BACKGROUND Angioimmunoblastic T-cell lymphoma(AITL) is a subtype of peripheral T-cell lymphoma, with heterogenous clinical manifestations and poor prognosis. Here,we report a case of AITL induced hemophagocytic lympho...BACKGROUND Angioimmunoblastic T-cell lymphoma(AITL) is a subtype of peripheral T-cell lymphoma, with heterogenous clinical manifestations and poor prognosis. Here,we report a case of AITL induced hemophagocytic lymphohistiocytosis(HLH)and disseminated intravascular coagulopathy(DIC).CASE SUMMARY An 83-year-old man presented with fever and purpura of both lower limbs for one month. Groin lymph node puncture and flow cytometry indicated a diagnosis of AITL. Bone marrow examination and other laboratory related indexes indicated DIC and HLH. The patient rapidly succumbed to gastrointestinal bleeding and septic shock.CONCLUSION This is the first reported case of AITL induced HLH and DIC. AITL is more aggressive in older adults. In addition to male gender, mediastinal lymphadenopathy, anaemia, and sustained high level of neutrophil-to-lymphocyte ratio may indicate a greater risk of death. Early diagnosis, early detection of severe complications, and prompt and effective treatment are vital.展开更多
AIM:To evaluated our management algorithm of the coagulopathy.We evaluated our management algorithm of the coagulopathy.METHODS:Between October 2001 and January 2013,160 CDC children with coagulopathy(fibrinogen,FIB&l...AIM:To evaluated our management algorithm of the coagulopathy.We evaluated our management algorithm of the coagulopathy.METHODS:Between October 2001 and January 2013,160 CDC children with coagulopathy(fibrinogen,FIB<2 g/L)were recruited.FIB≥1 g/L is generally required for safe elective surgery.We used FIB level as an indicator when:(1)patients with FIB levels between1-2 g/L underwent one-stage definitive operation;and(2)patients with FIB<1 g/L underwent 3 d of medical treatment.Thereafter,those with FIB≥1 g/L underwent one-stage definitive operation whereas those with FIB<1 g/L underwent external biliary drainage to allow liver function improvement.Those patients with liver function improvements underwent definitive operation after 7 d of drainage.RESULTS:After preoperative optimization,92.5%of CDC children with coagulopathy underwent successful one-stage definitive operation.The remaining 7.5%of CDC children required initial external bile drainage,and underwent definitive operation 11 d after the admission.The mean operative time and postoperative recovery duration were comparable to those with normal coagulations.The median follow-up period was 57 mo.No blood transfusion or other postoperative complications were encountered.CONCLUSION:Following our management protocol,the majority of CDC children with coagulopathy can be managed with one-stage definitive operation.展开更多
We report a case of 27 year old female patient who was admitted to the hospital with an acute flare up of ulcerative colitis.The patient presented with complaints of persistent abdominal pain and bloody diarrhea despi...We report a case of 27 year old female patient who was admitted to the hospital with an acute flare up of ulcerative colitis.The patient presented with complaints of persistent abdominal pain and bloody diarrhea despite aggressive therapy for her ulcerative colitis.A CT scan of the abdomen on admission revealed hepatic vein thrombosis,suggesting a diagnosis of Budd-Chiari syndrome.Significantly,an associated thrombosis of the inferior mesenteric vein was also detected.Based on imaging data and clinical assessment,the patient was started on anticoagulation therapy and an extensive work-up for hypercoagulability was initiated.Up to the time of publication,no significant findings suggesting this patient has an underlying coagulation disorder have been found.Based on our search of PUBMED,this report is one of only five reported adult cases of Budd-Chiari Syndrome associated with ulcerative colitis in the English literature in living patients without evidence of a co-existing coagulation disorder.This case highlights the potential for thrombosis at unusual sites in ulcerative colitis patients even in the absence of classical coagulation abnormalities.In addition to the case presented,we provide a brief review of previously reported cases of Budd-Chiari Syndrome occurring in patients with inflammatory bowel disease.展开更多
