Hepatic dysfunction following bone marrow transplantation (BMT) may present complex management issues. The incidence and aetiology of abnormal liver function following allogeneic and autologous BMT was reviewed over a 2 year period in Royal Perth Hospital and these findings were related to management decisions and patient outcome. Abnormal serum liver biochemistry during the first 12 post-transplant months occurred in all allogeneic (n = 31) and 14 of 23 (61%) autologous transplant patients; 13 (41%) allogeneic and three (13%) autologous patients developed severe hepatic dysfunction. In allogeneic transplants, the most common causes of liver disease were graft-versus-host disease (33%), drug hepatotoxicity (19%) and posttransplant viral hepatitis (15%); in autologous patients, disease recurrence (28%) and sepsis (17%) were the most frequent identifiable cause of abnormal liver function. The aetiology of abnormal liver biochemistry was not determined in 13 instances, but this did not adversely affect patient outcome. Percutaneous liver biopsy or endoscopic cholangiography were only required in three patients. Liver disease contributed to death in two allogeneic patients with multiple causes for liver dysfunction, and in one patient with refractory severe hepatic graft-versus-host disease. It was concluded that hepatic dysfunction is common after BMT, the cause of which can be determined in many cases with simple non-invasive tests used in conjunction with the clinical setting. Specific treatment, where necessary, is then able to be commenced in a majority of patients without the need for invasive investigation.

Adolescent↗

PubMedDate not supplied

Thrombocytopenia after brown snake envenomation.

The marked coagulation disturbances in patients after severe envenomation by brown snakes (genus Pseudonaja) were examined with particular emphasis on the sequential platelet counts. The common finding (in almost half the studied patients) of a progressive depletion in platelet numbers leading to thrombocytopenia, which in one case was severe, suggests that thrombocytopenia should be considered as a possible complicating factor in the management of these patients. This trend was not a feature of the cases that involved bites by tiger snakes. The finding of this study in relation to envenomation by brown snakes is in contrast to the widely held opinion that thrombocytopenia is not an outcome of snake-bites in Australia.

Australia↗