Comparing modified Lee and White method against 20-minute whole blood clotting test as bedside coagulation screening test in snake envenomation victims

Abstract Background: Twenty-minute whole blood clotting test (20WBCT) and Modified Lee and White (MLW) method are the most routinely employed bedside tests for detecting coagulopathic snake envenomation. Our study compared the diagnostic utility of MLW and 20WBCT for snakebite victims at a tertiary care hospital in Central Kerala, South India. Methods: This single-center study recruited 267 patients admitted with snake bites. 20WBCT and MLW were performed simultaneously at admission along with the measurement of Prothrombin Time (PT). The diagnostic utility of 20WBCT and MLW was determined by comparing the sensitivity (Sn), specificity (Sp), positive and negative predictive values, likelihood ratios, and accuracy at admission with an INR value > 1.4. Results: Out of 267 patients, 20 (7.5%) patients had VICC. Amongst those who had venom-induced consumption coagulopathy (VICC), MLW was prolonged for 17 patients, (Sn 85% 95% confidence interval [CI]: 61.1-96.0) whereas 20WBCT was abnormal for 11 patients (Sn 55%, 95% CI: 32.04-76.17). MLW and 20WBCT were falsely positive for the same patient (Sp 99.6%, 95% CI: 97.4-99.9%). Conclusion: MLW is more sensitive than 20WBCT to detect coagulopathy at the bedside amongst snakebite victims. However, further studies are necessary for standardizing bedside coagulation tests in snakebite cases.

Anesthesia strategy for factor X deficiency coagulopathy: case report

Abstract Factor X deficiency ranks among the rarest coagulopathies and has a variable presentation spectrum. We intend to present a proposal for anesthesia protocol for individuals with the coagulopathy. The excision of an ovarian neoplasm was proposed for a 26-year-old, female, ASA II patient, with congenital Factor X deficiency. Physical examination and lab tests were normal, except for Prothrombin Time (PT) 22.1s (VR: 8-14s), International Normalized Ratio (INR) 1.99 (VR: 0.8-1.2) and Activated Partial Thromboplastin Time (aPTT) 41.4s (VR: 25-37s). We concluded that a history of bleeding should always be investigated, along with a pre-anesthetic coagulation study.

Coagulopatía asociada a síndrome de malabsorción por enfermedad celíaca / Coagulopathy associated with celiac disease malabsorption syndrome

This article describes a 19-y-old patient with abdominal pain and signs of malnutrition. She had been treated previously with an antibiotic for chronic diarrhea. Laboratory analyses showed the presence mild hypoalbuminemia, and considerably prolonged prothrombin time. Tests revealed that hemostasis improved after the patient received fresh frozen plasma and vitamin k. A coagulation profile showed a decrease in clotting factors V, VII, IX, and fibrinogen. Positive serology (immunoglobulin A antitissue transglutaminase and immunoglobulin A antiendomysial antibodies) and small bowel mucosal histopathology confirmed the presence of celiac disease (CD). The girl recovered completely after she was put on a gluten-free diet. Vitamin K­deficiency is a rare complication that occurs in celiac disease manifestations. In addition to antibiotic therapy, treatment with other drugs that influence vitamin K resorption and metabolism may increase the risk of bleeding in patients with CD with hypoprothrombinemia.

A tromboelastometria identifica coagulopatia associada à insuficiência hepática e coagulação intravascular disseminada causadas por febre amarela, orientando a terapia hemostática específica: um relato de caso / Thromboelastometry identifies coagulopathy associated with liver failure and disseminated intravascular coagulation caused by yellow fever, guiding specific hemostatic therapy: a case report

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.

Coagulopatía y covid-19. recomendaciones para una realidad cambiante / Coagulopathy and COVID-19. Recommendations for a changing reality

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.

Trastornos hereditarios de la coagulación en adolescentes con sangrado menstrual excesivo, ¿debemos evaluar la vía fibrinolítica? / Inherited bleeding disorders in adolescents with excessive menstrual bleeding: should we evaluate the fibrinolytic pathway?

