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Fetal and Neonatal Alloimmune Thrombocytopenia
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
With heterozygous father, consider amniocentesis to determine fetal antigen status by PCR (CVS only if mother would terminate affected fetus). Multidisciplinary management should involve a hematologist and the blood bank.
Postpartum hemorrhage
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Wade D. Schwendemann, William J. Watson
The clinician must also pay continued attention to the hematologic status of the patient. Initial efforts at control should not be withheld during the attempts to obtain laboratory analysis on the patient, but once available, these laboratory values, particularly any abnormalities, must be addressed quickly. First among concerns in the bleeding patient is the red blood cell transfusion. Patients should receive two units of packed red blood cells as soon as deemed clinically appropriate by the attending clinician. Ideally this blood will be typed and crossmatched to the patient, but in cases where hemorrhage was not expected, uncrossmatched O negative blood may need to be infused. The degree of bleeding that would necessitate the transfusion of uncrossmatched units depends upon the assessment of the patient and the timing of the availability of type-specific crossmatched blood. Clinicians should consider red cell transfusion in cases where the estimated blood loss exceeds 1000 cc during a vaginal delivery or 1500 cc during a cesarean delivery. The transfusion of one unit of packed red blood cells can be expected to raise the hemoglobin concentration by 1 gm/dL or the hematocrit by 3%. The decision to transfuse a patient depends on the amount of blood loss, any maternal comorbidities, and the risk of recurrent bleeding (Table 2).
Spinal Cord Disease
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Hematologic: Sickle cell disease.Procoagulant states: thrombocytosis, malignancy.
Exploring the rationale for red cell transfusion in myelodysplastic syndrome patients: emerging data and future insights
Published in Expert Review of Hematology, 2022
Carlo Finelli, Sarah Parisi, Stefania Paolini
Some surveys, involving physicians involved in hematologic patients care, have been published on this topic. A cross-sectional web-based survey, performed to evaluate transfusion practice patterns for patients with acute leukemia in a variety of care settings, reported that, among 130 responders (99 of them were physicians), the most common Hb threshold for RBC transfusions was 7 g/dL for inpatients (47% of answers), followed 8 g/dL (35%), while for the outpatient setting the selected Hb threshold was 8 g/dL (47% of answers), followed by 7 (31%) and 7.5 (13%). While 54% of responders maintained the same Hb threshold for both inpatient and ambulatory setting, 21% chose a higher Hb value for outpatients. Most providers always used leukoreduced and irradiated RBCs. The majority of responder physicians referred to existing institutional transfusion guidelines [77]. Another web-based survey, involving 110 hematologists from Australia and New Zealand and specifically concerning MDS patients, showed that most respondents recommended RBC transfusion for Hb <8 g/dL, but with a higher threshold (<9 g/dL) for patients with cardiovascular disease, and a lower threshold (<7 g/dL) for younger asymptomatic subjects. The commonest post-transfusion desired Hb target was 9–10 g/dL [78].
Recurrent melena in a diagnosed case of Bernard Soulier syndrome
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Omair Ali Khan, Sheharyar Raashid, Sohaib Asghar, Ramsha Majeed, Mahnoor Fatima Sherazi, Fakeha Nayyer, Aisha Anis, Zainab Ehsan
Bernard Soulier Syndrome or BSS is a rare hematological disorder related to abnormal structure and function of platelets. It was initially described in 1948 by J Bernard and JP Soulier [1]. Other names for the disease include giant platelet syndrome, hemorrhagiparous thrombocytic dystrophy, macrothrombocytopenia, platelet glycoprotein Ib deficiency or Von Willebrand factor receptor deficiency. BSS has an autosomal recessive inheritance pattern affecting 1 in 1,000,000 people [2]. Characteristic lab findings include megakaryocytes, thrombocytopenia, increased bleeding time and impaired platelet agglutination in response to Ristocetin. It has also been classified as a giant platelet disorder, due to the appearance of abnormally large platelets. In addition to the typical clinical manifestations of epistaxis, cutaneous and mucosal bleeding, the disorder can also rarely present with menorrhagia and gastrointestinal tract bleeding. The dysfunction results from mutations which include nonsense, deletion, or missense mutations of the surface glycoprotein complex encoding genes [3]. Once diagnosed, the medical opinion of a hematologist should be sought as the management plan of each patient must be tailored according to the severity and symptoms of each individual case. There is no cure or prophylactic measures that can be implemented for bleeding disorders, it is only possible to manage the risks and complications.
Palliative care in hematologic malignancies: a multidisciplinary approach
Published in Expert Review of Hematology, 2020
Brittany Gatta, Thomas W LeBlanc
A high degree of trust in the palliative care team is what is needed in order to allow the oncologist to share the responsibility for their patients’ wellbeing. Part of the potential solution for building this trust ought to be further education for palliative care clinicians on the particular needs of hematologic malignancy patients (and their oncologists). Ideally, this would involve palliative care clinicians who are, in essence, sub-sub-specialists in hematologic malignancies. These clinicians would effectively accompany both hematologic oncologists and their patients by having an advanced understanding of hematologic diseases, their treatments, and the specific needs of this patient population [45,51,52]. This solution also highlights the opportunity at hand for training those who already have extensive experience with hematologic malignancy patients (e.g. RNs, social workers, etc.) in the skills of palliative care as a way to try to bridge this specialty gap.