scholarly journals Atypical complication in an adult patient with dengue and autoimmune hemolytic anemia: a case report

2021 ◽  
Vol 15 (1) ◽  
pp. 43-48
Author(s):  
Supat Chamnanchanunt ◽  
Pravinwan Thungthong ◽  
Chajchawan Nakhakes ◽  
Putza Chonsawat ◽  
Tawatchai Suwanban
Keyword(s):  
Hemolytic Anemia ◽  
Autoimmune Hemolytic Anemia ◽  
Rare Complication ◽  
Dengue Infection ◽  
Volume Overload ◽  
Factor Vii ◽  
Severe Dengue ◽  
Severe Bleeding ◽  
Bleeding Tendency ◽  
Recombinant Activated Factor Vii

Abstract Severe dengue infection is associated with life-threatening complications, including severe bleeding. The bleeding tendency is typically associated with the shock phase of infection, for which blood replacement may be needed. However, repetitive blood transfusion can lead to volume overload. Administration of recombinant activated factor VII (rFVIIa) might be used to counteract bleeding without inducing volume overload. We describe the case of a patient with severe dengue infection who presented with intractable bleeding; he was initially treated with massive blood transfusions, which resulted in volume overload. He was then treated with rFVIIa to reverse the bleeding. During the second week of his hospitalization, his hematocrit dropped precipitously, and autoimmune hemolytic anemia was diagnosed. Supportive treatment was provided until recovery. Autoimmune hemolytic anemia is a rare complication in adult patients with dengue. Supportive care was effective for this atypical complication.

Atypical complication in an adult patient with dengue and autoimmune hemolytic anemia: a case report

2021 ◽  
Vol 15 (1) ◽  
pp. 43-48
Author(s):  
Supat Chamnanchanunt ◽  
Pravinwan Thungthong ◽  
Chajchawan Nakhakes ◽  
Putza Chonsawat ◽  
Tawatchai Suwanban
Keyword(s):  
Hemolytic Anemia ◽  
Autoimmune Hemolytic Anemia ◽  
Rare Complication ◽  
Dengue Infection ◽  
Volume Overload ◽  
Factor Vii ◽  
Severe Dengue ◽  
Severe Bleeding ◽  
Bleeding Tendency ◽  
Recombinant Activated Factor Vii

Abstract Severe dengue infection is associated with life-threatening complications, including severe bleeding. The bleeding tendency is typically associated with the shock phase of infection, for which blood replacement may be needed. However, repetitive blood transfusion can lead to volume overload. Administration of recombinant activated factor VII (rFVIIa) might be used to counteract bleeding without inducing volume overload. We describe the case of a patient with severe dengue infection who presented with intractable bleeding; he was initially treated with massive blood transfusions, which resulted in volume overload. He was then treated with rFVIIa to reverse the bleeding. During the second week of his hospitalization, his hematocrit dropped precipitously, and autoimmune hemolytic anemia was diagnosed. Supportive treatment was provided until recovery. Autoimmune hemolytic anemia is a rare complication in adult patients with dengue. Supportive care was effective for this atypical complication.

scholarly journals Epidemiological and Clinical Features of Dengue Infection in Adults in the 2017 Outbreak in Vietnam

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Bui Vu Huy ◽  
Le Nguyen Minh Hoa ◽  
Dang Thi Thuy ◽  
Nguyen Van Kinh ◽  
Ta Thi Dieu Ngan ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Dengue Fever ◽  
Clinical Features ◽  
Dengue Infection ◽  
Clinical Manifestations ◽  
Warning Signs ◽  
Severe Dengue ◽  
Severe Bleeding ◽  
Cross Sectional ◽  
Number Of Patients

