Acquired Coagulopathy Owing to Parenteral Cefamandole: Renal Failure as a Predisposing Factor*
|
|
- Margaret Walters
- 6 years ago
- Views:
Transcription
1 ANNALS OF CLINICAL AND LABORATORY SCIENCE, Vol. 13, No. 5 Copyright 1983, Institute for Clinical Science, Inc. Acquired Coagulopathy Owing to Parenteral Cefamandole: Renal Failure as a Predisposing Factor* JAE C. CHANG, M.D. Department of Medicine, Wright State University School of Medicine, and Hematology and Oncology Section, Good Samaritan Hospital and Health Center, Dayton, OH ABSTRACT W ithin a span of four m onths at a 550 bed community hospital, four elderly patients who had been taking cefamandole for various infections developed a severe coagulopathy within 10 days after initiation of cefamandole. All patients had a prolonged prothrom bin tim e and activated partial thromboplastin time with a marked decrease of the vitamin K dependent clotting factors II, VII, IX, X, and also were found to have mild to m oderate renal function im pairm ent. The coagulopathy was prom ptly corrected to normal with or without treatm ent of vitamin K and/or fresh frozen plasma when the drug was discontinued. Treatm ent with vitamin K while on cefamandole also corrected the coagulation abnormalities and in vitro cefamandole had no direct effect on prothrombin time and activated partial throm boplastin tim e in therapeutic concentrations. These clinical and laboratory observations and the nature of high excretion rate of cefamandole in bile suggest cefamandole induced coagulopathy is caused by decreased vitamin K synthesis, probably secondary to rapid depletion of vitamin K producing intestinal organisms. Introduction Bleeding diathesis associated with low levels of clotting factors dependent upon vitamin K for their biosynthesis has been reported to occur occasionally in debilitated and undern o u rish ed patients re ceiving broad-spectrum antibiotics.2 3'5,8'9 n, is. is, I? The pathogenesis of bleeding has been thought to be caused by decreased synthesis of factors II, VII, IX, X secondary to elimination of vitamin K producing intestinal organism s. However, the possibility that suppression of the vitam in K d e p e n d e n t clo ttin g factors is caused by a direct inhibitory effect on the biosynthesis of the vitamin K dependent clotting factors by the antibiotic in question has not been excluded. At the Good Samaritan Hospital and * Requests for reprints should be addressed to the author at Hematology and Oncology Section, Good Samaritan Hospital and Health Center, Dayton, OH /83/ $01.20 Institute for Clinical Science, Inc.
2 Health Center which has a 550 bed capacity, four cases have b een observed with an acquired coagulopathy following an adm inistration of cefamandole within a span of four months. This syndrom e occurred in less than ten days of treatm ent w ith th e drug. B leeding tendency and abnormal clotting tests quickly reversed to norm al w hen the antibiotic was discontinued. It is of interest to note that coagulopathy seems to occur m ore often after cefamandole than with other antibiotics. If this phenomenon is true, clinical implication of cefamandole induced coagulopathy is thought to be very im portant. Described are clinical data and coagulation studies in these patients and in vitro study of the effects of cefamandole on prothrom bin tim e and activated partial thromboplastin time. These clinical and laboratory data suggest that cefamandole is a very potent inhibitor of vitam in K d ep en d en t factor synthesis, C E F A M A N D O L E A N D C O A G U LO PA TH Y probably owing to an increased excretion of the drug in bile resulting in depletion of the vitamin K producing intestinal organism s, especially in p a tien ts w ith a compromised renal function. Case Histories Four patients (table I) who received cefamandole for various infections were found initially to have an acquired coagulopathy characterized by a markedly prolonged prothrombin time (PT) and activated partial thromboplastin time (PIT). Three patients had clinical bleeding and one had no bleeding problem. All patients recovered from the acquired coagulopathy with or without treatments of vitamin K and/or fresh frozen plasma when cefamandole was discontinued. Case I (HX). This 58 year old white male with a long-standing history of rheumatoid arthritis, receiving acetyl salicylic acid, three to five g per day, was admitted because of sudden onset of severe chest pain. On admission, an electrocardiogram showed acute anterior myocardial infarction. The diagnosis was confirmed by cardiac enzyme studies. In the coronary care unit he was stable without any unusual complication except for bilateral pneumonitis, for which he was started on cefamandole one week after TABLE I C lin ic a l C h a r a c te r is tic s o f P a tie n ts Case I (HX) Case I I (SM) Case I I I (FX) Case IV (BX) Age Race/Sex White male White male White male White female Reason for Admission Acute myocardial Perforated duo Abdominal Fever and infarction denal ulcer lymphoma dehydration Nutritional status Normal Normal Normal Undernourished History of alcoholism No No No No Reason for cefamandole Pneumonitis Peritonitis Pneumonia Sepsis therapy Bleeding Bpistaxis Abdominal wall None Extensive purpura hematemesis hematoma in extremities Clotting studies PT (sec.) (normal: 12-14) PTT (sec.) (normal: 19-33) Hemogram Hemoglobin (g per dl) Hematocrit (%) WBC (per mm3) 13,000 19,000 9,400 14,300 Platelet (per mm3) 685, , , ,000 Hepatic function Normal Normal Normal Normal BUN/Creatinine normal: 5-19 mg per 41/2.7 44/6.2 19/1.6 61/2.2 dl/q mg per dl) P T : PIT: Prothrombin time Activated partial thromboplastin time