Resumen: Introducción: El Sangrado Menstrual Excesivo (SME) es un problema frecuente en la adolescencia. La prevalencia de trastornos hereditarios de la coagulación (THC) como causa del SME no está bien establecida y la participación de defectos de la vía fibrinolítica ha sido poco explorada. Objetivo: Determinar la prevalencia de THC y defectos de la fibrinólisis en adolescentes con SME. Pacientes y Método: Se incluyeron 93 adolescentes, edad 11 a 18 años. Los antecedentes personales y familiares de sangra do se obtuvieron con un cuestionario estandarizado. Se controló exámenes: tiempo de protrom- bina (TP), tiempo de tromboplastina parcial activada (TTPa), estudio del factor Von Willebrand, recuento y función plaquetaria. Los pacientes que no fueron diagnosticados como THC, se evaluaron adicionalmente con el tiempo de lisis del coágulo. Resultados: 41 pacientes (44%) fueron diagnos ticados como THC: Enfermedad de Von Willebrand n = 28, defectos de la función plaquetaria n = 8, hemofilia leve n = 5. Se confirmó disminución del tiempo de lisis del coágulo en 31 pacientes. El 54% de pacientes diagnosticado como THC, tuvo SME como la primera manifestación hemorrágica. Conclusión: Estos resultados apoyan la necesidad de evaluación de la coagulación, incluyendo la vía fibrinolítica, en el estudio de adolescentes con SME.

Abstract: Introduction: Heavy Menstrual Bleeding (EMB) is a frequent problem in adolescence. The prevalence of inherited bleeding disorders (IBD) as a cause of EMB is not well established and the involvement of fibri nolytic pathway defects has been poorly explored. Objective: To determine the prevalence of IBD and fibrinolysis defects in adolescents with EMBs. Patients and Method: 93 adolescents (11 to 18 years old) were included. Personal and family history of bleeding were obtained through a standard ized questionnaire. The following lab tests were performed: prothrombin time (PT), activated partial thromboplastin time (aPTT), von Willebrand factor quantification, and platelet count and function. Those patients who were not diagnosed with IBD were further evaluated with clot lysis time assay. Results: 41 patients (44%) were diagnosed as IBD (Von Willebrand disease n = 28, platelet func tion defects n=8, mild hemophilia n = 5. Decreased clot lysis time was found in 31 patients. 54% of patients diagnosed with IBD had EMB as the first hemorrhagic manifestation. Conclusion: These results support the need to evaluate the coagulation process, including the fibrinolytic pathway in the study of adolescents with EMB.

Efeito compensatório do fibrinogênio em paciente com aplasia de medula óssea, choque séptico e trombocitopenia grave guiado por tromboelastometria: relato de caso / Compensatory effect of fibrinogen in a patient with bone marrow aplasia, septic shock, and severe thrombocytopenia guided by thromboelastometry: a case report

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.

Elevated plasma D-dimer and hypersensitive C-reactive protein levels may indicate aortic disorders / Níveis plasmáticos elevados do dímero D e da proteína C reativa hipersensíveis podem indicar desordens aórticas

OBJECTIVE: D-dimer and C-reactive protein are of diagnostic and predictive values in patients have thrombotic tendency, such as vascular thrombosis, coronary artery disease and aortic dissection. However, the comparative study in these biomarkers between the patients with acute aortic dissection and coronary artery disease has not been sufficiently elucidated. METHODS: Consecutive surgical patients for acute type A aortic dissection (20 patients), aortic aneurysm (nine patients) or coronary artery disease (20 patients) were selected into this study. Plasma from preoperative blood samples and supernatant of aortic homogenate of the surgical specimens were detected for D-dimer and hypersensitive C-reactive protein (hs-CRP). RESULTS: Plasma D-dimer and hs-CRP values in type A aortic dissection or aortic aneurysm were much higher than in coronary artery disease patients or the healthy control (for D-dimer, aortic dissection: coronary artery disease, 0.4344 ± 0.2958 µg/ml vs. 0.0512 ± 0.0845 µg/ml, P < 0.0001; aortic dissection: healthy control, 0.4344 ± 0.2958 µg/ml vs. 0.1250 ± 0.1295 µg/ml, P = 0.0005; aortic aneurysm: coronary artery disease, 0.4200 ± 0.4039 µg/ml vs. 0.0512 ± 0.0845 µg/ml, P = 0.0013; and aortic aneurysm: healthy control, 0.4200 ± 0.4039 µg/ml vs. 0.1250 ± 0.1295 µg/ml, P = 0.0068; and for hs-CRP, aortic dissection: coronary artery disease, 4.400± 3.004 mg/L vs. 1.232±0.601 mg/L, P < 0.0001; aortic dissection:healthy control, 4.400 ± 3.004 mg/L vs. 0.790 ± 0.423 mg/L, P < 0.0001; aortic aneurysm: coronary artery disease, 2.314 ± 1.399 mg/L vs. 1.232 ± 0.601 mg/L, P = 0.0084; aortic aneurysm: healthy control, 2.314 ± 1.399 mg/L vs. 0.790 ± 0.423 mg/L, P = 0.0002; and coronary artery disease: healthy control, 1.232 ± 0.601 mg/L vs. 0.790 ± 0.423 mg/L, P = 0.0113). Besides, there were close correlations between plasma D-dimer and hs-CRP in overall (Y = 4.8798X + 0.8138, r² = 0.4497, r = 0.671, P < 0.001), aortic dissection ...

OBJETIVO: D-dímero e proteína C reativa são de valores de diagnóstico e preditivo em pacientes com tendência trombótica, como a trombose vascular, doença arterial coronária e dissecção aórtica. No entanto, o estudo comparativo desses biomarcadores entre os pacientes com dissecção aguda da aorta e doença arterial coronariana não foi suficientemente esclarecido. MÉTODOS: Pacientes cirúrgicos consecutivos foram selecionados para este estudo por tipo de dissecção aguda aórtica (20 pacientes), aneurisma da aorta (9 pacientes) ou doença arterial coronária (20 pacientes). O plasma a partir de amostras de sangue no pré-operatório e sobrenadante de homogenato de aorta dos espécimes cirúrgicos foi detectado para o D-dímero e proteína C reativa hipersensível. RESULTADOS: Os valores do plasma de D-dímero e proteína-C reativa em dissecção aórtica tipo A ou aneurisma da aorta foram muito superiores em pacientes com doença arterial coronariana ou de controles saudáveis (pelo D-dímero, dissecção aórtica: doença arterial coronariana, 0,4344 ± 0,2958 µg/ml vs 0,0512 ± 0,0845 µg/ml, P <0,0001; dissecção aórtica: controle saudável, 0,4344 ± 0,2958 µg/ml vs 0,1250 ± 0,1295 µg/ml, P = 0,0005; aneurisma da aorta: doença arterial coronariana, 0,4200 ± 0,4039 µg/ml vs 0,0512 ± 0,0845 µg/ml, P = 0,0013; e aneurisma de aorta: controle saudável, 0,4200 ± 0,4039 µg/ml vs. 0,1250 ± 0,1295 µg/ml, P = 0,0068 e para a hs-CRP, dissecção aórtica: doença arterial coronariana, 4,400 ± 3,004 mg/L vs. 1,232 ± 0,601 mg/L, P <0,0001; dissecção aórtica: grupo controle saudável, 4,400 ± 3,004 mg/L vs 0,790 ± 0,423 mg/L, P <0,0001; aneurisma da aorta: doença arterial coronariana, 2,314 ± 1,399 mg/L vs. 1,232 ± 0,601 mg/L, P = 0,0084; aneurisma da aorta: grupo controle saudável, 2,314 ± 1,399 mg/L vs. 0,790 ± 0,423 mg/L, P = 0,0002; e doença arterial coronariana: grupo controle saudável, 1,232 ± 0,601 mg/L versus 0,790 ± 0,423 mg/L, P = 0,0113). Além disso, houve correlações próximas ...

Laboratory studies in coagulation disorders.

It is important to go in a stepwise approach to diagnose spectrum of bleeding disorders, so that minimum tests are undertaken to make a definitive diagnosis and to avoid unnecessary tests and laboratory load. Depending on the abnormalities observed in the short screening, extended screening tests can be performed followed by specialized diagnostic tests. Bleeding time is prolonged in thrombocytopenia and platelet function disorders (PFD). If platelet count is normal, extended screening tests such as RVVT, PF3 availability and clot retraction can be performed. Russel viper venom directly activates FX, in presence of PF3, is an indicator of common pathway of coagulation. However, if there is deficiency of PF3 as obtained in PFD and APTT PT are normal, its prolongation indicates PFD. These can be tested invitro by performing RVVT with and without inosithin it is highly suggestive of underlying PFD. In such cases, diagnostic tests for PFD such as platelet aggregation with ADP, ADR, AA, Collagen and Ristocetin can be performed followed by electron microscopy if possible. Few of the interesting cases also have been discussed in the text.

