Management of Refractory Hemorrhage in a Kala-Azar Patient with Thrombocytopenia and Coagulopathy by Using Recombinant Factor VIIa (rFVIIa).

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 4090-4090
Author(s):  
Goksel Leblebisatan ◽  
Ilgen Sasmaz ◽  
Bulent Antmen ◽  
Yurdanur Kilinc ◽  
Umit Sizmaz Celik ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Platelet Transfusion ◽  
Leishmania Donovani ◽  
Factor Viia ◽  
Bone Marrow Aspiration ◽  
Fresh Frozen Plasma ◽  
Plasma Vitamin ◽  
Severe Thrombocytopenia ◽  
Kala Azar ◽  
Life Threatening

Abstract Objective: Platelet transfusion is used for the treatment of acute hemorrhages in diseases other than immunological events, which lead to severe thrombocytopenia. Besides the diseases in which production of platelets is completely terminated in the bone marrow and the platelet requirement is increased, immune thrombocytopenia and alloimmunization may also result in not being able to achieve the desired platelet levels with platelet transfusion, and life threatening hemorrhages. rFVIIa which is used for the management of life threatening hemorrhages in hemophiliac patients with inhibitors and in cases of acquired coagulopathies has also been used successfully in patients with thrombocytopenia. Here we present a case with a diagnosis of kala-azar, where nasal hemorrhage couldn’t be managed with conventional methods and required continuous replacement, and finally treated successfully by using rFVIIa. Case: At admittance to hospital, hepatosplenomegaly and pancytopenia were detected in the fifteen year old male patient. He was diagnosed with kala-azar upon the detection of Leishmania donovani amastigote form in the examination for bone marrow aspiration. Treatment with sodium stibogluconate was initiated (60 mg/kg). Replacements were performed in the patient due to thrombocytopenia and anemia, who developed nasal hemorrhage during follow-up and had anterior nasal cushion placed. The patient was supplemented with fresh frozen plasma, vitamin K and fibrinogen for his acquired coagulopathy. Since coagulopathy wasn’t corrected and nasal hemorrhage continued actively, 5-minute infusions of rFVIIa were administered to the patient at a dose of 4.8 mg (120 microgram/dl) three times every two hours. His hemorrhage was stopped by rFVIIa treatment. Conclusion: Our case demonstrated that use of rFVIIa for the management of hemorrhage in thrombocytopenic patients is also feasible in cases other than coagulopathy and that it may be an option for patients with hemorrhages that can not be managed with intensive platelet and plasma transfusions. This result shows that rFVIIa can be used effectively in other diseases other than hematological disorders that cause hemorrhage due to coagulopathy and thrombocytopenia.

scholarly journals Comparison of KAtex, Bone Marrow Aspiration and DAT for the Diagnosis of Visceral Leishmaniasis

2019 ◽  
Vol 6 (1) ◽  
pp. 12-15
Author(s):  
Ishrat Sharmin ◽  
AKM Quamruzzaman ◽  
Rezina Parveen ◽  
M Abdulah Yusuf ◽  
Rashida Akter Khanam
Keyword(s):  
Bone Marrow ◽  
Visceral Leishmaniasis ◽  
Leishmania Donovani ◽  
Bone Marrow Aspiration ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Medical College ◽  
Kala Azar ◽  
History Of ◽  
One Year

Background: Newly developed KAtex test can be used as a non invasive tool for diagnosis of Kala-azar. Objectives: The aim of the present study was to compare KAtex, Bone marrow aspiration and DAT to diagnose VL. Methodology: This cross-sectional study was carried out in the Department of Microbiology at Dhaka Medical College, Dhaka, Bangladesh in collaboration with the Department of Parasitology, Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh for a period of one year. Clinically suspected Kala-azar (VL) cases of different age and sex attending IEDCR, Dhaka from different Kala-azar endemic areas of Bangladesh were selected for this study. Patients having fever for more than 2 weeks, with or without splenomegaly, having history of loss of body weight following onset of fever were clinically suspected as Kala-azar cases. Microscopy and culture was performed in bone marrow (BM). KAtex was performed with urine sample. Agglutination of sensitized latex indicated presence of Leishmania donovani antigen in urine and thereby visceral leishmaniasis. No agglutination indicates absence of antigen in urine. DAT was done with serums of all cases. Result: Among 130 clinically suspected VL cases, 70 (53.85%) cases were BM positive and 60(46.15%) cases were BM negative. All the 70 BM positive cases were positive by KAtex and DAT. Among 60 BM negative cases, 15 were positive by KAtex and 23 were positive by DAT. The sensitivity of KAtex was 100.0% and specificity was 75.0%. The sensitivity of DAT was 100.0% and specificity is 61.6%. Conclusion: In conclusion, KAtex test is a good diagnostic tool for the detection of VL in comparison with DAT. Bangladesh Journal of Infectious Diseases, June 2019;6(1):12-15

