发热伴血小板减少综合征(Severe Fever with Thrombocytopenia Syndrome,SFTS)是我国于2009年发现的新发病毒性传染病,多分布在山区和丘陵地带,全年均可发病,多发于春、夏季。如不及时诊治,SFTS病死率可高达20%。为进一步规范SFTS临床诊疗工作,在2010年原卫生部发布的《发热伴血小板减少综征诊疗方案》基础上,结合国内外研究进展和诊疗经验,制定本诊疗方案。一、病原学发热伴血小板减少综征病毒(SFTSV)属白蛉纤细病毒科(Phenuiviridae),班达病毒属(Bandavirus Genus),分类为大别班达病毒(Dabie Banda Virus,DBV)。
BACKGROUND Thrombocytopenia is common in patients with sepsis and septic shock.AIM To analyse the decrease in the number of platelets for predicting bloodstream infection in patients with sepsis and septic shock in the intensive care unit.METHODS A retrospective analysis of patients admitted with sepsis and septic shock in Xingtai People Hospital was revisited.Patient population characteristics and laboratory data were collected for analysis.RESULTS The study group consisted of 85(39%)inpatients with bloodstream infection,and the control group consisted of 133(61%)with negative results or contamination.The percentage decline in platelet counts(PPCs)in patients positive for pathogens[57.1(41.3-74.6)]was distinctly higher than that in the control group[18.2(5.1–43.1)](P<0.001),whereas the PPCs were not significantly different among those with gram-positive bacteraemia,gram-negative bacteraemia,and fungal infection.Using receiver operating characteristic curves,the area under the curve of the platelet drop rate was 0.839(95%CI:0.783-0.895).CONCLUSION The percentage decline in platelet counts is sensitive in predicting bloodstream infection in patients with sepsis and septic shock.However,it cannot identify gram-positive bacteraemia,gram-negative bacteraemia,and fungal infection.
Cancer is a major global health issue;in 2020,there were 19.29 million new cancer cases and 9.96 million cancer deaths worldwide(Siegel et al.,2023).Despite ongoing research,chemotherapy remains the primary treatment due to its broad anti-cancer effects(Marra and Curigliano,2021).However,intravenous chemotherapeutic drugs commonly induce hematotoxicity,necessitating dose adjustments or treatment delays.Chemotherapy-induced thrombocytopenia(CIT)and neutropenia(CIN)are the primary manifestations of chemotherapy-induced hematotoxicity,which requires intervention due to the heightened risk of bleeding and infection(Blayney and Schwartzberg,2022).Currently,there are no FDA-approved treatments for CIT(Song and Al-Samkari,2023).While a CIT mouse model using 5-FU has been developed for drug evaluation(Shin et al.,2023),it lacks a comprehensive hematotoxicity assessment and the benefits of high throughput,cost-effectiveness,and visibility.Therefore,it is urgent to develop a high-throughput CIT model for risk assessment and safer chemotherapy strategies with clinical potential.
BACKGROUND The models for assessing liver function,mainly the Child–Pugh(CP),albuminbilirubin(ALBI),and platelet–ALBI(PALBI)classifications,have been validated for use in estimating the prognosis of hepatocellular carcinoma(HCC)patients.However,thrombocytopenia is a common finding and may influence the prognostic value of the three models in HCC.AIM To investigate and compare the prognostic performance of the above three models in thrombocytopenic HCC patients.METHODS A total of 135 patients with thrombocytopenic HCC who underwent radical surgery were retrospectively analyzed.Preoperative scores on the CP,ALBI and PALBI classifications were estimated accordingly.Kaplan–Meier curves with logrank tests and Cox regression models were used to explore the significant factors associated with overall survival(OS)and recurrence-free survival(RFS).RESULTS The preoperative platelet counts were significantly different among the CP,ALBI and PALBI groups.After a median follow-up of 28 mo,39.3%(53/135)of the patients experienced postoperative recurrence,and 36.3%(49/135)died.Univariate analysis suggested thatα-fetoprotein levels,tumor size,vascular invasion,and ALBI grade were significant predictors of OS and RFS.According to the multivariate Cox regression model,ALBI was identified as an independent prognostic factor.However,CP and PALBI grades were not statistically significant prognostic indicators.CONCLUSION The ALBI grade,rather than CP or PALBI grade,is a significant prognostic indicator for thrombocytopenic HCC patients.
May-Heglin Anomaly is an autosomal dominant disorder characterized by macrothrombocytopenia with a platelet function that is usually preserved. Platelets play an essential role in hemostasis. During pregnancy, a woman is susceptible to complications, including postpartum hemorrhage. Monitoring patients’ hemostatic functions and observing the patient’s clinical picture to maintain patient safety is paramount, while avoiding unnecessary therapeutic measures. This case report presents a rare instance of May-Heglin Anomaly (MHA) in a 35-year-old pregnant patient, with refractory thrombocytopenia despite receiving multiple platelet transfusions. Initially referred to as gravida 5 para 4 with severe thrombocytopenia at 28 weeks gestation, throughout her pregnancy, she was closely monitored and received over 40 units of platelets, which failed to increase her platelet count significantly. She delivered a healthy baby via vaginal delivery at 38 weeks, with her platelet count still critically low. This report highlights the challenges of managing MHA in pregnancy, the inefficacy of standard thrombocytopenia treatments such as platelet transfusion in MHA patients, and the importance of tailored management strategies to ensure maternal and fetal safety.
Aalaa A. Wahab MarzooqAseel Ahmed HusainAayat Jaaffar Naseeb
