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1.
Gac. méd. Méx ; 157(2): 209-214, mar.-abr. 2021. graf
Article in Spanish | LILACS | ID: biblio-1279103

ABSTRACT

Resumen La infección por coronavirus 2 del síndrome respiratorio agudo grave (SARS-CoV-2) es la causante de la pandemia de enfermedad por coronavirus 2019 (COVID-19), con un índice de letalidad alto. La mayoría de los pacientes graves desarrollan un tipo especial de coagulopatía no descrito hasta ahora y la cual se considera ahora la principal causa de muerte. Por esta razón, el tratamiento anticoagulante se ha convertido en una de las piedras angulares del tratamiento de esta infección. Sin embargo, la velocidad con la que se genera la evidencia respecto al uso de anticoagulantes es muy rápida y, en ocasiones difícil de interpretar y contradictoria. Luego de hacer una revisión extensa de la literatura publicada, se hace esta propuesta para el uso del tratamiento anticoagulante tomando en cuenta los recursos disponibles en México.


Abstract Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is the cause of the coronavirus disease 2019 (COVID-19) pandemic, which has a high case fatality rate. Most severely ill patients develop a special type of coagulopathy that had not been described before and that is now considered the main cause of death. For this reason, anticoagulant treatment has become one of the cornerstones of the treatment of this infection. However, the rate at which the evidence regarding the use of anticoagulants is generated is quite fast, and sometimes it is difficult to interpret and conflicting. After having performed an extensive review of the published literature, this proposal for the use of anticoagulant treatment is made, taking into account available resources in Mexico.


Subject(s)
Humans , Adult , Blood Coagulation Disorders/etiology , Blood Coagulation Disorders/therapy , COVID-19/complications , Anticoagulants/therapeutic use , Blood Coagulation Disorders/prevention & control , Algorithms , Guidelines as Topic , Mexico
3.
Rev. bras. ter. intensiva ; 32(3): 474-478, jul.-set. 2020. graf
Article in English, Portuguese | LILACS | ID: biblio-1138507

ABSTRACT

RESUMO Este relato de caso detalha um caso grave de febre amarela complicada por insuficiência hepática e coagulação intravascular disseminada. A tromboelastometria foi capaz de identificar os distúrbios da coagulação e orientar o tratamento hemostático. Relatamos o caso de um homem com 23 anos de idade admitido na unidade de terapia intensiva com quadro com início abrupto de febre e dor muscular generalizada associados a insuficiência hepática e coagulação intravascular disseminada. Os resultados dos exames laboratoriais convencionais revelaram trombocitopenia, enquanto a tromboelastometria sugeriu coagulopatia com discreta hipofibrinogenemia, consumo de fatores de coagulação e, consequentemente, aumento do risco de sangramento. Diferentemente dos exames laboratoriais convencionais, a tromboelastometria identificou o distúrbio de coagulação específico e, assim, orientou o tratamento hemostático. Administraram-se concentrados de fibrinogênio e vitamina K, não sendo necessária a transfusão de qualquer componente do sangue, mesmo na presença de trombocitopenia. A tromboelastometria permitiu a identificação precoce da coagulopatia e ajudou a orientar a terapêutica hemostática. A administração de fármacos hemostáticos, incluindo concentrados de fibrinogênio e vitamina K, melhorou os parâmetros tromboelastométricos, com correção do transtorno da coagulação. Não se realizou transfusão de hemocomponentes, e não ocorreu qualquer sangramento.


Abstract This case report a severe case of yellow fever complicated by liver failure and disseminated intravascular coagulation. Thromboelastometry was capable of identifying clotting disorders and guiding hemostatic therapy. We report the case of a 23-year-old male admitted to the Intensive Care Unit with sudden onset of fever, generalized muscle pain associated with liver failure, and disseminated intravascular coagulation. The results of conventional laboratory tests showed thrombocytopenia, whereas thromboelastometry suggested coagulopathy with slight hypofibrinogenemia, clotting factor consumption, and, consequently, an increased risk of bleeding. Unlike conventional laboratory tests, thromboelastometry identified the specific coagulation disorder and thereby guided hemostatic therapy. Both fibrinogen concentrates and vitamin K were administered, and no blood component transfusion was required, even in the presence of thrombocytopenia. Administration of hemostatic drugs, including fibrinogen concentrate and vitamin K, improved thromboelastometric parameters, correcting the complex coagulation disorder. Blood component transfusion was not performed, and there was no bleeding.


