Emerging Oral Treatments: Oral JAK Inhibitors for Alopecia Areata
Rubina Alves in Techniques in the Evaluation and Management of Hair Diseases, 2021
Alopecia areata (AA) is a chronic autoimmune disease of hair loss that can lead to significant disfigurement and cause a detrimental impact on patient well-being that may be independent of objective severity. Prompt treatment is therefore vital in stopping disease progression and reversing hair loss. Two decades of experimental research, using animal models of AA and genome-wide association studies in both mice and humans, have elucidated key mechanisms in AA pathogenesis. The most commonly reported adverse events (AEs) were upper respiratory tract infections. Additional AEs include other infections such as urinary tract infections, herpes zoster, and herpes simplex, as well as mild symptoms such gastrointestinal complaints, headache, acne, fatigue, weight gain, hyper-seborrhoea, anaemia, neutropaenia, and thrombocytopaenia. Patients should be advised about the increased risk of overall infections, especially those of the upper respiratory tract, opportunistic infections, and reactivation of latent infections such as tuberculosis.
Bleeding Disorders in Pregnancy, Including Thrombocytopenia
Tony Hollingworth in Differential Diagnosis in Obstetrics and Gynaecology: An A-Z, 2015
Bleeding in pregnancy may result predominantly from a coagulation defect or deficiency, or a reduction or functional defect in platelets. The acquired coagulopathies are more common in pregnancy and may complicate many high-risk pregnancies, and are particularly associated with obstetric calamities such as amniotic fluid embolism and abruptio placentae. The coagulopathy is defined on the basis of prolonged coagulation times, consumptive thrombocytopenia, and increased fibrinolysis. The rarer congenital bleeding disorders have a higher incidence where consanguineous marriages are frequent. Trombotic thrombocytopenic purpura is an uncommon but potentially devastating condition, which may arise in pregnancy and the postpartum period. The consistent features are thrombocytopenia, microangiopathic haemolytic anaemia, and ischaemic symptoms due to widespread formation of thrombi in the terminal circulation of several organs resulting in neurological and renal manifestations. Thrombotic thrombocytopenic purpura is rare; it had a high mortality until the introduction of plasma exchange, but it is around 10–20 per cent.
Liver Function Tests and Physiological Features of Liver Failure
Peter Kam, Ian Power, Michael J. Cousins, Philip J. Siddal in Principles of Physiology for the Anaesthetist, 2020
Liver function tests are laboratory tests and imaging used to diagnose, as well to monitor the progress of, liver disease/dysfunction. The investigative tests can be divided into blood tests, urine tests, imaging, and liver biopsy. Chronic liver disease is characterized by jaundice, loss of liver function and cirrhosis. Cirrhosis is a histological diagnosis associated with fibronodular changes in the liver resulting from continuing destruction, scarring and regeneration of liver tissue. The cardiovascular changes associated with chronic liver disease include a marked decrease in systemic vascular resistance caused by increased released of nitric oxide due to subclinical endotoxicaemia. Hypersplenism associated with chronic liver disease can cause thrombocytopenia. The main features of acute liver failure are encephalopathy, loss of synthetic functions of the liver and jaundice. The loss of liver function may be sudden and complete as in paracetamol overdose or slow and insidious.
Acute myocardial infarction and renal dysfunction due to chronic extreme anemia (hemoglobin 2.5 g/dL) in immune thrombocytopenia
Published in Baylor University Medical Center Proceedings, 2018
Mark Muenchrath, Katyayini Aribindi, Mark Farnie, Adrian DaSilva-DeAbreu
Immune thrombocytopenic purpura (ITP) is an acquired thrombocytopenia where autoantibodies are generated against platelet antigens. Primary ITP is often idiopathic, whereas secondary ITP has many potential causes, including drug induced, infection related (human immunodeficiency virus, hepatitis C), leukemias, or autoimmune such as systemic lupus erythematosus. ITP is a common cause of thrombocytopenia in asymptomatic individuals, where evidence of bleeding may be minor or absent. Chronic silent bleeding leading to extreme anemia in patients with ITP is rare, and evidence of multiorgan damage is even rarer; hence the relevance of this case report. Here we describe a case of primary ITP with severe chronic blood loss leading to profound anemia causing renal failure and a type II non–ST elevation myocardial infarction. Our patient underwent extensive workup for the etiology of both thrombocytopenia and anemia and was eventually treated with packed red blood cell and platelet transfusions, along with intravenous steroids and immunoglobulin therapy.
Immune thrombocytopenic purpura
Published in Journal of Community Hospital Internal Medicine Perspectives, 2019
Abir Zainal, Amr Salama, Richard Alweis
Immune thrombocytopenic purpura (ITP) is a bleeding disorder characterized by isolated thrombocytopenia (platelet count
Thrombocytopenia in pregnancy
Published in Journal of Obstetrics and Gynaecology, 2016
Thrombocytopenia during pregnancy is quite common. Evaluation of blood counts of pregnant women has shown that thrombocytopenia is the second most common haematological problem in pregnancy, after anaemia. While mostly thrombocytopenia has no consequences for either the mother or the foetus, in some cases it is associated with substantial maternal and/or neonatal morbidity and mortality. It may result from a number of diverse aetiologies. Adequate knowledge of these causes will help the clinicians in making proper diagnosis and management of thrombocytopenia in pregnancy. The evaluation of thrombocytopenia is essential to rule out any systemic disorders that may affect pregnancy management as thrombocytopenia can present as an isolated finding or in combination with underlying conditions. In this concise review, we have provided the overview of thrombocytopenia diagnosed during pregnancy.
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