Oznámení o úmrtí prof. Klementa

Václav Procházka, Jaromír Gumulec, Martin Radina

Vnitr Lek 2010, 56(Suppl 1):123  

Pařízkovy dny 2010

Václav Procházka

Vnitr Lek 2010, 56(Suppl 1):7  

Program konference

Vnitr Lek 2010, 56(Suppl 1):8-9  

The out-patient with a newly diagnosed thrombocytopenia

P. Kessler

Vnitr Lek 2010, 56(Suppl 1):10-13  

Most cases of thrombocytopenia are discovered incidentally in patients with various health problems, which have no bleeding symptoms. Most of them are inconsequential; however, sometimes thrombocytopenia is the first symptom of a serious or life-threatening disease. After the exclusion of pseudo thrombocytopenia, the attention should be focused on the most serious diagnoses, especially on disseminated intravascular coagulation, thrombotic microangiopathy, acute leukemias or heparin induced thrombocytopenia. These disorders should be diagnosed as soon as possible, because the early start of treatment is crucial to patient's survival. After these diseases...

Differential diagnosis of thrombocytopaenia in critically ill patients

J. Gumulec, R. Kula, O. Šimetka, L. Pleva, J. Ullrychová

Vnitr Lek 2010, 56(Suppl 1):14-26  

Many critically ill patients develop hemostatic abnormalities, ranging from isolated thrombocytopenia to complex defects, such as disseminated intravascular coagulation. New onset thrombocytopenia and multiple organ failure predicts poor outcome in critical illness. There are many causes for platelet count decline in critically ill patients and each of these may require specific therapeutic and supportive management. In recent years, new insights into the pathogenesis and clinical management of many hemostatic defects in critically ill patients have been accumulated and this knowledge is helpful in determining the optimal diagnostic and differential...

Thromocytopenia in malignancy. Introduction into the topic: causes, prognostic and therapeutic implications

E. Faber

Vnitr Lek 2010, 56(Suppl 1):27-30  

Incidence of thrombocytopenia in malignancy markedly differ according its pathogenesis. Clinical importance of thrombocytopenia including development of serious bleeding is not directly associated with the number of platelets but frequently with other circumstances or complications. Prognosis of patients with thrombocytopenia caused by marrow metastatic infiltration, disseminated coagulopathy or microangiopathy is generally very serious. The treatment of thrombocytopenia in malignancy should be aimed towards elimination of its cause.

Dysplastic changes in megakaryopoiesis according to WHO classification 2008

A. Buliková, J. Kissová, M. Antošová, L. Antošová, I. Trnavská

Vnitr Lek 2010, 56(Suppl 1):31-38  

Megakaryocytic dysplasia is frequent finding not only in patients with diagnose of myelodysplastic syndromes but also in wide spectrum of the other clinic situations. In this paper authors summarized the possibilities and also limitations of peripheral blood and bone marrow smears evaluation in the process of diagnose of myelodysplastic syndrome. Usual megakaryopoiesis with respect of morphology point of view is also mentioned during introduce of the paper.

Thrombocytopenia in myelodysplastic syndrome

J. Čermák

Vnitr Lek 2010, 56(Suppl 1):39-42  

Thrombocytopenia occurs at the time of diagnosis in approximately 30 % of patients with myelodysplastic syndrome (MDS) and may lead to serious complications in patients with both early and advanced disease. Multilineage dysplasia itself represents an adverse prognostic factor in MDS. A dysregulation of thrombopoiesis resulting in ineffective platelet production and increased apoptotic rate of platelets is the most common reason of thrombocytopenia in MDS patients, an absolute decrease in platelet production represents a less frequent reason of low platelet counts. Treatment approaches to thrombocytopenia include administration of donor platelet concentrates,...