Subject(s)
Humans , Male , Young Adult , Yellow Fever/complications , Blood Coagulation Disorders/diagnosis , Liver Failure/complications , Disseminated Intravascular Coagulation/complications , Thrombelastography/methods , Blood Coagulation Disorders/etiology , Blood Coagulation Disorders/therapy , Hemostatics/administration & dosage , Liver Failure/virology
4.
Medicina (B.Aires) ; 80(5): 505-511, ago. 2020. graf
Article in Spanish | LILACS | ID: biblio-1287203

ABSTRACT

Resumen La pandemia COVID-19 provocada por el betacoronavirus SARS-CoV-2 exige rápidas respuestas desde el campo de la medicina. El riesgo de tromboembolismo venoso y arterial está aumentado durante la infección, especialmente en pacientes críticos. En ese contexto se destaca una coagulopatía caracterizada por niveles elevados de dímero D, con tendencia a la falla multiorgánica, y aumento de la mortalidad. Esas anormalidades de la hemostasia responden a varios mecanismos que deben tenerse en cuenta para la toma de decisiones terapéuticas. Analizamos la evidencia científica disponible en la que se fundamenta el enfoque terapéutico de la coagulopatía descripta y sus complicaciones, con el objetivo de diseñar recomendaciones terapéuticas realistas tendientes a disminuir la morbilidad y la mortalidad en pacientes con COVID-19.


Abstract The coronavirus disease 2019 (COVID-19) pandemic requires rapid medical responses. The risk of venous and arterial thromboembolism increases in critically ill patients with SARS-CoV-2 infection. There is a hypercoagulable state that includes elevated levels of D-dimer, with an increased risk of organ failure and increased mortality. The abnormalities described in hemostasis should be considered for therapeutic decision making. We analyzed the available scientific evidence for the therapeutic approach of coagulopathy in the course of the disease with the objective of designing realistic therapeutic recommendations aimed at reducing morbidity and mortality in patients with COVID-19.


Subject(s)
Humans , Pneumonia, Viral/blood , Thromboembolism/complications , Blood Coagulation Disorders/etiology , Coronavirus Infections/blood , Coronavirus , Pandemics , Argentina/epidemiology , Blood Coagulation Disorders/diagnosis , Blood Coagulation Disorders/prevention & control , Blood Coagulation Disorders/epidemiology , Cytokines , Coronavirus Infections/complications , Coronavirus Infections/epidemiology , Disseminated Intravascular Coagulation , Betacoronavirus , SARS-CoV-2 , COVID-19
5.
Mem. Inst. Invest. Cienc. Salud (Impr.) ; 17(3): 5-9, dic.2019. tab
Article in Spanish | LILACS, BDNPAR | ID: biblio-1021561

ABSTRACT

La hemorragia postparto es una de las complicaciones obstétricas más temidas por los obstetras a nivel mundial, pudiendo causar la muerte de las puérperas. El objetivo de este estudio fue determinar las causas de las hemorragias y las patologías asociadas a estas en las pacientes atendidas en el Hospital Gineco-Obstétrico Enrique C. Sotomayor de Guayaquil, Ecuador en el periodo 2016­2018 y que estaban en su puerperio inmediato. Las mujeres atendidas en ese periodo en dicha institución fueron 528, de las cuales 160 presentaron hemorragias en el puerperio inmediato. Las hemorragias por desgarro del suelo pélvico representaron un 48,75% y se asociaron en un 35% a hematomas en las paredes del suelo, las causadas por retención de restos placentarios, constituyeron un 26,25% y el 20% presentó acretismo placentario y finalmente las ocasionadas por atonía uterina fueron de un 25%, correspondiendo un 25% a coagulopatías. Se concluyó que las hemorragias postparto por desgarro del suelo pélvico son la causa con mayor porcentaje en contraposición con otros estudios que indican que la atonía uterina es la causa más frecuente de hemorragias postparto inmediato(AU)


