Anesthetic management of 52 deliveries in parturients with idiopathic thrombocytopenic purpura

Objectives

To study the anesthetic management of parturients with idiopathic thrombocytopenic purpura (ITP) which is a frequent cause of thrombocytopenia in pregnant women and may lead to a dilemma since a low platelet count usually dictates not to perform epidural anesthesia.

Materials and methods

We report a retrospective study assessing the anesthetic management of 39 parturients with ITP corresponding to 52 deliveries found in a database of 10,203 deliveries over a 52-month-period.

Results

On the day of delivery, 32 parturients (61.5%) had a platelet count less than 100,000/mm³ and 19 (36.5%) received a neuraxial block. Six parturients with a platelet count less than 100,000 mm³ (19%) received neuraxial analgesia. The lowest platelet count among women who received epidural analgesia was 88,000/mm³. No anesthetic or neurological complication occurred.

Conclusion

Regional anesthesia should not necessary be withheld in ITP when the platelet count is less than 100,000/mm³.     

Nadroparin-induced skin necrosis then thrombocytosis in intensive care unit: difficulty in diagnosis

Skin necrosis is a rare complication in intensive care unit. A case-report of nadroparine-induced skin necrosis and thrombocytosis in a patient with traumatic paraplegia is reported. This case emphasised the difficulty in diagnosis despite absence of thrombopenia. A skin necrosis could suggest the diagnosis and a substitutive therapy must be administrated after heparin therapy withdrawal. A thrombocytosis is a little reported complication of low-molecular-weight heparins without complication.     

La transfusion et ses problématiques particulières en pédiatrie et néonatologie

Principles of transfusion strategy have been used for neonates and children similar to adults. However, due to substantial discrepancies between physiology/pathology in children and in their adult counterparts, decisions, indications, and doses are different from those of adults, especially in neonates. Specific data and practice guidelines for blood product transfusion are reported owing to the experience of pediatrics and neonatology units and partners of the French Blood product bank.     

Efficacité thérapeutique de l’autologous conditioned plasma (ACP™) : analyse de sa composition cellulaire et revue de la littérature

Purpose

To analyze the platelet counts of autologous conditioned plasma (ACP™) in a group of patients compared to that of whole blood and to determine the value of ACP™ based on a literature review.

Methods

In 2011, a prospective study was performed in a continuous series of patients presenting with chronic tendinopathies. Three 9 μL venous blood samples were obtained from each patient: the first to perform a full blood count and the second and third to prepare two doses of ACP™, one which was injected into the patient and the other which underwent biological testing. A bibliographic search was performed on PubMed with the key words “autologous conditioned plasma”. All studies both clinical and experimental, in English and in French, were included.

Results

The series included 14 male patients mean age 39 ± 14 years. The mean platelet count was 230,538.5 ± 23,663/μL in whole blood and 377,153.8 ± 69,169.9/μL in ACP™, P = 0.00015. The mean “ACP™ platelet count/whole blood platelet count” ratio was 1.64 ± 0.30. The number of red and white blood cells was below the detection thresholds. The systematic review identified eight studies: three in animals and five in human of which two clinical studies.

Conclusion

The preparation technique for ACP™ was rapid and easy to use. ACP™ had a platelet count that was significantly higher than that of whole blood and did not contain any red or white blood cells. The review of the literature did not clearly confirm the therapeutic efficacy of ACP™. Randomized clinical studies comparing ACP™ to placebo are needed.

Level of evidence

IV.     

Régression de sténoses intracrâniennes vertébrobasilaires symptomatiques sous corticothérapie au cours d’une maladie de Horton

Introduction

Involvement of intracranial arteries in giant cell arteritis is a rare condition but often carries a fatal prognosis. Corticosteroids seem to be insufficient to avoid ischemic cerebral complications, and could even promote the occurrence of stroke. We report the case of a patient with giant cell arteritis who experienced recurrent cerebellar stroke caused by intracranial vertebrobasilar stenoses with a favorable outcome following treatment.

Case report

A 77-year-old woman presented with a 3-month history of impaired general condition. She had new-onset headaches, jaw claudication and transient vertigo, especially when she woke-up. The brain MRI showed a recent cerebellar infarction. One week later, she was hospitalized for a clinical deterioration related to a recurrent cerebellar stroke caused by intracranial vertebro-basilar stenoses. Giant cell arteritis was confirmed on the temporal artery biopsy. A treatment with high-dose oral corticosteroids was begun associated with an intensive antiplatelet therapy. The clinical outcome was favorable with rapid improvement of gait imbalance together with a complete radiological regression of the intracranial stenoses.

Conclusion

Ischemic stroke in giant cell intracranial arteritis is a severe condition without a well-defined treatment. Corticosteroid therapy improves intracranial stenoses caused by vasculitis but should be initially associated with an intensive antithrombotic therapy to avoid early recurrence of cerebral infarcts.     

Antithrombotic strategies in elderly patients with acute coronary syndrome

Central illustration. Anti-thrombotic strategies in patients with acute coronary syndrome. ACS: acute coronary syndrome; ADP: adenosine diphosphate; CAD: coronary artery disease; CRP: C-reactive protein; IL-6; interleukin-6; DAPT: dual antiplatelet therapy; GRACE: Global Registry of Acute Coronary Events; NSTEMI: non-ST-segment elevation myocardial infarction; PAI-1: plasminogen activator inhibitor-1; PCI: percutaneous coronary intervention; PG12: prostaglandin 12; PPI: proton pump inhibitor; PRECISE-DAPT: PREdicting bleeding Complications in patients undergoing stent Implantation and SubsequEnt Dual AntiPlatelet Therapy; REACH: REduction of Atherothrombosis for Continued Health; STEMI: ST-segment elevation myocardial infarction; TIMI: Thrombolysis In Myocardial Infarction; Vwf: von Willebrand factor.