Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0012739 (disseminated intravascular coagulation)
 8,673 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To know the clinical characteristics and the prognostic factors of hyperleukocytic acute leukemia, we reviewed 244 patients with acute leukemia associated with hyperleukocytosis. Restrospective analysis and control study were used. Hyperleukocytosis occured in 8.5% of patients with acute leukemia. Hyperleukocytosis in ALL was more common than that in AML. Among AML with hyperleukocytosis, M5 subtype was the most. Hepatomegaly, splenomegaly, lymphadenopathy, DIC and CNSL were more frequent in hyperleukocytosis group. The complete remission rate was 41.4% for patients with hyperleukocytosis versus 54.2% for patients with non-hyperleukocytosis. The early mortality rate was significantly increased in hyperleukocytic patients (23.8%) as compared to the nonhyperleukocytic group (11.1%). Intracranial hemorrhage was the main cause of early death. The high risk factors of early death were: hemoglobin < or = 40 g/L, blood platelet < or = 30 x 10(9)/L, DIC, infection, CNSL at presentation. Acute leukemia with hyperleukocytosis has poor prognosis. Especially, acute myeloid leukemia with hyperleukocytosis must be taken seriously because of high early mortality rate.
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PMID:[244 patients with hyperleukocytic acute leukemia. Shanghai Leukemia Cooperation Group]. 1043 59

Thirty-four consecutive patients were hospitalized with diagnosis of severe Babesia infection over the course of 13 years. The average time from onset of symptoms to diagnosis was 15 days. When compared with uninfected febrile control patients, affected patients complained significantly more often of malaise, arthralgias and myalgias, and shortness of breath (P<.05), and they more often had thrombocytopenia and abnormal liver function (P<.05). Forty-one percent of patients with Babesia developed complications such as acute respiratory failure, disseminated intravascular coagulation, congestive heart failure, and renal failure. Analysis of data revealed that complicated babesiosis was more commonly associated with the presence of severe anemia (hemoglobin level <10 g/dL; P=.01) and higher parasitemia levels (>10%; P=.08). Patients were treated with a combination of drugs that included clindamycin, quinine, atovaquone, or azithromycin. Despite treatment, parasitemia persisted for an average of 8.5 days (range, 3--21 days). Exchange transfusion was performed for 7 patients, and it effectively reduced the high levels of parasitemia. Three patients died. Improved outcomes may result with prompt recognition and treatment of babesiosis.
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PMID:Severe babesiosis in Long Island: review of 34 cases and their complications. 1128

The resuscitation of the massively bleeding patient may seem superficially to be successful once the patient's vital signs have stabilized. The restoration of stable vital signs, however, does not confirm two critical elements of a thorough physiologic resuscitation: that there is truly adequate delivery of oxygen to all tissue beds and that physiologic disturbances that may have occurred because of massive transfusion during the resuscitation process have resolved. With respect to the adequacy of oxygen delivery, the current clinical endpoints, including mixed venous oxygen saturation, cardiac output, and serum lactate, reflect global perfusion and not regional oxygenation. Of these global measures, serum lactate is currently the best indicator as to whether some circulatory beds remain inadequately perfused. Serum lactate should be followed, and, in the event that elevated levels persist, measures to augment oxygen delivery (e.g., increasing cardiac output, hemoglobin concentration, oxygen saturation) should be undertaken. Gastric tonometry provides a method for specific examination of the splanchnic circulation. The current measurement techniques, however, require steady-state conditions and make it impractical in many physiologically dynamic situations. The physiologic disturbances associated with massive resuscitation (e.g., hyperkalemia, hypocalcemia, hypomagnesemia, hypothermia) should be anticipated. Coagulation disturbances occur, especially when massive transfusion is accompanied by hypotension, hypothermia, or acidosis. Coagulation parameters should be measured with the loss of each one half of blood volume or after each 30-minute interval, whichever occurs first. Evaluation at blood volume intervals is relevant to the development of a strictly dilutional coagulopathy. The development of DIC, occurring because of tissue factor exposure or acidosis, however, is related more to the time lapsed than to the absolute volume lost or replaced.
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PMID:The massively bleeding patient. 1177 75