3 4 2 0 C H A N G admission. Nine days after cefamandole was begun, he began to have recurrent epistaxis and developed massive hematemesis. Also noticed was excessive bleeding at the sites of the intravenous catheter and venipuncture. Acetyl salicylic acid had been withheld since his admission and chest pain was controlled initially with morphine sulfate and later with acetaminophen. Liver function tests were normal. Because of unexpected bleeding diathesis, coagulation studies were performed. Case 11 (SM). This 71 year old white male was admitted because of severe abdominal pain and recurrent vomiting for about three weeks. The symptoms became worse a few hours prior to admission. About two years previously, he had been treated with antacid for duodenal ulcer with an improvement of symptoms. On admission, an intestinal perforation was suspected and the patient underw ent laparotomy. A perforated duodenal ulcer was encountered and subtotal gastrectomy was performed along with truncal vagotomy and Billorth I anastomosis. Two days after surgery, he was given cefamandole. Five days after the cefamandole was started, a painful swelling developed in the right lower quadrant of the abdomen along with easy bruisability. Liver function tests were normal. Markedly prolonged PT and PTT were noted at 94 and 72 seconds, respectively. The patient received three units of fresh frozen plasma and underwent abdominal wall exploration. A huge abdominal wall hematoma was removed. Case 111 (FX). This 76 year old white male with a history of mild hypertension for several years was admitted because of progressive abdominal swelling and discomfort associated with edema on both feet for about two months. Prior to this admission, an abdominal com puterized axial tomography scan showed a large retroperitoneal mass. Abdominal lymphoma was suspected. Physical examination was unremarkable other than fullness in the left side of the abdomen. No lymphadenopathy was present. Evaluation including chest roentgenogram and bone marrow biopsy was normal. The patient underwent exploratory laparotomy and extensive retroperitoneal tumors were found. The pathology of biopsies revealed non-hodgkin s lymphoma, poorly differentiated lymphocytic, diffuse type. One day postoperatively, owing to development of pneumonia, he was started on cefamandole. Three days later, PT and PTT were found to be markedly prolonged to 31 and 39 seconds, respectively. Case IV (BX). This 86 year old white female, a moderately undernourished white female with known diagnosis of chronic brain syndrome and arteriosclerotic cerebrovascular disease, was admitted because of dehydration and fever. An appropriate infectious evaluation was performed because sepsis was suspected. Blood cultures grew anerobic gram negative rods which remained unidentified. Cefamandole was started immediately. On admission she had a slightly prolonged PT of 15.5 seconds and normal PTT of 24 seconds. Four days later, the patient developed extensive ecchymotic areas on the lower extremities and was found to have prolonged PT of 28 seconds and PTT of 39.5 seconds. Methods In all four patients, clinical evaluations have suggested that the coagulopathy was secondary to intravenous cefam andole therapy. Detailed clinical information was obtained including the reason of admission, history of bleeding problem, hepatic function, renal function, hem o gram, and PT and PTT as well as careful correlatio n for possible d ru g effects during hospitalization. Clotting studies including fibrinogen quantitation and assays of various coagulation factors, such as Factors II, V, VII, VIII, IX, and X, w ere perform ed according to standard factor assay methods using a specific coa g u la tio n fa c to r d e fic ie n t s u b s tra te plasm a* w hen PT and PTT w ere prolonged. The relationship betw een cefam andole th erap y and d e v e lo p m e n t of abnormal PT and PTT was carefully exam in ed and th e coagulation profile changes w ere correlated with treatm ent of fresh frozen plasma and vitamin K. F i nally, an in vitro experim ent was carried out to exclude direct effect of cefamandole on PT and PTT at its various concentrations. Blood sam ples w ere obtained from a normal subject and from Case III after his coagulation profile retu rn e d to norm al. T he plasm as w ere tested for PT and PTT after an in vitro incubation for 30 minutes at concentration of cefamandole ranging from 0 to 10,000 xg per ml. Results C l i n i c a l C h a r a c t e r i s t i c s In table I is summarized essential clinical inform ation. All patients w ere elderly and over 70 years old except for Case I who was 58 years old. Cases I and II had severe bleeding diathesis with un- * Dade Diagnostic, Inc., Miami, FL.
4 controlable epistaxis and hem atem esis, and a huge abdom inal wall hematoma, respectively. Case IV had extensive purpura in lower extrem ities but Case III had no clinical b leed in g. N u tritio n al status prior to and during this admission was norm al in all patients except Case IV, w ho was a d m itte d from a n u rsin g home and was m oderately undernourished. None of these patients had a history of alcoholism, and liver function tests including bilirubin and enzym es w ere normal. Because of severe infections such as pneum onitis, peritonitis, and sepsis, the patients w ere started on intravenous cefamandole. Although platelet count was normal, mild anem ia was present in all patients. W ithin 10 days after initiation of cefamandole, all patients developed a m arkedly prolonged PT and PTT. Abnormal renal function was present in all patients in mild to modest degree, characterized by the elevation of blood urea nitrogen and creatinine. C o a g u l a t i o n S t u d i e s W hen PT and PTT w ere prolonged, assays of various coagulation factors w ere perform ed and the results are shown in C E F A M A N D O L E A N D C O A G U LO PA T H Y 421 TABLE I I C o ag ulation T ests o f P a tie n ts table II. All the vitamin K dependent factors: II, VII, IX, X, w ere dim inished in all patients. Among these factors, factor V II was m ost profoundly d im in ish ed. Factors V and VIII, which are not the vitam in K d e p e n d e n t factors, w ere normal. No evidence of dissem inated intravascular coagulation or pathologic fibrinolysis was present. R e l a t i o n s h i p B e t w e e n C e f a m a n d o l e T h e r a p y a n d P T a n d P T T Two patients w ere treated with fresh frozen plasm a and th ree patients w ith p a re n te ra l p h y to n ad io n e, an aqueous colloidal solution of vitamin K. Either one or both treatm ents effectively corrected a prolonged PT and PTT within 24 hours as seen in Cases II and IV (figures 1 and 3). In Case II, as cefamandole was discontinued and three units of fresh frozen plasma were transfused, PT dropped from 94 seconds to 22 seconds; it gradually retu rn e d to norm al w ith th e vitam in K therapy. H ow ever, Case III was observed w ithout treatm ent of vitamin K or fresh frozen plasma. As seen in figure 2, PT and PTT began to im prove within 24 hours and returned to normal in five days. C a s e I (HX) C a s e I I (SM ) C a s e I I I (F X ) C a s e I V (BX) Date 2/26/81 2/27/81 4/9/81 5/27/81 6/11/81 Normal values AM PM PT (sec.) PTT (sec.) Fibrinogen quantitation (mg per dl) Factor II (%) Factor V (%) Factor VII (%) Factor VIII (%) Factor IX (%) Factor X {%) Soluble fibrin monomer <-> <-> (-) (-) Fibrin split product (-) (±> (±) (+) PT: Prothrombin time PTT: Activated partial thromboplastin time
