Ultrasound-Guided Transthoracic Needle Biopsy
Armin Ernst, David J. Feller–Kopman in Ultrasound–Guided Procedures and Investigations, 2005
There are few absolute contraindications to percutaneous transthoracic biopsy. The most important absolute contraindications are an unco-operative patient, a patient who cannot be maintained in the optimal position for biopsy, and intractable coughing. All other contraindications are relative and need a judicious evaluation of the risk of biopsy and the alternatives. Severe coagulopathies, thrombocytopenia of < 50,000, and uremic platelet dysfunction are also considered contraindications in my practice, unless corrected prior to the procedure. Routine laboratory evaluation of prothrombin time (PT) and partial thromboplastin time (PTT) or platelets in patients who have no history of bleeding problems and who are not taking anticoagulants are probably not indicated and these tests should be reserved for patients at risk for bleeding due to underlying disease. Patients with severe underlying lung disease or with a single lung will require immediate treatment for pneumothorax, and preparations should be made prior to biopsy. The author does not perform percutaneous lung biopsies in mechanically ventilated patients but would certainly consider pleural biopsy and mediastinal biopsy on a case-by-case basis. In any case, consideration of percutaneous transthoracic biopsy in the critically ill should be extremely uncommon. Severe pulmonary hypertension a relative contraindication, should also be considered for percutaneous lung biopsy (8–10,17,18).
Benzylpenicillin (Penicillin G)
M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson in Kucers’ The Use of Antibiotics, 2017
If administered in large doses of 6 g daily to uremic patients, or 24 g daily to those with normal renal function, Pen G can induce coagulation disorders. These may appear soon after Pen G administration is commenced and persist for about 4 days after it is stopped. Factors involved are platelet dysfunction, disturbed conversion of fibrinogen to fibrin and increased antithrombin III activity (Andrassy et al., 1976; Manian et al., 1990). Pen G therapy can also be associated with the development of acquired inhibitors of blood coagulation, particularly blocking inhibitors. These are proteins, but not necessarily antibodies, that can interfere with many aspects of the coagulation reaction. They are rarely, if ever, associated with overt bleeding. The prothrombin time is normal, but the activated partial thromboplastin time is usually prolonged. Uncommonly, Pen G hypersensitivity may be associated with the presence of specific clotting factor inhibitors which inactivate single factors. Inhibitors specifically directed against factors V, VIII, IX, and XI have been described, factor VIII inhibitors being the most common. These factor inhibitors appear to be antibodies, and their presence may be associated with severe bleeding (Orris et al., 1980).
The Risks of Silver Nanoparticles to the Human Body
Huiliang Cao in Silver Nanoparticles for Antibacterial Devices, 2017
Nanosilver can also interact with a coagulation system. The same team of researchers tested 24-nm silver particles. This size was chosen because the range of 20–25 nm had the strongest antibacterial activity among 15 tested nanosilver particles. No influence on the extrinsic coagulation pathway measured by prothrombin time was observed, whereas measurement of activated partial thromboplastin time (APTT) showed an inhibition of the intrinsic pathway of coagulation (Martinez-Gutierrez et al. 2010, 2011). An animal study performed by Shrivastava et al. (2009) showed that mice injected with nanosilver presented a decrease in platelet aggregation. These findings should be remembered while considering an application of nanosilver in patients with coagulation disorders or receiving anticoagulant therapy.
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.
Acquired Hemophilia A and urothelial carcinoma
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Fadi Taza, Nawar Suleman, Robert Paz, Christopher Haas
A 76-year-old man with a history notable for hypertension, hyperlipidemia, and chronic obstructive pulmonary initially presented in to an outside facility with a chief complaint of hematuria. At that time, he remained hemodynamically stable and laboratory diagnostics were significant for a preserved hemoglobin and unremarkable metabolic panel. Urinalysis demonstrated marked hematuria. Coagulation studies were within normal limits; prothrombin time (PT) of 14 seconds (s) (reference value RV 11.8–14.6s), activated partial thromboplastin time (aPTT) of 36 s (RV 23.4–36.2s), and international normalized ratio of 1.3 (RV 0.8–1.4). Diagnostic workup included a Computerized Tomography cystogram which demonstrated the presence of a bladder mass, which was confirmed on cystoscopy, and he underwent Transurethral Resection of Bladder Tumor (TUBRT). On pathology, microscopic examination revealed non-invasive high grade papillary urothelial carcinoma with rare foci of invasion. His post-operative course was complicated by urosepsis secondary to Enterobacter cloacae managed with vancomycin and cefepime.
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.
Related Knowledge Centers
- Anticoagulant
- Coagulation
- Fibrinogen
- Heparin
- Kaolinite
- Phosphatidylethanolamine
- Blood
- Blood Test
- Thrombin
- Factor V