Significance of specialised preconception counselling in oocyte donation pregnancy with prior history of postpartum eclampsia

2020 ◽  
Vol 13 (11) ◽  
pp. e235582
Author(s):  
Kim van Bentem ◽  
Lisa Lashley ◽  
Marie-Louise van der Hoorn
Keyword(s):  
Oocyte Donation ◽  
Subsequent Pregnancy ◽  
Prior History ◽  
High Dose ◽  
Gamete Donation ◽  
Sperm Donor ◽  
Lesbian Motherhood ◽  
History Of ◽  
Preconception Counselling ◽  
Alternative Decision

A well-known complication in oocyte donation (OD) pregnancy is preeclampsia. Here, we present a 31-year-old woman, pregnant after OD. She conceived by the reception of the oocyte from her partner (ROPA) and sperm from a sperm donor. She developed preeclampsia with severe features, necessitating caesarean delivery at 29 weeks’ gestation due to deterioration of her clinical condition. Admission at the intensive care unit postpartum was necessary, because of recurrent postpartum eclampsia and administration of high dose magnesium sulphate for convulsion prophylaxis. This case illustrates the importance of preconception counselling for patients who are considering to conceive by OD and double gamete donation. In this specific case an alternative way to conceive was available. However, ROPA was preferred as part of shared lesbian motherhood. The risk of complications in the subsequent pregnancy has led to an alternative decision to accomplish a second pregnancy.

scholarly journals Hormetic Effects of Thiophanate-Methyl in Multiple Isolates of Sclerotinia homoeocarpa

Plant Disease ◽  
2019 ◽  
Vol 103 (1) ◽  
pp. 89-94 ◽  
Author(s):  
Sumit Pradhan ◽  
Lee Miller ◽  
Vanessa Marcillo ◽  
Alma R. Koch ◽  
Nathalia Graf Grachet ◽  
...  
Keyword(s):  
Low Dose ◽  
Growth Stimulation ◽  
Prior History ◽  
High Dose ◽  
Sclerotinia Homoeocarpa ◽  
Dollar Spot ◽  
Thiophanate Methyl ◽  
Highly Sensitive ◽  
History Of ◽  
Sublethal Concentrations

Twenty-eight isolates of Sclerotinia homoeocarpa, causal agent of dollar spot disease in turf, were assessed for fungicide hormesis at sublethal concentrations of thiophanate-methyl (T-methyl). Each isolate was grown in corn meal agar amended with 11 concentrations of T-methyl (30,500 to 0.047 µg/liter), and the area of mycelial growth was determined relative to the control. Three replicates were used per concentration, and the experiment was repeated three to five times for each isolate. Reference isolates (EC50 > 20 µg/liter), with no prior history of T-methyl exposure, were highly sensitive and not stimulated by low doses. Likewise, no stimulation was observed in two highly sensitive isolates (EC50 > 30 µg/liter) that had been preconditioned by exposure to T-methyl, or in four T-methyl-tolerant isolates. Seventeen (81%) preconditioned T-methyl-tolerant isolates (EC50 = 294 to1,550 µg/liter) had statistically significant growth stimulation, in the range of 2.8 to 19.7% relative to the control. These results support that hormesis (low-dose stimulation, high-dose inhibition) is a common dose response in preconditioned S. homoeocarpa, particularly in response to subtoxic doses of T-methyl.

scholarly journals Acute liver failure following paracetamol overdose

2021 ◽  
pp. 175114372110077
Author(s):  
Mohammed Asif Arshad ◽  
Mansoor Nawaz Bangash
Keyword(s):  
Critical Care ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Correct Diagnosis ◽  
Paracetamol Overdose ◽  
Prior History ◽  
High Dose ◽  
The United Kingdom ◽  
Early Intubation ◽  
History Of