There is a discrepancy between the information from clotting tests which have routinely been used in clinical practice and evidence regarding thrombotic and bleeding events in patients with liver disease. This discrep...There is a discrepancy between the information from clotting tests which have routinely been used in clinical practice and evidence regarding thrombotic and bleeding events in patients with liver disease. This discrepancy leads us to rely on other variables which have been shown to be involved in haemostasis in these patients and/or to extrapolate the behaviour of these patients to other settings in order to decide the best clinical approach. The aims of the present review are as follows:(1) to present the information provided by clotting tests in cirrhotic patients;(2) to present the factors that may influence clotting in these patients;(3) to review the clinical evidence; and(4) to put forward a clinical approach based on the first 3 points.展开更多
Extracellular vesicles are composed of fragments of exfoliated plasma membrane,organelles or nuclei and are released after cell activation,apoptosis or destruction.Platelet-derived extracellular vesicles are the most ...Extracellular vesicles are composed of fragments of exfoliated plasma membrane,organelles or nuclei and are released after cell activation,apoptosis or destruction.Platelet-derived extracellular vesicles are the most abundant type of extracellular vesicle in the blood of patients with traumatic brain injury.Accumulated laboratory and clinical evidence shows that platelet-derived extracellular vesicles play an important role in coagulopathy and inflammation after traumatic brain injury.This review discusses the recent progress of research on platelet-derived extracellular vesicles in coagulopathy and inflammation and the potential of platelet-derived extracellular vesicles as therapeutic targets for traumatic brain injury.展开更多
Objective:The systemic inflammatory response is regarded as the major cause of endotoxin-induced coagulopathy,which is a strong predictor of mortality in patients with severe sepsis.Simvastatin plays an important role...Objective:The systemic inflammatory response is regarded as the major cause of endotoxin-induced coagulopathy,which is a strong predictor of mortality in patients with severe sepsis.Simvastatin plays an important role in reducing inflammation.In addition,the gut has long been hypothesized to be the“motor”of critical illness,driving or aggravating sepsis by the increased intestinal permeability and bacterial translocation.展开更多
AIM To investigate the efficacy of thrombomodulin(TM)-α for treatment of disseminated intravascular coagulopathy(DIC) in the field of gastrointestinal surgery. METHODS Thirty-six peri-operative DIC patients in the fi...AIM To investigate the efficacy of thrombomodulin(TM)-α for treatment of disseminated intravascular coagulopathy(DIC) in the field of gastrointestinal surgery. METHODS Thirty-six peri-operative DIC patients in the field of gastrointestinal surgery who were treated with TM-α were retrospectively investigated. The relationships between patient demographics and the efficacy of TM-α were examined. Analysis of survival at 28 d was also performed on some parameters by means of the Kaplan-Meier method. Relationships between the ini-tiation of TM-α and patient demographics were also evaluated. RESULTS Abscess formation or bacteremia was the most frequent cause of DIC(33%), followed by digestive tract perforation(31%). Twenty-six patients developed DIC after surgery, frequently within 1 wk(81%). TM-α was most often administered within 1 d of the DIC diagnosis(72%) and was continued for more than 3 d(64%). Although bleeding tendency was observed in 7 patients(19%), a hemostatic procedure was not needed. DIC scores, systemic inflammatory response syndrome(SIRS) scores, quick-sequential organ failure assessment(qS OFA) scores, platelet counts, and prothrombin time ratios significantly improved after 1 wk(P < 0.05, for all). The overall survival rate at 28 d was 71%. The duration of TM-α administration(≥ 4, ≤ 6) and improvements in DIC-associated scores(DIC, SIRS and q SOFA) at 1 wk were significantly better prognostic factors for 28-d survival(P < 0.05, for all). TM-α was administered significantly earlier to patients with severe clinical symptoms, such as high qS OFA scores, sepsis, shock or high lactate values(P < 0.05, for all). CONCLUSION Early administration of TM-α and improvements in each parameter were essential for treatment of DIC. The diagnosis of patients with mild symptoms requires further study.展开更多