Purpose. The clinical features and laboratory results of dengue-infected adult patients admitted to the hospital during the 2017 outbreak were analyzed in this study. Method. This is a cross-sectional study. 2922 patients aged 18 years or more with dengue fever in National Hospital for Tropical Diseases (NHTD) in the North and Hospital for Tropical Disease (HTD) in the South of Vietnam were recruited in this study. Result. Patients were admitted in the hospital around the year and concentrated from August to December, in 53/63 (84.0%) provinces in Vietnam, and patients in all ages were affected. The number of patients with dengue fever was 1675 (57.3%), dengue with warning signs 914 (31.3%), and severe dengue 333 (11.4%), respectively. Among patients with severe dengue, severe plasma leakage and dengue shock account for 238 (8.1%), severe organ impairment 73 (2.5%), and severe bleeding 22 (0.75%). The rate of mortality was 0.8%, and the outcome of dengue patients is worse in the elderly and people with underlying diseases. Conclusion. The 2017 dengue outbreak occurred in a larger scale than in the previous years in terms of time, location, and number of patients. More elderly patients were infected by dengue in this outbreak, and this may contribute to the mortality rate. Clinical manifestations of dengue patients in Southern Vietnam are more typical than the northern, but the rate of severe dengue is not different. The mortality risk and underlying conditions associated with dengue-infected elderly patients are worthy of further investigations in the future.

scholarly journals The Thrombogram in Rare Inherited Coagulation Disorders: Its Relation to Clinical Bleeding

2002 ◽  
Vol 88 (10) ◽  
pp. 576-582 ◽  
Author(s):  
Raed Al Dieri ◽  
Flora Peyvandi ◽  
Elena Santagostino ◽  
Muriel Giansily ◽  
Pier Mannuccio Mannucci ◽  
...  
Keyword(s):  
Lag Time ◽  
Peak Height ◽  
Factor Vii ◽  
Clotting Factor ◽  
Severe Bleeding ◽  
Factor V ◽  
Bleeding Tendency ◽  
Factor X ◽  
Factor Xi ◽  
Factor Concentration

SummaryWe investigated the relation between clotting factor concentration, the parameters of the thrombin generation curve (the thrombogram) and the severity of clinically observed bleeding in patients with congenital deficiency of prothrombin (n = 21), factor V (n = 22), factor VII (n = 22), factor X (n = 10), factor XI (n = 7) and factor XII (n = 6). The parameters used were: area under the curve (endogenous thrombin potential, ETP), peak concentration of thrombin attained and lag time before manifest formation.Peak height and ETP varied linearly with the concentration of prothrombin. For the other factors these parameters hyperbolically approached to the 100% limit with increasing clotting factor concentration. Half normal ETP was seen at about the following concentrations: prothrombin (50%), factor V (1%), factor VII (2%), factor X (5%) and factor XI (1%). As a rule, the peak height was somewhat more sensitive to clotting factor decrease than the ETP was.In all the patients with severe bleeding symptoms the ETP was less than 20% of normal. Bleeding tendency was absent or mild in patients with an ETP of 30% or higher. This value (except for prothrombin) is already obtained at concentrations of clotting factor of 1%-2%, which corroborates the clinical observation that a severe bleeding tendency is only seen in severe clotting factor deficiencies (less than 1%). The one exception was a patient with factor VII deficiency and severe bleeding, who showed a normal ETP value, albeit with a decreased peak height and a prolonged lag-time.

A Rare Cause of Anemia in Inflammatory Bowel Diseases: A Case Report and Review of Literature

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 5385-5385
Author(s):  
Waqas Ahmed ◽  
Kevin Monroe ◽  
James Essell ◽  
E. Randolph Broun
Keyword(s):  
Case Report ◽  
Hemolytic Anemia ◽  
Inflammatory Bowel Diseases ◽  
Autoimmune Hemolytic Anemia ◽  
Blood Smear ◽  
Rare Complication ◽  
Peripheral Blood Smear ◽  
Bowel Diseases ◽  
Inflammatory Bowel

