scholarly journals Platelet count monitoring in burn patients

2007 ◽  
pp. 212-219 ◽  
Author(s):  
Marina Pavic ◽  
Lara Milevoj
Keyword(s):  
Platelet Count ◽  
Burn Patients ◽  
Platelet Count Monitoring

scholarly journals Clinical Significance of the Serotonin Release Assay and Platelet Count Monitoring After Cardiac Surgery

2017 ◽  
Vol 24 (6) ◽  
pp. 944-949 ◽  
Author(s):  
Shinya Motohashi ◽  
Takefumi Matsuo ◽  
Hidenori Inoue ◽  
Makoto Kaneko ◽  
Shunya Shindo
Keyword(s):  
Cardiac Surgery ◽  
Platelet Count ◽  
Clinical Course ◽  
Serotonin Release ◽  
Enzyme Linked Immunosorbent Assay ◽  
Heparin Induced Thrombocytopenia ◽  
Release Assay ◽  
Immunological Assays ◽  
Platelet Count Monitoring ◽  
The Relationship

Heparin-induced thrombocytopenia (HIT) is one of the serious complications in patients who undergo cardiac surgery. However, there remains a major problem in diagnosing HIT because the current immunological assays for detection of HIT antibody have limitations. Furthermore, the clinical course of thrombocytopenia in this surgery makes it increasingly difficult to diagnose HIT. We investigated the relationship between platelet count and HIT antibody in 59 patients who underwent cardiac surgery using cardiopulmonary bypass (CPB). The number of postoperative HIT antibody-positive patients evaluated using enzyme-linked immunosorbent assay kit (polyanion IgG/IgA/IgM complex antibodies/antiplatelet factor 4 enhanced) was 37 (62.7%). In contrast, platelet activation by HIT antibody was evaluated using the serotonin release assay (SRA). More than 20% and 50% release of serotonin was obtained from 12 patients (20.3%) and 8 patients (13.6%), respectively. The levels of d-dimer were significantly different on postoperative day 14 between SRA-positive and SRA-negative groups; however, postoperative thrombus complication was not detected using sonography in the patients with positive serotonin release at all. After being decreased by the operation, their platelet count recovered within 2 weeks in both groups equally. In our study, although the patients were positive in the platelet activating HIT antibody assay, they remained free from thrombosis and their platelet count recovered after early postoperative platelet decrease. Therefore, in addition to the SRA, monitoring of platelet count might be still considered an indispensable factor to facilitate the prediction of HIT thrombosis prior to manifestation in the patients undergoing cardiac surgery using CPB.

How I Manage cyclic thrombocytopenia

Blood ◽  
2020 ◽  
Author(s):  
Paul A Kyrle ◽  
Sabine Eichinger
Keyword(s):  
Platelet Count ◽  
Immune Thrombocytopenia ◽  
Hematological Malignancies ◽  
Severe Bleeding ◽  
Typical Pattern ◽  
Periodic Fluctuation ◽  
Thrombopoietin Receptor ◽  
Primary Immune Thrombocytopenia ◽  
Platelet Count Monitoring ◽  
Mucocutaneous Bleeding

Cyclic thrombocytopenia (CTP) is a rare disease, which is characterized by periodic fluctuation of the platelet count. The pathogenesis of CTP is unknown and most likely heterogeneous. Patients with CTP are almost always misdiagnosed as having primary immune thrombocytopenia (ITP). The interval between ITP and CTP diagnosis can be many years. CTP patients often receive ITP-specific therapies including corticosteroids, thrombopoietin receptor agonists, rituximab and splenectomy which are followed by a transient increase in platelet count that is wrongly attributed to treatment effect with inevitable "relapse". CTP can be diagnosed by frequent platelet count monitoring which reveals a typical pattern of periodic platelet cycling. An early diagnosis of CTP will prevent these patients from being exposed to possibly harmful therapies. The bleeding phenotype is usually mild and consists of mucocutaneous bleeding at the time when the platelet count is at its nadir. Severe bleeding from other sites can occur but is rare. Some patients respond to cyclosporine A or to danazol, but most patients do not respond to any therapy. CTP can be associated with hematological malignancies or disorders of the thyroid gland. Nevertheless, spontaneous remissions can occur, even after many years.

scholarly journals SARS-COV-2 infection in a patient with Evans syndrome: A silent enemy or an ally?

