Wednesday May 5, 2010
Q: What is Posttransfusion purpura (PTP)?
Answer: Post-transfusion purpura (PTP) is an adverse reaction to a blood transfusion that occurs when the body produces alloantibodies to the introduced platelets' antigens. Posttransfusion purpura typically occurs 7-10 days following a transfusion. This syndrome can be induced by platelet transfusion, a small amount of platelets contaminating a red blood cell transfusion or, occasionally, following fresh frozen plasma (FFP) transfusion. PTP is most common in women who have had multiple pregnancies, and men who have undergone previous transfusions.
The thrombocytopenia responds to intravenous immunoglobulin (IVIG).
See nice review on PTP here
Wednesday, May 5, 2010
Tuesday, May 4, 2010
Tuesday May 4, 2010
Q: 35 year old male developed severe diarrhea, fever and abdominal pain after blood transfusion. Symptoms progressed very rapidly. CT scan of abdomen showed hepatic and splenic abscesses. Surgery back up is called and infectious diseases (ID) consult is obtained. Meanwhile blood bank confirmed contamination of stored blood. ID service started patient on Ciprofloxain. Which 'bug' they are suspecting?
Answer: Yersinia enterocolitica
Yersinia enterocolitica is a gram-negative bacillus and is a siderophilic (iron-loving) bacteria. Those with hereditary hemochromatosis are more susceptible to infection with Yersinia - and the most common contaminant of stored blood is Y. enterocolitica. Yersinia enterocolitica multiplies rapidly in whole blood or red blood cells stored at 4 to 8° C.
Other sources of infection are contaminated pork, milk, water, and tofu consumption. Infected individuals may shed Y enterocolitica in stools for 90 days after the symptom resolution.
Q: 35 year old male developed severe diarrhea, fever and abdominal pain after blood transfusion. Symptoms progressed very rapidly. CT scan of abdomen showed hepatic and splenic abscesses. Surgery back up is called and infectious diseases (ID) consult is obtained. Meanwhile blood bank confirmed contamination of stored blood. ID service started patient on Ciprofloxain. Which 'bug' they are suspecting?
Answer: Yersinia enterocolitica
Yersinia enterocolitica is a gram-negative bacillus and is a siderophilic (iron-loving) bacteria. Those with hereditary hemochromatosis are more susceptible to infection with Yersinia - and the most common contaminant of stored blood is Y. enterocolitica. Yersinia enterocolitica multiplies rapidly in whole blood or red blood cells stored at 4 to 8° C.
Other sources of infection are contaminated pork, milk, water, and tofu consumption. Infected individuals may shed Y enterocolitica in stools for 90 days after the symptom resolution.
Monday, May 3, 2010
Monday May 3, 2010
Vasoconstrictor extravasation
Antidote for vasoconstrictor extravasation in skin and tissues (dopamine, epinephrine, or norepinephrine) is PHENTOLAMINE. Infiltrate 5-15 mg of PHENTOLAMINE in 10 ml of normal saline into the area of extravasation as soon as possible. Treatment may be applied and effective up to 12 hours post extravasation of vasoconstrictor. Keep yourself ready for fluid bolus post treatment.
Mechanism of action: Phentolamine is a nonspecific alpha-adrenergic blocking agent which inhibits vasoconstriction and allow improved blood circulation through the affected area.
Vasoconstrictor extravasation
Antidote for vasoconstrictor extravasation in skin and tissues (dopamine, epinephrine, or norepinephrine) is PHENTOLAMINE. Infiltrate 5-15 mg of PHENTOLAMINE in 10 ml of normal saline into the area of extravasation as soon as possible. Treatment may be applied and effective up to 12 hours post extravasation of vasoconstrictor. Keep yourself ready for fluid bolus post treatment.
Mechanism of action: Phentolamine is a nonspecific alpha-adrenergic blocking agent which inhibits vasoconstriction and allow improved blood circulation through the affected area.
Sunday, May 2, 2010
Sunday May 2, 2010
Zinc Supplementation in Critically Ill Patients: - Just a Myth?
Introduction: The purpose of the paper is to provide a rationale for zinc supplementation as a potential therapeutic agent in critically ill patients by describing its role in health and disease, conducting a systematic review of current randomized trials in critical care, considering optimum route and dose of administration, and making recommendations for future research. Normal zinc homeostasis is required for a functional immune system, adequate antioxidant capacity, glucose homeostasis, and wound healing. In addition, zinc is a required cofactor for many enzymes, transcription factors, and replication factors. In non–critically ill patients, zinc supplementation has been associated with an improvement in markers of immune function.