Clinical and Infective Outcome of Parasitologicaly Confirmed Kala-Azar Patients Treated with Sodium Antimony Gluconate

1970 ◽  
Vol 11 (1) ◽  
pp. 12-16
Author(s):  
Quazi Tarikul Islam ◽  
Ahasan Habib ◽  
Azizul Haque Azad ◽  
HAM Nazmul Ahasan ◽  
Md Mahmudur Rahman Siddiqui ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Leishmania Donovani ◽  
Clinical Manifestations ◽  
Bone Marrow Aspiration ◽  
Sand Fly ◽  
College Hospital ◽  
Female Ratio ◽  
Medical College ◽  
Kala Azar ◽  
Sodium Antimony Gluconate

A total of fifty consecutive cases of Kala-azar admitted in the medicine units of Rajshahi Medical College Hospital during the period from February 2006 to October 2006 were included in this study. The number of the patients clearly indicates that the burden of Kala-azar in this region is significant and expanding. Male to female ratio was 1.9:1. Fever (96%) and splenomegaly (100%) were the predominant features. Hepatomegaly was found in 82% of the cases. Other clinical manifestations were Hyperpigmentation (76%), weight loss (62%), pallor (60%), jaundice (10%), oedema (10%), cough (6%) and lymphadenopathy (4%). Fever of 75% cases subsided within one week of starting treatment. Weight of 89.6% cases increased after completion of treatment. After completion of treatment spleen size regressed in 95.8% cases and no LD (Leishmania donovani) body was seen in 46 (92%) patients splenic / bone marrow aspiration after completion of treatment. 2 (4%) patients remain LD body positive after completion of treatment and 2 (4%) patients died during treatment. Still sodium antimony gluconate (SAG) is very effective in the clinical and parasitologicaly confirmed Kala-azar patients. A combination of sand fly control, early detection and treatment of the patients is the best approach for controlling Kala-azar. Keyword: Kala-azar, Sodium Stibogluconate, LD (Leishmania donovani) body, splenic or bone marrow aspiration. DOI:10.3329/jom.v11i1.4261 J Medicine 2010: 11: 12-16

Bone Marrow Aspiration Findings in Kala-Azar

2010 ◽  
Vol 54 (1) ◽  
pp. 12-24 ◽  
Author(s):  
Yahya Daneshbod ◽  
Seyed J. Dehghani ◽  
Khosrow Daneshbod
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Aspiration ◽  
Kala Azar

scholarly journals Pancytopenia: A Clinico Hematological Study

2011 ◽  
Vol 3 (01) ◽  
pp. 015-020 ◽  
Author(s):  
Gayathri B N. ◽  
Kadam Satyanarayan Rao
Keyword(s):  
Bone Marrow ◽  
Megaloblastic Anemia ◽  
Hematological Parameters ◽  
Disease Process ◽  
Bone Marrow Aspiration ◽  
Drug Induced ◽  
Male Predominance ◽  
Bone Marrow Hypoplasia ◽  
Life Threatening ◽  
A Prospective Study

ABSTRACT Background: Pancytopenia is a relatively common hematological entity. It is a striking feature of many serious and life-threatening illnesses, ranging from simple drug-induced bone marrow hypoplasia, megaloblastic anemia to fatal bone marrow aplasias and leukemias. The severity of pancytopenia and the underlying pathology determine the management and prognosis. Thus, identification of the correct cause will help in implementing appropriate therapy. Objectives: To study the clinical presentations in pancytopenia due to various causes; and to evaluate hematological parameters, including bone marrow aspiration. Materials and Methods: It was a prospective study, and 104 pancytopenic patients were evaluated clinically, along with hematological parameters and bone marrow aspiration in Hematology Unit, Department of Pathology, JJMMC, Davanagere, during the period of September 2005 to September 2007. Results: Among 104 cases studied, age of patients ranged from 2 to 80 years with a mean age of 41 years, and male predominance. Most of the patients presented with generalized weakness and fever. The commonest physical finding was pallor, followed by splenomegaly and hepatomegaly. Dimorphic anemia was the predominant blood picture. Bone marrow aspiration was conclusive in all cases. The commonest marrow finding was hypercellularity with megaloblastic erythropoiesis. The commonest cause for pancytopenia was megaloblastic anemia (74.04%), followed by aplastic anemia (18.26%). Conclusion: The present study concludes that detailed primary hematological investigations along with bone marrow aspiration in cytopenic patients are helpful for understanding disease process and to diagnose or to rule out the causes of cytopenia. These are also helpful in planning further investigations and management.