Postpartum hemorrhage is one of the obstetric complications most feared by obstetricians worldwide, and may cause the death of puerperal women. The objective of this study was to determine the causes of hemorrhages and the pathologies associated with these in the patients treated at the Enrique C. Sotomayor Obstetric Hospital of Guayaquil, Ecuador in the period 2016 - 2018 and that were in their immediate puerperium. The women who attended in that period were 528 women, 160 of them presented hemorrhages in the immediate puerperium. Hemorrhages by pelvic floor tearing represented 48.75% and 35% were associated to bruises in the floor walls, those caused by retention of placental remains constituted 26.25% and 20% presented accretism and finally those caused by uterine atony were 25% while 25% corresponded to coagulopathies. We concluded that the postpartum hemorrhages by tearing of the pelvic floor are the cause with the highest percentage; in contrast to other studies, which indicate that uterine aton is the most frequent cause of immediate postpartum hemorrhage(AU)


Subject(s)
Humans , Female , Pregnancy , Postpartum Period , Postpartum Hemorrhage/etiology , Obstetric Labor Complications/etiology , Placenta Accreta , Blood Coagulation Disorders/etiology , Retrospective Studies , Hematoma/etiology
6.
Rev. bras. ter. intensiva ; 30(3): 394-397, jul.-set. 2018. tab, graf
Article in Portuguese | LILACS | ID: biblio-977974

ABSTRACT

RESUMO A transfusão de concentrado de plaquetas é prática comum para prevenção de sangramento espontâneo ou decorrente de procedimentos invasivos; sabe-se que a transfusão de componentes alogênicos do sangue se associa a aumento da mortalidade e piora do desfecho clínico. A força do coágulo é avaliada por meio da tromboelastometria rotacional e determinada pela interação entre plaquetas e fibrinogênio. O efeito compensatório do incremento na concentração sérica de fibrinogênio na força do coágulo, em pacientes com trombocitopenia, tem sido demonstrado em diferentes contextos clínicos, incluindo sepse. Relatamos o caso de uma paciente com trombocitopenia grave, cujo resultado da tromboelastometria rotacional demonstrou efeito compensatório na força do coágulo determinada pelos níveis plasmáticos aumentados de fibrinogênio como reagente de fase aguda em pacientes sépticos. Relatamos o caso de uma paciente de 62 anos com diagnóstico de aplasia de medula óssea admitida a uma unidade de terapia intensiva com choque séptico e trombocitopenia grave. Nas primeiras 24 horas na unidade de terapia intensiva, ela apresentou quadro clínico de insuficiência respiratória aguda e choque. Foi necessário utilizar ventilação mecânica invasiva e fármaco vasoativo. A radiografia de tórax mostrou padrão de lesão pulmonar bilateral. Desta forma, foi solicitada broncoscopia com lavagem broncoalveolar para investigação diagnóstica. Conduziu-se uma tromboelastometria rotacional, e seu resultado mostrou perfil de coagulação normal. Apesar da trombocitopenia grave (1.000/mm3), os níveis de fibrinogênio aumentaram (1.050mg/dL) devido ao choque séptico. A broncoscopia foi realizada sem que subsequentemente ocorresse sangramento ativo. Este caso relata o uso da tromboelastometria como ferramenta diagnóstica em distúrbios da coagulação de pacientes graves, permitindo prevenir o uso desnecessário de transfusões profiláticas de concentrado de plaquetas.


ABSTRACT Platelet transfusion is a common practice to prevent spontaneous bleeding or bleeding due to invasive procedures. Transfusion of allogeneic blood components is associated with increased mortality and a worse clinical outcome. The clot strength is assessed by thromboelastometry and determined by the interaction between platelets and fibrinogen. The compensatory effect of high levels of fibrinogen on clot strength in patients with thrombocytopenia has been demonstrated in different clinical settings including sepsis. We report the case of a patient with severe thrombocytopenia whose thromboelastometry showed clot strength that was compensated for by the increase in plasma fibrinogen levels as an acute phase reactant of septic patients. Here, we report a case of a 62-year-old female diagnosed with bone marrow aplasia admitted in the intensive care unit with septic shock and severe thrombocytopenia. During the first 24 hours in the intensive care unit, she presented acute respiratory insufficiency and circulatory shock. The use of invasive mechanical ventilation and norepinephrine was required. Her chest X-ray showed bilateral lung injury. Thus, bronchoscopy with bronchoalveolar lavage was requested. Thromboelastometry was performed and resulted in a normal coagulable profile. Despite severe thrombocytopenia (1,000/mm3), fibrinogen levels were increased (1,050mg/dL) due to septic shock. Bronchoscopy was performed without any active or further bleeding. Here, we report the use of thromboelastometry in the diagnosis of coagulation disorders, preventing unnecessary prophylactic platelet transfusion.


