Viscoelastic properties of a blood clot and the manifestations of hemorrhagic syndrome in thrombocytopeniс patients with hemoblastosis

Введение. Тромбоцитопения является частым осложнением онкогематологических заболеваний, которое провоцирует развитие геморрагического синдрома. Уровень тромбоцитов в периферической крови, являющийся пороговым для переливания концентрата тромбоцитов (КТ), окончательно не установлен. Применение тромбоэластографии (ТЭГ) при тромбоцитопениях у онкогематологических больных может повысить прогностические возможности определения риска кровотечений. Цель исследования: оценить вязко-эластические свой ства сгустка крови при тромбоцитопении менее 50×109/л и их взаимосвязь с проявлениями геморрагического синдрома у онкогематологических больных. Материалы и методы. В исследование включено 84 пациента с гемобластозами и тромбоцитопенией менее 50×109/л, 54 (64%) мужчины и 30 (36%) женщин, медиана возраста — 54 года. В зависимости от уровня тромбоцитов в периферической крови пациентов разделили на 2 группы: группа 1 — 44 пациента с числом тромбоцитов от 25 до 50×109/л, группа 2 — 40 больных с содержанием тромбоцитов менее 25×109/л. Исследовали показатели периферической крови, коагулограммы и ТЭГ. Степень тяжести кровотечений оценивали по шкале проявлений геморрагического синдрома (ВОЗ) и по шкале оценки побочных явлений Национального института рака (США). Результаты. Гипокоагуляция по ТЭГ в группе 1 выявлена в 46% случаев, в группе 2 — в 75%. Значимые межгрупповые различия показателей ТЭГ получены только в отношении максимальной амплитуды. Геморрагический синдром в группе 1 диагностирован у 6 (13%) пациентов, в группе 2 — у 14 (35%). Однако предиктивная роль влияния количества тромбоцитов на частоту развития геморрагического синдрома не установлена (β = 0,016; p = 0,92). Сочетание тромбоцитопении и гипокоагуляции по ТЭГ проявлялось в виде геморрагического синдрома в 3,3 раза чаще, чем без гипокоагуляции (RR = 3,3; 95% ДИ = 1,20–9,05). В ряде случаев основанная на результатах ТЭГ трансфузионная тактика позволила избежать переливания КТ при инвазивных манипуляциях у больных с тромбоцитопенией менее 25 × 109 / л. Заключение. Глубина тромбоцитопении не является надежным предиктором геморрагического синдрома. Применение ТЭГ у пациентов с тромбоцитопенией позволяет оптимизировать трансфузионную тактику, избежав ненужных переливаний КТ. Сочетание тяжелой тромбоцитопении с гипокоагуляцией по данным ТЭГ служит показанием для профилактических трансфузий КТ. Background. Thrombocytopenia is a frequent complication of hemoblastosis that causes hemorrhagic syndrome. The threshold of peripheral blood platelet count for transfusion of platelet concentrate is discussed. Thromboelastography (TEG) can be considered as additional prognostic method for bleeding risk assessment in thrombocytopenic patients with leukemia. Objectives: to study changes in the viscoelastic properties of blood clot in hemoblastosis patients with thrombocytopenia less than 50×109/L and their relationship with the manifestations of hemorrhagic syndrome. Patients/ Methods. The study included 84 hemoblastosis patients — 54 (64%) men и 30 (36%) women with thrombocytopenia less than 50 × 109/L, median age — 54 years. All patients are divided into 2 groups according to the platelet count: Group 1 — 25–50×109/L, Group 2 — less than 25×109/L. Peri pheral blood counts, TEG and coagulogram parameters were evaluated in both groups. Manifestations of hemorrhagic syndrome were assessed according to the WHO bleeding scale and Common terminology criteria for adverse events of the National Cancer Institute (USA). Results. Hypocoagulation according TEG in Group 1 was found in 46% of cases, in Group 2 — in 75%. Significant intergroup differences in TEG parameters were obtained only in maximum amplitude. Hemorrhagic syndrome in Group 1 diagnosed in 6 (14%) patients, in Group 2 — in 14 (35%). There was no dependence of hemorrhagic syndrome frequency on the severity of thrombocytopenia (β = 0.016; p = 0.92). The combination of thrombocytopenia and hypocoagulation according TEG manifested as a hemorrhagic syndrome 3.3 times more often than without hypocoagulation (RR = 3.3; 95% CI = 1.20–9.05). In some cases, TEG-based transfusion tactics allowed to avoid unnecessary platelet concentrate transfusion during invasive procedures in patients with thrombocytopenia less than 25 × 109/L. Conclusions. Severity of platelet depletion is not accuracy predictor for hemorrhagic events. Use of TEG in patients with thrombocytopenia allows to optimize the transfusion tactics and to avoid unnecessary platelet concentrate transfusions. The combination of severe thrombocytopenia with hypocoagulation according TEG serves as indication for prophylactic platelet concentrate transfusion.

