Caesarean section in a patient with chronic portal vein thrombosis and thrombocytopenia: Case report

We report the case of a pregnant woman at term with primary anti-phospholipid syndrome, portal vein thrombosis, massive splenomegaly, oesophageal varices and thrombocytopenia. The patient underwent an elective caesarean section under general anaesthesia to minimise the risk of spleen and variceal rupture, with a favourable outcome for both the mother and the newborn. Chronic portal vein thrombosis is a rare condition, caused by various reasons, mainly thrombotic diathesis. It leads to increased portal pressure, with development of collateral circulation, splenomegaly and thrombocytopenia. Pregnancy in these conditions is considered high risk, but is not contraindicated if the underlying disorder is stabilised. The management of these patients should be multidisciplinary, under close monitoring; diagnosis and treatment of possible oesophageal varices is essential. The decision about mode of delivery and anaesthetic management must be individualised, depending on obstetric factors, the presence or absence of varices and thrombocytopenia, and associated comorbidities.
Source: Colombian Journal of Anesthesiology - Category: Anesthesiology Source Type: research

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The objective of the present study was to review the pathophysiology of APS and its association with female infertility. A bibliographic review of articles of the past 20 yearswas performed at the PubMed, Scielo, and Bireme databases. Antiphospholipid antibody syndrome may be associated with primary infertility, interfering with endometrial decidualization and with decreased ovarian reserve. Antiphospholipid antibodies also have direct negative effects on placentation, when they bind to the trophoblast, reducing their capacity for invasion, and proinflammatory effects, such as complement activation and neutrophil recruitme...
Source: Revista Brasileira de Ginecologia e Obstetricia - Category: OBGYN Source Type: research
ConclusionBased on the patient ’s medical history and all the examination results, it was possible to make a diagnosis of primary APS and, starting from diagnosis of thrombocytopenia, we were allowed to conclude that all of manifestation were epi-phenomena of a unique clinical entity, rather than unrelated diseases. Though APS is one of the most common thrombocytophilias, unfortunately, it is not recognized often enough. The lack of prevention in undiagnosed patients may cause severe complications which can in turn result in the death of those patients.
Source: Autoimmunity Highlights - Category: Allergy & Immunology Source Type: research
Paola Adele Lonati1†, Mariangela Scavone2,3†, Maria Gerosa4, Maria Orietta Borghi1,4, Francesca Pregnolato1, Daniele Curreli1, Gianmarco Podda2,3, Eti Alessandra Femia2,3, Wilma Barcellini5, Marco Cattaneo2,3, Francesco Tedesco1 and Pier Luigi Meroni1* 1Immunorheumatology Research Laboratory, Istituto Auxologico Italiano, IRCCS, Milan, Italy2Unità di Medicina II, ASST Santi Paolo e Carlo, Milan, Italy3Dipartimento di Scienze Della Salute, University of Milan, Milan, Italy4Dipartimento di Scienze Cliniche e di Comunità, University of Milan, Milan, Italy5UOC Ematologia, Fondazione IRCCS Ca&#x...
Source: Frontiers in Immunology - Category: Allergy & Immunology Source Type: research
Conclusion: In ischemic stroke or TIA patients with platelet count within normal range, platelet count may be a qualified predictor for long-term recurrent stroke, mortality, and poor functional outcome. Introduction Platelets exert a critical role in the pathogenesis of atherosclerotic complications of cardio-cerebrovascular disease, contributing to thrombus formation, and embolism (1, 2). Previous literature reported that platelets of various size and density are produced by megakaryocytes of different size and stages of maturation in different clinical conditions, suggesting various platelet patterns in differen...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
Purpose of review Although antiphospholipid syndrome (APS) is best known for conveying increased risk of thrombotic events and pregnancy morbidity, thrombocytopenia is also recognized as a common association. In this review, we will explore the relationship between thrombocytopenia and APS, highlighting our evolving understanding – and persistent knowledge gaps – through clinically oriented questions and answers. Recent findings A history of thrombocytopenia likely portends a more severe APS phenotype (including increased risk of thrombosis). Although the pathophysiology underlying thrombocytopenia in APS ...
Source: Current Opinion in Rheumatology - Category: Rheumatology Tags: CLINICAL THERAPEUTICS & HEMATOLOGIC COMPLICATIONS: Edited by W. Joseph McCune Source Type: research
Authors: Darmawan G, Hamijoyo L, Oehadian A, Bandiara R, Amalia L Abstract A 38-year-old woman presented with general weakness and vaginal bleeding. One month prior, she had been diagnosed with Evans syndrome (haemolytic anemia with positive Coombs test and thrombocytopenia) and was given oral steroid as maintenance therapy. Her serology examination was negative for hepatitis B, hepatitis C, and human immunodeficiency virus (HIV). Her obstetrical history was marked by miscarriage in second pregnancy and preeclampsia in third pregnancy. She used hormonal contraceptives until 5 months prior to admission. On physical ...
Source: Acta medica Indonesiana - Category: Internal Medicine Tags: Acta Med Indones Source Type: research
Conclusion:To the best of our knowledge, this is one of the largest congenital TTP cohorts described in the literature. This cohort is unique due to the fact that all members carry the same, previously unreported, ADAMTS13 gene mutation in the CUB1 domain of the gene. Our findings support an assumption that environmental and hereditary modifiers may influence disease course. Further research of the involved families may enable us to expand the understanding of the pathophysiology and develop better treatment options for this understudied rare condition.DisclosuresNo relevant conflicts of interest to declare.
Source: Blood - Category: Hematology Authors: Tags: 311. Disorders of Platelet Number or Function: Poster I Source Type: research
Conclusions: The application of the EtD framework provided a highly structured decision-making process when making clinical recommendations for hematologic conditions. Chairs and co-chairs tend to actively lead the panel discussions, which contributed to framework adherence. The optimal role of chairs and co-chairs versus other panelists need to be further investigated. Future studies should examine how the decision-making process of treatment and interventions for hematologic conditions differ between guidelines panels that use and do not use a structured framework to develop clinical practice recommendations.DisclosuresC...
Source: Blood - Category: Hematology Authors: Tags: 901. Health Services Research-Non-Malignant Conditions: Poster I Source Type: research
BackgroundPatients with immune thrombocytopenia (ITP) may be at increased risk of thromboembolism related to different causes, including the use of thrombopoietin receptor agonists and splenectomy. Patients with ITP who develop coronary artery disease (CAD) can be a further challenge given their risk of both thromboembolism and bleeding, which may significantly increase the risk of mortality and length of stay (LOS) compared to patients who do not have ITP. We aimed to study the impact of ITP in hospital outcomes of patients with CAD.MethodsWe utilized the National Inpatient Sample database from years 2009 - 2011. We selec...
Source: Blood - Category: Hematology Authors: Tags: 903. Outcomes Research-Non-Malignant Hematology Source Type: research
Authors: Yoshida Y, Kato H, Ikeda Y, Nangaku M Abstract Atypical hemolytic uremic syndrome (aHUS) is a type of thrombotic microangiopathy (TMA) defined by thrombocytopenia, microangiopathic hemolytic anemia, and renal failure. aHUS is caused by uncontrolled complement activation in the alternative pathway (AP). A variety of genetic defects in complement-related factors or acquired autoantibodies to the complement regulators have been found in 50 to 60% of all cases. Recently, however, the classification and diagnosis of aHUS are becoming more complicated. One reason for this is that some factors, which have not bee...
Source: Journal of Atherosclerosis and Thrombosis - Category: Cardiology Tags: J Atheroscler Thromb Source Type: research
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