2020 ◽  
pp. 115-115
Author(s):  
Nikola Pantic ◽  
Mirjana Mitrovic ◽  
Marijana Virijevic ◽  
Nikica Sabljic ◽  
Zlatko Pravdic ◽  
...  
Keyword(s):  
Platelet Count ◽  
Case Report ◽  
Autoimmune Diseases ◽  
Reference Range ◽  
Prior History ◽  
Limited Data ◽  
Evans Syndrome ◽  
History Of ◽  
Current Outbreak ◽  
Platelet Count Monitoring

During the current outbreak of Coronavirus disease 2019 (COVID-19), the way to manage patients with autoimmune diseases remains elusive due to limited data available. Case report: Addressing this issue we report a case of a COVID-19 positive 20-year-old female with prior history of Evans syndrome. She remained asymptomatic even though she had been treated with immunosuppressants (prednisolone and azathioprine) together with romiplostim. Moreover, her course of infection was accompanied by thrombocytosis, although her platelet count was mostly below the reference range before the infection. The patient was monitored vigilantly, with special regard to platelet count and signs of thrombotic events. Conclusion: Platelet count monitoring and romiplostim administration should be performed more cautiously in ITP patients infected by SARS-CoV-2.

Impact of Topical Heparin on Healing of Skin Graft Donor Site in Burn Patients

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ahmed Mohamed Salah El-Din El-Badawi ◽  
Sherine Mohamed Aboul-Fotouh ◽  
Ahmed Mohamed Abdelsalam ◽  
Mai Raafat Abdelazim Hammad
Keyword(s):  
Platelet Count ◽  
Conventional Treatment ◽  
Donor Site ◽  
Reference Value ◽  
Skin Grafting ◽  
Healing Time ◽  
Burn Patients ◽  
Donor Area ◽  
Graft Donor ◽  
Topical Heparin

Abstract Background The ability of topical heparin application to improve the healing outcome of burn wounds has been demonstrated by several studies. However, its impact on healing of skin graft donor site was not studied. Aim The present study was done to compare the healing outcome (healing time, pain, itching, scarring and complications) of topical heparin treatment with topical conventional treatment in the donor areas after skin grafting in burn patients. Methods This prospective, interventional, controlled, single-blinded clinical study was done on 40 patients with 2nd or 3rd degree burns of any etiology and <30% of body surface area requiring skin grafting, aged 18-65 years, of both sexes. Each patient was subjected to harvesting of two grafts. Patients served as their own controls. One donor area was treated with topical heparin and the other was treated with the topical conventional treatment. Immediately after graft harvesting, all donor areas were treated conventionally. Starting from the 2nd day, each donor area was treated once daily according to its group allocation. The topical heparin donor area was treated with heparin diluted in saline in a concentration of 250 IU/ml in a dose of 4200 IU/1% total body surface area (TBSA). The area was covered with gauze soaked with the solution for 5 days. The conventional treatment (control) donor area was covered by gauze soaked with an equivalent amount of normal saline on top of Vaseline gauze. Heparin was to be discontinued if the platelet count before each session was < 100,000 /mm3 and/or APTT exceeded double the reference value. Pain was assessed twice daily for 5 days. The patients’ donor areas were followed-up postoperatively for 8 weeks for healing time in days, itching over the wound and scarring using Vancouver Scar Scale. Complications in the form of wound site bleeding or infection were recorded. An analgesic was given twice daily for 5 days then as needed. Results There were no statistically significant differences between the two donor areas regarding the site and size. The healing time was significantly shorter in the heparin donor areas (P < 0.00001) with less scarring reported as significantly lower scores of the Vancouver scar scale compared with the control donor areas for each component and the total score (P < 0.05). Pain, itching and infection rate were insignificantly less in the heparin area. Bleeding was not observed in any of the areas in all cases and the daily values of platelet count and APTT in the five treatment days did not differ significantly compared with the preoperative values. None of the patients showed a platelet count < 100,000 /mm3 or APTT exceeding double the reference value. Conclusion Topical heparin treatment, compared with topical conventional treatment, of the donor areas after skin grafting in burn patients resulted in better clinical outcome manifested as significantly shorter wound healing time and significantly less scarring with no treatment-related complications.

