Low Platelets Food List

Conquer Low Platelets

Alternative And Natural Therapies For Itp (idiopathic Thrombocytopenia Purpura). Live Free From Itp. Complete Program To Increase Platelets. This Is What You Will Learn With this Guide: The Two Herbs That can help bring up your platelets. The Two Vitamins needed to keep those platelets from dropping. What foods may cause your platelets to drop. How science has confirmed the benefits of these herbs in their use with low platelets. Why your doctor may not know about these natural alternatives and how you can assist him in helping you. Different tests that naturopathic doctors do to determine your real state of health that may reverse the course of your body drastically. Understand some of the reasons why people develop low platelets. Discover how your digestive tract may be the culprit to your low platelet level problems. How you can prevent the most drastic step a splenectomy. How you can restore your health so that you dont need any more dangerous drugs. Get your life back and stop ending up in the hospital all the time. Learn why your immune system is attacking your platelets and how to calm it down. Learn what over the counter medications to stay away from if you have low platelets

Conquer Low Platelets Summary


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Neonatal Thrombocytopenia

Polycythemia Graft For Hyperviscosity

Platelet counts below 50 x 109 L (50,000 mm3) and who are bleeding. Neonatal alloimmune thrombocytopenia at term is managed as for fetal transfusion (Table 25.1). However, in the neonate, this transfusion may occur with the first pregnancy and technically, the platelet transfusion is much simpler. The dose is 1 unit. These concepts are of importance in making appropriate clinical decisions with regard to the transfusion of individual patients. Applying these concepts to platelet transfusions is as follows As the platelet count drops slightly below the normal range of 140 x 109 L, clinical bleeding will not occur, and the count may decrease to 30 x 109 L or lower before an increased risk of minor spontaneous clinical hemorrhage becomes evident (threshold). However, the transfusion trigger i.e., the decision to transfuse platelets, will be much lower than the 30 x 109 L, e.g., for example, 10 x 109 L. Once a decision is made to transfuse, the dose of platelets should result in a 20-40 x...

Thrombocytopenias Due to Increased Demand High Turnover

Etiology Thrombocytopenia

The bone marrow in these thrombocytopenias shows raised (or at least normal) megakaryocyte counts. Here too, there may be an increased presence of less mature forms with one or two nuclei (Figs. 60,61). Fig. 59 Forms of thrombocytopenia. a This blood smear shows normal size and density of thrombocytes. b In this blood smear thrombocyte density is lower and size has increased, a feature typical of immunothrombocytopenia. continued Essential thrombocytopenia, thrombocytopenic purpura (Werlhof disease) Thrombocytopenia in microangiopathy. This group includes thrombotic-thrombocytopenic purpura (see p. 144) and disseminated intravascular coagulation. Thrombocytopenia in hypersplenism of whatever etiology. Fig. 59 Continued. c Pseudothrombocytopenia. The thrombocytes are not lying free and scattered around, but agglutinated together, leading to a reading of thrombocytopenia from the automated blood analyzer. d Giant thrombocyte (as large as an erythrocyte) in thrombocytopenia. Dohle-type...

Thrombocytopenias Due to Reduced Cell Production

Causes Thrombocytopenia Adults

Measles, mononucleosis (Epstein-Barr virus, cytomegalovirus), rubella, and influenza may (usually in children) trigger thrombocytopenias of various types. In these cases, the virus affects the megakaryocytes directly. However, antibodies to thrombocytes may also arise in the course of these infections (p. 166), so that the pathomechanism of the parainfectious thrombocytopenias described by Werlhof in children may lie in impaired production and or increased degradation of thrombo-cytes. Neoplastic and aplastic bone marrow diseases. All neoplasms of the bone marrow cell series (e.g., leukemia, lymphoma, and plasmacytoma), together with their precursor forms (e.g., myelodysplasia), lead to progressive thrombocytopenia, as do panmyelophthisis and bone marrow infiltration by metastases from solid tumors. Vitamin deficiency. Folic acid and vitamin B12 deficiencies from various causes (p. 152) also affect the rapidly proliferating megakaryocytes. In these cases,...

Discharge And Home Healthcare Guidelines

The cardiovascular system becomes depressed, leading to depression of the vasomotor center in the brain and to hypotension. Conversely, in some individuals, intoxication causes the release of catecholamines from adrenal glands, which leads to hypertension. Intoxication depresses leukocyte movement into areas of inflammation, depresses platelet function, and leads to fibrinogen and clotting factor deficiency, thrombocytopenia, and decreased platelet function.

Blood Component Therapy

Indicated for bleeding if there is thrombocytopenia or platelet dysfunction in the setting of uncontrolled bleeding. Each unit of platelet concentrate should raise the platelet count by 5,000-10,000. Platelets are usually transfused 6-10 units at a time, which should increase the platelet count by 40-60,000. Thrombocytopenia is defined as a platelet count of less than 60,000. For surgery, the count should be greater than 50,000.

Central Venous Catheterization

Location The internal jugular approach is relatively contraindicated in patients with a carotid bruit, stenosis, or an aneurysm. The subclavian approach has an increased risk of pneumothorax in patients with emphysema or bullae. The external jugular or internal jugular approach is preferable in patients with coagulopathy or thrombocytopenia because of the ease of external compression. In patients with unilateral lung pathology or a chest tube already in place, the catheter should be placed on the side of predominant pathology or on the side with the chest tube if present.

Defects in Hemostasis

Thrombocytopenia is probably the most common defect encountered in the surgical population. Platelet disorders can be qualitative or quantitative. Quantitative deficits can be the result of consumption, decreased production, increased destruction or sequestration. Table 3.4. Etiologies of thrombocytopenia Heparin-Induced Thrombocytopenia

Stepby Step Diagnostic Sequence

Thrombocytopenia Thrombocytopenia, isolated (except ITP) + Recommended, - not recommended, (+) conditionally recommended, ITP idiopathic thrombocytopenia, OMF OMS osteomyelofibrosis osteomyelosclerosis, PV polycythemia vera, ET essential thrombocythemia, CMPD chronic myeloproliferative disorders, AL acute leukemia, NHL non-Hodgkin lymphoma, CLL chronic lymphocytic leukemia, FISH fluorescence in situ hybridization, AP alkaline phosphatase. + Recommended, - not recommended, (+) conditionally recommended, ITP idiopathic thrombocytopenia, OMF OMS osteomyelofibrosis osteomyelosclerosis, PV polycythemia vera, ET essential thrombocythemia, CMPD chronic myeloproliferative disorders, AL acute leukemia, NHL non-Hodgkin lymphoma, CLL chronic lymphocytic leukemia, FISH fluorescence in situ hybridization, AP alkaline phosphatase.

Extracutaneous Manifestations of Neonatal Lupus Erythematosus

The cytopenia most commonly associated with NLE has been thrombocytopenia (Watson et al. 1988). Remarkably, 5 of 57 children with cutaneous NLE in the national registry had neutropenia (Neiman et al. 2000). The cytopenias are transient and usually not associated with morbidity. One child had a nonfatal episode of gastrointestinal bleeding attributed to thrombocytopenia (Lee et al. 1993).

Brown recluse spider bite

Bite minimally symptomatic fewer than 10 of bites result in severe skin necrosis signs of progression within 48-72 hours of the bite mild-to-severe pain beginning 2-8 hours after bite central papule and associated erythema occur 6-12 hours after bite purple vesicle sometimes ulcerates stellate necrotic area sometimes ensues. Constitutional signs and symptoms hemol-ysis hemoglobinuria thrombocytopenia disseminated intravascular coagulation fever headache malaise arthralgia nausea vomiting

Blood Transfusion in Surgery II Cardiac and Vascular Surgery

The causes for blood transfusion in cardiac surgery are shown in Table 10.1. An important reason for red blood cell transfusion in cardiac surgery is extracorporeal circulation since this causes a dilution of the red cell mass of the patient. For patients with high hematocrits and a large intravascular volume, this dilution rarely precipitates a need for red cell transfusion. In some patients, however, preoperative hematocrits or intravascular volume or both may be low, (such as low weight females). Under these circumstances, the extracorporeal circuit will cause a significant dilution of the red cell mass, often to a hematocrit of less than 16. Extensive resections and lack of attention to good local hemostasis will also result in excessive bleeding which may also require red cell replacement. A third reason is extracorporeal damage occurring to platelets and activation of soluble systems such as the inflammatory and fibrinolytic systems. When the patient comes off the pump and has...