5 4 22 C H A N G Cefamandole (gm./day) 4 '...W///////////////////M. Fresh Frozen Plasma g 1 Phytonadione (mg.) 5 1. Prothrombin 40 Time (PT) (sec.) 30 Partial 20 Thromboplastin Time (PTT) 10 (sec.) 'PTV ''^ l S P l o" \ V*. j 1. 1i i 1 1i 1i i 1 Ii I i June 1981 F ig u r e 3. Case IV (BX): Restoration of PT and PTT to normal with either fresh frozen plasma or vitamin K while continuing on cefamandole April 1981 F i g u r e 1. Case II (SM): Effect of cefamandole, fresh frozen plasma, and vitamin K (phytonadione) on prothrombin time (PT) and activated partial thromboplastin time (PTT). Note prompt correction of the coagulopathy by fresh frozen plasma and vitamin K. A pparently in all patients cefam andole in d u ced coagulopathy d ev elo p ed in a short period, and the recovery was also prom pt with or without a specific therapy. In figure 3 is shown the effect of vitam in K in Case IV while continuing on cefam andole. In sp ite of continuous treatm ent of the drug, PT and PTT still re tu rn e d to norm al. This finding indicates that vitamin K is an effective agent in preventing cefamandole induced coagulopathy, and also suggests that cefam andole has no direct inhibitory effect on vitamin K activity or utilization. F i g u r e 2. Case III ( F X ) : Effect correction of abnormal PT and PTT in a few days by withdrawal of cefamandole. In V itro E f f e c t o f C e f a m a n d o l e o n PT AND PTT Following an in vitro incubation of the plasmas of both normal subject and Case III with cefamandole, PT and PTT were normal at a concentration of cefamandole up to 4,000 xg p er ml (table III). Slightly prolonged PT and PTT w ere noted only at concentration higher than 8,000 fig per ml in plasm a of b o th su b jects. T hese findings are in agreem ent with the study of C uster et al.6 Discussion In addition to broad -spectrum antibiotics, several cephalosporin antibiotics have been known to induce hemostatic defects in certain patients in rare in sta n c e s.3' C efam andole, a new er sem isynthetic broad-spectrum cephalosporin antibiotic which has effectiveness against various bacterial organisms such as Staphylococcus aureus, beta-hem o lytic and other streptococci, Escherichia coli, Klebsiella and Proteus species, and certain an ero b ic organism s, has b een suspected to have an effect on blood coagulation.3 67 G astrointestinal bleeding has been reported owing to vitamin K deficiency in patients on parenteral cefamandole. 10
6 CEFAM ANDOLE AND COAGULOPATHY TABLE I I I 4 23 In Vitro Effect of Cefamandole on PT and PTT P la s m a C e fa m a n d o le ( l ig /m l) P T ( s e c. ) N o r m a l S u b j e c t C a s e I I I (F X ) P T T ( s e c. ) N o r m a l S u b j e c t C a s e I I I (F X ) , , , , PT: PTT: Prothrombin time Activated partial thromboplastin time All patients had normal PT and PTT except a slight prolongation of PT in Case IV prior to or during the early stage of treatm ent with cefamandole as shown in figures 1, 2, and 3. Since the developm ent of prolonged PT and PTT certainly coincided with the treatm ent of cefamandole, the diagnosis of cefamandole induced coagulopathy is well established. The occurrence of four clinical cases of cefamandole induced coagulopathy within a span of four m onths at a 550 bed comm unity hospital suggests that this condition, w hen com pared with other antibiotics in clu d in g o th e r cep halosporin derivatives, may be a common complication of cefamandole therapy in clinical practice. Unlike the cases seen with other b ro ad -sp ectru m antib io tics, th ese p a tients had fairly good nutritional status. However, another clinical feature common to all four cases was mild to moderate renal function impairment. As coagulopathy was detected and cefamandole discontinued, abnormal coagulation profile rapidly returned to normal within five days w ith or w ithout treatment of fresh frozen plasma and/or vitamin K. W hen parenteral vitamin K and fresh frozen plasma were given, restoration to norm al PT and PTT o ccurred within 48 hours; without vitamin K administration and fresh frozen plasma, the restoration was less prompt. Normalization of PT and PTT was still com plete a few days after cefamandole was discontinued. Case IV was continuously treated with cefamandole despite the coagulopathy and was still found to have prom pt correction of th e clotting abnorm ality when treated with vitamin K. Cefamandole induced coagulopathy appears to be an acute phenom enon and is correctable without any specific treatm ent w hen the drug is discontinued. The coagulopathy can be m anaged more effectively in acute p hase by tre a tm e n t w ith e ith e r fresh frozen plasma or vitamin K. Failure of in vitro incubation of normal subject and patient s plasma with cefamandole to show any effect on PT and PTT indicates that cefamandole has no direct and significant interference on activity of vitamin K dependent factors. Although a slight prolongation of PT and PTT occurred at concentration higher than 8,000 jxg p er ml, this concentration is m uch higher than in vivo therapeutic plasma level. The fact that the prothrombin time was corrected by vitam in K adm inistration despite continued treatm ent with cefam andole excludes direct inhibition of synthesis of clotting factors as an etiologic m echanism. T herefore, it is postulated that cefamandole results in inhibition of
7 4 2 4 CHANG vitam in K synthesis ra th e r than direct action on vitamin K dependent clotting factors or inhibitory action on vitamin K activity or utilization. The clinical observation that cefamandole induced coagulopathy occurred in patients with an impaired renal function suggests it has an important role. Metabolic studies showed cefam andole was excreted in both bile and urine, and the level of cefamandole was found to be several times higher in bile of norm al subjects w hen compared with other cephalosporin derivatives such as cefazolin and cephalothin.16 Still, 65 percent to 80 percent of cefamandole is excreted primarily by the kidneys, largely as an unm etabolized d ru g.1 T herefore, w hen ren al functio n im p airm en t is present, a m uch higher concentration of the drug will reach the intestinal lumen via biliary excretion, resulting in rapid depletion of vitamin K producing intestinal organisms in a very short period of time. U rem ia has previously been suspected to be an important factor in producing antibiotic induced coagulopathy in certain patients.1215 Cefamandole is a very useful antibiotic in the treatm ent of infection with various bacterial organisms, but it should be used with an extrem e caution and appropriate dosage adjustment in patients with comprom ised renal function and in undernourished patients. Severe coagulopathy seems to occur m ore regularly than with other antibiotics owing to its high excretion rate in bile. This may produce acute and serious bleeding diathesis. If this iatrogenic condition is not recognized early, a serious clinical disaster may ensue. M onitoring can be done easily with a periodic d e te rm in a tio n of PT and PTT. M anagem ent is by an im m ediate withdrawal of the antibiotic and by treatm ent with fresh frozen plasma and/or vitamin K. If continuation of the antibiotic is desired, administration of prophylactic dose of vitamin K can be used during the antibiotic therapy. References 1. A m e r i c a n M e d i c a l A s s o c ia t i o n : A M A Drug Evaluations, 4th ed. Cephalosporins. Chicago, A M A Departm ent of Drugs. 