Subject(s)
Humans , Female , Shock, Septic/complications , Thrombelastography/methods , Thrombocytopenia/physiopathology , Fibrinogen/metabolism , Thrombocytopenia/etiology , Blood Coagulation Disorders/diagnosis , Blood Coagulation Disorders/etiology , Bronchoscopy/methods , Bone Marrow Cells/pathology , Intensive Care Units , Middle Aged
8.
Rev. Soc. Bras. Med. Trop ; 49(4): 520-522, July-Aug. 2016. graf
Article in English | LILACS | ID: lil-792804

ABSTRACT

Abstract: Because the majority of colubrid species are considered harmless to human beings, colubrid snakebites are rarely reported. However, the venom of Rhabdophis, which is part of the Colubridae family, is procoagulant and leads to severe coagulopathy. Here, we present a case of disseminated intravascular coagulation with enhanced fibrinolysis following a Rhabdophis bite. Although coagulopathy can be treated effectively with the specific Rhabdophis antivenom, this antivenom is not widely available in Indonesia. We also found transient hypertension secondary to the colubrid venom, an unusual finding.


Subject(s)
Humans , Animals , Male , Snake Bites/complications , Snake Venoms/poisoning , Blood Coagulation Disorders/etiology , Colubridae , Hypertension/etiology , Severity of Illness Index , Middle Aged
9.
Gastroenterol. latinoam ; 27(supl.1): S69-S71, 2016.
Article in Spanish | LILACS | ID: biblio-907658

ABSTRACT

Cirrhotic patients frequently exhibit abnormal coagulation tests such as prothrombin time (PT) and activated partial thromboplastin time (APTT) due to impairment in hepatic synthesis of coagulation factors. Due to these abnormalities and also to the numerous bleeding episodes that characterize advanced or decompensated liver cirrhosis, these patients were traditionally considered as “anticoagulated”. More recently, this paradigm has been challenged due to the increased occurrence of thrombotic complications among this population. This can only be understood when analyzed under the prism of the cellular theory of coagulation, which describes the complex interactions between endothelial, platelets and inflammatory cells that determine the status of coagulation, anticoagulation and fibrinolysis. The liver participates actively in this process contributing to the maintenance of a dynamic equilibrium in healthy patients. During liver failure there is evidence of impairment of synthesis of factors involved in the coagulation process, but also in anticoagulation and fibrinolysis. However, stable cirrhotic patients tend to maintain a delicate dynamic equilibrium. This equilibrium can be altered in acute decompensations leading to hemorrhagic or thrombotic complications.


Los pacientes con cirrosis presentan disminución en la producción de factores de coagulación de síntesis hepática, esto determina alteración del tiempo de protrombina (TP) y tiempo de tromboplastina parcial activada (TTPa). Esta característica, junto con los episodios de sangrado, que se presentan frecuentemente en pacientes descompensados y en etapa avanzada de la enfermedad, significó que por muchos años se considerara a los pacientes con daño hepático crónico como “anticoagulados”. En los últimos años este paradigma ha sido desafiado por estudios que muestran una mayor frecuencia de trombosis en esta población. Este fenómeno se comprende mejor con la teoría celular de la coagulación que integra a la ecuación las membranas celulares, especialmente de endotelio, plaquetas y células inflamatorias, y que permite visualizar las complejas interacciones entre factores coagulantes, anticoagulantes y fibrinolisis. El hígado participa en forma activa en este proceso que determina un amplio equilibrio dinámico en individuos sanos. El daño hepático claramente altera la coagulación, sin embargo, la evidencia actual demuestra que en la mayoría de los pacientes se produce un delicado rebalance hemostático, que determina una coagulación efectiva. Si este frágil equilibrio se altera, se produce un desbalance que puede generar un estado hemorrágico o trombótico.


