[How to interpret and pursue a prolonged quick time or APTT]. / Orientation diagnostique devant une anomalie du TP ou du TCA.

The standard hemostasis workup [quick time (QT), and activated partial thrombin time (APTT)] is very commonly prescribed but its interpretation is often difficult for practitioners who are not specialized in hemostasis. Here, we review the principles of the diagnostic approach to these tests. Only a very basic knowledge of the coagulation cascade is necessary to identify which clotting factor tests to prescribe and to interpret the results. Deficiency in several clotting factors suggests liver dysfunction, disseminated intravascular coagulation (DIC) or vitamin K deficiency. If a single factor is deficient, we review the different causes of acquired deficiencies and briefly discuss the characteristics of the different congenital defects, which generally require specialized management. Lupus anticoagulant is a common and generally benign cause of prolonged APTT to be aware of, which is not related to a hemorrhagic risk. A good knowledge of the diagnostic approach to abnormal QT or APTT generally allows the resolution of the most common situations.

Hemostasis and oxidative stress in chronic kidney disease in children and adolescents.

Chronic kidney disease (CKD) can be defined as the progressive loss of renal function, characterized by a decreased glomerular filtration rate (GFR). The etiology of CKD in childhood is mainly associated with congenital anomalies of the kidneys and urinary tract (CAKUT) and with glomerular diseases. The goal of this study was to investigate the hemostasis and oxidative stress in pediatric CKD of different etiologies. Fifty-four CKD children and adolescents and 52 controls were enrolled in this study. The evaluation of hemostasis was carried out by determination of D-dimer (D-Di) and plasminogen activator inhibitor (PAI-1) plasma levels, while oxidative stress was evaluated by thiobarbituric acid reactive substance (TBARS) levels, protein carbonyl content, plasma antioxidant capacity (MTT), and ascorbate. The D-Di was increased in CAKUT stage 3 or 4 patients compared with those with glomerular disease. PAI-1 was increased in patients with glomerular disease compared with CAKUT. Carbonyl protein content was higher in the control group compared with glomerular disease stage 3 or 4 patients. Our findings showed that the reduction in GFR is associated with a state of hypercoagulability. The analysis of integrated networks showed an expansion of connections among hemostatic and oxidative stress markers in CKD children and adolescents compared with controls.

[Bleeding management in the operating theatre]. / Gestion du saignement au bloc opératoire.

Despite all the measures taken preoperatively, bleeding may persist and require surgical control. Before considering treatment, it is necessary to establish the diagnosis with the origin of the bleeding. The surgical procedure depends on the aetiology. There are many surgical options and adjuvant measures to consider. They should be known by the operating theatre nurse, who is a major player in surgical management. Successful control of bleeding requires quality multidisciplinary collaboration.

[Mortality risk factors for upper gastrointestinal bleeding at Brazzville university hospital]. / Facteurs de risque de mortalite des hemorragies digestives hautes au CHU de Brazzaville.

In the absence of interventional endoscopy the treatment of upper digestive hemorrhage a the brazzaville university hospital is only medicinal. Objective of this work was to identify risk factors for upper gastrointestinal bleeding by conducting a retrospective case-type study conducted over a period of 2 years. The 180 patients included for upper digestive hemorrhage were divided into 2 groups accordind to their progressive modality : deceaded patients (cases) and non-deceased patients (controls). Risk factors for mortality were studied by logistic regression. The mortality linked to upper gastrointestinal bleedind was 36.6%, the risk factors for death were age between 30 and 60 with an OR of 9.79 ; male (OR of 2.03) ; late hospitalization over 24 hours (OR of 6.30) ; blood transfusions (OR of 3.5). The protective factors were hemoglobin greater 7 g/dL (OR of 0.28) ; treatment by proton pump inhibitors (OR of 0.36). In conclusion, reducing the still high mortalty rate in our country requires taking into account the identified risque factors and aquiring endoscopic hemostasis equipement.

En absence d'endoscopie interventionnelle, le traitement des hémorragies digestives hautes (HDH) au CHU de Brazzaville est essentiellement médicamenteux. L'objectif de ce travail était d'identifier les facteurs de risque de mortalité des HDH au CHU de Brazzaville en menant une étude pronostique rétrospective de type cas témoin sur une période de 2 ans. Les 180 patients inclus à l'étude pour une HDH ont été repartis en 2 groupes selon leur modalité évolutive : patients décédés (cas) et patients non décédés (témoins). Les facteurs de risques de mortalité ont été étudiés par régression logistique. La mortalité liée aux hémorragies digestives hautes était de 36,6%, les facteurs de risque de décès étaient l'âge entre 30 et 60 ans avec un OR de 9,79 ; le sexe masculin (OR : 2,03) ; la consultation tardive au-delà de 24 heures (OR : 6,30), les transfusions sanguines (OR : 3,5). Les facteurs protecteurs étaient l'hémoglobine supérieure à 7 g/dL (OR : 0,28) ; le traitement par inhibiteurs de la pompe à protons (OR : 0,36). En conclusion, la réduction de la mortalité encore élevée dans notre pays passe par la prise en compte des facteurs de risques identifiés et par l'acquisition de matériel d'hémostase endoscopique.