Clinical Experience with Drotrecogin Alfa Activated

Drotrecogin alfa (activated) was first tested in humans in 1995. At the time of the writing of this review, over 300 normal, healthy subjects have participated in multiple studies demonstrating the safety and pharmacokinetic profile of the protein. Regulatory approval of drotrecogin alfa (activated) was based on data from a single, randomized, placebo-controlled, phase III study 47 with supporting data from a single, randomized, placebo-controlled, phase II study 46 . The phase II study, completed in 1998, investigated multiple infusion rates and infusion durations of 48 and 96 h. Measures of coagulopathy (D-dimer, platelet count, fibrinogen level) was the primary endpoint of the effect of drotrecogin alfa (activated). In most patients, the platelet count and fibrinogen levels were normal and no effect of drotrecogin alfa (activated) therapy was observed 46 . However, concentrations of D-dimer were elevated in almost all patients. The decrease in D-dimer was only evident with infusion...

Primary Nursing Diagnosis

Since DIC always occurs in association with another condition, medical treatment focuses on correcting the underlying disorder. In addition, the physician seeks to return the patient to normal hemostasis. Active bleeding is managed by blood component therapy. To ascertain the success of cell and factor replacement, constant surveillance of laboratory values is critical to determine which blood components should be administered. In general, packed red blood cells are used to improve oxygen delivery by increasing the hemoglobin content of the blood. Fresh-frozen plasma replaces many of the clotting factors, whereas cryoprecipitate is the best source of fibrinogen and factors V VIII, and XIII. Platelet transfusion is used when the platelet count falls below 100,000 mm3.

Clinical Features

Most affected patients are children or young adults of Asian (Japan, Korea, Taiwan) and Latin American origin (Mexico) (1-5). Edema, vesiculopapular eruptions, small blisters, crusts, necrotic areas, and scars occur mainly on the face and limbs (Figs. 1 and 2). The oral mucosae may be involved. The lesions are not induced or exacerbated by UV radiation. The history may reveal previous similar recurrent eruptions. There is often high fever, malaise, weight loss, failure to thrive, lymphadenopathy, and hepatosplenomegaly. Some patients report hypersensitivity to insect bites, which may be a trigger factor (6). Laboratory tests often show leukopenia, anemia, thrombocytopenia, and signs of impaired liver function. In addition, antibodies to EBV can be detected in the serum.

If the patient is at high risk of bleeding or actively bleeding with DIC

If factor replacement therapy is transfused, fibrinogen and platelet levels should be obtained 30-60 minutes post-transfusion and every 4-6 hours thereafter to determine the efficacy of therapy. Each unit of platelets should increase the platelet count by 5000-10,000 mcL. Each unit of cryoprecipitate should increase the fibrinogen level by 5-10 mg dL.

Flow Cytometric Analysis of Reticulated Platelets

The precise identification of platelets in unseparated whole blood is an another critical aspect of the procedure. This can be achieved by the counterstaining of abundantly expressed platelet-specific glycoproteins such as GPIIb IIIa (CD41 CD61) or GPIb (CD42b) with phycoerythrin-labeled monoclonal antibodies. Such dual-color staining of unseparated whole blood samples avoids selective cell losses that may occur during the enrichment of platelets by centrifugation, and also serves as a basis for reliable platelet identification both in thrombocytopenia and in samples with abnormal platelet light-scatter characteristics.

Evaluation Of The Neonate

Minimum laboratory evaluation should include a complete blood cell count and lumbar puncture, as well as bacterial cultures of blood, urine, and cerebrospinal fluid to rule out bacterial infection. Cerebrospinal fluid analysis, in both nonpoliovirus EV and poliovirus infections, may show a pleocytosis suggestive of viral meningitis (usually

Blood Transfusion in Medicine VI Patients Infected with Human Immunodeficiency Virus

Thrombocytopenia and the need for allogeneic platelet transfusions. Thrombocytopenia in HIV infection is related partly to infection of the megakaryocyte by the HIV virus but is also due to a decrease in platelet survival, analogous to immune thrombocytopenic purpura (ITP). Bleeding, however, is not common and the thrombocytopenia frequently responds to either steroids or intravenous gammaglobulin. Platelet transfusions are best avoided, unless a hemostatic challenge, such as surgery or an invasive procedure, is imminent (see Chapter 28).

Clinical manifestation

Presenting symptom in all types excessive fatigue associated with a hypochromic anemia and splenomegaly Type i (adult nonneuronopathic form) onset of the manifestations from early childhood to late adulthood generalized yellowish bronze hyperpigmentation bleeding, secondary to thrombocytopenia, manifested as epistaxis and ecchymoses sequlae of monoclonal gammopathy or multiple myeloma

Development of Ceredase

The clinical trial that led to the approval of Ceredase was conducted on 12 patients, 4 adults and 8 children who were classified with Type I Gaucher Disease. Patients were given 60 IU of Ceredase kg of body weight by intravenous infusion once every 2 weeks for between 9 and 12 months. Part way through the trial, the dose of two severely affected children was increased to 60 IU kg every week. All patients in the trial showed a clinical response with a reduction in spleen volume and an increase in hemoglobin. Other clinical improvements observed in several patients included a reduction in liver size, reduction in plasma glucocerebroside and serum levels of tartrate-resistant acid phosphatase (a lyso-somal enzyme that is elevated in some lysosomal storage diseases), and an increase in platelet count. Some evidence of an improvement in the bone disease was observed in three of the patients 57 .

Steps in the Diagnosis of Chronic Myeloid Leukemia

Cml Myelocyte

Left-shift leukocytosis in conjunction with usually low-grade anemia, thrombocytopenia or thrombocytosis (which often correlates with the migration of small megakaryocyte nuclei into the blood stream), and clinical splenomegaly is typical of CML. LDH and uric acid concentrations are elevated as a result of the increased cell turnover.

Pharmacologic Highlights

Increases antibody titer and antigen-antibody reaction provides passive immunity against infection and induces rapid but short-term increases in platelet count Many children are managed as outpatients with frequent outpatient visits for therapeutics and platelet counts. If the platelet count is less than 15,000 mm3, the condition may be considered serious enough to warrant hospitalization. Institute safety precautions to prevent injury and the resultant bleeding and to assist with ambulation. Protect areas of hematoma, petechiae, and ecchymoses from further injury. Avoid intramuscular injections, but if they are essential, apply pressure for at least 10 minutes after the intramuscular injection and for 20 minutes after venipuncture. Avoid nasotracheal suctioning, if possible, to prevent bleeding. If a child is being managed as an outpatient, discuss the home environment with the parents or caregivers. Encourage the parents to set up one or two rooms at home (such as the child's...

Risk Of Fetalneonatal Infection

Maternal Varicella

Since the institution, about 30 years ago, of the recommendation for passive immunization of exposed newborns with VZIG as soon as possible after birth, it is rare for a newborn infant to die of disseminated varicella. Before VZIG became available, one study suggested a 20 fatality rate when the mother had onset of rash less than 4 days and up to 2 days after onset of rash at delivery (13). Infants in whom varicella is fatal often have a disseminated infection with pneumonia, extensive hemorrhagic skin vesicles, hepatitis, and thrombocytopenia. Mothers whose onset of rash is more than 48 hours after delivery may transmit varicella to their babies, but the disease is usually not severe because they transfer antibodies as well (7).

Treatment of sepsis

Activated protein C is a vitamin K-dependent plasma protein which limits coagulation and augments fibrinolysis. In severe sepsis, activated protein C (24 mcg kg hr for 96 hours) has been shown to decrease mortality from 30.8 to 24.7 . It should not be used in patients with thrombocytopenia, coagulopathy, recent surgery or recent hemorrhage because it increases the risk of bleeding.

