RESUMEN
Neurosurgical patients with suspected DIC receive large amount of transfusion support in form of red cell concentrates (RCC), platelet rich plasma (PRP) and fresh frozen plasma (FFP). However, there are very few studies which have studied the effect of blood components load in the outcome of the patient. We conducted a prospective observational study on 61 post operative neurosurgery patients suspected with DIC and had at least one deranged haemostatic parameter namely platelet count, prothrombin time, partial thromboplastin time and thrombin time. Their blood components load was co-related with the outcome and with the hemostatic derangements. Twenty-eight patients died in our study group. 19/28 died patients had DIC. The red cell load was significantly more in patients who died compared to those who were alive (p = 0.041). On the other hand, load of PRP as well as FFP was significantly different between the patients who were alive and dead. This difference was further heightened when the DIC deaths were compared with the other patients. This is especially true for FFP transfusion which was significantly higher in DIC deaths (p = 0.006). Also, the number of FFPs received by neurosurgical patients suspected with DIC was significantly more in patients >2 coagulation abnormalities (p = 0.008). However, no correlation was found between PRP and RCC received and number of coagulation abnormalities present. To conclude, the load of FFP was maximum in patients with DIC deaths and the load of RCC was associated with overall mortality.
Asunto(s)
Coagulación Sanguínea , Hematología/organización & administración , Hospitales de Distrito/organización & administración , Laboratorios de Hospital/organización & administración , Hematología/normas , Hospitales de Distrito/normas , Humanos , India , Laboratorios de Hospital/normas , Desarrollo de Programa/métodos , Desarrollo de Programa/normasRESUMEN
Adrenal insufficiency can often manifest with nonspecific complaints. Primary adrenal lymphoma is a rare cause of adrenal insufficiency. We present the case of a 55-year-old female who presented with nonspecific complaints of abdominal pain, pallor and weight loss and was found to have primary adrenal lymphoma. The case highlights the need to expeditiously initiate steroid replacement in patients with adrenal insufficiency, while efforts are made to establish the etiology of adrenal insufficiency.
Asunto(s)
Neoplasias de las Glándulas Suprarrenales/patología , Insuficiencia Suprarrenal/patología , Linfoma de Células B Grandes Difuso/patología , Neoplasias de las Glándulas Suprarrenales/complicaciones , Insuficiencia Suprarrenal/tratamiento farmacológico , Insuficiencia Suprarrenal/etiología , Antiinflamatorios/administración & dosificación , Biopsia con Aguja Fina , Resultado Fatal , Femenino , Humanos , Hidrocortisona/administración & dosificación , Linfoma de Células B Grandes Difuso/complicaciones , Persona de Mediana Edad , Tomografía Computarizada por Rayos XRESUMEN
Serum ferritin (SF) values =10 micro g/l are diagnostic of absent Bone Marrow Iron (BMI) stores and therefore of iron deficiency (ID). However, SF, which may be elevated as a part of acute phase reaction, is an unreliable indicator of BMI stores in the setting of chronic disorders, making it difficult to diagnose ID in these patients. Thus, in chronic disorders (CD) such as tuberculosis, bone marrow examination is the only reliable way to establish ID. This study was done in order to identify levels of SF that would be indicative of absent BMI stores and also to study a combination of hematological and biochemical parameters that would be helpful in raising the predictive power of SF in patients of tuberculosis. Fifty-five tuberculosis patients were studied and classified into Iron Deplete (ID) and Iron Replete (IR) based on BMI. Raising the cut-off values of SF from =10 micro g/l to =30 micro g/l diagnosed 88% of ID cases correctly, as compared with 61% when cut-off levels of =10 micro g/l were used. At cut-off values higher than 30 micro g/l, the sensitivity was markedly reduced. Therefore, raising cut-off levels of SF to =30 micro g/l was most effective in predicting absent BMI, especially in a population where ID is highly prevalent. Combination of SF =30 micro g/l with mean corpuscular volume (MCV), erythrocyte sedimentation rate (ESR) and total iron binding capacity (TIBC) did not improve the predictive power of SF further. Also, 89.5% cases could be correctly classified by logistic regression equations using SF with ESR and C- reactive protein (CRP).