BACKGROUND Umbilical cord milking(UCM)is an alternative placental transfusion method for delayed umbilical cord clamping in routine obstetric practice,allowing prompt resuscitation of an infant.Thus,UCM has been adopt...BACKGROUND Umbilical cord milking(UCM)is an alternative placental transfusion method for delayed umbilical cord clamping in routine obstetric practice,allowing prompt resuscitation of an infant.Thus,UCM has been adopted at some tertiary neonatal centers for preterm infants to enhance placental-to-fetal transfusion.It is not suggested for babies less than 28 wk of gestational age because it is associated with severe brain hemorrhage.For late preterm or term infants who do not require resuscitation,cord management is recommended to increase iron levels and prevent the development of iron deficiency anemia,which is associated with impaired motor development,behavioral problems,and cognitive delays.Concerns remain about whether UCM increases the incidence of intraventricular hemorrhage.However,there are very few reports of late preterm infants presenting with neonatal hemorrhage stroke(NHS)and severe coagulopathy after receiving UCM.Here,we report a case of a late preterm infant born at 34 wk of gestation.She abruptly deteriorated,exhibiting signs and symptoms of NHS and severe coagulopathy after receiving UCM on the first day of life.CASE SUMMARY A female preterm infant born at 34 wk of gestation received UCM after birth.She was small for her gestational age and described as vigorous with Apgar scores of 9 and 10 at one minute and five minutes of life,respectively.After hospitalization in the neonatal intensive care unit,she showed hypoglycemia and metabolic acidosis.The baby was administered glucose and sodium bicarbonate infusions.Intramuscular vitamin K1 was also used to prevent vitamin K deficiency.The baby developed umbilical cord bleeding and gastric bleeding on day 1 of life;a physical examination showed bilateral conjunctival hemorrhage,and a blood test showed thrombocytopenia,prolonged prothrombin time,prolonged activated partial thromboplastin time,low fibrinogen,raised D-dimer levels and anemia.A subsequent cranial ultrasound and computed tomography scan showed a left parenchymal brain hemorrhage with extension into the ventricular and subarachnoid spaces.The patient was diagnosed with NHS in addition to disseminated intravascular coagulation(DIC).Fresh frozen plasma(FFP)and prothrombin complex concentrate were given for coagulopathy.Red blood cell and platelet transfusions were provided for thrombocytopenia and anemia.A bolus of midazolam,intravenous calcium and phenobarbital sodium were administered to control seizures.The baby’s clinical condition improved on day 5 of life,and the baby was hospitalized for 46 d and recovered well without seizure recurrence.Our case report suggests that preterm infants who receive UCM should undergo careful clinical assessment for intracranial hemorrhage,NHS and severe coagulopathy that may develop under certain circumstances.Supportive management,such as intensive care,FFP and blood transfusion,is recommended when the development of massive NHS and associated DIC is suspected.CONCLUSION Our case report suggests that for late preterm infants who are small for gestational age and who receive UCM for alternative placental transfusion,neonatal health care professionals should be cautious in assessing the development of NHS and severe coagulopathy.Neonatal health care professionals should also be more cautious in assessing the complications of late preterm infants after they receive UCM.展开更多
Massive hemorrhage isgerenally defined as hemorrhage requiring the transfusion of 10 or more red cell concentrate units in 24 h.It mostly occurs following severe trauma as well as major surgery,which might be complica...Massive hemorrhage isgerenally defined as hemorrhage requiring the transfusion of 10 or more red cell concentrate units in 24 h.It mostly occurs following severe trauma as well as major surgery,which might be complicated with hypovolemic shock as well as disseminated intravascular coagulation(DIC).Its mortality展开更多
Coagulopathy is a well-known consequence of trauma and is the most common cause of mortality in the young. However, its cause and management is still controversial. A new concept in the understanding of coagulopathy i...Coagulopathy is a well-known consequence of trauma and is the most common cause of mortality in the young. However, its cause and management is still controversial. A new concept in the understanding of coagulopathy in trauma is the occurrence of Acute coagulopathy of trauma(ACo T). ACo T is associated with hypo perfusion and tissue trauma as seen in massive injury. The incidence of coagulopathy increases with injury scores and is associated with higher number of ventilator days, higher morbidity and mortality. The process of coagulation