Bleeding
Mervyn Dean, Juan-Diego Harris, Claud Regnard, Jo Hockley in Symptom Relief in Palliative Care, 2018
These can be caused by platelet deficiency or malfunction, by excessive clotting (e.g. with pancreatic carcinoma), or may be due to widespread microvascular clotting which uses up clotting factors, resulting in a coexistent tendency to bleed (disseminated intravascular coagulation – DIC). If treatment is appropriate, coagulation disorders invariably require admission to hospital under the care of a hematology team. In very advanced disease such treatment is not usually appropriate, but some cases of DIC respond to a simpler regimen of an antifibrinolytic such as tranexamic acid and low dose heparin.19 The advice of a hematologist remains essential. Fortunately such events are uncommon, and usually occur in the last hours or days of life when distressing bleeding can be managed as described above.
Responding to the Community’s Need for Therapeutic Hemapheresis
James L. MacPherson, Duke O. Kasprisin in Therapeutic Hemapheresis, 2019
As a note of interest, hemapheresis and its therapeutic application have more than any other event brought the clinical hematologist directly into the blood bank in a management as well as a consultative role. Traditionally blood banking came under the perview of the pathologist or, in rare cases, a physician trained in blood banking. Although many pathologists have kept up with developments while blood banking has gone from a laboratory science to a manufacturing and more clinical specialty, clearly, their overwhelming dominance of this field has diminished. No one will complain, however, that this integration of these two related subspecialties has been to the detriment of blood banking. Quite the opposite. The mingling has breathed new directions, vigor, and controversy into the rather compliant and comfortable world of blood banks.
Quality Control in Bone Marrow Processing
Adrian P. Gee in BONE MARROW PROCESSING and PURGING, 2020
Bone marrow processing laboratories have been successfully run by people with a diversity of training and backgrounds. In many cases, research technicians who were instrumental in the development of the procedure have gone on to perform the clinical treatments, once certified by the hospital and state. Technicians with experience in blood banking have the ideal training, since they have extensive experience in cell manipulation, aseptic technique, documentation, and issues related to quality control. When building a team it is obviously important to select compatible individuals, who appreciate the critical nature of the work and are prepared to put in long hours at short notice. Where not required by law, certification of training in hematology is strongly recommended. Details of the formal training, certifications, and experience of all the staff should be kept on file within the laboratory.
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.
Clostridium difficile infection in a children’s hospital with specific patterns among pediatric oncology and hematopoietic stem cell transplantation populations
Published in Pediatric Hematology and Oncology, 2020
Jessica L. Spruit, Tristan Knight, Colleen Sweeney, Hossein Salimnia, Süreyya Savaşan
Specimens were coded according to the population the patient represented at the time of sampling. Hematology patients were defined as those with nonmalignant hematological conditions (e.g. thalassemia, sickle cell anemia, coagulation/bleeding disorders, immunodeficiencies, etc.). Oncology patients were defined as those with malignant conditions, whom were actively receiving treatment, had been diagnosed with malignancy but had not yet begun treatment, or had completed treatment in the past 6 months. HSCT patients were defined as those whom had begun a preparative/conditioning regimen, or had received a stem cell transplant. Patients who received an autologous HSCT for a malignancy and then continued with further surveillance or treatment for their malignancy were coded as oncology following engraftment of the HSCT. Patients who received allogeneic HSCT for a malignancy were coded as HSCT following that intervention unless their disease recurred and/or they received further treatment for the recurrent disease, in which case they were coded as oncology from that point. Other pediatric patients were defined as all others, including patients who were hospitalized on the acute care or intensive care units, those managed by other subspecialty services, and those who were tested in the emergency department.
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].