Hemostatic disorders induced by skin contact with Lonomia obliqua (Lepidoptera, Saturniidae) caterpillars.

Patients envenomed by Lonomia sp caterpillars initially experience a mild burning pain, headache, nausea, vomiting, and skin and mucosal hemorrhages. Some patients can rapidly progress to a severe coagulopathy that presents as visceral or intracerebral hemorrhaging. We studied the hemostatic alterations that occurred in 14 patients who were envenomed by Lonomia obliqua in Southern Brazil and presented at the Hospital São Vicente de Paulo (Passo Fundo, RS), Brazil during the summers of 1993 and 1994 when Lonomia antivenom was not yet available for treatment. The patients were classified into to 4 clinical groups: 0 (two patients), I (eight patients), II (two patients), and III (two patients). The patients were admitted to the hospital between 4 hours and five days after contact with the caterpillars. In this study, the coagulation parameters of the patients were followed up for up to 172 hours after the accidents. The patients received no treatment with the exceptions of two patients who received blood transfusions and antifibrinolytic treatment. The observed abnormalities related to blood coagulation and fibrinolytic factors were similar regardless of the severity of the bleeding symptoms. These findings suggest that alterations in hemostatic parameters without thrombocytopenia are not predictors of the seriousness of such accidents. Thus, consumptive disorder and reactive fibrinolysis are not proportional to mild coagulopathy. Furthermore, these patients recovered. The hemostatic parameters of most of the patients normalized between 96 and 120 h after the accident.

Hemostatic disorders induced by skin contact with Lonomia obliqua (Lepidoptera, Saturniidae) caterpillars

ABSTRACT Patients envenomed by Lonomia sp caterpillars initially experience a mild burning pain, headache, nausea, vomiting, and skin and mucosal hemorrhages. Some patients can rapidly progress to a severe coagulopathy that presents as visceral or intracerebral hemorrhaging. We studied the hemostatic alterations that occurred in 14 patients who were envenomed by Lonomia obliqua in Southern Brazil and presented at the Hospital São Vicente de Paulo (Passo Fundo, RS), Brazil during the summers of 1993 and 1994 when Lonomia antivenom was not yet available for treatment. The patients were classified into to 4 clinical groups: 0 (two patients), I (eight patients), II (two patients), and III (two patients). The patients were admitted to the hospital between 4 hours and five days after contact with the caterpillars. In this study, the coagulation parameters of the patients were followed up for up to 172 hours after the accidents. The patients received no treatment with the exceptions of two patients who received blood transfusions and antifibrinolytic treatment. The observed abnormalities related to blood coagulation and fibrinolytic factors were similar regardless of the severity of the bleeding symptoms. These findings suggest that alterations in hemostatic parameters without thrombocytopenia are not predictors of the seriousness of such accidents. Thus, consumptive disorder and reactive fibrinolysis are not proportional to mild coagulopathy. Furthermore, these patients recovered. The hemostatic parameters of most of the patients normalized between 96 and 120 h after the accident.

[Haemostatic disorders in children]. / Hämostaseologie in der Pädiatrie.

Haemorrhagic and thrombotic events occur in both children and adults. The underlying causes are congenital or acquired disorders. In contrast to haemorrhagic disorders, inherited thrombotic disorders nearly exclusively in association with additional external risk factors lead to thrombotic events predominantly during the newborn period and adolescence. It is necessary to be aware of age-specific properties of coagulation in order to correctly interpret clinical and laboratory findings and to provide optimal care for children with haemorrhagic and thrombotic complications.

Accesos vasculares en hemodiálisis e intervenciones del personal de salud y pacientes en caso de complicaciones de las mismas, en dos instituciones de salud, primer semestre 2011 / Vascular access in hemodialysis and interventions of health personnel and patients in case of complications thereof, in two health institutions, the first half of 2011

La insuficiencia renal crónica es la disminución progresiva de la tasa de filtrado glomerular secundario a pérdida irreversible de nefronas funcionantes, y como alternativa de tratamiento se tiene la hemodiálisis.La presente investigación es cuantitativa y cualitativa, de tipo descriptivo, transversal y retroprospectivo; demuestra el manejo de los accesos vasculares en hemodiálisis por parte del personal de salud en enfermería y pacientes. Se trabajo con una muestra de 176 pacientes y 17 Licenciadas de enfermería de dos instituciones de salud; Caja Nacional de salud y el Hospital Clínico Viedma en el año 2011.Se utilizó un cuestionario para los pacientes y el personal de salud, donde los resultados reflejaron que existe un déficit de conocimientos en cuanto al manejo de los accesos vasculares por parte del paciente y el personal de enfermería; lo cual se asocia con las complicaciones observadas. Se observó una mayor incidencia de infección causada por el mal uso por parte de los pacientes. Se constató los procedimientos mal realizados en accesos vasculares por el personal de salud en enfermería, con mayor incidencia en la institución de la Caja Nacional de Salud

Anesthetic concerns for patients with coagulopathy.