scholarly journals A clinical study to evaluate platelet count and serum albumin as independent prognostic factors in predicting the outcome in burn patients in a tertiary care hospital

2020 ◽  
Vol 7 (7) ◽  
pp. 2305
Author(s):  
Kavitha Jayanthi Balachandran ◽  
Serbin Mohammed
Keyword(s):  
Platelet Count ◽  
Serum Albumin ◽  
Tertiary Care ◽  
Survival Rates ◽  
Age Groups ◽  
Severity Index ◽  
Care Hospital ◽  
Burn Patients ◽  
Mortality And Morbidity ◽  
Reliable Marker

Background: Burns can affect the population of all age groups and regions. There has been a reduction in the mortality and morbidity of burn patients due to improvements in standards of medical care. Several laboratory values were proposed to indicate the prognosis of burns patients. Of these, the oldest is abbreviated burn severity index (ABSI), which includes variables such as sex, age, total burned body surface area (BSA), full-thickness injuries, and burns attributable to inhalation. Later the acute physiology and chronic health evaluation (APACHE) II and APACHE III scales which incorporates biochemical markers to improve predictive power evolved.Methods: In this study, in a tertiary care government institution, we attempt to assess platelet count and serum albumin independently in the prognosis of burns patient, in a background of sepsis.Results: For analysis, patients were divided into two groups- survivors and non-survivors as sepsis development and mortality was observed. There was a progressive decline in the platelet count in non-survivors, while the initial fall improved in those who survived. There was only a marginal difference between the two groups in serum albumin levels.Conclusions: A serial fall in platelet count is a predictor of sepsis and mortality in burn patients. It is an indicator of bone marrow depression and correlation with leucocyte count needs to be evaluated. In those patients where the initial fall in platelet count improved, survival rates were high. As a biochemical marker, serum albumin was not a reliable marker in predicting sepsis and mortality. 

scholarly journals Incidence of thrombocytopenia in neonates receiving phototherapy for indirect hyperbilirubinemia: a prospective cohort study

2019 ◽  
Vol 7 (9) ◽  
pp. 3505
Author(s):  
Mubashir H. Shah ◽  
Ramya Vedula ◽  
Reashma Roshan
Keyword(s):  
Cohort Study ◽  
Platelet Count ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Case Reports ◽  
Severe Thrombocytopenia ◽  
Term Neonates ◽  
Preterm Babies ◽  
Double Surface ◽  
Platelet Count Monitoring

Background: Thrombocytopenia as a side effect of phototherapy has not been mentioned in the standard literature but was described briefly as isolated case reports after the phototherapy came in vogue in 1958. The purpose of this study was to find the incidence of thrombocytopenia in neonates with uncomplicated indirect hyperbilirubinemia receiving phototherapy in a referral hospital.Methods: This was a prospective cohort study conducted in a referral hospital over a period of 18 months from June 1, 2013 to November 1, 2014.Results: A total of 103 babies were enrolled. The overall incidence of post-phototherapy thrombocytopenia was 45.6% while mild, moderate and severe thrombocytopenia was present in 66%, 21.3% and 12.8% of babies respectively. The lowest platelet count observed was 31,000/mm3 but none of the neonates showed bleeding manifestations. The incidence of thrombocytopenia following phototherapy was significantly higher in preterm babies, infants who received double surface phototherapy, babies who received phototherapy for >72 hours and in babies who received phototherapy on day 2 or 3 of life.Conclusions: Neonates requiring phototherapy for hyperbilirubinemia are at risk of developing thrombocytopenia, hence the treatment should be initiated based on the standard guidelines. Unnecessary use and prolongation of phototherapy should be avoided considering the possible side effects. Platelet count should be monitored particularly in pre-term neonates receiving phototherapy. Neonates receiving double surface phototherapy and those requiring phototherapy for longer duration require more frequent platelet count monitoring. 

