Hemorrhagic complications during extracorporeal membrane oxygenation - The role of anticoagulation and platelets

PURPOSE: Hemorrhagic complications during extracorporeal membrane oxygenation are frequent and have a negative impact on outcome. We studied the association between activated partial thromboplastin time or platelet count and the occurrence of hemorrhagic complications. The secondary objective was to determine risk factors for hemorrhagic complications. METHODS: Retrospective cohort study in a single-center Dutch university hospital. We included all adult patients on extracorporeal membrane oxygenation admitted to the intensive care unit between 2010 and 2017. RESULTS: We included 164 consecutive patients of which 73 (45%) had a hemorrhagic complication. The most prevalent hemorrhagic complications were surgical site (62%) and cannula site bleeding (18%). Survival to discharge was 67% in the patients without a hemorrhagic complication and 33% in the patients with hemorrhagic complications (p < .01). A higher activated partial thromboplastin time in the 24 h prior was associated with the occurrence of hemorrhagic complications (adjusted hazard ratio per 10 s increase 1.14; (95% CI 1.05-1.24). Venoarterial extracorporeal membrane oxygenation, duration of support, and higher activated partial thromboplastin time were risk factors for the occurrence of hemorrhagic complications. CONCLUSIONS: Higher activated partial thromboplastin time is associated with the occurrence of hemorrhagic complications

Influence of vitamin K antagonist treatment on activated partial thromboplastin time

A

A perioperative uncontrollable bleeding in an elderly patient with acquired hemophilia A: a case report

Acquired hemophilia A should be taken into account in the differential diagnosis of perioperative bleeding in patients without any apparent reason for activated partial thromboplastin time prolongation

PENGARUH LAMA PENUNDAAN DARAH SITRAT PADA SUHU 20±1ºC TERHADAP PEMERIKSAAN ACTIVATED PARTIAL THROMBOPLASTIN TIME (APTT)

Latar Belakang : Pemeriksaan Activated Partial Thromboplastin Time (APTT) digunakan untuk menguji pembekuan darah melalui jalur intrinsik dan jalur bersama. Pemeriksaan APTT dengan sampel darah sitrat dan plasma harus segera diperiksa. Adanya penundaan spesimen darah sitrat dapat menyumbang kesalahan pra analitik mencapai 68%. Penundaan darah sitrat sebelum disentrifugasi terjadi karena sampel yang didapatkan banyak sehingga harus bergiliran dalam mensentrifugasi. Selain itu, proses pengiriman sampel dari bangsal ke laboratorium yang membutuhkan transportasi sehingga harus dilakukan penundan dalam mensentrifugasi untuk mendapatkan plasma sitrat. Tujuan : Mengetahui pengaruh lama penundaan darah sitrat pada suhu 20±1oC terhadap nilai Activated Partial Thromboplastin Time (APTT). Metode : Penelitian pre experimental design dengan desain static group comparison. Sampel penelitian adalah darah sitrat seluruh Mahasiswa DIII Semester 6 Jurusan Analis Kesehatan Politeknik Kementerian Kesehatan Republik Indonesia sebanyak 17 sampel. Sampel dibagi menjadi dua kelompok yaitu kelompok kontrol dan kelompok perlakuan. Kelompok kontrol yaitu darah sitrat yang segera disentrifugasi sedangkan kelompok perlakuan yaitu darah sitrat yang ditunda selama 1 jam dan 2 jam pada suhu 20±1ºC. Kemudian dilakukan pengukuran nilai Activated Partial Thromboplastin Time (APTT). Data dianalisis secara deskriptif dan statistik menggunakan One-Way ANOVA. Hasil : Rerata nilai APTT pada darah sitrat yang segera diperiksa 33, 7 detik dan rerata nilai APTT pada darah sitrat yang ditunda 1 jam pada suhu 20±1ºC 30, 6 detik sedangkan darah sitrat yang ditunda 2 jam pada suhu 20±1ºC 27, 4 detik. Berdasarkan hasil tersebut, dapat diketahui bahwa semakin lama penundaan darah sitrat maka nilai Activated Partial Thromboplastin Time (APTT) semakin menurun. Kesimpulan : Ada pengaruh lama penundaan darah sitrat pada suhu 20±1oC terhadap pemeriksaan Activated Partial Thromboplastin Time (APTT). Kata kunci : Penundaan, Activated Partial Thromboplastin Time (APTT), darah sitrat

