European journal of haematology
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The aim of the present work was to summarise in a single paper all the options for prevention of life-threatening infections due to encapsulated bacteria in patients with hyposplenism or asplenia. Prevention of these infections should be obtained in all patients with 1) patient and family education, 2) prophylaxis by means of vaccination against Haemophilus influenzae and Streptococcus pneumoniae, 3) antibiotic prophylaxis, based primarily on penicillin, 4) delay of elective splenectomy or use methods of tissue salvage in splenic trauma. ⋯ Moreover, antibacterial prophylaxis could select antibacterial-resistant pathogens and is highly conditioned by patient's compliance. Therefore, empirical antibacterial therapy of fever and/or suspected infection should be recommended to all splenectomised patients independently from time elapsing from splenectomy, vaccinal status and assumption of antibacterial prophylaxis.
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Skeletal morbidity is a major problem in multiple myeloma. Histomorphometric studies have demonstrated that increased bone resorption can be present even in the absence of radiographic abnormalities. To overcome diagnostic problems in estimating the activity of bone resorption, new laboratory parameters that reflect bone metabolism accurately are urgently needed. ⋯ Urinary NTx showed borderline significance (P = 0.05), and Dpd had no prognostic value in the survival analysis. Our data show that serum ICTP and urinary Dpd levels increase in parallel to advanced disease stages, and gives the first report on a significant difference in the bone resorption parameters ICTP and Dpd between individuals with MGUS and patients with myeloma in stage I. Among the bone resorption parameters studied serum ICTP was found to be the best prognostic factor for survival in multiple myeloma.
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Tranexamic acid (an antifibrinolytic agent) is of proven benefit in the treatment of bleeding in patients with congenital and acquired coagulation disorders. We report the case of a patient with an acquired Factor VIII inhibitor, who was on a prophylactic dose of tranexamic acid because of recurrent bleeding episodes and developed a pulmonary embolism. Although studies using tranexamic acid have not shown a definite increased risk for the development of venous thrombosis, this is the likely cause of the pulmonary embolism in this patient.
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Comparative Study
Haemoglobin concentrations appear to be lower in indigenous Greenlanders than in Danes: assessment of haemoglobin in 234 Greenlanders and in 2804 Danes.
To compare haemoglobin concentrations in Greenlanders and Danes. ⋯ Haemoglobin concentrations in Greenlanders were significantly lower than in Danes both in men (p<0.0001) and in women (p<0.0001). Delta(mean haemoglobin) in men was 8.0 g/L (0.5 mmol/L) and in women 6.2 g/L (0.4 mmol/L). Variations in haemoglobin levels may be due to genetic differences.
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Comparative Study Clinical Trial
Comparison between deferoxamine and deferiprone (L1) in iron-loaded thalassemia patients.
Iron-chelating therapy with deferoxamine in patients with thalassemia major has dramatically improved the prognosis of this disease. However, the limitations of this treatment have stimulated the design of alternative orally active iron chelators. ⋯ L1 had comparable efficacy as deferoxamine with minimal side effects and better compliance. Provided long term side effects are not encountered, L1 seems to be a valuable alternative iron chelator for patients unable or unwilling to use deferoxamine effectively.