Subject(s)
Humans , Blood Coagulation Disorders/etiology , Liver Cirrhosis/physiopathology , Liver Diseases/complications , Chronic Disease , Hemorrhage/etiology , Liver Diseases/physiopathology , Thrombosis/etiology
10.
Rev. chil. anest ; 44(2): 147-150, 2015.
Article in Spanish | LILACS | ID: biblio-831321

ABSTRACT

The case of a patient that bleed approximatelly 40 lts during a liver and kidney transplant is reported. Strategies directed to maintain hemodynamic and hemostatic conditions are discussed. Elective surgery in patients that may require massive transfusion allow to planify a strategy directed to avoid hypothermia, appearence of metabolic acidosis and coagulopathy. All of these conditions have been related to the appearence and maintenance of bleeding. Maintenance of hemostatic condition appears particularly important requiring a strategy of early administration of blood components directed to preserve an adequate level of clotting factors and platelets. The same considerations must be kept in mind when the requirement of massive transfusion is not expected and the coagulation condition must be preserved or restored.


Se reporta el caso de un paciente que sangró 40 litros durante un trasplante hepático y renal, discutiéndoselas estrategias utilizadas, mantener adecuadas condiciones hemodinámicas y hemostáticas.La cirugía electiva en pacientes que pueden requerir transfusión masiva permite planificar la implementación de medidas dirigidas a prevenir la aparición de hipotermia, acidosis metabólica y coagulopatía, los cuales han sido identificados, relacionados a la aparición y mantención de un estado de mayor sangrado. La mantención de adecuadas condiciones hemostáticas aparece como un factor de gran importancia, requiriendo una estrategia que requiere la precoz administración de hemocomponentes, con la idea de mantener adecuados niveles de factores de coagulación y plaquetas. Estas mismas consideraciones deben tenerse presente cuando el requerimiento de transfusión masiva es imprevisto, y las condiciones de hemostasia deben ser mantenidas o restauradas.


Subject(s)
Humans , Male , Middle Aged , Hemorrhage/prevention & control , Blood Transfusion/methods , Blood Coagulation Disorders/prevention & control , Ketosis/etiology , Ketosis/prevention & control , Hemorrhage/etiology , Hypothermia/etiology , Hypothermia/prevention & control , Blood Component Transfusion/methods , Liver Transplantation/adverse effects , Kidney Transplantation/adverse effects , Blood Coagulation Disorders/etiology
11.
Bol. Hosp. Viña del Mar ; 70(2): 71-72, jun.2014. ilus
Article in Spanish | LILACS | ID: lil-779176

ABSTRACT

La enfermedad celiaca (EC) es una enfermedad frecuente de naturaleza autoinmune y afectación sistémica, inducida por la ingesta de gluten, el que produce una inflamación crónica y difusa de la mucosa del intestino delgado así como de otros órganos como piel y hueso. Si bien la forma de presentación más conocida es en niños en forma de diarrea crónica, pérdida de peso y retraso ponderal, EC también se diagnostica en adultos, siendo un 20 por ciento de los diagnósticos realizados en mayores de 60 años. La presentación gastrointestinal se presenta solo en el 50 por ciento de los casos de adultos. El caso presentado es de un paciente varón de 34 años con historia de obesidad, hospitalizado por un cuadro de baja de peso, trastorno de coagulación severo asociado a hematuria, hematomas generalizados y hemopericardio. Se objetiva hipokalemia, hipoalbuminemia e hipocalcemia. Se trató con aporte de vitamina K, calcio y potasio endovenoso lográndose rápida normalización de todos sus parámetros y llegando al diagnóstico etiológico de EC. Este caso nos alerta sobre la EC, frecuentemente subdiagnosticada en sus presentaciones habituales y que, además, puede debutar de esta manera inhabitual y grave como es el trastorno severo de la coagulación del cual hay muy escasa bibliografía disponible y que con el adecuado manejo se logra una respuesta exitosa en poco tiempo...


