thromboplastin and Anemia

Topics: Adult; Anemia; Blood Transfusion, Autologous; Brain Injuries; Central Nervous System Neoplasms; Cesarean Section; Female; Humans; Intraoperative Period; Leukemia; Male; Neurosurgical Procedures; Plasmacytoma; Pregnancy; Prostatic Hyperplasia; Thromboplastin

The tissue factor (TF)-dependent extrinsic pathway has been suggested to be a central mechanism by which the coagulation cascade is locally activated in the lungs of patients with acute lung injury and acute respiratory distress syndrome (ALI/ARDS) and thus represents an attractive target for therapeutic intervention. This study was designed to determine the pharmacokinetic and safety profiles of ALT-836, an anti-TF antibody, in patients with ALI/ARDS.. This was a prospective, randomized, placebo-controlled, dose-escalation Phase I clinical trial in adult patients who had suspected or proven infection, were receiving mechanical ventilation and had ALI/ARDS (PaO(2)/FiO(2) ≤ 300 mm). Eighteen patients (6 per cohort) were randomized in a 5:1 ratio to receive ALT-836 or placebo, and were treated within 48 hours after meeting screening criteria. Cohorts of patients were administered a single intravenously dose of 0.06, 0.08 or 0.1 mg/kg ALT-836 or placebo. Blood samples were taken for pharmacokinetic and immunogenicity measurements. Safety was assessed by adverse events, vital signs, ECGs, laboratory, coagulation and pulmonary function parameters.. Pharmacokinetic analysis showed a dose dependent exposure to ALT-836 across the infusion range of 0.06 to 0.1 mg/kg. No anti-ALT-836 antibody response was observed in the study population during the trial. No major bleeding episodes were reported in the ALT-836 treated patients. The most frequent adverse events were anemia, observed in both placebo and ALT-836 treated patients, and ALT-836 dose dependent, self-resolved hematuria, which suggested 0.08 mg/kg as an acceptable dose level of ALT-836 in this patient population.. Overall, this study showed that ALT-836 could be safely administered to patients with sepsis-induced ALI/ARDS.. ClinicalTrials.gov: NCT01438853.

Topics: Acute Lung Injury; Adult; Aged; Anemia; Antibodies; Biological Products; Cohort Studies; Female; Hematuria; Humans; Immunoglobulin G; Male; Middle Aged; Prospective Studies; Recombinant Fusion Proteins; Recombinant Proteins; Respiration, Artificial; Respiratory Distress Syndrome; Thromboplastin

Dear Editor, Scurvy is a nutritional disorder which can develop after prolonged (>1-3 months) severe vitamin C deficiency. Vitamin C is a cofactor in several enzyme reactions involved in collagen synthesis. The defect in collagen causes blood vessel fragility, poor wound healing, mucocutaneous bleedings, hair abnormalities, bone pains, and joint contractures due to periosteal and intraarticular bleeding (1,2). Risk factors for scurvy development are undernutrition, low socioeconomic status, older age, male sex, alcoholism, tobacco smoking, and severe psychiatric illnesses (1-3). The required daily intake for vitamin C is ~60 mg, and this amount of vitamin C can be found in only one medium-sized orange. For this reason, the disease is rarely encountered in developed countries and is often underrecognized by healthcare personnel. Herein, we present an illustrative case of scurvy in order to raise the awareness of this disorder. A 61-year-old Caucasian man was admitted to hospital due to fatigue, hypotension (80/50 mmHg), severe normocytic anemia (hemoglobin 76 g/L), kidney failure (estimated glomerular filtration rate of 6 mL/min/1.73m2) and mild elevation in C-reactive protein (30.9 mg/L). Prior medical history included radical cystoprostatectomy with an ileal conduit performed eight years ago due to a bladder tumor and moderate chronic kidney disease with recurrent urinary tract infections. The patient was also an alcoholic and tobacco smoker, with a very low-income and a poor diet. He did not use any medications. Heteroanamnestically, the current clinical state had developed slowly over several weeks. At admission, the patient was afebrile, lethargic, malnourished, and immobile due to generalized weakness, bone pains, and hip and knee contractures. He had generalized edema, mostly related to kidney failure, as well as severe hypoalbuminemia (serum albumin 19 g/L). There were multiple ecchymoses (Figure 1, a) and perifollicular bleedings (Figure 1, b) in the skin. The teeth were defective, and the patient's facial hair had a "corkscrew" appearance (Figure 1, c). The platelet count was normal, as was the serum fibrinogen level and the prothrombin- and activated partial thromboplastin times. Vancomycin-resistant Enterococcus faecium and multi-drug-resistant Acinetobacter baumanii were isolated from the urine. Therefore, hemodialysis, linezolid, and colistin were started. However, the patient continued to be lethargic, immobile, and with prominent skin bleed

