Monitoring heparin effect in patients at risk of DV thrombosis

This work was designed to find out the optimal investigation [s] for monitoring heparin therapy. 50 patients, 25 males and 25 females, suffering from various cardiopulmonary diseases having or at risk of deep venous thrombosis admitted to ICU of Ain Shams University hospitals were treated with intermittent [4 hourly] I.V. heparin therapy. Blood samples were withdrawn before, 1, 2, 3 and 4 hours after heparin injections and the samples were analysed for ACT, APTT, IT and factor X[a] assay as well as protamine sulphate titration for heparin level and in vitro estimation of heparin level in plasma by APTT and IT. We found that ACT is the most practical and reliable test for monitoring heparin effect as it correlated significantly with heparin level using protamine titration test. It is especially useful when APTT and TT were paralyzed. On the other hand, factor X[a] assay is very unreliable as it measures mainly the anti-X[a] activity of heparin without the antithrombin effect. It was also found that therapeutic levels 3 hours after heparin injection were not significantly different from pre - injection levels denoting increase risk of thrombosis. Thus intermittent schedule for heparin injection is unreliable method of anticoagulation in patients at risk of D.V.T, pulmonary, or coronary embolism

Study of some acute phase proteins in type I diabetic patients with and without ketoacidosis

Five serum acute phase proteins: haptoglobin [HG], transferrin [TF]. alpha 1 glycoprotein [AGL], alpha 2 macroglobulin [AMG] and C reactive protein [CRP] were studied together with random serum glucose [RSG].total and differential white cell count and erythrocytes sedimentation rate [ESR] in 14 type I diabetic patients during ketoacidosis. They comprised 8 males and 6 females with a a mean age of 21 +/- 4.2 years. Ten apparantly healthy subjects: 6 males and 4 females with a mean age of 22 +/- 5 years served as controls. Ketoacidosis was controlled, then diabetes was treated properly with insulin and dieting. 14 to 18 days after ketoacidosis control [end of study], 12 out of the 14 patients were reexamined and resampled. AMG was significantly higher [S: P<0.05] during ketoacidosis than at the end of study with non significant [NS: P>0.05] difference between patients with and without infection. NS difference was found between levels of HG, TF and AGL during ketoacidosis and at the end of study. Similarly NS difference was found between their levels in patients [either during ketosis or at end of study] and controls. However TF level was significantly lower in patients with infection than those without together with a concomitant significantly higher ESR, neutrophilic and positive CRP. A strong positive correlation was found between AMG and RSG values [p<0.001], while, a strong negative correlation [p<0.001] was found between TF and both neutrophil count and ESR. This suggests that AMG value is directly proportional to the degree of hyperglycaemia, while, both low TF level and positive CRP are mainly related to occurrence of infection in type I DM