scholarly journals An Unusual Case of Aplastic Anemia Caused by Temozolomide

2010 ◽  
Vol 2010 ◽  
pp. 1-2 ◽  
Author(s):  
Gazi Comez ◽  
Alper Sevinc ◽  
Ozlem Nuray Sever ◽  
Taner Babacan ◽  
Ibrahim Sarı ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Adjuvant Therapy ◽  
Aplastic Anemia ◽  
Adjuvant Treatment ◽  
Unusual Case ◽  
English Literature ◽  
Bone Marrow Aspiration ◽  
High Grade Glioma ◽  
High Grade ◽  
Life Threatening

Radiotherapy and concomitant/adjuvant therapy with temozolomide are a common treatment regimen for children and adults with high-grade glioma. Although temozolomide is generally safe, it can rarely cause life-threatening complications. Here we report a case of a 31-year-old female patient who underwent surgical resection followed by radiotherapy plus concomitant temozolomide. She developed pancytopenia after adjuvant treatment with temozolomide. A bone marrow aspiration and biopsy showed hypocellularity with very few erythroid and myeloid cells, consistent with aplastic anemia. In the English literature, aplastic anemia due to temozolomide is extremely rare.

Refractory Thrombocytopenia Due to Allo-Immune Anti-CD36 Complicating Unrelated Donor Bone Marrow Transplant in a CD36-Negative Recipient.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4951-4951
Author(s):  
William R. Broderick ◽  
Amir A. Toor ◽  
Brian R. Curtis ◽  
Tulio E. Rodriguez ◽  
Scott E. Smith ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Transplant ◽  
Platelet Transfusion ◽  
Family Members ◽  
Marrow Transplant ◽  
Unrelated Donor ◽  
Severe Thrombocytopenia ◽  
Allogeneic Bone ◽  
Donor Bone Marrow ◽  
Antibody Titers

Abstract Platelet transfusion refractoriness following allogeneic bone marrow transplantation usually stems from HLA alloimmunization. However other platelet antigens may serve as targets of alloimmune reactivity. A 24-year-old Palestinian male with atypical CML in chronic phase underwent matched unrelated donor bone marrow transplant from a 39-year-old female, HLA-A, B, C and DR allele level matched donor. Conditioning was with busulfan 0.8mg/Kg IV q6 hours day -8 through -4, cyclophosphamide 60mg/Kg IV daily day -3 & -2 and rabbit anti-thymocyte globulin 1.5mg/Kg IV daily day -5 & -4. Graft versus host disease prophylaxis was with mini-dose methotrexate and tacrolimus, with filgrastim given for hematopoietic reconstitution. The cell dose was 1.86x106 CD34+ cells/Kg recipient body weight (3.66x108 mononuclear cells/Kg). Neutrophil engraftment occurred on day +14, and was complicated by a diffuse purpuric skin rash, with hypoxia and pulmonary infiltrates which resolved with corticosteroid therapy. His post-transplant course was also complicated by severe, transfusion refractory thrombocytopenia (to random donor pools, apheresis and crossmatched platelet units) starting on day +5 with platelet counts of <5x103/μL. He developed intra-retinal hemorrhage of the right eye, scleral hemorrhage bilaterally, epistaxis and muco-cutaneous bleeding. During the first 30 days following BMT he received 53 doses of platelets in addition to aminocaproic acid. He did not have DIC, splenomegaly or evidence of microangiopathy. HLA alloantibodies were not identified. Antigen Capture ELISA and flow cytometry for platelet specific antibody identification however demonstrated antibodies specific for CD36 in the patient’s serum (Fig). Platelets from the bone marrow donor typed positive for CD36. IVIG 0.5gm/Kg IV on d+13, 14, and 17 and Rituximab 375mg/m2 IV d + 17, 64, 72, and 82 were administered with no therapeutic response. The patient finally responded to transfusions of platelets collected from family members (parents, siblings and cousins) who were CD36negative. Bone marrow biopsies 2 months and 4 months following transplantation showed no evidence of residual disease with trilineage engraftment and adequate megakaryocytes, normal cytogenetics and >98% donor chimerism. As his immunosuppression has been tapered over time, the antibody titer has declined (Fig) as has his platelet transfusion requirement (41 doses transfused between day 31 and 120). However he remains dependent upon directed donor platelet transfusions from his CD36 negative family members at 120 days from transplant. The CD36 negative phenotype is rare in Caucasians, however, platelets from about 5% of individuals of Asian or African descent lack CD36. DNA sequencing to determine CD36 mutations in this patient is underway. We hypothesize that this patient developed a host vs. graft humoral response against donor derived and transfused platelets resulting in sustained severe thrombocytopenia. Patient serum CD36 antibody titers following transplant Patient serum CD36 antibody titers following transplant

scholarly journals Recombinant Activated Factor VIIa Use in Massive Transfusion and Coagulopathy Unresponsive to Conventional Therapy