Thrombocytopenia in patients with acute promyelocytic leukemia

Z. Kořístek

Vnitr Lek 2010, 56(Suppl 1):43-45  

Fatal bleeding is still the main cause of early death in patients with acute promyelocytic leukemia (APL). The severe bleeding disorder arises from thrombocytopenia and, obviously, from complex coagulopathy typical for APL. The extend of thrombocytopenia is related to the severity of coagulopathy, and this was the reason why thrombocytopenia was considered when the three risk groups (low, intermediate, high risk) for APL were made by Sanz et al. Contrary to leukocyte concentration in time of diagnosis which increases the probability of relapse, thrombocytopenia mirrors more likely the risk of early death. Risk of bleeding is inversely related to the...

Use of platelet lysate for mesenchymal stem cell cultivation

E. Matějková, V. Foltánková, J. Michálek, B. Kubešová

Vnitr Lek 2010, 56(Suppl 1):46-50  

Mesenchymal stem cells (MSCs) are a heterogeneous subset of stromal stem cells that can be isolated from many adult tissues. They can differentiate into cells of the mesodermal lineage, such as adipocytes, osteocytes and chondrocytes, as well as cells of other embryonic lineages. MSCs can interact with cells of both the innate and adaptive immune systems, leading to the modulation of several effector functions. After in vivo administration, MSCs induce peripheral tolerance and migrate to injured tissues, where they can inhibit the release of pro-inflammatory cytokines and promote the survival of damaged cells. This article recapitulates experimental...

Thrombocytopenia in a newborn

D. Wechsler, T. Jimramovský, Z. Doležel

Vnitr Lek 2010, 56(Suppl 1):51-54  

The article adresses in newborn with thrombocytopenias. It summarizes possible etiology and briefly describes the possibility of categorizing the throbocytopenias in newborns. Diagnostic and therapeutic options are outlined. The article is concluded with a case report on newborn with neonatal alloimmune thrombocytopenia.

Heparin-induced thrombocytopenia in children threated with low-molecular weight heparins. Is there any reason to misgiving?

O. Zapletal, J. Blatný, J. Štarha

Vnitr Lek 2010, 56(Suppl 1):55-57  

Heparin-induced thrombocytopenia (HIT) is relatively common adverse event of the treatment with heparins. Authors review available published data on ethiology, epidemiology, diagnostics, clinical findings and treatment options of HIT in general, but also point out certain specific issues related to HIT in children. We also present a case report of 5-month old infant with primary diagnosis of short bowel syndrome, who developed HIT. We do confirm that HIT is rare complication of heparin treatment in children. Incidence of HIT is smaller when using low molecular weight heparin (LMWH) than unfractioned heparin (UFH). Nevertheless HIT should be always...

Local intravenous fibrinolysis in children and adolescents

I. Hofírek, M. Penka, M. Zvarová, S. Šárník, J. Blatný, O. Zapletal, J. Rotnágl, O. Sochor

Vnitr Lek 2010, 56(Suppl 1):58-63  

The paper provides an evaluation of success factors and fibrinolytic dose regimes in adolescents and children whose deep vein thrombosis was managed with local ultrasound-enhanced fibrinolysis. It discusses factors determining success of fibrinolysis and reviews fibrinolytic dosing as well as plasma levels of the main monitored parameters (D-dimer and fibrinogen). The main risk factors associated with the development of deep vein thrombosis in a series of 15 cases included oral contraception use and the presence of genetic predisposition for thrombophilia. Success of thrombolysis did not depend on the duration of administration or a dose of a fibrinolytic...

Chronic immune thrombocytopenic purpura - successful treatment with anti-CD 20 antibodies

V. Fiamoli, J. Blatný

Vnitr Lek 2010, 56(Suppl 1):64-65  

Immune thrombocytopenic purpura is common bleeding disorder in children characterized by skin and mucous bleeding. There is an isolated thrombocytopenia caused by antithrombotic antibodies. The standard treatment is corticosteroids and intravenous immunoglobulins. The alternative treatment might be anti-CD 20 antibodies. Splenectomy should be considered when treatment mentioned above failed. In adult patients we can use also trombopoetin analogs as a novel approach in the therapy. We describe the case of five-year-old girl sent to our clinic with low platelet count and diffuse bruising. The intravenous immunoglobulins administered did not lead to sufficient...

