This document discusses thrombocytopenia during pregnancy. It lists various potential causes including gestational thrombocytopenia, ITP, preeclampsia, and others. Gestational thrombocytopenia is the most common cause, affecting around 75% of cases. ITP occurs in around 1-2 per 10,000 pregnancies and is diagnosed after ruling out other causes. The document outlines clinical features, pathogenesis, diagnosis, effects on pregnancy, and management approaches for both conditions. It emphasizes that bleeding is unlikely with platelet counts above 50x109/L and risk of neonatal issues is generally low with ITP. Treatment involves corticosteroids, IVIg, or platelet transfusions as needed.
DIC during Pregnancy is the most dreaded complication and matter to clear the concepts is required.
the slides clear and give a better idea about disseminated intravascular coagulation.
hope you find all your answers to queries in these slides.
DIC during Pregnancy is the most dreaded complication and matter to clear the concepts is required.
the slides clear and give a better idea about disseminated intravascular coagulation.
hope you find all your answers to queries in these slides.
Sickle cell anemia is an autosome linked recessive trait that can be transmitted from parents to the offspring when
both the partners are carrier for the gene (or heterozygous). The disease is controlled by a single pair of allele, HbA
and HbS. Out of the three possible genotypes only homozygous individuals for HbS (HbS, HbS) show the diseased phenotype. The ability to predict the clinical course of SCD during pregnancy is difficult. It is mandatory to follow up the patient closely from the very beginning i.e. from preconception to antenatal till labor. SCD is associated with both maternal and fetal complications and is associated with an increased incidence of perinatal mortality, premature
labor, fetal growth restriction and acute painful crises during pregnancy.
Ovarian Hyperstimulation Syndrome(OHSS), is a Rare iatrogenic complication of ovarian stimulation occurring during the luteal phase or during early pregnancy where a patient's ovaries become swollen and fluid builds up around her abdomen
Sickle cell anemia is an autosome linked recessive trait that can be transmitted from parents to the offspring when
both the partners are carrier for the gene (or heterozygous). The disease is controlled by a single pair of allele, HbA
and HbS. Out of the three possible genotypes only homozygous individuals for HbS (HbS, HbS) show the diseased phenotype. The ability to predict the clinical course of SCD during pregnancy is difficult. It is mandatory to follow up the patient closely from the very beginning i.e. from preconception to antenatal till labor. SCD is associated with both maternal and fetal complications and is associated with an increased incidence of perinatal mortality, premature
labor, fetal growth restriction and acute painful crises during pregnancy.
Ovarian Hyperstimulation Syndrome(OHSS), is a Rare iatrogenic complication of ovarian stimulation occurring during the luteal phase or during early pregnancy where a patient's ovaries become swollen and fluid builds up around her abdomen
When your blood has too few platelets, mild
to serious bleeding can occur. Bleeding can occur inside your body (internal
bleeding) or underneath your skin or from the surface of your skin (external
bleeding).
A normal platelet count in adults ranges
from 150,000 to 450,000 platelets per microliter of blood. A platelet count of
less than 150,000 platelets per microliter is lower than normal. If your blood
platelet count falls below normal, you have thrombocytopenia.
However, the risk for serious bleeding
doesn't occur until the count becomes very low—less than 10,000 or 20,000
platelets per microliter. Mild bleeding sometimes occurs when the count is less
than 50,000 platelets per microliter.
Many factors can cause a low platelet
count, such as:
-- The body's bone marrow doesn't make enough
platelets.
-- The bone marrow makes enough platelets, but
the body destroys them or uses them up.
-- The spleen holds on to too many platelets.
The spleen is an organ that normally stores about one-third of the body's
platelets. It also helps your body fight infection and remove unwanted cell
material.
-- A combination of the above factors.
-- How long thrombocytopenia lasts depends on
its cause. It can last from days to years.
The treatment for this condition also
depends on its cause and severity. Mild thrombocytopenia often doesn't require
treatment. If the condition causes or puts you at risk for serious bleeding,
you may need medicines or blood or
platelet transfusions. Rarely, the spleen may need to be removed.
Thrombocytopenia is most frequently encountered Hematological problem in hospitalized patients. The most common causes and differential diagnosis of In-patient and Outpatient presentations of Thrombocytopenia is discussed here. Useful for Internal Medicine Boards . Archer Internal Medicine Board review lectures will be released soon.
Organizations running awards or recognition programs know there's a lot that goes into getting your program ready. In the flurry of prepping their awards program many organizations are looking for a solution to help them manage and streamline the awards process. That's where awards software comes in.
This lecture was prepared as a continuing medical education (CME) activity for the Philippine Obstetrical and Gynecological Society (POGS) Cebu chapter to update maternal health providers regarding the danger of Zika virus infection, particularly during pregnancy. This is a compilation of different literature materials available on the ongoing outbreaks of Zika virus infection in Latin America.
This ppt may help in understanding Rh negative women during pregnancy, labour and postpartum. Great advancements have been made in the detection and management of this condition, and many of our Rh-negative women can now have a happy obstetric career.
Blood transfusion in obstetric haemorrhageWafaa Benjamin
Blood transfusion may be a life-saving procedure but it is not without risk.
