A narrative review of red blood cell distribution width as a marker for pulmonary embolism

AbstractRed blood cell distribution width (RDW) is a marker of variability in red blood cell size, and is routinely reported as part of a patient ’s complete blood count. RDW has been shown to be associated with the prediction, severity and prognosis of pulmonary embolism (PE) in recent studies. The underlying biomolecular mechanism of the relationship of RDW to PE is largely unknown, but is thought to be due to the relationship of RDW with acute inflammatory markers and variations in blood viscosity. This review substantiates that a high RDW level, defined using either an arbitrary number or according to receiver operator curve statistics, is associated with a higher risk of acute PE, increased severity (massive vs. submassive) of PE and increased mortality in patients with PE. Nevertheless, the comparison of current studies is limited due to the definition of high RDW (each study uses a different RDW cutoff level), the broad range of exclusion criteria and the inclusion of differing modalities used to diagnose a PE (computed t omography angiogram, ventilation-perfusion study, or clinical diagnosis). Despite the above limitations, these studies provide a promising future clinical use for RDW as a marker of PE.
Source: Journal of Thrombosis and Thrombolysis - Category: Hematology Source Type: research

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Parang S Sanghavi, Bhavin G JankhariaIndian Journal of Radiology and Imaging 2019 29(3):289-298 In dual-energy CT (DECT), two different x-ray spectra are used to acquire two image datasets of the same region, to allow the analysis of energy-dependent changes in the attenuation of different materials. Each type of material demonstrates a relatively specific change in attenuation between images obtained with a high-energy spectrum and those obtained with a low-energy spectrum. Based on the relatively specific change in attenuation with two different energies, material composition information can be obtained to allow tissue ...
Source: Indian Journal of Radiology and Imaging - Category: Radiology Authors: Source Type: research
Authors: Ammar H, Ohri C, Hajouli S, Kulkarni S, Tefera E, Fouda R, Govindu R Abstract OBJECTIVES: Approximately one in six patients hospitalized with syncope have pulmonary embolism (PE), according to the PE in Syncope Italian Trial study. Subsequent studies using administrative data have reported a PE prevalence of
Source: Southern Medical Journal - Category: General Medicine Tags: South Med J Source Type: research
We report the use of a surgical approach with sternotomy for left ventricle venting in a 21-year-old patient who was placed under veno-arterial extracorporeal membrane oxygenation for refractory cardiac arrest with severe pulmonary edema, respiratory failure, and left ventricle stasis. A 21-year-old woman was admitted for laparoscopic sleeve gastrectomy. In the recovery room, she developed a refractory circulatory shock. Transthoracic echocardiography revealed a dilated cardiomyopathy with severe left ventricle systolic dysfunction (left ventricle ejection fraction at 20%). Coronary angiogram was normal. On day 2, she unde...
Source: Perfusion - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Perfusion Source Type: research
This study had afatal flaw: they did not keep track of all the Non-STEMI patients who were NOT enrolled, but instead were sent for immediate angiogram.  It was done in Europe, where the guidelines suggest taking all shockable arrests emergently to the cath lab.  So it is highly likely that physicians were very reluctant to enroll patients; they did not want them to be randomized to no angiogram.  This strong suspicion is supported by their data:only 22 of 437 (5.0%) patients in this study had OMI.What percent of shockable arrests without STE have an OMI?  This large registry in Circulatio...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
This study had afatal flaw: they did not keep track of all the Non-STEMI patients who were NOT enrolled, but instead were sent for immediate angiogram.  It was done in Europe, where the guidelines suggest taking all shockable arrests emergently to the cath lab.  So it is highly likely that physicians were very reluctant to enroll patients; they did not want them to be randomized to no angiogram.  This strong suspicion is supported by their data:only 22 of 437 (5.0%) patients in this study had OMI. What percent of shockable arrests without STE have an OMI?  This large registry in Circ...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
​BY JENNIFER TUONG; IVAN KHARCHENKO; JEAN LUC AGARD; &AHMED RAZIUDDIN, MDA 65-year-old man who had HIV well-controlled with highly active antiretroviral therapy, hypertension, sciatica, and restless leg syndrome presented to the emergency department with left leg pain. He also had had chemotherapy and radiation for anal cancer. The patient said the pain had started 45 minutes earlier when he was sitting on the toilet.He described the pain as sore in quality and 10/10 on the pain scale. He reported that it had started in his lower back and radiated to his left leg. He said he had had no trauma or weakness to the regio...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research
Conclusions: In this pilot study, we have demonstrated the feasibility and potential utility of V/Q PET/CT for the management of patients with suspected acute PE. V/Q PET/CT may be of particular relevance in cases of equivocal findings or isolated subsegmental findings on CTPA, adding further discriminatory information to allow important decision-making regarding application or withholding of treatment courses of therapeutic anticoagulation, which may confer an increased risk of bleeding. Given the other advantages of V/Q PET/CT (reduced acquisition time, low radiation dose), and with increasing availability of 68Ga-genera...
Source: Journal of Nuclear Medicine - Category: Nuclear Medicine Authors: Tags: Outcomes/Infectious Disease/Pulmonary II Source Type: research
Conclusion: Hybrid SPECT/CT (Q) imaging has a high diagnostic accuracy for detecting PTE than planar (Q) scans interpreted with chest radiographs. In addition, low dose CT used in SPECT/CT was able to identify other non-embolic pathologies (eg: pneumonia, emphysematous bullae, tumor or lymphadenopathy) responsible for perfusion defects which could have been missed on chest radiography thereby increasing the specificity. Modified PIOPED II had a higher number of non-diagnostic results compared to PISAPED which increases the latter's clinical utility.
Source: Journal of Nuclear Medicine - Category: Nuclear Medicine Authors: Tags: Cardiovascular Clinical Science Posters Source Type: research
CONCLUSIONS: RPO is a predictor of recurrent VTE after a first acute PE, mainly when assessed by perfusion lung scan. This article is protected by copyright. All rights reserved. PMID: 31063646 [PubMed - as supplied by publisher]
Source: Thrombosis and Haemostasis - Category: Hematology Authors: Tags: J Thromb Haemost Source Type: research
In conclusion, our survey demonstrates the enhancement of PE-related trainings, especially for physicians in lower-level hospitals, aged ≤ 35 years and from non-respiratory department, can h elp to improve the management of PE in Chinese physicians. And our study also highlights the need for the establishment of national guidelines for the management of PE in China.
Source: Journal of Thrombosis and Thrombolysis - Category: Hematology Source Type: research
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