Mon enfant saigne facilement: approche clinique et paraclinique pour le praticien [My child bleeds easily: clinical and paraclinical approach]

The aim of this review article is to provide a clinical guideline for the child presenting with easy bruising, distinguishing among the different etiologic groups associated with this symptom what is normal and what is not, allowing then to establish an algorithm for work-up and follow-up. We also precise in which concrete situation it would be necessary to refer the child to a pediatric hematologist.

Expérience de dix ans de réanimation chirurgicale d'un centre hospitalier universitaire. Détermination d'un critère d'identification des patients à risque de décéder de coagulopathie irréversible [10 years experience in surgical resuscitation at a university hospital center. Determination of a criterion for identifying patients at risk for fatal irreversible coagulopathy]

The authors evaluated ten years of surgical reanimation in the University Centre of Lausanne (CHUV). Irreversible coagulopathy (IC) is the predominant cause of death for the polytraumatized patient. Acidosis, hypothermy, and coagulation troubles are crucial elements of this coagulopathy. The authors looked for a criterion allowing the identification of dying of IC. In a retrospective study, laboratory results of pH, TP, PTT, thrombocyte count and the need for blood transfusion units were checked for each major step of the primary evaluation and treatment of the polytraumatized patients. These results were considered as critical according to criteria of the literature (30). The authors conclude that the apparation of a third critical value may be useful to identify the polytraumatized patient at risk of dying of IC status. This criterion may also guide the trauma team in selecting a damage control surgical approach (DCS). This criterion was then introduced into an algorithm involving the Emergency Department, the operating room and the Intensive Care Unit. This criterion is a new tool to address the patient at the crucial moment to the appropriate hospital structure.

Haematological and biochemical characteristics of the splenic effluent blood in schistosomal patients undergoing splenectomy

OBJECTIVE: To assess hematological and biochemical features of splenic effluent blood and their influence on the rise of hematological values after splenectomy.METHODS: we studied 20 patients undergoing surgical treatment for schistosomatic portal hypertension. We collected blood samples for CBC, coagulation, bilirubin and albumin in the splenic vein (perioperative) and peripheral blood (immediately pre and postoperative periods).RESULTS: the splenic blood showed higher values of red blood cells, hemoglobin, hematocrit, platelet count, total leukocytes, neutrophils, lymphocytes, monocytes, eosinophils and basophils, as well as reduction of laboratory coagulation parameters in relation to peripheral blood collected preoperatively. In the postoperative peripheral blood there was an increase in the overall leukocytes and in their neutrophil component, and decreased levels of basophils, eosinophils and lymphocytes. The other postoperative variables of complete blood count and coagulation tests were not different compared with the splenic blood. The albumin values were lower postoperatively when compared to preoperative and splenic blood. There were higher values of direct bilirubin in the postoperative period when compared with the preoperative and splenic blood. Postoperative indirect bilirubin was lower compared to its value in the splenic blood.CONCLUSION: hematological and biochemical values of splenic effluent blood are higher than those found in peripheral blood in the presence of schistosomal splenomegaly. However, the splenic blood effluent is not sufficient to raise the blood levels found after splenectomy.

Idiopathic pulmonary hemosiderosis with cystic lesions: A rare presentation

This report describes a case of a 49-year-old man with cough, recurrent hemoptysis, and dyspnea during 18 months, presenting with radiological findings of alveolar infiltrate and cystic lesions in left upper lobe. Laboratory studies revealed normocytic hypochromic anemia and normal coagulation tests. C-reactive protein and mucoproteins were negative. Serum protein electrophoresis and complement, urinalysis, serum creatinine, creatinine clearance, and 24-hour urine protein were normal. Tests for antineutrophil cytoplasmic antibodies and anti-glomerular-basement membrane antibodies were negative. Tests for connective tissue diseases were all negative. Histological findings were consistent with those of idiopathic pulmonary hemosiderosis. Radiological findings are discussed.