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Thrombocytopenia in Septicemia: ? The Role of Disseminated Intravascular Coagulation

10.1055/s-0039-1680680 ◽

1977 ◽

Author(s):

Peter B. Neame ◽

Jack Hirsh ◽

Hymie L. Nossel

Keyword(s):

Platelet Count ◽

Disseminated Intravascular Coagulation ◽

Degradation Products ◽

Protamine Sulfate ◽

Severe Thrombocytopenia ◽

Factor V ◽

Intravascular Coagulation ◽

Group 2 ◽

Group 1

Thrombocytopenia is frequently seen in septicemia but its mechanism is uncertain. We have carried out detailed studies in 18 septicemic patients who had associated thrombocytopenia to determine whether this was associated with coagulation abnormalities indicative of disseminated intravascular coagulation (DIC) or whether it was more frequently an isolated event.Tests performed as indicators of DIC included fibrinogen degradation products (FDP), protamine sulfate test (PS), T½ I125 fibrinogen survival and in some patients fibrinopeptide A assay (FPA). Two distinct patterns of results emerged. In one, made up of patients with mild to moderate thrombocytopenia (platelet count 48,000-135,000/μl), there was no evidence of DIC on the basis of FDP, PS and FPA assays. In the second group, in which there was more severe thrombocytopenia (platelet count 2,000-39,000,/μl), there was definite evidence of DIC on the basis of FDP and protamine sulfate assays. The levels of fibrinogen, Factor VIII and Factor V were significantly lower in group 2 than in group 1.It is concluded that thrombocytopenia can occur in septicemia without evidence of associated DIC, but in those cases with severe thrombocytopenia the fall in platelet count is usually accompanied by consumption of fibrinogen.

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Platelet Function and Activation in Patients with Immune Thrombocytopenia Treated with Eltrombopag: Comparison with Steroid-Treated and Untreated Patients,

Blood ◽

10.1182/blood.v118.21.3280.3280 ◽

2011 ◽

Vol 118 (21) ◽

pp. 3280-3280

Author(s):

Johanna Haselboeck ◽

Alexandra Kaider ◽

Ingrid Pabinger ◽

Simon Panzer

Keyword(s):

