losartan-potassium and Disseminated-Intravascular-Coagulation

Topics: Aged; Anemia; Arthritis, Rheumatoid; Disease Progression; Disseminated Intravascular Coagulation; Erythropoietin; Humans; Kidney Failure, Chronic; Male; Recombinant Proteins; Red-Cell Aplasia, Pure; Renal Dialysis

Patients with cancer-related anemia have an inadequate Epo response that is further impaired by cancer treatments such as chemotherapy. Significant number of studies have demonstrated that treatment of anemia in cancer patients using recombinant human EPO(rHuEPO, epoetin alfa) significantly increases hemoglobin(Hb) levels,reduces transfusion requirements,and improves quality of life,particularly by relieving fatigue. However,the findings of several studies have raised the possibility of an adverse effect of thromboembolism. The American Society of Clinical Oncology and the American Society of Hematology developed an evidence-based clinical practice guideline for the use of epoetin in patients with cancer. In cancer patients, the risk of bleeding depends not only on the platelet count, but also on the underlying disease, in accordance with coagulation defects. The cause of thrombocytopenia must be established prior to platelet transfusion since platelet transfusions may be relatively contraindicated in certain conditions e. g., heparin-induced thrombocytopenia(HIT), and thrombotic thrombocytopenic purpura/hemolytic uremic syndrome(TTP/HUS).

Topics: Anemia; Disseminated Intravascular Coagulation; Epoetin Alfa; Erythropoietin; Female; Hematinics; Humans; Male; Neoplasms; Platelet Transfusion; Quality of Life; Recombinant Proteins; Thrombocytopenia

Calciphylaxis occurred in a 40-year old female patient with end-stage renal failure. The patient developed livedo racemosa ("livedo reticularis") with painful skin necrosis and ulcers involving multiple areas of the hip and legs after 22 years of hemodialysis. X-ray-examinations revealed calcinosis of peripheral arteries, especially of the pelvis, thigh and hands, while histological examinations showed a fibrosis and calcinosis of small subcutaneous arteries. A generalized cutaneous microangiopathy could be demonstrated by transcutaneous oxygen pressure measurements. Laboratory data showed a moderate secondary hyperparathyroidism with mild elevation of calcium-phosphate product. In addition to the hemodialysis an attempt was made to improve the microcirculation by vasoactive drugs. The clinical course was characterized by slow healing of the ulcers and occurrence of new areas of cutaneous necrosis. Calciphylaxis is a rare late complication in patients with advanced, often end-stage renal failure. It has characteristic histopathological features and is frequently, but not always, associated with a disturbed calcium and phosphorus metabolism and mildly elevated levels of parathyroid hormone. Calciphylaxis is classified as a special type of metastatic calcinosis.

Topics: Adult; Aluminum Hydroxide; Calciphylaxis; Calcium; Cholecalciferol; Disseminated Intravascular Coagulation; Ergocalciferols; Erythropoietin; Female; Humans; Ischemia; Kidney Failure, Chronic; Long-Term Care; Necrosis; Parathyroid Hormone; Renal Dialysis; Skin Diseases, Vascular

Topics: Acute Kidney Injury; Adult; Anemia; Animals; Blood Platelets; Disseminated Intravascular Coagulation; Erythropoietin; Female; Folic Acid; Hemolysis; Humans; Kidney Diseases; Kidney Failure, Chronic; Kidney Transplantation; Polycythemia; Pre-Eclampsia; Pregnancy; Rabbits; Renal Dialysis; Transplantation, Homologous