scholarly journals Vaccine-Induced Thrombotic Thrombocytopenia: Novelty Testing in the Diagnostic Work-up?

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 1061-1061
Author(s):  
Rossella Rosari Cacciola ◽  
Veronica Vecchio ◽  
Elio Gentilini Cacciola ◽  
Emma Cacciola
Keyword(s):  
Conflicts Of Interest ◽  
Clot Lysis ◽  
Clotting Time ◽  
Vein Thrombosis ◽  
History Of ◽  
Diagnostic Work ◽  
Deep Vein ◽  
Work Up ◽  
Diagnostic Work Up ◽  
Maximum Clot Firmness

Abstract COVID-19 vaccination campagnies with several vaccines types are currently undeway. Recently, the ASTRA ZENECA vaccine has raised public alarm with concerns regarding the development of thrombotic events known as vaccine-induced thrombotic thrombocytopenia (VITT). Early and limited studies have implicated an antibody-mediated platelet activation as the mechanism of the clotting events. Aim of this study was to investigate the platelet and coagulation activation using specialized tests. In this study we enrolled 60 patients (40 men, 20 women; mean age 55±10 years) without cardiovascular risk factors or a history of thrombosis who reported having poplitea deep vein thrombosis (35/60) and pulmonary embolism (25/60) revealed with lower-limb ultrasonography and computed tomography (CT) angiography, respectively, 7 days after vaccination with ASTRA ZENECA. All patients were evaluated for initial testing such as platelet count, prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (Fib) and D-dimer (DD). Platelets were measured by automated analyzer, PT and APTT by coagulometric test, Fib using Clauss method, and DD using ELISA. Complete blood hemostasis was studied by platelet function assay (PFA-100) on Collagen/ADP (CT-ADP) and Collagen/Epinephrine (CT-EPI) cartridges and Thromboelastometry method on Clotting Time (CT), Clotting Formation Time (CFT), Maximum Clot Firmness (MCF), and clot lysis at 30 minutes (LY-30). All patients had thrombocytopenia (60±5x109/L), longer PT (28±10 s) and PTT (50±10 s), lower Fib (80±20 mg/dl), higher DD ((550±100 mg/l). All patients had shorter C/ADP and C/EPI (C/ADP, n.v. 68-121 s (42±10 s) and C/EPI n.v. 84-160 s (38±5 s) and shorter CT (CT, unit: s. n.v. 100-240 s) (INTEM 30±20 s, EXTEM 18±10 s), shorter CFT (CFT, unit: s, n.v. 30-160 s (INTEM 11±10 s, EXTEM 19±10 s), longer MCF (MCF, unit: mm, n.v. 50-72 mm (INTEM 128±10 mm, EXTEM 110±10 mm), and lower LY-30 (LY-30, %: v.n. 15% (INTEM 0.8%, EXTEM 0.7%). These interesting findings may be the novelty in the diagnostic work-up of the VITT. If these tests may aid in the diagnosis of VITT deserve to be confirmed and need reproducing in other studies. Disclosures No relevant conflicts of interest to declare.

A new rapid bedside assay for quantitative testing of D-Dimer (Cardiac D-Dimer) in the diagnostic work-up for deep vein thrombosis

2003 ◽  
Vol 111 (3) ◽  
pp. 149-153 ◽  
Author(s):  
Cristina Legnani ◽  
Simone Fariselli ◽  
Michela Cini ◽  
Gaetana Oca ◽  
Carmela Abate ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Vein Thrombosis ◽  
Diagnostic Work ◽  
Deep Vein ◽  
Work Up ◽  
Diagnostic Work Up ◽  
D Dimer

Impact of gender on the clinical presentation and diagnosis of deep-vein thrombosis

2010 ◽  
Vol 103 (04) ◽  
pp. 710-717 ◽  
Author(s):  
Hanno Riess ◽  
Viola Hach-Wunderle ◽  
Horst Gerlach ◽  
Heike Carnarius ◽  
Sonja Eberle ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Clinical Presentation ◽  
Risk Groups ◽  
Pretest Probability ◽  
Probability Score ◽  
Vein Thrombosis ◽  
Diagnostic Work ◽  
Deep Vein ◽  
Work Up ◽  
Diagnostic Work Up

