Z odborné literatury

Vnitr Lek 2005, 51(7-8):918-921  

Sepsa a Československé fórum pre sepsu

M. Bucová

Vnitr Lek 2005, 51(7-8):801  

Úvodní slovo k přednáškám z XXI. Vanýskova dne

M. Penka

Vnitr Lek 2005, 51(7-8):774  

Retrospectives and perspectives of current haematology

M. Penka

Vnitr Lek 2005, 51(7-8):775-780  

Haematology is relatively new branch that has been established as an advanced branch of internal medicine in the beginning of the last century. From the beginning it is characterised by very narrow relationship between clinical and laboratory aspects. Further characteristic feature of haematology is its very deep concentration on research activities and cognition of disease fundamentals in cellular, subcellular and molecular levels and immediate use of these pieces of knowledge in practical medicine. Haematology infiltrates even other branches through important research findings. However this penetration is given by markedly interdisciplinary character...

Primary antithrombotic prevention of venous thrombosis in internal medicine

J. Kvasnička

Vnitr Lek 2005, 51(7-8):781-789  

Two large clinical studies MEDENOX and PREVENT in acute ill medical patients show a consistent 50% reduction in venous thromboembolism (VTE) with low molecular heparin (LMWH) prophylaxis. Therefore, the prophylaxis of VTE with low dose of unfractioned heparin (grade 1 A) or LMWH (grade 1 A) is now recommended to the medical patients who have been admitted to the hospital with congestive heart failure or severe respiratory disease, or who are confined to bed (for more than 72 hours) and have one or more additional risk factors (infection, prior VTE, cancer, thrombophilia etc). But this recommendation is not widely practiced, partly due to the heterogenity...

Anticoagulant treatment of deep vein thrombosis in ambulatory practice

D. Karetová

Vnitr Lek 2005, 51(7-8):790-794  

A classical anticoagulation therapy in acute phases of venous thromboses is especially based on low-molecular weight heparin (LMWH) administration today. Treatment with non-fractionated heparin is indicated only exclusively, in particular in situations where the increased risk of bleeding or the necessity of performing surgery or other intervention is being expected. LMWH administration resulted in general improvement of the care for patients with deep vein thromboses. We reach an efficient therapy in most patients without necessity of laboratory monitoring, only with dosage depending on patient's body weight. Subcutaneous administration 1-times or...

Invasive controlled treatment of deep venous thrombosis

I. Hofírek, M. Penka, S. Šárník, J. Rotnágl, J. Blatný, M. Zvarová, B. Vojtíšek, J. Šmídová

Vnitr Lek 2005, 51(7-8):795-801  

Objective:Targeted administration of thrombolytics via endovascular catheters placement directly to thrombi under the control of duplex sonography is presented in the paper. Patients and Methods:Patients with extensive thrombosis of venous system with the possibility of thrombolysis administration without known contraindications were indicated for interventions. Time duration from distinct clinical manifestations of the disease was 5 to 21 days. Unilateral ileofemoral thromboses were found in 25 cases. Ileofemoral thrombosis with shared thrombosis of vena cava inferior was solved 3-times, in 2 cases in paediatric patients...

Phenotype and genotype analysis of hereditary hypofibrinogenaemia and dysfibrinogenaemia

A. Bátorová, D. Horváthová, P. de Moerloose, M. Neerman-Arbez, M. Mistrík

Vnitr Lek 2005, 51(7-8):802-808  

Inherited fibrinogen disorders, either quantitative (afibrinogenemia, hypofibrinogenemia) or qualitative (dysfibrinogenemia) represent a rare blood coagulation disorders. Clinical manifestation is variable and the bleeding may paradoxically be associated with the thrombotic events. Recently the function of all components of the complex fibrinogen molecule as well as the molecular basis of fibrinogen disorders were defined. Currently the attention is focused upon the relationship between the clinical phenotype and the type of molecular defect with the aim to predict the clinical picture of disease. The phenotype analysis in 67 patients with inherited...