Hemostatic evaluation of rabbits envenomed with Bothrops alternatus treated with anti-bothropic serum, desmopressin and tranexamin acid / Avaliação hemostática de coelhos envenenados com Bothrops alternatus e tratados com soro antibotrópico, desmopressina e ácido tranexâmico

In Brazil, snakes from the Bothrops genus are responsible for thousands of accidents, and their venoms are mainly composed of proteolytic enzymes. Although the antibothropic serum produced by the Brazilian Institutes is remarkably efficient, more studies are necessary, especially in veterinary medicine. The venom contain enzymes and non-enzymatic proteins that interfere with hemostasis leading to hemorrhage or even thrombosis. Possible treatment associations with known bothropic antivenom were the reason for the development of the present study. The aim of this study was to evaluate hemostasis alterations caused by Bothrops alternatus venom in rabbits followed by treatments with anti-bothropic serum, tranexamic acid and desmopressin. Twenty New Zealand rabbits were distributed into five groups (n=4) that were experimentally envenomed with 150mcg/kg of B. alternatus venom via intramuscular injection and treated as follow: Group 1 (G1) was the positive control and received venom and PBS/BSA; Group 2 (G2) was treated with tranexamic acid; Group 3 (G3) with desmopressin; Group 4 (G4) with tranexamic acid and anti-bothropic serum; and Group 5 (G5) with anti-bothropic serum and desmopressin. Blood samples were collected before venom administration, and one, four, eight and 12 hours after, for Partial activated partial thromboplastin time, Prothrombin Time, Thrombin Time and fibrinogen evaluation. Thrombin generation (TG) test was carried out with a pool of samples from final times (8 and 12h). At the end of 12h, all animals were euthanized and necropsy was conducted. Samples from muscle tissue, heart, lungs and kidney were analyzed. Classic coagulation tests showed no significant differences amongst groups and times. However, TG indicated that the venom causes a hypocoagulability state, which was not reversed by proposed treatments. Histology showed muscle inflammation, hemorrhage and necrosis, as well as hemorrhage in other tissues with no differences amongst groups. B. alternatus envenomation causes hypocoagulability detected by TG assay, but not through classical coagulation tests. The use of tranexamic acid and desmopressin for hemostasis stabilization after inoculation of the venom did not show advantage in coagulation restoration.(AU)

No Brasil, as serpentes do gênero Bothrops são responsáveis por milhares de acidentes, e seus venenos são compostos principalmente de enzimas proteolíticas. Embora o soro antiofídico produzido pelos institutos brasileiros seja notavelmente eficiente, mais estudos são necessários, especialmente na medicina veterinária. O veneno contem enzimas e proteínas não-enzimáticas que interferem com a hemostasia levando a hemorragias ou trombose. A associação de outros tratamentos ao soro antibotrópico foi a razão para o desenvolvimento do presente estudo. O objetivo deste estudo foi avaliar as alterações da hemostasia causadas pelo veneno de Bothrops alternatus em coelhos, após tratamento com soro antibotrópico, ácido tranexâmico e desmopressina. Vinte coelhos da Nova Zelândia foram distribuídos em cinco grupos (n = 4) que foram submetidos a experimentos com 150mcg/kg de veneno de B. alternatus por injeção intramuscular. O Grupo 1 (G1) foi o controle positivo e recebeu veneno e PBS / BSA, enquanto o Grupo 2 (G2) foi tratado com ácido tranexâmico, o Grupo 3 (G3) com desmopressina, o Grupo 4 (G4) com ácido tranexâmico e soro antibotrópico, e o Grupo 5 (G5) com soro antibotrópico e desmopressina. As amostras de sangue foram coletadas antes da administração do veneno, e uma, quatro, oito e 12 horas após os tratamentos para realização de tempo de tromboplastina parcial ativada parcial (TTPa), tempo de protrombina (TP), tempo de trombina (TT) e mensuração de fibrinogênio. Para o ensaio de geração de trombina (TG) foi realizado com um pool de amostras nos tempos finais (8 e 12h). Ao final das 12h, todos os animais foram sacrificados e a necropsia foi realizada. Amostras de tecido muscular, coração, pulmões e rins foram analisadas. Os testes TTPa, TP, TT e fibrinogênio não mostraram diferenças significativas entre os grupos e os tempos. No entanto, o TG indicou que o veneno causa um estado de hipocoagulabilidade, que não foi revertido pelos tratamentos propostos. Na histologia, foram observadas inflamação muscular, hemorragia e necrose, além de hemorragia em outros tecidos, sem diferenças entre os grupos. O envenenamento por B. alternatus causa hipocoagulabilidade detectada mais precocemente pelo teste de geração de trombina. O uso de ácido tranexâmico e desmopressina para estabilização da hemostasia após a inoculação do veneno não mostrou vantagem na restauração da coagulação.(AU)

