Acute severe thrombocytopenia following iodinated radiographic contrast medium infusion: a case report.

Acute contrast-induced thrombocytopenia is an unusual complication, and it is a rare event with the use of modern low-osmolarity iodinated contrast medium. There are only a few reports that exist in English literature. Case presentation: The authors report the case of a 79-year-old male patient with severe, life-threatening thrombocytopenia after administration of intravenous nonionic low-osmolarity contrast medium. His platelet count dropped from 179×109/l to 2×109/l after 1 h of radiocontrast infusion. Which has returned gradually to normal level within days with corticosteroid administration and platelet transfusion. Conclusion: Iodinated contrast-induced thrombocytopenia is a rare complication with an unknown causative mechanism. There is no definitive treatment for this condition, with corticosteroids being used in most cases. The platelet count normalizes within a few days regardless of any interventions, but supportive treatment is important to avoid any unwanted complications. Further studies are still needed for a better understanding of the exact mechanism of this condition.

Pretreatment neutrophil-to-lymphocyte ratio as a potential prognostic biomarker for newly diagnosed patients with metastatic castration-sensitive prostate cancer.

BACKGROUND: Although the prognostic role of neutrophil-to-lymphocyte ratio (NLR) has been assessed in patients with metastatic castration-resistant prostate cancer, data on its impact on oncological outcomes of patients with metastatic castration-sensitive prostate cancer (mCSPC) are scarce. AIM: This study aims to examine the influence of elevated pretreatment NLR on time to prostatic-specific antigen (PSA) progression and overall survival (OS) of patients with mCSPC. METHODS: We retrospectively reviewed patients presenting between June 2007 and June 2019 with mCSPC. Survival was estimated by the Kaplan-Meier method and compared by the log-rank test. Multivariate analyses were used to assess the factors influencing time to PSA progression and OS. RESULTS: A total of 189 patients were included; median age = 69 years, median PSA = 155 ng/mL, 41(22%) had visceral metastasis. Median time to PSA progression was shorter for patients with NLR ≥4 (n = 37) compared to patients with NLR < 4 (n = 146); 11.3 and 18.3 months, respectively, P = .015. Patients with NLR ≥4 also had inferior median OS (23.9 vs 49.5 months, P = .001). On multivariate analysis, NLR ≥4 was not an independent factor for time to PSA progression. However, NLR ≥4 was an independent factor of inferior OS (HR: 2.75, 95% CI: 1.01-7.87, P = .047). Other independent factors predicting inferior OS included Eastern Cooperative Oncology Group Performance Status ≥1, high-volume status, and Hb < 12. CONCLUSION: Elevated pretreatment NLR independently predicts inferior OS in newly diagnosed patients with mCSPC. However, NLR was not a predictor of time to PSA progression.

Patterns and predictors of thromboembolic events among patients with gastric cancer.

Patients with gastric cancer are at higher risk for venous thromboembolic events (VTE). Majority of such patients are treated in ambulatory settings where thromboprophylaxis is not routinely offered. In this study, we report on VTE rates and search for predictors that may help identify patients at higher risk to justify VTE-prophylaxis in ambulatory settings. Patients with pathologically-confirmed gastric adenocarcinoma were retrospectively reviewed for VTE detected by imaging studies. Clinical and pathological features known to increase the risk of VTE were studied. Khorana risk assessment model was applied on patients receiving chemotherapy. A total of 671 patients; median age 55 years, were recruited. VTE were diagnosed in 150 (22.4%) patients, including 42 (28.0%) pulmonary embolism and 18 (12.0%) upper extremity deep vein thrombosis (DVT). Majority (> 80%) developed VTE while in ambulatory settings and none had been on thromboprophylaxis. Rate was higher (27.1%) among 365 patients with metastatic compared to 16.7% among 306 patients with nonmetastatic disease, p = 0.001. Patients with metastatic disease who received multiple lines of chemotherapy (n = 85) had significantly higher rate of VTE compared to those who received a single line; 48.2% versus 19.4%, p < 0.001. Among the whole group, Khorana risk score, age, gender, smoking and obesity had no impact on VTE rates. Patients with metastatic gastric cancer, especially when treated with multiple lines of chemotherapy, are at a significantly higher risk of VTE. Khorana risk score had no impact on VTE rates. Thromboprophylaxis in ambulatory patients with metastatic gastric cancer worth studying.