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Breast cancer
Published in Peter Hoskin, Peter Ostler, Clinical Oncology, 2020
Fungating tumours can become infected causing an offensive discharge or lead to chronic blood loss. Uncontrolled disease in the axilla can lead to brachial plexopathy and lymphoedema of the arm. Hypercalcaemia, spinal cord compression and pathological fracture are seen in patients with widespread skeletal metastases (see Chapter 21). Pulmonary spread can lead to pleural effusion and lymphangitis (Figure 8.20). Mediastinal lymph node spread can lead to local complications such as superior vena cava obstruction, oesophageal compression or recurrent laryngeal nerve palsy (Figure 8.21). Occasionally, pericardial invasion will lead to a pericardial effusion, which may in turn lead to cardiac tamponade (Figure 8.22). Disseminated intravascular coagulation is a rare complication of advanced disease when the tumour burden is high and usually heralds the terminal phase of the disease. It arises due to mucin production by the tumour which can activate the clotting cascade causing uncontrolled coagulation coupled with a physiological thrombolysis leading to occlusion of both small and large blood vessels. Consumption of clotting factors deranges thrombin time and activated partial thromboplastin time resulting in a bleeding tendency, while platelet consumption leads to thrombocytopenia manifested as epistaxis, petechiae and bruising. Fibrin degradation products are elevated.
Lupus Anticoagulants: Characteristics, Methods of Laboratory Detection and Some Clinical Associations
Published in E. Nigel Harris, Thomas Exner, Graham R. V. Hughes, Ronald A. Asherson, Phospholipid-Binding Antibodies, 2020
Thomas Exner, Douglas Triplett
TTI are usually expressed as ratios with the patient result divided by the mean normal result. A normal range up to 1.3 is commonly quoted, but depends on the thromboplastin used and its dilution. TTIs are regarded as relatively nonspecific. Thus, they are prolonged in patients taking oral anticoagulants and in those with simple extrinsic factor deficiencies. Possibly the test would be more specific if mixtures of patient and normal plasmas were to be used. Certainly it may be more useful if the result is expressed as a ratio obtained with two different dilutions of tissue factor and if a phospholipid correction procedure can be applied.51
Congenital Platelet Dysfunction and von Willebrand Disease
Published in Harold R. Schumacher, William A. Rock, Sanford A. Stass, Handbook of Hematologic Pathology, 2019
An initial hemostatic evaluation revealed a normal prothrombin time and a normal thrombin time, but a partial thromboplastin time prolonged 10 sec above the upper limit of normal. A CBC showed a normal WBC; an RBC, hemoglobin, and hematocrit all at or just above the lower limit of normal; and, a platelet count in the center of the normal range. On the peripheral blood film, platelets appeared present in normal numbers, showed a normal size distribution, appeared to exhibit a normal clumping tendency, and appeared to be of normal granularity. A template bleeding time had previously been performed on two separate occasions, and in each case was moderately prolonged at 14–16 min (normal range 2–8 min).
Testing strategies used in the diagnosis of rare inherited bleeding disorders
Published in Expert Review of Hematology, 2023
Laboratory tests of hemostasis can be categorized into screening tests, specific or diagnostic tests, and esoteric assays. Testing is performed on platelet-poor plasma, platelet-rich plasma, or whole blood. Only platelet-poor plasma–based assays can be processed, frozen, and shipped to remote testing sites following guidelines (Table 5) [17,18]. Selected esoteric platelet assays (platelet transmission electron microscopy and platelet surface glycoprotein flow cytometry) can be shipped at ambient temperatures [19,20] but must arrive at the testing laboratory within the established specimen stability limits. Screening tests such as the prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), and the platelet function analyzer-100 (PFA-100) are available in most laboratories that perform routine testing. Specific assays such as fibrinogen and d-dimer are also available in these laboratories. More specialized assays, such as mixing studies with normal pooled plasma, and diagnostic assays, such as coagulation factor and inhibitor assays, are restricted to more specialized laboratories. Although there is likely no specific definition of an esoteric assay, most would consider assays such as platelet aggregation assays, platelet flow cytometry assays, and platelet electron microscopy as esoteric assays. These assays require expertise and are restricted to even fewer laboratories.
Bilateral Sequential Acute Macular Neuroretinopathy in an Asian Indian Female with β Thalassemia Trait following (Corona Virus Disease) COVID-19 Vaccination and Probable Recent COVID Infection - Multimodal Imaging Study
Published in Ocular Immunology and Inflammation, 2022
Srinivasan Sanjay, Santosh Gopi Krishna Gadde, Naresh Kumar Yadav, Ankush Kawali, Aditi Gupta, Rohit Shetty, Padmamalini Mahendradas
Her laboratory investigations done 10 days after the onset of her ocular symptoms included Haemoglobin % 10.9 g/dl (11.5–16 g/dl), Red Blood Cell count - 5.67 mill/cmm (3.9–5.6 millions/cumm, Mean Corpuscular Volume - 64.2 fl (75–95 fl), Packed Cell Volume - 36.4 (30–40%), Mean Corpuscular Haemoglobin - 19.2 pg (26–32 pg) Mean Corpuscular Haemoglobin Concentration - 29.9 g/dl (30–35 g/dl), Red Blood Cell Distribution Width 16.9% (11–16%), Platelet Count - 3.05 (1.5–4.0 lakhs/cumm) C- reactive protein- negative,Erythrocyte Sedimentation Rate −07 (0–20 mm/hour), serum Vitamin D - 9.14 (30–100 ng/ml), Reverse transcriptase polymerase chain reaction (RT-PCR) for Corona virus disease (COVID-19) was negative, SARS-CoV-2 RBD Total (IgG & IgM) - >10.00 (POSITIVE) (<1.0: Negative, >/ = 1.0: Positive), D- Dimer, serum ferritin, lactate dehydrogenase were within normal limits, peripheral blood smear showed microcytic hypochromic with mild anisocytosis and erythrocytosis. Prothrombin time - 13.90 seconds (11.0–13.4 Secs), Activated partial thromboplastin time was normal. At the time of ocular diagnosis, the thought process was whether AMN was due to COVID-19 or to the vaccination as total SARS- CoV-2 antibodies were raised.
Serine protease from Indian Cobra venom: its anticoagulant property and effect on human fibrinogen
Published in Toxin Reviews, 2022
K. N. Neema, Vivek Hamse Kameshwar, Zohara Nafeesa, Divya Kumar, Priya Babu Shubha, M. N. Nagendra Prasad, Shivananju Nanjunda Swamy
According to APTT assay, in the presence of calcium ions, thromboplastin activates coagulation factors of the intrinsic pathway in the plasma leading to clot formation. Clotting time is proportional to the concentration of factors VIII, IX, XI, and XII as well as common pathway factors II, V, and X. Whereas PT measures the time taken by the citrated plasma to clot in the presence of tissue thromboplastin and Ca2+ which activates extrinsic pathway of the human blood coagulation cascade. This assists in estimating the cause and extent of the hemorrhagic disorder. When thromboplastin reagent is added to citrated plasma, a clotting cascade is initiated forming a gel clot. The time required for clot formation would be prolonged if there is a deficiency of factor (s) activity in the extrinsic pathway of the coagulation cycle. Venom protease prolonged the clotting time for re-calcification Figure 3(c) and activated partial thromboplastin time (APTT) but have negligible variations for PT test as shown in Table 1, which suggests that serine protease from Naja naja venom, works on intrinsic pathway but has minimal effect on the extrinsic pathway.