Many patients with hematologic malignancies develop dangerously low platelet counts due to their disease, their treatment, or both. To mitigate the risk of bleeding, such patients have historically received prophylactic platelet transfusions. Recently, however, the value of this practice has been called into question. Does it really help to give platelets on a preventative basis?… Read More…
In a trial involving patients with cirrhosis and thrombocytopenia, treatment with eltrombopag before invasive procedures reduced the need for platelet transfusions. More thrombotic events of the portal venous system were observed with eltrombopag than with placebo. Thrombocytopenia is frequently observed in patients with chronic liver disease, with studies suggesting that it occurs in up to 76%… Read More…
A 48-year-old man came to the emergency department in early August with a 3-day history of influenza-like symptoms and profound dyspnea on exertion, which had started 3 days after his return to Boston from a vacation in California. Read this latest Clinical Problem-Solving case on NEJM.org. The hantavirus pulmonary syndrome came to national attention in… Read More…
Pharmacologic thromboprophylaxis has been proven to reduce the incidence of venous thromboembolism in both surgical patients and acutely ill medical patients. In surgical patients, thromboprophylaxis has been shown to reduce the incidence of fatal pulmonary embolism and the rate of death from any cause; in medical patients, studies have shown that thromboprophylaxis is associated with… Read More…
In the latest article in our Clinical Therapeutics review series, a young woman with immune thrombocytopenia (ITP) who has been treated with a thrombopoietin-receptor agonist presents for advice regarding long-term treatment. The agents in this therapeutic class, romiplostim and eltrombopag, are effective in increasing platelet counts. Immune thrombocytopenia is a disorder that is characterized by immune-mediated… Read More…
In this week’s Case Record of the Massachusetts General Hospital, a 16-year-old girl with a history of lupus nephritis was seen in the emergency department because of altered mental status. She was somnolent and agitated and had no focal neurologic signs. Brain CT revealed no abnormalities. Laboratory studies revealed anemia and thrombocytopenia. A diagnosis of… Read More…