Developmental History of the Enzyme 1051 Preclinical Development

The theoretical lack of systemic activation after rFVIIa treatment has been supported by preclinical data. Studies in the standard rabbit stasis model, developed as a thrombosis model in which injury was induced to the vessel wall, have demonstrated that rFVIIa (100 to 1000 g kg b.w.) or prothrombin complex concentrate (factor VIII inhibitor bypass activity FEIBA 50 to 100 U kg Immuno, Deerfield, IL) caused clot formation at the site of injury after 30 min of stasis (restricted blood flow). This reflects the normal pharmacological response to tissue injury. rFVIIa caused no change in platelet count or fibrinogen concentration even 3 h after administration. Furthermore, no changes were noted in anti-thrombin levels, nor was there any evidence of generation of soluble fibrin monomers, as judged by an ethanol gelation test. In contrast, FEIBA caused a significant dose-dependent decrease in platelets and fibrinogen, suggesting a general activation of the coagulation system. Administration...

General Approach to Laboratory Testing

When a dermatologist, family practitioner, internist, or rheumatologist first sees a patient with CLE, their principal concern should be to rule out evidence of systemic disease. After all, 15 of patients with CLE progress to SLE in 10-15 years of observation (Rowell 1984). In addition to a complete medical history and physical examination, clinical laboratory findings can be very helpful in this regard. Specifically, a blood chemistry panel allows screening for renal or hepatic involvement. Creatine phosphokinase testing assists in ruling out muscle inflammation. Evidence for autoimmune hemolytic anemia or thrombocytopenia is looked for in the complete blood cell count as well as in the lactic dehydrogenase, reticulocyte count, Coombs' direct antibody testing, serum haptoglobin, and antiplatelet antibodies. A routine urinalysis free of cellular casts or protein makes it highly unlikely that the kidney is involved. Specific autoantibodies, almost never observed in CLE, if found, can...

Clinical Manifestations Of Dengue Infection

Dengue fever is characterized by sudden onset of fever, frontal headache, retro-orbital pain, general malaise, generalized myalgias and arthralgias, nausea, vomiting, and rash. One characteristic feature of dengue fever is the severity of body pain, which can be incapacitating and explains why the disease is sometimes called breakbone fever. Other nonspecific symptoms may be present, such as anorexia, mild conjunctival injection, diarrhea, pruritus, and changes in taste sensation. Leukopenia and thrombocytopenia are frequent, and liver enzymes may be mildly elevated. The febrile period lasts 5-7 days, but the patient may remain symptomatic for several more days. The disappearance of fever correlates with the disappearance of viremia. Convalescence may be marked by a period of lassitude. There have been reports of severe depression after the acute period of illness (4,5). Skin eruptions may be more common in primary infections (6). The rash may be present in different ways, including...

Dengue Infection In The Pregnant Woman

Tations, and one case developed DHF also complicated by severe preeclampsia (25). In 1999, Carles also reported four mothers in French Guiana with dengue infection within 1 week of delivery (26). Although low platelet counts were reported, no hemorrhagic complication was recorded. Reports of dengue infections have come from Guadeloupe (one mother developed severe thrombocytopenia, giving birth via cesarean section, and the other had preterm labor mothers and infants recovered without complications) and from Thailand (thrombocytopenia with and without hemorrhagic complications) (27-29). In a review of laboratory-positive cases of mother-infant pairs in Puerto Rico from 1994 to 2003, four cases of maternal-fetal transmission were documented. All mothers were positive for anti-dengue IgM antibody, and infants were diagnosed by virus isolation, polymerase chain reaction, or anti-dengue IgM detection (CDC, unpublished data, 2003). In three of the four cases, the disease in the mother was...

Specific Laboratory Tests that Can Be Abnormal in Cutaneous Lupus Erythematosus

Patients with CLE had anemia ranging from 2 to 27 of the time, whereas patients with SLE had anemia 30 of the time. Eight percent of patients with SLE have hemolytic anemia, whereas it does not occur in patients with CLE (Pistiner et al. 1991). Between 0 and 30 of patients with CLE have leukopenia vs 51 of patients with SLE. Thrombocytopenia occurs in 2 -4 of patients with CLE as opposed to in 16 of those with SLE.

Laboratory Evaluation Of The Mother And The Newborn

The laboratory evaluation of both mother and newborn with a suspected case of dengue must include a variety of diagnostic tests, including specific tests for dengue. A complete blood cell count (CBC) with differential should be ordered for evaluation of the WBC count, hemoglobin and hematocrit levels. Serial CBCs are needed during the first days of illness to evaluate the disease progression, especially for hemoconcentra-tion, an important marker of increased capillary permeability. Serial platelet count measurements are also needed. A continuous, marked decline in platelet level could be the first sign of the development of DHF.

Hematological Malignancies In Adults

Outside of the context of massive transfusion, use of blood components other than red cells is not common in solid tumors. Chemotherapy associated cytopenias do occur, however, in ovarian carcinoma, small cell carcinoma of the lung and breast cancer, and platelet transfusion may be required. It is uncertain whether these populations of recipients benefit from leukoreduced blood products, although patients who require treatment with multiple courses of chemotherapy with associated thrombocytopenia will likely require platelet transfusion and, therefore, benefit from leukoreduced blood products.

Blood Transfusion in Medicine V Acute Gastrointestinal Bleeding

Many patients presenting with acute gastrointestinal bleeding have an underlying coagulopathy. Although the underlying coagulopathy may not in itself have precipitated the bleeding, as a definable anatomical abnormality may be present, the coagulopathy may exacerbate the bleeding. In addition, moderate red cell transfusion (4-6 units) may exacerbate the coagulopathy by dilution of clotting factors. Examples are patients with liver disease who develop upper gastrointestinal bleeding from esophageal varices patients anticoagulated with warfarin who present with lower gastrointestinal bleeding patients taking aspirin presenting with upper gastrointestinal bleeding or patients with hypersplenism and associated thrombocytopenia. It is important to assess the presence and severity of a coagulopathy in these patients by measurement of the prothrombin time (PT) and the platelet count. The PT may be only minimally prolonged at the time of presentation. However, as these patients are transfused...

Chronic Lymphocytic Leukemia Tcell Type TCLL

T-CLL is a rare small T-cell disorder. The median age of onset is 57 years. Patients usually present with high lymphocyte count, mild to moderate splenomegaly, and lymphadenopathy. Chromosomal abnormalities of 14q11, 14q32, 7p15 have been found in most cases (1). T-CLL probably represents a small cell variant of prolymphocyte leukemia (T-PLL). T-PLL is characterized by lymphocyte counts greater than 100 x 109 L, marked hepatosplenomegaly, anemia, thrombocytopenia, and lymphadenopathy. Typical T-PLL shows medium-sized lymphocytes with a high nuclear-cytoplasmic ratio and round to oval nuclei, and prominent nucleoli. In a series of 92 patients with T-PLL, 26 (28 ) had cutaneous involvement (2). T-PLL is probably the most common form of mature T-cell leukemia, usually with CD4+, CD8-, or, less frequently, CD4+ CD8+ immunophenotype (3). T-PLL is aggressive and has a median survival of less than 1 year.

Risk Infection Care Plan

Budgetary impact of heparin-induced thrombocytopenia with thrombosis and treatment with the direct thrombin inhibitor Argatroban (P401E). ASHP 39th Midyear Clinical Meeting. Orlando, FL, 2004. 20. Arnold R, Kim R, Tang B. The cost-effectiveness of argatroban treatment in heparin-induced thrombocytopenia the effect of early versus delayed treatment. Cardiol Rev 2005 14 7-13.

Neonatal Lupus Erythematosus

Anti Antila

NLE is a rare disease presenting in the neonatal period that resolves in the first 6 months of life. Associated disorders include transient thrombocytopenia, leukopenia, and a congenital heart block. Affected are children of mothers suffering from SLE. Clinically, children exhibit lesions as seen in SCLE. The causative agents are maternal IgG antinuclear antibodies (usually anti-Ro SSA, less frequently anti-La SSB, a-fodrin, and U1-RNP).