1980, pp Ansell, J. E., Kumar, R., and D eykin, D.: The spectrum of vitam in K deficiency. J. Am. Med. Assoc. 238:40-42, B a n g, N. U., D w y e r, A., C a m p b e l l, S. S., M a r k s, C. A., and H e i d e n r e i c h, R. O.: Mechanism of cephamandole-associated bleeding. 20th Interscience Conference on Antimicrobial Agents and Chemotherapy, New Orleans, 1980, Abstract B r o w n, C. H., Ill, N a t e l s o n E. M. W., W il l ia m s, T. W., J r., and A l f r e y, C. P., Jr.: The hemostatic defect produced by carbenicillin. New Eng. J. Med. 291: , C o l v in, B. T., and L l o y d, M. J.: Severe coagulation defect due to a dietary deficiency of vitamin K. J. Clin. Pathol. 30: , C u s t e r, G. M., B r ig g s, B. R., and S m it h, R. E.: Effect of cefamandole nafate on blood coagulation and platelet function. Antimicrob. Agents Chemother. 16: , C u s t e r, G. M., B r ig g s, B. R., and S m it h, R. E.: Cefamandole nafate and blood coagulation. Ohio State Med. J. 76: , F r ic k, P. G., R i e d l e r, G., and B rog l i, H.: Dose response and minimal daily requirement for vitamin K in man. J. Appl. Physiol. 23: , H a m, J. M.: Hypoprothrombinemia in patients undergoing prolonged intensive care. Med. J. Aust. 2: , H o o p e r, C. A., H a n e y, B. B., and St o n e, H. H. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet 7:39-40, K l i p p e l, A. P. and P it s in g e r, B. Hypoprothrombinemia secondary to antibiotic therapy and manifested by massive gastrointestinal hemorrhage. Arch. Surg. 96: , L e r n e r, P. I, and L u b in, A.: Coagulopathy with cefazolin in uremia. New Eng. J. Med. 290:1324, M a t s a n io t is, N., M e s s a r it a k is, J., and V l a c h o u, C.: Hypoprothrombinaemic bleeding in infants associated with diarrhea and antibiotics. Report of two cases. Arch. Dis. Child. 45: , N a t e l s o n, E. A., B r o w n, C. H., Ill, B r a d s h a w, M. W., et al.: Influence of cephalosporin antibiotics on blood coagulation and platelet function. Antimicrob. Agents Chemother. 9:91-93, P i n e o, G. F., G a l l u s, A. S., and H ir s h, J.: Unexpected vitamin K deficiency in hospitalized patients. Can. Med. Assoc. J. 109: , R a t z a n, K. R., B a k e r, H. B., and L a u r e d o, I.: Excretion of cefamandole, cefazolin, and cephalothin into T-tube bile. Antimicrob. Agents Chemother, i3: , Y u d i s, M., M a h o o d, W. H., and M a x w e l l, R.: Bleeding problems with carbenicillin. Lancet 2:599, 1972.
ACQUIRED COAGULATION ABNORMALITIES
ACQUIRED COAGULATION ABNORMALITIES ACQUIRED COAGULATION ABNORMALITIES - causes 1. Liver disease 2. Vitamin K deficiency 3. Increased consumption of the clotting factors (disseminated intravascular coagulation
More informationReemergence of the International Normalized Ratio for the Standardization of Prothrombin Time*
ANNALS O F CLINICAL AND LABORATORY SCIEN CE, Vol. 23, No. 3 Copyright 1993, Institute for Clinical Science, Inc. Reemergence of the International Normalized Ratio for the Standardization of Prothrombin
More informationLearning Objectives: At the end of this exercise, the student will be able to:
Applications in Transfusion Medicine- A CBL Exercise- Student Guide 1 Title: Applications in Transfusion Medicine A CBL Exercise Purpose: At the conclusion of this exercise, students will be able to apply
More informationDr. MUBARAK ABDELRAHMAN MD PEDIATRICS AND CHILD HEALTH Assistant Professor FACULTY OF MEDICINE -JAZAN
Dr. MUBARAK ABDELRAHMAN MD PEDIATRICS AND CHILD HEALTH Assistant Professor FACULTY OF MEDICINE -JAZAN The student should be able:» To identify the mechanism of homeostasis and the role of vessels, platelets
More informationViscoelastic Measurement of Clot Formation: A New Test of Platelet Function
ANNALS OF CLINICAL AND LABORATORY SCIENCE, Vol. 13, No. 2 Copyright 1983, Institute for Clinical Science, Inc. Viscoelastic Measurement of Clot Formation: A New Test of Platelet Function ABDUS SALEEM,
More informationTigecycline-induced Hypofibrinogenaemia in a Patient with End-stage Renal Diseases S Wang, Z Li, L Li, F Liu ABSTRACT
Tigecycline-induced Hypofibrinogenaemia in a Patient with End-stage Renal Diseases S Wang, Z Li, L Li, F Liu ABSTRACT Tigecycline is a broad-spectrum antibiotic agent used to treat severe or multidrug-resistant
More informationThe following content was supplied by the author as supporting material and has not been copy-edited or verified by JBJS.
Page 1 The following content was supplied by the author as supporting material and has not been copy-edited or verified by JBJS. Appendix TABLE E-1 Care-Module Trigger Events That May Indicate an Adverse
More informationIndex. Note: Page numbers of article titles are in boldface type.
Note: Page numbers of article titles are in boldface type. A Abdominal tumors, in children, 530 531 Alkalinization, in tumor lysis syndrome, 516 Allopurinol, in tumor lysis syndrome, 515 Anaphylaxis, drug
More informationSensitivity of Serum Fructosamine in Short Term Glycemic Control
A N N A L S O F C L IN IC A L A N D L A B O R A T O R Y S C IE N C E, Vol. 19, N o. 2 Copyright 1989, Institute for Clinical Science, Inc. Sensitivity of Serum Fructosamine in Short Term Glycemic Control
More informationAquaMEPHYTON (PHYTONADIONE) Aqueous Colloidal Solution of Vitamin K 1
9073025 INJECTION AquaMEPHYTON (PHYTONADIONE) Aqueous Colloidal Solution of Vitamin K 1 WARNING - INTRAVENOUS AND INTRAMUSCULAR USE Severe reactions, including fatalities, have occurred during and immediately
More informationDisseminated Intravascular Coagulation (DIC) Seminar. Ron Kopilov 4 th year Medical Student, Tel Aviv University Internal Medicine A 8.3.