SummaryIt is uncertain whether gender influences the clinical presentation of deep-vein thrombosis (DVT) and the discriminative value of the Wells diagnostic pretest probability score. The aim of the study was to determine whether gender impacts the clinical presentation and diagnosis of DVT. The study analysed a cohort of 4,976 outpatients with clinically suspected DVT of the leg prospectively recruited by 326 vascular medicine physicians in the German ambulatory care sector between October and December 2005. The diagnosis of DVT was based on compression ultrasonography in 96% of patients. Among 4,777 patients who had a diagnostic work-up for DVT there were more women (n=2,998) than men (n=1,779). However, the prevalence of confirmed DVT was 37.0% (658/1779) in men vs. 24.3% (730/2,998) in women (p<0.001). Among patients with confirmed DVT, proximal DVT was more common in men (59.6% vs. 44.5% in women, p<0.001). Swelling of the leg, pitting oedema and dilated superficial veins were more frequently reported by men (p<0.001). The percentage of patients with a high probability Wells clinical pretest score was higher in men than in women (67.0% vs. 57.0%, p<0.001). However, overall, the score equally discriminated risk groups for DVT in both sexes. In conclusion, women were more frequently referred for a diagnostic work-up for DVT than men, but the prevalence of DVT was higher in men and their thrombotic events were more severe. Nevertheless, the Wells clinical pretest probability score correctly identified low- and high-risk groups in both genders.

scholarly journals The Diagnostic Performance of a Non-Emergency Department-Based Deep Vein Thrombosis Ambulatory Care Pathway

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 3405-3405
Author(s):  
Pape-Mamadou Sene ◽  
Denis Yahiaoui ◽  
Maral Koolian ◽  
Vicky Tagalakis
Keyword(s):  
Emergency Department ◽  
Ambulatory Care ◽  
Diagnostic Performance ◽  
Care Pathway ◽  
Vein Thrombosis ◽  
Diagnostic Work ◽  
Deep Vein ◽  
Work Up ◽  
Diagnostic Work Up

Background Ambulatory management of isolated acute deep vein thrombosis (DVT) is the standard of care in most patient populations, and in clinical practice is mostly initiated in the emergency department (ED). However, patients referred to the ED with suspected DVT often experience unnecessary delays to diagnosis and subsequent long stays to determine appropriate treatment and follow up care. We implemented a DVT ambulatory care pathway that does not include the ED for referred patients with suspected isolated DVT that begins with pre-test risk stratification in the community and subsequent algorithm-based diagnostic work-up, treatment, and follow-up at a tertiary care centre in Montreal Canada. Objective To determine the diagnostic performance of a non-ED based DVT ambulatory care pathway. Methods We determined the prevalence of DVT over a 46 week period between August 2018 and June 2019 among ambulatory patients with suspected isolated DVT who following community-based risk stratification using the modified Well's clinical prediction score were referred for diagnostic work up and treatment using a newly implemented non-ED based DVT ambulatory care pathway. Results Among 122 patients referred by community physicians, 86 (70%) met pre-defined pathway criteria for assessment of suspected DVT. In all, 42 (49%) were referred with an unlikely/low modified Well's score and 44 (51%) with a likely/high score. Overall, the prevalence of DVT was 19.8%, specifically 9.5% in the unlikely/low and 30.2% in the likely/high pretest probability groups, respectively. Conclusion Our results show that the diagnostic performance of a non-ED based acute DVT ambulatory care pathway is in line with literature estimates. The advantage of this pathway is that it offers clear, evidence-based guidance for community physicians to diagnosis and treat patients in an ambulatory setting without using the ED. The approach is likely to result in both healthcare and economic benefits, including increased patient satisfaction and shorter ED stays. Disclosures Tagalakis: Sanofi Aventis: Other: investigator initiated grant;participated on ad boards; Pfizer: Other: participated on ad boards; BMS-Pfizer: Other: participated on ad boards; Servier: Other: participated on ad boards; Bayer: Other: participated on ad boards.

