Effect of liver cirrhosis complicated with thrombocytopenia on perioperative period / 中华消化外科杂志

Objective:To investigate the effect of liver cirrhosis complicated with thrombocytopenia on perioperative period.Methods:The retrospective and descriptive study was conducted. The clinical data of 75 cirrhosis patients complicated with thrombocytopenia who were admitted to the Fuyang City Second People's Hospital from July 2020 to February 2022 were collec-ted. There were 56 males and 19 females, aged (58±11)years. Observation indicators: (1) preoperative conditions; (2) intraoperative and postoperative conditions. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the one way ANOVA. Pairwise comparison was conducted using the LSD- t test. Count data were descri-bed as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Comparison of ordinal data was analyzed using the rank sum test. Results:(1) Preoperative conditions. Of 75 cirrhosis patients complicated with thrombocytopenia, there were significant differences in the preoperative Child-Pugh grading and platelet count between patients with mild, moderate, and severe thrombocytopenia ( P<0.05). Results of further analysis showed that compared with patients with mild thrombocytopenia, patients with moderate and severe thrombocytopenia had significantly lower preoperative platelet count ( P<0.05). Compared with patients with moderate thrombocytopenia, patients with severe thrombocytopenia had significantly lower preoperative platelet count ( P<0.05). (2) Intraoperative and postoperative conditions. Of 75 cirrhosis patients complicated with thrombocytopenia, there were significant differences in the surgical anesthesia methods, operation time, postoperative bleeding, duration of hospital stay between patients with mild, moderate, and severe thrombocytopenia ( P<0.05). Results of further analysis showed that compared with patients with mild or moderate thrombocytopenia, patients with severe thrombocytopenia had a higher proportion of general anesthesia during surgery ( P<0.05) and compared with patients with mild thrombocytopenia, patients with severe thrombocytopenia significantly increased operation time and duration of hospital stay ( P<0.05). Of the 6 patients with severe thrombocytopenia, 3 of 5 cases with intraoperative platelet transfusion and 1 case without intraoperative platelet transfusion experienced postoperative bleeding, respectively, showing no significant difference between them ( P>0.05). Four patients with postoperative bleeding were successfully stopped bleeding after treatment and there was no death in the 75 patients. Conclusions:Patients with severe thrombocytopenia have longer operation time and duration of hospital stay, and higher proportion of general anesthesia than those with mild or moderate thrombocytopenia. Perioperative platelet transfusion cannot reduce the risk of postoperative bleeding.

Síndrome de Evans Fisher / Evans fisher syndrome

Paciente femenina de 35 años de edad con color de la piel blanca, con antecedentes de cefalea migrañosa. Comenzó con manifestaciones purpúreas en forma de petequias y equimosis diseminadas por todo el cuerpo; palidez cutánea mucosa e íctero en piel y esclera, además de coluria. Se realizaron estudios hematológicos, humorales e inmunológicos. Es atendida en la sala de Medicina Interna del Hospital General Docente Comandante Pinares. Con evolución satisfactoria al tratamiento con esteroides y la inmunoglobulina intravenosa. Se realizó la discusión diagnóstica del caso confirmándose el Síndrome de Evans-Fisher, se revisa la bibliografía actualizada sobre la enfermedad(AU)

We report a case of a 35-year-old female patient, white skin color, with a history of migraine headache. She began with purple manifestations in the form of petechiae and ecchymoses spread throughout the body; mucous skin pallor and icterus in skin and sclera, as well as coluria. Hematological, humoral and immunological studies were carried out. She was treated in the Internal Medicine ward at Comandante Pinares General Teaching Hospital. She evolved satisfactorily to treatment with steroids and intravenous immunoglobulin. The diagnostic discussion of this case was carried out, confirming the Evans-Fisher Syndrome, the updated bibliography on the disease was reviewed(AU)

Predictors of Mortality in Severe Leptospirosis

Introduction: Rheumatoid arthritis (RA) is a chronicmultisystem disease of unknown cause. The characteristicfeature of RA is persistent inflammatory synovitis usuallyinvolving the peripheral joints in a symmetric fashion.Hence;the present study was undertaken for assessing rheumatoidfactor titers in extra-articular manifestation of rheumatoidarthritis.Material and methods: A total number of 50 patientswho met the inclusion criteria were included in this study.Rheumatoid arthritis diagnosed as per 2010 revised criteriafor the classification of RA were enrolled. The RA patientsthus selected were screened for various common clinicalfeatures, articular and extra-articular manifestations usinga structured Proforma designed for this study. At the end ofthe study the titers of RF factor in articular and extra articularmanifestations in 50 rheumatoid arthritis patients screenedwere calculated and expressed as percentage. All the resultswere recorded in Microsoft excel sheet and were analysed bySPSS software.Results: The clinical examination in the study revealedpallor in 34(68%) patients. Rheumatoid factor titres of 1:16were observed in 4(13%) of patients, 1:32 in 7(24%), 1:64 in8(28%) and 1;128 in 10(35%) of patients. Hemoglobin <8g/dl in 10 patients i.e.;(20%), 8-10g/dl in 14 patients i.e;40%,10-12g/dl in 10 patients i.e.; 28%. (Normal Hb 12-14g/dlin females, 14-16g/dl in males). Peripheral smear showed24 patients i.e 70% of them had normocytic normochromicanemia. Extra-articular manifestations were seen in about72%, Anemia in 34(68%), Lymphadenopathy in 8(16%),Purpuric –rash in 4(8%), Rheumatoid nodules in 4(8%) andSplenomegaly in 2(4%).Conclusion: Extra-articular manifestations contributesignificantly to the morbidity and mortality in rheumatoidarthritis. Careful screening of all patients for extra-articularmanifestations may help reduce the same, with the propermanagement of such patients

Maternal and fetal outcome of dengue fever in pregnancy.