Obstetric conditions associated with the need for blood transfusion (whether emergency or not) may lead to morbidity and mortality if not managed correctly.
Adverse events associated with transfusion are increasingly important:
So, strict adherence to correct sampling, cross-match and administration procedures is therefore of paramount importance, even in an emergency.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
2. Causes
1. Spurious result (reduced platelets on automated
Coulter counter {platelet clumping or misreading
of large immature platelets as red cells}
2. Gestational thrombocytopenia
3. Immune thrombocytopenic purpura (ITP)
4. Pre-eclampsia and Haemolysis, Elevated Liver
enzymes and Low Platelets (HELLP) syndrome
5. Disseminated intravascular coagulation (DIC)
Aboubakr Elnashar
3. 6. Haemolytic uraemic syndrome (HUS) /thrombotic
thrombocytopenic purpura (TTP)
7. Sepsis
8. Human immunodeficiency virus (HIV), drugs and
infections (e.g. malaria)
9. Systemic lupus erythematosus (SLE) and
antiphospholipid syndrome (APS)
10. Bone marrow suppression.
Aboubakr Elnashar
4. Incidence
5-10%: of pregnant women
Gestational' thrombocytopenia:75%
Chronic ITP:
1-2/10,000 pregnancies.
usually affects young Women
female to male ratio = 3:1
Aboubakr Elnashar
5. AIloimmune thrombocytopenia
fetal disorder
{fetomaternal incompatibility for platelet antigens
(similar to Rhesus haemolytic disease of the
newborn)}
No maternal symptoms and the mother is not
thrombocytopenic.
The condition develops in utero, affects all children
including the firstborn, but is usually (except in the
case of Subsequent siblings) diagnosed after birth.
Incidence: 1 in 2000
causes 10% of all cases of neonatal
thrombocytopenia.
Aboubakr Elnashar
6. Clinical features
Gestational thrombocytopenia:
Benign condition
platelet count <100 x 109/L: no adverse
consequences for mother or baby.
Thrombocytopenia in the first half of pregnancy:
less likely to be gestational: possible diagnosis of
ITP.
Aboubakr Elnashar
7. ITP
Isolated thrombocytopenia without any associated
haematological abnormality.
No splenomegaly or lymphadenopathy.
Haemorrhage: unlikely with platelet counts >50 x
109/L
Spontaneous haemorrhage without surgery:
unlikely with counts >20 x 109/L.
±skin bruising or gum bleeding
severe haemorrhage: rare.
Aboubakr Elnashar
8. Pathogenesis
Gestational thrombocytopenia
Normal pregnancy: Platelet count fall progressively
5% to 10%: thrombocytopenic levels (50-150 x
109/L) by term.
ITP
Autoantibodies against platelet surface antigens:
peripheral platelet destruction by the
reticuloendothelial system, particularly the spleen.
Aboubakr Elnashar
9. Diagnosis
ITP
By exclusion: other causes (infection and PET)
Bone marrow:
normal or megakaryocytic
not necessary in pregnancy in cases of isolated
thrombocytopenia unless it is severe (platelet count
<30 x 109/L)
Antiplatelet antibody:
not readily available
not helpful {absence of antiplatelet antibodies does
not exclude the diagnosis of ITP.}
Aboubakr Elnashar
10. Effect of pregnancy on ITP
Pregnancy does not affect the course of ITP
Anxieties arise around the time of delivery
{possible bleeding associated with
vaginal and abdominal delivery and
regional anaesthesia and analgesia}.
Aboubakr Elnashar
11. Effect of ITP on pregnancy
Capillary bleeding and purpura:
unlikely with a platelet count of >50 x 109/L
Spontaneous mucous membrane bleeding:
not a risk with platelet counts >20 x 109/L.
Aboubakr Elnashar
12. Antiplatelet IgG can cross the placenta: fetal
thrombocytopenia.
Prediction of the fetal platelet count from
maternal platelet count
antibody level or
splenectomy status: not possible
Fetal platelet counts <50 x 109/L:
5% to 10%
10-15% in:
ITP before pregnancy
symptomatic ITP in the index pregnancy.
Aboubakr Elnashar
13. Antenatal or neonatal intracranial haemorrhage
0% to 1.5%
lowest in the absence of
maternal symptoms or a history of ITP prior to the
index pregnancy.
One of the best predictors of severe neonatal
thrombocytopenia is a previously affected child
Incidence of serious haemorrhage in the fetus and
neonate: low.
Aboubakr Elnashar
15. ITP
Maternal considerations
Exclude associated conditions:
SLE (ANA, double stranded DNA, smith) or
APS.
The platelet count should be monitored
monthly and then more frequently in 3rd T: therapy
can be instituted if required prior to delivery.
Treatment is only required in 1st and 3rd T:
The woman is symptomatic with bleeding
The platelet count is <20 x 109/L
The count needs to be increased prior to a
procedure such as chorionic villous sampling (CVS)
Aboubakr Elnashar
16. Counts:
<50 x 109/L (even in the absence of bleeding):
prophylactic treatment prior to delivery.