DIAGNOSTIC WORK-UP AND DIAGNOSTIC SAFETY IN PATIENTS WITH SUSPECTED DEEP VEIN THROMBOSIS - DATA FROM THE GERMAN TULIPA REGISTRY

2007 ◽  
Vol 5 ◽  
pp. P-W-517-P-W-517
Author(s):  
S.M. Schellong ◽  
H. Gerlach ◽  
V. Hach-Wunderle ◽  
E. Rabe ◽  
H.B. Riess ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Vein Thrombosis ◽  
Diagnostic Work ◽  
Deep Vein ◽  
Work Up ◽  
Diagnostic Work Up

Imaging for venous thrombosis

ESC CardioMed ◽  
2018 ◽  
pp. 2806-2810
Author(s):  
Frederikus A. Klok ◽  
Charlotte E. A. Dronkers ◽  
Menno V. Huisman
Keyword(s):  
Deep Vein Thrombosis ◽  
Venous Thrombosis ◽  
Imaging Techniques ◽  
Clinical Decision ◽  
Cerebral Vein ◽  
Vein Thrombosis ◽  
Diagnostic Work ◽  
Deep Vein ◽  
Work Up ◽  
Test Probability

The diagnostic work-up of upper and of lower extremity deep vein thrombosis starts with the assessment of the pre-test probability by using a validated clinical decision rule, followed by imaging if deep vein thrombosis cannot reliably be rule out. For splanchnic vein thrombosis and cerebral vein thrombosis, the diagnostic assessment starts with imaging. Currently, the imaging techniques most widely used in clinical practice are compression ultrasonography, computed tomography, and magnetic resonance imaging, with a diagnostic standard dependent on the specific site of the venous thrombosis. This chapter provides an overview of the diagnostic accuracy and potential pitfalls of imaging techniques for the different sites of venous thrombosis.

scholarly journals Cannabinoid Hyperemesis Syndrome: The Missed Diagnosis

2020 ◽  
Vol 6 (3) ◽  
pp. 127-130
Author(s):  
João B. Fonseca ◽  
Daniela Vilaverde ◽  
Rosa Rodrigues ◽  
Pedro Morgado
Keyword(s):  
Illicit Drug ◽  
Cannabis User ◽  
Cannabinoid Hyperemesis Syndrome ◽  
History Of ◽  
Missed Diagnosis ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up ◽  
Cyclic Vomiting

Cannabis is the most cultivated and abused illicit drug worldwide. Paradoxically to the antiemetic properties attributed to cannabis, a relatively new cannabinoid hyperemesis syndrome (CHS) started to be recognized and is characterized by cyclic vomiting that are interspaced by asymptomatic phases. We present a case of a 36‑year‑old woman who repeatedly presented to the emergency room with cyclic vomiting that alleviated with hot showers. She was a long‑term cannabis user and the diagnosis was only established several years later after the onset of symptoms. The diagnostic work up was unremarkable, and the only effective treatment was cannabis cessation. Hot bathing behavior is a key characteristic of this syndrome. CHS is a new clinical condition that should be considered in a setting of recurrent and intractable vomiting in patients with a history of cannabis use.

Bone Marrow Aspirate Can Be Avoided in Low-Risk MGUS Patients

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 3997-3997
Author(s):  
Silvia Mangiacavalli ◽  
Federica Cocito ◽  
Lara Pochintesta ◽  
Cristiana Pascutto ◽  
Alessandra Pompa ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Aspirate ◽  
Conflicts Of Interest ◽  
Univariate Analysis ◽  
Low Risk ◽  
Invasive Procedures ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up ◽  
Monoclonal Component