In vitro haemostatic efficacy of aqueous, methanol and ethanol plant extracts of three medicinal plant species in Palestine / Eficácia hemostática in vitro de extratos aquosos, metanólicos e etanólicos de três espécies de plantas medicinais na Palestina

Abstract The haemostatic efficacy of different extract types of Satureja thymbra L., Thymbra spicata L. (Lamiaceae) and Verbascum fruticulosum Post. (Scrophulariaceae) was evaluated in this study via the Prothrombin time (PT) and Activated partial thromboplastin time (aPTT) analysis. Aqueous, methanol and ethanol extracts of the examined plant species leaves were prepared to a final concentration 50 mg/mL. In vitro PT and aPTT assays were conducted on normal platelet poor plasma blood samples by a digital coagulation analyzer. The obtained results revealed anticoagulation activity of all investigated plant species with observed variations among them. The aqueous and ethanol extracts of T. spicata as well as the aqueous extract of S. thymbra prolonged PT values significantly (p < 0.05). While, all V. fruticulosum extract types have had no significant effect on the PT values. The recorded aPTT data showed that all aqueous extracts have had a significant effect on the blood haemostasis as they increased aPTT values in all plant species under study. Out of which, both the ethanol and methanol extracts of T. spicata and methanol extract of S. thymbra showed similar effect. Of great concern, it was clearly noticed that the aqueous and ethanol extract of T. spicata and the aqueous extract of S. thymbra possess the strongest anticoagulation effect as they increased both PT and aPTT values significantly relative to the control (p < 0.05). The variable anticoagulation bioactivity among the studied plant species could be referred to the various solvents degrees of solubility of different phyto-constituents. Thus, the efficacy of the plant species extracts evaluation as anticoagulants or coagulants were related to the plant species and to the solvent of extraction.

Resumo A eficácia hemostática de diferentes tipos de extrato de Satureja thymbra L., Thymbra spicata L. (Lamiaceae) e Verbascum fruticulosum Post. (Scrophulariaceae) foi avaliada neste estudo pelo tempo de protrombina (TP) e tempo de tromboplastina parcial ativada (TTPa). Os extratos aquosos, metanólicos e etanólicos das folhas das espécies de plantas examinadas foram preparados para uma concentração final de 50 mg/mL. Os ensaios de TP e TTPa in vitro foram realizados em amostras normais de sangue, pobre em plaquetas, por um analisador de coagulação digital. Os resultados obtidos revelaram atividade anticoagulante de todas as espécies de plantas investigadas, com variações observadas dentre elas. Os extratos aquosos e etanólicos de T. spicata e o extrato aquoso de S. thymbra prolongaram significativamente os valores de TP (p <0,05). Entretanto, todos os tipos de extratos de V. fruticulosum não tiveram efeito significativo sobre os valores de TP. Os dados registrados do TTPa mostraram que todos os extratos aquosos tiveram um efeito significativo na hemostase do sangue, pois aumentaram os valores de TTPa em todas as espécies de plantas em estudo. Dos quais, ambos os extratos etanólicos e metanólicos de T. spicata e o extrato metanólico de S. thymbra mostraram efeito semelhante. De grande preocupação, notou-se claramente que os extratos aquoso e etanólico de T. spicata e o extrato aquoso de S. thymbra apresentam efeito anticoagulante mais forte, aumentando os valores de TP e TTPa significativamente em relação ao controle (p <0,05). A variável bioatividade anticoagulante dentre as espécies vegetais estudadas pôde ser referida aos vários graus de solventes de solubilidade de diferentes fitoconstituintes. Assim, a eficácia da avaliação de extratos de espécies vegetais como anticoagulantes ou coagulantes foi relacionada às espécies vegetais e ao solvente de extração.

Rotational thromboelastometry (ROTEM) parameters in dogs with haemoperitoneum and their associations with clinical and laboratory signs.

