Demographics of canine immune-mediated haemolytic anaemia in the Southeastern United States

Detailed examination of the records of 57 dogs referred to our clinic with the diagnosis of immunemediated haemolytic anaemia was accomplished. Only untreated dogs or dogs who had only received supportive therapy were included in the study group comprising 30 male dogs and 27 female dogs. Age distribution followed the general age distribution of our patient population. There was no within-breed sex or age predilection. The youngest dog was 11 months of age and the oldest dog was 13 years of age. Overall mortality rate among the study population was 51% (29 dogs). Certain canine breeds were over-represented in this study and these same breeds had high mortality rates. Included were 11 cocker spaniels (19%; 82% mortality rate, 9 of 11 dogs), nine dogs with terrier in their name (16%; 78% mortality rate, 7 of 9 dogs), six German shepherds (11%; 50% mortality rate, 3 of 6 dogs), five doberman pinschers (9%; 60% mortality rate, 3 of 5 dogs), and five miniature schnauzers (9%; 60% mortality rate, 3 of 5 dogs). Immune-mediated haemolytic anaemia was considered secondary to hepatic disease in 16 dogs (28%), septicaemia in 10 dogs (18%) and neoplasia in six dogs (11%), i.e. signs and data supporting these processes were reported to have preceded anaemia. A total of 29 dogs (51%) also had thrombocytopenia (platelet counts less than 60000 cells/µl), eight (14%) dogs had major venous thrombosis, eight (14%) dogs had associated disseminated intravascular coagulation, and 24 (42%) of the dogs had evidence of renal disease — proteinuria and cylinduria. About 35% (20 dogs) of the patients were treated from June to August, and 63% (36 dogs) of the patients were direct antiglobulin positive (immunoglobulin G with or without complement). A variety of red cell morphological changes were observed including stomatocytes, bowl forms, knizocytes, schistocytes and spherocytes. Spherocytes were observed in 11 dogs (19%). Absolute reticulocytosis was observed in 26 dogs (46%). A variety of treatment combinations including glucocorticoids, azathioprine, cyclophosphamide, anabolic steroids, heparin, intravenous human gamma globulin, and blood component therapy were used without identifiable success associated with any given protocol.     

Vaginal metastasis and thrombocytopenia from renal cell carcinoma

BACKGROUND: Vaginal cancer represents approximately 1-2% of genital tract malignancies. Most cases represent metastasis from the cervix, endometrium, or colon. Metastasis of renal cell carcinoma to the vagina is extremely rare. CASE: A 58-year-old female presented with a bleeding vaginal lesion. Laboratory studies revealed severe thrombocytopenia, and radiological studies revealed a left renal mass; excision was consistent with metastatic renal cell carcinoma. A subsequent nephrectomy confirmed renal cell carcinoma. Postoperatively, the patient underwent immunotherapy and the thrombocytopenia resolved. CONCLUSION: We report the first case of metastatic renal cell carcinoma presenting as a vaginal metastasis with thrombocytopenia as a paraneoplastic manifestation. Renal cell carcinoma must be in the differential diagnosis of a clear cell neoplasm in a postmenopausal woman, particularly with systemic symptoms suggestive of a paraneoplastic syndrome.     

Anesthesia for obstetric patients with Gaucher disease: survey and review

Pregnancy and delivery in patients with non-neuronopathic Gaucher disease, whether treated with enzyme replacement or untreated, are usually uncomplicated. Various factors may influence mode of delivery, vaginal or cesarean section, as well as type of anesthesia, general or regional, used during delivery. This retrospective review was intended to highlight some of the practical issues relating to obstetric anesthetic management, based on a review of the literature and experiences from a large referral clinic for Gaucher disease. In the past decade, there were 16 deliveries in 11 women in our institution. There were five normal vaginal deliveries, two vacuum extractions, one placental extraction, and eight cesarean sections. Platelet counts were 27-215 x 10(9)/L. Two spontaneous deliveries and one vacuum extraction were performed under epidural anesthesia; two other women having vaginal deliveries and one vacuum extraction were given i.v. analgesia; the fifth was given i.v. patient-controlled analgesia. The placental extraction was performed under general anesthesia. Seven of the women having cesarean deliveries received spinal anesthesia; the breech presentation required general anesthesia. There were no anesthesia-related side effects or complications, although there were some instances of post-partum bleeding irrespective of enzyme therapy. Gaucher disease affects multiple organs and can be a challenge to the anesthesiologist. Based on this survey we suggest that anesthetic management requires particular attention to hematological parameters before delivery. A multidisciplinary approach and extensive communication among obstetrician, hematologist and anesthesiologist is required to anticipate the possibility of post-partum hemorrhage, and preclude skeletal damage.     

Platelet therapy

Thrombocytopenia is a major cause of bleeding episodes at all ages. The pathophysiology, causes of thrombocytopenia and clinical presentation have been reviewed briefly. However the emphasis has been laid on various aspects of platelet support such as indications and amount of platelet support essential for management of bleeding episodes with the help of platelet concentrates, single donor platelets. Strategies for management of platelet transfusion refractoriness has also been included for effective management of bleeding episodes in these conditions.     