Disseminated Intravascular Coagulation (DIC) Seminar Ron Kopilov 4 th year Medical Student, Tel Aviv University Internal Medicine A 8.3.2012 1 Our plan: Understand the pathophysiology Identify risk factors
More informationCoagulation Disorders. Dr. Muhammad Shamim Assistant Professor, BMU
Coagulation Disorders Dr. Muhammad Shamim Assistant Professor, BMU 1 Introduction Local Vs. General Hematoma & Joint bleed Coagulation Skin/Mucosal Petechiae & Purpura PLT wound / surgical bleeding Immediate
More informationBlood Transfusion Guidelines in Clinical Practice
Blood Transfusion Guidelines in Clinical Practice Salwa Hindawi Director of Blood Transfusion Services Associate Professor in Haematology and Transfusion Medicine King Abdalaziz University, Jeddah Saudi
More informationOnline Supplement for:
Online Supplement for: INFLUENCE OF COMBINED INTRAVENOUS AND TOPICAL ANTIBIOTIC PROPHYLAXIS ON THE INCIDENCE OF INFECTIONS, ORGAN DYSFUNCTIONS, AND MORTALITY IN CRITICALLY ILL SURGICAL PATIENTS A PROSPECTIVE,
More informationA Comparison of two Macroscopic Platelet Agglutination Assays for von Willebrand Factor
ANNALS O F CLINICAL AND LABORATORY SC IEN CE, Vol. 20, No. 1 Copyright 1990, Institute for Clinical Science, Inc. A Comparison of two Macroscopic Platelet Agglutination Assays for von Willebrand Factor
More informationBLEEDING DISORDERS Simple complement:
BLEEDING DISORDERS Simple complement: 1. Select the statement that describe the thrombocytopenia definition: A. Marked decrease of the Von Willebrandt factor B. Absence of antihemophilic factor A C. Disorder
More informationLONG DIALYSIS SESSIONS (DAILY, NOCTURNAL ETC) Ercan Ok, Izm ir, Turkey. Chair: Mustafa Arici, Ankara, Turkey Bernard Canaud, Montpellier, France
LONG DIALYSIS SESSIONS (DAILY, NOCTURNAL ETC) Ercan Ok, Izm ir, Turkey Chair: Mustafa Arici, Ankara, Turkey Bernard Canaud, Montpellier, France Prof Ercan Ok Divis ion of N ephrology E ge U nivers ity
More informationPerforated peptic ulcer
Perforated peptic ulcer - Despite the widespread use of gastric anti-secretory agents and eradication therapy, the incidence of perforated peptic ulcer has changed little, age limits increase NSAIDs elderly
More informationBacteriemia and sepsis
Bacteriemia and sepsis Case 1 An 80-year-old man is brought to the emergency room by his son, who noted that his father had become lethargic and has decreased urination over the past 4 days. The patient
More informationBiochemistry of Vitamin K
Lecture 4 Biochemistry of Vitamin K The Objectives Types and chemistry of vitamin K Sources and daily requirements Functions Synthesis of γ-carboxyglutamate in: Prothrombin and blood clotting factors Osteocalcin
More informationThere are two main causes of a low platelet count
Thrombocytopenia Thrombocytopenia is a condition in which a person's blood has an unusually low level of platelets Platelets, also called thrombocytes, are found in a person's blood along with red blood
More informationGeneral approach to the investigation of haemostasis. Jan Gert Nel Dept. of Haematology University of Pretoria 2013
General approach to the investigation of haemostasis Jan Gert Nel Dept. of Haematology University of Pretoria 2013 Clinical reasons to investigate haemostasis Investigating a clinically suspected bleeding
More information2/2/2011. Blood Components and Transfusions. Why Blood Transfusion?
Blood Components and Transfusions Describe blood components Identify nursing responsibilities r/t blood transfusion Discuss factors r/t blood transfusion including blood typing, Rh factor, and cross matching
More informationAXITAB-CV TAB. COMPOSITION :
AXITAB-CV TAB. COMPOSITION : Each film coated tablet contains: Cefuroxime Axetil I.P. Eq. to Anhydrous 500mg. Potassium Clavulanate Diluted I.P. Eq. to Clavulanic Acid 125mg DESCRIPTION : Cefuroxime Axetil
More informationCEDR 2018 QCDR Measures for CMS 2018 MIPS Performance Year Reporting
ACEP19 Emergency Department Utilization of CT for Minor Blunt Head Trauma for Aged 18 Years and Older Percentage of visits for aged 18 years and older who presented with a minor blunt head trauma who had
More informationProper Completion of a Death Certificate"
Proper Completion of a Death Certificate" Pennsylvania Department of Health Bureau of Health Statistics and Research Division of Statistical Registries Division of Vital Records Why should you care? 1.
More information"DENTAL MANAGEMENT OF A PATIENT TAKING ANTICOAGULANTS"
"DENTAL MANAGEMENT OF A PATIENT TAKING ANTICOAGULANTS" ------------------------------------------------------------------------ LT J.D. Molinaro, DC, USN 11 August 2000 Introduction Any patient receiving
More informationHEME 10 Bleeding Disorders
HEME 10 Bleeding Disorders When injury occurs, three mechanisms occur Blood vessels Primary hemostasis Secondary hemostasis Diseases of the blood vessels Platelet disorders Thrombocytopenia Functional
More informationEffective Date: Approved by: Laboratory Director, Jerry Barker (electronic signature)
1 of 5 Policy #: 702 (PHL-702-05) Effective Date: 9/30/2004 Reviewed Date: 8/1/2016 Subject: TRANSFUSION GUIDELINES Approved by: Laboratory Director, Jerry Barker (electronic signature) Approved by: Laboratory
More informationImpaired Platelet Function Associated witn Parenteral Nafcillin*
ANNALS O F CLIN ICAL AND LABORATORY SCIEN CE, Vol. 20, No. 1 Copyright 1990, Institute for Clinical Science, Inc. Impaired Platelet Function Associated witn Parenteral Nafcillin* ELAINE K. JETER, M.D.,
More informationClinical Comparison of Cefotaxime with Gentamicin plus Clindamycin in the Treatment of Peritonitis and Other Soft-Tissue Infections
REVIEWS OF INFECTIOUS DISEASES. VOL. 4, SUPPLEMENT. SEPTEMBER-OCTOBER 982 982 by The University of Chicago. All rights reserved. 062-0886/82/0405-022$02.00 Clinical Comparison of with Gentamicin plus Clindamycin
More informationTransfusion Reactions
Transfusion Reactions From A to T Provincial Blood Coordinating Program Daphne Osborne MN PANC (C) RN We want you to know Definition Appropriate actions Classification Complete case studies Transfusion
More informationE levated Prolactin Level in Prostates with Latent Carcinoma
ANNALS OF CLINICAL AND LABORATORY SCIENCE, Vol. 17, No. 3 Copyright 1987, Institute for Clinical Science, Inc. E levated Prolactin Level in Prostates with Latent Carcinoma RYUICHI YATANI, M.D.,* ITSUO
More informationLiver failure &portal hypertension
Liver failure &portal hypertension Objectives: by the end of this lecture each student should be able to : Diagnose liver failure (acute or chronic) List the causes of acute liver failure Diagnose and
More informationGUIDELINES FOR THE EARLY MANAGEMENT OF PATIENTS WITH ACUTE ISCHEMIC STROKE
2018 UPDATE QUICK SHEET 2018 American Heart Association GUIDELINES FOR THE EARLY MANAGEMENT OF PATIENTS WITH ACUTE ISCHEMIC STROKE A Summary for Healthcare Professionals from the American Heart Association/American
More informationThrombosis and Coagulation Abnormalities Associated with Cancer
ANNALS OF CLINICAL AND LABORATORY SCIENCE, Vol. 24, No. 1 Copyright 1994, Institute for Clinical Science, Inc. Thrombosis and Coagulation Abnormalities Associated with Cancer ARMAND B. GLASSMAN, M.D. and
More informationCase Report Spontaneous Intramural Duodenal Hematoma: Pancreatitis, Obstructive Jaundice, and Upper Intestinal Obstruction
Case Reports in Surgery Volume 2016, Article ID 5321081, 4 pages http://dx.doi.org/10.1155/2016/5321081 Case Report Spontaneous Intramural Duodenal Hematoma: Pancreatitis, Obstructive Jaundice, and Upper
More informationOverview INTRODUCTION 3/15/2018. Headache Emergencies. Other way to differentiate between them? Is there an easy way to differentiate between them?
