International journal of laboratory hematology
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Review Case Reports
Acquired hemophilia: a case report and review of the literature.
Acquired hemophilia A (AHA) is a rare bleeding disorder caused by autoantibodies against clotting factor VIII (FVIII). FVIII autoantibody is characterized as polyclonal immunoglobulin G directed against the FVIII procoagulant activity. This disease occurs most commonly in the elderly population and with preponderance of men in nonpregnancy-related AHA. ⋯ The principles of treatment consist in controlling the bleeding and eradicating the inhibitor. Because of the overall high relapse rate (15-33%), it is also recommended to follow up these patients. The review summarizes what is currently known about the epidemiology, pathogenesis, clinical features, diagnosis, treatment and prognosis of AHA and starts with a case report.
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Comparative Study
Accuracy of noninvasive hemoglobin and invasive point-of-care hemoglobin testing compared with a laboratory analyzer.
Hemoglobin concentration is assessed to detect anemia and its associated morbidities. Hemoglobin is usually determined from venous or capillary blood samples run on a laboratory analyzer. However, this method requires a needle stick and results can be delayed. It also exposes caregivers to risks associated with needle sticks and blood exposure. Noninvasive hemoglobin determination would be of benefit to patients and caregivers because it would allow for quick and painless point-of-care assessment. ⋯ Noninvasive hemoglobin testing with SpHb provided similar accuracy as invasive point-of-care hemoglobin testing and may enable more efficient and effective patient care.
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Although the function of platelets in the maintenance of hemostasis has been studied in great detail, more recent evidence has highlighted a central role for platelets in the host inflammatory and immune responses. Platelets by virtue of their large numbers and their ability to rapidly release a broad spectrum of immunomodulatory cytokines, chemokines, and other mediators act as circulating sentinels. Upon detection of a pathogen, platelets quickly activate and begin to drive the ensuing inflammatory response. ⋯ Platelet-neutrophil interactions are known to induce the release of neutrophil extracellular traps (NETs) in response to either bacterial or viral infection, and platelets have been shown to internalize pathogens, sequestering them in engulfment vacuoles. Finally, emerging data indicate that platelets also participate in the host immune response by directly killing infected cells. This review will highlight the central role platelets play in the initiation and modulation of the host inflammatory and immune responses.
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Emergency hemostasis testing is typically used to determine which blood products are needed to correct hemostatic defects associated with bleeding. Rapid assessment of hemostasis can be performed using standard or viscoelastic hemostasis tests in the clinical laboratory, satellite laboratory, or using point-of-care methods. The major drawback of standard coagulation testing is that most clinical laboratories are focused more on accuracy than on turnaround time. ⋯ Viscoelastic testing is currently the only method that can detect severe fibrinolysis. Platelet function testing is useful for detection of hereditary platelet function problems and some antiplatelet medication monitoring, but is less useful for preoperative bleeding risk assessment or diagnosing the cause of acquire bleeding syndromes. This review will highlight different approaches to the rapid assessment of hemostasis.