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Epidural and Intrathecal Analgesia
Published in Pamela E. Macintyre, Stephan A. Schug, Acute Pain Management, 2021
Pamela E. Macintyre, Stephan A. Schug
Longer therapy with heparin can result in a heparin-induced thrombocytopenia. Guidelines recommend a platelet count prior to insertion or removal of an epidural catheter after more than four days of heparin therapy (Horlocker et al, 2018).
Acquired Bleeding Disorders Associated with the Character of the Surgery
Published in Harold R. Schumacher, William A. Rock, Sanford A. Stass, Handbook of Hematologic Pathology, 2019
William A. Rock, Robert F. Baugh
Heparin-induced thrombocytopenia. Mechanism: Heparin initiates immune destruction of circulating platelets. Usually seen immediately postoperatively, when platelets fail to increase, yet all other parameters are correcting. Management: Eliminate all possible sources of heparin, such as keep open intravenous lines, and be absolutely confident of heparin reversal. Interestingly, these cases do not always have bleeding despite low values. They most often clot well, and platelet infusions may or may not be indicated. Platelet infusions are contraindicated while heparin is still present.
Safe prescribing in cardiology
Published in Ian Mann, Christopher Critoph, Caroline Coats, Peter Collins, The Junior Doctor’s Guide to Cardiology, 2017
Ian Mann, Christopher Critoph, Caroline Coats, Peter Collins
Heparin-induced thrombocytopenia. Suspect this if there is more than a 50% reduction in platelet count, often occurring 5 to 10 days after initiation of heparin in patients with thrombosis, skin necrosis or microemboli.
A comparison of four methods to estimate dim light melatonin onset: a repeatability and agreement study
Published in Chronobiology International, 2023
Raphaëlle Glacet, Eve Reynaud, Ludivine Robin-Choteau, Nathalie Reix, Laurence Hugueny, Elisabeth Ruppert, Pierre A. Geoffroy, Ülker Kilic-Huck, Henri Comtet, Patrice Bourgin
Blood samples were collected during 3 days (40 samples of 8 mL). Samples used in this study were those collected during the evening/night periods (10 samples each), hourly from 5 h before lights off (hour at which participants went to bed and turned the lights off during the protocol) to 1 h after lights off, then every 2 h from 1 h after lights off to 7 h after lights off. Light exposure before lights off was dim light (<8 lux) and samples from lights off to 8 h after were collected when the subjects were asleep in total darkness. The subjects kept a peripheral venous catheter and were perfused with heparin sodium diluted in 0.9% NaCl during the whole protocol to avoid blood coagulation in the peripheral venous catheter. A platelet count was made to confirm the absence of a heparin-induced thrombocytopenia. Blood samples were collected in EDTA tubes, centrifuged immediately after and the plasma volume was distributed in microtubes. All samples were frozen immediately at −20 °C and then stored at −80 °C until melatonin assessments.
Safety profile of COVID-19 vaccines, preventive strategies, and patient management
Published in Expert Review of Vaccines, 2022
M. Mukhyaprana Prabhu, Subish Palaian, Mukhtar Ansari
This rare complication needs special attention. Recipients should be educated of the possible association and should seek immediate care for signs and symptoms suggestive of thrombocytopenia (e.g. new petechiae or bruising) or thrombotic complications (including shortness of breath, chest pain, lower extremity edema, persistent severe abdominal pain, unabating severe headache, severe backache, new focal neurologic symptoms, and seizures). Evaluation with a complete blood count and differential (including the platelet count), quantitative D-dimer, heparin-induced thrombocytopenia (HIT) testing, and imaging of any suspected site of the thrombosis should be done [63]. An onset that occurs 4 to 30 days after vaccination, with a platelet count <150,000/µL, elevated D-dimer, and a positive anti-PF4 antibody (HIT antibody), suggests the diagnosis. Patients should be managed as those with heparin-induced thrombocytopenia. Nonheparin/nonwarfarin anticoagulation (e.g. argatroban or direct oral anticoagulant) should be started. Intravenous immunoglobulin and high-dose steroids can benefit individuals in improving the platelet count within days. Platelet transfusion is indicated in individuals presenting with bleeding or severe thrombocytopenia [64,65]. For those individuals who developed VITTS following the first dose of ChAdOx1 nCoV-19, observational data suggestswitching to mRNA vaccines for the second dose. Similarly, if an individual develops VITTS following the second dose, then the booster, if needed, should be chosen from mRNA vaccines [66].
Neuro-Ophthalmic Literature Review
Published in Neuro-Ophthalmology, 2020
David A. Bellows, Noel C.Y. Chan, John J. Chen, Hui-Chen Cheng, Peter W. MacIntosh, Jenny A. Nij Bijvank, Panitha Jindahra, Michael S. Vaphiades
The authors report a 26-year-old previously healthy man who presented with a two-week history of flu-like symptoms, followed by a one-day history of new-onset headache, left-sided weakness, and left eye proptosis. He had thrombocytopenia, hypofibrinogenemia, and elevated D-dimer which led to a diagnosis of disseminated intravascular coagulation (DIC) of unknown aetiology. Head CT demonstrated multifocal intraparenchymal haemorrhages, convexity subarachnoid haemorrhage, and hyperdense superior sagittal sinus. Intravenous unfractionated heparin was initiated. Despite this, repeat imaging demonstrated worsening and new cerebral venous sinus thrombosis (CVST). The severe thrombocytopenia persisted. Viral, bacterial, and fungal cultures returned negative. A diagnosis of heparin-induced thrombocytopenia (HIT) was made. He was switched to fondaparinux, and methylprednisolone was started. Twenty-four hours later, the patient’s clinical condition improved rapidly. The diagnosis of spontaneous HIT syndrome was confirmed by strong positive serotonin release from the patient’s serum.