Antiphospholipid syndrome - diagnosis and treatment

A. Buliková, M. Penka

Vnitr Lek 2005, 51(7-8):809-817  

Antiphospoholid syndrome is the most common form of acquired thrombophilia. It can cause significant morbidity and even mortality. Any organ system and any size of vessel can be affected during clinical course of the disease. Therefore, the antiphospholipid syndrome can manifest itself in a wide variety of clinical features. Despite advances in the understanding of the pathogenesis of antiphospholipid antibodies impact on their target structures, the mainstay of management is still anticoagulation. In this review, we focused on diagnostic procedure in patients with antiphospholipid antibodies and we summarised therapeutic approaches.

Thrombophilia

P. Dulíček

Vnitr Lek 2005, 51(7-8):819-825  

Venous thromboembolism is still major medicinal problem. In the last couple of years, the significant progress concerning the etiopathogesis of this disease has been made, which could enable us to explain the cause of many cases of venous thrombosis, mainly with the familiar occurrence. The knowledge of criteria of the indication for thrombophilia work-up and especially pragmatic clinical interpretation of results are very important. These results together with perfect knowledge of family and personal history of venous thrombosis can help us to assess thrombophilic potential of every individual and enable us to choose the correct strategy of thromboprophylax...

Antiaggregant therapy

J. Malý, M. Pecka, P. Dulíček, M. Blažek, L. Smolej

Vnitr Lek 2005, 51(7-8):826-832  

Antiaggregant treatment is suitable for all at risk patients with atherothrombosis and its cardiovascular complications. Antiaggregant treatment decreases severe vascular events in at risk patients, myocardial infarctions, non-fatal strokes, transient ischaemic attacks, unstable angina, obstructive peripheral vascular disease. It decreases a risk of embolism caused by atrial fibrillation and a risk of vascular occlusion in other patients at high risk. Antiaggregant treatment should be administered long-term. The basic antiaggregant drug is acetylsalicylic acid (ASA) which is commonly used in doses of 75-150 mg daily. Acetylsalicylic acid is an effective...

Platelet membrane glycoproteins from the point of view of their genetic changes

J. Gumulec, M. Penka, R. Richterová, M. Brejcha, D. Klodová, M. Wróbel, P. Janotová, K. Klaricová, M. Kneiflová, M. Kučerová, M. Radina

Vnitr Lek 2005, 51(7-8):833-839  

The role of platelets in haemostasis is entirely essential. It starts with platelets' adhesion to a place of vessel damage with following enlargement to the whole area of uncovered subendotelium and continues with secretion of mediators stored in platelets' granules to form big platelets aggregations. Thrombocytes' adhesion is a process initiated by their contact with nonphysiological surfaces. Here, collagen from the extracellular matrix and subendothelium plays a basic role. Interactions between collagen and thrombocytes are mediated by different glycoprotein receptors, implanted in platelets surface, and von Willebrand factor from plasma or subendothelium....

Platelet membrane glycoprotein Ia/IIa in the view of its genetic changes

J. Gumulec, M. Penka, R. Richterová, M. Brejcha, D. Klodová, M. Wróbel, P. Janotová, K. Klaricová, M. Kneiflová, M. Kučerová, M. Radina

Vnitr Lek 2005, 51(7-8):840-844  

Myocardial infarction commonly originates, similarly to an occlusion of other parts of arterial circulation, from a formation of platelet thrombus in the site of atherosclerotic plaque rupture. Both, arteriosclerosis and thrombosis, contribute to the genesis of this type occlusion, though every one of these factors exerts with different significance in different patients. Younger patients with early occurrence of myocardial infarction usually have coronary atherosclerosis less significant and they have higher incidence of normal or almost normal coronarogram. Uniqueness of the role of thrombocytes in a genesis of arterial thrombotic occlusions turns...

