Hypercalcaemic Crisis — A Case Study of Three Unusual Cases of Iatrogenic Vitamin D and Calcium I n t o x i c a t i o n Bhakti Desai*, Anand Gokani**, Alpana Shukla***, PS Tampi**** A b s t r a c t Severe hypercalcaemia is potentially life-threatening complication of several diseases. Most commonly it is caused by cancers that enhance bone resorption. Though rare, Vitamin D intoxi- cat
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Microsoft powerpoint - poster hemofilia adq isth 2009TREATMENT OF ACQUIRED HEMOPHILIA A WITH RECOMBINANT ACTIVATED FVII
M. A. Cermelj, S. Ouviña, A. Guzmán, O. Torres, A. Ferro Centro de Hematología, Trombosis y Análisis Clínicos, CEHTAC, Buenos Aires, Argentina Introduction
Acquired hemophilia A ( acq He A) is a rare condition, and is due Case 1: 7 years old girl with acq He A detected during nephrotic
to the production of autoantibodies in adult life which inactivate FVIII. Typical clinical manifestations of de acquired form are corticosteroids. She presented post-traumatic subscapular haematoma and extensive cutaneous purpura and internal hemorrhage: bleeding multiple ecchymoses. APTT: 138 sec, FVIII < 1%, FVIII inhibitor titre (INH): into the joints is not a prominent feature . Both sexes are affected 59 BU/ml. She was treated with prednisone 2 mg/kg/day orally for 45 days, and there may be identifiable underlying conditions. Diagnosis is but 20 days later she presented post-traumatic retroperitoneal haematoma based on the finding of a low FVIII level associated with the and was treated with 1 g/kg gamma-globulin and corticosteroids during 30 presence of a time-dependent inhibitor in the plasma patient.
days (INH at the end of the treatment: 1793 BU/ml). After that she Treatment of the condition involves the use of an activated presented a bleeding wound in her face, and was treated with activated prothrombin complex concentrate or recombinant activated FVII prothrombin complex concentrates (INH: 1350 BU/ml) with non adequate to control bleeding episodes. In addition, immunosuppression with clinical response. She was treated with prednisone 1 mg/kg/day during 45 steroids is usually effective at reducing inhibitor production and days (INH: 2623 BU/ml). Response test to rFVIIa 90 μg/kg was performed bringing about a sustained rise in the FVIII level. We report two and INH decreased to 107 BU/ml 60 min post infusion. Episodic treatment patients with acq He A with high FVIII inhibitor titre.
with rFVIIa was selected. She only presented minor episodes of bleeding atthe moment.
Material and Methods
Case 2: 68 years old female with low grade stage III lymphoma,
PT measure was performed with Thromborel S, Dade Behring, in previously treated with CHOP schedule, 8 months later she showed a BCT coagulometer, Dade Behring, Marburg, Germany. APTT was performed with Pathromtin SL, Dade Behring, in a BCT compartamental syndrome caused by a tension based haematoma on the forearm with vascular compromise. APTT:130 sec, FVIII<1%, INH: 860 concentration was also determined in the same coagulometer by BU/ml. She received rFVIIa 90 μg/kg each 3 hours during 3 days. INH: 162 coagulometric and chromogenic methods. FVIII inhibitor was determinated through both Bethesda and Chromogenic methods.
Chromogenic method : FVIII is activated by thrombin, the resultingFVIIIa increases the conversion of FX to FXa in the presence of Conclusion:
In both patients rFVIIa provided a safe and effective treatment for bleeding determinated through the hydrolysis of FXa specific sustrate p- episodes, an adequated haemostatic cover and reduced the FVIII inhibitor nitroanilide. The realesed amount of p-nitroanilide measure to 405 nm is proportional to the activity of FXa and then to the FVIIIconcentration in the sample. The patient plasma dilution thatleaves a residual of FVIII activity of 50% has 1 unit of inhibitor ofchromogenic sustrate/ml (CS/ml).
Draft – Zest Quest Outcomes/Grade Level Indicators Outcome 1: By the end of fifth grade, students will describe the effects of the Zest Quest Seven Daily Healthy Habits (ZQSDHH) on wellness and accessing valid resources (content, accessing valid resources). SC Hlth Stds. 1, 2 Grade K: K.1.A: Identify healthy and unhealthy behaviors. K.1.C: Differentiate between active a