Thrombocytopenia and coagulopathy in hepatopathy: an introduction into the issue

J. Charvát

Vnitr Lek 2010, 56(Suppl 1):66-69  

The liver is the key organ for blood coagulation processes. The liver has an effect on platelet count and their quality. Additionally, it is the organ where most coagulation and fibrinolytic factors as well as their inhibitors are synthesized. Degradation of activated coagulation and fibrinolytic factors also occurs in the liver. Likewise, endogenous heparin and what is called heparin-like substance may be released from the liver. Patients often do not bleed even in the presence of a substantial deficiency of procoagulation factors as this condition is associated with decreased levels of coagulation inhibitors while, in other cases, they do bleed for...

Monitoring of coagulation parameters and options to influence them in patients with liver cirrhosis prior to invasive procedures

P. Vychodil, E. Kieslichová

Vnitr Lek 2010, 56(Suppl 1):70-73  

For coagulation monitoring in cirrhotic patients it is sufficient to measure PT, aPTT, fibrinogen, platelets and to take history of antiaggregation therapy. In doubt, or in extensive untreatable bleeding, native thrombelastography and modified heparinase I thrombeastography measurement for detection of heparinoid influence is indicated. The most important for adjustment of the coagulation state is platelet concentrate preparation for thrombocytopenic patients and correction of PT close before procedure, or in the beginning of procedure if possible.

Immune thrombocytopaenia, diagnosis, classification, differential diagnosis

L. Červinek

Vnitr Lek 2010, 56(Suppl 1):75-77  

Immune thrombocytopaenia (ITP) is classified among autoimmune disease. Recently, new recommendations regarding standardization of terminology, diagnostic investigations and treatment modalities have been issued. Detailed history, physical assessment and manual blood count are the main pillars of ITP diagnosis. To exclude secondary immune thrombocytopaenia, the diagnostics should, in selected groups of patients, include serologic determination of infections or of autoimmune or lymphoproliferative diseases.

Treatment of thrombocytopaenia in gravidity

A. Hluší, J. Procházková, V. Krčová, K. Indrák

Vnitr Lek 2010, 56(Suppl 1):78-80  

Immune thrombocytopaenia (ITP) is an acquired, immune disease characterized by a decrease in blood platelet count. The most frequent cause of thrombocyte deficiency in gravidity is benign gestational thrombocytopaenia, ITP is relatively rare. An optimal management of a pregnant patient with ITP involves good interdisciplinary collaboration between a haematologist, gynaecologist, anaesthesiologist and neonatologist. Depending on thrombocyte count, rigorous haematological follow-up is required. Pharmacological treatment is indicated in only a small proportion of patients and mainly involves administration of corticosteroids and immunoglonulines. After...

Thrombocytopenia in patients with proved antiphospholipid antibodies or with antiphospholipid syndrome

A. Buliková, D. Haruštiaková, J. Zavřelová, L. Dušek, M. Penka

Vnitr Lek 2010, 56(Suppl 1):81-90  

Thrombocytopenia in patients with antiphospholipid antibodies (APA) is relative common finding which is found in approximately 20-40% of cases. There are likely different mechanisms resulting in thrombocytopenia in these situations. Authors summarise current knowledge of pathophysiology, clinical manifestations and management of APA-associated thrombocytopenia and other causes of decreased value of peripheral blood platelets in APA positive persons.

Differential diagnosis of thrombocytopaenia in pregnancy

J. Gumulec, O. Šimetka, M. Procházka, J. Ullrychová

Vnitr Lek 2010, 56(Suppl 1):91-97  

The recognition of thrombocytopenia is quite common in pregnancy, occurring in nearly 10 % of pregnant women. An unusual aspect of most of these events is that the majority are physiological. This, so called gestational thrombocytopenia must be differentiated from the less common, but clinically significant occurrence of a pathological mechanism for the platelet count decline. Such events are commonly associated with evident clinical features and are potentially serious issues in the maintenance of pregnancy and the health of the mother. In these cases the accurate diagnosis must be made very quickly. Moreover, uterine evacuation is indicated in the...