50 to 80 x 109 /L
may warrant treatment prior to delivery {facilitate
safe regional analgesia}.
Aboubakr Elnashar
17. CS:
only required for obstetric indications
Epidural and spinal anaesthesia:
safe with stable counts >75 to 80 x 109/L.
Bleeding time does not predict haemorrhage and is
not indicated‘
Aboubakr Elnashar
18. Corticosteroids:
first-line therapy
Prednisolone dose:
Non pregnant:
(60-80 mg/d, 1 mg/kg/d)
Pregnancy:
lower doses (20-30 mg/d): safe and effective.
then dose may be weaned to the lowest that will
maintain a satisfactory (>50 x 109/L) maternal
platelet count
Aboubakr Elnashar
19. IV immunoglobulin (IVIg)
Indication:
resistant cases
women likely to require prolonged therapy
women requiring a high maintenance dose of
prednisolone or
who are intolerant of prednisolone.
Mechanism:
delaying clearance of IgG-coated platelets from the
maternal circulation.
Aboubakr Elnashar
20. Response:
more rapid (24-48 h) than with steroids: useful if a
rapid response is required.
lasts for two to three weeks
Disadvantages:
Expensive
seldom produces long-term remission.
Dose:
0.4 g/kg/ day for five days or 1 g/kg over eight hours,
repeated two days later if there is an inadequate
response.
Aboubakr Elnashar
21. Anti-D immunoglobulin
Indication:
non-splenectomised rhesus-positive women.
Mechanism:
creating a decoy to competitively inhibit the
destruction of antibody-coated platelets: raise platlet
count.
Doses: IV bolus
50 to 70 µg/kg.
Safe and effective in 2nd and 3rd T.
Monitor baby
neonatal jaundice
anaemia, and
direct antiglobulin test positivity after delivery.
Aboubakr Elnashar
22. Splenectomy
should be avoided in pregnancy if possible
May be necessary in extreme cases.
Performed in the second trimester and can at this
stage be performed laparoscopically.
Women with ITP who have previously been treated
with splenectomy should continue penicillin
prophylaxis throughout pregnancy.
Aboubakr Elnashar
23. Other options for women who fail to respond to
oral prednisolone and IVIg
i.v. methylprednisolone
azathioprine or ciclosporin.
danazol and vincristine: Although not recommend
have been successfully used for severe resistant
cases in pregnancy.
Aboubakr Elnashar
24. Platelet transfusions
last resort for bleeding or
prior to surgery
increase antibody titres
do not result in a sustained increase in platelet
counts.
Aboubakr Elnashar
25. Fetal considerations
No place for serial fetal blood samples earlier in
gestation {Transfer of IgG increases at the end of
pregnancy and the baby is not at risk of bleeding
before labour and delivery}
The risk of fetal blood sampling via cordocentesis
(cord spasm, haemorrhage from the cord puncture
site) is similar (or even higher in thrombocytopenic
fetuses) to the risk of intracerebral haemorrhage
(ICH).
Aboubakr Elnashar
26. CS:
only indicated for obstetric reasons.
{no conclusive evidence that SC reduces the
incidence of ICH, or that it is less traumatic for the
fetus than vaginal delivery}
Aboubakr Elnashar
27. Neonatal consideration
Cord platelet count is determined immediately
after delivery
Neonatal platelet count:
only reaches a nadir after two to five days in affected
infants {splenic circulation is established}: most
hemorrhagic events in neonates occur 24-48h after
delivery at the nadir of the platelet count: monitoring
is necessary over this time.
IVIg
the recommended treatment for neonates with
bleeding or severe thrombocytopenia; this may be
given prophylactically if the platelet count of the cord
blood is low «20 x 109 /L).
Aboubakr Elnashar
28. Conclusion
ITP
The diagnosis of ITP is one of exclusion and
should only be made once other causes of
thrombocytopenia have been excluded.
Bleeding is unlikely if the platelet count is >50 x
109/L.
The risk of serious thrombocytopenia and
haemorrhage in the neonate from transplacental
passage of antiplatelet IgG is low.
CS is only required for obstetric indications and
epidural and spinal anaesthesiajanalgesia are safe
with stable counts >75 to 80 x 109/L.
Treatment, if required, should be with
corticosteroids or IVIg). Aboubakr Elnashar
29. History and
Physical
Normal
Repeat
platlet count
normal
- Assume lab error
- No further
workup
1st T platlet count low
Assume ITP
Counsel: risks of neonatal thrombocytopenia
Inform anesthesia and pediatric staff
Ensure no spontaneous bleeding
Ensure platelets >50K at delivery
1st T platlet
count
normal
Assume gestational
thrombocytopenia: no
further work up
Abnormal
Aboubakr Elnashar
30. Abnormal
History of
medications
-Alternative
medication
- Counsel maternal
an fetal risk
Evidence of
systemic
disease
Management depend on type of
illness e.g. self limiting viral
illness or ch rheumatologic dis
Elevated BP
with normal
BP in 1st T
Assume hypertensive
disorder of pregnancy
Management depend on
gest age and s and s of
maternal and f disease
Aboubakr Elnashar