Platelet Count ◽

Treatment Group ◽

Prospective Study ◽

Platelet Function ◽

Immune Thrombocytopenia ◽

Steroid Treatment ◽

Group 3 ◽

Group 2 ◽

Group 1 ◽

Normally Distributed

Abstract Abstract 3280 Background: Eltrombopag has recently been approved for treatment in immune thrombocytopenia (ITP). Studies on platelet function in eltrombopag-treated patients in comparison to steroid-treated or untreated ITP patients are not available. Objectives: To assess the function of eltrombopag-induced platelets, we compared platelets from eltrombopag-treated patients to those from ITP patients treated with steroids and a group of patients without treatment in a prospective study (ClinicalTrials.gov number NCT00888901). Patients/Methods: We compared platelet function in patients treated with eltrombopag after treatment-induced platelet rise (group 1) to those under steroid treatment (group 2) and ITP patients without treatment (group 3) in a non-randomized prospective study. Platelet function was assessed by adhesion under high shear conditions (surface coverage, SC), P-selectin expression, and formation of platelet-monocyte aggregates (PMA) after treatment induced platelet rise or, in group 3, in patients with ITP without treatment and platelet count between 50–100×109/L at the time of inclusion. Data are given as median [quartiles]. Correlations of the outcome measures are described by the Spearman correlation coefficient. In case of normally distributed data, analysis of variance (ANOVA) and of covariance (ANCOVA) models and in case of non-normally distributed parameters the nonparametric Kruskal-Wallis test were used to compare the groups Results: Eleven patients (female=9) were included in the treatment group with eltrombopag (group 1), thirteen (female=5) in the steroid treatment (group 2) and 6 patients as untreated controls (group 3). None of these patients developed severe bleeding during the study period, none received rescue medication. Four/30 patients were not included in the final analysis, three because they had no treatment induced platelet rise (1 on eltrombopag and 2 on steroids) and 1 because of aspirin medication. Thus, ten patients on eltrombopag, ten patients on steroid treatment and 6 untreated patients were evaluated in the comparative analyses of platelet function. Platelet counts [x109/L] were 48.25 [45.00–59.00] in group 1 after eltrombopag-induced platelet rise, 82.75 [78.50–112.00] in group 2 and 69.25 [65.00–73.00] in group 3. SC was highest in steroid-treated patients (11.25% [8.10–14.00%]) compared to eltrombopag-treated (5.80% [1.80–9.00%]) and untreated (5.03% [3.80–6.20%]) patients and correlated significantly with the platelet count (r=0.72, p<0.0001). There were no differences in P-selectin expression [GeoMFI] (1.15 [0.47–2.77] in group 1, 0.27 [0.10–0.99] in group 2 and 0.59 [0.47–1.44] in group 3; p=0.34) and PMA levels (6.19% [3.91–21.39%] in group 1, 9.73% [1.88–13.29%] in group 2, and 6.56% [4.82–8.43%] in group 3; p=0.93) between the groups. Two patients developed venous thromboses during eltrombopag treatment. No characteristic alteration of platelet function and activation was identified in those 2 patients when compared to the other eltrombopag-treated patients. Conclusions: We proofed a good functional competence of eltrombopag-induced platelets. No substantial hyper-reactivity of eltrombopag-induced platelets in comparison to those of steroid-treated and untreated patients was determined. Disclosures: Pabinger: GlaxoSmithKline: Research Funding, Speakers Bureau. Panzer:GlaxoSmithKline: Speakers Bureau.

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Influence of aspirin or heparin on platelet function and postoperative blood loss after coronary artery bypass surgery

Perfusion ◽

10.1191/0267659106pf845oa ◽

2006 ◽

Vol 21 (1) ◽

pp. 61-66 ◽

Cited By ~ 7

Author(s):

Edmundas Sirvinskas ◽

Audrone Veikutiene ◽

Pranas Grybauskas ◽

Jurate Cimbolaityte ◽

Ausra Mongirdiene ◽

...

Keyword(s):

