Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi最新文献

{"title":"[Acquired factor Ⅴ inhibitor induced by surgical trauma complicated with fatal hemorrhage: a case report and literature review].","authors":"Y H Zhang, X Pan, X X Chu, W Xu","doi":"10.3760/cma.j.cn121090-20241128-00491","DOIUrl":"10.3760/cma.j.cn121090-20241128-00491","url":null,"abstract":"<p><p><b>Objective:</b> To explore the diagnosis, treatment, and prognosis of patients with acquired factor Ⅴ inhibitors. <b>Methods:</b> We analyzed a case of acquired factor Ⅴ inhibitor treated in the department of critical care medicine at Shanghai East Hospital in 2022. A literature review was conducted using the search terms [ (\"Factor V\" OR \"Factor V Inhibitors\") AND (\"Autoantibodies\" OR \"Immune System Diseases\") ] AND [acquired (Title/Abstract) OR autoimmune (Title/Abstract) OR inhibitor (Title/Abstract) ] in the PubMed database. Chinese databases (Wanfang, VIP, and CNKI) were searched using (acquired factor V inhibitor OR acquired coagulation factor V inhibitor OR coagulation factor V antibody OR coagulation factor V autoantibody) AND (deficiency OR inhibition OR dysfunction) . <b>Results:</b> A 56-year-old male was admitted to the department of critical care medicine due to coagulopathy following surgery. Laboratory tests showed normal blood routine but revealed prolonged PT of 76.7 s, APTT of 83.1 s, and an INR of 7.14. Coagulation factor assays indicated factor V activity at 8.4%, which continued to decline. Immediate and 2-hour delayed mixing studies failed to correct the coagulation abnormalities. The factor V inhibitor titer was measured at 8 BU/ml. It was considered that surgical trauma induced the production of an acquired factor V inhibitor, leading to fatal bleeding. After treatment with corticosteroids, cyclophosphamide, and plasma exchange, the coagulation abnormalities were corrected. The literature search identified 16 cases reported in China and approximately 200 cases reported globally. <b>Conclusion:</b> Patients with acquired factor V inhibitors exhibit diverse clinical manifestations. Current treatment options include combined therapies such as supportive care, corticosteroids, immunosuppressants, and plasma exchange. The prognosis of patients depends on the inducing factors and the timeliness of diagnosis and treatment.</p>","PeriodicalId":24016,"journal":{"name":"Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi","volume":"45 S1","pages":"36-39"},"PeriodicalIF":0.0,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Post-traumatic acquired hemophilia A: a case report and literature review].","authors":"Y Y Xie, M R Yang, M Z Zhang, Z L Deng, L H Wang, J Y Li, J J Zhao, B L Hua, Z Y Yan","doi":"10.3760/cma.j.cn121090-20241223-00581","DOIUrl":"10.3760/cma.j.cn121090-20241223-00581","url":null,"abstract":"<p><p>Acquired Hemophilia A is an acquired bleeding disorder characterized by reduced FⅧ activity due to the presence of autoantibodies against anticoagulant factor Ⅷ in the circulation. Laboratory tests are typically characterized by prolonged isolated activated partial thromboplastin time (APTT). Clinically, it often manifests as severe bleeding, and 50% of AHA patients can identify the cause. This article reports on a patient with post-traumatic AHA who rapidly improved after antibody removal and bypass replacement therapy, followed by wound healing following surgical intervention. A review of relevant literature is also conducted to enhance clinicians' awareness of AHA, which presents with normal coagulation initially and gradually develops into prolonged APTT accompanied by bleeding manifestations, aiming for early diagnosis and timely treatment.</p>","PeriodicalId":24016,"journal":{"name":"Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi","volume":"45 S1","pages":"100-103"},"PeriodicalIF":0.0,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Disseminated intravascular coagulation caused by amniotic fluid embolism: a case report and literature review].","authors":"S F Li, X Xin, J Xiao, W C Ding, J L Wu, S S Wang, S H Chen, L Feng, X G Lin","doi":"10.3760/cma.j.cn121090-20241130-00501","DOIUrl":"10.3760/cma.j.cn121090-20241130-00501","url":null,"abstract":"<p><p>Amniotic fluid embolism (AFE) is a rare but extremely dangerous obstetric catastrophic disease, with coagulation dysfunction being a common clinical manifestation. This article reports a case of AFE with disseminated intravascular coagulation as the initial presentation, and conducts literature review. In order to increase the attention of clinical physicians to obstetric coagulation dysfunction and provide a basis for early identification and treatment of AFE.