Hemorrhagic disseminated intravascular coagulation (DIC) associated with the presence of underlying advanced or metastatic tumors are often difficult to control by conventional methods. We report the use of recombinant activated factor VII (rFVIIa) in patients with cancer and bleeding secondary to DIC. A total of 18 patients with cancer met pre-defined criteria for DIC. All patients had failed to respond to transfusion with blood products and treatment of the underlying malignancy prior to the introduction of rFVIIa. The median laboratory data at the time of treatment with rFVIIa were as follows: hemoglobin, 7.7 g/dl; platelets, 54 x 10(9)/l; prothrombin time, 21 s; activated partial thromboplastin time, 41 s fibrinogen, 83 mg/dl; D-dimer, 17 microg/ml; and antithrombin, 32%. The dose of rFVIIa was 90 microg/kg and the median number of doses administered was 5 (range, 3-10). Serial measurements of coagulation parameters were obtained at frequent intervals during treatment with rFVIIa. Of the 18 patients, 15 responded with cessation of bleeding and improvement in coagulation data. The prothrombin time and activated partial thromboplastin time normalized in all responding patients within 24 h of treatment. The median fibrinogen was 214 mg/dl while the median D-dimer was 6 microg/dl at 48 h following the administration of rFVIIa. No thromboembolic complications were observed following rFVIIa. Our data provide evidence that rFVIIa can be used successfully to control the hemorrhagic episodes associated with DIC. Although this type of treatment appears to be safe, close monitoring of the patients is warranted.
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PMID:Recombinant activated factor VII in patients with cancer and hemorrhagic disseminated intravascular coagulation. 1538 25

Sixteen fatal dog envenomations by the snake Vipera palaestinae over a 14-y period are described. Most envenomations occurred during the late night hours in the warm months, and 8/16 dogs were bitten on the limbs. The most frequent clinical signs upon admission were soft tissue swelling and edema, local pain, depression, bleeding, lameness, dyspnea, and 6 dogs were in shock. Thrombocytopenia was present in 14/16 cases and increased hematocrit (13/16) and hemoglobin (9/16) concentration were the most common hematological abnormalities upon admission. Biochemical abnormalities included increased activities of muscle enzymes and alkaline phosphatase, hypocalcemia, and hypocholesterolemia. Creatine kinase activity was markedly increased in 2 dogs. During hospitalization serious complications in many dogs were disseminated intravascular coagulation, acute renal failure, seizures, cardiac arrhythmias, acute necrotizing pancreatitis and severe laryngeal edema; these required intensive and expensive therapies. Specific antivenin (10 ml) administered to 8/16 dogs did not prevent death. Glucocorticosteroids were given in 8 cases; however, their use was associated with complications. Four dogs suffered sudden death, 2 of which died 1-2 d after discharge. Necropsy performed on 3/16 dogs found soft tissue swelling and local bleeding at the envenomation sites as well as bleeding in several distal body organs and tissues.
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PMID:Fatal Vipera xanthina palestinae envenomation in 16 dogs. 1548 52

An 82-year-old woman with hematemesis was admitted to our hospital. Diagnosis of bleeding from gastric ulcer was made and an emergency operation was performed. Although she fell into sudden hypotension, ventricular tachycardia and severe hemodilution lasting for 45 minutes (minimum hemoglobin concentration of 1.8 g x dl(-1)) caused by intraoperative massive hemorrhage, she recovered without any apparent postoperative damage in major organs. The major reasons for evading organ damage may be attributable to maintenance of blood pressure and circulatory volume, and to early medication for prevention of systemic inflammatory response syndrome or disseminated intravascular coagulation.
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PMID:[An elderly patient without evidence of major organ damage following severe hemodilution caused by massive intraoperative hemorrhage]. 1649 98

This study evaluated the antitumor effect and safety of S-1, an oral fluoropyrimidine derivative, in patients with metastatic pancreatic cancer. Chemo-naive patients with pancreatic adenocarcinoma, and measurable metastatic lesions were enrolled. S-1 was administered orally twice daily after meals at a dose of 80, 100, or 120 mg/day for body surface areas (BSAs) of less than 1.25 m(2), between 1.25 m(2) and less than 1.5, or 1.5 m(2) or greater, respectively, for 28 consecutive days, followed by a 14-day rest. Fifteen (37.5%) of 40 patients responded to treatment, including 1 complete response and 14 partial responses. The median time to progression and the overall survival time were 3.7 months (95% confidence interval, 2.2-5.6 months) and 9.2 months (95% confidence interval, 7.5-10.8 months), respectively. The major adverse events were anorexia, fatigue, hemoglobin reduction, nausea and pigmentation change, although most were tolerable and reversible. Although disseminated intravascular coagulation occurred in two patients, the condition resolved with anticoagulant therapy. S-1 is an effective and well-tolerated drug. The effectiveness of this drug should be confirmed in a phase III study.
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PMID:A late phase II study of S-1 for metastatic pancreatic cancer. 1752 Feb 53

Renal failure is an important complication of snakebite and a major cause of mortality. We aimed to study the clinical profile of snake envenomation in Southeast Anatolia, Turkey, in an adult population. We retrospectively analyzed the records of 200 snakebite victims from 1998 to 2006 at the Dicle University School of Medicine, Diyarbakir, Turkey. Sixteen patients (8%) developed AKI (acute kidney injury). Of those, 25% required dialysis and 18% died. There was no difference between groups in age, arrival time to hospital, and hospital stay time. Both groups received similar hydration and therapy at admission. Disseminated intravascular coagulation (DIC) was observed in 25% of the AKI group and was significantly higher than the non-AKI group (7.1%; p = 0.014). There was no significant difference regarding hemoglobin, platelet levels, and prothrombin time at admission. The prevalence of thrombocytopenia (<150,000 K/UL ) was 60% in the AKI group and 40% in the non-AKI group (p > 0.05). WBC count was significantly higher in the AKI group than in those without AKI (p = 0.001); serum albumin was significantly lower in the AKI group than in those without AKI (p = 0.013). AKI is an important complication of snakebite that may lead to mortality. Despite some troublesome aspects due to its retrospective design, this is a large series from Southeast Anatolia of Turkey in an adult population. Subjects with high WBC, low albumin, and DIC should be closely followed up for the development of AKI.
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PMID:Snakebite-induced acute kidney injury: data from Southeast Anatolia. 1819 43

