Trombosis de la arteria renal después de suspender la terapia anticoagulante en una trasplantada renal con trombofilia: Caso Clínico / Renal artery thrombosis after withdrawal from anticoagulation therapy in a kidney transplant recipient with thrombophilia: Report of one case

Kidney graft loss because arterial thrombosis is not common and is related to risk factors such as recurrent vascular hemodialysis access thrombosis, collagen-vascular disease, repeated miscarriage, diabetes mellitus and thrombophilia. Patients having this last disorder have an increased risk of repeated thrombosis in successive transplants unless they receive anticoagulation therapy. We report a 51 year-old diabetic woman who had a history of recurrent vascular hemodialysis access thrombosis (both native and prosthetic) while on dialysis and received a cadaveric donor kidney. One month after transplantation she had axillary vein thrombosis complicated with pulmonary embolism and received anticoagulants for six months. Just days after stopping the anticoagulation, she became suddenly anuric due to renal artery thrombosis and complete graft infarction. The coagulation study showed moderate hyperhomocysteinemia and a significant protein C deficiency (39 percent). Days after nephrectomy she suffered a femoral vein thrombosis and anticoagulation was prescribed for life.

Aplasia medular tratada exitosamente con ciclosporina en un paciente en hemodiálisis crónica / Bone marrow aplasia during hemodialysis successfully treated with cyclosporine: report of one case

A 28 years old male on chronic hemodialysis for 40 months due to a IgA crescentic glomerulonephritis developed pancytopenia (hematocrit 16 percent, white blood cell count 3.800 mm3 and platelets 11.000 mm3. The bone marrow aspirate showed erythropoietic hyperplasia. Hemolytic anemia, folate or vitamin B12 deficiency and paroxysmal nocturnal hemoglobinuria were ruled out. Steroids were given with a transient elevation of red cells and platelets, which lasted only for some weeks. Afterwards, intravenous immunoglobulin was given without benefit. Two months after, a bone marrow biopsy and a bone marrow magnetic resonance imaging showed severe aplasia. Cyclosporine was started with a rapid increase in blood cells count. Eight months later, he received a renal transplant from a cadaveric donor. Immunosupression was achieved with cyclosporine, prednisone and mycofenolate mofetil. The patient required hemodialysis for the first three weeks and a mild acute cellular rejection was treated with methylprednisolone. At discharge, 6 weeks later, serum creatinine was 2.4 mg/dl and creatinine clearance 37.6 ml/min. During the first months after transplant, platelet count and hemoglobin decreased and a bone marrow biopsy showed only mild hypoplasia. Four months after renal transplant the hematocrit was 43 percent, white blood cell count 6.600 mm3 and platelets, 150.000 mm3 and did not change during the first year of follow up (Rev Méd Chile 2004; 132: 989-94).

Síndrome hemorragíparo por exposición a raticida: comunicación de un caso / Bleeding disorder caused by exposure to a rodenticide: report of 1 case

We report a 22 years old male, admitted to the emergency room due to a life threatening coagulation disorder, with prothrombin times fluctuation between 5 and 37 percent and very low activity of factors II, VII, IX and X. In the month prior to the admission, the patient had used the rodenticide difethialone, without any precaution to avoid accidental exposure. The patient was maintained with fresh frozen plasma until oral vitamin K1 was obtained. This medication corrected the coagulation disorder

Tiempo de tromboplastina parcial activado y tiempo de trombina en el control de la heparinoterapia: comparacion de diferentes tromboplastinas; estudio in vitro / Partial thromboplastin time activated and thrombin time in control of heparin-therapy: comparison of different thromboplastins: in vitro study

Se estudio in vitro la sensibilidad de las diferentes tromboplastinas comerciales usadas en Colombia, con el tiempo de tromboplastina parcial activado, usando un "pool" de plasmas normales con diferentes concentraciones de heparina (0,2 a 0.6 unidades por ml). Igualmente se midio el efecto heparinico por medio del tiempo de trombina. La tromboplastina mas sensible fue el Pathromtin y la menos sensible el Actin. Ambas con diferencias estadisticamente significativas (p<0.001). E1TT demuestra gran sensibilidad, pocos factores inciden sobre el y permite determinar las concentraciones de heparina plasmaticas. Los diferentes laboratorios deberan establecer la sensibilidad de las diferentes tromboplastinas que utilizan para proporcionar una monitoria efectiva durante el tratamiento anticoagulante con heparina.