INTRODUCTION: Rotational thromboelastometry (ROTEM) is a viscoelastic coagulation test that allows the evaluation of haemostasis from clot formation to clot dissolution. The aim of this retrospective study was to describe the changes in haemostasis using ROTEM parameters in dogs presenting with spontaneous or traumatic haemoperitoneum and to evaluate any associations between clinical and laboratory parameters at presentation with the ROTEM. We hypothesized that the dogs would show signs of hypocoagulability and hyperfibrinolysis and that these changes would correlate with the degree of hypoperfusion. Clinical records were searched for a period of 5 years for dogs presenting with a haemoperitoneum und for whom a -ROTEM analysis at presentation was carried out. Forty dogs were identified, and various clinical and laboratory parameter (heart rate, blood pressure, blood glucose, lactate, serum albumin concentration, PCV (venous and abdominal), ionized calcium, pH and base excess) were retrieved. The following ROTEM parameters were analysed: extrinsic clotting time (ExTEM CT), clot formation time (ExTEM CFT), clot firmness (ExTEM MCF) and maximum lysis (ExTEM ML), as well as fibrinogen (FibTEM) CT and MCF. Compared to institutional reference intervals, dogs with haemoabdomen showed prolongation of ExTEM and FibTEM CT, ExTEM CFT and 50% were hypocoagulable and 62% thrombocytopenic. No hyperfibrinolysis could be detected. Multiple linear regression models showed an association between decreased base excess, trauma and ROTEM signs for hypocoagulability. Furthermore, age was associated with a stronger fibrin clot. In conclusion, 50% of the dogs presented hypocoagulable and changes in ROTEM parameters are similar to those seen with consumption coagulopathy. Base excess and trauma were associated with hypocoagulability, while increasing age was associated with a stronger fibrin clot.

INTRODUCTION: La thromboélastométrie rotationnelle (ROTEM) est un test de coagulation viscoélastique qui permet d'évaluer l'hémostase depuis la formation du caillot jusqu'à sa dissolution. Le but de cette étude rétrospective était de décrire les changements de l'hémostase à l'aide des paramètres ROTEM chez des chiens présentant un hémopéritoine spontané ou traumatique et d'évaluer d'éventuelles association entre les paramètres cliniques et de laboratoire lors de la présentation avec le ROTEM. Nous avons émis l'hypothèse que les chiens montreraient des signes d'hypocoagulabilité et d'hyperfibrinolyse et que ces changements seraient en corrélation avec le degré d'hypoperfusion. Les dossiers cliniques ont été recherchés surune période de 5 ans pour les chiens présentant un hémopéritoine et pour lesquels une analyse ROTEM à la présentation avait été effectuée. Quarante chiens ont été identifiés et divers paramètres cliniques et de laboratoire (fréquence cardiaque, tension artérielle, glycémie, lactate, concentration d'albumine sérique, PCV (veineux et abdominal), calcium ionisé, pH et excès basique) ont été relevés. Les paramètres ­ROTEM suivants ont été analysés: temps de coagulation extrinsèque (ExTEM CT), temps de formation de caillot (ExTEM CFT), fermeté du caillot (ExTEM MCF) et lyse maximale (ExTEM ML), ainsi que fibrinogène ­(FibTEM) CT et MCF. Par rapport aux intervalles de référence admis, les chiens avec hémoabdomen ont montré une prolongation d'ExTEM et FibTEM CT, ExTEM CFT, 50% étaient hypocoagulables et 62% thrombocytopéniques. Aucune hyperfibrinolyse n'a pu être détectée. Plusieurs modèles de régression linéaire ont montré une association entre une diminution de l'excès basique, des traumatismes et des signes ROTEM d'hypocoagulabilité. De plus, l'âge était associé à un caillot de fibrine plus fort. En conclusion, 50% des chiens présentaient une hypocoagulabilité et les changements dans les paramètres ROTEM sont similaires à ceux observés lors de coagulopathie de consommation. Un excès basique et un traumatisme étaient associés à une hypocoagulabilité, tandis qu'une augmentation de l'âge était associée à un caillot de fibrine plus fort.

[Understanding haemostasis to improve its management]. / L'hémostase, comprendre c'est maîtriser.

Haemostasis represents all the complex and interdependent mechanisms which enable bleeding to stop. This process involves the vessel walls, platelets, coagulation factors and von Willebrand factor. In the event of a disorder, the specific characterisation of the condition is the first stage of the diagnosis. Treatment is mainly based on substitution. All these disorders and their complications require multidisciplinary and specialised care.

[The lead nurse in a paediatric haemostasis unit]. / L'infirmière référente en centre de traitement pédiatrique des troubles de l'hémostase.

In an approach of global collaboration, the lead nurse in a paediatric haemostasis unit uses her technical and educational role to participate in the management of the child's specific disorder. As a resource person, she coordinates the care and ensures the continuity of the child's care.

[Uterine rupture of the unscarred uterus: A report of 10 cases]. / Rupture utérine sur utérus non cicatriciel : à propos de 10 cas.

