American journal of clinical pathology
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Am. J. Clin. Pathol. · Jul 2010
A novel thromboelastographic score to identify overt disseminated intravascular coagulation resulting in a hypocoagulable state.
Thromboelastography (TEM) yields a multitude of data that are complicated to analyze. We evaluated its value in identification of global coagulopathy in overt disseminated intravascular coagulation (DIC). We studied 21 patients, each with International Society for Haemostasis and Thrombosis scores of 5 or more (compatible with overt DIC) and less than 5 (suggestive of nonovert DIC), who underwent whole blood nonadditive TEM. ⋯ Individual TEM parameters correlated variably with conventional tests. Their combination into a cohesive TEM score possibly better captured the multiple hemostatic derangements occurring in DIC. The TEM score may bring objectivity to the analysis of TEM data.
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Am. J. Clin. Pathol. · Jul 2010
Case ReportsAutopsy findings in eight patients with fatal H1N1 influenza.
A novel H1N1 influenza A virus emerged in April 2009, and rapidly reached pandemic proportions. We report a retrospective observational case study of pathologic findings in 8 patients with fatal novel H1N1 infection at the University of Michigan Health Systems (Ann Arbor) compared with 8 age-, sex-, body mass index-, and treatment-matched control subjects. Diffuse alveolar damage (DAD) in acute and organizing phases affected all patients with influenza and was accompanied by acute bronchopneumonia in 6 patients. ⋯ Cytophagocytosis was seen in all influenza-related cases. The autopsy findings in our patients with novel H1N1 influenza resemble other influenza virus infections with the exception of prominent thrombosis and hemophagocytosis. The possibility of hemophagocytic syndrome should be investigated in severely ill patients with H1N1 infection.
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Elevated levels of circulating procoagulants like tissue factor may increase the risk of systemic coagulation activation, thrombin generation, and consumptive coagulopathy. I measured procoagulant activity in plasma by using a clot-based assay that incorporated normal plasma to replace missing factors, corn trypsin inhibitor to block contact activation, factor VIIa to improve sensitivity to tissue factor activity, and anti-tissue factor antibodies to measure tissue factor-specific activity. Procoagulant activity was evaluated in 58 trauma patients. ⋯ In control subjects, tissue factor activity was below the detection limit of the assay. Tissue factor activity was 3- to 4-fold higher in trauma patients with coagulopathy vs patients without coagulopathy (P = .002). Trauma patients with coagulopathy have increased circulating tissue factor activity.
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Am. J. Clin. Pathol. · Jul 2010
Comparative StudyAutomated heart-type fatty acid-binding protein assay for the early diagnosis of acute myocardial infarction.
We compared an automated quantitative heart-type fatty acid-binding protein (H-FABP) assay with other cardiac-marker assays to examine its usefulness as an early diagnostic marker of acute myocardial infarction (AMI). Serum samples for cardiac troponin T (cTnT), creatine kinase-MB isozyme (CK-MB), myoglobin, and H-FABP were obtained from 64 patients with AMI and 53 patients with other conditions (control group). ⋯ Specificities of cTnT, CK-MB, myoglobin, H-FABP (by ELISA), H-FABP (by LTIA), and ECG were 98.1%, 71.7%, 81.1%, 77.4%, 90.6%, and 92.5%, respectively. The automated H-FABP (by LTIA) is superior to cTnT, CK-MB, myoglobin, and H-FABP (by ELISA) tests for the diagnosis of AMI in patients admitted within 4 hours from the onset of chest pain.