[Main dysproteinemias in aged patients and their effect on hemostasis].
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Heymann nephritis was induced in rats with spontaneous hypertension (group HN), and renal lesions were investigated at the twentieth and thirty-sixth week. An identical group given antihypertensive drugs (group HN-AH), an identical group given anticoagulant drugs (group HN-AC), and a nonimmunized control group of spontaneously hypertensive rats (controls) were also examined. Massive proteinuria, hypoalbuminemia, and hyperlipidemia were present in groups with induced Heymann nephritis (HN, HN-AH, and HN-AC). Coagulation studies demonstrated a shortening of prothrombin time, an increase in serum fibrinogen and thrombocytes, and a reduction of antithrombin III in the groups HN and HN-AH. Necrotizing lesions were observed only in group HN and without further elevation in blood pressure. Intravascular thrombosis was prominent at the twentieth week, and marked fibrinoid necrosis appeared at the thirty-sixth week. These vascular lesions were not observed in the HN-AH, HN-AC, and control groups. Thus, a state of hypercoagulability in addition to high blood pressure probably contributes to the genesis of necrotizing vascular lesions in spontaneously hypertensive rats with nephritis.
Female sex hormones have an influence not only on the reproductive process, but on nearly all organs and functional systems. This explains their broad spectre of side-effects, which by their degree of subjective annoyance may impair the acceptability of hormonal contraception or--through a suggested risk to the patient--even enforce discontinuation of medication. The significance of quite a number of alterations in biochemical and metabolic parameters cannot yet be fully elucidated. The author offers a summary of the principal side-effects of present-day hormonal contraceptives.
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The hemostatic toxicity of low dose L-asparaginase from Erwinia carotovora (Erwinase) has been reported to be negligible in adult patients with acute lymphoblastic leukemia (ALL); conversely, no consistent data have been obtained when Erwinase is administered at intermediate doses. We report preliminary clinical and laboratory hemostatic data from 10 adult patients with ALL treated during induction phase with intermediate doses of Erwinase (20,000 IU/m2s.c. every other day, for a total of six administrations). No thrombotic or hemorrhagic events were registered and the mean values of PT, aPTT, fibrinogen, antithrombin and D-dimer did not change during treatment. Only one patient showed a decrease of antithrombin (48% on day 8) requiring temporary suspension of Erwinase therapy. These data suggest that intermediate doses of Erwinase also have negligible hemostatic toxicity in adult patients with ALL.
Sepsis is noted for producing disruptions in hemostasis. The patient-related risk factors, clinical presentation, and management strategies are dependent upon the presiding disorder. Platelet deficiency and dysfunction, hepatic protein disorders, and disseminated intravascular coagulation are the most common clinical problems. Nursing care focuses on prevention, early recognition, and supportive care for the thrombotic or bleeding patient. An overview of the disorders of hemostasis in sepsis and nursing care of these patients are described in this article.
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Blood rheology was examined in 163 patients with gastric cancer. The 4th stage of the disease was detected in 51 of them. The following changes of blood rheology were found: changes of a blood and plasma viscosity and red blood cells hyperaggregation. These changes lead to hypo- and dysproteinaemia, erythron system disorders, endogenous intoxication, hemostasis disorders which correlated in severity with the disease stage. These patients need correction of rheological disorders.
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