Background Acute liver failure is a rare syndrome comprising a coagulopathy of liver origin, jaundice and encephalopathy in a patient with no prior history of liver disease. Paracetamol overdose is the leading cause of acute liver failure in the United Kingdom and often presents with extrahepatic organ dysfunction requiring critical care. Presentation: We present the case of a patient with hyper acute liver failure secondary to paracetamol overdose. Management and discussion: Management focused on ensuring the correct diagnosis had been made, administering N-acetyl cysteine, fluid resuscitation and broad spectrum antimicrobials. Early intubation and transfer to a transplant centre were undertaken following development of hepatic encephalopathy. Neuroprotective measures and hypertonic saline were instituted to reduce the risk of intracranial hypertension. High dose haemofiltration was also started to help reduce ammonia levels. Aggressive critical care therapies with specialised input results in good outcomes for patients admitted with paracetamol induced hyper acute liver failure. Liver transplant is reserved for those patients unlikely to survive with medical treatment alone.

Long Term Infectious Complications Following Reduced Intensity Conditioning (RIC) Allogeneic HLA-Identical Sibling Transplantation (allo-SCT).

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 2850-2850
Author(s):  
Anne Etienne ◽  
Mohamad Mohty ◽  
Catherine Faucher ◽  
Sabine Furst ◽  
Jean El-Cheikh ◽  
...  
Keyword(s):  
Low Dose ◽  
Chronic Gvhd ◽  
Infectious Complications ◽  
Prior History ◽  
High Dose ◽  
Infectious Episode ◽  
Donor Bone Marrow ◽  
Increased Risk ◽  
History Of

Abstract In the setting of RIC for allo-SCT, long term outcomes are still poorly defined. Of note, the epidemiology of long term transplant-related infections is still sparse. This prospective report describes infectious complications occurring beyond 6 months after allo-SCT, in 159 consecutive patients who received a RIC allo-SCT from an HLA-identical sibling. Patients characteristics are as follow: median age was 50 (range, 18–68) years. 68 patients (43%) had a myeloid malignancy, whereas 66 patients (41%) had a lymphoid malignancy. The remaining 25 patients (16%) were treated for metastatic non-hematological malignancies. The majority of patients (n=126, 79%) had an advanced disease with high risk features precluding the use of myeloablative allo-SCT. 24 patients (15%) received donor bone marrow (BM), while the remaining 135 patients (85%) received PBSCs. In addition to fludarabine and busulfan, the RIC regimen included high dose ATG in 20 patients (13%) and low dose ATG in 95 (60%). 24 patients (15%) received fludarabine, busulfan and TLI, while the remaining 24 patients (15%) received fludarabine and low dose TBI. With a median follow-up of 19 (range, 6–90) months, 120 patients (75%) experienced at least one infectious episode (total number of episodes, 366) beyond the first six months after allo-SCT developing at a median of 8 (range, 6–34) months. In all, 212 infectious episodes (58%) required hospitalization (7% in the intensive care unit) for a median duration of 10 (1–91) days. 144 episodes (39%) could be documented (bacterial, n=48; viral, n=78; fungal, n=18). Microbiologically documented infections were distributed as follow: gram negative bacteria (18%), other bacteria (15%), CMV positive antigenemia (17%), HSV (19%), VZV (15%), other viruses (3%), aspergillus (6%), candida species (6%), other (1%). 76% of patients with an infection were under systemic immunosuppressive therapy for chronic GVHD at time of infection. Moreover, 85 patients (71%) experienced more than one infectious episode (median, 2; range, 1–12). In multivariate analysis, active or prior history of extensive chronic GVHD and the use of a BM graft were the strongest factors significantly associated with an increased risk of long term infections (P=0.0003; RR=2.04; 95%CI, 1.4–3.0; and P=0.005; RR=2; 95%CI, 1.2–3.2 respectively), highlighting the raising concern about the deleterious impact of severe chronic GVHD occurring after RIC allo-SCT, but also the protective effect of donor origin immunity based on graft origin and content. In this series of patients surviving at least 6 months after RIC allo-SCT, the overall long term transplant-related mortality was 11% (n=18), of whom 12 deaths were attributed to chronic GVHD and its complications including infections, and 5 deaths solely attributed to infections. In all, these results suggest that, despite reduction in early toxicity associated with the use of RIC regimens, long term debilitating chronic GVHD and its corollary of continuous immunosuppression and subsequent infections are still a matter of concern. Prospective efforts to develop optimal antimicrobial preventive strategies are needed to further improve the safety of the procedure and the overall benefits of RIC preparative regimens before allo-SCT.