2005 ◽  
Vol 33 (2) ◽  
pp. 196-200 ◽  
Author(s):  
C. J. D. Gowers ◽  
M. J. A. Parr
Keyword(s):  
Conventional Therapy ◽  
Factor Viia ◽  
Artery Aneurysm ◽  
Fresh Frozen Plasma ◽  
Iliac Artery Aneurysm ◽  
Rfviia Administration ◽  
Fresh Frozen ◽  
Life Threatening ◽  
Close Range ◽  
Acute Fatty Liver

We report a retrospective analysis of patients admitted to a tertiary intensive care unit who received recombinant activated factor VIIa (rFVIIa) in an effort to control life-threatening haemorrhage and coagulopathy. Data extracted included: demographics, diagnoses and clinical course, dosage of rFVIIa, blood product requirements and coagulation tests prior to and after rFVIIa, pH, base deficit and temperature. During the study period rFVIIa was given to nine patients with refractory coagulopathy in imminent danger of death. Three patients were post cardiac surgery, three patients had multiple blunt trauma, one patient had a close range shotgun wound to the abdomen, one patient had a ruptured iliac artery aneurysm and one patient was post caesarean section with acute fatty liver of pregnancy. Improvements in prothrombin time (PT) (median 17s pre vs 10.6s post rFVIIa (P<0.05)) were seen in all nine cases. Reduced requirements for red blood cells, fresh frozen plasma, platelets and cryoprecipitate followed rFVIIa administration in eight cases. One patient died after 48 hours of complications unrelated to the initial pathology. Seven patients were discharged from hospital; one remains in hospital. rFVIIa provided improvement in coagulopathy unresponsive to conventional therapy.

scholarly journals LD Body in Epitrochliar Lymphnode in a Bone Marrow and Splenic Aspiration Negative Indian Kala Azar

1970 ◽  
Vol 12 (2) ◽  
pp. 188-190
Author(s):  
Ratan Das Gupta ◽  
Aparna Das ◽  
Titu Miah ◽  
Mohammad Ashik Imran Khan ◽  
Muntasir Hasnain ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Adult Male ◽  
Leishmania Donovani ◽  
Sand Fly ◽  
Parasitic Disease ◽  
Common Presentation ◽  
Kala Azar

Kala Azar is a parasitic disease cause by Leishmania Donovani, transmitted by sand fly phlebotomus. Lymphadenopathy is not a common presentation in Indian Kala azar. We present an adult male from endemic zone of kalaazar presented with epitrochlear lymphadenopathy and hepato-splenomegaly and diagnosed by presence LD in lymphnode biopsy. Keyword: Kala Azar, Lymphadenopathy, Leishmania Donovani (LD) body, Bangladesh DOI: http://dx.doi.org/10.3329/jom.v12i2.8429 JOM 2011; 12(2): 188-190

scholarly journals Vancomycin-dependent antibodies associated with thrombocytopenia and refractoriness to platelet transfusion in patients with leukemia

Blood ◽  
1990 ◽  
Vol 75 (2) ◽  
pp. 518-523 ◽  
Author(s):  
DJ Christie ◽  
N van Buren ◽  
SS Lennon ◽  
JL Putnam
Keyword(s):  
Platelet Transfusion ◽  
Protein A ◽  
Enzyme Linked Immunosorbent Assay ◽  
Severe Thrombocytopenia ◽  
Staphylococcal Protein A ◽  
Igg Antibodies ◽  
Patient Withdrawal ◽  
Life Threatening ◽  
Drug Dependent ◽  
Vancomycin Treatment

Two patients with leukemia experienced profound thrombocytopenia and refractoriness to platelet transfusion during vancomycin treatment. In one patient, withdrawal of drug and administration of platelet transfusions restored platelet counts to near normal levels (approximately 100 x 10(9)/L), however, subsequent challenge with vancomycin due to recurring infection again precipitated severe thrombocytopenia (platelets less than 10 x 10(9)/L) and life- threatening hemorrhagic symptoms. Potent vancomycin-dependent antiplatelet antibodies were detected in the serum of both patients during the refractory period using staphylococcal protein A rosette formation. Employing a monoclonal antibody-antigen capture enzyme- linked immunosorbent assay (ELISA), the patients were found to have vancomycin-dependent IgG antibodies that bound specifically to platelet glycoproteins (GP) IIb and/or IIIa. One of these antibodies failed to react with platelets deficient in GPIIb/IIIa obtained from an individual with Glanzmann's thrombasthenia. These findings provide the first major evidence for drug-dependent antibodies in association with severe thrombocytopenia and refractoriness to platelet transfusion in alloimmunized leukemia patients and, further, provide the first demonstration of vancomycin-dependent antibodies reactive with platelets.

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