Platelet Count ◽

Coronary Artery ◽

Platelet Aggregation ◽

Blood Loss ◽

Platelet Function ◽

Artery Bypass ◽

Postoperative Blood Loss ◽

Group 3 ◽

Group 2 ◽

Group 1

The aim of the study was to assess the effect of aspirin or heparin pretreatment on platelet function and bleeding in the early postoperative period after coronary artery bypass grafting (CABG) surgery. Seventy-five male patients with coronary artery disease who underwent CABG with cardiopulmonary bypass (CPB) were studied. The patients were divided into three groups: Group 1 ( n = 25) included patients receiving aspirin pretreatment, Group 2 ( n = 22) received heparin pretreatment, and Group 3 ( n = 28) included patients who received no antiplatelet or anticoagulant pretreatment. Twenty-four hours after surgery, all patients were administered aspirin therapy that was continued throughout their hospitalization period. We assessed the following preoperative blood coagulation indices: activated partial thromboplastin time (aPTT), international normalized ratio (INR), and fibrinogen. We compared platelet count and platelet aggregation induced by adenosinediphosphate (ADP) before surgery, 1 h after surgery, 20 h after surgery and on the seventh postoperative day. We assessed drained blood loss within 20 postoperative hours. Preoperative blood coagulation indices did not differ among the groups. Platelet count was also similar. One hour after surgery, platelet count significantly decreased in all groups ( p <0.001), after 20 postoperative hours it did not undergo any marked changes, and on the seventh postoperative day, it significantly increased in all groups ( p <0.001). Before surgery, the lowest index of ADP-induced platelet aggregation was found in Group 1 ( p <0.05). One hour after surgery, platelet aggregation significantly decreased in all groups, most markedly in Group 3 ( p <0.001), yet after 20 h, its restitution tendency and a significant increase in all groups was noted. On the seventh day, a further increase in the statistical mean platelet aggregation value was noted in Groups 2 and 3. Comparison of platelet aggregation after 20 postoperative hours and on the seventh day after surgery revealed a significantly higher than 10% increase of the index in 32% of patients in Group 1 ( p <0.05), 27.3% of patients in Group 2 ( p <0.05) and in 35.7% of patients in Group 3 ( p <0.001). The lowest statistically significant value of postoperative blood loss was noted in Group 2 ( p <0.01). Our study has shown that aspirin or heparin pretreatment had no impact on the dynamics of platelet function in the early postoperative period after CABG. The lowest postoperative blood loss was noted in patients pretreated with heparin.

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Prominent features of platelet count, plateletcrit, mean platelet volume and platelet distribution width in pulmonary tuberculosis

Multidisciplinary Respiratory Medicine ◽

10.4081/mrm.2012.625 ◽

2012 ◽

Vol 7 ◽

Author(s):

Füsun Şahin ◽

Esra Yazar ◽

Pınar Yıldız

Keyword(s):

Platelet Count ◽

Pulmonary Tuberculosis ◽

Advanced Stage ◽

Platelet Distribution Width ◽

Platelet Volume ◽

Acute Phase Reactants ◽

Distribution Width ◽

Group 3 ◽

Group 2 ◽

Group 1

Background: We aimed to investigate the relation of platelet count (PLT) and plateletcrit (PCT), mean platelet volume (MPV) and platelet distribution width (PDW) with other acute phase reactants and radiological extent in pulmonary tuberculosis (PTB). Methods: One hundred patients with PTB (Group 1), 50 patients with community-acquired pneumonia (Group 2) and 28 healthy control individuals (Group 3) were included in this analytic study. Results: WBC (White Blood Cell), ESR (Eritrocyte Sedimentation Rate), CRP (C-Reactive Protein), PLT and PCT values were both in Group 1 and Group 2 than in Group 3. PDW values were significantly higher in Group 1 than Group 3. WBC, ESR and CRP values were lower, while PLT and PCT values were higher in the Group 1 compared to Group 2 (p < 0.001). PLT was positively correlated with CRP and ESR values in the tuberculosis group (p < 0.001), while it was not correlated with CRP and ESR in the pneumonia group (p > 0.05). ESR, CRP, PLT and PCT values were found higher in radiological advanced stage (Stage 3) patients with PTB, while hemoglobin (Hb) was found lower (p < 0.05). Higher WBC, ESR, CRP and PCT values as well as radiological advanced stage were more common in PTB patients with thrombocytosis compared to the patients with normal platelet count, whereas Hb was found lower in these patients. Conclusions: This study indicates that reactive thrombocytosis and higher PCT and PDW develop frequently in PTB and there is a relation between thrombocytosis and acute phase reactants, that is the inflammatory response. In addition, tuberculosis with radiological advanced stage is seen more frequently in the patients with thrombocytosis and higher PCT, drawing attention to the possible role of platelets in the cell-based immune process of tuberculosis.

