scholarly journals Outcome of Conservative Therapy in COVID-19 Patients Presenting with Gastrointestinal Bleeding

2020 ◽  
Author(s):  
Shalimar ◽  
Manas Vaishnav ◽  
Anshuman Elhence ◽  
Ramesh Kumar ◽  
Srikant Mohta ◽  
...  
Keyword(s):  
Management Strategies ◽  
Fresh Frozen Plasma ◽  
Response To Treatment ◽  
Gi Bleeding ◽  
Hypoxemic Respiratory Failure ◽  
Acute Hypoxemic Respiratory Failure ◽  
Packed Red Blood Cells ◽  
Initial Control ◽  
Fresh Frozen

Background/Objective: There is a paucity of data on the management of gastrointestinal (GI) bleeding in patients with COVID-19 amid concerns about the risk of transmission during endoscopic procedures. We aimed to study the outcomes of conservative treatment for GI bleeding in patients with COVID-19. Methods: In this retrospective analysis, 24 of 1342 (1.8%) patients with COVID-19, presenting with GI bleeding from 22 April to 22 July 2020, were included. Results: The mean age of patients was 45.8 (12.7) years; 17 (70.8%) were males; upper GI (UGI) bleeding: lower GI (LGI) 23:1. Twenty-two (91.6%) patients had evidence of cirrhosis- 21 presented with UGI bleeding while one had bleeding from hemorrhoids. Two patients without cirrhosis were presumed to have non-variceal bleeding. The medical therapy for UGI bleeding included vasoconstrictors- somatostatin in 17 (73.9%) and terlipressin in 4 (17.4%) patients. All patients with UGI bleeding received proton pump inhibitors and antibiotics. Packed red blood cells (PRBCs), fresh frozen plasma and platelets were transfused in 14 (60.9%), 3 (13.0%) and 3 (13.0%), respectively. The median PRBCs transfused was 1 (0-3) unit(s). The initial control of UGI bleeding was achieved in all 23 patients and none required an emergency endoscopy. At 5-day follow-up, none rebled or died. Two patients later rebled, one had intermittent bleed due to gastric antral vascular ectasia, while another had rebleed 19 days after discharge. Three (12.5%) cirrhosis patients succumbed to acute hypoxemic respiratory failure during hospital stay. Conclusion: Conservative management strategies including pharmacotherapy, restrictive transfusion strategy, and close hemodynamic monitoring can successfully manage GI bleeding in COVID-19 patients and reduce need for urgent endoscopy. The decision for proceeding with endoscopy should be taken by a multidisciplinary team after consideration of the patient's condition, response to treatment, resources and the risks involved, on a case to case basis.

Liver Failure in a Dog Following Suspected Ingestion of Blue-Green Algae (Microcystis spp.): A Case Report and Review of the Toxin

2013 ◽  
Vol 49 (5) ◽  
pp. 342-346 ◽  
Author(s):  
Lionel Sebbag ◽  
Nicole Smee ◽  
Deon van der Merwe ◽  
Dustin Schmid
Keyword(s):  
Green Algae ◽  
Acute Hepatic Failure ◽  
Fresh Frozen Plasma ◽  
Blue Green Algae ◽  
Fresh Frozen ◽  
Adenosyl Methionine ◽  
B Complex Vitamins ◽  
Time Of Admission ◽  
Frozen Plasma

A 2.5 yr old spayed female Weimaraner presented after ingestion of blue-green algae (Microcystis spp.). One day prior to presentation, the patient was swimming at a local lake known to be contaminated with high levels of blue-green algae that was responsible for deaths of several other dogs the same summer. The patient presented 24 hr after exposure with vomiting, inappetence, weakness, and lethargy. Blood work at the time of admission was consistent with acute hepatic failure, characteristic findings of intoxication by Microcystis spp. Diagnosis was suspected by analyzing a water sample from the location where the patient was swimming. Supportive care including fluids, fresh frozen plasma, whole blood, vitamin K, B complex vitamins, S-adenosyl methionine, and Silybum marianum were started. The patient was discharged on supportive medications, and follow-up blood work showed continued improvement. Ingestion is typically fatal for most patients. This is the first canine to be reported in the literature to survive treatment after known exposure.