Avaliação do desempenho dos reagentes do tempo de tromboplastina parcial ativada utilizados para detectar o anticoagulante lúpico

INTRODUÇÃO: O anticoagulante lúpico é uma imunoglobulina pertencente à família dos anticorpos antifosfolípides. A sua ação in vitro é interferir nos testes de coagulação dependentes de fosfolípides. O tempo de tromboplastina parcial ativada (TTPA) é um teste utilizado como screening na pesquisa do anticoagulante lúpico. Os reagentes utilizados neste teste apresentam grandes variações quanto à sensibilidade. OBJETIVO: Avaliar o desempenho dos reagentes do TTPA e detectar a presença do anticoagulante lúpico através de diferentes testes da coagulação. MATERIAL E MÉTODO: A pesquisa do anticoagulante lúpico foi realizada em 50 amostras plasmáticas de pacientes do sexo feminino através dos testes do TTPA, do tempo de coagulação do caulim (TCC), do tempo de tromboplastina parcial ativada diluída (TTPAd) e do tempo do veneno da víbora de Russel diluído (TVVRd). Três cefalinas comerciais foram avaliadas pelos testes do TTPA e do TTPAd. Na comparação entre os reagentes estudados foi aplicado o cálculo do intervalo de confiança (95%). RESULTADOS: Os três reagentes avaliados apresentaram boa concordância e os métodos utilizados responderam bem à pesquisa do anticoagulante lúpico. DISCUSSÃO E CONCLUSÃO: As três cefalinas comerciais avaliadas podem ser utilizadas na rotina laboratorial para a pesquisa do anticoagulante lúpico.

Avaliação do pool de plasma caseiro como controle normal para o tempo de tromboplastina parcial ativada (TTP)

INTRODUÇÃO: A utilização correta de um plasma-controle para a comparação com o plasma do paciente nos testes de coagulação é fundamental para a garantia de um resultado seguro dessas provas laboratoriais. OBJETIVO: O presente estudo analisou a viabilidade do uso de um pool de plasma caseiro, realizado com cinco (P5) e 20 (P20) amostras a partir de pacientes normais, para ser utilizado como controle normal do tempo de tromboplastina parcial (TTP). MATERIAL E MÉTODO: Os dois pools de plasma caseiro foram analisados em relação a um controle normal comercial (AP). Foram 10 dias de experimento e a cada dia os dois pools caseiro eram feitos. Para cada dia foi feito o TTP de P5, P20 e AP. Todos os pacientes com solicitação de TTP, em cada dia do experimento, tiveram a relação de tempos (R) determinada frente a P5, P20 e AP. As ferramentas estatísticas utilizadas foram média (X), análise de variância e teste de Tukey. RESULTADOS: A análise estatística demonstrou que os valores de TTP são significativamente diferentes entre AP e P5 e entre AP e P20, mas não há diferença significativa entre P5 e P20. Quando a relação de tempos foi analisada, não houve diferença significativa entre AP, P5 e P20. CONCLUSÃO: O estudo demonstrou que pode ser utilizado como controle normal um pool de plasma caseiro, feito a partir de cinco ou 20 amostras.

Effect of different glycosaminoglycans in a guinea-pig carotid-artery thrombosis model

Heparin is the most frequently used drug for the prevention and treatment of thrombosis. Its use, however, is restricted by its side-effects. To study the efficacy of other glycosaminoglycans that could substitute heparin in the management of arterial thrombosis, 60 guinea-pigs were randomly allocated into 6 groups: G1= control, G2= heparin (150 IU/kg), G3= heparan sulfate from beef pancreas (2.5 mg/kg), G4= heparan sulfate from beef lung (2.5 mg/kg), G5= N-acetylated heparan from beef pancreas, G6= dermatan sulfate from beef intestine (2.5 mg/kg). Ten minutes after intravenous injection of the drugs, thrombosis was induced by the injection of a 50% glucose solution into a segment of the right carotid artery isolated between 2 thread loops during 10 minutes. Three hours later the artery was re-exposed and if a thrombus was present it was measured, withdrawn and weighed. Thrombin time and activated partial thromboplastin time were measured in all animals. Thrombus developed in 90% of the animals in the control group, 0% in G2 and G3, 62.5% in G4, 87.5% in G5 and G6. Only in the animals treated with heparin the coagulation tests were prolonged. In conclusion, in the used dose only the heparan sulfate from beef pancreas presented an antithrombotic effect similar to heparin in this experimental model.