P10: IBRUTINIB ASSOCIATED AUTOIMMUNE HEMOLYTIC ANEMIA

2016 ◽  
Vol 64 (3) ◽  
pp. 821.1-821 ◽  
Author(s):  
S Datla ◽  
P Draksharam ◽  
G Sidhu
Keyword(s):  
High Risk ◽  
Hemolytic Anemia ◽  
Autoimmune Hemolytic Anemia ◽  
Kinase Inhibitor ◽  
Lymphocytic Leukemia ◽  
Prior History ◽  
High Dose ◽  
History Of ◽  
Review Reports ◽  
Positive Direct

Purpose of StudyAutoimmune hemolytic anemia (AIHA) is a common phenomenon in Chronic lymphocytic Leukemia (CLL)/Small Lymphocytic Lymphoma (SLL) accounting for about 4–7% of cases. AIHA is commonly associated with certain conventional chemotherapy agents used in CLL/SLL. Ibrutinib, bruton tyrosine kinase inhibitor is category 1 indication for high risk (del 17p) and relapsed/refractory CLL. Literature review reports 11cases of Ibrutinib associated AIHA.We report a case of AIHA precipitated by Ibrutinib in an high risk CLL patient, with prior history of AIHA.Methods UsedPatient is an 81 year old black man diagnosed with asymptomatic Stage I CLL (del 17p) in 2010 and was on active surveillance. He developed AIHA in 2012, with good response to steroids and Rituximab. Subsequently he received 8 cycles of rituximab for symptomatic CLL with resolution of symptoms. In 9/2014, noted to have progression of disease with worsening B symptoms, leukocytosis and lymphadenopathy. He was started on Ibrutinib 420 mg PO daily with regression of lymphadenopathy within 3 weeks of therapy, but presented with symptomatic anemia with hemoglobin of 3 gm/dl, positive direct Coomb's test, elevated reticulocyte count and LDH consistent with AIHA. WBC elevated at 360 K/uL from baseline of 150 K/uL and hemoglobin fell to 3 g/dl from 10 g/dl since Ibrutinib was initiated. Ibrutinib was held and patient received high dose prednisone followed by IVIG and cautious transfusion with minimal improvement in hemoglobin. Hemoglobin slowly up trended with weekly Rituximab and high dose steroids and remained stable around 10 gm/dl after 4 weeks of Rituximab. Ibrutinib was subsequently restarted with overall clinical improvement.Summary of ResultsIn our patient, occurrence of AIHA falls in between 2–4 weeks as other reported cases suggesting that Ibrutinib could be a likely precipitating factor.ConclusionsReview of data, reveals that 22% of patients had history of AIC prior to Ibrutinib, however occurrence of AIHA on Ibrutinib seems to be less common (0.7%).Mechanism of action of Ibrutinib associated cytopenias remains unclear. It was hypothesized that it may be due to IL-2 induced kinase inhibition by Ibrutinib, and needs further investigation.

Cardiac Toxicity After High-Dose Melphlan and Autologous Hematopoietic Stem Cell Transplantation for Multiple Myeloma

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 2027-2027
Author(s):  
Zartash Gul ◽  
Qaiser Bashir ◽  
Yago Nieto ◽  
Nazeer Sherwani ◽  
Simrit Parmar ◽  
...  
Keyword(s):  
Chest Pain ◽  
Cardiac Disease ◽  
Cardiac Toxicity ◽  
Prior History ◽  
High Dose ◽  
Al Amyloidosis ◽  
Bundle Branch Block ◽  
Hematopoietic Stem ◽  
History Of