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Blood coagulation system in chronic benzene poisoning via inhalation

Kazan medical journal ◽

10.17750/kmj2017-758 ◽

2017 ◽

Vol 98 (5) ◽

pp. 758-763

Author(s):

R A Oruzhov ◽

R A Zhafarova

Keyword(s):

Blood Coagulation ◽

Fibrinolytic Activity ◽

Blood Clotting ◽

Blood Clot ◽

Coagulation System ◽

Clot Retraction ◽

Prothrombin Index ◽

Group 3 ◽

Group 2 ◽

Group 1

Aim. To experimentally study the changes occurring in blood coagulation system in exposure to low-dose benzene. Methods. The experiment was performed on 36 rabbits by chronic exposure of the animals to benzene during 4 months on a daily basis 4 hours a day with 1 non-exposure day a week and a one-month recovery period after the end of exposure. The average poisoning concentration of benzene in the chambers was between 1240±82 mg/m3. The animals were divided into three groups: group 1 was exposed to gradually increasing concentration of benzene, group 2 - to fluctuating (intermittent) concentrations of benzene, group 3 included unexposed to benzene animals and was used as the control group. Overall blood clotting activity, blood clotting time, blood clot retraction, plasma recalcification time, plasma tolerance to heparin, prothrombin index, fibrinogen concentration, blood fibrinolytic activity were determined. Results. In a month after exposure blood clot retraction rates in groups 1 and 2 increased by 79.8 and 23.1% respectively. Plasma tolerance to heparin most significantly changed in animals from group 2 (by 15.4%). Prothrombin time increased by 11.4% in group 1 while in group 3 this parameter decreased by 0.4%. Prothrombin index in group 1 decreased by 4.3%, and in group 2 the changes were not statistically significant. Concentration of fibrinogen in the blood in group 1 had no significant changes and decreased by 4.2% while in group 2 it decreased by 10.4%. Fibrinolytic activity in group 1 and 2 decreased by 47.5 and 5.8% respectively. Conclusion. The studied benzene concentrations impair blood coagulation and anti-coagulation systems including two stages of hemostasis: 1st stage - from factor XII activation, 2nd stage - from prothrombin (factor II) activation.

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Neutrophil count to albumin ratio as a new predictor of mortality in patients with COVID-19 ınfection

Revista da Associação Médica Brasileira ◽

10.1590/1806-9282.66.s2.77 ◽

2020 ◽

Vol 66 (suppl 2) ◽

pp. 77-81 ◽

Cited By ~ 1

Author(s):

Ceyhun Varim ◽

Selcuk Yaylaci ◽

Taner Demirci ◽

Tezcan Kaya ◽

Ahmet Nalbant ◽

...

Keyword(s):

Platelet Count ◽

Neutrophil Count ◽

Mortality Risk ◽

Demographic Data ◽

C Reactive Protein ◽

Albumin Ratio ◽

Reactive Protein ◽

Severe Group ◽

Group 2 ◽

Group 1

SUMMARY BACKGROUND Coronavirus Disease 2019 is an acute inflammatory respiratory disease. It causes many changes in hemogram parameters. Low albumin levels are associated with mortality risk in hospitalized patients. The aim of the present study is to reveal the place of neutrophil count to albumin ratio in predicting mortality in patients with COVID-19. METHODS 144 patients, 65 females and 79 males, were included in the study. Patients were divided into 2 groups. Group 1 was the non-severe group (n:85), and Group 2 was severe (n:59). Demographic data, neutrophil, lymphocyte and platelet counts, albumin and C-reactive protein (CRP) levels were recorded. Neutrophil count to albumin ratio (NAR) was calculated by dividing the absolute neutrophil counts by the albumin levels. The NAR and levels of the two groups were then compared. RESULTS There were no significant differences in gender and platelet count (201 vs. 211 K/mL) between the groups (p>0,05). Ages (62.0 ± 14.3 vs 68.6 ± 12.2 years), albumin (33.1 vs 29.9 gr/L), CRP (33 vs 113 mg/l), neutrophil count (4 vs 7.24 K/mL), WBC counts (6.70 vs 8.50 K/mL), NAR values (113.5 vs 267.2) and number of Death (5 vs 33) were found to be statistically higher (p <0.001) in Group 2 than in Group 1. The NAR value of 201.5 showed mortality in all patients with COVID-19 to have 71.1% sensitivity and 71.7% specificity (AUC:0.736, 95% CI: 0.641-0.832, p<0.001) CONCLUSION The present study showed that NAR levels can be a cheap and simple marker for predicting mortality in patients with COVID-19.