Acute Granulocytic Myeloid Leukemia AML

Acute granulocytic (myeloid) leukemia (AML) (M0-M3) accounts approximately for 40-50 of all acute leukemias with the incidence of the different FAB types reported as Ml 18 , M2 28 , M3 8 (1). The AML types differ with respect to cell line and degree of differentiation. In AML with minimal evidence of myeloid differentiation (M0) or without maturation (Ml), the predominant cell is undifferentiated by light microscopy, peroxidase negative and expresses CD34+, CD33+ but lacks CD15. Acute granulocytic (myeloid) leukemia with maturation (M2) is distinguished from Ml by clear evidence of maturation. Myeloblasts with granules and promyelo-cytes accounts for more than 50 of nucleated cells. Acute promyelocytic leukemia (APL, M3) is recognized by a predominance of promyelocytes, many of which contain large azurophilic granules. In the M2 and M3 variants, the majority of blasts usually are peroxidase positive. The blasts express CD15 and are usually negative for CD34. Patients with AML M2 may...

Uremic Encephalopathy and Hemolytic Uremic Syndrome

Hemolytic uremic syndrome is defined as a multiorgan disease characterized by the triad of microan-giopathic hemolytic anemia, thrombocytopenia and uremia. CNS complications are commonly seen (20-50 ) 45 . Hemolytic uremic syndrome caused by O-157 Escherichia coli enterocolitis can potentially result in fatal CNS complications in infants and children. MR imaging sometimes shows irreversible lesions in the basal ganglia or cortex, representing infarction or cortical laminar necrosis. DW imaging can show these lesions as hyperintense with decreased ADC (Fig. 7.19).

Platelet Autoantibodies

Platelet autoantibodies are most commonly seen in idiopathic thrombocytopenic purpura (ITP). It is important to appreciate that, although such patients may have low platelet counts ( 10 x 109 L), the platelets are larger in size and the hematocrit is usually normal. This differentiates these patients from other patients with thrombocytopenia, such as acute leukemia, where the platelets are normal or reduced in size and the hematocrit usually decreased. Patients with ITP may show evidence of mucosal bleeding, such as easy bruising, and sometimes epistaxis, but severe bleeding is not frequently observed and it is likely that the larger platelets and higher hematocrit are protective to the patient in this regard. Thus the threshold for the platelet transfusion in a patient with ITP is not the same as in diseases such as acute leukemia. In addition, the natural history of 2. How low is the platelet count and is there clinically significant active bleeding If a platelet transfusion is...

ICSO Supported Reperfusion

Details on feasibility, safety and effectiveness of ICSO in acute myocardial infarction were provided by Komamura and Kodama.68 Twelve ICSO treated patients with primary transmural acute myocardial infarction (9 anterior, one lateral and 2 inferior AMI) as well as 22 unsupported anterior AMI patients had successful intracoronary thrombolysis with urokinase. A 7F balloon catheter was inserted into the coronary sinus (for right or left circumflex occlusions) of the GCV (for LAD occlusions), and a 1 hr ICSO treatment (10 sec coronary sinus occlusions, 5 sec release periods) was initiated just before the lytic treatment. With ICSO occlusions, mean coronary sinus pressure rose from 8.3 to 38.1 mm Hg. There were no adverse effects on hemo-dynamics, no serious ventricular arrhythmias, no hemolysis or fall in platelet counts. There was no difference in LV function, but the ICSO group exhibited fewer abnormally contracting segments than the control group. In the whole ICSO group, no...

Nonspecific Skin Lesions in Patients with Systemic Lupus Erythematosus

Vascular lesions play a dominant role. Raynaud's phenomenon occurs frequently in SLE, as it does in other collagen vascular diseases. Leukocytoclastic vasculitis may arise, often associated with periods of increased disease activity it may present as cutaneous necrotizing vasculitis (palpable purpura) or as urticarial vasculitis, less often as arteritis, with symptoms similar to polyarteritis nodosa. Thrombophlebitis and thrombotic vessel damage is seen particularly in patients with secondary antiphospholipid syndrome, leading to livedo reticularis or acral cyanosis or necrosis. Thrombocytopenia may cause thrombocytopenic purpura. Similar to patients with dermatomyositis, patients with SLE often show nailfold erythema, telangiectasia, or hemorrhage. Characteristic nonspecific signs are thin, brittle hair with an uncombed appearance, referred to as woolly or lupus hair, and telogen effluvium.

Platinoid Mechanism and toxicityPlatinoid Overdose Management

CNS Seizures, encephalopathy, heavy-metal induced sensory peripheral neuropathy-axonopathy, retinal toxicity, reduced color vision, ototoxicity (high-frequency). Renal Distal tubular necrosis with subsequent acute renal failure (ARF). Bone marrow Myelosuppression anemia, thrombocytopenia.

Preeclampsia Eclampsia

White Matter Lesions Year Old

Hemolysis, elevated liver enzymes and low platelets (HELLP syndrome) is a thrombotic mi-croangiopathic vasculopathy in pregnancy. Fatalities are attributable to intracranial hemorrhage, which may occur either in isolation or as part of the HELLP syndrome. The DW imaging findings are similar to those in eclampsia preeclampsia.

Classification Antihypertensive depresses sympathetic nervous system

Side Effects CV Edema, pericardial effusion that may progress to tamponade (acute compression of heart caused by fluid or blood in pericardium), CHF, angina pectoris, changes in direction of T waves, increased HR. In children, rebound hypertension following slow withdrawal. GI N&V. CNS Headache, fatigue. Hypersensitivity Rashes, including bullous eruptions and Stevens-Johnson syndrome. Hematologie Initially, decrease in hematocrit, hemoglobin, and erythro-cyte count but all return to normal. Rarely, thrombocytopenia and leu-kopenia. Other Hypertrichosis (enhanced hair growth, pigmentation and thickening of fine body hair 3-6 weeks after initiation of therapy), breast tenderness, darkening of skin. Drug Interactions CNS depressant drugs, especially those used in conscious sedation T Hypotension Indomethaein l Effects NSAIDS l Effects Sympathomimetics l Effects How Supplied Tablet 2.5 mg, 10 mg

Fat Embolism Syndrome

The major clinical signs of fat embolism are respiratory insufficiency, mental deterioration, and a petechial rash. The petechiae are typically seen in the conjunctivae, as well as on the chest and the axillae. These major signs may be accompanied by fever tachycardia thrombocytopenia fat globules in the urine, sputum and retina as well as renal failure. Most individuals who die from fat embolism do so as a result of pulmonary failure. There are two theories as to the cause of pulmonary injury. The first holds that the injury is caused by the mechanical obstruction of the pulmonary vasculature by large globules of fat. The second theory is that free fatty acids, released from either the marrow directly or from fat lodged in the lungs, cause direct toxic injury to the pneumocytes and endothelium, with resultant abnormalities in gas exchange. Microscopically, there are fat emboli in the pulmonary vasculature, with edema, transudate, and exudate in the alveoli. Visualization of fat...

Clinical Presentation

The clinical presentation of amniotic fluid emboli is sudden dyspnea, hypotension, and seizures, followed by cardiovascular arrest.18,22,23 Of the 40 individuals studied by Clark et al. who had cardiac arrest, all but two arrested within the first hour.17 If death does not occur immediately, consumptive coagulopathy usually develops. Clark et al. reported that 38 of the 46 patients they studied had clinical or laboratory evidence of a coagulopathy eight individuals died before their clotting status could be evaluated, either clinically or by laboratory testing. Typically, laboratory studies show decreased fibrinogen, elevated levels of fibrin split products, prolonged partial throm-boplastin and prothrombin times, and thrombocytopenia.

Guidelines For The Diagnosis Of Congenital Toxoplasmosis In A Neonate Or Young Infant

Laboratory Complete blood cell count with differential and platelet count serum quanti tative immunoglobulins liver function tests, including 7GTP and bilirubin urinalysis, serum creatinine CSF cell count protein and glucose Radiologic Brain computed tomographic scan with and without contrast chest x-ray

Hivaids Introduction

Infants with perinatal acquired AIDS are normal at birth but may develop symptoms within the first 18 months of life. Clinical manifestations in children include fever decreased CD4 count anemia decreased WBC count (less than 3,000 cells mm3) neutropenia (absolute neutrophil count of less than 1,500 cells mm3) thrombocytopenia myelosuppression vitamin K deficiency hepatitis pancreatitis stomatitis and esophagitis meningitis retinitis (common with low CD4 counts) otitis media and sinusitis (chronic or recurrent) lymphadenopathy hepatosplenomegaly recurrent bacterial infections (especially, Streptococcus pneumoniae and Haemophilus influenzae) Mycobacterium infections (MAC) or tuberculosis cytomegalovirus (CMV) failure to thrive (in infants) chronic diarrhea neurologic involvement, (developmental delays and microcephaly in infants, or loss of motor skills in the older child) and pulmonary infections (Pneumocystis carinii PCP , lymphocytic interstitial pneumonitis LIP , and pulmonary...