is better described by the cell based model with a central role for platelets rather than the older plasma based model. This shift in our understanding supports the theory that ACo T results from the endothelial release of thrombomodulin and activated protein C in the presence of hypoperfusion. This in turn leads on to a hyperfibrinolytic and hypocoagulable state. Viscoelastic hemostatic assays are replacing the older tests like prothrombin time in the assessment of coagulopathy. These tests are accurate, determine the need for transfusion and can be performed at the point of care. Damage control resuscitation includes newer concepts like permissive hypotension, increased use of plasma as a part of massive transfusion protocols and damage control surgery.展开更多
Traumatic brain injury(TBI)-induced coagulopathy has increasingly been recognized as a significant risk factor for poor outcomes,but the pathogenesis remains poorly understood.In this study,we aimed to investigate the...Traumatic brain injury(TBI)-induced coagulopathy has increasingly been recognized as a significant risk factor for poor outcomes,but the pathogenesis remains poorly understood.In this study,we aimed to investigate the causal role of acrolein,a typical lipid peroxidation product,in TBI-induced coagulopathy,and further explore the underlying molecular mechanisms.We found that the level of plasma acrolein in TBI patients suffering from coagulopathy was higher than that in those without coagulopathy.Using a controlled cortical impact mouse model,we demonstrated that the acrolein scavenger phenelzine prevented TBI-induced coagulopathy and recombinant ADAMTS-13 prevented acrolein-induced coagulopathy by cleaving von Willebrand factor(VWF).Our results showed that acrolein may contribute to an early hypercoagulable state after TBI by regulating VWF secretion.mRNA sequencing(mRNA-seq)and transcriptome analysis indicated that acrolein over-activated autophagy,and subsequent experiments revealed that acrolein activated autophagy partly by regulating the Akt/mTOR pathway.In addition,we demonstrated that acrolein was produced in the perilesional cortex,affected endothelial cell integrity,and disrupted the blood-brain barrier.In conclusion,in this study we uncovered a novel pro-coagulant effect of acrolein that may contribute to TBI-induced coagulopathy and vascular leakage,providing an alternative therapeutic target.展开更多
Acute liver failure (ALF) is the rapid onset of severe liver dysfunction, defined by the presence of hepatic encephalop-athy and impaired synthetic function (international normal-ized ratio of≥1.5) in the absence of ...Acute liver failure (ALF) is the rapid onset of severe liver dysfunction, defined by the presence of hepatic encephalop-athy and impaired synthetic function (international normal-ized ratio of≥1.5) in the absence of underlying liver disease. The elevated international normalized ratio value in ALF is often misinterpreted as an increased hemorrhagic tendency, which can lead to inappropriate, prophylactic transfusions of blood products. However, global assessments of coagulop-athy via viscoelastic tests or thrombin generation assay suggest a reestablished hemostatic, or even hypercoagu-lable, status in patients with ALF. Although the current versions of global assays are not perfect, they can provide more nuanced insights into the hemostatic system in ALF than the conventional measures of coagulopathy.展开更多
Coagulopathy,characterized by a high D-dimer level,is a common pathological occurrence in coronavirus dis-ease 2019(COVID-19)and is associated with poor prognosis.Severe cases with COVID-19 is associated with a signif...Coagulopathy,characterized by a high D-dimer level,is a common pathological occurrence in coronavirus dis-ease 2019(COVID-19)and is associated with poor prognosis.Severe cases with COVID-19 is associated with a significantly higher risk of deep vein thrombosis and acute pulmonary embolism.Pulmonary intravascular coagulopathy is the characteristic coagulopathy in COVID-19.Unlike sepsis-induced coagulopathy and dissem-inated intravascular coagulation,which are manifestations of systemic coagulopathy,pulmonary intravascular coagulopathy is a manifestation of a local coagulation disorder in the lung.The progression from pulmonary intravascular coagulopathy to sepsis-induced coagulopathy or disseminated intravascular coagulation in the con-text of COVID-19 may indicate that the patient’s coagulation dysfunction has progressed from local to systemic.Exploring the associated coagulation disease will aid in the understanding of the pathophysiological mechanisms underlying severe COVID-19.展开更多