Distúrbio de coagulação em crianças e adolescentes com traumatismo cranioencefálico moderado e grave / Coagulation disorder in children and adolescents with moderate to severe traumatic brain injury

OBJETIVOS: Descrever o perfil epidemiológico de crianças e adolescentes com traumatismo cranioencefálico moderado e grave internados em unidade de tratamento intensivo; descrever a freqüência de alterações na coagulação destes pacientes; determinar a relação entre a coagulopatia e a gravidade do trauma; analisar os fatores associados à coagulopatia; e verificar a influência da coagulopatia na mortalidade desses pacientes. MÉTODOS: Estudo transversal com 301 pacientes de até 16 anos internados em terapia intensiva devido a traumatismo cranioencefálico moderado e grave, compreendendo período de 5 anos. O perfil de coagulação foi associado com achados clínicos, epidemiológicos e tomográficos. Análises univariada e multivariada foram empregadas para verificar a associação entre presença de coagulopatia e mortalidade. RESULTADOS: A idade mínima foi de 23 dias, e a máxima, de 16 anos (média de 7,9 anos). Cerca de 77 por cento dos pacientes apresentaram coagulopatia, cuja ocorrência esteve diretamente associada à gravidade do trauma, mas não ao aumento da mortalidade. Os fatores associados com a presença de coagulopatia foram: gravidade do traumatismo cranioencefálico (OR = 2,83; IC95 por cento 1,58-5,07), diagnóstico de edema e ingurgitamento cerebral à tomografia computadorizada de crânio (OR = 2,11; IC95 por cento 1,13-4,07) e ocorrência de trauma torácico e/ou abdominal (OR = 2,07; IC95 por cento 1,11-4,00). Aproximadamente 35 por cento dos pacientes morreram. Em análise multivariada, os fatores que se relacionaram ao aumento do risco de morrer foram: ocorrência de distúrbios de sódio (OR = 5,56; IC95 por cento 2,90-10,65), hipotensão no centro de tratamento intensivo (OR = 12,58; IC95 por cento 4,40-35,00) e síndrome do desconforto respiratório agudo (OR = 13,57; IC95 por cento 1,51-121,66). CONCLUSÃO: O surgimento de coagulopatia é uma complicação freqüente nos pacientes vítimas de traumatismo cranioencefálico moderado e grave. Apesar...

OBJECTIVES: To describe the epidemiological profile of children and adolescents with moderate to severe traumatic brain injury admitted to an intensive care unit; to describe the frequency of coagulation disorders in these patients; to determine the relationship between coagulopathy and trauma severity; to assess the factors associated with coagulopathy; and to assess the effect of coagulopathy on the mortality of these patients. METHODS: Cross-sectional study with 301 patients aged up to 16 years admitted to an intensive care unit due to moderate to severe traumatic brain injury, carried out over a 5-year period. The coagulation profile was associated with clinical, epidemiological and CT findings. Univariate and multivariate analyses were used to check the association between coagulopathy and mortality. RESULTS: Minimum age was 23 days, and maximum age was 16 years (mean of 7.9 years). About 77 percent of patients had coagulopathy, whose occurrence was directly associated with the severity of the trauma, but not with the rise in mortality. The factors associated with the presence of coagulopathy were the following: severity of the traumatic brain injury (OR = 2.83; 95 percentCI 1.58-5.07), diagnosis of brain swelling on cranial computed tomography (OR = 2.11; 95 percentCI 1.13-4.07) and occurrence of chest and/or abdominal injury (OR = 2.07; 95 percentCI 1.11-4.00). Approximately 35 percent of patients died. The multivariate analysis showed that the factors associated with an increased risk of death were presence of sodium disorders (OR = 5.56; 95 percentCI 2.90-10.65), hypotension in the intensive care unit (OR = 12.58; 95 percentCI 4.40-35.00) and acute respiratory distress syndrome (OR = 13.57; 95 percentCI 1.51-121.66). CONCLUSION:The development of coagulopathy is a frequent complication in patients with moderate to severe traumatic brain injury. Even though it is not closely associated with death in this study, it may be regarded...