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Thromboelastometry in Patients Receiving Platelet Transfusion after Chemotherapy.

Blood ◽

10.1182/blood.v104.11.3630.3630 ◽

2004 ◽

Vol 104 (11) ◽

pp. 3630-3630

Author(s):

Henning Dehmel ◽

Andreas Tiede ◽

Silvia Horter ◽

Arnold Ganser ◽

Mario von Depka

Keyword(s):

Platelet Count ◽

Platelet Transfusion ◽

Reference Range ◽

Bleeding Risk ◽

Substantial Improvement ◽

Severe Thrombocytopenia ◽

Bleeding Events ◽

Bleeding Symptom ◽

Before And After ◽

Risk Of Hemorrhage

Abstract Prophylactic platelet transfusion is frequently administered to reduce the risk of hemorrhage in patients undergoing chemotherapy for leukemia or cancer. A platelet count of 10 or 20x109 L−1 is often used as an occasion for platelet transfusion. In clinical studies, the bleeding risk was similar using either threshold (Rebulla, NEJM1997; 337:1870, Wand, Blood1998; 91:3601). Moreover, serious bleeding events were not related to the patients’ platelet count. Thromboelastometry with ROTEM® Whole-Blood Coagulation Analyzer (Pentapharm, Munich, Germany) is a method that may provide a better estimate of the risk of hemorrhage because it also depends on platelet function and plasma coagulation. We therefore performed a pilot study in 13 adult patients receiving prophylactic platelet transfusion after chemotherapy for leukemia or lymphoma. ROTEM® was performed using an ellagic acid based activating reagent (in-TEM®, Pentapharm). Clotting profiles were evaluated using the following thromboelastometric measures: clotting time (CT), clot formation time (CFT), and maximum clot firmness (MCF). The median platelet count before transfusion was 9x109 L−1 (range 1 to 20). CT was within the normal range in all patients (median 168 s, range 125–212, reference range 100–240). In contrast, a prolonged CFT (median 139 s, range 51–4526, reference range 30–110) and reduced MCF (median 34 mm, range 19–54, reference range 50–72) was recorded. Correlation between platelet count and CFT (R=−0.41, Spearman) or MCF (R=+0.48) was weak and not statistically significant. 15 min after platelet transfusion, there was an increase in platelet count (median 39x109 L−1, range 23–48) and a substantial improvement of CFT (median 99 s, range 44–332) and MCF (median 49 mm, range 40–64). Changes in thromboelastometric measures were due to platelet transfusion as the addition of cytochalasin D (fib-TEM®, Pentapharm) resulted in identical profiles before and after transfusion. Changes in platelet count correlated with changes in MCF (R=+0.73, P<0.01), but not CFT (R=−0.40, P=0.17). Comparing patients who had a maximum of one mild bleeding symptom (n=9) with patients who experienced one severe or at least two mild bleeding symptoms (n=4), there was no difference in platelet counts (median 10 vs. 9x109 L−1, p=0.77). In contrast, there was a trend towards a shorter CFT (median 111 vs. 388 s, P=0.09) and higher MCF (median 39 vs. 29.5 mm, P=0.09) in the group of non-bleeding patients. In summary, ROTEM® seems to be a sensitive method to detect hemostatic changes in patients with severe thrombocytopenia receiving platelet transfusion and to identify thrombocytopenic patients with an increased bleeding risk. Therefore, further studies to evaluate ROTEM® as a means to estimate the bleeding risk in thrombocytopenic patients are warranted.