According to a new international classification of vascular lesions,venous vascular malformation has become the most common type of congenital vascular malformation.A characteristic of this disease is its life-long pr...According to a new international classification of vascular lesions,venous vascular malformation has become the most common type of congenital vascular malformation.A characteristic of this disease is its life-long progressive development,which is the main cause of harm to health and is different from hemangioma.Severe hemangioma with thrombocytopenia (Kasabach-Merritt syndrome)[1]is often encountered in children,especially in infants younger than 1 year old.Coagulation abnormalities in Kasabach-Merritt syndrome are mainly caused by increased platelet destruction.展开更多
基金Supported by the National Natural Science Foundation of China,No. 82160692 and No. 82160037。
文摘BACKGROUND Angioimmunoblastic T-cell lymphoma(AITL) is a subtype of peripheral T-cell lymphoma, with heterogenous clinical manifestations and poor prognosis. Here,we report a case of AITL induced hemophagocytic lymphohistiocytosis(HLH)and disseminated intravascular coagulopathy(DIC).CASE SUMMARY An 83-year-old man presented with fever and purpura of both lower limbs for one month. Groin lymph node puncture and flow cytometry indicated a diagnosis of AITL. Bone marrow examination and other laboratory related indexes indicated DIC and HLH. The patient rapidly succumbed to gastrointestinal bleeding and septic shock.CONCLUSION This is the first reported case of AITL induced HLH and DIC. AITL is more aggressive in older adults. In addition to male gender, mediastinal lymphadenopathy, anaemia, and sustained high level of neutrophil-to-lymphocyte ratio may indicate a greater risk of death. Early diagnosis, early detection of severe complications, and prompt and effective treatment are vital.
文摘AIM:To evaluated our management algorithm of the coagulopathy.We evaluated our management algorithm of the coagulopathy.METHODS:Between October 2001 and January 2013,160 CDC children with coagulopathy(fibrinogen,FIB<2 g/L)were recruited.FIB≥1 g/L is generally required for safe elective surgery.We used FIB level as an indicator when:(1)patients with FIB levels between1-2 g/L underwent one-stage definitive operation;and(2)patients with FIB<1 g/L underwent 3 d of medical treatment.Thereafter,those with FIB≥1 g/L underwent one-stage definitive operation whereas those with FIB<1 g/L underwent external biliary drainage to allow liver function improvement.Those patients with liver function improvements underwent definitive operation after 7 d of drainage.RESULTS:After preoperative optimization,92.5%of CDC children with coagulopathy underwent successful one-stage definitive operation.The remaining 7.5%of CDC children required initial external bile drainage,and underwent definitive operation 11 d after the admission.The mean operative time and postoperative recovery duration were comparable to those with normal coagulations.The median follow-up period was 57 mo.No blood transfusion or other postoperative complications were encountered.CONCLUSION:Following our management protocol,the majority of CDC children with coagulopathy can be managed with one-stage definitive operation.
文摘We report a case of 27 year old female patient who was admitted to the hospital with an acute flare up of ulcerative colitis.The patient presented with complaints of persistent abdominal pain and bloody diarrhea despite aggressive therapy for her ulcerative colitis.A CT scan of the abdomen on admission revealed hepatic vein thrombosis,suggesting a diagnosis of Budd-Chiari syndrome.Significantly,an associated thrombosis of the inferior mesenteric vein was also detected.Based on imaging data and clinical assessment,the patient was started on anticoagulation therapy and an extensive work-up for hypercoagulability was initiated.Up to the time of publication,no significant findings suggesting this patient has an underlying coagulation disorder have been found.Based on our search of PUBMED,this report is one of only five reported adult cases of Budd-Chiari Syndrome associated with ulcerative colitis in the English literature in living patients without evidence of a co-existing coagulation disorder.This case highlights the potential for thrombosis at unusual sites in ulcerative colitis patients even in the absence of classical coagulation abnormalities.In addition to the case presented,we provide a brief review of previously reported cases of Budd-Chiari Syndrome occurring in patients with inflammatory bowel disease.