Sulfonation and anticoagulant activity of botryosphaeran from Botryosphaeria rhodina MAMB-05 grown on fructose

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Sulfonation and anticoagulant activity of fungal exocellular β-(1→6)-d-glucan (lasiodiplodan)

An exocellular β-(1→6)-d-glucan (lasiodiplodan) produced by a strain of Lasiodiplodia theobromae (MMLR) grown on sucrose was derivatized by sulfonation to promote anticoagulant activity. The structural features of the sulfonated β-(1→6)-d-glucan were investigated by UV-vis, FT-IR and 13C NMR spectroscopy, and the anticoagulant activity was investigated by the classical coagulation assays APTT, PT and TT using heparin as standard. The content of sulfur and degree of substitution of the sulfonated glucan was 11.73% and 0.95, respectively. UV spectroscopy showed a band at 261 nm due to the unsaturated bond formed in the sulfonation reaction. Results of FT-IR and 13C NMR indicated that sulfonyl groups were inserted on the polysaccharide. The sulfonated β-(1→6)-d-glucan presented anticoagulant activity as demonstrated by the increase in dose dependence of APTT and TT, and these actions most likely occurred because of the inserted sulfonate groups on the polysaccharide. The lasiodiplodan did not inhibit the coagulation tests. © 2012 Elsevier Ltd.

Perfil hematológico, hemostático e terapêutico da intoxicação experimental

Pós-graduação em Medicina Veterinária - FMVZ

Malária no Pará: estudo do quadro clínico e laboratorial nas infecções causadas pelo Plasmodium vivax, na atualidade

A malária é considerada pela Organização Mundial de Saúde (OMS) como o maior problema de Saúde Pública na atualidade e os estudos produzidos mais recentemente, apontam para algumas mudanças em termos clínicos e padrões laboratoriais. Com o objetivo de detectar essas mudanças, foram estudadas as manifestações clínicas e laboratoriais da infecção malárica causada pelo Plasmodium vivax. O estudo caracterizou-se por ser longitudinal e prospectivo, tendo sido realizado no Instituto Evandro Chagas (IEC), na cidade de Belém, no período de novembro de 2001 a junho de 2002. A metodologia utilizada constou de diagnóstico pelo exame da gota espessa e por acompanhamento clínico e laboratorial de pacientes portadores de malária por P. vivax, durante todo o tratamento. Foram avaliados 127 pacientes nos aspectos epidemiológico, clínico e laboratorial, incluindo sexo, cor, profissão, procedência da infecção, período de incubação e persistência de cefaléia, calafrios e febre, além de outros sintomas ao final do tratamento. A avaliação laboratorial inclui densidade parasitária e exames relacionados à coagulação sangüínea, além de hemograma completo, aminotransferases, bilirrubinas, fosfatase alcalina, uréia e creatinina séricas. Dados do presente estudo demonstram uma ocorrência maior de casos entre estudantes e donas de casa como o perfil epidemiológico relacionado ao tipo de ocupação dos doentes portadores de malária atendidos em área urbana. O presente ensaio corrobora estudos anteriores relativos à ação esquizonticida da cloroquina em um tempo médio de 48 à 72 horas e revela significativa plaquetopenia até hoje não muito estudada em malária por P. vivax, e apesar deste achado, as provas de coagulação sangüíneas não mostraram alterações significantes. A palidez cutâneo-mucosa em D7 foi observada em 124 dos 127 pacientes estudados, embora este dado não tenha obrigatoriamente correlação com o achado de anemia.

The Rapid TEG α-Angle may be a sensitive predictor of transfusion in moderately injured blunt trauma patients