Massive Transfusion

2018 ◽  
pp. 169-180
Author(s):  
Jay Berger
Keyword(s):  
Red Blood Cells ◽  
Blood Volume ◽  
Blood Cells ◽  
Massive Transfusion ◽  
Fresh Frozen Plasma ◽  
Metabolic Complications ◽  
Packed Red Blood Cells ◽  
Fresh Frozen ◽  
Life Threatening ◽  
Frozen Plasma

Massive transfusion is defined as transfusion of 3 units of packed red blood cells in less than 1 hour in an adult, replacement of more than 1 blood volume in 24 hours, or replacement of more than 50% of blood volume in 3 hours. Massive transfusion protocols are implemented in cases of life-threatening hemorrhage after trauma, during a surgical procedure, or during childbirth. These protocols are intended to minimize the adverse effects of hypovolemia, dilutional anemia, metabolic complications, and coagulopathy with early empiric replacement of blood products and transfusion of fresh frozen plasma, platelets, and packed red blood cells in a composition that approximates that of whole blood.

Primary Plasma Therapy For Thrombotic Thrombocytopenic Purpura

1981 ◽  
Author(s):  
D C Case
Keyword(s):  
Platelet Count ◽  
Blood Cells ◽  
Reticulocyte Count ◽  
Fresh Frozen Plasma ◽  
Red Cell ◽  
Peripheral Smear ◽  
Plasma Therapy ◽  
Packed Red Blood Cells ◽  
Fresh Frozen ◽  
Frozen Plasma

A 25-year old male was admitted for an episode of right sided headache and subsequent generalized seizure. On admission his temperature was 37.6°. He had generalized petechiae and conjunctival hemorrhages. Organomegaly and lymphadenopathy were absent. There was mild left sided weakness. The Hgb. was 6.9 g/dl., reticulocyte count 10%, WBC 11,500/mm3, and platelet count 10,000/mm3. There were numerous schistocytes on the peripheral smear; bone marrow revealed panhyperplasia. Coagulation studies were normal. The BUN was 30, and the creatinine 1.7 mg/dl. Plasma was positive for Hgb. CT scan was negative for gross intracranial bleeding. The diagnosis of T.T.P. was made. On admission, the patient received 10 units of platelets and 2 units of packed red blood cells. He did not require further red cell or platelet transfusions during the rest of his hospital course. He was then started on infusions of fresh-frozen plasma. He then received one unit every 3 hours for 6 days, one unit every 6 hours for 2 days, then one unit every 12 hours for 2 days and finally 1 unit daily for 5 days. The response was immediate. After the infusions were started, the hematologic parameters steadily improved. The patient’s hematuria rapidly improved. Further CNS symptoms did not appear. The patient’s Hgb. was 12 g/dl, and reticulocyte count was 2.5% by the 9th day. His platelet count was normal by the 4th day. The patient was discharged on the 15th day. Infusions of plasma were discontinued at the time of discharge. The patient required plasma therapy 4 weeks later for recurrent thrombocytopenia (50,000/mm3). The patient has remained normal for 9 months since therapy and further plasma has not been required. Primary plasma therapy for T.T.P. as sole treatment should be further studied.

Thrombocytopenia in dogs with anticoagulant rodenticide-induced hemorrhage: eight cases (1990-1995)

1997 ◽  
Vol 33 (5) ◽  
pp. 417-422 ◽  
Author(s):  
DC Lewis ◽  
DS Bruyette ◽  
DL Kellerman ◽  
SA Smith
Keyword(s):  
Differential Diagnosis ◽  
Platelet Count ◽  
Electrolyte Solutions ◽  
Fresh Frozen Plasma ◽  
Response To Treatment ◽  
Anticoagulant Rodenticide ◽  
Fresh Frozen ◽  
Frozen Plasma

Thrombocytopenia was documented in eight of 11 dogs with anticoagulant rodenticide-induced hemorrhage. Thrombocytopenia was transient and generally mild-to-moderate, but it became marked (i.e., less than 30,000 platelets/microl) in two cases. Petechial hemorrhages were not noted in any case. There was no relationship between hematocrit and platelet count. Platelet count changes in response to treatment with fresh-frozen plasma and isotonic electrolyte solutions were variable. Anticoagulant rodenticide toxicity should be included as a differential diagnosis for dogs with hemorrhage accompanied by mild-to-moderate thrombocytopenia.