Celiac disease is a systemic autoimmune disease induced by ingestion of gluten, which causes chronic and diffuse inflammation of the small intestine mucosa and other organs such as skin and bone. While the best known form of presentation is in children as chronic diarrhea, weight loss and failure to thrive; this disease is also being diagnosed in adults. Twenty percent of new cases are diagnosed in patients over 60 years, 50 percent of them have a gastrointestinal form only. We present the case of a 34 years old male patient with obesity history, admitted with weight loss, severe coagulation disorder, hematuria, generalized bruising, haemopericardium, hypokalemia, hypoalbuminemia and hypocalcemia. The patient was treated with Vitamin K, calcium and potassium, achieving a quick normalization of all parameters. The etiologic diagnosis was celiac disease. This case alerts us about this illness, frequently underdiagnosed in usual presentations. Celiac disease can debut with severe bleeding disorder, with little literature available. A successful response can be achieved in a short time with proper management...


Subject(s)
Humans , Male , Adult , Celiac Disease/complications , Celiac Disease/diagnosis , Blood Coagulation Disorders/etiology
12.
Rev. méd. Chile ; 141(11): 1420-1426, nov. 2013. tab
Article in Spanish | LILACS | ID: lil-704569

ABSTRACT

Background: Patients who have suffered multiple traumatic injuries, have a serious risk for death. Hypothermia, acidosis and coagulopathy are three complications in these patients, whose presence is known as lethal triad and indicates bad prognosis.Aim: To determine if the lethal triad in multiple trauma patients is associated withhigher mortality and Injury Score Severity (ISS). Material and Methods: Onehundred multiple trauma patients aged 26 to 56 years (90 males), admitted toan emergency room, were studied. Body temperature, prothrombin time, partialthromboplastin time, platelet count and blood gases were determined on admission.Results: Twenty six patients had the lethal triad and 15% died in the emergencyroom within the first 6 hours. No death was recorded among the 74 patients withoutthe lethal triad. The mean ISS among patients with and without the lethal triad was31.7 and 25.6, respectively (p < 0.05). Conclusions: The presence of the lethal triadamong patients with multiple trauma is associated with a higher mortality and ISS.


Subject(s)
Adolescent , Adult , Female , Humans , Male , Middle Aged , Young Adult , Acidosis/etiology , Blood Coagulation Disorders/etiology , Hypothermia/etiology , Multiple Trauma/complications , Acidosis/mortality , Blood Coagulation Disorders/mortality , Emergency Service, Hospital , Hypothermia/mortality , Injury Severity Score , Multiple Trauma/mortality , Prognosis , Risk Factors , Survival Analysis
13.
Rev. chil. med. intensiv ; 27(4): 215-223, 2012. tab
Article in Spanish | LILACS | ID: biblio-831361

ABSTRACT

En trauma, la principal causa de muerte es el sangrado no controlado. Para su prevención es fundamental corregir precozmente la coagulopatía aguda del trauma mediante la reanimación con control de daños. Hay evidencia que la administración precoz de todos los hemoderivados con una relación entre ellos cercana a 1:1, podría mejorar la sobrevida en los pacientes de trauma, aunque estos hallazgos deben corroborarse en estudios clínicos randomizados, junto con determinar cuál es la relación óptima. En pacientes estables una estrategia transfusional restrictiva es segura y adecuada. En el presente artículo se revisará el manejo transfusional de los pacientes de trauma, dando especial énfasis a aquellos que requieren transfusión masiva.


In trauma, the leading cause of death is uncontrolled bleeding. For early prevention is essential the correction the acute coagulopathy of trauma using damage-control resuscitation. There is evidence that early administration of 1:1 transfusion ratios of blood products are associated with increased survival in trauma patients with massive transfusion requirements. Although, these findings must be corroborated in randomized clinical trials, along with determining which is the optimum. In stable patients, restrictive transfusion strategy is safe and appropriate. In this article, we review the transfusion management of trauma patients with special emphasis on those requiring massive transfusion.