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Use of Lenalidomide (Revlimid® +/− Corticosteroids in Relapsed/Refractory Multiple Myeloma Patients with Elevated Baseline Serum Creatinine Levels.

Blood ◽

10.1182/blood.v108.11.3548.3548 ◽

2006 ◽

Vol 108 (11) ◽

pp. 3548-3548 ◽

Cited By ~ 4

Author(s):

Donna E. Reece ◽

Esther Masih-Khan ◽

Christine Chen ◽

Lisa Wang ◽

Saima Dean ◽

...

Keyword(s):

Multiple Myeloma ◽

Platelet Count ◽

Serum Creatinine ◽

Median Number ◽

Bleeding Complications ◽

Baseline Serum ◽

Prior Therapy ◽

Group 2 ◽

Grade 3 ◽

Group 1

Abstract Lenalidomide (Revlimid®; Rev) is an important novel agent for the treatment of multiple myeloma (MM) patients (pts). Since MM pts are at risk for renal insufficiency, we evaluated whether an abnormal serum creatinine (cr) level affected the outcome of pts treated with Rev +/− corticosteroids (CS). Between 12/05 and 07/06, 69 MM pts who had progressed after at least 1 line of prior therapy were treated in our center with Rev +/− CS as part of Celgene’s Expanded Access Program in Canada. Eligibility criteria included a platelet count (pl ct) ≥ 30 x 109/L and neutrophil count ≥ 1.0 x 109/L; a cr level of ≤220 umol/L was required unless a waiver was obtained. Protocol therapy consisted of Rev + dexamethasone (dex) in 44, Rev + prednisone in 7, Rev + dex and prednisone at different time points in 5 and Rev alone in 13. The median age was 60 yrs (35–79); 36 (52%) were male; median β2-microglobulin was 214 nm/L (114–1420); Ig subtype was IgG in 42, IgA in 12, IgM in 1 and light chain only in 14. Prior therapy included ASCT in 59 pts (86%), thalidomide in 51 (74%), bortezomib in 21 (30%) and oral cyclophosphamide in 52 (75%); the median number of prior regimens was 2 (1–5). Twenty-three pts (33%) had an elevated baseline cr level (> 89 umol/L for females and 109 umol/L for males in our center). The median cr was 138 umol/L (110–412) in these pts (group 1), compared with 80 umol/L (51–109) in group 2 (control) (p=0.001). Five pts in group 1 had a cr level ≥ 177 umol/L (2 mg/dL). Both groups were similar except that group 1 had more males (p=0.04) and the baseline platelet count (pl ct) was lower (35% vs. 4% with pl ct less than 50 x 109/L; p=0.0007). RESULTS: The median number of cycles of Rev +/− CS given to date was 4 (1–8) in both groups, and the median follow-up is 4 mos (0.5–8). After 3 cycles of Rev, the median cr was 104 umol/L (61–372) in group 1 and 79 umol/L (53–180) in group 2. In group1, cr decreased in 39% and increased in 26%, compared with 39% and 32% in group 2, respectively (p=0.56). The incidence of grade 3–4 neutropenia was 43% vs. 46%, febrile neutropenia 13% vs. 9%, any infection 17% vs. 20% and G-CSF use 66% vs. 57% among pts in group 1 vs. 2 (p=NS for all comparisons). More in group 1 experienced grade 3–4 thrombocytopenia and required at least 1 pl transfusion (52% vs. 17%; p=0.003). In group 1, 6 (26%) pts required pl transfusion in only 1 cycle, 5 (22%) in 2 cycles and 1 (4%) in 3 cycles. However, the only 2 significant bleeding complications were seen in group 2. There were 2 deaths (8.7%) in group 1 and 4 (8.7%) in group 2. Table 1 summarizes the preliminary anti-myeloma results in these 2 groups. CONCLUSIONS: Rev +/− CS can be given safely to selected patients with an elevated baseline cr level; pts with an elevated cr had lower baseline pl cts, and required more pl transfusions; the response rate, PFS and OS to date are similar in patients with a normal vs. elevated cr level. Table 1 Serum cr N nCR/PR PFS 95% CI OS 95% CI PFS=progression free survival; OS=overall survival; the differences are not significant. Elevated 23 61% 30% 11–52% 72% 46–86% Normal 46 54% 50% 31–67% 76% 55–88%