Use of Clinical Endpoints in a Novel Disease Target

In the absence of either clinically convincing data relating a surrogate endpoint to clinical outcome or, alternatively, intrinsically meaningful surrogates, it is extremely difficult to design pivotal studies of rare disorders using surrogate endpoints. This is unfortunate, as these are the rare heterogeneous long-standing disorders for which surrogates are most useful and needed, particularly when disease prevention and not reversal is the only achievable endpoint. In some disorders, there are intrinsically meaningful surrogates that can allow their use. For Gaucher's disease, the authorities noted that treated patients showed changes in anemia and thrombocytopenia that were intrinsically meaningful and supported the interpretation of the associated decreases in spleen size. Even though hemoglobin or platelet count endpoints may be laboratory values, the clinical benefit of a higher hemoglobin level or platelet count is established and accepted in other disorders.

Common Nursing Diagnoses See Ineffective Tissue Perfusion

Defining Characteristics (Specify in iron deficiency anemia irritability, anxiety, blood loss in the stool, hypochronic RBCs, normal or near normal RBC count, decreased serum ferritin and iron in sickle cell anemia pallor, weakness, anorexia, easy fatigability, jaundice and developmental delays in aplastic anemia pallor, fatigue, weakness, loss of appetite, normochromic, normocytic RBCs in reduced numbers, leukopenia, thrombocytopenia risk of spontaneous bleeding or bleeding after mild to severe trauma .)

Propranolol hydrochloride

Hematologic Agranulocytosis, thrombocytopenia. Allergic Fever, sore throat, respiratory distress, rash, pharyngitis, laryngospasm, anaphylaxis. Skin Fever, pruritus, rash. Ophthalmic Dry eyes. GU Decreased libido, impotence, urinary tract infection. Other Hypoglycemia. Respiratory Bron-chospasm, dyspnea, wheezing. Additional Side Effects Psoriasislike eruptions, skin necrosis, SLE (rare).

New onset proteinuria hypertension and at least one of the following

Two occasions at least six hours apart Thrombocytopenia Less than 100,000 platelets per mm3 2. Laboratory evaluation consists of hematocrit (hemoconcentration suggests preeclampsia), platelet count, protein excretion, serum creatinine, serum uric acid, serum alanine and aspartate aminotransferase concentrations (ALT, AST), and lactic acid dehydrogenase concentration (LDH). G. Hematologic changes. Increased platelet turnover is a consistent feature of preeclampsia. The most common coagulation abnormality in preeclampsia is thrombocytopenia.

Severe preeclampsia

Delivery should be initiated, after a course of antenatal corticosteroid therapy if possible, when there is poorly controlled, severe hypertension, eclampsia, thrombocytopenia (less than 100,000 platelets microL), elevated liver function tests with epigastric or right upper quadrant pain, pulmonary edema, rise in serum creatinine concentration by 1 mg dL over baseline, placental abruption, or persistent severe headache or visual changes. Fetal indications for delivery include nonreassuring fetal testing, severe oligohydramnios, or severe fetal growth restriction (less than the 5th percentile).

Sex Hormone Treatment

Female preponderance and primary manifestation or exacerbation of preexisting LE during pregnancy is interpreted as involvement of sex hormones in the pathogenesis of LE (Piette et al. 1995, Wilder 1998). Consequently, therapeutic implementation of sex hormones has been controversially discussed in the past (Piette et al. 1995, Asherson and Lahita 1991). Nandrolone and danazol have been studied as weak androgens, but results have been ambiguous (Englert and Hughes 1988, Hazelton et al. 1983, Masse et al. 1980, Morley et al. 1982, Torrelo et al. 1990). Nandrolone did not show any effects in female patients but worsened symptoms in male patients. Whereas the beneficial role of danazol in the treatment of SLE-associated immune thrombocytopenia is appreciated, positive effects on CLE have been demonstrated in only a few patients. Hirsutism and weight gain as well as skin rash at higher doses further limit its therapeutic range. The adrenal steroid hormone dehydroepiandro-sterone has been...

Classification Antitubercular drug

Uses Prevention of disseminated Mycobacterium avium complex (MAC) disease in clients with advanced HIV infection. Contraindications Hypersensitiv-ity to rifabutin or other rifamycins (e.g., rifampin). Use in clients with active tuberculosis. Lactation. Special Concerns Safety and efficacy have not been determined in children, although the drug has been used in HIV-positive children. Side Effects Oral Taste perversion, discolored saliva (brownish-orange). GI Anorexia, abdominal pain, diarrhea, dyspepsia, eructation, flatulence, N&V. Respiratory Chest pain, chest pressure or pain with dyspnea. CNS Insomnia, seizures, paresthesia, aphasia, confusion. Musculoskeletal Asthenia, myalgia, arthralgia, myo-sitis. Body as a whole Fever, headache, generalized pain, flu-like syndrome. Dermatologic Rash, skin discoloration. Hematologic Neutro-penia, leukopenia, anemia, eosino-philia, thrombocytopenia. Miscella

Itp Introduction

Idiopathic thrombocytopenic purpura (ITP) is an acquired hemorrhagic blood disorder. It is characterized by excessive destruction of platelets (thrombocytopenia) and purpura (a discoloration caused by petechiae beneath the skin). Etiology is unknown but it is believed to be an autoimmune response to disease-related antigens. ITP is classified into two forms 1) acute form, which arises usually after an upper respiratory infection, measles, mumps, or chickenpox and 2) chronic form, which is unresponsive to treatment (with persistent thrombocytopenia) beyond 6 months of diagnosis. Classic signs and symptoms of ITP may include easy bruising with petechiae, and or ecchymosis over bony prominences bleeding from mucous membranes (i.e., epistaxis, bleeding gums) hematuria hematemesis hemarthrosis hematomas over the lower extremities. ITP is seen most frequently between the ages of 2 and 10 years in children. It is rarely seen in infants less than 6 months of age. Treatment is primarily...

Leukemia And Lymphoma Introduction

Pathologic effects of leukemia include the replacement of normal bone marrow elements by leukemic cells which results in clinical manifestations of anemia, neutropenia, and thrombocytopenia. Symptoms related to anemia may result in fatigue, weakness, pallor, and lethargy. Neutropenia predisposes the child to febrile episodes and infection. Symptoms related to thrombocytopenia may result in cutaneous bruises or purpura, petechiae, epistaxis, melena, and gingival bleeding. Other common symptoms related to leukemic infiltration include hepatosplenomegaly and lymphadenopathy bone and joint pain anorexia abdominal pain weight loss. Other symptoms, that are very rare, may include hematuria, gastrointestinal bleeding, or central nervous system (CNS) bleeding. Prognosis is based on age and initial WBC at diagnosis, sex, histologic type of the disease, number of chromosomes, the DNA-index, morphology and cell-surface immunologic markers.

Therapeutic Applications

Ancrod has been used in Europe and Canada since 1968 for various conditions, including heparin-induced thrombocytopenia and deep-vein thrombosis. It was first described for use in stroke patients in 1983. The U.S. Stroke Treatment with Ancrod Trial (STAT) assessed the efficacy and safety of ancrod in the treatment of acute stroke. The study randomized 500 patients to ancrod or placebo treatment initiated within 3 h of symptom onset. Treatment was given as a continuous 72-h infusion, followed by 1-h infusions at 96 h and 120 h. The results of the trial have shown that patients benefit in neurological outcome (placebo 34 vs. ancrod 42 ) with only a modest increase in bleeding risk 82,89-92 . The European Stroke Treatment with Ancrod Trial (ESTAT) increased the time of initiating treatment to 6 h after symptom onset, but this trial was terminated as no efficacy was found on interim analysis 93 .