INTRODUCTION: Uterine rupture in the healthy uterus is a rare obstetrical complication, not much suspected and with badly identified risk factors. Thus, there exists frequent delay for treatment and therefore fetal-maternal important morbidity and mortality. This article describes clinical signs and symptoms, management, and maternal and neonatal prognosis of uterine rupture. METHODS: Descriptive retrospective study within 13 maternity hospitals, reporting 10 series of cases of uterine rupture on gravid healthy uterus during the third trimester of pregnancy. RESULT: The incidence was 2.8/100,000 births. Surgical treatment was conservative in 9 out of 10 cases, the maternal prognosis was good with no maternal deaths and 6 out of 7 patients had at least one subsequent pregnancy. The fetal prognosis was more reserved, with 2 fetal or neonatal deaths and 1 with motor disability. 6/6 patients (100%) had at least one iterative Caesarean section during the following pregnancies with healthy fetuses. CONCLUSION: In this series of 10 cases over 25years, maternal-fetal morbidity and mortality were significant, in agreement with the literature. Maternal prognosis remained favorable. When surgical treatment is conservative a subsequent pregnancy is possible and an iterative cesarean section must be performed.

Factor XIII-guided treatment algorithm reduces blood transfusion in burn surgery / Algoritmo de tratamento guiado pelo fator XIII reduz a transfusão sanguínea na cirurgia de queimados

Abstract Background and objectives: Major burn surgery causes large hemorrhage and coagulation dysfunction. Treatment algorithms guided by ROTEM® and factor VIIa reduce the need for blood products, but there is no evidence regarding factor XIII. Factor XIII deficiency changes clot stability and decreases wound healing. This study evaluates the efficacy and safety of factor XIII correction and its repercussion on transfusion requirements in burn surgery. Methods: Randomized retrospective study with 40 patients undergoing surgery at the Burn Unit, allocated into Group A those with factor XIII assessment (n = 20), and Group B, those without assessment (n = 20). Erythrocyte transfusion was guided by a hemoglobin trigger of 10 g.dL-1 and the other blood products by routine coagulation and ROTEM® tests. Analysis of blood product consumption included units of erythrocytes, fresh frozen plasma, platelets, and fibrinogen. The coagulation biomarker analysis compared the pre- and post-operative values. Results and conclusions: Group A (with factor XIII study) and Group B had identical total body surface area burned. All patients in Group A had a preoperative factor XIII deficiency, whose correction significantly reduced units of erythrocyte concentrate transfusion (1.95 vs. 4.05, p = 0.001). Pre- and post-operative coagulation biomarkers were similar between groups, revealing that routine coagulation tests did not identify factor XIII deficiency. There were no recorded thromboembolic events. Correction of factor XIII deficiency in burn surgery proved to be safe and effective for reducing perioperative transfusion of erythrocyte units.

Resumo Justificativa e objetivos: A cirurgia no grande queimado causa hemorragia de grande porte e disfunção da coagulação. Os algoritmos de tratamento guiados por ROTEM® e fator VIIa reduzem as necessidades de hemoderivados, mas falta evidência em relação ao fator XIII. A deficiência do fator XIII altera a estabilidade do coágulo e diminui a cicatrização. Este estudo avalia a eficácia e a segurança da correção do fator XIII e sua repercussão nas necessidades transfusionais na cirurgia do queimado. Métodos: Estudo retrospectivo randomizado de 40 doentes submetidos à cirurgia na Unidade de Queimados alocados em grupo A com estudo do fator XIII (n = 20) e grupo B sem estudo (n = 20). A transfusão eritrocitária foi guiada por gatilho de hemoglobina de 10 g.dL-1 e os outros hemoderivados por testes de coagulação de rotina e ROTEM®. A análise do consumo de hemoderivados incluiu unidades de eritrócitos, plasma fresco congelado, plaquetas e fibrinogênio. A análise dos biomarcadores da coagulação comparou os valores pré e pós-operatórios. Resultados e conclusões: O grupo A (com estudo de fator XIII) e o grupo B apresentaram área de superfície corporal total queimada idêntica. Todos os doentes do grupo A revelaram déficit pré-operatório de fator XIII, cuja correção reduziu significativamente a transfusão de unidades de concentrado eritrocitário (1,95 vs. 4,05, p = 0,001). Os biomarcadores de coagulação pré e pós-operatórios foram semelhantes entre os grupos, revelaram que os testes de coagulação de rotina não identificam o déficit de fator XIII. Sem eventos tromboembólicos registrados. A correção do fator XIII na cirurgia do queimado revelou-se segura e eficaz na redução da transfusão perioperatória de unidades de eritrócitos.