</p>","PeriodicalId":24016,"journal":{"name":"Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi","volume":"45 S1","pages":"82-84"},"PeriodicalIF":0.0,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Cardiac transplantation for recurrent cardiogenic shock following cardiac surgery: a case report].","authors":"T Yang, H Y Ye, H K Liang","doi":"10.3760/cma.j.cn121090-20241130-00506","DOIUrl":"10.3760/cma.j.cn121090-20241130-00506","url":null,"abstract":"<p><p>Heart failure and cardiogenic shock occurred again on the patient who undergone coronary artery bypass grafting, mechanical mitral valve replacement, and tricuspid valve repair surgery for coronary heart disease, mitral regurgitation, and tricuspid valve regurgitation 2 months ago. His heart function could not recover after Intra-Aortic Balloon Pump (IABP) supported for 1 month, and then Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) was applied. During the VA-ECMO assisted procedure, complex coagulation dysfunction was present, bleeding and thrombosis was coexisting. Treatment with anti-infective drugs, adjustment dosage of anticoagulant and anti-infective drugs, and infusion of blood products, coagulation function was improved. Cardiac transplantation was applied after VA-ECMO support for 10 days. Right heart failure, multiple serosal fluid accumulation (in the chest and abdominal cavities), repeated infections in the lungs and blood flow, liver dysfunction, renal dysfunction, coagulation dysfunction, pneumothorax were occurred successively after cardiac transplantation. The patient recovered and discharged from the hospital after active treatment. The recipient's quality of life is good and the transplanted heart function is basically normal.</p>","PeriodicalId":24016,"journal":{"name":"Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi","volume":"45 S1","pages":"114-116"},"PeriodicalIF":0.0,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Disseminated intravascular coagulation caused by exertional heat stroke: a case report and literature review].","authors":"L Zhang, Z H Zhang, Z Y Sun, X Y Xu, G S Zhou","doi":"10.3760/cma.j.cn121090-20241225-00588","DOIUrl":"10.3760/cma.j.cn121090-20241225-00588","url":null,"abstract":"<p><p><b>Objective:</b> To explore the mechanisms and clinical manifestations of disseminated intravascular coagulation (DIC) caused by exertional heat stroke. <b>Methods:</b> Analyze the clinical data of a patient with exertional heat stroke in Yichang Central People's Hospital and review relevant literature to evaluate the association between heat stroke and DIC, summarizing clinical presentations and laboratory findings. <b>Results:</b> The patient exhibited symptoms such as high fever and altered consciousness after engaging in intense labor in a high-temperature environment. Laboratory tests showed a platelet count of 43×10(9)/L, D-dimer level of 5.3 mg/L, and prothrombin time of 21.8 s, which are consistent with a diagnosis of DIC. Following prompt cooling, fluid resuscitation, appropriate anticoagulant, goal-directed replacement therapy and supportive therapy, the patient's condition gradually improved. <b>Conclusion:</b> Exertional heat stroke can lead to DIC, and clinical attention should be paid to its early recognition and intervention. Effective coagulation management and timely anticoagulant and supportive therapy are crucial for improving prognosis.</p>","PeriodicalId":24016,"journal":{"name":"Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi","volume":"45 S1","pages":"68-72"},"PeriodicalIF":0.0,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Experience in comprehensive treatment of vascular rupture of limbs and traumatic coagulopathy caused by blunt injury].","authors":"X Y Li, L J Xu","doi":"10.3760/cma.j.cn121090-20241225-00589","DOIUrl":"10.3760/cma.j.cn121090-20241225-00589","url":null,"abstract":"<p><p>Vascular injury caused by trauma is not uncommon in clinic, which may lead to traumatic coagulopathy, ischemic necrosis of limbs, amputation or death due to hemorrhagic shock, which is obviously related to adverse outcomes. A 53-year-old male patient with severe impact injury in our department was retrospectively analyzed. Crushing injury resulted in femoral artery disconnection of lower limbs, which led to ischemia and traumatic coagulopathy of lower