POST-TRANSFUSION PURPURA VS. HEPARIN-INDUCED THROMBOCYTOPENIA: DIFFERENTIAL DIAGNOSIS IN CLINICAL PRACTICE

Introduction Heparin-induced thrombocytopenia (HIT) is an acquired, prothrombotic disorder, caused by antibodies to a complex of heparin and platelet factor 4 (PF4) that activates platelets, resulting in the release of procoagulant microparticles, thrombocytopenia occurrence, generation of thrombin, and frequent thromboses. Case Outline We present a case of severe HIT in a 68-year-old female, which occurred after cardiosurgery of the left atrial myxoma with the aim to point out the importance of differential diagnosis of thrombocytopenia in patients recently exposed to heparin. Platelet count dropped on the eleventh postoperative day, six days after unfractioned heparin and enoxaparine treatment, to 4?109/l. The correct diagnosis failed to be made at first. Since thrombocytopenia remained refractory to a corticosteroid treatment and platelet transfusion, the patient was hospitalized on the 13th postoperative day at the Institute of Hematology. The diagnosis of HIT was confirmed with the high-probability clinical score (4T's) and strongly positive antiheparin-PF4 (PaGIA) test as well as positive platelet aggregation test. The treatment started with a smaller therapeutic doses of danaparoid than recommended of 750 U intravenous bolus and was followed by continuous infusions of 100 U per 1 h and intravenous gammaglobulins in full dosage for four days. The platelet count started to rise on the third day and it was completely normalized on the 5th day of the therapy. Conclusion Treatment of severe HIT with small doses of danaparoid supplemented by intravenous gamma globulin was successful. Additional awareness of heparin-induced thrombocytopenia is needed, especially of HIT in differential diagnosis of thrombocytopenia in patients recently exposed to heparin.

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Cardiac Outpouchings: Definitions, Differential Diagnosis, and Therapeutic Approach

Cardiology Research and Practice ◽

10.1155/2021/6792643 ◽

2021 ◽

Vol 2021 ◽

pp. 1-10

Author(s):

Riccardo Scagliola ◽

Gian Marco Rosa ◽

Sara Seitun

Keyword(s):

Differential Diagnosis ◽

Clinical Practice ◽

Therapeutic Approach ◽

Tissue Characterization ◽

Case Reports ◽

Case Series ◽

Diagnostic Challenge ◽

Comprehensive Overview ◽

Search Data ◽

Data Location

Background and Aims. Cardiac outpouchings encounter a series of distinct congenital or acquired entities (i.e. aneurysms, pseudoaneurysms, diverticula, and herniations), whose knowledge is still poorly widespread in clinical practice. This review aims to provide a comprehensive overview focusing on definition, differential diagnosis, and prognostic outcomes of cardiac outpouchings, as well as further insights on therapeutic options, in order to assist physicians in the most appropriate decision-making. Methods. The material reviewed was obtained by the following search engines: MEDLINE (PubMed), EMBASE, Google Scholar, and Clinical Trials databases, from January 1966 until March 2021. We searched for the following keywords (in title and/or abstract): (“cardiac” OR “heart”) AND (“outpouching” OR “outpouch” OR “aneurysm” OR “pseudoaneurysm” OR “false aneurysm” OR “diverticulum” OR “herniation”). Review articles, original articles, case series, and case reports with literature review were included in our search. Data from patients with congenital or acquired cardiac outpouchings, from prenatal to geriatric age range, were investigated. Results. Out of the 378 papers initially retrieved, 165 duplicates and 84 records in languages other than English were removed. Among the 129 remaining articles, 76 were included in our research material, on the basis of the following inclusion criteria: (a) papers pertaining to the research topic; (b) peer-reviewed articles; (c) using standardized diagnostic criteria; and (d) reporting raw prevalence data. Location, morphologic features, wall motion abnormalities, and tissue characterization were found to have a significant impact in recognition and differential diagnosis of cardiac outpouchings as well as to play a significant role in defining their natural history and prognostic outcomes. Conclusions. Careful recognition of cardiac outpouchings remains a diagnostic challenge in clinical practice. Due to a broad cluster of distinctive and heterogeneous entities, their knowledge and timely recognition play a pivotal role in order to provide the most appropriate clinical management and therapeutic approach.