Results: In critically ill patients, only 4 randomized trials have examined the effect of zinc supplementation on clinical outcomes.
Conclusion: Thus, because of the paucity of clinical data, there is inadequate evidence to recommend the routine use of high-dose zinc supplementation in the critically ill. A first step would be to determine the optimal dose that has a maximal positive effect on underlying inflammatory, immunologic, and metabolic processes yet is safe and tolerated by critically ill patients. Subsequently, large, rigorously designed, randomized trials are required to elucidate the efficacy of such doses of zinc supplementation in this patient population.
Zinc Supplementation in Critically Ill Patients: A Key Pharmaconutrient? - Journal of Parenteral and Enteral Nutrition, Vol. 32, No. 5, 509-519 (2008)
Editors' note: Negative studies are as important to look into as postive studies to prevent harm to patients!
Zinc Supplementation in Critically Ill Patients: - Just a Myth?
Introduction: The purpose of the paper is to provide a rationale for zinc supplementation as a potential therapeutic agent in critically ill patients by describing its role in health and disease, conducting a systematic review of current randomized trials in critical care, considering optimum route and dose of administration, and making recommendations for future research. Normal zinc homeostasis is required for a functional immune system, adequate antioxidant capacity, glucose homeostasis, and wound healing. In addition, zinc is a required cofactor for many enzymes, transcription factors, and replication factors. In non–critically ill patients, zinc supplementation has been associated with an improvement in markers of immune function.
Results: In critically ill patients, only 4 randomized trials have examined the effect of zinc supplementation on clinical outcomes.
- When all 4 studies were aggregated, zinc supplementation was associated with a nonsignificant reduction in mortality (relative risk = 0.63, 95% confidence intervals 0.25-1.59, P = .33) and length of stay in intensive care (–0.35 days, –0.85 to 0.15; P = .17)
Conclusion: Thus, because of the paucity of clinical data, there is inadequate evidence to recommend the routine use of high-dose zinc supplementation in the critically ill. A first step would be to determine the optimal dose that has a maximal positive effect on underlying inflammatory, immunologic, and metabolic processes yet is safe and tolerated by critically ill patients. Subsequently, large, rigorously designed, randomized trials are required to elucidate the efficacy of such doses of zinc supplementation in this patient population.
Zinc Supplementation in Critically Ill Patients: A Key Pharmaconutrient? - Journal of Parenteral and Enteral Nutrition, Vol. 32, No. 5, 509-519 (2008)
Editors' note: Negative studies are as important to look into as postive studies to prevent harm to patients!
Saturday, May 1, 2010
Saturday May 1, 2010
Scenario: 22 year male with multiple myeloma presented to ER with severe facial pain. He recently received a drug from his oncologist and was told its good for bones and actually he recommend the same drug for patient's mom once a year! You examined the patient and call for maxillo-facial surgical consult.
Answer: Zoledronate (Zometa)
Zoledronate (Zometa) is a bisphosphonate. Zometa is used to prevent skeletal fractures in patients with multiple myeloma, Paget's disease and other cancers, as well as for treating osteoporosis. The standard dose for zoledronate is 4 mg to be infused intravenously over 15 min every 4 weeks in cancer patients but has been approved as a once-yearly 5 mg infusion for treatment of osteoporosis!
A rare complication is osteonecrosis of the jaw. Risk is higher if such patients require dental workup. Jaw bone damage and death occurs as a result of reduced local blood supply (avascular osteonecrosis). Severe cases require surgical removal of the affected bone.
Scenario: 22 year male with multiple myeloma presented to ER with severe facial pain. He recently received a drug from his oncologist and was told its good for bones and actually he recommend the same drug for patient's mom once a year! You examined the patient and call for maxillo-facial surgical consult.
Answer: Zoledronate (Zometa)
Zoledronate (Zometa) is a bisphosphonate. Zometa is used to prevent skeletal fractures in patients with multiple myeloma, Paget's disease and other cancers, as well as for treating osteoporosis. The standard dose for zoledronate is 4 mg to be infused intravenously over 15 min every 4 weeks in cancer patients but has been approved as a once-yearly 5 mg infusion for treatment of osteoporosis!
A rare complication is osteonecrosis of the jaw. Risk is higher if such patients require dental workup. Jaw bone damage and death occurs as a result of reduced local blood supply (avascular osteonecrosis). Severe cases require surgical removal of the affected bone.
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