Enterohaemorrhagic Escherichia coli

Among E.coli strains, four strain types are particularly pathogenic and cause gastroenteritis. These are enteropathogenic E. coli (EPEC), enterotoxigenic E. coli (ETEC), enteroinvasive E. coli (EIEC) and enterohaemorrhagic E. coli (EHEC). Acute symptoms of E. coli infections include diarrhoea, abdominal cramp and vomiting. In the developing countries, infections caused by E. coli (EPEC, ETEC) are particularly prevalent and are a major cause of undernutrition. In the industrialised countries, it is EHEC which presents the greatest concerns as EHEC infections can have life-threatening health consequences, such as haemolytic ureamic syndrome (HUS). This may occur in up to 10 of patients, particularly young children and the elderly. HUS is characterised by acute renal failure, haemolytic anaemia and thrombocytopenia. EHEC infections can lead to long term or permanent kidney damage. Other sequelae include erythema and thrombotic thrombocytopenia purpura. On average 2-7 of patients with HUS...

Fields Of Expertise Within Toxicology

Hematotoxicity is another area of active investigation. Benzene is an excellent example of the extremes that can be caused by substances that are toxic to the bone marrow. Chronic exposure to benzene can cause either leukemia, or bone marrow injury that can lead to aplastic anemia 6,7 . Agranulocytosis and aplastic anemia are infrequent but deadly toxic effects of several drugs. Anemias related to deficiencies of each of the formed elements of the blood also are known, and some of these are toxicological in origin. For example, thrombocytopenia is an established and potentially deadly adverse effect of heparin, though the etiology may be immunological 8 .

Typical Laboratory Findings

As in idiopathic lupus, antinuclear antibodies (ANAs) are almost always present, and the pattern is usually homogenous. Although antibodies against single-stranded DNA are common, unlike idiopathic lupus, antibodies against double-stranded DNA are uncommon. Antihistone antibodies are classic (Fritzler and Tan 1978) however, they are not diagnostic because they are often present in idiopathic lupus, and the exact specificity is even different for lupus caused by different drugs (Burlingame and Rubin 1991, Portanova et al. 1987). Antineutrophil cytoplasmic antibodies, many with specificity for myeloperoxidase, are common (Dunphy et al. 2000, Nassberger et al. 1990). These antibodies may activate neutrophils and increase inflammation (Falk et al. 1990). Mild anemia, leukopenia, and thrombocytopenia are common. Complement levels are usually normal,but they can be depressed (Rich 1996). When the offending drug is discontinued, manifestations such as anemia usually resolve with other...

Blood Transfusion in Obstetrics

Thrombocytopenia may be common (5-7 ) and is often mild (80-120 x 109 L). Platelet transfusions are rarely, if ever, indicated. Acute blood loss can be a sudden event in obstetrics. The causes are shown in Table 24.3. Depending on the severity (Table 24.4), transfusion may be required. In massive transfusion, (arbitrarily after 10 more units of blood have been transfused), the entire blood volume of the pregnant woman has been replaced. In such rare cases, the patient should be followed by serial assessments of clotting times and platelet counts and replacement with plasma or platelets may be necessary (Chapter 14). Thrombocytopenia in pregnancy is not uncommon. The causes are shown in Table 24.5. Platelet transfusions are rarely given the only exception being severe DIC associated with amniotic fluid embolism, fetal death, or abruptio placentae. If Rhesus positive platelets are given to a Rhesus negative female, anti-D (RhIg) should be administered (50-300 pig). The platelets should...

Immunophenotypic Analysis of Platelets

Resting platelets constitutively express many surface glycoproteins that are easily identified by flow cytometry. Upon platelet activation, many surface receptors are modulated in both copy number and conformation, while others, absent from the resting platelet surface, are newly expressed. This unit describes several strategies to evaluate platelet function by evaluating surface receptor expression on resting and activated platelets using flow cytometry. Three methods are described here in detail determination of resting platelet surface receptor expression (see Basic Protocol 1 and Alternate Protocol) determination of platelet activation using P-selectin (CD62P) expression (see Basic Protocol 2), which reflects platelet a-granule release (McEver, 2001), or PAC1 binding, which detects the activated conformation of glycoprotein (GP) IIb-IIIa (integrin aIIbp3 Shattil et al., 1985) and determination of procoagulant platelets and platelet-derived microparticles using annexin V binding or...

Description Medical Coagulation Disorders

I diopathic thrombocytopenia purpura (ITP) is an acquired hemorrhagic disorder that is characterized by an increased destruction of platelets because of antiplatelet antibodies. The antibodies attach to the platelets, reduce their life span, and lead to a platelet count below 100,000 mm3 but occasionally as low as 5000 mm3. ITP can be divided into two categories acute and chronic. Acute ITP is generally a self-limiting childhood disorder, whereas chronic ITP predominantly affects adults and is characterized by thrombocytopenia of more than 6 months. The most life-threatening complication of ITP is intracerebral hemorrhage, which is most likely to occur if the platelet count falls below 1000 mm3. Hemorrhage into the kidneys, abdominal cavity, or retroperitoneal space is also possible. Prognosis for acute ITP is excellent, with nearly 80 of patients recovering without treatment. The mortality rate from hemorrhage is 1 in children and 5 in adults. Older age and a previous history of...

Delayed Blood Transfusion Reactions

All other delayed reactions are exceedingly uncommon. Transfusion associated graft versus host disease (TA-GVHD) occurs between 4-20 days after transfusion. It is a devastating event and is discussed in more detail in Chapter 37. Posttransfusion purpura is another very uncommon complication of blood transfusion which occurs about 8-14 days after blood transfusion. In this situation, patients present typically with bruising or other features of thrombocytopenia, such as epistaxis. The platelet count may be extremely low, often less than 5 x 109 L. The patient's pretransfusion platelet count, when available, is normal. This reaction is typically observed in cardiac surgery and, therefore, the patient presents 5-10 days after discharge. Posttransfusion purpura is due to the development of an antibody which is capable of causing premature removal of autologous (patient's own) platelets. The most common platelet antigen involved is called PlA1 (HPA 1a) and patients who develop this...

Platelets Indications and Dosing

Atomic Layer Deposition System

The clinical indications for platelet transfusions are to prevent or stop bleeding in patients with low platelet counts (thrombocytopenia) or less commonly, in patients with dysfunctional platelets (thrombocytopathy). These indications occur in several different types of clinical settings. First, patients with severe throm-bocytopenia. The most common indication in this setting is to prevent spontaneous bleeding, particularly spontaneous intracranial bleeding. Most current literature now shows that this is unlikely to occur unless the platelet count decreases below 10 x 109 L (10,000 mm3) and a high risk is not present until the platelet count decreases below 5 x 109 L (5,000 mm3). In the past, a threshold value of 20 x 109 L (20,000 mm3) was commonly used by hematologists to prevent spontaneous bleeding in patients with acute leukemia and bone marrow transplantation, but this is now obsolete. The second clinical situation is thrombocytopenia in a patient for whom an invasive...

Pregnancy Category B vaginal

Special Concerns Use with caution in infants up to 1 month of age, in clients with GI disease, liver or renal disease, or a history of allergy or asthma. Safety and efficacy of topical products have not been established in children less than 12 years of age. Side Effects Oral Candidiasis. GI N&V, diarrhea, bloody diarrhea, abdominal pain, GI disturbances, te-nesmus, flatulence, bloating, anorexia, weight loss, esophagitis. Nonspecific colitis, pseudomembranous colitis (may be severe). Allergic Morbilliform rash (most common). Also, maculopapular rash, urticaria, pruritus, fever, hypotension. Rarely, polyarteritis, anaphylaxis, erythema multiforme. Hematologic Leukope-nia, neutropenia, eosinophilia, thrombocytopenia, agranulocytosis. Miscellaneous Superinfection. Also sore throat, fatigue, urinary frequency, headache.

Thrombotic Thrombocytopenic Purpura

Thrombotic thrombocytopenic purpura is a multisystem vasculopathy characterized by microangio-pathic hemolytic anemia, thrombocytopenia, renal involvement, fluctuating neurologic manifestations and fever 46 . Neuropathology shows hyaline thrombosis and occlusion of capillaries and arterioles without surrounding inflammatory reaction, which results in infarcts and petechial hemorrhages. MR findings are variable, ranging from punctate white matter lesions to posterior reversible encephalopathy syndrome, multifocal gray matter edema, infarction and hemorrhage. DW imaging can differentiate between these lesions (Fig. 7.20), which is important since some of the lesions seen on T2-weighted images may disappear following treatment with plasma exchange 47 .