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Pulmonary vascular pressure-flow characteristics in canine pulmonary embolism

Journal of Applied Physiology ◽

10.1152/jappl.1990.68.2.462 ◽

1990 ◽

Vol 68 (2) ◽

pp. 462-467 ◽

Cited By ~ 13

Author(s):

I. Hasinoff ◽

J. Ducas ◽

U. Schick ◽

R. M. Prewitt

Keyword(s):

Pulmonary Hypertension ◽

Left Atrial ◽

Blood Clot ◽

Autologous Blood ◽

Flow Characteristics ◽

Atrial Pressure ◽

Left Atrial Pressure ◽

Pressure Flow ◽

Group 2 ◽

Group 1

We tested the hypothesis that, in canine embolic pulmonary hypertension, upstream transmission of increased left atrial pressure (LAP) is inversely related to the level of the pressure intercept (PI) obtained by extrapolation from the linear pulmonary vascular pressure-flow (P-Q) plot. P-Q coordinates were obtained by varying Q through systemic fistulas. Seven group 1 dogs were embolized with autologous blood clot to produce marked pulmonary hypertension and mean pulmonary arterial pressure (PAP), and PI increased from 15 to 41 mmHg (P less than 0.001) and from 8.8 to 31 mmHg (P less than 0.001), respectively. Before and after embolization we assessed effects of increased LAP, produced by inflation of a left atrial balloon, on PAP at constant Q. Embolization depressed the mean slope of this relationship from 0.78 to 0.16 (P less than 0.001). Subsequently, six group 2 dogs were embolized to produce moderate pulmonary hypertension with a mean PI of 22 mmHg. This value was significantly less than PI in group 1 (P less than 0.01). After embolization, the slope of the PAP-LAP relationship was greater in group 2 than group 1: 0.47 vs. 0.16 (P less than 0.01). We conclude that the upstream transmission of left atrial pressure is inversely related to PI and that marked embolic pulmonary hypertension produces an effective vascular waterfall.

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Application of Long-Acting VLHL PAI-1 during Sutureless Partial Nephrectomy in Mice Reduces Bleeding

BioMed Research International ◽

10.1155/2015/392862 ◽

2015 ◽

Vol 2015 ◽

pp. 1-7

Author(s):

Khaled Shahrour ◽

Rick Keck ◽

Jerzy Jankun

Keyword(s):

Partial Nephrectomy ◽

Blood Clot ◽

Treated Group ◽

Group 4 ◽

Final Weight ◽

Group 3 ◽

Group 2 ◽

Long Acting ◽

Pai 1 ◽

Group 1

PAI-1 prevents lysis of blood clot by inhibiting the urokinase and tPA induced conversion of plasminogen to plasmin. VLHL PAI-1 protein mutant was created to extend half-life over 700 hours. The objective of this paper was to test VLHL PAI-1 effects on bleeding during partial nephrectomy in mice. All animals had a left partial nephrectomy after intravenous infusion of saline or tPA. The animals were divided into four groups. Group 1 was infused with saline and kidney was exposed to saline too; Group 2 was infused with saline and kidney was exposed to PAI-1. Group 3 was infused with tPA and kidney was exposed to saline, while Group 4 was infused with tPA and kidney was exposed to PAI-1. Preweighed gauze containing PAI-1 or saline was then applied to the kidney for 30 minutes. The gauze was afterward weighed and blood loss was measured by subtracting the preweight of gauze from the final weight. We have observed a statistically significant (P≤0.05) reduction of bleeding in PAI-1-treated group in comparison to saline and tPA-treated groups. Based on these results we propose that VLHL PAI-1 can be used therapeutically in limiting the flow of blood from renal wounds.

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