Abstract Introduction: Anemia is a common problem in patients with inflammatory bowel diseases (IBD), and its etiology is usually multifactorial. It can be produced by chronic blood loss, nutritional deficiencies, and drugs such as salazopyrine; however it can also due to auto immune hemolysis, which is a rare complication of IBD. We report a case of coombs positive autoimmune hemolytic anemia associated with ulcerative colitis both diagnosed at the same presentation. Case Report: A 32 year old man with no significant past medical history presented with complaint of dark colored urine, jaundiced skin and fatigue for 4 weeks. He also reported diarrhea mixed intermittently with blood for last few months. Physical exam was consistent with jaundice and anemia (pallor and icterus) with slightly palpable spleen. Initial lab work up showed Hb of 3.8 with normal platelet and WBC count, high reticulocytes count of 7% .LFT showed serum bilirubin of 3.6 (direct 0.4) with normal serum ALT and AST levels .Serum LDH was high (1032 U/l) while serum haptoglobin was low (0.11 mg/dl). Peripheral smear showed anisopoikilocytosis & spherocytosis. (See Figure 1) Further investigations revealed a positive direct Coombs test consistent with diagnosis of autoimmune hemolytic anemia. CT abdomen and pelvis showed mild splenomegaly & non-specific enlarged mesenteric lymph nodes. Colonoscopy revealed ulcerative pancolitis confirmed by histological findings of biopsies taken. Patient received PRBC transfusions and was started on steroids and mesalamine and was discharged on maintenance dose. His symptoms resolved in 4 weeks and Hb remained stable with no evidence of further hemolysis at 4 month follow up .Repeated CT abdomen & pelvis showed resolution of the lymphadenopathy. Figure 1: Peripheral Blood smear showing anisopoikilocytosis & spherocytosis. Figure 1:. Peripheral Blood smear showing anisopoikilocytosis & spherocytosis. Discussion: Autoimmune hemolytic anemia (AIHA) is a rare complication of IBD. The exact underlying pathogenesis of this association remains obscure; however it has been attributed to the production of cross reacting anti erythrocyte antibodies. In AIHA associated with IBD, corticosteroids are considered to be first line therapy and often cause remission of hemolysis along with treatment for IBD Immunomodulators and splenectomy has been used for patients with refractory AIHA. Colectomy done for fulminant colitis has also been reported to induce remission of AIHA. Further studies for long term follow up and pathogenesis of this association are warranted.

scholarly journals PROGNOSTIC FACTORS OF SEVERE DENGUE INFECTIONS IN CHILDREN

2020 ◽  
Vol 8 (1) ◽  
pp. 44
Author(s):  
Senja Baiduri ◽  
Dominicius Husada ◽  
Dwiyanti Puspitasari ◽  
Leny Kartina ◽  
Parwati Setiono Basuki ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Dengue Fever ◽  
Complete Blood Count ◽  
Dengue Infection ◽  
Clinical Signs ◽  
Morbidity And Mortality ◽  
Severe Dengue ◽  
Bivariate Analysis ◽  
Severe Bleeding ◽  
Prolonged Aptt

The  incidence of dengue fever increase annually and can increase morbidity and mortality. Dengue fever is mosquito-borne disease and caused by one of four serotype dengue viruses. Severe dengue is characterized either by plasma leakage, fluid accumulation, respiratory distress, severe bleeding, or organ impairment. Mortality and serious morbidity of dengue were caused by several factors including the late recognition of the disease and the changing of clinical signs and symptoms. Understanding the prognostic factors in severe dengue will give early warning to physician thus decreasing the morbidity and mortality, and also improving the treatment and disease management. The aim of this study was to analyze the prognostic factors of severe dengue infection in children. This study was observational cohort study in children (2 months-18 years) with dengue infection according to WHO 2009 criteria which admitted in  Soetomo and Soewandhie Hospital Surabaya. Analysis with univariate, bivariate and multivariate with IBM SPSS Statistic 17. All patients were confirmed by serologic marker (NS-1 or IgM/IgG Dengue). Clinical and laboratory examination such as complete blood count, aspartate aminotrasnferase (AST), alanine aminotrasferase (ALT), albumin, and both partial trombocite time and activated partial trombosit time (PTT and aPPT) were analyzed comparing nonsevere dengue and severe dengue patients. There were 40 subjects innonsevere and 27 subjects with severe dengue infection. On bivariate analysis, there were significant differences of nutritional status, abdominal pain, petechiae, pleural effusion, leukopenia, thrombocytopenia, hypoalbuminemia, history of transfusion, increasing AST>3x, prolonged PPT and APTT between severe and nonsevere dengue group. After multivariate analyzed, the prognostic factors of severe dengue were overweight/obesity (p=0.003, RR 94), vomiting (p=0.02, RR 13.3), hepatomegaly (p=0.01, RR=69.4), and prolonged APTT (p=0.005, RR=43.25). In conclusion, overweight/obesity, vomiting, hepatomegaly, and prolonged APTT were prognostic factors in severe dengue infection in children.Those factors should be monitored closely in order to reduce the mortality and serious morbidity.