Overview Headache Emergencies Primary versus Secondary headache disorder Red flags 4 cases of unusual headache emergencies Disclaimer: we will not talk about brain bleed as patients usually go the ED.
More informationBlood is serious business
Transfusion at RCH BLOOD TRANSFUSION Anthea Greenway Dept of Clinical Haematology >10000 fresh blood products per year Supports craniofacial and cardiac surgery Support bone marrow, liver transplant and
More informationEarly Klebsiella pneumoniae Liver Abscesses associated with Pylephlebitis Mimic
Early Klebsiella pneumoniae Liver Abscesses associated with Pylephlebitis Mimic Hepatocellular Carcinoma Chih-Hao Shen, MD 3, Jung-Chung Lin, MD, PhD 2, Hsuan-Hwai Lin, MD 1, You-Chen Chao, MD 1, and Tsai-Yuan
More informationMesporin TM. Ceftriaxone sodium. Rapid onset, sustained action, for a broad spectrum of infections
Ceftriaxone sodium Rapid onset, sustained action, for a broad spectrum of infections 1, 2, 3 Antibiotic with a broad spectrum of activity Broad spectrum of activity against gram-positive* and gram-negative
More informationStudy of correlation of changes in D-DIMER levels and coagulation profile with the development of coagulation disorders
Original article: Study of correlation of changes in D-DIMER levels and coagulation profile with the development of coagulation disorders 1 Dr Gurpreet Singh, 2 Dr Mahima Sharma, 3 Dr R K Chrungoo, 4 Dr.
More informationA Repeat Case of Idiopathic Spontaneous Hemothorax
Case Report A Repeat Case of Idiopathic Spontaneous Hemothorax Felix R. Gaw, MD Jack H. Bloch, MD, PhD, FACS Nolan J. Anderson, MD, FACS Spontaneous hemothorax, a collection of blood in the pleural cavity
More informationISTITUTO DI RICERCHE FARMACOLOGICHE MARIO NEGRI CLINICAL RESEARCH CENTER ALDO E FOR CELE RARE DACCO DISEASES ALDO E CELE DACCO
ISTITUTO DI RICERCHE FARMACOLOGICHE MARIO NEGRI CENTRO MARIO DI NEGRI RICERCHE INSTITUTE CLINICHE FOR PHARMACOLOGICAL PER LE MALATTIE RESEARCH RARE CLINICAL RESEARCH CENTER ALDO E FOR CELE RARE DACCO DISEASES
More informationMedical PCCN. AACN Progressive Critical Care Nursing.
Medical PCCN AACN Progressive Critical Care Nursing http://killexams.com/pass4sure/exam-detail/pccn Question: 83 What would be identified on the arterial blood gas results as a reflection of acute respiratory
More informationThyroid Screening in the Newborn: Utah Experience
ANNALS OF CLINICAL AND LABORATORY SCIENCE, Vol. 13, No. 1 Copyright 1983, Institute for Clinical Science, Inc. Thyroid Screening in the Newborn: Utah Experience BRUCE A. BUEHLER. M.D.,* MELVIN J. GORTATOUSKI,
More informationVITAMIN K 1 INJECTION Phytonadione Injectable Emulsion, USP Aqueous Dispersion of Vitamin K 1
VITAMIN K 1 INJECTION Phytonadione Injectable Emulsion, USP Aqueous Dispersion of Vitamin K 1 Ampul Rx only Protect from light. Keep ampuls in tray until time of use. WARNING INTRAVENOUS AND INTRAMUSCULAR
More informationMedical APMLE. Podiatry and Medical.
Medical APMLE Podiatry and Medical http://killexams.com/exam-detail/apmle Question: 290 Signs and symptoms of hemolytic transfusion reactions include: A. Hypothermia B. Hypertension C. Polyuria D. Abnormal
More information(telavancin) Healthcare Professional s Guide. Version 2, 4 November 2014
VIBATIV (telavancin) Healthcare Professional s Guide Version 2, 4 November 2014 1 Table of Contents Introduction... 3 About Vibativ / Therapeutic indications... 3 Antimicrobial spectrum of activity for
More informationBlood Components & Indications for Transfusion. Neda Kalhor
Blood Components & Indications for Transfusion Neda Kalhor Blood products Cellular Components: Red blood cells - Leukocyte-reduced RBCs - Washed RBCs - Irradiated RBCs Platelets - Random-donor platelets
More informationChronic Hepatic Disease
Chronic Hepatic Disease 10 th Leading Cause of Death Liver Functions Energy Metabolism Protein Synthesis Solubilization, Transport, and Storage Protects and Clears drugs, damaged cells Causes of Liver
More informationEmergency Medical Training Services Emergency Medical Technician Paramedic Program Outlines Outline Topic: HEMATOLOGY Revised: 11/2013
Emergency Medical Training Services Emergency Medical Technician Paramedic Program Outlines Outline Topic: HEMATOLOGY Revised: 11/2013 What type of tissue is blood? Blood is considered liquid connective
More informationChapter 3 Diseases of the Blood and Bloodforming Organs and Certain Disorders Involving the Immune Mechanism D50-D89
Chapter 3 Diseases of the Blood and Bloodforming Organs and Certain Disorders Involving the Immune Mechanism D50-D89 Presented by Jennifer Kurkulonis 1 FOUR MAJOR TYPES OF BLOOD CELLS White blood cells
More informationHemostasis Haemostasis means prevention of blood loss from blood vessels.