Critically ill children in pediatric intensive care units are commonly indicated for blood transfusion due to many reasons. Children are quite different from adults during growth and development, and that should be taken into consideration. It is very difficult to establish a universal transfusion guideline for critically ill children, especially preterm neonates. Treating underlying disease and targeted replacement therapy are the most effective approaches. Red blood cells are the first choice for replacement therapy in decompensated anemic patients. The critical hemoglobin concentration may be higher in critically ill children for many reasons. Whole blood is used only in the following conditions or diseases: (1) exchange transfusion; (2) after cardiopulmonary bypass; (3) extracorporeal membrane oxygenation; (4) massive transfusion, especially in multiple component deficiency. The characteristics of hemorrhagic diseases are so varied that their therapy should depend on the specific needs associated with the underlying disease. In general, platelet transfusion is not needed when a patient has platelet count greater than 10,000/mm3 and is without active bleeding, platelet functional deficiency or other risk factors such as sepsis. Patients with risk factors or age less than 4 months should be taken into special consideration, and the critical thrombocyte level will be raised. Platelet transfusion is not recommended in patients with immune-mediated thrombocytopenia or thrombocytopenia due to acceleration of platelet destruction without active bleeding or life-threatening hemorrhage. There are many kinds of plasma-derived products, and recombinant factors are commonly used for hemorrhagic patients due to coagulation factor deficiency depending on the characteristics of the diseases. The most effective way to correct disseminated intravascular coagulation (DIC) is to treat the underlying disease. Anticoagulant therapy is very important; heparin is the most common agent used for DIC but the results are usually not satisfactory. Antithrombin III, protein C, or recombinant thrombomodulin has been used successfully to treat this condition. For reducing the risk of organism transmission and adverse reactions resulting from blood transfusion, the following measures have been suggested: (1) replacement therapy using products other than blood (e.g., erythropoietin, iron preparation, granulocyte colony-stimulating factor); (2) special component replacement therapy for specific diseases; (3) autotransfusion; (4) subdividing whole packed blood products into smaller volumes to reduce donor exposure; (5) advances in virus-inactivating procedures. To avoid viral transmission, vapor-heated or pasteurized products and genetic recombinant products are recommended. Cytomegalovirus (CMV)-seronegative blood, leukoreduced and/or irradiated blood are recommended for prevention of CMV infection, graft-versus-host-disease and alloimmunization in neonate and immunocompromised patient transfusion. There is no reason to prescribe a plasma product for nutritional supplementation because of the risk of complications. The principle: complications of transfusion must be avoided, the rate of blood exposure should be reduced and the safety of the transfused agents or components should be maintained must always be kept in mind.
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PMID:Transfusion therapy in critically ill children. 1894 9

Immune thrombocytopenia (ITP) is an acquired bleeding autoimmune disorder characterized by a markedly decreased blood platelet count. The disorder is variable, frequently having an acute onset of limited duration in children and a more chronic course in adults. A number of therapeutic agents have demonstrated efficacy in increasing the platelet counts in both children and adults. Anti-RhD immunoglobulin (anti-D) is one such agent, and has been successfully used in the setting of both acute and chronic immune thrombocytopenia. In this report we review the use of anti-D in the management of ITP. While the FDA-approved dose of 50 mg/kg has documented efficacy in increasing platelet counts in approximately 80% of children and 70% of adults, a higher dose of 75 microg/kg has been shown to result in a more rapid increase in platelet count without a greater reduction in hemoglobin. Anti-D is generally ineffective in patients who have failed splenectomy. Anti-RhD therapy has been shown capable of delaying splenectomy in adult patients, but does not significantly increase the total number of patients in whom the procedure can be avoided. Anti-D therapy appears to inhibit macrophage phagocytosis by a combination of both FcR blockade and inflammatory cytokine inhibition of platelet phagocytosis within the spleen. Anti-RhD treatment is associated with mild to moderate infusion toxicities. Rare life-threatening toxicities such as hemoglobinuria, acute renal failure and disseminated intravascular coagulation have been reported. Recommendations have been proposed to reduce the risk of these complications. Anti-D immunoglobulin can be an effective option for rapidly increasing platelet counts in patients with symptomatic ITP.
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PMID:Anti-RhD immunoglobulin in the treatment of immune thrombocytopenia. 1970 96


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