[Factor XIII-guided treatment algorithm reduces blood transfusion in burn surgery]. / Algoritmo de tratamento guiado pelo fator XIII reduz a transfusão sanguínea na cirurgia de queimados.

BACKGROUND AND OBJECTIVES: Major burn surgery causes large hemorrhage and coagulation dysfunction. Treatment algorithms guided by ROTEM® and factor VIIa reduce the need for blood products, but there is no evidence regarding factor XIII. Factor XIII deficiency changes clot stability and decreases wound healing. This study evaluates the efficacy and safety of factor XIII correction and its repercussion on transfusion requirements in burn surgery. METHODS: Randomized retrospective study with 40 patients undergoing surgery at the Burn Unit, allocated into Group A those with factor XIII assessment (n = 20), and Group B, those without assessment (n = 20). Erythrocyte transfusion was guided by a hemoglobin trigger of 10g.dL-1 and the other blood products by routine coagulation and ROTEM® tests. Analysis of blood product consumption included units of erythrocytes, fresh frozen plasma, platelets, and fibrinogen. The coagulation biomarker analysis compared the pre- and post-operative values. RESULTS AND CONCLUSIONS: Group A (with factor XIII study) and Group B had identical total body surface area burned. All patients in Group A had a preoperative factor XIII deficiency, whose correction significantly reduced units of erythrocyte concentrate transfusion (1.95 vs. 4.05, p = 0.001). Pre- and post-operative coagulation biomarkers were similar between groups, revealing that routine coagulation tests did not identify factor XIII deficiency. There were no recorded thromboembolic events. Correction of factor XIII deficiency in burn surgery proved to be safe and effective for reducing perioperative transfusion of erythrocyte units.

[Anticoagulation impact on bleeding risk during HoLEP: Monocentric study of 156 patients]. / Impact des anticoagulants sur le risque hémorragique au cours de l'HoLEP : étude monocentrique de 156 patients.

OBJECTIVE: Compare the length of hospital stay and the complications after HoLEP between three groups of patients: a control group, a group with antiplatelet therapy, a group with anticoagulation therapy. MATERIALS: Retrospective cohort study that included all consecutive patients who underwent HoLEP for prostatic hyperplasia in our center from may 2013 to may 2016. Anticoagulated patients and patients under clopidogrel had respectively a relay with heparine and aspirine. Patients were seen after surgery at 1 and 3 months. RESULTS: A hundred and fifty six patients were analysed, mean age was 70.7 years (DS 6.8), mean prostate volume 88.8g (DS 34.1). 106 patients were in the control group, 34 had antiplatelet therapy and 16 had anticoagulation therapy. There were no difference between the 3 groups for mean age, mean prostatic volume, PSA. There was also no difference for length of intervention, irrigated volume and length of morcellation between the three groups. There were no difference between patients in the control group and patients with antiplatelet therapy for length of hospital stay (2.1 days vs 2.0 days), lenght of urethral catheterization (1.6 days vs 1.5 days). There was a statistical difference between patients in the control group and patients with anticoagulation therapy for lenght of hospital stay (2.0 days vs 4.4 days; P=0.01), length of bladder irrigation (0.9 day vs 1.8 days; P=0.01), lenght of urethral catheterization (1.6 days vs 3.5 days; P=0.01). Transfusion rate was 18.75% (n=3) for patients with anticoagulation, 2.9% (n=1) for patients under antiplatelet therapy and 0.9% (n=1) for patients in the control group. CONCLUSION: Anticoagulation during HoLEP is a valid option but need to be proceed with carefully management. LEVEL OF PROOF: 4.

Platelets and immunity: From physiology to pathology.

Blood platelets are cells acting during primary haemostasis. The thrombocytopenia observed in many different types of infectious processes begs the question of the relationship between cells and infectious pathogens and the role of platelets in the detection of biological hazards. This in turn brings us back to the role of platelets - via their molecular, membrane and secretory arsenal - in the detection and repair of vascular hazards. The common denominator between a breakdown of haemostasis and the risk of infection has been shown to be a cutoff point in the inflammatory continuum between physiology and physiopathology. The trophic role of platelets - as topical factor and as platelet transfusions - and their inflammatory complexities appear to correlate this proposed model, as reported in this short review.

Impact of a pneumatic tube system transport on hemostasis parameters measurement: the experiment of Cochin universitary hospital (AP-HP, Paris, France).