Case report: quetiapine-induced transient elevation of activated partial thromboplastin time

We report a case of 3-year old Pakistani boy who was previously well and brought to the hospital because of an accidental ingestion of quetiapine 8 hours before admission. No gastric lavage or activated charcoal done because of late presentation. He developed headache, excessive drinking and sleepiness few hours post ingestion but his symptoms resolved before arrival. His laboratory work up (Full blood count, blood urea and serum electrolytes, liver function test and coagulation profile) showed only an elevated activated Partial Thromboplastin Time (APTT). The patient was discharged after 24 hours. We checked APTTweekly. Even though, he remained well clinically his APTT continued to be high until after 1.5 months of ingestion when repeated APTT was normalized. Review at literature reported many anti-psychotics including quetiapine can cause an elevation of Prothrombin Time (PT) and APTT and low platelet count in adult patients taking them regularly [6], drug overdose can cause APTT elevation as well [4]. We conclude that this 3 years old child has quetiapine-induced transient elevation of APTT

COAGULATION PROFILE IN PATIENTS SUFFERING FROM ACUTE BRUCELLOSIS

Objective: Although brucellosis has almost been eradicated from most of the developed countries, it still continues to be a major but somehow neglected disease in the developing and underdeveloped countries. In the past, hematological abnormalities like anemia, thrombocytopenia have been reported to be seen in brucellosis patients. The objective of the present study is to observe and study the coagulation profile of patients suffering from acute brucellosis.Methods: Blood samples were collected from brucellosis patients and healthy volunteers and were analyzed in automated blood coagulation analyzer and automated hematology analyzer to find out the values of prothrombin time (PT), activated partial thromboplastin time (aPTT) and platelet count.Results: Statistical analysis revealed that there was marginal increase in the aPTT level and platelet count in brucellosis patients than that of the control patients.Conclusion: The study revealed that there might be a tendency of prolonged aPTT and increase in platelet levels in brucellosis patients.Keywords: Brucellosis, coagulation profile, prothrombin time (PT), activated partial thromboplastin time (aPTT), platelet count

Canine reference intervals for coagulation markers using the STA Satellite and the STA-R Evolution analyzers

The aim of the current study was to determine canine reference intervals for prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen, and antithrombin (AT) according to international recommendations. The STA Satellite coefficients of variation of within-laboratory imprecision were 3.9%, 1.3%, 6.9%, and 5.1% for PT, APTT, fibrinogen, and AT, respectively. At 4uC, citrated specimens were stable up to 8 hr for whole blood and 36 hr for plasma, except for APTT, which increased slightly (<1 sec). Nonparametric reference intervals determined in citrated plasma from 139 healthy fasting purebred dogs were 6.9–8.8 sec, 13.1–17.2 sec, 1.24–4.30 g/l, and 104–188% for PT, APTT, fibrinogen, and AT, respectively. Based on Passing–Bablok comparison between STA Satellite and STA-R Evolution using 60 frozen specimens from a canine plasma bank, the corresponding reference intervals were transferred to the STA-R Evolution: 7.1–9.2 sec, 12.9–17.3 sec, 1.20–4.43 g/l, and 94–159% for PT, APTT, fibrinogen, and AT, respectively

An unusual cause of spontaneous bleeding in the intensive care unit – mastocytosis: a case report

We report the case of a 39-year old male patient who presented with anaphylactoid shock and diffuse bleeding with prolonged activated partial thromboplastin time at the emergency room. The diagnosis of aggressive mastocytosis was suspected and then confirmed by raised tryptase level and mastocytic infiltration of the bone marrow. The outcome was favorable with supportive measures, antihistamine drugs, and imatinib mesylate