Seminars in hematology
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Trauma is a leading cause of death and disability. Hemorrhage is the major mechanism responsible for death during the first 24 hours following trauma. One quarter of severely injured patients present in the emergency room with acute coagulopathy of trauma and shock (ACOT). ⋯ The resuscitation-associated coagulopathy (RAC) is secondary to a combination of acidosis, hypothermia and dilution from intravenous blood and fluid therapy. RAC may further aggravate acidosis and hypoxia resulting in a vicious cycle. This review focuses on the biology of the trauma-associated coagulopathy, and reviews current therapeutic strategies.
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Seminars in hematology · Jul 2013
ReviewThrombocytopenia in the intensive care unit-diagnostic approach and management.
Thrombocytopenia often complicates critical illness and is associated with increased morbidity and mortality. Approaching thrombocytopenia is challenging in the intensive care unit (ICU) because of the multifactorial pathogenesis of this disorder. Interpretation of the platelet count course after ICU admission is helpful to narrow down the cause of thrombocytopenia. ⋯ A rapid decrease in platelet counts of more than 50% within 1-2 days, especially if occurring after an intermittent rise, requires immediate attention as it may be a symptom of immune-mediated mechanisms, eg, heparin-induced thrombocytopenia. Treatment should target the underlying disease. Platelet transfusions are indicated in bleeding patients, while there is no strong evidence supporting the usefulness of prophylactic transfusions in ICU patients.
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Seminars in hematology · Jan 2013
Review Historical ArticleAdvanced and relapsed/refractory Hodgkin lymphoma: what has been achieved during the last 50 years.
During the last 50 years there has been great progress in understanding the biology of Hodgkin disease, which is now called Hodgkin lymphoma (HL), since it has been definitely shown to be a lymphoid neoplasm and its B-cell origin has been documented in the vast majority of cases. Progress in biology has also resulted in the identification of numerous biological prognostic factors, which may facilitate the definition of high-risk groups of patients and provide guidance for individualized therapy. Unfortunately, biological prognostic factors have not been incorporated in prognostic models applicable in everyday practice and need prospective validation. ⋯ Furthermore, better understanding of the biology of HL has permitted the development of targeted therapy. Anti-CD30 targeting with brentuximab vedotin (BV) was the first targeted therapy to be approved for relapsed/refractory HL, either after autologous stem cell transplantation (auto-SCF) failure or after failure of two regimens in patients who were not candidates for transplant. Hopefully, the determination of the optimal role and timing of BV treatment and the development and approval of other targeted compounds will further improve the outcome of advanced stage as well as relapsed/refractory HL.
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Seminars in hematology · Jan 2013
ReviewIndividualized treatment for immune thrombocytopenia: predicting bleeding risk.
Treatment of patients with immune thrombocytopenia (ITP) is often directed at increasing the platelet count and preventing significant hemorrhage even when there is minimal bleeding present. This approach, however, requires that a large number of patients receive prophylactic treatment to prevent major bleeding events. Identification of initial risk factors for development of severe bleeding would allow for more directed and personalized therapy. This review provides a summary of the current literature with the intent to explore various clinical and laboratory risk factors for severe bleeding including mucosal bleeding, platelet count, and aspects of platelet function.
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Seminars in hematology · Jan 2012
ReviewQuality of life, social challenges, and psychosocial support for long-term survivors after allogeneic hematopoietic stem-cell transplantation.
Over the last two decades quality of life (QoL) and the social challenges of allogeneic hematopoietic stem cell transplant (allo-HSCT) survivors have been emerging as subjects of extensive research and are now considered as very important aspects in the pretransplant evaluation and management of allo-HSCT recipients. Recognition of QoL challenges in allo-HSCT survivors allows timely interventions leading to improvement of post-transplant outcomes. It needs to be recognized that long-lasting life changes associated with survivorship after allo-HSCT also significantly affect QoL of partners of allo-HSCT survivors. Currently, resources should be focused on how research findings can be used by patients, their partners, and physicians to optimize QoL and psychosocial adjustment.