文摘There is a discrepancy between the information from clotting tests which have routinely been used in clinical practice and evidence regarding thrombotic and bleeding events in patients with liver disease. This discrepancy leads us to rely on other variables which have been shown to be involved in haemostasis in these patients and/or to extrapolate the behaviour of these patients to other settings in order to decide the best clinical approach. The aims of the present review are as follows:(1) to present the information provided by clotting tests in cirrhotic patients;(2) to present the factors that may influence clotting in these patients;(3) to review the clinical evidence; and(4) to put forward a clinical approach based on the first 3 points.
基金supported by Scientific Research Program of Tianjin Education Commission(Natural Science)of China,No.2019ZD034(to QJD).
文摘Extracellular vesicles are composed of fragments of exfoliated plasma membrane,organelles or nuclei and are released after cell activation,apoptosis or destruction.Platelet-derived extracellular vesicles are the most abundant type of extracellular vesicle in the blood of patients with traumatic brain injury.Accumulated laboratory and clinical evidence shows that platelet-derived extracellular vesicles play an important role in coagulopathy and inflammation after traumatic brain injury.This review discusses the recent progress of research on platelet-derived extracellular vesicles in coagulopathy and inflammation and the potential of platelet-derived extracellular vesicles as therapeutic targets for traumatic brain injury.
基金This study was supported by grants from the National Natural Science Foundation of China(No.81873434)and the Natural Science Foundation of Hubei Province(No.2020CFA065).
文摘Objective:The systemic inflammatory response is regarded as the major cause of endotoxin-induced coagulopathy,which is a strong predictor of mortality in patients with severe sepsis.Simvastatin plays an important role in reducing inflammation.In addition,the gut has long been hypothesized to be the“motor”of critical illness,driving or aggravating sepsis by the increased intestinal permeability and bacterial translocation.
文摘AIM To investigate the efficacy of thrombomodulin(TM)-α for treatment of disseminated intravascular coagulopathy(DIC) in the field of gastrointestinal surgery. METHODS Thirty-six peri-operative DIC patients in the field of gastrointestinal surgery who were treated with TM-α were retrospectively investigated. The relationships between patient demographics and the efficacy of TM-α were examined. Analysis of survival at 28 d was also performed on some parameters by means of the Kaplan-Meier method. Relationships between the ini-tiation of TM-α and patient demographics were also evaluated. RESULTS Abscess formation or bacteremia was the most frequent cause of DIC(33%), followed by digestive tract perforation(31%). Twenty-six patients developed DIC after surgery, frequently within 1 wk(81%). TM-α was most often administered within 1 d of the DIC diagnosis(72%) and was continued for more than 3 d(64%). Although bleeding tendency was observed in 7 patients(19%), a hemostatic procedure was not needed. DIC scores, systemic inflammatory response syndrome(SIRS) scores, quick-sequential organ failure assessment(qS OFA) scores, platelet counts, and prothrombin time ratios significantly improved after 1 wk(P < 0.05, for all). The overall survival rate at 28 d was 71%. The duration of TM-α administration(≥ 4, ≤ 6) and improvements in DIC-associated scores(DIC, SIRS and q SOFA) at 1 wk were significantly better prognostic factors for 28-d survival(P < 0.05, for all). TM-α was administered significantly earlier to patients with severe clinical symptoms, such as high qS OFA scores, sepsis, shock or high lactate values(P < 0.05, for all). CONCLUSION Early administration of TM-α and improvements in each parameter were essential for treatment of DIC. The diagnosis of patients with mild symptoms requires further study.
基金Supported by Zhejiang Province Medical Science and Technology Foundation of China,No.2021PY057.