PURPOSE OF REVIEW: Patients often receive preoperative therapies that interfere with hemostasis, and can present for surgery with underlying hemostatic disorders because of pre-existing preoperative anticoagulation or antiplatelet therapy. Perioperative bleeding can occur following surgery due to multiple causes; however, the addition of pharmacologic agents creates an acquired defect that complicates the surgical injury and may result in increased blood loss. An understanding of the potential impact of anticoagulation therapies on hemostasis is critical in managing these patients. Further, newer agents are evolving in clinical practice that clinicians should be aware of. RECENT FINDINGS: The anticoagulants and antiplatelet agents that patients are receiving preoperatively apart from unfractionated heparin include low-molecular-weight heparins (LMWHs); a pentasaccharide (fondaparinux); oral anticoagulants: vitamin K antagonists (warfarin), new oral Xa inhibitors (rivaroxaban, apixiban), or the oral direct thrombin inhibitor (DTI) dabigatran; platelet inhibitors: thienopyridines (clopidogrel, ticlopidine, prasugrel) or IIb/IIIa receptor antagonists (tirofiban, abciximab, eptifibatide); or DTIs (r-hirudin, bivalirudin, argatroban). SUMMARY: There are multiple pharmacologic therapies that surgical patients may be exposed to preoperatively, although there are currently few available methods to antagonize their effects. Often therapeutic prohemostatic pharmacologic approaches are used to treat or prevent bleeding, in addition to transfusional therapies.

Ceruloplasmin prevents hemostatic disorders during experimental hyperammonemia.

Experimental hyperammonemia in rats was accompanied by hemostatic disorders manifesting in coagulopathy (activation of the intrinsic pathway of blood coagulation) and suppression of platelet function. Ceruloplasmin in a total dose of 60 mg/kg effectively normalized coagulation hemostasis and functional activity of platelets by improving secretory processes in platelets and increasing aggregation rate.

StarClose femoral arteriotomy closure device: an advance in arterial closure.

Millions of femoral arterial punctures are performed annually worldwide for the diagnosis and treatment of cardiovascular disease. Traditionally, hemostasis following arterial sheath removal has employed compression techniques but more recently, a number of arteriotomy closure devices have become available, none of which have been shown to produce an outcome superior to the standard technique of compression. The authors investigated a novel device, which utilizes a nitinol clip that gathers the artery from the outside producing a purse-string-like seal, with very promising results. The authors feel that this device has great potential, may impact significantly on the closure of arteriotomy sites and may also find application in other aspects of procedural medicine.

Coagulopathy of acute promyelocytic leukemia.

Life-threatening bleeding is frequent in acute leukemias, particularly in acute promyelocytic leukemia (APL), a distinct subtype of acute myelogenous leukemia, characterized by the balanced reciprocal translocation between chromosomes 15 and 17. Laboratory assessments show profound hemostatic imbalance compatible with the clinical picture of disseminated intravascular coagulation. Activation of the coagulation system, hyperfibrinolysis and nonspecific proteases activity can be observed in this condition. An important pathogenetic role is attributed to the leukemic cell properties for activating hemostatic mechanisms. This review will summarize what is currently known about the coagulopathy of APL, the principal pathogenetic mechanisms, and the therapeutic tools for the management of this complication. Special attention will be devoted to the new therapy with all-trans retinoic acid, which has completely changed the natural history of APL and APL-related coagulopathy.

Estrategias para mejorar la función endotelial y las alteraciones hemostáticas en pacientes con aterosclerosis / Therapeutic options to improve endothelial function and hemostatic properties in atherosclerotic disease

Las células endoteliales (CE) que recubren la capa íntima de las arterias intervienen de forma importante en la regulación de la hemostasia. En reposo, las CE mantienen la fluidez circulatoria y promueven la activación de numerosas funciones anticoagulantes. Tras lesión vascular, como ocurre en la aterosclerosis, las CE se convierten en una superficie trombogénica a través de la inducción de sustancias procoagulantes, inhibición de los mecanismos anticoagulantes naturales y favoreciendo el depósito intravascular de fibrina. Diversas estrategias terapéuticas y modificaciones del estilo de vida pueden modular la función endotelial. Estudios recientes indican que algunos de los beneficios que se obtienen tras la administración de hipolipemiantes, antioxidantes, estrógenos e inhibidores del enzima convertidor de la angiotensina (IECAs), pueden deberse a sus efectos sobre la función endotelial y los mecanismos hemostáticos. Investigaciones en curso permitirán establecer el papel fisiopatológico de la disfunción endotelial y de las medidas encaminadas a la prevención y tratamiento de la aterosclerosis (AU)

Endothelial cells (EC) form the luminal surface and thus have a central role in the regulation of hemostasis. In the quiescent state, EC mantain blood fluidity and inhibit clot formation by promoting the activity of numerous anticoagulant pathways. However, following vascular injury, such as in atherosclerotic diseases, the EC can promote the deposition and persistence of fibrin through coordinate induction of procoagulants and suppression of anticoagulant mechanisms. A growing list of therapeutic modalities and life style changes have been shown to modulate endothelial dysfunction. Among them, lipid—lowering agents, estrogens, antioxidants and angiotensin-converting-enzyme inhibitors (ACEI) achieve much of their benefit through effects improving EC function and hemostatic mechanisms. Future investigations will shed more light on the pathophysiology of endothelial dysfunction to provide new options for the prevention and treatment of atherosclerotic disease (AU)