Changes in platelet count (PLT) are very important during pregnancy. Many platelet disorders occur during pregnancy and a reduction in PLT is the most common hemostasis abnormality identified, and this has important implications for mother and foetus. Many of these disorders share clinical and laboratory features, making accurate diagnosis difficult. The aim of this study was to establish reference intervals of platelet parameters for some of the more important pathologies associated to pregnancy (pre-eclampsia, gestational diabetes, autoimmune disorders, viral infections) using the automated hematology analyzer Sysmex XE-2100 and to evaluate the difference between healthy and pathological pregnancy. We enrolled in our study 100 pregnant women in the third trimester of pregnancy. The parameters analyzed included PLT, platelet distribution width, and mean platelet volume (MPV). We found statistically significant difference in PLT in pre-eclampsia, autoimmune disorders, and viral infections. Our results demonstrated also a statistically significant difference in MPV in pre-eclampsia and gestational diabetes. Our results allow the clinicians to detect hematologic change by simple complete blood count useful for the management of the pathological pregnancies. In conclusion, the overall picture of platelet disorders is extremely variegated, leading to numerous diagnostic and therapeutic problems whose solutions require close collaboration between clinicians and laboratory specialists.
Extremely elderly patients are being treated with anticoagulant therapy with increasing frequency. We sought to assess the rates of bleeding in such patients and to carefully examine risk factors that might predict this bleeding. This was a prospective cohort study conducted from 1 January 2007 to 29 February 2008 at an anticoagulation clinic in Modena, Italy. Ninety patients, 90 years or older, among 1635 patients with nonvalvular atrial fibrillation were studied; 69 (77%) were women with a median age of 91.71 years (range 90-98). During the enrolment period, all the patients were interviewed during an ambulatory visit and were followed in the outpatient setting. Hemorrhagic, thromboembolic and fatal events over 1 year of follow-up were monitored. Six (7%) patients discontinued vitamin K antagonists (three due to bleeding, two due to noncompliance, two due to physician recommendation). Twenty-one (23%) patients died, and 35 (39%) were admitted to hospital. One patient had an intracranial hemorrhage [1%, 95% confidence interval (CI) 0.27-6.0], two patients had a major extracranial hemorrhage (2%, 95% CI 0.7-8.0). One patient had an ischemic stroke (1%, 95% CI 0.27-6.0), two patients had embolic arterial ischemia (2%, 95% CI 0.7-8.0). All the events occurred when the international normalized ratio was outside the target range, or after oral anticoagulation had been stopped. In our study of extremely elderly anticoagulated patients, we found low rates of bleeding and thromboembolism. These findings support the use of oral anticoagulants in such patients.
The serum concentrations of soluble interleukin-2 receptors and urine neopterin were studied in 82 patients with malignant lymphomas (25 patients with Hodgkin's disease and 57 patients with non-Hodgkin's lymphoma. Increases in soluble interleukin-2 receptors and in urinary neopterin were significantly correlated with the clinical phase of the disease. The average values in both Hodgkirfs disease and non-Hodgkin's lymphoma patients suffering from the disease in its active phase were significantly higher than those of patients in complete remission. Neopterin concentrations (but not soluble interleukin-2 receptor concentrations) were also elevated in clinical stages III-IV of each disease. Urinary neopterin correlated directly and significantly with the erythrocyte sedimentation rate and inversely with haemoglobin. Finally, a longitudinal analysis showed a general tendency for the markers to return to normal values, in accordance with the favourable outcome of therapy; this was more evident for urinary neopterin than for soluble interleukin-2 receptors. These findings seem to confirm that soluble interleukin-2 receptors and especially urinary neopterin can be useful markers for monitoring and prognosis of malignant lymphomas.
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