文摘BACKGROUND Umbilical cord milking(UCM)is an alternative placental transfusion method for delayed umbilical cord clamping in routine obstetric practice,allowing prompt resuscitation of an infant.Thus,UCM has been adopted at some tertiary neonatal centers for preterm infants to enhance placental-to-fetal transfusion.It is not suggested for babies less than 28 wk of gestational age because it is associated with severe brain hemorrhage.For late preterm or term infants who do not require resuscitation,cord management is recommended to increase iron levels and prevent the development of iron deficiency anemia,which is associated with impaired motor development,behavioral problems,and cognitive delays.Concerns remain about whether UCM increases the incidence of intraventricular hemorrhage.However,there are very few reports of late preterm infants presenting with neonatal hemorrhage stroke(NHS)and severe coagulopathy after receiving UCM.Here,we report a case of a late preterm infant born at 34 wk of gestation.She abruptly deteriorated,exhibiting signs and symptoms of NHS and severe coagulopathy after receiving UCM on the first day of life.CASE SUMMARY A female preterm infant born at 34 wk of gestation received UCM after birth.She was small for her gestational age and described as vigorous with Apgar scores of 9 and 10 at one minute and five minutes of life,respectively.After hospitalization in the neonatal intensive care unit,she showed hypoglycemia and metabolic acidosis.The baby was administered glucose and sodium bicarbonate infusions.Intramuscular vitamin K1 was also used to prevent vitamin K deficiency.The baby developed umbilical cord bleeding and gastric bleeding on day 1 of life;a physical examination showed bilateral conjunctival hemorrhage,and a blood test showed thrombocytopenia,prolonged prothrombin time,prolonged activated partial thromboplastin time,low fibrinogen,raised D-dimer levels and anemia.A subsequent cranial ultrasound and computed tomography scan showed a left parenchymal brain hemorrhage with extension into the ventricular and subarachnoid spaces.The patient was diagnosed with NHS in addition to disseminated intravascular coagulation(DIC).Fresh frozen plasma(FFP)and prothrombin complex concentrate were given for coagulopathy.Red blood cell and platelet transfusions were provided for thrombocytopenia and anemia.A bolus of midazolam,intravenous calcium and phenobarbital sodium were administered to control seizures.The baby’s clinical condition improved on day 5 of life,and the baby was hospitalized for 46 d and recovered well without seizure recurrence.Our case report suggests that preterm infants who receive UCM should undergo careful clinical assessment for intracranial hemorrhage,NHS and severe coagulopathy that may develop under certain circumstances.Supportive management,such as intensive care,FFP and blood transfusion,is recommended when the development of massive NHS and associated DIC is suspected.CONCLUSION Our case report suggests that for late preterm infants who are small for gestational age and who receive UCM for alternative placental transfusion,neonatal health care professionals should be cautious in assessing the development of NHS and severe coagulopathy.Neonatal health care professionals should also be more cautious in assessing the complications of late preterm infants after they receive UCM.
基金supported by a Project Funded by the Priority Academic Program Development of Jiangsu Higher Education Institutions
文摘Massive hemorrhage isgerenally defined as hemorrhage requiring the transfusion of 10 or more red cell concentrate units in 24 h.It mostly occurs following severe trauma as well as major surgery,which might be complicated with hypovolemic shock as well as disseminated intravascular coagulation(DIC).Its mortality
文摘Coagulopathy is a well-known consequence of trauma and is the most common cause of mortality in the young. However, its cause and management is still controversial. A new concept in the understanding of coagulopathy in trauma is the occurrence of Acute coagulopathy of trauma(ACo T). ACo T is associated with hypo perfusion and tissue trauma as seen in massive injury. The incidence of coagulopathy increases with injury scores and is associated with higher number of ventilator days, higher morbidity and mortality. The process of coagulation is better described by the cell based model with a central role for platelets rather than the older plasma based model. This shift in our understanding supports the theory that ACo T results from the endothelial release of thrombomodulin and activated protein C in the presence of hypoperfusion. This in turn leads on to a hyperfibrinolytic and hypocoagulable state. Viscoelastic hemostatic assays are replacing the older tests like prothrombin time in the assessment of coagulopathy. These tests are accurate, determine the need for transfusion and can be performed at the point of care. Damage control resuscitation includes newer concepts like permissive hypotension, increased use of plasma as a part of massive transfusion protocols and damage control surgery.
