晚期妊娠合并血小板减少50例临床分析

目的探讨晚期妊娠合并血小板减少的原因及围生期处理。方法对潍坊市妇幼保健院在2001年6月至2008年8月收治的50例晚期妊娠合并血小板减少患者的临床资料进行回顾性分析。结果晚期妊娠合并血小板减少的主要原因包括妊娠相关性血小板减少,特发性血小板减少性紫癜和妊娠期高血压疾病。在治疗原发病的基础上,血小板计数<50×109/L的患者分娩前应用糖皮质激素,术前或分娩期输新鲜血小板和新鲜冰冻血浆。50例中31例经阴分娩,19例剖宫产;产后出血15例,新生儿颅内出血3例。结论晚期妊娠合并血小板减少病因主要为妊娠合并血小板减少和特发性血小板减少性紫癜。在针对病因治疗的基础上,糖皮质激素及血小板制剂是治疗晚期妊娠合并血小板减少的有效手段。     

The treatment of venous thromboembolism in special populations

Anticoagulant therapy for the typical venous thromboembolism patient is straightforward with predictably favorable outcomes. However, for certain patients with venous thromboembolism, there remains uncertainty and controversy about optimal treatment. These controversial areas include venous thromboembolism patients with: heparin resistance, renal insufficiency, morbid obesity, cancer, antiphospholipid antibody syndrome, recurrent thrombosis despite appropriate anticoagulation, and patients with unprovoked VTE who may or may not benefit from thrombophilia testing. This review summarizes the current data for these special patient populations with venous thromboembolism and provides our recommendations for management.     

血液病相关颅内出血的临床和影像学特点分析

 目的　分析血液病相关颅内出血（ICH）的临床和影像学特点,提高临床医师的认识。方法　1998年1月至2010年5月发生的与原发血液病相关的ICH病例31例,回顾性分析其基础疾病、临床和影像学表现以及导致死亡的危险因素。结果　发生ICH的血液病以急性髓细胞白血病（AML）、特发性血小板减少性紫癜（ITP）多见,分别为13例和6例,多表现为头痛、烦躁、恶性呕吐和意识障碍,缺乏定位体征,影像学表现以渗血为主,CT与MRI诊断的符合率为60 %（3／5）,头颅MRI的ICH检出率高于CT。总病死率为71 %（22／31）,发热、白细胞＞5×109／L、血小板＜50×109／L、免疫球蛋白增高、凝血功能异常、全身多部位出血等是ICH的危险因素,具备≥2个危险因素者病死率为86.4 %（19／22）,显著高于有≤1个危险因素的患者病死率[33.3 %（3／9）]（χ2＝8.718,P＝0.003）。结论　血液病相关ICH是威胁患者生命的严重并发症,头颅MRI有助于提高血液病相关ICH诊断率,发热、白细胞＞5×109／L、血小板＜50×109／L、免疫球蛋白增高、凝血功能异常等多种危险因素并存可导致血液病ICH患者死亡率增加。     

Corticosteroids in the treatment of dengue illness

Dengue infection results in significant morbidity and mortality worldwide. Current recommended treatment is largely supportive with careful fluid replacement, with no specific treatment available. Although corticosteroids are not mentioned in the WHO guidelines on the management of dengue, clinicians use corticosteroids empirically based on the presumed immunological basis of the complications of dengue. The evidence base for the benefit or lack of benefit of corticosteroids in dengue is limited; previous studies have been small, with methodological flaws, less stringent randomisation and unclear allocation concealment, and were performed a long time ago. Studies so far have only been in patients with shock syndrome, and the possible effects of corticosteroids on thrombocytopenia and bleeding as well as other complications of dengue are unknown. All previous studies have been in children; the effect of corticosteroid treatment in adults with dengue infection has not been evaluated. The possible beneficial effects of corticosteroids on the various manifestations of dengue infection need evaluation by adequately powered, well designed, randomised controlled trials.     

