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Revista Medica de Chile Dec 2008Thrombotic thrombocytopenic purpura (TTP) is characterized by anemia, thrombocytopenia, neurological and renal involvement of variable severity and it has a dismal... (Review)
Review
BACKGROUND
Thrombotic thrombocytopenic purpura (TTP) is characterized by anemia, thrombocytopenia, neurological and renal involvement of variable severity and it has a dismal prognosis. Platelet-derived von Willebrand Factor-cleaving metalloprotease ADAMTS-13 activity may orient the diagnosis, but normal levels do not discard it. The most effective therapy thus known is plasmapheresis.
AIM
To report the experience in 18 patients with TTP.
MATERIAL AND METHODS
Retrospective assessment of 11 patients and prospective assessment of seven subjects with TTP, aged 15 to 81 years.
RESULTS
All presented with anemia, thrombocytopenia and LDH elevation. Sixteen had neurological symptoms, five had fever, four had macroscopic urinary excretion of pigments, four had petechiae, and two had nosebleeds. Haptoglobin was low in 10 of 11 patients in whom it was measured. ADAMTS-13 had low activity in 15 of 17 patients (in 11, the inhibitor was found). Seventeen patients were treated with plasmapheresis and nine received steroids also. Seven patients died due to shock with respiratory involvement or multiple organic failure.
CONCLUSIONS
TTP has heterogeneous modes of presentation. If the diagnosis is strongly suspected, plasmapheresis can be started without laboratory confirmation. An ADAMTS-13 activity below 6% is almost exclusive of TTP .
Topics: ADAM Proteins; ADAMTS13 Protein; Adolescent; Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Plasmapheresis; Prospective Studies; Purpura, Thrombotic Thrombocytopenic; Retrospective Studies
PubMed: 19350168
DOI: No ID Found -
Mayo Clinic Proceedings Sep 2020
Topics: Adult; Cerebral Ventricles; Humans; Male; Meningitis, Meningococcal; Purpura
PubMed: 32861336
DOI: 10.1016/j.mayocp.2020.07.005 -
Fa Yi Xue Za Zhi Jun 2018To study the main features of mechanical asphyxia--the pathological characteristics of petechial hemorrhage after high temperature effect (roasted, boiled) and its...
OBJECTIVES
To study the main features of mechanical asphyxia--the pathological characteristics of petechial hemorrhage after high temperature effect (roasted, boiled) and its changing rules.
METHODS
Rabbit model of mechanical asphyxia death with choking neck and death from anteposition hanging was established. The experimental rabbits were randomly divided into roasted group and boiled group (=4, in each group). The laryngeal ventricles and cardiopulmonary tissues in the roasted group were roasted for 3, 6 and 10 min, and the positions of petechial hemorrhage were observed and photographed. The same organs and tissues in the boiled group were heated in boiling water (100 ℃), and were observed and photographed at 30 and 60 s. Then histopathological examination was performed on all the laryngeal ventricles and cardiopulmonary tissues.
RESULTS
The petechial hemorrhage originating from laryngeal ventricle, trachea and lung did not disappear after high temperature treatment in the eight rabbits. The deepened color was visible to naked eyes and distinct from the surrounding normal tissues, with bleeding under the microscope.
CONCLUSIONS
Petechial hemorrhage caused by mechanical asphyxia would not disappear under high temperature, which might be related to the manner of death, the intensity and time of action, and the individual differences.
Topics: Animals; Asphyxia; Fever; Hemorrhage; Purpura; Rabbits; Temperature
PubMed: 30896101
DOI: 10.12116/j.issn.1004-5619.2018.06.011 -
Internal Medicine (Tokyo, Japan) 2008We report a case of meningococcemia without meningitis, which is a rare infectious disease in Japan. A 32-year-old woman was referred to our hospital with fever and... (Review)
Review
We report a case of meningococcemia without meningitis, which is a rare infectious disease in Japan. A 32-year-old woman was referred to our hospital with fever and joint pain. Her clinical presentation and the results of laboratory examination on admission suggested viral infection. However, her condition rapidly progressed to septic shock with fulminans purpura. Blood culture grew Neisseria meningitidis. She received antimicrobial therapy and underwent localized therapy for skin lesions. Meningococcal infection should be considered in patients who have fever along with skin rash or petechiae even when there are no signs of meningitis. In this report, we also review case reports of meningococcemia without meningitis in Japan.
Topics: Adult; Anti-Infective Agents; Female; Humans; Japan; Meningococcal Infections; Neisseria meningitidis; Purpura Fulminans
PubMed: 18758132
DOI: 10.2169/internalmedicine.47.1046 -
American Family Physician Dec 2015
Topics: Adult; Antigens, Human Platelet; Diagnosis, Differential; Disease Management; Female; Glucocorticoids; Humans; Immunoglobulins, Intravenous; Infant, Newborn; Infections; Kasabach-Merritt Syndrome; Monitoring, Immunologic; Platelet Transfusion; Pregnancy; Pregnancy Complications; Purpura; Purpura, Thrombocytopenic; Rh Isoimmunization; Thrombocytopenia, Neonatal Alloimmune
PubMed: 26760417
DOI: No ID Found -
BMJ Case Reports Mar 2011The authors present a case report of extensive facial petechiae following esophagogastroduodenoscopy (EGD). The patient was a previously healthy male who did not receive...
