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91.
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。 相似文献
92.
Rajapakse S 《Transactions of the Royal Society of Tropical Medicine and Hygiene》2009,103(2):122-126
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. 相似文献
93.
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。 相似文献
94.
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。 相似文献
95.
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。 相似文献
96.
H. CHANDRA S. CHANDRA A. RAWAT S. K. VERMA 《International journal of laboratory hematology》2010,32(5):498-505
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. 相似文献
97.
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. 相似文献
98.
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. 相似文献
99.
Surgeons commonly use heparin as prophylaxis against post-operative venous thromboembolism. Heparin-induced thrombocytopenia and thrombosis syndrome (HITTS) is a rare but potentially fatal complication of heparin therapy. We describe a case of HITTS in a 49-year-old woman, after elective cholecystectomy, which resulted in a CVA. The purpose of this case report is to increase the awareness of this phenomenon among health care professionals involved in day-care surgery and to discuss its management. 相似文献
100.
目的:观察重组人白细胞介素鄄11(recombinatehumaninterleukin11熏rhIL鄄11)治疗化疗后血小板减少的疗效和毒性,以及用药后血小板变化的规律和特点。方法:20例(47周期)化疗后血小板减少患者接受rhIL鄄1125μg·kg-1·d-1皮下注射,平均用药6d,同一患者各周期的化疗方案及剂量强度相同。结果:第1、2周期化疗前血小板基础值分别为穴165.0±65.2雪×109/L和穴346.4±78.3雪×109/L;应用rhIL鄄11的天数分别为(7.0±5.7)d和(4.5±6.7)d;化疗后血小板计数小于50×109/L的平均持续天数分别为(5.0±3.6)d和(3.5±3.9)d;差异均有统计学意义。外周血血小板计数回升天数平均为4d,有12个周期血小板计数最高值大于400×109/L,血小板计数最高值出现在应用rhIL鄄11后(17.0±5.5)d;主要不良反应包括水肿、乏力、头晕头痛、肌肉关节疼痛。结论:rhIL鄄11能有效治疗化疗所致的血小板减少,血小板计数回升相对缓慢,作用持续时间较长,耐受性好。 相似文献