limbs. A blood transfusion device was used to make a shunt for emergency temporary vascular bypass, during which he experienced coagulation disorder, rhabdomyolysis, osteofascial compartment syndrome and wound infection. By supplementing coagulation substrate, correcting coagulation function, strengthening anti-infection, reducing muscle tension through incision and multiple debridement operations, the diagnosis and treatment process of one limb was preserved. For traumatic vascular injuries, especially blunt injuries, early detection, early intervention and early treatment, and timely adjustment of surgical strategies can avoid limb ischemia and necrosis and reduce adverse outcomes.</p>","PeriodicalId":24016,"journal":{"name":"Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi","volume":"45 S1","pages":"107-109"},"PeriodicalIF":0.0,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Immune thrombotic thrombocytopenic purpura treated with Obinutuzumab: a case report and literature review].","authors":"X T Chen, Y Q Zhao, Q Li, H T Li, D D Li, Q Zhang, J Y Fu, D X Lu, D Y Zhang, S J Fan","doi":"10.3760/cma.j.cn121090-20241123-00474","DOIUrl":"10.3760/cma.j.cn121090-20241123-00474","url":null,"abstract":"<p><p><b>Objective:</b> To explore the safety and efficacy of Obinutuzumab in the treatment of immune thrombotic thrombocytopenic purpura. <b>Methods:</b> Data from a case of immune thrombotic thrombocytopenic purpura (iTTP) admitted to the Department of haematology of the First Affiliated Hospital of Harbin Medical University were evaluated retrospectively and a literature review was performed. <b>Results:</b> A 66-year-old female patient was admitted to our hospital for thrombocytopenia. On admission, physical examination showed that yellow skin and sclera. The patient was fully conscious but had a decreasing ability to calculate. Laboratory examination revealed a platelet count of 7×10(9)/L; liver function: alanine aminotransferase 55.2 U/L, azelaic aminotransferase 117.5 U/L; total bilirubin 142.7 μmol/L, direct bilirubin 64.6 μmol/L, indirect bilirubin 78.1 μmol/L; lactate dehydrogenase: 2362 U/L; creatinine: 260.7 μmol/L; peripheral blood smear showed 4% fragmented erythrocytes; ADAMTS13 activity 2.7% and positive inhibitor (1.12 BU). The patient is treated with plasma exchange and glucocorticoids, but the patient's symptoms worsened. Rituximab was permanently discontinued for severe infusion reactions. Treatment with Obinutuzumab (1000 mg, qw×2 w) and she achieved a complete remission for 18 months. The treatment was well tolerated with no adverse events related to Obinutuzumab. <b>Conclusion:</b> For iTTP patients with rituximab intolerance, obinutuzumab is a safe and effective alternative treatment option.</p>","PeriodicalId":24016,"journal":{"name":"Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi","volume":"45 S1","pages":"53-56"},"PeriodicalIF":0.0,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[BCMA/CS1 bispecific CAR-T cell therapy for multiple myeloma complicated with thrombocytopenia: a case report and literature review].","authors":"P R Li, Y Y Li, M Y Du, H W Jiang, H Mei","doi":"10.3760/cma.j.cn121090-20241202-00524","DOIUrl":"10.3760/cma.j.cn121090-20241202-00524","url":null,"abstract":"<p><p><b>Objective:</b> To investigate the clinical manifestations, diagnostic and therapeutic strategies, for thrombocytopenia after BCMA/CS1 bispecific chimeric antigen receptor T-cell (CAR-T cell) therapy in patients with multiple myeloma. <b>Methods:</b> Retrospective collection and analysis were conducted on the clinical data of a patient with multiple myeloma who received BCMA/CS1 bispecific CAR-T cell therapy in the Hematology Department of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, in June 2021. To review the literature, Chinese databases (CNKI, Wanfang Database) and PubMed were searched from their inception up to November 2024 using the keywords \"chimeric antigen receptor T-cell therapy\", \"thrombocytopenia\", \"CAR-T\", \"BCMA\", and \"CS1\" . <b>Results:</b> A 72-year-old male patient was diagnosed with light chain κ-type multiple myeloma (R-ISS stage Ⅱ) in a local hospital and had a prolonged treatment course with poor disease control despite multiple adjustments of chemotherapy regimens. The patient met the inclusion criteria for the BCMA/CS1 dual-target CAR-T cell clinical trial (NCT04662099) and achieved complete remission two months after receiving a low dose of CAR-T cells. On the 8th day after CAR-T cell