Abstract Abstract 2027 Background: High-dose melphalan (HDM), 200 mg/m2, is the standard regimen for autologous hematopoietic stem cell transplant (auto-HCT) for multiple myeloma (MM). Although HDM-induced cardiotoxicity is reported, its incidence is not well known. In this retrospective analysis we evaluated the incidence of cardiotoxicity and its impact on outcome in patients undergoing auto-HCT for MM. Methods: Three-hundred and sixty-nine consecutive patients who received melphalan 200 mg/m2 for auto-HCT ASCT between January 2006 and December 2009 were included in these analyses. Cardiac toxicity was defined as any cardiac adverse event reported from the day of administration of melphalan to day+ 30 after auto-HCT. Results: Patient characteristics are summarized in Table 1. Median age at auto-HCT was 59 years (32–78 years). Median time from diagnosis to auto-HCT was 8.0 months (1.8–266.3). Patients undergoing auto-HCT had a left ventricular ejection fraction (LVEF) of >40%, and no symptomatic cardiac disease. Thirty-five patients had concurrent or AL amyloidosis, and 43 patients had a prior history of cardiac disease. By day +30 after auto-HCT, 34 patients (9.2%) developed one or more adverse cardiac adverse events (AE). Twenty-seven patients experienced a single cardiac AE: atrial fibrillation (a fib): 16, congestive heart failure (CHF): 3, supraventricular tachycardia (SVT): 3, ischemic chest pain: 2, ventricular bigeminy: 1, diastolic dysfunction: 1 and sudden cardiac death in a patient with AL amyloidosis: 1. Seven patients had a combination of 2 or more cardiac adverse events: CHF + a fib: 4, ischemic chest pain + QT prolongation: 1, ischemic chest pain + left bundle branch block (LBBB): 1, ischemic chest pain + premature ventricular contractions (PVCs): 1. Overall, supraventricular arrhythmias were responsible for cardiac AE in 6.2% (23/369) of the patients. Twenty-eight patients (82%) fully recovered from the cardiac AE. Four patients required long term pharmacologic treatment of a fib, and one patient with a fib developed a cerebellar infarct without residual neurologic deficits. Patients with cardiac AE were older (median age: 62 vs. 59, p=0.014) and had a prior history of cardiac disease (17/34 vs. 20/335, p=0.0001) compared to patients without cardiac AE. Gender, concurrent AL amyloidosis, interval between diagnosis and auto-HCT, or transplant before or after the year 2000 were not associated with cardiac AE. Median overall follow up was 28 months (1–369). 100-day non-relapse mortality (NRM) was 3% (1/34) vs. 0% (0/335) in patients with or without cardiac AEs (p=0.09). Kaplan-Meier estimates of 3-year OS were 70% vs. 84% in patients with or without cardiac AE (p=0.084). Conclusions: HDM and auto-HCT was associated with cardiac AEs in 9% of patients. A fib and CHF were the most common cardiac AEs, but >80% fully recovered without long-term sequelae. Patients with cardiac AE were relatively older and had a prior history of cardiac disease. There was no significant difference in NRM or OS in patients with or without melphalan-associated cardiac AEs. <PR, includes Stable Disease, No Response, PD, Minimal Response; >=VGPR: includes Complete Remission (CR);, Very Good Partial Response and Partial Remission (VGPR), PR: Partial remission. RBBB (Right bundle branch block). Disclosures: No relevant conflicts of interest to declare.

Efficacy of radioimmunotherapy-based conditioning with high-dose chemotherapy and autologous stem cell transplantation for transformed lymphoma.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 8556-8556
Author(s):  
Amrita Y. Krishnan ◽  
Marielle Wondergem ◽  
Joycelynne Palmer ◽  
Avichai Shimoni ◽  
Andrew Antony Raubitschek ◽  
...  
Keyword(s):  
Univariate Analysis ◽  
Disease Status ◽  
Large Cell ◽  
Median Number ◽  
High Dose Chemotherapy ◽  
Prior History ◽  
High Dose ◽  
Non Hodgkin Lymphoma ◽  
History Of ◽  
Histological Confirmation