Background & objectives: As adult dengue fever increases it also affects women with pregnancy. Dengue fever is mainly treated conservatively. However, complications like pre-eclampsia, pre-term labour, increased risk of caesarean section and fetal transmission have been noted. During dengue epidemic in our region we noted many women with dengue fever and observed certain different problems. Methods: A retrospective analysis of all pregnant women admitted in obstetric ward with dengue fever over a period of 18 months was done. Results: The striking feature observed was the presence of severe thrombocytopenia in 78.57% of the study population. In addition, coexistence of other vector borne diseases was also noted. Conclusion: Most cases only require conservative treatment. Only women who went into labour required platelet transfusion. Outcome seemed to correlate with gestational age of occurrence of dengue fever.

AIDS presenting with severe thrombocytopenia: A case report / 대한내과학회지

The hematologic manifestations of human immunodeficiency virus (HIV) infection and acquired immune deficiency syndrome (AIDS) are common and may cause symptoms that are life threatening and impair the quality of life in these patients1). The most important of these manifestations is cytopenia. Among cytopenias, thrombocytopenia is caused by immune-mediated destruction of platelets, in addition to inadequate platelet production2). Thrombocytopenia has been reported in 5~15% of HIV-seropositive patients3). Profound thrombocytopenia (< 20,000/mm3) is rare (occurs in only 1.5% of cases) and presents only during advanced AIDS. With the exception of thrombocytopenia associated with advanced AIDS, severe thrombocytopenia in AIDS patients is extremely rare3). There are only a few reports of AIDS patients who first presented with severe thrombocytopenia. Here we report the case study of an AIDS patient who first presented with severe thrombocytopenia, mild abdominal distension, and edema in both lower legs. A brief review of the relevant literature is also presented.

AIDS presenting with severe thrombocytopenia: A case report / 대한내과학회지

The hematologic manifestations of human immunodeficiency virus (HIV) infection and acquired immune deficiency syndrome (AIDS) are common and may cause symptoms that are life threatening and impair the quality of life in these patients1). The most important of these manifestations is cytopenia. Among cytopenias, thrombocytopenia is caused by immune-mediated destruction of platelets, in addition to inadequate platelet production2). Thrombocytopenia has been reported in 5~15% of HIV-seropositive patients3). Profound thrombocytopenia (< 20,000/mm3) is rare (occurs in only 1.5% of cases) and presents only during advanced AIDS. With the exception of thrombocytopenia associated with advanced AIDS, severe thrombocytopenia in AIDS patients is extremely rare3). There are only a few reports of AIDS patients who first presented with severe thrombocytopenia. Here we report the case study of an AIDS patient who first presented with severe thrombocytopenia, mild abdominal distension, and edema in both lower legs. A brief review of the relevant literature is also presented.

Estimate of Thrombopoiesis by Flow Cytometric Analysis of Reticulated Platelets in Patients with Severe Thrombocytopenia / 대한진단검사의학회지

BACKGROUND: Analysis of reticulated platelets (RPs) is useful for discriminating the causes of thrombocytopenia and monitoring the thrombopoiesis. In the patients with severe thrombocytopenia, we evaluated the thrombopoiesis-discriminating ability of several indices applying forward scatter (FSC) and thiazole orange (TO) fluorescence in addition to the percentage of reticulated platelets (RPs%). METHODS: Forty cases with decreased thrombopoiesis, twenty cases with increased thrombopoiesis and twenty cases with liver cirrhosis were selected. By flow cytometry with two analytic methods, dependent on or independent of the staining of CD41-PE as a platelet marker, the primary parameters including RPs% were measured and the applied parameters were calculated from them. And we compared the diagnostic efficiency of each parameter and analyzed the purity of platelet light scatter gate. RESULTS: The purity of platelet light scatter gate was significantly lower in patients with severe thrombocytopenia than in healthy persons with normal platelet counts (P<10(-6)), so the use of CD41-PE for platelet gating improved the diagnostic efficiency of RPs%. Compared to the primary parameters, the applied parameters originated from RPs%, FSC and TO fluorescence improved diagnostic efficiency significantly (RPs%: 55%, RPs%xs delta MFI: 80%) between decreased and increased thrombopoiesis groups. CONCLUSIONS: In the patients with severe thrombocytopenia, the estimate of the thrombopoiesis by a flow cytometric analysis can be more predictable by using platelet markers and by considering the fluorescence intensity of TO together with the RPs%.