Tissue Doppler imaging and NT-proBNP levels show the early impairment of ventricular function in patients with beta-thalassaemia major

WOS: 000247267600002PubMed ID: 17608095B-thalassaemia major is a chronic haemolytic anaemia, and congestive heart failure (CHF) is the most common cause of death in this disease. N terminal pro B type natriuretic peptide (NT-proBNP) increases with the severity of CHF and predicts the prognosis. The aim of this study was to investigate the relation between left ventricular systolic and diastolic function determined by standard pulsed wave Doppler (PWD), tissue Doppler imaging (TDI) and NT-proBNP in patients with B-thalassaemia major. Thirty-four patients with B-thalassaemia major and 34 healthy individuals were included in the study. Blood samples were taken for NT-proBNP. All patients and controls underwent echocardiographic examination. All cardiac chambers were significantly increased in the patient group. Left and right ventricular (LY, RV) ejection fractions and all diastolic parameters were normal in the patients and controls. Tissue Doppler imaging (TDI) showed a significant decrease in IV and RV S-m velocities in patients compared to the controls. NT-proBNP levels were also significantly higher in the patient group. There was a negative correlation between serum NT-proBNP levels and IV Sm and RV Sm velocities in patients (r = -0.426, P = 0.006 and r = -0.409, P = 0.009, respectively). Linear regression analysis showed that LV S-m and RV S-m were independent predictors for NT-proBNR Our findings suggest that although iron overload in patients with B-thalassaemia major impairs the systolic and diastolic functions of both ventricles, it impairs the systolic function earlier than diastolic function. Tissue Doppler imaging is an easy and reliable method in the early determination of ventricular dysfunction in these patients

Relationship between thrombocytopenia and mortality and morbidity in the internal medicine intensive care unit

WOS: 000480626400044Purpose: In this study, we aimed to determine the incidance, causes, clinical outcomes and the effect on mortality and morbidity of thrombocytopenia in an University internal medicine intensive care unit (IMICU). Materials and Methods: Between July 2011 and August 2012, 165 patients who were followed up in intensive care unit and whose platelet count was below 150,000 / uL were included in the study. The causes of thrombocytopenia were investigated. Patients with and without thrombocytopenia were compared in terms of mortality and duration of stay in intensive care unit. Results: During the study period, thrombocytopenia was developed in %30.1 of patients in IMICU (165/548). Causes of thrombocytopenia in 30 (% 18) patients was sepsis and in 18 (% 10,9) was disseminated intravascular coagulation (DIC).. During the study, 115 (% 69.7) of 165 thrombocytopenic patients and 173 (% 45.1) of 383 non-thrombocytopenic patients died. Mortality in the patients with thrombocytopenia was higher. There was a statistically significant increase in mortality as the platelet count drops. Statistically significant increase in mortality were detected as the platelet count decreased in patients with the same APACHE II score. Conclusio: The most common causes of thrombocytopenia are sepsis and DIC, and thrombocytopenia is an effect that increases the mortality in the intensive care unit

Transfusion-associated graft-versus-host disease

Trans fusion-associated graft-versus-host disease (TA-GVHD) is a relatively rare and interesting entity. Despite a range of pathophysiological and therapeutic approaches, it has a high mortality. It is possible to prevent the disease by prophylaxis only. It is possible to miss the entity in routine clinical practice and reach a different diagnosis due to its non-specific signs and symptoms. Four patients with signs and symptoms suggestive of TA-GVHD were evaluated and the literature reviewed. The transfusion history was of great importance, as was the exclusion of other conditions that may present with similar signs and symptoms (fever, skin rash, diarrhea, pancytopenia, icterus and renal failure). Confirmation of TA-GVHD was by skin biopsy. TA-GVHD must be considered as a differential diagnosis in patients who present with fever, pancytopenia, diarrhea, skin rash and icterus, and the transfusion history must be questioned. Mortality is very high despite various therapeutic approaches. This makes prophylaxis essential. TA-GVHD can be prevented by irradiation of blood products and by avoiding the use of blood transfusions from family donors. (C) 2006 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved