cel/mm³ during firsts 24 h from postoperative. All patients underwent evaluation for four Ts score (thrombocytopenia, use preview of heparin, thrombosis and platelets decreased not related to heparin). In order to a four Ts score e" 6 was considered as suggestive of heparin induced thrombocytopenia type II. The mortality rate in intensive care (ICU) and hospital, length of stay, healthy state and incidence from thrombosis were compared in patients with score > 6 (group 1) and < 6 (group 2). RESULTS: It was include 120 patients who met the inclusions criterions. There was no difference between the groups in related to age, gender, time of cardiopulmonary bypass and surgery. However, the incidence of thrombosis was higher in group 1 (23% vs. 0%, P<0.0001), as well as the greater score is related to higher hospital mortality rate. CONCLUSION: The score > 6, in postoperative cardiac surgical patients, it is associated to higher incidence of thrombosis as well as the greater score is related to higher hospital mortality rate.
Subject(s)
Female , Humans , Male , Middle Aged , Cardiac Surgical Procedures/adverse effects , Thrombocytopenia/diagnosis , Anticoagulants/adverse effects , Hospital Mortality , Heparin/adverse effects , Incidence , Prognosis , Prospective Studies , Risk Assessment/methods , Thrombocytopenia/etiology , Thrombocytopenia/mortalityABSTRACT
Enlist risk factors of thrombocytopenia in sick neonates and determine the outcome in sick neonates with thrombocytopenia in relation to risks factors. This descriptive case series study was conducted for a period of 6 months from 2007 to August 2007 in Pediatric Unit-TI, Nishtar Hospital, Multan. A total of 100 sick neonates with thrombocytopenia were included in the study. Neonates with different risks factors were evaluated which were of neonatal infection, birth asphyxia, prematurity, RDS, NEC and others [jaundice, infant of diabetic mother]. Among 100 cases with thrombocytopenia [platelets count< 150,000/ul] were included in this study, Out of 100 cases 35 [35%] were found to have early onset thrombocytopenia and 65cases [65%] were found to have late onset thrombocytopenia. Out of 100 cases, 43 cases were neonatal infection with thrombocytopenia, 23 [67.4%] were with early onset sepsis and 20 cases [46.5%] were late onset sepsis. Out of 100 cases, 17 [17%] cases were of birth asphyxia,11 cases were prematurity with birth weight <2.5 kg and gestational age <37 weeks, 6 cases of prematurity [54.5%] were with hemorrhage skin manifestation and remaining were occult mild thrombocytopenia, 20 cases of RDS with thrombocytopenia, 5 cases with NEC with thrombocytopenia and 4 cases with mild thrombocytopenia. The common manifestations in thrombocytopenic cases were petechiae and bruises followed by gastrointestinal hemorrhages. The leading causes of thrombocytopenia in sick neonates are infections, asphyxia, prematurity, RDS, NEC. Apart from the platelets counts the bleeding manifestations also depend upon underlying ailments
Subject(s)
Humans , Infant, Newborn , Risk Factors , Thrombocytopenia/mortality , Blood Platelets , Sepsis , Infant MortalityABSTRACT
Heparin induced thrombocytopenia with thrombosis (HITTS) is a syndrome with broad spectrum of clinical features that has been diagnosed with more frequency, Up to 5 per cent of patients exposed to heparin develop some type of manifestations. The etiology is probably related with the development of antibodies against a complex between heparin and platelet factor 4. The mortality is close to 25 per cent in patients who develop the thrombotic spectrum of the syndrome. This is a review about HITTS and the new alternatives for anticoagulation in experimentation today.
Subject(s)
Humans , Thrombocytopenia/etiology , Thrombocytopenia/mortality , Thrombosis , HeparinABSTRACT
Introducción. El síndrome de Wiskott-Aldrich es un padecimiento recesivo ligado al cromosoma X, caracterizado por la triada de eccema, trombocitopenia e inmunodeficiencia variable, generalmente letal por la tendencia a infecciones graves. Caso clínico. Se describe el caso de lactante masculino de seis meses de edad quien manifestó inicialmente eccema a los 20 días de vida y cinco meses después se hicieron aparentes infecciones y petequias corroborándose trombocitopenia. Conclusiones. Tener presente esta posibilidad en el paciente varón con eccema, trombositopenia y tendencia a infecciones ya que se tiene la opción terepéutica del transplante de médula ósea
Subject(s)
Infant , Humans , Male , Bone Marrow Transplantation , Wiskott-Aldrich Syndrome/physiopathology , Wiskott-Aldrich Syndrome/genetics , Wiskott-Aldrich Syndrome/therapy , Thrombocytopenia/diagnosis , Thrombocytopenia/genetics , Thrombocytopenia/mortality , Cerebral Hemorrhage/complications , Cerebral Hemorrhage/mortalityABSTRACT
O proposito do presente trabalho e colaborar para o estudo da patogenia da plaquetopenia que ocorre na Leptospirose. A pesquisa foi feita de maneira prospectiva e o grupo de casos foi constituido por 30 pacientes internados com hipotese diagnostica de Leptospirose na Clinica de Doencas Infecciosas e Parasitarias do Hospital das Clinicas da Faculdade de Medicina de Sao Paulo. Investigou-se a possibilidade de haver consumo de plaquetas por coagulacao intra vascular disseminada, ou a possibilidade de destruicao periferica de plaquetas por anticorpos e, se poderia haver inibicao da producao de plaquetas em nivel medular. Para a investigacao desejada foram utilizados os seguintes exames: contagem de plaquetas, tempo de protrombina, tempo de recalcificacao, tempo de trombina, tempo de tromboplastia parcial ativada, dosagem do fibrinogenio, dosagem do fator V, dosagem do fator VIII, dosagem dos produtos de degradacao da fibrina, dosagem da antitrombina III, mielograma e pesquisa de anticorpos antiplaquetas. Foram ainda estudados o hemograma, a dosagem de ureia, a dosagem de creatinina, a dosagem das enzimas hepaticas (aspartatoaminotransferase, alaninaaminotransferase, desidrogenase lactica, gamaglutamiltranspeptidade e fosfatase alcalina), e a dosagem das bilirrubinas. A analise dos dados obtidos no presente trabalho