Infections remain an issue of particular relevance in renal transplant patients, particularly viral infections. Human parvovirus B19 infection causes severe refractory anaemia, pancytopenia and thrombotic microangiopathy. Its presence is recognized by analysing blood polymerase chain reaction (PCR) and by the discovery of typical giant proerythroblasts in the bone marrow. We report the case of a 65 year-old man with a history of deceased donor renal transplant in September 2014. At 38 days after the transplant, the patient presented progressive anaemia that was resistant to erythropoiesis-stimulating agents. At 64 days after transplant, hyperthermia occurred with progressive deterioration of the patient's general condition. The viral serology and the first blood PCR for human parvovirus B19 were both negative. At 4 months and 19 days after, a bone marrow biopsy was conducted, showing giant erythroblasts with nuclear viral inclusions that were compatible with parvovirus; a PCR in the tissue confirmed the diagnosis. A second blood PCR was positive for parvovirus. After treatment with intravenous immunoglobulin and the temporary discontinuation of mycophenolate mofetil, a complete remission of the disease occurred, although the blood PCR for parvovirus B19 remained positive, so monitoring is necessary for future likely recurrence.
Background and Aims OL-HDF provides multiple advantages and benefits to patients compared to conventional high-flow hemodialysis (HFHD). Current monitors have a wide variety of biosensors and devices that provide continuous information on the patient's biological parameter and the efficiency of the dialysis session. Monofrequency bioimpedance (BIVA) provides information regarding the state of hydration (HE) and nutrition (EN) of our patients. Method Observational study in 493 patients, distributed in 8 dialysis centers and with a three different model of dialysis monitor. Demographic data, dialysis techniques and regimens, mean values for one month of ultrafiltration rate readings and KT are analyzed. The continuous measurement of DD is estimated by the ion dialysance biosensor. The OL-HDF technique is post-dilutional. The BIVA measurement is performed between 10 and 30 minutes after the end of the session. The Kt/V is estimated from the total TBW (V) by BIVA, using the Watson and Hume-Wiers formulas. Statistical analysis: descriptive, t-Student for statistics of groups and independent samples, Chi square for the association in cross tables. Results See Table 1. Conclusion Obtaining lower dialysis dose values in OL-HDF than in HFHD in some monitor models, despite longer dialysis times and greater dialyzer surface area, is probably due to dilution due to post- re-infusion and/or to the positioning of the dialysance sensors within the hydraulic circuit. This makes us think about the advisability of maintaining urea Kt/V measurements, by laboratory, to ensure adequate dialysis quality.
Background and Aims The skeletal muscle index (SMI) is an impedance parameter that assesses muscle mass, and the phase angle (PA) is inversely related to strength and muscle mass in hemodialysis patients. Both parameters may represent useful and inexpensive tools to identify sarcopenic patients. Method The presence of sarcopenia was analyzed in 348 normohydrated patients in 5 hemodialysis centers by means of vector bioimpedance using the BIA101 BIVA PRO equipment. To do this, the skeletal muscle index (SMI) and the phase angle (PA) are evaluated as markers of muscle mass and strength, respectively. Results Mean SMI and PA were 8.64 ± 1.5 and 5.2 ± 0.9. The mean PA was 5.6 ± 0.9 in those with SMI within normality (9.2 ± 1.9) (p<0.001). In moderate and severe sarcopenics patients, the means of SMI (8.9 ± 1.2 vs 7.5 ± 0.9) and PA (5.3 ± 0.86 vs 4.7 ± 0.67) were significantly lower (p < 0.001) (Table 1). In patients on standard hemodialysis, the PA (P = .02) and the SMI (P = .004) were significantly lower. The PA (P = .014) and the SMI (p < 0.01) were significantly lower in the female gender but the number of sarcopenic patients was higher among the men (p< 0.001). The cut-off value of PA, which predicted a higher risk of sarcopenia, was 3.5 in all patients (95% CI, 0.60-0.71; P = .0001; 100% sensitivity, 96% specificity ); 3.55 for men (95% CI, 0.57-0.78; P = .003; 100% sensitivity, 94% specificity) and 3.65 for women (95% CI, 0.60-0.73 ; P = .0001; 100% sensitivity, 96% specificity) (Fig. 1). In the logistic regression analysis, male gender, standard hemodialysis technique, and PA were associated with a higher risk of sarcopenia (Table 2). Conclusion PA is a good predictor of sarcopenia in hemodialysis patients.
We report a case of a 64-year-old man who, 44 days after starting treatment with prasugrel, presented with severe thrombocytopenia, anaemia, renal failure, and severe ADAMTS13 activity deficiency, along with a high titer of autoantibodies to this protease. LEARNING POINTS• Drug-induced TTP is a rare condition and difficult to diagnose.• Decreased activity of ADAMTS13, unusual in drug-induced TTP, was present in this case. KEYWORDS Thrombotic microangiopathy; thrombotic thrombocytopenic purpura; prasugrel. . INTRODUCTION Thrombotic thrombocytopenic purpura (TTP) is defined as a severe deficiency of ADAMTS13, but the diagnosis of TTP relies initially on clinical judgment, since ADAMTS13 measures are often not available for several days, and different methodologies may yield different results. ADAMTS13 can be completely deficient, genetically impaired or inhibited by autoantibody. It is now observed that all cases of acquired TTP, including those that are drug induced, are associated with inhibiting antibodies to ADAMTS13. TTP is unique among the primary thrombotic microangiopathy (TMA) syndromes, in which renal function abnormalities occur but renal failure is rare. TTP typically has more systemic manifestations of organ injury than the other primary TMA syndromes. In TTP, abnormalities of the central nervous system, heart, pancreas, thyroid glands, adrenal glands, intestinal mucosa and other tissues may occur. CASE REPORTA 64-year-old male patient with a medical history of hypertension, type 2 diabetes mellitus, and dyslipidemia was admitted to hospital due to a ST-elevated coronary syndrome in 2013. He underwent fibrinolysis with tenecteplase (metylase) without complications, followed by placement of a TAXUS drug-eluting stent, placed into the anterior descending coronary artery. He was started on prasugrel 10 mg daily and discharged from the hospital on day 12 after admission. The patient was readmitted to hospital 36 days later due to nausea, vomiting, abdominal pain, and purpuric lesions. Upon arrival to the emergency department, he was hypotensive and oliguric. An abdominal computed tomography (CT) was immediately performed and was
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