Subject(s)
Humans , Wounds and Injuries/complications , Wounds and Injuries/therapy , Blood Transfusion/methods , Blood Coagulation Disorders/etiology , Blood Coagulation Disorders/therapy , Hemorrhage/etiology , Hemorrhage/therapy , Prognosis
14.
Rev. chil. med. intensiv ; 27(4): 224-226, 2012.
Article in Spanish | LILACS | ID: biblio-831362

ABSTRACT

En la actualidad, el trauma constituye, por su alta frecuencia de presentación un problema no solo en su manejo sino que también de salud pública. La mejoría en los diferentes sistemas de rescate permite la recepción de pacientes más graves cuyo requerimiento de transfusiones es mayor y si bien son en grupo minoritario dentro del total de trauma aportan con una alta mortalidad especialmente en las primeras horas siendo la hemorragia y la coagulopatía la causa de ésta. Los recientes conflictos bélicos han planteado un cambio en el manejo transfusional de estos pacientes orientando hacia prácticas que incrementan la relación de GR, plasma fresco congelado (PFC)y plaquetas aportadas, tratando de simular el aporte de sangre total en las primeras horas de ocurrido el accidente.


Trauma is a very important public health problem and also a practice management. The aim of prehospital care of bleeding patient is to deliver the patient to a facility for definitive care. Trauma associated bleeding and coagulopaty is the principal cause of preventible death. Recent military experience suggest that FFP and platelets should be given early and more often to injured patient.


Subject(s)
Humans , Wounds and Injuries/complications , Wounds and Injuries/therapy , Blood Transfusion/methods , Blood Coagulation Disorders/etiology , Blood Coagulation Disorders/therapy , Shock, Hemorrhagic/etiology , Shock, Hemorrhagic/therapy
15.
Acta cir. bras ; 24(5): 338-346, Sept.-Oct. 2009. graf, tab
Article in English | LILACS | ID: lil-529151

ABSTRACT

PURPOSE: Acute ischemia-reperfusion (I/R) of extremities means serious challenge in the clinical practice. Furthermore, the issue of preventive cooling is still controversial. In this canine model we investigated whether limb I/R -with or without cooling- has an influence on hematological and hemostaseological factors. METHODS: Femoral vessels were exposed and clamped for 3 hours. After release the clamps, 4-hour reperfusion was secured. The same procedures with cooling using ice bags, as well as warm and cold sham-operations were performed. Before operations, from the excluded limb by the end of ischemia, during the reperfusion, and for 5 postoperative days afterwards blood samples were collected for testing hematological and blood coagulation parameters. RESULTS: After I/R activated partial thromboplastin time was elongated on 2nd-4th postoperative days. The highest values were on the 2nd day in cold I/R group, accompanied by increased prothrombin time values. The hematological parameters and fibrinogen level showed non-specific changes. In excluded ischemic limb the blood composition showed controversial data. Cold ischemia induced larger alterations, however platelet count, hematocrit changed more expressly in warm ischemia. CONCLUSION: These results indicate the risk of coagulopathy following limb I/R on early post-eventually days, which risk is higher in the case of cold I/R.


OBJETIVO: Isquemia-Reperfusão aguda (I/R) de extremidades representa um desafio sério na prática clínica. Além disso, o tema de prevenção pelo resfriamento é ainda controverso. Nesse modelo canino, investigou-se se I/R de membros -com ou sem resfriamento- tem influência nos fatores hematológicos e hemostaseológicos. MÉTODOS: Os vasos femorais foram expostos e clampeados por 3 horas. Após liberação dos clampes, foi realizada a reperfusão por 4-horas. Os mesmos procedimentos com e sem resfriamento usando bolsas de gelo, assim como operações simuladas com e sem resfriamento foram realizados. Antes das operações, do membro excluído ao final da isquemia, durante a reperfusão e por 5 dias de pós-operatório, amostras sanguíneas foram colhidas para exames hematológicos e parâmetros de coagulação. RESULTADOS: Após I/R, o tempo de tromboplastina parcial ativada foi alargado no 2º.-4º. dias de pós-operatório. Os valores mais altos foram no 2º.dia no grupo deI/R fria, acompanhada pelo aumento dos valores do tempo de protrombina. Os parâmetros hematológicos e o nível de fibrinogênio mostraram mudanças não específicas. No membro isquêmico excluído a composição sanguínea mostrou dados controversos. A isquemia fria induziu maiores alterações, entretanto, a contagem de plaquetas e o hematócrito mudaram mais expressivamente na isquemia morna. CONCLUSÃO: Estes resultados indicam risco de coagulopatia após I/R de membros nos dias mais precoces após o evento, sendo mais elevado no caso da I/R fria.