١ Hemostasis Haemostasis means prevention of blood loss from blood vessels. Bleeding is stopped by several mechanisms, which are: 1. Local vasoconstriction 2. Formation of platelet plug 3. Blood coagulation
More informationDepartment of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
SIRIRAJ MEDICAL LIBRARY SpecialIssue Clinical Practice Guide for the Management of Dengue Hemorrhagic Fever (DHF), Siriraj Hospital Kulkanya Chokephaibulkit, M.D., Wanee Wisuthsarewong, M.D., Gavivann
More informationBlood products and plasma substitutes
Blood products and plasma substitutes Plasma substitutes Dextran 70 and polygeline are macromolecular substances which are metabolized slowly; they may be used to expand and maintain blood volume in shock
More informationP-RMS: LT/H/PSUR/0004/001
Core Safety Profile Active substance: Dalteparine Pharmaceutical form(s)/strength: Solution for injection, 2500 I.U./0.2ml, 2500 I.U./ml, 5000 I.U./0.2ml, 7500 I.U./0.3ml, 7500 I.U./0.75ml, 10000 I.U./0.4ml,
More informationRoutine Clinic Lab Studies
Routine Lab Studies Routine Clinic Lab Studies With all lab studies, a Tacrolimus level will be obtained. These drug levels are routinely assessed to ensure that there is enough or not too much anti-rejection
More informationAnalysis of Two Types of Granulocyte Transfusions in Patients with Acute Leukemia and Septicemia
ANNALS OF CLINICAL AND LABORATORY SCIENCE, Vol. 12, No. 2 Copyright 1982, Institute for Clinical Science, Inc. Analysis of Two Types of Granulocyte Transfusions in Patients with Acute Leukemia and Septicemia
More informationPathophysiology. Tutorial 3 Hemodynamic Disorders
Pathophysiology Tutorial 3 Hemodynamic Disorders ILOs Recall different causes of thrombosis. Explain different types of embolism and their predisposing factors. Differentiate between hemorrhage types.
More informationRoutine preoperative coagulation tests: are they necessary?
Routine preoperative coagulation tests: are they necessary? Dr Azzah Alzahrani MD Pediatrics Hematology /Oncology PSMMS Outline Introduction. Brief review of hemostatic mechanisms. A clinical aspect of
More informationTRANSFUSION REACTION EVALUATION
Lab Dept: Test Name: Transfusion Services TRANSFUSION REACTION EVALUATION General Information Lab Order Codes: Synonyms: CPT Codes: Test Includes: TRXR Transfusion Complication Workup; Hemolytic reaction
More informationOutpatient treatment in women with acute pyelonephritis after visiting emergency department
LETTER TO THE EDITOR Korean J Intern Med 2017;32:369-373 Outpatient treatment in women with acute pyelonephritis after visiting emergency department Hee Kyoung Choi 1,*, Jin-Won Chung 2, Won Sup Oh 3,
More informationLiver Disease. By: Michael Martins
Liver Disease By: Michael Martins Recently I have been getting a flurry of patients that have some serious liver complications. This week s literature review will be the dental management of the patients
More informationINVESTIGATION OF ADVERSE TRANSFUSION REACTIONS TABLE OF RECOMMENDED TESTS. Type of Reaction Presentation Recommended Tests Follow-up Tests
Minor Allergic (Urticarial) Urticaria, pruritis, flushing, rash If skin reaction only and mild hives/ rash
More informationGUIDELINES FOR THE TRANSFUSION OF BLOOD COMPONENTS
CHILDREN S HOSPITALS AND CLINICS OF MINNESOTA Introduction: GUIDELINES FOR THE TRANSFUSION OF BLOOD COMPONENTS These guidelines have been developed in conjunction with the hospital Transfusion Committee.
More informationSurgery for Complications of Peptic Ulcer Disease (Definitive Treatment)
Surgery for Complications of Peptic Ulcer Disease (Definitive Treatment) Amid Keshavarzi, MD UCHSC Grand Round 3/20/2006 Department of Surgery Introduction Epidemiology Pathophysiology Clinical manifestation
More informationNEONATAL SEPSIS. Dalima Ari Wahono Astrawinata Departemen Patologi Klinik, FKUI-RSCM
NEONATAL SEPSIS Dalima Ari Wahono Astrawinata Departemen Patologi Klinik, FKUI- Background Neonatal sepsis : Early-onset Late-onset Early-onset : mostly premature neonates Within 24 hours 85% 24-48 hours
More informationTRANSFUSION GUIDELINES FOR CARDIOTHORACIC UNIT 2006
TRANSFUSION GUIDELINES FOR CARDIOTHORACIC UNIT 2006 CTU blood product transfusion guidelines 2006 1 Summary of guidelines RED CELLS (10-15ml/kg) This applies to ward patients / icu patients who are stable.
More informationSummary of the risk management plan (RMP) for Gazyvaro (obinutuzumab)
EMA/319729/2014 Summary of the risk management plan (RMP) for Gazyvaro (obinutuzumab) This is a summary of the risk management plan (RMP) for Gazyvaro, which details the measures to be taken in order to
More informationOnline Supplementary Data. Country Number of centers Number of patients randomized
A Randomized, Double-Blind, -Controlled, Phase-2B Study to Evaluate the Safety and Efficacy of Recombinant Human Soluble Thrombomodulin, ART-123, in Patients with Sepsis and Suspected Disseminated Intravascular
More informationKIDNEY FAILURE. What causes kidney failure People who are most at risk for kidney failure usually have one or more of the following causes:
KIDNEY FAILURE Your kidneys are a pair of organs located toward your lower back. One kidney is on each side of your spine. They filter your blood and remove toxins from your body. Your kidneys send toxins
More informationColon ischemia. Bible class 12 September Stefan Christen. ACG Clinical Guideline: Am J Gastroenterol 2015
Colon ischemia Bible class 12 September 2018 Stefan Christen ACG Clinical Guideline: Am J Gastroenterol 2015 Definition Definition Imbalance between blood supply and metabolic demands of the colonocytes
More informationROSOBAC-1GM / ROSOBAC-FORT
ROSOBAC-1GM / ROSOBAC-FORT ROSOBAC - 1GM. COMPOSITION : Each vial contains Sterile Cefoperazone Sodium IP Eq. to Anhydrous Cefoperazone - Sterile Sulbactam Sodium USP Eq. to Anhydrous Sulbactam - ROSOBAC
More informationWhich Blunt Trauma Patients Should Be Studied by Abdominal CT?