8556 Background: Transformed non-Hodgkin lymphoma (TF NHL) has a poor prognosis with median survival of 7-20 months. Studies have suggested the benefit of HDC. The series by Eide showed 47%, 5yr OS in 47 pts treated with HDC and ASCT (Br J Hem 2011). Our multicenter experience with RIT plus HDC (Yttrium 90 ibritumomab tiuxetan plus BEAM; carmustine, etoposide, cytarabine, melphalan "ZBEAM") demonstrated the safety and efficacy of the regimen in diffuse large cell lymphoma (DLCL). Therefore, the regimen was explored in other subtypes of NHL. Herein we report the outcome of 57 pts with TF NHL treated with ZBEAM conditioning and ASCT at three centers (City of Hope USA n=20, VUMC the Netherlands n=31, Chaim Sheba Med Center, Israel n=6.) between 2003- 2011. Methods: Histological confirmation of transformation was defined as dx of DLCL in pts with either a prior history or concomitant dx of follicular NHL. Results: Median age at ASCT was 59.6 yrs (range 41-69). Median number of prior regimens 2 (range 1-6), all pts received rituximab in at least one regimen. Disease status at ASCT: 1st CR 29, 1stPR 7,1st rel 9, IF 5, 2nd CR 5, 2nd rel 1, >3CR 1. Median time from TF NHL dx to ASCT was 7.7 mo (range 2.8-116). Pts engrafted white cells at median of 12 days (range 8-33). Non relapse mortality was 3.5%. There were two second malignancies: 1 MDS and 1 SCC Skin. Median f/u for living pts was 29 mo (range 7-100). Two year PFS was 69.67% (95%CI 59.39 - 77.83) and OS 90.29% (95% CI: 79.63 - 95.52). On univariate analysis, number of prior regimens, time from TF NHL dx to ASCT and history of marrow involvement were not significant for PFS and OS. Disease status at ASCT was significant for PFS in 1st CR vs relapse disease ( p=0.03) The relapsed pts had a significant increase in risk of relapse/progression or death post ASCT compared to the 1CR patients. [HR = 2.9, (95% CI: 1.07 - 7.9)]. Conclusions: ZBEAM conditioning with ASCT is an active treatment for pts with TF NHL, and is particularly efficacious as consolidation for pts in 1st CR.

scholarly journals Incidence and Risk Factors of Invasive Fungal Infection in Adult Patients Receiving Allogeneic Hematopoietic SCT Recipients

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 2476-2476
Author(s):  
Yao-Chung LIU ◽  
Jyh-Pyng Gau ◽  
Cheng-Hwai Tzeng
Keyword(s):  
Risk Factors ◽  
Fungal Infection ◽  
Invasive Fungal Infection ◽  
Chronic Gvhd ◽  
Prior History ◽  
High Dose ◽  
Hematopoietic Stem ◽  
Post Transplant ◽  
Blood And Marrow Transplantation ◽  
History Of