The HELLP syndrome - its course and endothelial activation markers activity

O. Šimetka, J. Procházková, J. Gumulec, I. Michalec, H. Zewdiová, R. Kolářová, M. Procházka

Vnitr Lek 2010, 56(Suppl 1):98-103  

Aims of the study:Analysis of the course of pregnancy and its outcomes in patients with confirmed HELLP syndrome and comparison with published literature. An analysis of endothelial activation markers in patients with HELLP syndrome and their comparison with values found in physiological pregnancies. Study design:Prospective cohort study. Study aim and methods:We followed up 34 pregnancies complicated with the HELLP syndrome in women who gave birth at the Perinatology Centre Ostrava between 2004 and 2009. We performed analyses of endothelial activation markers using ELISA, immunoturbidimetry, ELISA with fluorogenic...

The strategy of laboratory diagnostics and differential diagnostics of thrombocytopenia

M. Kušnierová, P. Kessler

Vnitr Lek 2010, 56(Suppl 1):104-108  

Thrombocytopenia is a pathological state characterized by decreased platelet count under the lower limit of the physiological range, i.e. 150 × 10⁹ per liter. This disorder can be associated with clinical manifestation of the hemorrhagic diathesis. The risk of bleeding is closely associated with the depth of platelets count decrease. Spontaneous bleeding (in absence of any other coagulation disorder) usually occurs when the platelet count decreases below 20 × 10⁹ per liter. The first step, which should be done, when a newly diagnosed thrombocytopenia occurs, is a thorough review of a blood smear. Firstly, it is necessary to exclude...

The application of IPF (Immature platelet fraction) in laboratory diagnostics

M. Ryzí, J. Gumulec

Vnitr Lek 2010, 56(Suppl 1):109-111  

Young platelets - reticulated platelets - are a marker of the thromopoiesis. The determination of reticulated platelets can be used to a laboratory diagnosis of thrombocytopenias and to the monitoring of a platelet kinetics after the chemotherapy and after bone marrow transplantation. Reticulated platelets have been measured by flow cytometry. This determination has been expensive, time spending and it has been never standardise. Now it is possible to measure young platelets as a part of the full blood count by the haematological analyser Sysmex XE-5 000. Reticulated platelets are named as IPF (Immature platelet fraction) in this analyser.

Microparticles

L. Slavík, J. Úlehlová, A. Hluší, J. Procházková, M. Procházka, V. Krčová, K. Indrák

Vnitr Lek 2010, 56(Suppl 1):112-116  

Microparticles (MPs) are particles sized 0.05-1 mm. Their composition varies considerably depending on their origin. On their surface, however, glycoproteins are always found, that are also expressed on the cell surface. This characteristic is used for their detection using monoclonal antibodies. MPs are released as fragments from the plasma membrane of practically all types of eukaryotic cells, either after their stimulation or during apoptosis. MPs may also be formed in the process of cellular tissue damage. Thus, MP formation may represent a wide response to common stimuli in processes such as cellular stress. Endothelial damage and membrane disruption...

Flow cytometry in analysis of platelets

L. Kovářová

Vnitr Lek 2010, 56(Suppl 1):117-119  

Flow cytometry is a modern screening method used for cell analysis in many clinical and research laboratories. In the study of biology and functional status of platelets are its applications: 1. detection of inherited and acquired platelets defects; 2. platelets activation in vivo; 3. applications in blood transfusion; 4. platelet turnover studies. Each of these applications has its advantages and drawbacks. The aim of this paper is to summarize and explain basic applications of flow cytometry and its use in analysis of platelets.

Changes of the laboratory indicators of hemostasis in hepatopathy

R. Hrabcová, P. Kessler, J. Gumulec, M. Kouri

Vnitr Lek 2010, 56(Suppl 1):120-122  

The liver has a central role in hemostasis. It is the major site of synthesis of the coagulation factors, inhibitors and components of fibrinolytic system. The liver also functions as a site for clearance of their activated forms from the circulation. Liver disease leads to a shift in the delicately controlled hemostatic system in both primary and secondary hemostasis.

XVI. Pařízkovy dny. Ostrava-Poruba, 25.-26. březen 2010. Sborník abstrakt

Vnitr Lek 2010, 56(Suppl 1):125-127