Subject(s)
Animals , Dogs , Blood Coagulation Disorders/blood , Cold Temperature/adverse effects , Hindlimb/blood supply , Ischemia/blood , Lower Extremity/blood supply , Reperfusion Injury/blood , Body Temperature , Blood Coagulation Disorders/etiology , Disease Models, Animal , Fibrinogen/analysis , Hemorheology , Hemostasis , Random Allocation , Reperfusion Injury/complications
16.
Indian J Pediatr ; 2008 Dec; 75(12): 1261-3
Article in English | IMSEAR | ID: sea-81847

ABSTRACT

We describe two cases of Reactive Hemophagocytic syndrome (RHS) occurring in rheumatic diseases in childhood. Patient 1, an adolescent girl with systemic onset Juvenile idopathic arthritis (JRA) presented like severe sepsis with shock, hepatic dysfunction and coagulopathy. Patient 2 presented with cardiac tamponade, she was later detected to have systemic lupus erythematosus (SLE). Her bone marrow aspirate revealed prominent hemophagocytosis. Both cases improved with pulse methylprednisolone therapy.


Subject(s)
Adolescent , Arthritis, Juvenile/complications , Blood Coagulation Disorders/etiology , Cardiac Tamponade/etiology , Female , Glucocorticoids/administration & dosage , Humans , Liver/physiopathology , Lupus Erythematosus, Systemic/complications , Lymphohistiocytosis, Hemophagocytic/complications , Methylprednisolone/administration & dosage , Pulse Therapy, Drug
18.
Article in English | WPRIM | ID: wpr-206217

ABSTRACT

BACKGROUND/AIMS: Coagulopathy is a common complication of snakebite, but there is little information on the clinical importance of coagulopathy. We analyzed the characteristics of coagulopathy after envenomation. METHODS: Ninety-eight patients who experienced snakebite were enrolled in this study. We divided all the patients into three groups by the ISTH DIC scoring system: the normal, simple coagulopathy and DIC groups. The coagulopathy group included both the simple coagulopathy and DIC groups. We then conducted a case-control study. RESULTS: There was a significant decrease in the Hct, protein, albumin, ALP and cholesterol levels in the coagulopathy group, and only the cholesterol level was deceased in the DIC group (p<0.05). Leukocytosis and rhabdomyolysis were significantly associated with coagulopathy, and hemolysis and rhabdomyolysis were associated with DIC (p<0.05). The presence of rhabdomyolysis was considered a risk factor for coagulopathy (p<0.05). These conditions continued for up to six to seven days after the snakebite. CONCLUSIONS: Evaluation of coagulopathy with using these characteristics is helpful to properly manage the patients who experience snakebite.


Subject(s)
Animals , Blood Coagulation Disorders/etiology , Case-Control Studies , Female , Hemolysis/drug effects , Humans , Incidence , Leukocytosis/etiology , Male , Retrospective Studies , Rhabdomyolysis/etiology , Risk Factors , Snake Bites/complications
19.
Article in English | IMSEAR | ID: sea-134810

ABSTRACT

A four year old Muslim female child came with alleged h/o fall in school with bluish discoloration around the left eye, neck, back and limbs. The paediatrician suspected this to be a case of bleeding disorder because of family history as her elder sister was suffering from platelet disorder. Finally it turned out to be a physical assault case with no any ill or evil intention.


Subject(s)
Battered Child Syndrome/complications , Blood Coagulation Disorders/etiology , Child , Contusions/etiology , Female , Humans , Islam
20.
J. bras. med ; 93(2): 46-47, ago. 2007. tab
Article in Portuguese | LILACS | ID: lil-603842

ABSTRACT

Coagulação intravascular disseminada é uma síndrome caracterizada por ativação sistêmica da coagulação, com conseqüente deposição intravascular de fibrina, trombose vascular e disfunção de órgão. O consumo de plaquetas e fatores de coagulação provoca trombocitopenia e sangramentos. O principal fator etiológico no paciente grave é a sepse. O tratamento consiste em tratar a causa e repor hemoderivados se houver sangramento ou algum procedimento cirúrgico for programado.


Subject(s)
Male , Female , Disseminated Intravascular Coagulation/diagnosis , Disseminated Intravascular Coagulation/physiopathology , Disseminated Intravascular Coagulation/therapy , Critical Care , Sepsis/complications , Blood Coagulation Disorders/etiology
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