Pattern of coagulopathy in viperidae snake bite

The study was carried out in the Department of Physiology, Isra University, Hyderabad. Seventy three cases of viperidae snake bite were studied to observe the pattern of coagulopathy. All had prolonged clotting time at the time of admission. Prothrombin time was increased in 56 cases, activated partial thromboplastin time was increased in 63 cases, bleeding time was normal in all cases. Platelet count was decreased in 28 cases and fibrinogen levels were decreased in 36 cases. Disseminated intravascular coagulation was found to be the predominant pattern of coagulopathy in viperidae snake bite cases

Effects of prolonged poisoning by cobra venom on blood coagulation, platelets and fibrinolysis

The effects of Cobra Venom [CV] on blood coagulation, platelets and fibrinolytic system were studied in rabbits after injecting repeated doses of 0.05 MLD of the Venom. Thrombocytopenia was the earliest change to appear. It was followed by rise in serum fibrinogen degradation products and prolongation of prothrombin time, [PT] activated partial thromboplastin time [APTT] and thrombin time [TT] indicating a progressive consumption coagulapathy and activation of fibrinolysis. Red blood cell morphology was unchanged during first three weeks; whereas fragmentation appeared after fourth week and it increased in severity with further envenomations i.e., when chronic disseminated intravascular clotting was established

Ischemic stroke in children: a study of the associated alterations

Acidente vascular cerebral Isquêmico (AVCI) na infância é relativamente raro, de conhecimento ainda obscuro, e com etiologia multifatorial. Pode causar grave impacto na criança e ser a primeira manifestação de doença sistêmica. O subdiagnóstico ainda é comum e são praticamente inexistentes as pesquisas sobre o assunto no nosso meio. Desordens protrombóticas têm sido descritas como importantes fatores causais do evento isquêmico na infância. Foram estudados 46 pacientes de zero a 18 anos, com diagnóstico de AVCI, no período de março/2002 a setembro/2003. Exames laboratoriais, incluindo proteínas de coagulação e ecocardiograma foram realizados. AVCI neonatal ocorreu em 35% dos casos. Crise focal e hemiparesia foram os sintomas iniciais mais freqüentes; 40% dos casos apresentaram patologia prévia. Anormalidades nas proteínas S e C ocorreram em 22% e 17% da amostra. Alterações associadas, principalmente as que geram um estado hipercoagulável, indicam que mais de um fator de risco pode causar essa doença na infância.

Trombofilia-estado actual / Trombofilia-current state

Introducción: Los estados de trombofilia son una tendencia especial a producir trombosis venosa, que se presentan habitualmente en personas jóvenes y a menudo son recurrentes. Sus consecuencias más trascendentes son el Tromboembolismo Pulmonar y el Síndrome Post-trombótico. Objetivos: Teniendo en cuenta las patologías de la coagulación que pueden producir estados de trombofilia en pacientes jóvenes, se evaluó la prevalencía de estos procesos en pacientes con síndrome post-trombótico severo. Lugar de aplicación: Departamento de Flebología y Linfología del Hospital Nacional de Clínicas, Córdoba. Materiales y métodos: Durante el periodo marzo de 2001 a marzo de 2002 concurrieron a la consulta flebológica 635 pacientes, de los cuales seis de ellos, 3 hombres y 3 mujeres menores de 45 años, presentaban severos trastornos del retorno venoso compatibles con cuadros postrombóticos. La edad promedio de 39 años (r: 29-45); Estos pacientes fueron estudiados mediante clínica de rutina, ecodoppler color venoso y análisis específicos de laboratorio como la Resistencia a la Proteína C activada, Proteína C, Proteína S, Anticuerpos antifosfolípidos, Antitrombina III, homocisteinemia. Resultados: Se obtuvieron valores anómalos en el perfil biológico del laboratorio en 3 pacientes; la correlación clínica y del laboratorio fue la siguiente: positivo para proteína C y Proteína S; Positivo para Anticuerpos Antifosfolípidos; y positivo para Hiperhomocisteinemia. Conclusiones: Deben preconizarse los estudios de laboratorio necesarios para descartar estados trombofilicos en pacientes menores de 45 años que presenten un primer episodio de trombosis o bien cualquier paciente que haya presentado trombosis recurrentes. Es importante resaltar que la detección temprana de estas patologías y la oportuna derivación al hematólogo, permiten establecer un tratamiento preventivo y así evitar episodios trombóticos con sus respectivas complicaciones.