Active von Willebrand Factor in patients with a bleeding diathesis

Introduction: Increased levels of circulating von Willebrand Factor (VWF) in its active, platelet-binding conformation have been implicated in the pathogenesis of several thrombotic conditions as well as bleeding conditions characterized by severe thrombocytopenia. However, it is unclear whether the proportion of activated VWF in the circulation also plays a role in patients with mild to moderate bleeding without thrombocytopenia. Methods: Citrated plasma samples were collected from 145 patients with a bleeding diathesis with unknown cause. Active VWF levels were measured with an in-house developed ELISA assay. In addition, VWF antigen (VWF:Ag), VWF ristocetin cofactor activity (VWF:RCo) and (flow-cytometric) platelet-VWF binding (Plt:VWF) were determined. Results: Active VWF levels were on average mildly, but not significantly, lowered in patients with a bleeding diathesis compared to the reference interval (especially in individuals with non-O blood groups). Active VWF was not significantly different for subjects with (median 107.4%, IQR 18.3) versus without (median 111.1%, IQR 32.3%) an increased bleeding score, nor between subjects with suspected VWD (median 104%, IQR 20.6%) versus other suspected causes of bleeding diathesis (median 111.7%, IQR 33.3%). Conclusion: In this clinically heterogeneous population of patients with a mild bleeding phenotype, quantification of active VWF levels does not have added diagnostic value to VWF:Ag and VWF activity assays in the diagnosis of unexplained bleeding disorders

Fungal systematics and evolution : FUSE 7

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2021 Update of the International Council for Standardization in Haematology Recommendations for Laboratory Measurement of Direct Oral Anticoagulants

International audienceIn 2018, the International Council for Standardization in Haematology (ICSH) published a consensus document providing guidance for laboratories on measuring direct oral anticoagulants (DOACs). Since that publication, several significant changes related to DOACs have occurred, including the approval of a new DOAC by the Food and Drug Administration, betrixaban, and a specific DOAC reversal agent intended for use when the reversal of anticoagulation with apixaban or rivaroxaban is needed due to life-threatening or uncontrolled bleeding, andexanet alfa. In addition, this ICSH Working Party recognized areas where additional information was warranted, including patient population considerations and updates in point-of-care testing. The information in this manuscript supplements our previous ICSH DOAC laboratory guidance document. The recommendations provided are based on (1) information from peer-reviewed publications about laboratory measurement of DOACs, (2) contributing author's personal experience/expert opinion and (3) good laboratory practice

The powers of emptiness

Foucault is often considered to be the commensurate theorist of power. His late work provides an impressive array of concepts that enables a multi-dimensional analysis of the historical, material, and discursive facets of power. What is missing from this approach, however, is the factor of passionate attachments, or what we might term the sublime motivations that underlie any regime of control. Lacan’s ethical thought prioritizes precisely the issue of the sublime, and, more to the point, the process of sublimation which establishes an effective “short-circuit” between socially valorized objects and direct drive satisfactions of individuals. Key here is the notion of das Ding, the place of the absent object of primordial satisfaction that generates libidinal enjoyment and draws the subject toward the pinnacle of social valorization. Lacan thus shows us what Foucault cannot theorize. That is to say, if sublimation consists of a relation to the real of das Ding, then it cannot be limited in the terms of its activation to the powers of discursive domain alone; it remains a self-initiating and self-regulating form of power