重组人白细胞介素-11预防化疗所致血小板减少的临床研究

目的　评价国产重组人白细胞介素 11(rhIL 11)预防肿瘤化疗患者血小板减少的疗效及不良反应。方法　采用随机双盲自身交叉对照研究方法 ,将试验药品和安慰剂分为A药和B药 ,入选患者随机分为AB组或BA组。在化疗结束后 2 4h开始用药 ,2 5 μg kg体重 ,皮下注射 ,每日 1次 ,连续用药 7～ 14d或至血小板计数≥ 30 0× 10 9 L。结果　有 118例可评价疗效。rhIL 11可显著升高化疗后血小板最低值和化疗第 2 1天血小板值 ,升高幅度分别达 6 0 .7%和 86 .1% (P <0 .0 0 1) ;治疗周期出现血小板减少 (<10 0× 10 9 L)的持续时间为 1.0± 2 .0d ,而对照周期为 6 .9± 5 .4d。主要不良反应为注射部位疼痛 (2 4 .6 % )、红肿 (16 .1% )、硬结 (11.9% )、结膜充血 (16 .1% )、水肿 (8.5 % )、心悸(6 .8% )、乏力 (5 .1% )等 ,大都程度较轻 ,无其他严重不良反应。结论　rhIL 11具有明显的促血小板生成作用 ,可显著减少肿瘤患者化疗后血小板减少的发生 ,缩短血小板减少的持续时间。不良反应较轻且较易处理。     

血小板减少症患者血清血小板生成素的测定

目的探讨血小板减少症患者血清血小板生成素（thrombopoietin，TPO）水平及其与外周血小板计数（platelet counts，PLT）之间的关系。方法采用ELISA法检测55例不同病因血小板减少症患者血清TPO水平，同时用自动血细胞仪测定其PLT，以20例健康人为正常对照。结果原发性血小板减少性紫癜（ITP）较正常对照组血清TPO略低，但差异无显著性（P〉0．05）；再生障碍性贫血（AA）、急性白血病（AL）患者血清TPO水平较正常对照组升高，且与PLT呈负相关。结论不同病因的血小板减少症血清TPO水平不同，PLT是TPO水平重要的反馈调节因素之一。TPO的检测有助于临时鉴别血小板减少症的病因及指导治疗。     

Acute lymphoblastic leukemia presenting with gross hematuria

A case of a six-year-old boy presenting with gross hematuria is reported. Investigations revealed the etiology of the hematuria to be thrombocytopenia in the setting of newly diagnosed acute lymphoblastic leukemia. The diagnosis of leukemia was confirmed by bone marrow examination. The patient’s hematuria completely resolved with platelet transfusions. Although thrombocytopenia is a very common presenting feature of acute lymphoblastic leukemia, gross hematuria is exceedingly rare. Thus, thrombocytopenia potentially caused by acute leukemia should be considered in a child presenting with gross hematuria.     

Spontaneous intracerebral hemorrhage in critically ill patients: incidence over six years and associated factors

Objective: Intracerebral hemorrhage (ICH) is associated with a high mortality. The present study sought to determine the incidence of spontaneous ICH in an intensive care unit (ICU) and associated factors. Design: A 6 year retrospective study. Setting: A general ICU in a university hospital. Patients: All ICU patients developing ICH were included in the study. All trauma and neurosurgical patients were excluded, as well as patients who were admitted to the ICU because of ICH. Measurements and results: During the study period 3032 patients were hospitalized in the ICU, and 834 were excluded. The remaining 2198 patients comprised the study population. Computed tomography of the head was performed in a total of 227 patients, and the 9 patients found to have new onset ICH comprise the group of interest. None of these patients were hypertensive. Seven of the patients had either a primary hematologic malignancy or bone marrow transplantation. Eight had thrombocytopenia of < 100 × 10⁹/l (median 10 × 10⁹/l, range 3–150 × 10⁹/l), and in 6 it preceded ICH by 5 days or more. Only in one patient were both PTT and PT prolonged. All were mechanically ventilated with high peak inspiratory pressure (PIP) (median 37 cmH₂O, range 20–43 cmH₂O). Arterial carbon dioxide tension (PaCO₂) was considerably elevated (median 65 mmHg, range 41–87 mmHg). All of the patients had impaired renal and hepatic function (urea: median 14 mmol/l, range 9.9–52 mmol/l; bilirubin: median 94 μ mol/l, range 20–360 μ mol/l), and five had septicemia. Eight of the patients bled to other sites before they developed ICH. All patients died shortly after the diagnosis of ICH. Conclusions: Spontaneous nonhypertensive ICH is a rare, fatal event in the ICU. Associated factors include thrombocytopenia, the need for mechanical ventilation, elevated PIP and PaCO₂, sepsis, and impaired hepatic and renal function. Received: 5 March 1998 Final revision received: 10 August 1998 Accepted: 12 October 1998     

全髋置换术合并血小板减少的处理 (附29例报告)

目的探讨血小板减少对全髋置换术的影响及其处理方法.方法分析1997年10月～2001年10月施行的合并血小板减少的全髋置换术29例.结果血小板减少患者术后Harris评分提高,与血小板正常患者相似,但输血量同正常组比较有显著性差异.血小板计数80～99×109/L组同50～79×109/L组间无明显差异,＜50×109/L组同50～79×109/L组间输血量、输血小板量有显著性差异,＜50×109/L组同80～99×109/L组间输血量有显著性差异.结论血小板减少对患者的功能恢复无明显影响,但血小板计数＜50×109/L患者所需输血和血小板量明显增加,只要术中做好足够的血小板支持,该类患者完全能够渡过围手术期.