infusion, the patient developed grade 3 cytokine release syndrome, followed by severe gastrointestinal bleeding and persistent grade ≥3 thrombocytopenia, accompanied by a significant increase in thrombopoietin levels, with no megakaryocytes observed in bone marrow cytology. After treatment with rituximab, significant improvement was observed with platelet count gradually increased. However, the patient experienced persistent malnutrition and cachexia, and transferred to the gastroenterology department, after which follow-up was lost. A total of 24 relevant English articles and 8 Chinese articles were retrieved from the literature search. <b>Conclusion:</b> CAR-T cell therapy associated thrombocytopenia is characterized by thrombocytopenia and megakaryocyte production disorders. Persistent thrombocytopenia increases the risk of bleeding, and the use of CD20 monoclonal antibodies and supportive therapy can effectively improve thrombocytopenia.</p>","PeriodicalId":24016,"journal":{"name":"Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi","volume":"45 S1","pages":"63-67"},"PeriodicalIF":0.0,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Acute promyelocytic leukemia with disseminated intravascular coagulation: a case report and literature review].","authors":"W J Gu, R F Fu, L Zhang, R C Yang, X F Liu","doi":"10.3760/cma.j.cn121090-20241130-00502","DOIUrl":"10.3760/cma.j.cn121090-20241130-00502","url":null,"abstract":"<p><p>Acute promyelocytic leukemia (APL) is characterized by an aggressive onset and rapid progression. During induction chemotherapy, it is prone to being complicated by disseminated intravascular coagulation (DIC), which is a leading cause of early death in patients. This study reports a case of APL complicated by DIC during induction therapy with all-trans retinoic acid (ATRA) combined with arsenic trioxide (ATO). The patient's coagulopathy was corrected through active transfusion of blood products and replacement therapy with coagulation factors. Subsequently, complete remission was achieved after multiple courses of chemotherapy. This article provides a detailed description of the patient's disease onset and treatment process, exploring the differences in pathogenesis, clinical presentation, and treatment strategies between APL-associated DIC and DIC caused by other diseases, alongside a review of the relevant literature.</p>","PeriodicalId":24016,"journal":{"name":"Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi","volume":"45 S1","pages":"85-88"},"PeriodicalIF":0.0,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Recurrent arterial thrombosis during extracorporeal membrane oxygenation: a case report and literature review].","authors":"J Jin, J Liu, L J Xu","doi":"10.3760/cma.j.cn121090-20241128-00490","DOIUrl":"10.3760/cma.j.cn121090-20241128-00490","url":null,"abstract":"<p><p>Extracorporeal membrane oxygenation (ECMO) is an advanced technology that provides short-term life support for patients with severe cardiopulmonary failure based on the principle of cardiopulmonary bypass. However, various complications such as acute limb ischemia, osteofascial compartment syndrome, hemorrhage and thrombosis can also occur. A retrospective analysis was performed on a 58-year-old Han male patient with acute myocardial infarction complicated with cardiogenic shock in our department. After the conventional treatment failed, he received urgent VA-ECMO treatment. During this period, arterial thrombosis occurred repeatedly, improved after anticoagulant and antithrombotic treatment, and finally died due to infection. Acute limb ischemia caused by arteriovenous thrombosis is one of the possible serious complications during ECMO treatment. Prevention of thrombosis and optimization of anticoagulant and antithrombotic regimen are the main therapeutic measures. Anticoagulation is still the main treatment method for venous thrombosis during ECMO treatment. Anti-thrombotic drugs are not routinely given during ECMO, while anti-thrombotic drugs are the primary treatment for high-risk arterial thrombosis risk patients. Therefore, early detection of complications and timely intervention are crucial. Early intervention or surgical operation can reduce the incidence of ischemia,improve the survival rate and reduce the disabling outcome.</p>","PeriodicalId":24016,"journal":{"name":"Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi","volume":"45 S1","pages":"92-96"},"PeriodicalIF":0.0,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}