Samples transported by pneumatic tube system are submitted to forces of acceleration and deceleration which can affect laboratory parameters. At Cochin hospital, majority of samples of hemostasis, except for platelets tests, are transported by pneumatic tube system. The objective of this study was to evaluate the impact of a pneumatic tube system (PTS) transport compared to hand-delivered transport on samples and to qualify Cochin hospital PTS according to requirements of standard ISO 15189. A bibliographical study was made and showed that pneumatic tube system particularly influences platelets tests. Four citrate tubes were collected in 5 healthy volunteers in the maternity: 2 tubes were transported by PTS and 2 others were hand-delivered to the laboratory. Five coagulation tests were analyzed: prothrombine time (PT), activated partial thromboplastin time (aPTT), factor (F) V, FVIII and platelet closure time with PFA-100TM collagen/epinephrine. For each volunteer, the results obtained by PTS and by hand-delivered transport were compared with formula usually used for biological analysis retake: 2.8 x standard deviation of reproductibility variation coefficient (SH GTA 01, COFRAC). This study did not show an impact of PTS on PT, aPTT, FV and FVIII. For PFA-100TM collagen/epinephrine, we noted an impact on 2/5 volunteers. These results, in agreement with the literature, led to the conclusion that Cochin hospital PTS is in compliance to transport samples for usual coagulation tests except platelet tests. This study allowed to issue French recommendations for PTS transport of hemostasis tubes qualification available on "Groupe français d'hémostase et thrombose" Web site.

In vitro haemostatic efficacy of aqueous, methanol and ethanol plant extracts of three medicinal plant species in Palestine

Abstract The haemostatic efficacy of different extract types of Satureja thymbra L., Thymbra spicata L. (Lamiaceae) and Verbascum fruticulosum Post. (Scrophulariaceae) was evaluated in this study via the Prothrombin time (PT) and Activated partial thromboplastin time (aPTT) analysis. Aqueous, methanol and ethanol extracts of the examined plant species leaves were prepared to a final concentration 50 mg/mL. In vitro PT and aPTT assays were conducted on normal platelet poor plasma blood samples by a digital coagulation analyzer. The obtained results revealed anticoagulation activity of all investigated plant species with observed variations among them. The aqueous and ethanol extracts of T. spicata as well as the aqueous extract of S. thymbra prolonged PT values significantly (p 0.05). While, all V. fruticulosum extract types have had no significant effect on the PT values. The recorded aPTT data showed that all aqueous extracts have had a significant effect on the blood haemostasis as they increased aPTT values in all plant species under study. Out of which, both the ethanol and methanol extracts of T. spicata and methanol extract of S. thymbra showed similar effect. Of great concern, it was clearly noticed that the aqueous and ethanol extract of T. spicata and the aqueous extract of S. thymbra possess the strongest anticoagulation effect as they increased both PT and aPTT values significantly relative to the control (p 0.05). The variable anticoagulation bioactivity among the studied plant species could be referred to the various solvents degrees of solubility of different phyto-constituents. Thus, the efficacy of the plant species extracts evaluation as anticoagulants or coagulants were related to the plant species and to the solvent of extraction.

Resumo A eficácia hemostática de diferentes tipos de extrato de Satureja thymbra L., Thymbra spicata L. (Lamiaceae) e Verbascum fruticulosum Post. (Scrophulariaceae) foi avaliada neste estudo pelo tempo de protrombina (TP) e tempo de tromboplastina parcial ativada (TTPa). Os extratos aquosos, metanólicos e etanólicos das folhas das espécies de plantas examinadas foram preparados para uma concentração final de 50 mg/mL. Os ensaios de TP e TTPa in vitro foram realizados em amostras normais de sangue, pobre em plaquetas, por um analisador de coagulação digital. Os resultados obtidos revelaram atividade anticoagulante de todas as espécies de plantas investigadas, com variações observadas dentre elas. Os extratos aquosos e etanólicos de T. spicata e o extrato aquoso de S. thymbra prolongaram significativamente os valores de TP (p 0,05). Entretanto, todos os tipos de extratos de V. fruticulosum não tiveram efeito significativo sobre os valores de TP. Os dados registrados do TTPa mostraram que todos os extratos aquosos tiveram um efeito significativo na hemostase do sangue, pois aumentaram os valores de TTPa em todas as espécies de plantas em estudo. Dos quais, ambos os extratos etanólicos e metanólicos de T. spicata e o extrato metanólico de S. thymbra mostraram efeito semelhante. De grande preocupação, notou-se claramente que os extratos aquoso e etanólico de T. spicata e o extrato aquoso de S. thymbra apresentam efeito anticoagulante mais forte, aumentando os valores de TP e TTPa significativamente em relação ao controle (p 0,05). A variável bioatividade anticoagulante dentre as espécies vegetais estudadas pôde ser referida aos vários graus de solventes de solubilidade de diferentes fitoconstituintes. Assim, a eficácia da avaliação de extratos de espécies vegetais como anticoagulantes ou coagulantes foi relacionada às espécies vegetais e ao solvente de extração.