Aplasias of All Bone Marrow Series Panmyelopathy Panmyelophthisis Aplastic Anemia

In unexplained anemia, thrombocytopenia, or leukocytopenia, any possible triggers (Table 25) must be discontinued or avoided. Panmyelophthisis or aplastic anemia is an acute disease that can only be overcome with aggressive treatment (glucocorticoids, cyclosporin, antilymphocyte globulin).

Laboratory Diagnosis Of Congenital Toxoplasmosis

All neonates suspected of having a congenital infection should have a complete blood cell count (20), including a platelet count to screen for thrombocytopenia (40,41) and eosinophilia (42) (although the latter has not been a common finding in many infected infants), and liver function tests. A lumbar puncture should be done to determine if there is a disproportional increase in cerebrospinal fluid (CSF) protein relative to the degree of pleocytosis (25,43,44) and a computed axial tomographic scan of the brain with contrast to detect diffuse cerebral calcifications (27). Every infant suspected to be congenitally infected (especially those who are asymptomatic) should have a thorough ophthalmologic examination to detect any ocular complications (i.e., chorioretinitis) (Table 1) (1).

Blood Transfusion in Surgery I Ordering Practices and Transfusion Styles

Illustrative examples of transfusion styles are (1) the routine administration of plasma in association with red cell transfusions in surgery. In the past, surgeons or anesthesiologists would transfuse a unit of plasma for every two or three units of red cells transfused during surgery. For most patients with normal hemostatic mechanisms presurgically, there is no evidence that this is of any benefit. Transfusion of plasma may, however, be useful when large volumes of allogeneic red cells or salvaged autologous red cells are transfused (approximating, 0.5-1 blood volume) and initial replacement is red cells in crystalloid. (2) The routine transfusion of platelets presurgically, if the platelet count is less than 100 x 109 L outside of the context of neurosurgical or ophthalmic procedures. In clinical situations where the operative field is well visualized and hemostasis can be controlled by good surgical technique, this practice is of no known benefit. Patients who exhibit excessive...

The Drugs

The antimetabolites include methotrexate (a folate antagonist), 5-fluorouracil (5-FU), and gemcitabine (pyrimidine analogues), and 6-mercaptopurine (a purine analogue). They exert their action by disrupting DNA chain elongation, either by directly incorporating into the chain or by depleting the cells of necessary enzymes. Toxicities include myelosuppression, thrombocytopenia, nausea and vomiting, and mucositis.1,2


Each unit of platelets contains 5 x 1010 platelets in 60 mL of plasma. They are stored for up to 5 days. They must be stored at room temperature to maintain their activity (-70 ). Each unit of pooled platelets will typically increase the platelet count by 10,000. Platelets are given to correct nonimmune thrombocytopenia. Patients with immune thrombocytopenia (ITP) do not respond with increased counts following administration of platelets. If these transfusions are needed to support surgery for ITP splenectomy, then they should not be administered until the splenic hilum is clamped.

Congenital Infection

Thrombocytopenia (120 mg dL) appear to correlate with clinical indicators of CNS damage (78). About 70 of infants with symptomatic congenital CMV infection have an abnormal neonatal cranial computed tomographic scan intracerebral calcifications are the most frequent finding (78). Other less frequently noted computed tomographic scan findings include ventricular dilation, cortical atrophy, white matter abnormalities, and migration abnormalities.


Ness, drowsiness, fatigue, hallucinations, insomnia, lethargy, mental changes, memory loss, strange dreams. GI Diarrhea, ischemic colitis, nausea, mesenteric arterial thrombosis, vomiting. Hematologic Agranulocytosis, thrombocytopenia. Allergic Fever, sore throat, respiratory distress, rash, pharyngitis, laryngos-pasm, anaphylaxis. Skin Pruritus, rash, increased skin pigmentation, sweating, dry skin, alopecia, skin irritation, psoriasis. Ophthalmic Dry, burning eyes. GU Dysuria, impotence, nocturia. Other Hypoglycemia or hyperglycemia. Respiratory Bronchospasm, dyspnea, wheezing. Drug Interactions See also Drug Interactions for Beta-Adrenergic Blocking Agents and Antihypertensive Agents.


Anemia can result from hemorrhage, hemolysis, or bone marrow hypoplasia. Megaloblastic anemia, usually a result of folate deficiency, has been observed in 20-40 of seriously ill, hospitalized alcoholic patients and in up to 4 of ambulatory alcoholics. Alcohol inhibits absorption of folate. There is not a strong correlation between megaloblastic anemia and the presence of liver disease. Alcohol also has a direct toxic effect on the bone marrow, which results in a transient sideroblastic anemia. Reticulocytosis commonly occurs as part of recovery from alcohol toxicity (Lee, 1999). Transient thrombocytopenia is found after consumption of large quantities of alcohol, especially in binge drinkers (Hardin, 2001). Leukopenia is less common, resulting from the same mechanisms of toxic and nutritional factors already mentioned. Hypersplenism, an irreversible complication, may also contribute to leukopenia, thrombocytopenia, and anemia. Alcohol also affects both thrombotic and coagulation...


During the first week after infection, parvovirus B19 causes a viremia that may be associated with fever, malaise, and other constitutional symptoms. During this period of viremia, the bone marrow is also infected, and the virus replicates in and kills the erythroid progenitor cells, resulting in their depletion. The reticulocyte count drops precipitously and is followed by anemia. In most otherwise healthy individuals, these changes are inconsequential with complete recovery of the bone marrow. However, in individuals with red blood cells that have a shorter than normal life span and who have underlying chronic anemia, parvovirus infection can result in serious anemia. This could be a potential problem in pregnant women who are already severely anemic. Parvovirus B19 can also occasionally infect other cell lines, causing leukopenia and thrombocytopenia (9,10). The immune response to parvovirus is primarily through antibody production and immunity is lifelong.

Reactive Left Shift

Hematology Shift Left

Fig. 38 Left shift. a and b Typical blood smear after bacterial infection toxic granulation in a segmented granulocyte (1), monocyte with gray-blue cytoplasm (2), metamyelocyte (3), and myelocyte (4). c Blood analysis in sepsis promyelocyte (1) and orthochromatic erythroblast (2). Thrombocytopenia. d and e Reactive left shift as far as promyelocytes (1). Particularly striking are the reddish granules in a band neutrophilic granulocyte (2). Fig. 38 Left shift. a and b Typical blood smear after bacterial infection toxic granulation in a segmented granulocyte (1), monocyte with gray-blue cytoplasm (2), metamyelocyte (3), and myelocyte (4). c Blood analysis in sepsis promyelocyte (1) and orthochromatic erythroblast (2). Thrombocytopenia. d and e Reactive left shift as far as promyelocytes (1). Particularly striking are the reddish granules in a band neutrophilic granulocyte (2).


CNS Confusion, depression, drowsiness, anxiety, nervousness. Hematologic Anemia, leuko-penia, thrombocytopenia, hemolytic anemia, macrocytic anemia, me-themoglobinemia. Hepatic Hepatitis, cholestatic jaundice, hepatic en-cephalopathy, hepatic necrosis. Der-matologic Rash, injection site irritation, erythema, ulceration, bullous


Megakaryocytes Nucleus

When anemia accompanied by moderately elevated (although sometimes reduced) leukocyte counts, thrombocytopenia or thrombocytosis, clinically evident splenic tumor, left shift up to and including sporadic myeloblasts, and eosinophilia, the presence of a large proportion of red cellpre-cursors (normoblasts) in the differential blood analysis, osteomyelosclero-sis should be suspected. BCR-ABL gene analysis is negative.

Fetal Transfusions

Alloimmune thrombocytopenia occurs in approximately 1 2000-1 5000 pregnancies. This condition is due to antibodies to platelet antigens which cross the placenta and destroy fetal platelets. It is similar to HDN, except that the antibodies are directed against platelets, rather than red cells. Maternal serum is not routinely screened, however, for platelet alloantibodies. IUT of platelets are given with second or later pregnancies, often where the first infant was born with thromb-ocytopenia.