scholarly journals Sepsis-induced Autoimmune Hemolytic Anemia: A Case Report

2020 ◽  
Vol 4 (4) ◽  
pp. 668-670
Author(s):  
Zach Edwards ◽  
Stephen DeMeo
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Case Report ◽  
Hemolytic Anemia ◽  
Patient Outcomes ◽  
Autoimmune Hemolytic Anemia ◽  
Rare Complication ◽  
Signs And Symptoms ◽  
Emergency Physicians ◽  
Colonic Diverticula

Introduction: Sepsis commonly brings patients to the emergency department (ED). Patient outcomes can vary widely. In some cases, rare complications of sepsis such as autoimmune hemolytic anemia can occur. Case Report: A 68-year-old female presented with sepsis secondary to infected nephrolithiasis. The patient had signs and symptoms consistent with hemolysis upon arrival to the ED. Her hemolysis progressively worsened over a two-day period leading to a diagnosis of warm autoimmune hemolytic anemia. She responded well to treatment; however, her condition began to worsen due to a new infection caused by perforated colonic diverticula. The patient ultimately expired from complications of her perforated colonic diverticula. Conclusion: It is crucial that emergency physicians understand the risk factors, symptoms, pathophysiology, and treatment of this rare complication of sepsis so that favorable patient outcomes can be achieved.

An Interesting Case of EBV-Associated Autoimmune Hemolytic Anemia

2019 ◽  
Vol 152 (Supplement_1) ◽  
pp. S87-S88
Author(s):  
Sapna Desai ◽  
Jeffrey West ◽  
Salvador Sena
Keyword(s):  
Hemolytic Anemia ◽  
Autoimmune Hemolytic Anemia ◽  
Cell Function ◽  
Hepatitis B Surface Antigen ◽  
Rare Complication ◽  
Macrocytic Anemia ◽  
Interesting Case ◽  
Significant Past Medical History ◽  
Adequate Treatment ◽  
Laboratory Test Results

Abstract We report a case of a 28-year-old male with no significant past medical history who presented with a weeklong history of flu-like symptoms, dark urine, and cold-induced pain and discoloration in his fingers. Upon presentation, he was noted to be significantly jaundiced. Abdominal ultrasound showed splenomegaly. Laboratory test results returned as follows: hematocrit, 26.4%; hemoglobin, 9.0 g/dL; WBC count, 9.8 × 109/L; and automated differential, 0.42 segmented neutrophils, 0.44 lymphocytes, and 0.08 monocytes. Manual differential showed 0.26 atypical lymphocytes, 0.21 lymphocytes, 0.10 monocytes, 0.03 metamyelocytes, and 0.05 segmented neutrophils. He was found to have a normochromic macrocytic anemia with absolute lymphocytosis, monocytosis, and thrombocytopenia. Peripheral blood smear revealed normochromic macrocytic RBCs with anisocytosis. Downey type II cells, plasmacytoid lymphocytes, large activated lymphocytes, and monocytes were present in addition to a neutrophilic left shift up to metamyelocytes. Liver function tests showed elevated levels of total bilirubin (8.4 mg/dL), direct bilirubin (2.6 mg/dL), aspartate aminotransferase (193 U/L), alanine aminotransferase (102 U/L), and alkaline phosphatase (132 U/L). Urinalysis was positive for urobilinogen. Serology was nonreactive for anti–hepatitis A IgM, hepatitis B surface antigen, and anti–hepatitis C antibody. Positive results were obtained for a rapid monoscreening test and Epstein-Barr virus viral capsid antigen IgM. Direct antiglobulin testing showed positivity for IgG, and complement and cold autoantibody were detected. He was transfused and treated with prednisone, IVIG, and external warmth. After improvement, the patient was discharged with recommendations for follow-up. Hemolytic anemia is a relatively rare complication of patients with infectious mononucleosis and occurs in approximately 1% to 3% of these patients. The pathogenesis of EBV-related autoimmune hemolytic anemia is unknown, with a suspicion for inadequate B-cell function after infection. Appropriate laboratory testing and analysis are critical for rapid diagnosis in these patients to ensure adequate treatment with no long-term sequelae.