Background. To guide the administration of blood products, coagulation screening of trauma patients should be fast and accurate. The purpose of this study was to identify the correlation between CCT and TEG in trauma, to determine which CCT or TEG parameter is most sensitive in predicting transfusion in trauma, and to define TEG cut-off points for trauma care. Methods. A six-month, prospective observational study of 76 adult patients with suspected multiple injuries was conducted at a Level 1 trauma centre of a university hospital. Physicians blinded to TEG results made the decision to transfuse based on clinical evaluation. Results. The study results showed that conventional coagulation tests correlate moderately with Rapid TEG parameters (R: 0.44–0.61). Kaolin and Rapid TEG were more sensitive than CCTs, and the Rapid TEG α-Angle was identified as the single parameter with the greatest sensitivity (84%) and validity (77%) at a cut-off of 74.7 degrees. When the Rapid TEG α-Angle was combined with heart rate >75 bpm, or haematocrit < 41%, sensitivity (84%, 88%) and specificity (75%, 73%) were improved. Conclusion. Cutoff points for transfusion can be determined with the Rapid TEG α-Angle and can provide better sensitivity than CCTs, but a larger study population is needed to reproduce this finding.

Can RapidTEG accelerate the search for coagulopathies in the patient with multiple injuries?

Hypothesis: Early recognition of coagulopathy may improve the care of patients with multiple injuries. Rapid thrombelastography (RapidTEG) is a new variant of thrombelastography (TEG), in which coagulation is initiated by the addition of protein tissue factor. The kinetics of coagulation and the times of measurement were compared for two variants of TEG--RapidTEG and conventional TEG, in which coagulation was initiated with kaolin. The measurements were performed on blood samples from 20 patients with multiple injuries. The RapidTEG results were also compared with conventional measurements of blood coagulation. The mean time for the RapidTEG test was 19.2 +/- 3.1 minutes (mean +/- SD), in comparison with 29.9 +/- 4.3 minutes for kaolin TEG and 34.1 +/- 14.5 minutes for conventional coagulation tests. The mean time for the RapidTEG test was 30.8 +/- 5.72 minutes, in comparison with 41.5 +/- 5.66 minutes for kaolin TEG and 64.9 +/- 18.8 for conventional coagulation tests---measured from admission of the patients to the resuscitation bay until the results were available. There were significant correlations between the RapidTEG results and those from kaolin TEG and conventional coagulation tests. RapidTEG is the most rapid available test for providing reliable information on coagulopathy in patients with multiple injuries. This has implications for improving patient care.

Estudo levantamento das anomalias da coagulação em leites individuais de vacas leiteiras da Ilha Terceira

Dissertação de Mestrado, Tecnologia e Segurança Alimentar, 4 de Abril de 2016, Universidade dos Açores.

Clínica de animais de companhia

O presente relatório apresenta as atividades desenvolvidas no estágio decorrido no Hospital Ars Veterinaria. A primeira parte do relatório refere-se ao relatório de casuística com apresentação de casos e procedimentos acompanhados. A segunda refere-se à monografia com o tema “Opções terapêuticas em hemangiossarcoma canino” e encontra-se ilustrada por três casos clínicos. O hemangiossarcoma é uma neoplasia descrita com origem endotelial, devido à aparência histológica, no entanto descobertas recentes sugerem que provém de células progenitoras hematopoiéticas. Os sinais clínicos são inespecíficos e variáveis. A localização mais comum é o baço, embora ocorra noutras localizações. O diagnóstico requer o estadiamento tumoral e para ser completo deve incluir hematologia e bioquímica sérica, provas de coagulação, exames imagiológicos e confirmação histopatológica. O tratamento base é cirúrgico associado a protocolos quimioterápicos baseados em doxorrubicina. Novas terapias começam a ser investigadas de forma a melhorar os tempos de sobrevivência desta neoplasia de prognóstico reservado; Abstract: Small animal medicine This report was elaborated following a traineeship at the Ars Veterinaria Hospital. The first part concerns about cases report and includes presentation of cases and followed procedures. The second part is the monography under the theme “therapeutical options in canine hemangiosarcoma” and it presents three clinical cases seen during the internship. The hemangiossarcoma is a cancer described to have endothelial origin, because of its histological appearance, but recent discoveries suggest that it originates from hematopoietic progenitor cells. The clinical signs are variable and unspecific. The most common location is the spleen, but others might exist. The diagnosis demands tumoral staging, which to be complete must include hematology and biochemical analysis, coagulation tests, imagiologic tests and histopathologic confirmation. The basic treatment is surgical, associated with chemotherapy based on doxorubicin. New therapies are beginning to be investigated, aiming improve survival times of this cancer with reserved prognosis.