Trombosis y vacuna para COVID-19. ¡Que podemos decir los hematólogos!

Recientemente ha surgido una controversia en la población sobre el riesgo de trombosis de la vacuna para el coronavirus SARS-CoV-2 y muchos pacientes nos consultan sobre el riesgo de que una complicación trombótica fatal ocurra luego de vacunarse.Esto se ha visto potenciado por la difusión en los medios de comunicación que resaltan noticias surgidas desde Europa y EEUU en el último mes sobre la suspensión por la Agencia Europea de Medicamentos (EMA) de la vacunación a causa de un raro fenómeno de plaquetopenia y trombosis en sitios inusuales, con una mortalidad de hasta 20-40%(1).Sobre este raro evento adverso de la vacuna creo que debemos aclarar algunos conceptos importantes para informar correctamente a nuestros pacientes

Venous thromboembolism in Latin America: a review and guide to diagnosis and treatment for primary care

There are various region-specific challenges to the diagnosis and effective treatment of venous thromboembolism in Latin America. Clear guidance for physicians and patient education could improve adherence to existing guidelines. This review examines available information on the burden of pulmonary embolism and deep vein thrombosis in Latin America and the regional issues surrounding the diagnosis and treatment of pulmonary embolism and deep vein thrombosis. Potential barriers to appropriate care, as well as treatment options and limitations on their use, are discussed. Finally, an algorithmic approach to the diagnosis and treatment of venous thromboembolism in ambulatory patients is proposed and care pathways for patients with pulmonary embolism and deep vein thrombosis are outlined for primary care providers in Latin America

Auer rod-like inclusions in IgG kappa multiple myeloma cells

Las inclusiones pseudo bastones de Auer en el citoplasma de células plasmáticas son un hallazgo morfológico muy poco frecuente. Se observan mayormente en mieloma múltiple de tipo IgG kappa, como en el presente caso. Su significado pronóstico aún no ha sido determinado.Auer rod-like inclusions in plasma cells cytoplasm is a very infrequent morphologic finding. They are mainly observed in IgG kappa multiple myeloma, as in the present case. Their prognostic relevance is still unknown

Púrpura fulminans asociada a déficit adquirido de proteína S en una paciente con neumonía por Streptococcus pneumoniae

Purpura fulminans is a hematological emergency characterized by cutaneous necrosis and laboratory disseminated intravascular coagulation (DIC) parameters. It can appear associated with severe infections, as an autoimmune process after benign infections in childhood or be the presenting symptom of a congenital protein C or S deficiency. A clinical case of purpura fulminans associated with acquired protein S deficiency is described in a 6-year-old patient with severe Streptococcus Pneumoniae pneumonia.La púrpura fulminans es una emergencia hematológica que se caracteriza por presentar necrosis cutánea y parámetros de coagulación intravascular diseminada (CID) en el laboratorio. Puede presentarse asociada a infecciones severas, como un proceso autoinmune posterior a infecciones benignas en la infancia o ser el síntoma de presentación de una deficiencia congénita de proteínas C o S. Se describe un caso clínico de púrpura fulminans asociado a déficit adquirido de proteína S en una paciente de 6 años con neumonía grave por Streptococcus pneumoniae

Uso de plasma de convaleciente en el tratamiento de paciente con neumonía por COVID-19. Reporte de caso

Sars-Cov-2, known as COVID-19, is a virus belonging to coronavirus family, whose characteristicis the development of respiratory diseases, mainly pneumonia, with a high risk of progression to acute respiratory distress syndrome, which in turn is related to high morbidity and mortality rates that vary from case to case. Although a specific management scheme is not available, the use of convalescent plasma has been proposed as a therapeutic alternative, so studies are currently being carried out to evaluate its efficacy, although there are preliminary reports of published studies with encouraging results with low risk and possible benefits of this therapy. We present our case experience regarding the use of convalescent plasma in a 24 years old patient diagnosed with COVID-19 pneumonia at our institution.El SARS-CoV-2, conocido como COVID-19, es un virus perteneciente a la familia de los coronavirus, cuya característica es el desarrollo de enfermedades respiratorias, principalmente neumonía, con alto riesgo de progresión a síndrome de dificultad respiratoria aguda, la cual a su vez se relaciona con altos índices de morbi-mortalidad que varían según cada caso. Si bien no se dispone de un esquema de manejo específico, el uso de plasma de convalecientes se ha propuesto como una alternativa terapéutica por lo que en la actualidad se realizan estudios para evaluar su efectividad, aunque hay reportes preliminares de trabajos publicados con resultados alentadores en función del bajo riesgo frente a los beneficios potenciales de esta terapéutica. Presentamos la experiencia respecto al uso de plasma de convaleciente en un paciente de 24 años, con diagnóstico de neumonía por COVID-19 en nuestra institución

Apixaban for Extended Treatment of Venous Thromboembolism

BACKGROUND Apixaban, an oral factor Xa inhibitor that can be administered in a simple, fixed-dose regimen, may be an option for the extended treatment of venous thromboembolism. METHODS In this randomized, double-blind study, we compared two doses of apixaban (2.5 mg and 5 mg, twice daily) with placebo in patients with venous thromboembolism who had completed 6 to 12 months of anticoagulation therapy and for whom there was clinical equipoise regarding the continuation or cessation of anticoagulation therapy. The study drugs were administered for 12 months. RESULTS A total of 2486 patients underwent randomization, of whom 2482 were included in the intention-to-treat analyses. Symptomatic recurrent venous thromboembolism or death from venous thromboembolism occurred in 73 of the 829 patients (8.8%) who were receiving placebo, as compared with 14 of the 840 patients (1.7%) who were receiving 2.5 mg of apixaban (a difference of 7.2 percentage points; 95% confidence interval [CI], 5.0 to 9.3) and 14 of the 813 patients (1.7%) who were receiving 5 mg of apixaban (a difference of 7.0 percentage points; 95% CI, 4.9 to 9.1) (P <0.001 for both comparisons). The rates of major bleeding were 0.5% in the placebo group, 0.2% in the 2.5-mg apixaban group, and 0.1% in the 5-mg apixaban group. The rates of clinically relevant nonmajor bleeding were 2.3% in the placebo group, 3.0% in the 2.5-mg apixaban group, and 4.2% in the 5-mg apixaban group. The rate of death from any cause was 1.7% in the placebo group, as compared with 0.8% in the 2.5-mg apixaban group and 0.5% in the 5-mg apixaban group. CONCLUSIONS Extended anticoagulation with apixaban at either a treatment dose (5 mg) or a thromboprophylactic dose (2.5 mg) reduced the risk of recurrent venous thromboembolism without increasing the rate of major bleeding. (Funded by Bristol-Myers Squibb and Pfizer; AMPLIFY-EXT ClinicalTrials.gov number, NCT00633893.