Topics: Anemia; Anticoagulants; Ascorbic Acid; Ascorbic Acid Deficiency; C-Reactive Protein; Colistin; Contracture; Fatigue; Fibrinogen; Humans; Linezolid; Male; Middle Aged; Prothrombin; Renal Insufficiency; Scurvy; Serum Albumin; Thromboplastin; Vancomycin; Vitamins

Topics: Anemia; Biomarkers; Blood Proteins; Cardiovascular Diseases; Comorbidity; Endothelium, Vascular; Erythropoietin; Follow-Up Studies; Humans; Injections, Subcutaneous; Kidney Failure, Chronic; Lipoproteins; Recombinant Proteins; Renal Dialysis; Thromboplastin

Topics: Alanine Transaminase; Anemia; Aspartate Aminotransferases; Blood Coagulation Disorders; Blood Coagulation Tests; Blood Platelets; Blood Transfusion; Cerebral Hemorrhage; Ecchymosis; Female; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Male; Prognosis; Prothrombin; Prothrombin Time; Seizures; Spinal Puncture; Subarachnoid Hemorrhage; Thrombin; Thromboplastin; Vitamin K

Topics: Anemia; Anticoagulants; Blood Cell Count; Blood Coagulation Disorders; Blood Coagulation Factors; Blood Platelets; Blood Transfusion; Fibrinogen; Fibrinolysis; Hematologic Diseases; Hemorrhage; Humans; Infant, Newborn; Postoperative Complications; Preoperative Care; Prothrombin; Prothrombin Time; Thromboplastin

Topics: Anemia; Anemia, Hemolytic; Anemia, Hypochromic; Anemia, Pernicious; Blood Coagulation; Blood Proteins; Chloramphenicol; Epidemiology; Epoetin Alfa; Erythropoietin; Haptoglobins; Hematologic Diseases; Hematology; Hemochromatosis; Humans; Iron-Dextran Complex; Leukemia; Polycythemia; Thromboplastin; Vitamin B 12

Topics: Anemia; Exchange Transfusion, Whole Blood; Factor VII Deficiency; Factor VIII; Hemophilia B; Hemorrhagic Disorders; Humans; Hyperbilirubinemia; Hypoprothrombinemias; Infant; Infant, Newborn; Infant, Newborn, Diseases; Prednisone; Scalp; Skull Fractures; Thromboplastin; Vitamin K 1

Topics: Anemia; Blood Coagulation; Blood Coagulation Factors; Blood Coagulation Tests; Blood Platelets; Calcium; Factor IX; Factor V; Factor VII; Factor VIII; Factor X; Factor XI; Factor XII; Fibrinogen; Hemolysis; Humans; Kidney Diseases; Liver Diseases; Prothrombin; Thromboplastin

Topics: Anemia; Anemia, Megaloblastic; Humans; Thromboplastin; Vitamin B 12

Topics: Anemia; Factor XI Deficiency; Hemophilia A; Medicine; Sex Chromosome Disorders; Thromboplastin

Topics: Anemia; Anemia, Pernicious; Thromboplastin; Vitamin B 12