The three antimalarials available at this time for the treatment of CLE are chloroquine, hydroxychloroquine, and quinacrine. Overall, these drugs are relatively safe, but there are some laboratory abnormalities to consider. Chloroquine slightly decreases creatinine levels in half of its users, most likely by raising plasma aldosterone levels (Musa-bayane 1994).Forty-five percent of hydroxychloroquine is excreted in the kidneys,and the drug is associated with up to a 10 decrease in creatinine clearance (Landewe et al. 1995). Therefore, the dosage should be adjusted for patients with renal impariment. Antimalarials also have a beneficial antihyperlipidemic effect. Hydroxychloroquine induces a 15 -20 decrease in total cholesterol, triglyceride, and LDL levels (Wallace et al. 1990). It is associated with only one case of agranulocytosis, in a patient who was given 1,200 mg daily,which is up to six times the current recommended dosage (Polano et al. 1965), and a handful of case reports of...

Leukemia Cutis

Leukemia Monocytic

INTRODUCTION Leukemia is a result of neoplastic proliferation of bone marrow-derived leukocytes, the majority of which are of B-cell origin. The disease may be subdivided into acute or chronic forms. The acute form presents with anemia, thrombocytopenia, hemorrhage, adenopathy, hepatosplenomegaly, and a rapidly fatal course. The chronic indolent form is often incidentally diagnosed following prolonged episodes of fever, weight loss, and infection. The acute leukemias are more likely to show eye involvement than chronic leukemias. Leukemia cutis may occur concurrently with bone marrow involvement, as an isolated site of relapse, or as the initial manifestation of leukemia. Leukemia cutis occurs in 25 to 30 of infants with congenital leukemia. In older persons the incidence of leukemia cutis at diagnosis is approximately 10 in acute myeloid leukemia and 1 in acute lymphoblastic leukemia. Between 75 and 90 of patients with leukemia will show eye or adnexal involvement at some stage of...


Thrombocytopenia and leukopenia are dose dependent and may be reversed by reducing the dose or temporarily discontinuing use of azathioprine. Other reported hematologic adverse effects include eosinophilia, leukocytosis, neutropenia, anemia, aplastic anemia, and fatal myelogenous leukemia.


Amrubicin (14) is a totally synthetic anthracycline, and differs more substantially than nemorubicin from the parent doxorubicin. It lacks the 4-methoxy and 14-hydroxy groups on the chromophore and the 3'-amino group in the sugar unit, but has an amino group at the 9-position on the chromophore. It was designed as a less cardiotoxic anthracycline79 and is a prodrug, with the major metabolite (the 13-alcohol amrubicinol) being 3-8-fold more cytotoxic in cell culture than amrubicin itself.80 Both compounds act via topo II-generated double-strand DNA breaks.81 In human tumor xenografts the metabolite accumulates to higher levels than that of doxorubicin in the tumors but at lower levels in normal tissues, suggesting that its selective distribution plays a large part in the observed more potent therapeutic activity.82 Amrubicin was less active than doxorubicin against a panel of human lung tumor cell lines in culture,83 but was superior to doxorubicin in vivo in both murine tumor models...

US without SonoRx

Figure 24.4 The decision-analytic model shows the three strategies that were examined by Arnold and researchers 22 to evaluate the financial implications of the direct thrombin inhibitor argatroban for early treatment ( 48 hours after thrombocytopenia onset), compared with delayed treatment, of heparin-induced thrombocytopenia (HIT) with or without thrombosis.


Platelet count, creatinine, urine protein, and liver enzymes, should be repeated once or twice weekly in women with mild stable preeclampsia. Protein excretion can be quantified with a protein-to-creatinine ratio. 2. A rising hematocrit suggests progression to more severe disease, while a falling hematocrit may be a sign of hemolysis. An elevated lactic acid dehydrogenase (LDH) concentration is a better sign of hemolysis, and a marker of severe disease or HELLP syndrome (ie, Hemolysis, Elevated Liver enzymes, Low Platelets). Hemolysis can be confirmed by observation of schistocytes on a blood smear. Gestational age greater than or equal to 38 weeks of gestation Platelet count less than 100,000 cells per mm3 Deteriorating liver function Progressive deterioration in renal function Abruptio placentae Persistent severe headaches or visual changes Persistent severe epigastric pain, nausea, or vomiting


The side effects from IFN-a during initial exposure to the drug are fever, chills, myalgias, and malaise which could be easily controlled with antipyretics. Dose related side effects are gastrointestinal complaints, metallic taste, anorexia, leucopoe-nia, decrease in platelet count, elevation of liver function tests as well as stupor, psychosis and peripheral neuropathy.

Neonatal Evaluation

Tory distress requiring intubation, shock, and bradycardia and thrombocytopenia. They were also more likely (46 vs 2 ) to have positive cultures from sites other than the bloodstream, including abscess fluid, cerebrospinal fluid, ascitic fluid, and sputum (2). Therefore, in any low birth weight infant with respiratory distress and history of prolonged antibiotic therapy, parenteral nutrition, intralipid infusions, or with indwelling intravascular catheters, fungal sepsis should be suspected.


In Phase I trials, SU5416 (semaxanib, 53) had an MTD of 145 mgm _2 when provided as intravenous doses twice weekly in Cremophor. However, the MTD in Phase I II trials in combination with gemcitabine and cisplatin was reduced to 85 mgm_2 due to observation of thromboembolic events at the higher dose.333'334 A Phase III trial with SU5416 (53) (in combination with IFL) was terminated in 2002 after interim analysis showed a lack of clinical benefit.321 SU6668 (54) has a low volume of distribution, and, in Phase I trials, the plasma half-life of the compound was 1 h in fasted patients, and 2h in fed patients.321 Little toxicity was observed when the compound was administered once per day (100-2400mgm_2), but twice daily dosing caused pain, fatigue, thrombocytopenia, and gastrointestinal toxicity.335 In Phase I trials, SU11248 (55) (Sutent, Sunitinib) achieved the target drug plasma levels when dosed at 50mgday_ 1 orally and has recently been approved for treatment of metastatic renal cell...


Some poisonings are not accomplished with one large dose, but with multiple smaller doses. Here, the action of the arsenic on the skin causes an initial erythematous flush with subsequent development of melanosis, hyper-keratosis, and desquamation. Months after an acute ingestion of arsenic, transverse white bands (Mees's lines) can be seen on the nails. Arsenic can also cause anemia, leukopenia, thrombocytopenia, and basophilic stippling.

Congenital Malaria

Laria from maternal transmission (2,26-34). In these cases, infants generally presented with fever 3-8 weeks after delivery, although some who developed symptoms in the first week of life were not diagnosed until later. Two infants were born prematurely. It is not clear whether maternal malaria precipitated the preterm delivery, although both mothers had positive blood smears at delivery. Most infants also presented with symptoms of poor feeding, irritability, or lethargy. Anemia and thrombocytopenia were reported in several cases, although other infants reportedly had normal laboratory parameters. The diagnosis was made in all infants by thick and thin blood smears. P. vivax malaria was reported for 18 infants (75 ), P. falciparum malaria was found in 4 infants (17 ), and P. malariae was detected in 2 infants (8 ). Most infants were treated with chloroquine. Other treatment regimens included chloroquine with primaquine (4 cases), quinine or intravenous quinidine (2 cases), and...


Thrombocytopenia, anemia, infections, bleeding, packed cell transfusions, platelet transfusions. CV Bradycardia and hypotension (including during the infusion), hypertension, severe CV events (including asymptomatic ventricular tachycardia, bigeminy, syncope, completeAVblock), abnormal ECG (including nonspecific repolarization abnormalities, sinus tachycardia, premature beats). Muscu-loskeletal Peripheral neuropathy (including mild paresthesia), myalgia, arthralgia. Oral Mucositis. GI N&V, diarrhea. Miscellaneous Alopecia, fever associated with severe neutropenia infections of the urinary tract and upper respiratory tract as well as sepsis due to neutropenia. Drug Interactions Ketoconazole Inhibition of metabolism of paclitaxel by ketoconazole How Supplied Injection 6 mg mL