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Tremorography in the clinical practice

Neuromuscular Diseases ◽

10.17650/2222-8721-2019-9-4-61-72 ◽

2020 ◽

Vol 9 (4) ◽

pp. 61-72

Author(s):

T. G. Govorova ◽

T. E. Popova ◽

A. A. Tappakhov

Keyword(s):

Differential Diagnosis ◽

Clinical Practice ◽

Movement Disorders ◽

Clinical Characteristics ◽

Objective Assessment ◽

Diagnostic Value ◽

Common Type ◽

Routine Practice ◽

Pathological Tremor

Tremor is the most common type of movement disorders. In practice this differential diagnosis of hyperkinesis is diagnosed clinically and the use of additional methods of objective assessment of tremor increases the accuracy of diagnosis. The use of paraclinical methods of objective assessment of tremor improves the accuracy of diagnosis. Comparison of the neurophysiological parameters of tremor with clinical characteristics has a high diagnostic value, which justifies its use in the routine practice of neurologists. The purpose of the review is to analysis basic electrophysiological characteristics of pathological tremor, as well as the presentation of the material of its own observation.

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Three “Red Lines” for Pattern Recognition-Based Differential Diagnosis Using Optical Coherence Tomography in Clinical Practice

Journal of Neuro-Ophthalmology ◽

10.1097/wno.0000000000001173 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Axel Petzold

Keyword(s):

Pattern Recognition ◽

Optical Coherence Tomography ◽

Differential Diagnosis ◽

Clinical Practice ◽

Optical Coherence

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Procalcitonin as a diagnostic marker of infections and inflammation

Diagnostyka Laboratoryjna ◽

10.5604/01.3001.0013.7712 ◽

2018 ◽

Vol 54 (3) ◽

pp. 179-184

Author(s):

Weronika Kolasińska ◽

Agnieszka Jankowska-Kulawy

Keyword(s):

Differential Diagnosis ◽

Clinical Practice ◽

Systemic Inflammatory Response Syndrome ◽

Inflammatory Response ◽

Viral Infections ◽

Diagnostic Marker ◽

Systemic Inflammatory Response ◽

Clinical Algorithms

Infections are quite common, especially in long-term hospitalized patients. Eearly differential diagnosis of severe bacterial and viral infections in patients in severe or critical condition is particularly important. Procalcitonin is a good and, above all, early marker of sepsis and generalized inflammatory states. 85% sensitivity and 91% specificity of this study were shown in the differentiation patients with systemic inflammatory response syndrome noninfectious and sepsis defined as a systemic inflammatory response syndrome induced by infection. The usage of procalcitonin assays in clinical algorithms may accelerate the diagnosis of infectious conditions, reduce the abuse of antibiotics and optimize therapy with these drugs. Therefore, the determination of procalcitonin concentration is increasingly used in clinical practice.

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Case 22

10.1093/med/9780190603434.003.0026 ◽

2018 ◽

Author(s):

Bashar Katirji

Keyword(s):

Differential Diagnosis ◽

Clinical Practice ◽

Nerve Conduction ◽

Nerve Conduction Studies ◽

Genetic Defects ◽

Neurological Manifestations ◽

Charcot Marie Tooth ◽

Charcot Marie Tooth Disease ◽

Inherited Neuropathy ◽

Tooth Disease

Charcot-Marie-Tooth disease is the most common inherited neuropathy encountered in clinical practice. The disorder encompasses a large number of subtypes; most share common neurological manifestations. Charcot-Marie-Tooth disease is often subdivided into many subtypes based on pathophysiological or inheritance patterns. There are demyelinating and axonal types, as well as dominant, recessive, or X-linked forms. This case presents a typical patient with Charcot-Marie-Tooth disease and highlights the neurological findings. This is followed by emphasis on the findings seen on nerve conduction studies showing the differences between the demyelinating, axonal, and intermediate types. A list of the known genetic defects described so far is presented. A working and practical differential diagnosis and algorithm is also suggested.

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