妊娠自然流产合并血小板减少及其免疫相关性疾病分析

目的探讨妊娠期合并血小板减少以及妊娠合并血小板减少中发生自然流产与妊娠相关免疫疾病的关系。方法对55例妊娠期后血小板减少的孕妇进行回顾性分析。结果妊娠后血小板减少患者中心磷脂抗体（ACA）阳性和妊娠相关性血小板减少（PAT）占主要部分。55例患者中自然流产率为40％,PAT组与合并免疫相关疾病组的自然流产率没有统计学差异。结论妊娠期的免疫异常可能是导致妊娠期血小板下降及自然流产的根本原因。     

不同原因血小板减少症TPO检测及意义

目的研究不同原因血小板减少症患者血清血小板生成素（TP0）的变化及临床意义。方法对114例患者分为ITP组、血液肿瘤组、其他血液病和实体肿瘤组4个小组,应用双抗夹心ABC--ELISA法测定TP0,并进行星光分析。结果ITP组、血液肿瘤组、其他血液病和实体肿瘤组的血清TPO水平分别为129。54±78．84pg／ml、100．25±69．75pg／ml、175．58±107．29pg／ml和157．50±109．44pg／ml;对照组则为149．59±71．55pg／ml。血液肿瘤组TP0水平明显低于对照组（P〈0．05）,其他血液病组则高于对照组（P〈0．05）。ITP组和实体肿瘤组则与对照组比较无统计学意义（P〉0．05）。结论不同原因血小板减少症患者血清TP0水平不相一致,可能与引起血小板减少的机制不同有关。检测血小板减少症患者血清TP0水平对鉴别诊断和临床治疗有指导意义。     

1例卡马西平致白细胞、血小板减少及肝功能损害患者的药学实践

目的 通过参与1例卡马西平致白细胞、血小板减少及肝功能损害治疗全过程,探讨临床药师发挥的作用。方法 对临床药师参与1例卡马西平致白细胞、血小板减少及肝功能损害治疗过程的分析,用药调整,为患者提供个体化药学监护。结果 临床药师建议得到采纳,患者经过系统性治疗及个体化的药学监护,其白细胞、血小板水平、肝脏功能恢复正常,获得满意的临床治疗效果。结论 临床药师非常有必要对使用卡马西平的患者开展药学监护工作,保障用药安全。     

ORIGINAL ARTICLE: Role of mean platelet volume as discriminating guide for bone marrow disease in patients with thrombocytopenia

Recently, platelet indices have been evaluated to determine their utility in knowing the mechanism of thrombocytopenia. This study was conducted to analyze the role of mean platelet volume (MPV) as a guide or an indicator for bone marrow disease in thrombocytopenic patients. All the patients with thrombocytopenia for various causes followed by bone marrow examination were divided into two groups, one group with and another without bone marrow disease, depending on pathophysiology. The MPV was statistically analyzed in both the groups to assess its role as guide for bone marrow disease in these patients. Mean MPV (average score of all individual mean values in patients) in the group with bone marrow disease was 7.3 fl, while in the group without bone marrow disease, it was 8.62 fl. Although the difference in MPV in the two groups of with (including megaloblastic anemia) and without bone marrow involvement was statistically significant (P value <0.001), its sensitivity and specificity scores as observed by receptor operating characteristic (ROC) curve at cut-off of <8.15 fl were not highly sufficient (67.7% sensitive and 65% specific). The study concluded that although MPV can be used as an initial hint for bone marrow disease in thrombocytopenic patients, it has limited sensitivity and specificity. The differentiation of megaloblastic anemia from other causes of pancytopenia involving the marrow requires bone marrow examination rather than using MPV as an indicator. Bone marrow examination remains the gold standard for discriminating hypoproductive type of thrombocytopenia from the hyperdestructive one. In addition, the role of other platelet indices should also be assessed further to know a better indicator for bone marrow involvement in thrombocytopenic patients.     

Intracerebral hemorrhage secondary to thrombocytopenia in a patient treated with temozolomide

Thrombocytopenia related intracerebral hemorrhage (ICH) secondary to chemotherapy induced myelosuppression can be very difficult to manage and may result in the death of the patient. We present the case of a 26-year-old male suffering a fatal ICH in the context of treatment of a high grade glioma with temozolomide. The clinician should be aware that a dose dependent severe and possible irreversible myelotoxicity can occur with temozolomide treatment resulting in substantial morbidity.     

Envenoming by the viperid snake Proatheris superciliaris: A case report

Snake bites caused by viperid snakes of Atheris genus are extremely rare, envenoming of a bite of related viper Proatheris superciliaris was described only once in the literature. The present case study depicts the envenoming of a 57 years old Czech man, a private herpetologist, who was bitten to his finger. He developed painful local reaction, nausea, hematuria, hypertension, chest and lumbar pain. Coagulopathy and thrombocytopenia subsequently developed as well as acute renal failure, hepatic and lung lesion. Intensive care therapy was purely symptomatic and supportive as no antisera exists. Treatment included haemodialysis, substitution of fresh frozen plasma and platelets. Patient completely recovered during 1 month.