Abstract Abstract 3997 Monoclonal gammopathy of undetermined significance (MGUS) is a premalignant plasmacell dyscrasia with a high prevalence. Diagnostic criteria include: presence of serum monoclonal component (MC) <30 g/l, <10% clonal plasma cells in the bone marrow (BMPC) and absence of end-organ damage according to CRAB criteria. Define the minimal diagnostic work up of patients with small amount of MC (<1.5 g/dl) at low risk for progression to multiple myeloma (MM) according to Mayo clinic stratification is still a matter of debate. This study assess the risk of missing a MM diagnosis not performing invasive procedures (bone marrow aspirate or biopsy) in presence of small amount MC. After approval by our local ethical committee, we retrospectively reviewed medical records of 2304 patients addressed to our single Hematology department for definition MC of IgG or IgA isotype. Diagnostic work-up included: bone marrow aspirate, skeletal bone survey and laboratory tests (i.e. complete blood count, chemistry screening including calcium and creatinine, serum protein electrophoresis and immunofixation, 24-hour urine electrophoresis for quantification of urinary monoclonal component). Patients were defined as having low-risk MC entity according to IMWG criteria (i.e. <1.5 mg/dl). There were 940 out of 2304 patients (41%) presenting with low-risk MC, among them a not negligible percentage (10%, 93 pts) encountered the criteria for MM after completing the scheduled diagnostic work-up. In detail 36% of them were asymptomatic, the remaining 64% presented at least one of CRAB criteria for active disease (60% had lytic lesions at skeletal survey). When adopting lower cut-off value of MC the criteria for MM were encountered in smaller amount of pts. In detail: 6% (30 out of 499 pts) and 4% (8 out of 206 pts) respectively for cut-off value at 1 or 0.5 g/dl respectively. Univariate analysis found a significant correlation between MC amount and BMPC either in MGUS (p<0.001) and MM patients (p<0.001). The probability of missing a MM diagnosis due to a set of value below a specified cut-off was assessed by means of a ROC curve analysis. The probability of finding a clonal BMPC infiltration ≥10% was of 15.4% keeping the serum MC cut-off value at 1.5 g/dl. The risk of missed MM diagnosis was significantly lower choosing low MC cut-off, with 7.5% and 2.8% risk of missed diagnosis for MC cut-off value of 1 g/dl and 0.5 g/dl respectively. Similar specificity value were found either when selecting patients with none of the CRAB criteria for symptomatic disease or with a IgA isotype. In conclusion our study showed a strict correlation between the amount of serum MC and BMPC infiltration. Excluding cases presenting with any of CRAB symptoms, the risk of missed MM diagnosis is very low (7.5%) in patients with a MC <1 g/dl, confirming the chance to avoid invasive procedures during diagnostic work-up of opportunely selected patients. Disclosures: No relevant conflicts of interest to declare.

Altered fibrin clot structure/function in patients with idiopathic venous thromboembolism and in their relatives

Blood ◽  
2009 ◽  
Vol 114 (19) ◽  
pp. 4272-4278 ◽  
Author(s):  
Anetta Undas ◽  
Krystyna Zawilska ◽  
Mariola Ciesla-Dul ◽  
Agata Lehmann-Kopydłowska ◽  
Agnieszka Skubiszak ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Structure Function ◽  
Ex Vivo ◽  
Fibrin Clot ◽  
Clot Lysis ◽  
Vein Thrombosis ◽  
Reactive Protein ◽  
History Of ◽  
Deep Vein ◽  
Clot Structure

Abstract We tested the hypothesis that fibrin structure/function is unfavorably altered in patients after idiopathic venous thromboembolism (VTE) and their relatives. Ex vivo plasma fibrin clot permeability, turbidimetry, and efficiency of fibrinolysis were investigated in 100 patients with first-ever VTE, including 34 with pulmonary embolism (PE), 100 first-degree relatives, and 100 asymptomatic controls with no history of thrombotic events. Known thrombophilia, cancer, trauma, and surgery were exclusion criteria. VTE patients and their relatives were characterized by lower clot permeability (P < .001), lower compaction (P < .001), higher maximum clot absorbancy (P < .001), and prolonged clot lysis time (P < .001) than controls, with more pronounced abnormalities, except maximum clot absorbance, in the patients versus relatives (all P < .01). Fibrin clots obtained for PE patients were more permeable, less compact, and were lysed more efficiently compared with deep-vein thrombosis patients (all P < .05) with no differences in their relatives. Being VTE relative, fibrinogen, and C-reactive protein were independent predictors of clot permeability and fibrinolysis time in combined analysis of controls and relatives. We conclude that altered fibrin clot features are associated with idiopathic VTE with a different profile of fibrin variables in PE. Similar features can be detected in VTE relatives. Fibrin properties might represent novel risk factors for thrombosis.

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