[Use of thrombelastography to guide posttraumatic hemostatic therapy: More coagulation factor concentrates and less allogenic blood transfusion?] / Intérêt de la thromboélastographie pour guider la correction de la coagulopathie post-traumatique : plus de MDS, moins de PSL ?

Viscoelastic technics are used for 10 years and include the ROTEM® and the TEG®. These devices that exploit the viscoelastic properties of the clotting blood, allow a rapid and global analysis of the haemostatic process taking into account all the process interfering with haemostasis such as inflammation. It has been shown that the use of these technics in clinical situations such as trauma, postpartum haemorrhage, gastrointestinal bleeding or cardiac surgery may reduce the need for blood product, the cost and perhaps may improve the outcome of the patients. Thanks to a rapid identification of the underlying coagulation deficit, these technics facilitate decision-making during acute care and help to guide the treatment, particularly with coagulation factor's concentrate.

Así comienza la vida plaquetaria: un viaje desde los megacariocitos medulares a las plaquetas circulantes / The birth of a platelet: A trip from bone marrow megakaryocytes to circulating platelets / Começa assim a vida plaquetária: uma viagem desde os megacariócitos medulares às plaquetas circulantes

Tal vez por haber sido consideradas como simples restos citoplasmáticos de los megacariocitos encargadas únicamente de la reparación de heridas, las plaquetas han tenido un lugar secundario en cuanto a su estudio e interés en comparación con los otros componentes celulares de la sangre. Sin embargo, en los últimos 20 años se ha avanzado mucho en el conocimiento de estas fascinantes células que de a poco han recobrado un lugar destacado dentro de la hematología. A lo largo de este trabajo se han revisado los aportes más destacados y novedosos acerca del proceso de biogénesis plaquetaria, su regulación por el microambiente medular y factores humorales, recorriendo desde la generación de megacariocitos hasta la liberación de plaquetas libres.

Perhaps for being considered mere megakaryocyte cytoplasmic debris responsible for wound repair alone, platelets have had a secondary role when compared to other cellular blood components. However, in the last 20 years we have learned much more about these fascinating cells, which have slowly regained a prominent place in hematology. This review discusses the most outstanding and novel contributions on platelet biogenesis, its regulation by the bone marrow microenvironment and humoral factors, analyzing from megakaryocyte generation to platelet release.

Talvez por ter sido considerados simples restos citoplasmáticos dos megacariócitos, encarregadas apenas da reparação de feridas, as plaquetas têm tido um lugar secundário quanto a seu estudo e interesse em comparação com os outros componentes celulares do sangue. Entretanto, nos últimos 20 anos foi possível aprender muito a respeito destas fascinantes células que aos poucos foram recobrando um lugar de destaque dentro da hematologia. Ao longo deste trabalho foram revistas as contribuições mais destacadas e novas acerca do processo de biogênese plaquetária, sua regulação pelo microambiente medular e fatores humorais, percorrendo desde a geração de megacariócitos até a liberação de plaquetas livres.

[Thromboelastometric profile of unwashed shed blood after primary knee arthroplasty]. / Évaluation du profil thromboélastométrique du sang épanché après arthroplastie primaire du genou.

INTRODUCTION: Knee arthroplasty causes significant blood loss. Different blood-saving measures exist like retransfusion of unwashed salvaged blood. Some studies question the quality of this blood and in particular its ability to clot. These studies use "static" coagulation tests reflecting only partially the reality, unlike viscoelastic methods. The main objective of this study was to evaluate the salvaged blood thromboelastometric profile using ROTEM® system and to compare these results with patient venous blood. MATERIALS AND METHODS: We performed an observational, prospective, single-center study conducted over 3 months in 2013. Agreement of local ethical committee and patient consent were obtained beforehand. All adult patients who underwent a primary total knee arthroplasty were included. A thromboelastometric profile and standard laboratory tests (hemoglobin, platelets count, PT, aPTT, fibrinogen) were performed in the same time on patient venous blood and on unwashed salvaged blood in the PACU. RESULTS: Twenty patients were included. The median duration of surgery was 93 minutes. Thirteen patients (65%) received tranexamic acid during procedure. The median volume of shed blood was 225 mL. Two patients (10%) received a reinfusion. Analysis of shed blood showed a major deficiency of clotting factor in standard biology (PT<10%) and an absence of clot formation in thromboelastometric test (In-tem®, Ex-tem®, Fib-tem® or Ap-tem®). Compared to venous blood, shed blood had significantly lower hemoglobin levels: 8.8 vs 13.5 g/dL (P<0.0001). Allogenic transfusion concerned 5% of patients. DISCUSSION: In this work, we confirmed that shed blood was naturally uncoagulable probably due to a multifactorial mechanism involving a major clot factor deficiency and an activation of fibrinolysis.