Clinical Toxicology of Spider Bites
Jürg Meier, Julian White in Handbook of: Clinical Toxicology of Animal Venoms and Poisons, 2017
Viscerocutaneous loxoscelism is relatively uncommon to rare. In Chile a recent series found 16% of all cases of loxoscelism as viscerocutaneous193. When present the systemic signs are observed in the first 24 hours after envenoming. Besides the cutaneous effects, as seen in the purely cutaneous form of loxoscelism, clinical manifestations are due to haematological disturbances such as intravascular hemolysis, thrombocytopenia and disseminated intravascular coagulation 193,227. There is no established relationship between the intensity of hemolytic and proteolytic (cutaneous) effects; patients with mild cutaneous effects may present with massive hemolysis. Laboratory findings include haemoglobinemia, increased bilirubin, hemoglobinuria and proteinuria.
Therapeutic Pheresis: Precautions and Nursing Intervention
James L. MacPherson, Duke O. Kasprisin in Therapeutic Hemapheresis, 2019
Throughout any pheresis procedure, the nurse should be aware of potential hemolysis. Whenever blood is exposed to a mechanical manipulation there is the potential for hemolysis. Visual inspection of the connection tubings and restricting aspects of the apparatus must be made throughout the entire procedure. In addition, at our facility, upon completion of the first pass, two capillary specimens are collected and centrifuged for visual examination for the presence of hemolysis in the plasma. If there is any suspicion of hemolysis resulting from mechanical destruction of red cells, such as the presence of a pinkish coloring to the plasma layer, the procedure should be discontinued immediately. However, the venous access should be maintained, and this can be accomplished by the addition of 0.9% sodium chloride, injection (normal saline) at a keep vein open (KVO) or maintenance rate of infusion. The medical director of the pheresis unit should be alerted, and a blood specimen from both the patient and the reinfusion bag should be obtained. The specimen from the patient should be collected in an anticoagulated tube. Since the reinfusion product is anticoagulated, a tube without anticoagulant can be used to collect this specimen. If at all possible, a urine specimen should be collected to observe for the presence of hemoglobinuria depending on the clinical condition of the patient. Increased fluid intake is encouraged.
The complement system in health and disease
Gabriel Virella in Medical Immunology, 2019
Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired disorder on the surface of selected hemopoietic stem cell lines and their erythrocyte progeny. The patients develop hemolytic anemia manifested by the intermittent passage of dark urine (due to hemoglobinuria), which usually is more accentuated at night. The spontaneous hemolysis is due to an increased susceptibility of the abnormal population of erythrocytes to complement-mediated lysis. The erythrocytes are not responsible for the activation of the complement system; rather, they are lysed as innocent bystanders when complement is activated.
Application of microwave ablation in the emergent control of intraoperative life-threatening tumor hemorrhage during hepatic surgeries
Published in International Journal of Hyperthermia, 2018
Haoming Zhou, Jindao Wu, Wei Ling, Deming Zhu, Ling Lu, Xuehao Wang, Liyong Pu, Lianbao Kong
MWA has a good safety profile with low rates of complications, such as haemorrhage, bile duct injury, liver abscess, colon perforation, skin burns and tumour seeding [15]. Fever and post-procedural malaise occur after ablation in some cases. Low-grade fever, discomfort and dull abdominal pain in the right upper quadrant occurred in Cases 1 and 3 and improved after symptomatic treatment. No other major complications were identified. The patient in the third case died of tumour metastasis 18 months after surgery. In addition, prolonged administration of microwaves may cause haemoglobinuria or acute kidney failure [16]. In all three cases, 125 ml of NaHCO3 solution was prophylactically used to prevent renal insult during the operation and post-operatively. No haemoglobinuria or renal dysfunction was identified by urine testing and serum renal function examination.
Bilateral anterior segment dysgenesis and peripheral avascular retina with tractional retinal detachment in an infant with multiple congenital anomalies-hypotony-seizures syndrome 3
Published in Ophthalmic Genetics, 2021
Frances Wu, Paula C. Goldenberg, Shizuo Mukai
Genetic testing for familial exudative vitreoretinopathy (FEVR), Norrie disease, and Wagner syndrome were negative. Whole-exome sequencing (WES) revealed compound heterozygous mutations in the PIGT gene, consisting of a maternally inherited c.918dupC pathogenic variant and paternally inherited c.1580A>G variant of uncertain significance (VUS). The patient was found to have developmental delay, microcephaly with head circumference less than 1st percentile for age, and hearing impairment treated with hearing aids. Facial features were consistent with those described in MCAHS3; specifically, depressed nasal bridge, short anteverted nose, prominent philtrum, full cheeks, and open mouth characteristic of hypotonia (1). There was one seizure-like episode, but subsequent electroencephalogram and brain MRI were normal. Testing for paroxysmal nocturnal hemoglobinuria (PNH) was negative. Echocardiogram and ultrasound of the kidneys and bladder were normal.
Ultrasonography-guided percutaneous microwave ablation for large hepatic cavernous haemangiomas
Published in International Journal of Hyperthermia, 2018
Fangyi Liu, Xiaoling Yu, Ping Liang, Zhigang Cheng, Zhiyu Han, Jie Yu
In our study, the complications of all patients belonged to minor ones such as fever, local pain with grade 1 and increment of liver enzymes test. The incidence rates were similar to the ones after the MWA of liver malignancies [24]. About 14 out of 15 cases of haemoglobinuria after therapy tended to improve without additional remedy or management. The reason of occurrence of haemoglobinuria might be a mass of blood cells were ruined in an HCH ablation procedure. Blocking the feeding artery was failure in the case who developed AKI shortly after MWA, because when the volume of aspiration blood from the haemangioma during ablation was 400 ml, the blood could still be extracted. So we stopped aspirating. The failure to block the feeding artery may lead to more red blood cells undergoing budding and fragmentation, which presumably resulted in a more massive thermal haemolysis. Van Tilborg et al. [19] reported two patients with very large symptomatic HCHs who developed AKI shortly after bipolar RF ablation, caused by massive heat-induced intravascular haemolysis, which was related with the size of the ablation zone and length of the procedure. The ablation time was 33 min for the patient in our study, the tumour maximum diameter was 10 cm. The failure to block the feeding artery and the long ablation time and the larger diameter may be risk factors for AKI. When treating large HCHs with thermal ablation, the number of ablations and the duration of the ablation sequences should be reduced to the absolute minimum, in order to prevent hemepigment-induced AKI.
Related Knowledge Centers
- Acute Tubular Necrosis
- Intravascular Hemolysis
- Oxygen
- Protein
- Urine
- Hemoglobin
- Red Blood Cell
- Blood Plasma
- Kidney
- Intensive Care Medicine