基金the National Natural Science Foundation of China(81630027).
文摘Traumatic brain injury(TBI)-induced coagulopathy has increasingly been recognized as a significant risk factor for poor outcomes,but the pathogenesis remains poorly understood.In this study,we aimed to investigate the causal role of acrolein,a typical lipid peroxidation product,in TBI-induced coagulopathy,and further explore the underlying molecular mechanisms.We found that the level of plasma acrolein in TBI patients suffering from coagulopathy was higher than that in those without coagulopathy.Using a controlled cortical impact mouse model,we demonstrated that the acrolein scavenger phenelzine prevented TBI-induced coagulopathy and recombinant ADAMTS-13 prevented acrolein-induced coagulopathy by cleaving von Willebrand factor(VWF).Our results showed that acrolein may contribute to an early hypercoagulable state after TBI by regulating VWF secretion.mRNA sequencing(mRNA-seq)and transcriptome analysis indicated that acrolein over-activated autophagy,and subsequent experiments revealed that acrolein activated autophagy partly by regulating the Akt/mTOR pathway.In addition,we demonstrated that acrolein was produced in the perilesional cortex,affected endothelial cell integrity,and disrupted the blood-brain barrier.In conclusion,in this study we uncovered a novel pro-coagulant effect of acrolein that may contribute to TBI-induced coagulopathy and vascular leakage,providing an alternative therapeutic target.
基金This work was supported by the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health under award number K23AA028297(to PHC)and Johns Hopkins University Clinician Scientist Award(to PHC).
文摘Acute liver failure (ALF) is the rapid onset of severe liver dysfunction, defined by the presence of hepatic encephalop-athy and impaired synthetic function (international normal-ized ratio of≥1.5) in the absence of underlying liver disease. The elevated international normalized ratio value in ALF is often misinterpreted as an increased hemorrhagic tendency, which can lead to inappropriate, prophylactic transfusions of blood products. However, global assessments of coagulop-athy via viscoelastic tests or thrombin generation assay suggest a reestablished hemostatic, or even hypercoagu-lable, status in patients with ALF. Although the current versions of global assays are not perfect, they can provide more nuanced insights into the hemostatic system in ALF than the conventional measures of coagulopathy.
基金This work was supported by the Scientific Project of The Educational Department of Liaoning Province(Grant no.ZF2019010)China Medical University’s COVID-19 prevention-and control-related research projects.
文摘Coagulopathy,characterized by a high D-dimer level,is a common pathological occurrence in coronavirus dis-ease 2019(COVID-19)and is associated with poor prognosis.Severe cases with COVID-19 is associated with a significantly higher risk of deep vein thrombosis and acute pulmonary embolism.Pulmonary intravascular coagulopathy is the characteristic coagulopathy in COVID-19.Unlike sepsis-induced coagulopathy and dissem-inated intravascular coagulation,which are manifestations of systemic coagulopathy,pulmonary intravascular coagulopathy is a manifestation of a local coagulation disorder in the lung.The progression from pulmonary intravascular coagulopathy to sepsis-induced coagulopathy or disseminated intravascular coagulation in the con-text of COVID-19 may indicate that the patient’s coagulation dysfunction has progressed from local to systemic.Exploring the associated coagulation disease will aid in the understanding of the pathophysiological mechanisms underlying severe COVID-19.
文摘According to a new international classification of vascular lesions,venous vascular malformation has become the most common type of congenital vascular malformation.A characteristic of this disease is its life-long progressive development,which is the main cause of harm to health and is different from hemangioma.Severe hemangioma with thrombocytopenia (Kasabach-Merritt syndrome)[1]is often encountered in children,especially in infants younger than 1 year old.Coagulation abnormalities in Kasabach-Merritt syndrome are mainly caused by increased platelet destruction.