Platelet membrane glycoprotein IIb/IIIa in the view of its genetic changes

J. Gumulec, M. Penka, R. Richterová, M. Brejcha, D. Klodová, M. Wróbel, P. Janotová, K. Klaricová, M. Kneiflová, M. Kučerová, M. Radina

Vnitr Lek 2005, 51(7-8):845-853  

Uniqueness of the role of thrombocytes in a genesis of arterial thrombotic occlusions turns the attention to the platelets and platelet glycoproteins, which are involved in the process of platelet thrombus formation. Genetic variants of platelet glycoproteins originating from point mutations of their genes can be associated with increased thrombocyte aggregability (GP IIIa PlA1/PlA2). GP IIIa PlA2 (complex GP IIb/IIIa) variant significantly increases thrombocyte aggregability and mediates smooth muscle cells proliferation changes. Pl(A) polymorphism seems to interfere in the aetiopathogenesis of coronary disease and MI so that men with PlA2 allele...

Thrombocytopenic purpuras

P. Salaj

Vnitr Lek 2005, 51(7-8):854-860  

Thrombocytopenic purpura represents a heterogeneous group of diseases which is characterized by bleeding tendency and a low number of platelets. In general, the risk of bleeding increases with a decreased number of platelets. However, the patient prognosis depends more on the type and cause of disease than on platelet numbers. The detailed differential diagnosis of thrombocytopenia is very important because the reduced number of platelets is only one of the symptoms associated with other diseases. Pathophysiological etiology of thrombocytopenias is characterized by low platelet production, higher platelet destruction in blood stream or sequestration...

Thrombocytosis and thrombocythemia

J. Schwarz, M. Penka

Vnitr Lek 2005, 51(7-8):861-872  

In this review, we recommend the nosological classification of the Ph- myeloproliferative disorders with thrombocythemia (MPD-T) to be performed either according to the WHO or to the Rotterdam criteria, both of which are based on demonstration of specific histopathological features of the respective MPD-T. The most frequent of the primary MPD-Ts is the proliferative, prefibrotic or early fibrotic phase of idiopathic myelofibrosis, but reactive thrombocytoses are even more frequently seen. The differences between the primary MPD-Ts and secondary thrombocytoses are discussed along with the issue of clonality of these disorders and the methodology of...

Antithrombotic therapy in the etiology of an acute posthaemorrhagic anaemia

I. Krč, V. Krčová

Vnitr Lek 2005, 51(7-8):873-877  

In patients, undergoing for various reasons an antithrombotic therapy, severe, life-threatening bleeding can occur, mostly originating in upper parts of the gastrointestinal tract. From the viewpoint of internal medicine, this type of bleeding represents the most important cause of an acute posthaemorrhagic anaemia. Crucial factors influencing the fate of the patient appear to be both the magnitude of blood loss and the time interval from the outset of bleeding to the beginning of effective treatment. Although in approximately 80% of cases a spontaneous improvement of haemorrhagic manifestations can occur in 48 hours, this brings about a high lethality...

Anemia of chronic disease

L. Raida

Vnitr Lek 2005, 51(7-8):878-880  

Anemia of chronic disease may be defined as a hypoproliferative one mediated by the increase of cytokines production because of underlying, usually inflammatory or malignant, disorder. The high levels of some cytokines are particularly produced in such diseases and can negatively influence the proliferation and maturation of erythroid progenitors by the decrease of erythropoietin production, iron mobilisation from the cells of reticuloendothelial system and its final incorporation into the erythroblasts. Red cells surviving is shortened and insufficiently compensated by the hypoprolipherative erythropoiesis, as well. In clinical practice, anemia of...

Autoimmune haemolytic anaemias

J. Čermák

Vnitr Lek 2005, 51(7-8):881-885  

Immune hemolytic anemia results from a dysregulation of cooperation between T- and B-lymphocytes in a process of "self tolerance" of autologous antigens. Antibodies of IgG-subtype lead to the hemolysis at 37 °C which is mainly extravascular, an optimal temperature for hemolysis of IgM subtype antibodies is 4 °C and the hemolysis may have either intravascular or extravascular character. The agent evoking hemolysis is often undetectable, a part of immune hemolytic anemias may occur as a secondary disease in the course of infections, inflammations, autoimmune disorders or tumors. An antiglobulin test represents an essential tool for diagnosis of immune...