Hemostasis with Erythropoietin in Massive, Uncontrollable, Diffuse GI Bleeding.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 4082-4082
Author(s):  
Veronica C. Zaharia ◽  
Daniel R. Zaharia
Keyword(s):  
Small Intestine ◽  
Protein S ◽  
Large Cell ◽  
Cell Interaction ◽  
Fresh Frozen Plasma ◽  
Gi Bleeding ◽  
Mesenteric Lymph Nodes ◽  
Packed Red Blood Cells ◽  
Hemostatic Factor ◽  
Uremic Patients

Abstract Purpose: Erythropoietin currently used as a hemopoietic agent, has remarkable hemostatic activity which can be lifesaving in diffuse, uncontrollable bleeding processes. Following is an example case report: Case presentation: 47 y/o male was admitted with massive GI bleeding and a Hemoglobin (Hg) of 6.7 mg/dl requiring transfusion of 26U Packed Red Blood Cells {PRBC) and 9U of Fresh Frozen Plasma (FFP). The work up revealed a large cell lymphoma infiltrating the mesenteric lymph nodes, the retroperitoneum and the spleen. The small intestine was diffusely infiltrated and bleeding. A portion of the small intestine was resected in an attempt to stop the bleeding; still, the bleeding continued and the Hg could not be raised above 7.8. Erythropoietin 20,000U was administered subcutaneously on day 9 to help correct the anemia. An additional 40,000U were administered on day 14 and 21. Three days after the 2nd dose of Erythropoietin the bowel movement did not appear grossly bloody, the Hg stabilized, and chemotherapy could be administered. After discharge with a follow up of 10 months his Hg stabilized at 12–12.5 mg/dl without any bleeding or transfusion. Discussion: Erythropoietin has been shown to shorten the bleeding time in chronic renal failure patients on hemodialysis by improving the platelet/subendotelial cell interaction and by raising the platelet count. An enhanced platelet aggregation in response to Ristocetin was noted in Erythropoietin treated uremic patients. This effect was correlated with a rise in platelet Serotonin. Erythropoietin also has been found to have a procoagulant effect in uremic patients by decreasing the protein C, protein S, antithrombin III level. These observations offer an explanation for the clinically observed hemostatic effect of Erythropoietin. Conclusion: This and other cases have shown that Erythropoietin is a potent hemostatic factor in anemic patients with diffuse uncontrollable bleeding processes, where large amounts of transfused PRBC can barely keep up with the losses and hemostatic procedures can either not be done or failed. As more experience accumulates Erythropoietin may start a second life as a hemostatic factor. Figure Figure

scholarly journals The Role of Supportive Therapy in Pediatric Malignancies

2016 ◽  
Vol 62 (2) ◽  
pp. 251-256
Author(s):  
Zsuzsanna Erzsébet Papp ◽  
Mária-Adrienne Horváth
Keyword(s):  
Growth Factors ◽  
Red Blood Cells ◽  
Blood Cells ◽  
Wide Spectrum ◽  
Fresh Frozen Plasma ◽  
Cancer Type ◽  
Infection Prophylaxis ◽  
Packed Red Blood Cells ◽  
Fresh Frozen ◽  
Frozen Plasma