A Benchmark for Platelet Count Monitoring with Low-Molecular-Weight Heparin: Expanding Implementation of National Patient Safety Goals

2009 ◽  
Vol 43 (9) ◽  
pp. 1519-1521
Author(s):  
Sarah A Spinler
Keyword(s):  
Molecular Weight ◽  
Patient Safety ◽  
Platelet Count ◽  
Low Molecular Weight Heparin ◽  
Thrombin Inhibitor ◽  
Low Molecular Weight ◽  
Initial Management ◽  
National Patient ◽  
Monitoring Protocols ◽  
Platelet Count Monitoring

Practitioners in US hospitals are implementing anticoagulation dosing and monitoring protocols to improve the safety of anticoagulation, consistent with National Patient Safety Goal 03.05.01. An audit of the Utrecht Patient Oriented Database of patients treated with low-molecular-weight heparin (LMWH) at the University Medical Center Utrecht revealed low compliance with platelet count monitoring as well as initial management of suspected heparin-induced thrombocytopenia (HIT). Limitations to this work included the inability to exclude other drug-induced causes of thrombocytopenia and their definition of the frequency of platelet count monitoring for compliance in patients given venous thromboembolism prophylaxis. Despite these limitations, the authors’ work represents the first published report on extending the quality of heparin anticoagulation management to platelet count monitoring and evaluation for HIT in a large patient population. Clinicians should include evaluations of compliance with platelet count monitoring with unfractionated heparin and LMWH, as well as appropriateness of the initial management strategies for HIT, and direct thrombin inhibitor protocols in their patient safety practice assessments.

Adherence to Guidelines for Monitoring for Heparin-Induced Thrombocytopenia in Patients Treated with Low Molecular Weight Heparin

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 1282-1282
Author(s):  
Maarten ten Berg ◽  
Patricia Van den Bemt ◽  
Albert huisman ◽  
Fred Schobben ◽  
Toine Egberts ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Platelet Count ◽  
Clinical Guidelines ◽  
Low Molecular Weight Heparin ◽  
Low Molecular Weight ◽  
Platelet Factor ◽  
Heparin Induced Thrombocytopenia ◽  
Alternative Anticoagulation ◽  
Life Threatening ◽  
Platelet Count Monitoring

Abstract Laboratory monitoring for early detection of adverse drug reactions is recommended for many drugs. For patients treated with low molecular weight heparin (LMWH), the Summary of Product Characteristics (SPC) and clinical guidelines recommend to monitor the platelet count for heparin-induced thrombocytopenia (HIT), a potentially life-threatening adverse event, characterised by a typical drop in platelet count. When the platelet count drops without obvious explanation in these patients, testing for heparin-platelet factor 4 antibodies (HPF4-Ab) and initiating alternative anticoagulation are advised. In the current study adherence to recommended platelet count monitoring in clinical patients without thrombocytopenia-associated diseases treated with LMWH for at least five days at our institution, and adherence to recommended testing for HPF4-Ab and initiation of alternative anticoagulation in patients with potential HIT (defined as a drop of at least 50% in platelet count between days 5 and 14 following the start of LMWH treatment, or stopdate, whichever occurred first, compared to the highest platelet count within days 1–4) were investigated. Data from the Utrecht Patient Oriented Database (UPOD) were used for this retrospective cohort study. Inpatients exposed to the LMWHs dalteparin or nadroparin for at least five days during the period 2004–2005 were included. Patients with thrombocytopenia-related diseases were excluded. Firstly, adherence to recommended platelet count monitoring, based on recommendations from SPCs and clinical guidelines, was investigated. Secondly, the association between patient- and treatment characteristics and obtaining at least 2 platelets counts during treatment was investigated. Thirdly, adherence to recommended testing for HPF4-Ab and initiating treatment with danaparoid was investigated in patients with potential HIT. 6,804 patients with 7,770 episodes of LMWH treatment of at least five days were included. Adherence to the recommendations for platelet count monitoring from the SPC of nadroparin and dalteparin was 36.5% and 26.3% respectively. Adherence to the different platelet count monitoring recommendations from the 2002 clinical guideline on HIT was 23.0% and 41.5%. Obtaining at least 2 platelet counts during treatment was found to be strongly associated with ICU admission, previous UFH exposure, and a treatment duration of at least 10 days. There were 98 patients with potential HIT. Adherence to testing for HPF4-Ab in patients with potential HIT was 6.1%. Adherence to starting alternative anticoagulation in patients with potential HIT treatment was 0%. The results of this study suggest that adherence to recommendations for monitoring for HIT with LMWH is low at our institution. The results of this study justify to say that there is a need to think of appropriate actions for improving the awareness of HIT as an adverse reaction to LMWH, and to secure the safe use of LMWH.

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