Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Heparin-induced thrombocytopenia (HIT) is a major health problem, especially in cardiac surgery theaters, cardiac catheterization labs, and intensive care units. Some patients with HIT develop serious thrombotic complications like limb ischemia and gangrene, while others may not develop such complications and have only mild thrombocytopenia. Current laboratory diagnostic tools incur significant time delays before confirming HIT, therefore upon clinical suspicion, treatment of HIT should start immediately while awaiting laboratory results. This is a review of the types, phases, pathophysiology, clinical presentation and diagnosis of HIT, and its current management strategies.
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PMID:Heparin-induced thrombocytopenia (HIT): Identification and treatment pathways. 3008 45

Hemophagocytic syndrome combines febrile hepatosplenomegaly, pancytopenia, hypofibrinemia, and hepatic dysfunction. It is characterized by bone marrow and organ infiltration of activated, nonmalignant macrophages that phagocytize blood cells. It is rare among renal transplant recipients. Here, we present the successful management of late-onset cytomegalovirusinduced hemophagocytic lymphohistiocytosis in a kidney transplant recipient after coronary artery bypass graft surgery. In 2012, our patient had end-stage kidney disease due to diabetic nephropathy and underwent related living-donor renal transplant. He was also hypertensive and hyperuricemic and had heart ischemia for which percutaneous coronary intervention for triple vessel disease was performed before transplant. In March 2017, he underwent successful aortic valve replacement and coronary artery bypass graft surgery; however, the patient had persistent thrombocytopenia. Heparin-induced thrombocytopenia was negative. His bone marrow showed hemophagocytosis possibly due to cytomegalovirus. Moreover, antiglycoprotein IIb/IIIA autoantibodies were positive. A positron emission tomography scan was negative for malignancy. He started treatment for cytomegalovirus with modifi cation of his immunosuppressive regimen (pulse steroid). Antiplatelet therapy was held and only resu med if platelet count exceeded 30000/L. Moreover, he received intravenous immunoglobulin and romiplostim treatment with partial response. Throughout treatment, he had stable kidney graft function with improving platelet count. A multi disciplinary approach is needed to treat patients with hemophagocytic syndrome, especially renal transplant recipients. Late-onset cytomegalovirus is an important cause for this syndrome.
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PMID:Successful Management of Late-Onset Cytomegalovirus-Induced Hemophagocytic Lymphohistiocytosis in Kidney Transplant Recipient After Coronary Artery Bypass Graft Surgery. 3077 56

Heparin-induced thrombocytopenia is a rare complication of treatment with both unfractionated heparin (UFH) and low molecular weight heparin (LMWH). Antibodies against the complex heparin-platelet factor 4 are the main cause of pathogenesis, resulting in the activation of thrombocytes, coagulation, endothelium, monocytes, neutrophils and subsequent highly prothrombotic state. The prothrombotic state can result not only in venous but also in arterial thrombosis at different locations (which is manifested apart from venous thromboembolic disease also by acute limb ischemia, acute myocardial infarction, ischemic stroke, skin necrotizing lesion exanthema). If HIT is not adequately treated, it may be fatal in up to 10% of patients. For early diagnosis, a combination of 4T scores and diagnostic lab tests for HIT is required. Immediate discontinuation of heparin therapy (UFH, LMWH) and switching to non-heparin anticoagulants (fondaparinux, bivalirudin, argatroban or in some situations DOACs) are essential in HIT treatment. The case report describes the patient after primary knee replacement, complicated by the development of HIT with no evidence of venous thromboembolic disease. Preoperatively, the patient was administrated nadroparin due to paroxysmal atrial fibrillation, after the development of HIT, anticoagulation was modified to fondaparinux and subsequently to warfarin after the platelet count normalization. Key words: unfractioned heparin, low molecular weight heparin, thrombocytopenia, total knee replacement.
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PMID:[Heparin-Induced Thrombocytopenia after Total Knee Replacement]. 3239 15


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