Comparative Study of Coagulation Profile in Benign and Malignant Neoplasms in Bhopal, India

BACKGROUND Thrombosis is a well-recognized and common complication in patients with malignant disease and can contribute significantly to the morbidity and mortality of this disease. We wanted to compare the coagulation parameters in benign and malignant neoplasms. METHODS A comparative study was done and a total of 230 cases (75 benign and 155 malignant) and 120 controls were evaluated. After processing the blood samples, various tests like complete blood count, platelet count, prothrombin time (PT), activated partial thromboplastin time (APTT), fibrin degradation product (FDP), and D-Dimer were done. RESULTS Significant differences were noted in the coagulation parameters of both the groups. Malignant cases show abnormal coagulation parameters as compared to control group. Mean platelet count - control - 250 +/- 61, cases - 375 +/- 100, mean PT – control - 14.1 +/- 6 s, cases - 15.2 +/- 1.2 s, mean APTT- control - 29.5 +/- 1.3 s, cases - 34.8 +/- 2.5 s. CONCLUSIONS Cancer is associated with a high risk of thrombotic complications. Altered coagulation parameters significantly correlate with malignant nature of tumour and also their spread. Preventing this complication is clinically relevant because it significantly contributes to morbidity and mortality in these patients. KEY WORDS Coagulation, Neoplasm, FDP, D-Dimer, Thrombosis

CLINICAL FEATURES AND COAGULATION ABNORMALITIES IN CHILDREN WITH SEPSIS AT DANANG HOSPITAL FOR WOMEN AND CHILDREN

Objective: To determine the relationship between coagulation abnormalities and main clinical features, and hematologic tests. Methods: A descriptive cross-sectional study was conducted in 65 children with sepsis at the PICU, Da Nang Hospital for Women and Children from April 2012 to June 2013. Results: The frequency of internal hemorrhage in septic shock children was significantly higher than in children with sepsis (p < 0.001). The rate of thrombocytopenia was 30.8%, in which 10.8% of the children had severe thrombocytopenia (<50 x 109/l). Hypofibrinogenemia was observed in 30.8% of the patients, in which severe hypofibrinogenemia (≤ 1 g/l) was observed in 16.9% of the children. The frequency of reduced prothrombin ratio was 40%, in which 23.1% of the patients had prothrombin ratio < 50%. 35.4% of the patients had rAPTT > 1.15. Positive D-dimer and DIC were observed in 53.8% and 20% of the patients, respectively. Hemostatic changes showed the significant relationship with hemorrhage and the mortality of sepsis. Conclusion: Children with sepsis, especially septic shock were at high risk of coagulation dysfunction and coagulation abnormalities showed the correlation with hemorrhage and the mortality of sepsis. Key words: coagulation abnormalities, sepsis, children

Assessment of Hemostasis

Hemostasis is the collection of biological mechanisms responsible for bleeding cessation following surgical procedures or trauma. Congenital and acquired disorders affecting any element of the hemostatic system can result in a spectrum of bleeding pathologies ranging from inability to form stable blood clot to the pathologic propagation of blood clot outside the area of injury. Assessing the hemostatic system in an accurate and timely fashion is critical for detection of these disorders. This review briefly covers the mechanisms of primary and secondary hemostasis before comprehensively exploring the approach to preoperative evaluation of hemostasis, the strengths and weaknesses of commonly used laboratory tests of coagulation, the interpretation of test results, and the management of patients found to have abnormal hemostatic systems. Figures detail the mechanisms of hemostasis and the important features of viscoelastic testing. Tables explain the parameters frequently measured in viscoelastic testing and propose potential treatment plans based on test findings. Key words: coagulation; conventional coagulation tests; hemostasis; thromboelastography; thromboelastometry

Assessment of Hemostasis

Hemostasis is the collection of biological mechanisms responsible for bleeding cessation following surgical procedures or trauma. Congenital and acquired disorders affecting any element of the hemostatic system can result in a spectrum of bleeding pathologies ranging from inability to form stable blood clot to the pathologic propagation of blood clot outside the area of injury. Assessing the hemostatic system in an accurate and timely fashion is critical for detection of these disorders. This review briefly covers the mechanisms of primary and secondary hemostasis before comprehensively exploring the approach to preoperative evaluation of hemostasis, the strengths and weaknesses of commonly used laboratory tests of coagulation, the interpretation of test results, and the management of patients found to have abnormal hemostatic systems. Figures detail the mechanisms of hemostasis and the important features of viscoelastic testing. Tables explain the parameters frequently measured in viscoelastic testing and propose potential treatment plans based on test findings. Key words: coagulation; conventional coagulation tests; hemostasis; thromboelastography; thromboelastometry

Molecular weight of Hydroxyethyl Starch Molecules influences Coagulation Profile measured by thrombelastography

SummaryBackgroundThe consensus about the ideal intravenous fluid in trauma patients remains open. However, hypertonic saline and hydroxyethyl starch (HES) seems to have advantages in terms of immuno-modulatory and haemodynamic effects. Nevertheless clotting abnormalities are frequently reported in association with the use of HES. We investigated the influence of light, medium and heavy molecular weight (MW) hydroxyethyl starch (HES) on coagulation in 29 healthy subjects.MethodsRinger’s lactate (RL) served as a control solution. Thrombelastography using Haemoscope’s Thrombelastograph® (TEG®) hemostasis system was used to assess the effect of HES polymers and RL. TEG analysis was performed using recalcified native whole blood both with and without the addition of platelet activating factor IV (PAF IV) before and immediately after infusion of one of the solutions.ResultsInfusion of RL or one of the three HES solutions exerts an anticoagulant effect as demonstrated by a increase in clot formation time (R) and a decrease in maximum amplitude (MA), and the angle. The addition of PAF IV reversed these changes.ConclusionsThis data indicate clear evidence of platelet activity per se or platelet interaction with the plasmatic coagulation system. Key words: Coagulation, thrombelastography, platelets, hydroxyethyl-starch