The authors present a case report of extensive facial petechiae following esophagogastroduodenoscopy (EGD). The patient was a previously healthy male who did not receive any medication predisposing to haemorrhage, nor did he suffer from any underlying disorder (as the subsequent diagnostic work-up demonstrated) that predisposed to the extensive facial capillary rupture. Increased intrathoracic pressure during EGD can rarely result in similar cases that are alarming to the patient and possibly the endoscopy staff, and awareness of their potential and their benign nature and prognosis can assist in reassuring patients.
Topics: Endoscopy, Digestive System; Face; Humans; Male; Middle Aged; Purpura
PubMed: 22707662
DOI: 10.1136/bcr.09.2010.3375 -
The New England Journal of Medicine Jun 2017
Topics: Child, Preschool; Humans; Male; Meningococcal Infections; Neisseria meningitidis, Serogroup B; Purpura Fulminans
PubMed: 28564574
DOI: 10.1056/NEJMicm1700231 -
Blood Sep 2017
Topics: Anemia; Hemorrhage; Humans; Purpura, Thrombocytopenic, Idiopathic; Purpura, Thrombotic Thrombocytopenic
PubMed: 28882834
DOI: 10.1182/blood-2017-07-795922 -
BMC Musculoskeletal Disorders Nov 2023The use of a tourniquet in combination with tranexamic acid (TXA) not only ensures clear vision, reduces intraoperative blood loss and shortens operative time but also... (Randomized Controlled Trial)
Randomized Controlled Trial
Blood-conserving and therapeutic efficacy of intravenous tranexamic acid at different time points after primary total knee arthroplasty with tourniquet application: a randomised controlled trial.
BACKGROUND
The use of a tourniquet in combination with tranexamic acid (TXA) not only ensures clear vision, reduces intraoperative blood loss and shortens operative time but also improves cement-bone inter-digitation in total knee arthroplasty (TKA). However, there is no proof whether the blood flow blocking effect of tourniquet affects the antifibrinolytic effect of TXA, and the optimal timing of TXA administration is still unclear. Therefore, this study aims to investigate the effect of the first dose of TXA administered intravenously before tourniquet compression and release in TKA on perioperative blood loss and therapeutic efficacy in patients.
METHODS
In this double-blind trial, 90 patients undergoing primary TKA were randomised into 2 groups: Group A, patients received intravenous TXA 10 min before tourniquet compression (20 mg/kg) and 3, 6 and 24 h later (10 mg/kg), and Group B, patients were treated the same as those in Group A but received intravenous TXA before tourniquet release. The primary outcomes were changes in blood loss, haemoglobin and haematocrit. Secondary outcomes included operation and tourniquet times, blood transfusion rate, subcutaneous petechiae and circumferential changes in the operated limb, visual analogue scale (VAS) score, hospital for special surgery (HSS) score, length of stay (LOS) postoperatively, complications and patient satisfaction.
RESULTS
No statistically significant difference was found between the 2 groups with regard to age, sex, weight, body mass index (BMI), Kellgren-Lawrence class, preoperative blood volume, preoperative laboratory values, operation and tourniquet times, transfusion rate, knee circumference, preoperative HSS, or VAS score (P:n.s.). There was no significant difference in intraoperative blood loss (IBL) (52.7 ml vs. 63.4 ml, P = 0.07), hidden blood loss (HBL) (91.4 ml vs. 119.9, P = 0.4) or total blood loss (TBL) (144.1 ml vs. 183.3 ml, P = 0.72) between Groups A and B. Haemoglobin, haematocrit and red blood cell count (RBC) dropped to a low point on postoperative day 3 and then rebounded, returning to normal levels on day 21, and the trend of change between the 2 groups was not statistically significant (P:n.s.). There was no significant difference in subcutaneous ecchymosis incidence, knee swelling rate, HSS score, VAS score, LOS postoperatively, complication rate or patient satisfaction (P:n.s.).
CONCLUSION
TXA was administered intravenously prior to tourniquet compression could effectively reduce blood loss in patients who had undergone total knee arthroplasty. However, there was no significant difference in knee swelling rate, subcutaneous bruising and petechiae incidence, knee function, complication rate or satisfaction between patients who TXA was given intravenously before tourniquet compression and release in primary TKA.
Topics: Humans; Tranexamic Acid; Blood Loss, Surgical; Arthroplasty, Replacement, Knee; Tourniquets; Antifibrinolytic Agents; Administration, Intravenous; Purpura; Hemoglobins
PubMed: 37978365
DOI: 10.1186/s12891-023-07036-y -
BMJ Case Reports Sep 2012The authors report the case of a 50-year-old alcoholic man with chronic hepatitis C virus infection, who presented to the emergency department with fever and exuberant...
The authors report the case of a 50-year-old alcoholic man with chronic hepatitis C virus infection, who presented to the emergency department with fever and exuberant ecchymoses and petechiae on both legs. After a careful examination and laboratory assessment, the not-so-obvious hypothesis of scurvy was disclosed. Simply with vitamin C replacement and nutritional advice, a dramatic improvement in his condition was observed. In modern societies, a generalised access to food renders scurvy as a rare disease, often misdiagnosed. A multidisciplinary approach is emphasised as the key to a more simple differential diagnosis, avoiding unnecessary exams and preventing serious complications, or even death, if left untreated.
Topics: Diagnosis, Differential; Ecchymosis; Emergency Service, Hospital; Fever; Gingival Diseases; Humans; Leg; Male; Middle Aged; Purpura; Scurvy
PubMed: 22987898
DOI: 10.1136/bcr-02-2012-5819