MDCT of Bowel and Mesenteric Injury: How Findings Influence Management 4 th Nordic Trauma Radiology Course 2006 4 th Nordic Trauma Radiology Course 2006 Stuart E. Mirvis, M.D., FACR Department of Radiology
More informationTreatment of the Medically Compromised Patient
Treatment of the Medically Compromised Patient Nashville Area Continuing Dental Education Series November 3, 2010 Harry J. Brown, MD Chief Medical Officer, Nashville Area Outline General Principles Specific
More informationSalicylate (Aspirin) Ingestion California Poison Control Background 1. The prevalence of aspirin-containing analgesic products makes
Salicylate (Aspirin) Ingestion California Poison Control 1-800-876-4766 Background 1. The prevalence of aspirin-containing analgesic products makes these agents, found in virtually every household, common
More informationClinical Trial of Young Red Blood Cells Prepared by Apheresis
ANNALS OF CLINICAL AND LABORATORY SCIENCE, Vol. 16, No. 6 Copyright 1986, Institute for Clinical Science, Inc. Clinical Trial of Young Red Blood Cells Prepared by Apheresis PATRICIA PISCIOTTO, M.D.,* THOMAS
More informationJohn Davidson Consultant in Intensive Care Medicine Freeman Hospital, Newcastle upon Tyne
John Davidson Consultant in Intensive Care Medicine Freeman Hospital, Newcastle upon Tyne Overview of coagulation Testing coagulation Coagulopathy in ICU Incidence Causes Evaluation Management Coagulation
More informationHENOCH SCHÖNLEIN PURPURA (VASCULAR PURPURA, ANAPHYLACTOID PURPURA) IN CHILDREN Single choice tests (SC)
HENOCH HÖNLEIN PURPURA (VAULAR PURPURA, ANAPHYLACTOID PURPURA) IN CHILDREN Single choice tests () 1. Choose the type of bleeding characteristic for the Henoch Schönlein purpura (vascular purpura, anaphylactoid
More informationEDUCATIONAL COMMENTARY DISSEMINATED INTRAVASCULAR COAGULATION
EDUCATIONAL COMMENTARY DISSEMINATED INTRAVASCULAR COAGULATION Educational commentary is provided through our affiliation with the American Society for Clinical Pathology (ASCP). To obtain FREE CME/CMLE
More informationEasy Bleeding General Presentation
Easy Bleeding General Presentation It is not uncommon for children to bleed and bruise after experiencing trauma. However, a child may also have an underlying coagulopathy, which results in easy and possibly
More informationPOSTGRADUATE INSTITUTE OF MEDICINE UNIVERSITY OF COLOMBO
POSTGRADUATE INSTITUTE OF MEDICINE UNIVERSITY OF COLOMBO Selection Examination for Enrolment to the in-service Training Programme in Postgraduate Certificate in Basic Laboratory Sciences leading to the
More informationResident, PGY1 David Geffen School of Medicine at UCLA. Los Angeles Society of Pathology Resident and Fellow Symposium 2013
Resident, PGY1 David Geffen School of Medicine at UCLA Los Angeles Society of Pathology Resident and Fellow Symposium 2013 85 year old female with past medical history including paroxysmal atrial fibrillation,
More informationPHARMACOLOGY II. Dr Shariq Syed Associate Professor AIKTC, SoP
PHARMACOLOGY II Dr Shariq Syed Associate Professor AIKTC, SoP INTRODUCTION TO BACTERIA! INTRODUCTION TO BACTERIA! THEY COME IN DIFFERENT SHAPES ANTIMICROBIAL SITES OF ACTION SULPHONAMIDES 1930, Physician/researcher
More informationHeparin-Induced Thrombocytopenia. Steven Baroletti, PharmD., M.B.A., BCPS Brigham and Women s Hospital
Heparin-Induced Thrombocytopenia Steven Baroletti, PharmD., M.B.A., BCPS Brigham and Women s Hospital Heparin-induced thrombocytopenia (HIT) A serious concern associated with thrombosis development following
More informationBone Marrow Transplantation
Bone Marrow Transplantation Introduction Bone marrow is the spongy tissue inside all of your bones, including your hip and thigh bones. The bone marrow is like a factory that makes different types of blood
More informationSickle Cell Disease. Edward Malters, MD
Sickle Cell Disease Edward Malters, MD Introduction Vaso-occlusive phenomena and hemolysis are the clinical hallmarks of Sickle Cell Disease (SCD) Inherited disorder due to homozygosity for the abnormal
More informationPediatric urinary tract infection. Dr. Nariman Fahmi Pediatrics/2013
Pediatric urinary tract infection Dr. Nariman Fahmi Pediatrics/2013 objectives EPIDEMIOLOGY CAUSATIVE PATHOGENS PATHOGENESIS CATEGORIES OF URINARY TRACT INFECTIONS AND CLINICAL MANIFESTATIONS IN pediatrics
More informationAbstracting Hematopoietic Neoplasms
CASE 1: LYMPHOMA PHYSICAL EXAMINATION 43yo male with a history of lower gastrointestinal bleeding and melena undergoing colonoscopy and biopsy to rule out neoplasm versus inflammation. Patient had no other
More informationCoagulation, Haemostasis and interpretation of Coagulation tests
Coagulation, Haemostasis and interpretation of Coagulation tests Learning Outcomes Indicate the normal ranges for routine clotting screen and explain what each measurement means Recognise how to detect
More informationNURSING DEPARTMENT CRITICAL CARE POLICY MANUAL CRITICAL CARE PROTOCOLS EPTIFIBATIDE (INTEGRILIN) PROTOCOL
NURSING DEPARTMENT CRITICAL CARE POLICY MANUAL CRITICAL CARE S EPTIFIBATIDE (INTEGRILIN) I. PURPOSE: A. Integrilin (Eptifibatide) is a specific and potent inhibitor of the platelet receptor glycoprotein
More informationIndex. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Anemia(s), 412 426 categories in morphologic approach to, macrocytic, 412 414 microcytic, 412 414 normocytic, 412 413 categorizing, 412
More informationIndex. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Abdomen, acute, in oncological surgery patients, critical care issues in, 101 102 Acquired factor VIII inhibitors, in critically ill cancer
More informationSevere β-lactam allergy. Alternative (use for mild-moderate β-lactam allergy) therapy
Recommended Empirical Antibiotic Regimens for MICU Patients Notes: The antibiotic regimens shown are general guidelines and should not replace clinical judgment. Always assess for antibiotic allergies.
More information1. Adequate diet and iron intake to prevent iron deficiency 2. Signs and symptoms of malignant disease
Hematology/Oncology Description: The pediatric hematology-oncology division sees a wide spectrum of pediatric disease including but not limited to leukemia, hemophilia, solid tumors, ITP, and other blood
More informationHemodynamic Disorders, Thrombosis, and Shock. Richard A. McPherson, M.D.
Hemodynamic Disorders, Thrombosis, and Shock Richard A. McPherson, M.D. Edema The accumulation of abnormal amounts of fluid in intercellular spaces of body cavities. Inflammation and release of mediators
More informationBCCA Protocol Summary for Combined Modality Adjuvant Therapy for High Risk Rectal Carcinoma using Capecitabine and Radiation Therapy
BCCA Protocol Summary for Combined Modality Adjuvant Therapy for High Risk Rectal Carcinoma using Capecitabine and Radiation Therapy Protocol Code: Tumour Group: Contact Physician: GIRCRT Gastrointestinal
More informationPackage leaflet: Information for the patient Tranexamic acid 100 mg/ml Solution for Injection tranexamic acid
Package leaflet: Information for the patient Tranexamic acid 100 mg/ml Solution for Injection tranexamic acid Read all of this leaflet carefully before you are given this medicine because it contains important
More information