AbstractChildhood cancer is a major psycho-social and health problem. International study groups establish complex, efficient, and concrete Cytostatic Protocols for every cancer type. During chemotherapy patients become extremely vulnerable to infections, so it is necessary to complete the treatment with blood substitution, anti-infection medication, growth factors and other complementary products.Materials and Methods: We studied the importance of the wide palette of adjuvant therapy near the intensive cytostatic treatment in the period of March 2014-November 2015 at the hemato-oncology department in Pediatric Clinic of Mures County Hospital.Results: In this period we treated 20 children (9 female, 11 male) aged between 9 months-18 years. We had 15 cases of haemopathies (13 acute leukemia and two lymphomas), and five solid tumors. Packed red blood cells, platelets, and fresh frozen plasma were given in the aplastic period. A patient benefited, on average, a total of 70ml/kg packed red blood cells and 50 U platelets. For infection prophylaxis and treatment every child benefited associated infective medication.Discussions: Packed red blood cells, platelets, and fresh frozen plasma were given to patients with a deficiency in the ability to produce normal blood cells which are temporarily worsened by chemotherapy. Antibiotic and antifungal medications are given to all febrile and neutropenic patients. We use wide spectrum antibiotics in association for preventing sepsis. Growth factors are stimulating the bone marrow to increase leukocyte number. Since introducing additional immunostimulant medication, we observed a significant decrease of infection in the aplastic period.Conclusions: Oncology protocols use only 3-5 cytostatic drugs. Maintaining the patient’s life during the treatment, it is necessary to use a large spectrum of supportive medications.

scholarly journals High Ratio Resuscitation in Patients with Systemic acquired Coagulopathy vs Endogenous Acute Coagulopathy

2014 ◽  
Vol 3 (2) ◽  
pp. 68-72
Author(s):  
Robert Derenbecker
Keyword(s):  
Injury Severity ◽  
Traumatic Injury ◽  
Retrospective Chart Review ◽  
International Normalized Ratio ◽  
Fresh Frozen Plasma ◽  
High Ratio ◽  
Packed Red Blood Cells ◽  
Fresh Frozen ◽  
Level I ◽  
Transfusion Ratio

ABSTRACT Background Two main mechanisms of coagulopathy related to trauma have been described: systemic acquired coagulopathy (SAC) and endogenous acute coagulopathy (EAC). Resuscitation with high ratios of fresh frozen plasma to packed red blood cells (FFP:PRBC) has been shown to improve patient outcomes. Systemic acquired coagulopathy is related to acidosis, hypothermia and hemodilution. Endogenous acute coagulopathy is related to severe hemorrhage and shock, with resultant effects on intrinsic clotting pathways inducing coagulopathy more rapidly than SAC. We hypothesize that high ratio resuscitation will show improved mortality outcomes for both SAC and EAC. Study Design A retrospective chart review was performed for patients at an urban level I trauma center. All patients with international normalized ratio (INR) > 1.2 during the first 6 hours after admission who received operative intervention and at least 6 units of PRBCs following traumatic injury were included. Patients with INR > 1.2 on admission were stratified to the EAC group while patients with normal admission INR with subsequent postoperative increase in INR > 1.2 were stratified into the SAC group. Transfusion ratios for FFP:PRBC were also collected for each patient. High ratio resuscitation was defined as FFP:PRBC ≥ 1:2 and low as FFP:PRBC < 1:2. Outcomes between groups were analyzed. Results Total of 95 patients met inclusion criteria. Fifty-six (59%) patients met criteria for EAC and 39 (41%) patients developed criteria for SAC during the first 6 hours of admission. The initial average base deficit was greater in EAC vs SAC patients (–6.3 vs –4.8, p = 0.03). Endogenous acute coagulopathy patients had a higher initial INR than SAC (1.4 vs 1.1, p = 0.001), and a higher average injury severity score (ISS) (27.6 vs 21.5, p = 0.03). Regarding transfusion ratios, for both EAC and SAC, a high transfusion ratio when compared to a low transfusion ratio conveyed improved mortality (EAC: 32.5 vs 81%, p = 0.01; SAC:9 vs 64.7%, p = 0.03). For high ratio resuscitation in both groups, patients with SAC showed improved mortality compared to EAC (9 vs 32.5%, p = 0.01). Conclusion For patients with EAC and SAC, a high transfusion ratio conveyed an overall improvement in mortality. However, subgroup analysis demonstrated that despite a high transfusion ratio, EAC patients continued to have a significantly higher mortality than SAC patients. Further investigations into the mechanisms involved in EAC and interventions to improve outcomes are needed. How to cite this article Duchesne J, Derenbecker R. High Ratio Resuscitation in Patients with Systemic acquired Coagulopathy vs Endogenous Acute Coagulopathy. Panam J Trauma Crit Care Emerg Surg 2014;3(2):68-72.

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