Bleeding after cardiac surgery

2006 ◽  
Vol 26 (S 02) ◽  
pp. S76-S86
Author(s):  
C. Spies ◽  
H. Grubitzsch ◽  
H. Schönfeld ◽  
M. Sander ◽  
Th. Volk ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Blood Loss ◽  
Factor Vii ◽  
Coagulation System ◽  
Severe Bleeding ◽  
International Studies ◽  
Recombinant Activated Factor Vii ◽  
Activated Factor Vii ◽  
Increased Risk ◽  
Heart Lung Machine

SummaryCardiac surgery carries the risk of significant blood loss requiring the transfusion of blood products. In addition to such blood loss, international studies have shown that severe bleeding necessitating re-operation occurs in 3–5% of patients. Morbidity and mortality are significantly increased, so effective and safe haemostatic measures will decisively improve outcome of patients.Recombinant activated factor VII (rFVIIa) has been approved for the treatment of patients with inhibitor haemophilia, as well as with Glanzmann’s thrombasthenia and factor VII deficiency. Many publications have appeared in the last few years which report the successful and reliable use of rFVIIa for the treatment of refractory bleeding after cardiac surgery. This review presents the pathophysiological changes in the coagulation system which occur when a heart-lung machine is used and which have been blamed for an increased risk of bleeding in patients who have undergone cardiac surgery. Published experience with rFVIIa in paediatric and adult cardiac surgery is presented and discussed critically with regard to the efficacy and safety of its use.

F7 gene variants modulate protein levels in a large cohort of patients with factor VII deficiency

2017 ◽  
Vol 117 (08) ◽  
pp. 1455-1464 ◽  
Author(s):  
Gabriele Quintavalle ◽  
Federica Riccardi ◽  
Gianna Rivolta ◽  
Davide Martorana ◽  
Caterina Di Perna ◽  
...  
Keyword(s):  
Diagnostic Testing ◽  
Autosomal Recessive Inheritance ◽  
Large Cohort ◽  
Factor Vii ◽  
Common Mechanism ◽  
Poor Correlation ◽  
Severe Bleeding ◽  
Bleeding Tendency ◽  
Large Deletions ◽  
Fvii Deficiency

SummaryCongenital factor VII (FVII) deficiency is a rare bleeding disorder caused by mutations in F7 gene with autosomal recessive inheritance. A clinical heterogeneity with poor correlation with FVII:C levels has been described. It was the objective of this study to identify genetic defects and to evaluate their relationships with phenotype in a large cohort of patients with FVII:C<50%. One hundred twenty-three probands were genotyped for F7 mutations and three polymorphic variants and classified according to recently published clinical scores. Forty out of 123 patients (33?%) were symptomatic (43 bleedings). A severe bleeding tendency was observed only in patients with FVII:C<0.10%. Epistaxis (11%) and menorrhagia (32% of females in fertile age) were the most frequent bleedings. Molecular analysis detected 48 mutations, 20 not reported in the F7 international databases. Most mutations (62%) were missense, large deletions were 6.2%. Compound heterozygotes/homozygotes for mutations presented lower FVII:C levels compared to the other classes (Chi2=43.709, p<0,001). The polymorphisms distribution was significantly different among the three F7 genotypic groups (Chi2=72.289, p<0,001). The presence of truncating mutations was associated with lowest FVII:C levels (Chi2=21.351, p=0.002). This study confirms the clinical and molecular variability of the disease and the type of symptoms. It shows a good correlation between the type of F7 mutation and/or polymorphisms and FVII:C levels, without a direct link between FVII:C and bleeding tendency. The results suggest that large deletions are underestimated and that they represent a common mechanism of F7 gene inactivation which should always be investigated in the diagnostic testing for FVII deficiency.

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