Hematologic changes in cyanotic congenital heart disease: a review

Griesman, Josh; Karahalios, Dean S; Prendergast, Claire

doi:10.1016/j.ppedcard.2020.101193

Cited by 8 publications

(4 citation statements)

References 30 publications

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“…13 Stroke represents 1 of the 10 most frequent causes of mortality in patients aged between 5 and 24. 14 It is imperative to follow evidence-based clinical guidelines such as those published by Ferriero et al 15 however, the existence of this guidelines for the diagnosis and treatment of children with stroke in Mexico and Latin-America is lacking. Systematic clinical research to support the development of guidelines is difficult to conduct because of the relative rarity of stroke in children and the diverse subgroups of patients.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of Pediatric Stroke and Association of Delayed Diagnosis with Mortality in a Mexican Tertiary Care Hospital

Garza-Alatorre

Falcon-Delgado

et al. 2021

Neuropediatrics

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Background and objectives Pediatric cerebrovascular disease carries significant morbidity and mortality. Early recognition of a pediatric stroke as well and its most common risk factors are important, but that diagnosis is often delayed. It is believed that the incidence in our center is higher than it appears. This study aims to assess the incidence and characteristics of the pediatric stroke in our university hospital. Likewise, this study seeks to evaluate if a longer symptoms-to-diagnosis time is associated with mortality in patients with ischemic stroke. Methods A retrospective study including children with stroke admitted to the UANL University Hospital from January 2013 to December 2016. Results A total of 41 patients and 46 stroke episodes were admitted. About 45.7% had an ischemic stroke and 54.3% had a hemorrhagic stroke. A mortality of 24.4% and a morbidity of 60.9% were recorded. Regarding ischemic and hemorrhagic stroke, an increased symptoms-to-diagnosis time and a higher mortality were obtained with a relative risk of 2.667 (95% confidence interval [CI]: 1.09–6.524, p = 0.013) and 8.0 (95% CI: 2.18–29.24, p = < 0.0001), respectively. A continuous increase in the incidence rate, ranging from 4.57 to 13.21 per 1,000 admissions comparing the first period (2013) versus the last period (2016), p = 0.02, was found in our center. Conclusions Pediatric stroke is a rare disease; however, its incidence shows a continuous increase. More awareness toward pediatric stroke is needed.

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Section: Discussionmentioning

confidence: 99%

Characteristics of Pediatric Stroke and Association of Delayed Diagnosis with Mortality in a Mexican Tertiary Care Hospital

Garza-Alatorre

Falcon-Delgado

et al. 2021

Neuropediatrics

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“…However, it appears to be due to the inhibition of megakaryocyte differentiation consequent to chronic hypoxia and right-to-left shunt in the Botallo arterial duct, allowing blood to bypass the pulmonary bed, where megakaryocytes break down into platelets (32)(33)(34). Furthermore, the increased risk of bleeding in these patients is due not only to thrombocytopenia but also to reduced levels of large multimers of vWf (11,32). In addition, bone marrow suppression in sepsis or immune reactions may also determine thrombocytopenia (35).…”

Section: Pre-existing Conditions and Comorbiditiesmentioning

confidence: 99%

Hemostasis in neonatal ECMO

et al. 2022

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Extracorporeal membrane oxygenation (ECMO) is a life-saving support for cardio-respiratory function. Over the last 50 years, the extracorporeal field has faced huge technological progress. However, despite the improvements in technique and materials, coagulation problems are still the main contributor to morbidity and mortality of ECMO patients. Indeed, the incidence and survival rates of the main hemorrhagic and thrombotic complications in neonatal respiratory ECMO are relevant. The main culprit is related to the intrinsic nature of ECMO: the contact phase activation. The exposure of the human blood to the non-endothelial surface triggers a systemic inflammatory response syndrome, which chronically activates the thrombin generation and ultimately leads to coagulative derangements. Pre-existing illness-related hemostatic dysfunction and the peculiarity of the neonatal clotting balance further complicate the picture. Systemic anticoagulation is the management's mainstay, aiming to prevent thrombosis within the circuit and bleeding complications in the patient. Although other agents (i.e., direct thrombin inhibitors) have been recently introduced, unfractionated heparin (UFH) is the standard of care worldwide. Currently, there are multiple tests exploring ECMO-induced coagulopathy. A combination of the parameters mentioned above and the evaluation of the patient's underlying clinical context should be used to provide a goal-directed antithrombotic strategy. However, the ideal algorithm for monitoring anticoagulation is currently unknown, resulting in a large inter-institutional diagnostic variability. In this review, we face the features of the available monitoring tests and approaches, mainly focusing on the role of point-of-care (POC) viscoelastic assays in neonatal ECMO. Current gaps in knowledge and areas that warrant further study will also be addressed.

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“…Adaptation to chronic systemic hypoxaemia can lead to secondary erythrocytosis with a variety of downstream effects. 4 Tetralogy of Fallot with pulmonary artery (ToF-PA) is considered the most extreme form of ToF. 5 In ToF-PA, the aorta is the only vessel arising from the heart, and the pulmonary trunk is absent or atretic.…”

Section: Introductionmentioning

confidence: 99%

“…This causes a variable degree of systemic low oxygen tension and low haemoglobin saturation, often clinically visible as cyanosis. Adaptation to chronic systemic hypoxaemia can lead to secondary erythrocytosis with a variety of downstream effects 4 …”

Section: Introductionmentioning

confidence: 99%

Anaesthesia for non‐cardiac surgery of a dog with tetralogy of Fallot with pulmonary atresia

Ferrari

Kriström²,

Dirven³

et al. 2022

Vet Record Case Reports

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Tetralogy of Fallot with atresia of the pulmonary artery (ToF-PA) is a rare congenital cardiac malformation. The life expectancy of affected canine individuals is short: in fact, only puppies or young adults with ToF-PA are described in literature. Typically, these patients require general anaesthesia for diagnostic procedures, and are considered at high risk for anaesthesia-related complications. The present report describes successful anaesthesia for dental surgery of a 12-year-old dog affected by ToF-PA and an extracardiac shunting vessel connecting aorta and pulmonary artery. The echocardiographic findings are described and the anaesthetic protocol and the complications encountered during anaesthesia are discussed.

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Hematologic changes in cyanotic congenital heart disease: a review

Cited by 8 publications

References 30 publications

Characteristics of Pediatric Stroke and Association of Delayed Diagnosis with Mortality in a Mexican Tertiary Care Hospital

Characteristics of Pediatric Stroke and Association of Delayed Diagnosis with Mortality in a Mexican Tertiary Care Hospital

Hemostasis in neonatal ECMO

Anaesthesia for non‐cardiac surgery of a dog with tetralogy of Fallot with pulmonary atresia

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