Immediate complications of therapy

Bleeding occurs even when APTT ratio within the therapeutic range but risk 4 with 4APTT ratio. Treatment Stop heparin until APTT ratio < 2.5. In life-threatening bleeding use protamine sulphate 1mg 100iu of heparin given in preceding hour. Thrombocytopenia Mild 5 platelets common early in heparin therapy not significant. Severe thrombocytopenia less common (HITT) occurs 6-10d after therapy begun may be associated thrombosis. Stop heparin. Give alternative antithrombin drug such as lep-irudin...

Platelet refractoriness

Occasionally patients show little no increment in the platelet count after platelet transfusions. This is called platelet refractoriness. May be due to physical or immunological mechanisms in the patient. The commonest physical mechanism is of platelet circulatory half-life reduction caused by concurrent sepsis or coagulopathy e.g. DIC. Immunological causes include induction of anti-HLA antibodies due to allosensitisation from previous transfusions or generation of anti-platelet antibodies such...

Stage 1 primary infection

Entry of HIV-1 or HIV-2 through a mucosal surface after sexual contact, direct inoculation into the bloodstream by contaminated blood products, or IV drug abuse can be followed by a transient febrile illness up to 6 weeks later associated with oral ulceration, pharyngitis, and lym-phadenopathy. Photophobia, meningism, myalgia, prostration, encephalopathy and meningitis may also occur. FBC may show lym-phopenia or lymphocytosis often with atypical lymphocytes, neutropenia, thrombocytopenia or...

Affecting T cells B cells and neutrophils

An rare autosomal recessive or sometimes X-linked disorder where T 408 cells, B cells and granulocytes are absent. Such children present with serious infection at birth or shortly afterwards. They have no lymph nodes or tonsils, and the usual thymic shadow is absent. Bone marrow is hypoplastic, and there may also be thrombocytopenia and anaemia. It appears to be a pluripotential stem cell failure and carries a dire prognosis. The only curative therapy is BMT.

General considerations

There are no universally accepted protocols for the management of anticoagulation in pregnancy. There are few controlled studies and much of the information relates to non-pregnant subjects. Both oral anticoagulants and heparin have advantages and disadvantages in pregnancy. LMWH are a significant advance in management. Warfarin crosses the placenta and is teratogenic in the first trimester. Exposure during weeks 6-12 can cause warfarin embryopathy with nasal hypoplasia, stippled epiphyses and...

Essential 1 thrombocythaemia ET

ET (syn. primary or idiopathic thrombocythaemia) is characterised by persistent thrombocytosis that is neither reactive (i.e. secondary to another condition pXXX) nor due to another myeloproliferative or myelodys-plastic disorder. It is a diagnosis of exclusion and may be biologically heterogeneous. True incidence unknown slight excess in 3 median age at diagnosis 60 years frequently occurs < 40 years very rare < 20 years. Aetiology unknown. No association with radiation, drugs, chemicals...

Druginduced thrombocytopenia

Many drugs implicated in idiosyncratic thrombocytopenia, largely through increased destruction usually immune mechanism. In most cases the patient has been using the drug for several weeks months and thrombocy- topenia is severe (< 20 x 109 L). Most commonly implicated are heparin, quinine, quinidine, gold, sulphonamides, trimethoprim, penicillins, cephalosporins, cimetidine, ranitidine, diazepam, sodium valproate, phenacetin, rifampicin, PAS, thiazides, (furosemide), chlorpropamide,...

Numerical abnormalities of platelets thrombocytopenia

Defines a platelet count < 150 x 109 L. May be due either to decreased bone marrow production of platelets or to increased destruction or sequestration of platelets from the circulation (or both). Platelet counts > 100 x 109 L are not usually associated with any haemorrhagic problems. Purpura, easy bruising and prolonged post-traumatic bleeding are increasingly common as the platelet count falls < 50 x 109 L. Although there is no platelet count at which a patient definitely will or will...

Immune thrombocytopenia

These conditions are due to IgG and IgM antibodies which react with antigenic sites (usually GPIIb IIIa in ITP, platelet alloantigens in post-transfusion purpura and neonatal isoimmune purpura) on the platelet cell membrane, may fix complement and cause accelerated platelet destruction through phagocytosis by reticuloendothelial cells in liver and spleen. A compensatory increase in bone marrow megakaryocytopoiesis usually occurs which may occasionally prevent or delay the development of severe...

Reduced platelet count

Thrombocytopenia is defined as platelet count < 150 x 109 L. Although there is no precise platelet count at which a patient will or will not bleed, most patients with a count > 50 x 109 L are asymptomatic. The risk of spontaneous haemorrhage increases significantly < 20 x 109 L. Purpura is the most common presenting symptom and is usually found on the lower limbs and areas subject to pressure. May be followed by bleeding gums, epistaxis or more serious life-threatening haemorrhage. A...

Elevated platelet count

Thrombocytosis is defined as a platelet count > 450 x 109 L. May be due to a primary myeloproliferative disorder (MPD) or a secondary reactive 20 feature. If the platelet count is markedly elevated a patient with a myeloproliferative disorder has a risk of haemorrhage (due to the production of dysfunctional platelets), or thrombosis, or both. The patient's history may reveal features of the condition to which the elevated platelet count is secondary. Clinical examination may provide similar...

Thrombocytopenia in pregnancy

A normal uncomplicated pregnancy is associated with a platelet count in the normal range though up to 10 of normal deliveries may be associ-36 ated with mild thrombocytopenia (> 100 x 109 L). Detection of thrombocytopenia in a pregnant patient requires consideration not only of the diagnoses listed in the previous section but also the conditions associated with pregnancy which cause thrombocytopenia. An additional important consideration is the possible effect on the fetus and its delivery....

Heparininduced thrombocytopenia HIT

Uncommon but sometimes life-threatening condition due to immune complex-mediated thrombocytopenia in patients treated with heparin. Early recognition reduces morbidity and mortality. Estimated incidence 1-3 of patients receiving heparin for > 1week. Occurs both with full dose regimens and 'minidose' regimens (5000IU bd) or low doses used for 'flushing' IV lines. Less common with low molecular weight heparin. IgG antibodies formed in response to heparin therapy form immune complexes with...

Can Folic Acid Help In Getting Rid Of Hbe Dieseas

Blood film in homozygous sickle cell disease. Note the elongated sickled red cells. Confirmatory tests Haemoglobin electrophoresis shows 80-99 HbS with no normal HbA. HbF may be elevated to about 15 . Parents will have features of sickle cell trait. In at-risk groups pregnant woman should be screened early in pregnancy. If both parents of fetus are carriers offer prenatal neonatal diagnosis. Affected babies should be given penicillin daily and be immunised against S. pneumoniae, Hinfluenzae...