Rare forms of hereditary anaemia in the Czech and Slovak populations - β- and δβ-thalassaemia and unstable haemoglobin variants

V. Divoký, S. Walczysková, D. Pospíšilová, M. Priwitzerová, S. Takáčová, I. Kostelecká, M. Divoká, Š. Rožmanová, M. Jarošová, J. Čermák, K. Indrák, Česko-slovenská kooperativní skupina pro diagnostiku hemoglobinopatií

Vnitr Lek 2005, 51(7-8):886-893  

We present a review of the spectrum and frequency of mutations of the β-globin gene in the Czech and Slovak patients with clinical symptoms of β-thalassaemia or δβ-thalassaemia and of Heinz body haemolytic anaemia associated with unstable haemoglobinopathies. In the Czech and Slovak populations, β-thalassaemia appears to be an uncommon disorder, which, however, must be considered as the prevailing cause of congenital hypochromic microcytic anaemia. All β-thalassaemia patients were heterozygous, manifesting thalassaemia minor, with rare exceptions of dominantly inherited β-thalassaemia with phenotype that ranged from...

Assuring reliability of blood count examinations

M. Matýšková, L. Bourková, J. Hoblová

Vnitr Lek 2005, 51(7-8):894-899  

Blood count examination belongs to the basic laboratory examinations. Therefore it is necessary to dedicate sufficient care both from the side of the clinician and of the laboratory staff. Like by other laboratory examinations, including patient's clinical information on the request form, and on accurate interpretation both from the laboratory and clinician. The clinician should have at least a basic knowledge about possibilities of the laboratory; about testimonial value of individual assessments and about possible interferences and cross reactions. The laboratory has to have a well documented control system which includes not only passages about...

Haemotherapy and its safety

E. Tesařová, D. Fabiánová, A. Pejchalová, B. Kubešová

Vnitr Lek 2005, 51(7-8):900-904  

Haemotherapy is characterized as applications of blood products and haemoderivates. Traditionally is haemotherapy associated with risks. Their character and importance changed during the history. Only one initially known immunology risk was associated with an incompatible transfusion in AB0 system administered. This immunology risk was detected shortly after discovery of blood groups in 1901. Infectious risks supported haemotherapy from its birth. In the first instance was detected blood transmission of syphilis. In the seventieth of last century was detected blood transmission of viruses, hepatitis B respectively. In the eightieth and in the nineties...

Post transfusion reactions

B. Kubešová, E. Tesařová

Vnitr Lek 2005, 51(7-8):905-908  

Post transfusion reaction (PTR) is understood as an adverse effect of application of a transfusion product. The risk of some PTRs may be minimalized by the GMP (Good Manufacturing Practice) and by its appropriate processing in the stage of clinical application (blood drawing and identification of the sample, proper fill in of the application formulary, appropriate handling with the product, including the application of the product to the patient). Some of the PTRs may be influenced by preventive means (deleukotization, irradiation), the others may be minimalized only by bearing them in mind with the possibility of starting the diagnostic and therapeutic...

Refractoriness to platelet transfusion

R. Pacasová, E. Tesařová, B. Kubešová

Vnitr Lek 2005, 51(7-8):909-912  

Platelets together with blood vessels and coagulation promote hemostasis. Platelet transfusions are indicated for therapy in patients with actual bleeding and thrombocytopenic manifestations or for prophylaxis against major bleeding of thrombocytopenic or thrombocytopathic patients. Post-transfusion platelet increment is counted as the CCI index. The inadequate platelet increment could signify for non-immune procedural platelet refractoriness bound on the quality of platelet transfusion, non-immune clinical platelet refractoriness caused by increased platelets consumption or immunological platelet refractoriness due to presence of allo-antibodies or,...

Haemovigilance

R. Procházková

Vnitr Lek 2005, 51(7-8):913-917  

Haemovigilance is a system of actions, comprising detection, summary and analysis of information concerning severe adverse effects and events on the part of transfusion donors and recipients and epidemiological monitoring of blood donors. In the complex conception a clinical section, which means transfusion indication criteria, their control, good practice in the course of transfusion administration, is also included in the definition. System of reporting of adverse effects of transfusions, which depends on clinical doctors knowledge and approach, is of a key importance. Superior legislative, procedure standards, operable network connecting state authorities,...