Abstract To investigate the incidence and risk factors for the occurrence of proven or probable invasive fungal infection (IFI) in adult patients receiving allogeneic hematopoietic stem cell transplantation (HSCT), 421 patients undergoing HSCT between 2002 and 2013 in our hospital were retrospectively analyzed. Thirty-one patients with the median age of 42 years (range: 19-60) developed IFI after HSCT. The post-HSCT IFI incidence was 7.4% and median time from HSCT to the diagnosis of IFI was 139 days (range: 2-1809). The risk factors for the occurrence of IFI were analyzed using Cox regression models.Of the pretransplant factors, European Group for Blood and Marrow Transplantation (EMBT) risk>2 (P=0.001) and prior history of IFI (P=0.006) or DM (P=0.042) were the significant predictors for post-HSCT IFI by univariate analyses. In multivariate analysis, EMBT risk>2 (P=0.015) and prior history of IFI (P=0.006) retained significance. Of the post-transplant factors, acute graft-versus-disease (aGVHD) overall grade III-IV (P<0.001), extensive chronic GVHD (cGVHD) (P=0.002), post-transplant lymphoproliferative disorders (PTLD) (P=0.005) and the use of high-dose steroids (P<0.001) were statistically significant in univariate analyses. After multivariate analysis, high-dose steroids (P<0.001) and aGVHD overall grade III-IV (P=0.045) retained significance. These results suggest that risk group stratification prior HSCT and monitoring of IFI in patients with severe GVHD and receiving high-dose steroids is mandatory to decrease the risk of post-HSCT IFI, especially in those with prior history of IFI. Abstract 2476. Table 1.Possible factors for the occurrence of invasive fungal infection (IFI) after adult allogeneic HSCTIFIUnivariate analysisMultivariate analysisFactorsNo. of patientsN%HR95%CIP-valueHR95%CIP-valueEMBT risk=<216952.9>22522610.35.0381.930-13.1510.0013.3901.273-9.0290.015Prior history IFINo406276.6Yes15426.64.4571.551-12.8060.0065.8071.675-20.1290.006Prior history DMNo402286.9Yes19315.73.4901.045-11.6530.042aGVHDNo or Overall Gr. I-II379236.0Gr. III-IV42819.06.9363.046-15.796<0.0012.6271.023-6.7480.045High steroids*No367123.2Yes541935.111.1485.401-23.008<0.00111.1853.875-32.289<0.001cGVHDNo or limited364195.2Extensive571221.03.1311.518-6.4590.002PTLDNo405276.6Yes164254.6271.607-13.3200.005Abbreviations: CI = confidence interval; HR = hazard ratio; EBMT = European Group for Blood and Marrow Transplantation; HSCT = hematopoietic stem cell transplantation; GVHD = graft-versus-host disease; aGVHD = acute GVHD; cGVHD = chronic GVHD; Gr.= grade; PTLD = Post-transplant lymphoproliferative disorders. DM = Diabetes mellitus. High steroids* = post-HSCT high-dose steroid; Significant values (P<0.05) are given in bold. Figure 1 Incidence of post-HSCT IFI per year Figure 1. Incidence of post-HSCT IFI per year Figure 2 Overall survival of the patients with IFI Figure 2. Overall survival of the patients with IFI Disclosures No relevant conflicts of interest to declare.

ITI with high-dose FIX and combined immunosuppressive therapy in a patient with severe haemophilia B and inhibitor

2009 ◽  
Vol 29 (02) ◽  
pp. 155-157 ◽  
Author(s):  
H. Hauch ◽  
J. Rischewski ◽  
U. Kordes ◽  
J. Schneppenheim ◽  
R. Schneppenheim ◽  
...  
Keyword(s):  
Nephrotic Syndrome ◽  
Immunosuppressive Agents ◽  
Tolerance Induction ◽  
Intravenous Immunoglobulins ◽  
Factor Ix ◽  
High Dose ◽  
Allergic Reactions ◽  
Success Rates ◽  
Serious Infections ◽  
History Of

SummaryInhibitor development is a rare but serious event in hemophilia B patients. Management is hampered by the frequent occurrence of allergic reactions to factor IX, low success rates of current inhibitor elimination protocols and the risk of development of nephrotic syndrome. Single cases of immune tolerance induction (ITI) including immunosuppressive agents like mycophenolat mofetil (MMF) or rituximab have been reported. We present a case of successful inhibitor elimination with a combined immune-modulating therapy and high-dose factor IX (FIX). This boy had developed a FIX inhibitor at the age of 5 years and had a history of allergic reactions to FIX and to FEIBA→. Under on-demand treatment with recombinant activated FVII the inhibitor became undetectable but the boy suffered from multiple joint and muscle bleeds. At the age of 11.5 years ITI was attempted with a combination of rituximab, MMF, dexamethasone, intravenous immunoglobulins and high-dose FIX. The inhibitor did not reappear and FIX half-life normalized. No allergic reaction, no signs of nephrotic syndrome and no serious infections were observed.

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