The Medical journal of Australia
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Delayed-onset thrombocytopenia developed in 12 patients while they were receiving either prophylactic or therapeutic heparin. Five of the patients had thrombocytopenia alone, and seven had thromboembolic complications which contributed to the death of one patient. These complications included deep venous thrombosis (four patients), pulmonary embolism (three patients), myocardial infarction (one patient), sagittal sinus thrombosis (one patient), and femoral artery occlusion (one patient). ⋯ All patients had heparin-dependent platelet-aggregating factor in their plasma. The characteristics of the heparin-dependent platelet-aggregating reaction were the same in all patients, but the nadir of thrombocytopenia was lower in patients with delayed-onset heparin-induced thrombocytopenia and complicating thromboembolism. These findings highlight the necessity for early recognition of this syndrome and for the prompt withdrawal of heparin to prevent considerable patient morbidity.
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A non-fatal case of acute renal failure with associated coagulopathy after envenomation by a western brown snake (Pseudonaja nuchalis) is described. The coagulopathy did not respond to the initial administration of polyvalent antivenom, but resolved rapidly after later infusion of large doses of specific antivenom. ⋯ Other Australian cases of snakebite associated with renal failure or coagulopathy are reviewed. An adequate dose of the correct antivenom, and infusion of fresh frozen plasma if indicated, is the best treatment of coagulopathy after snakebite.
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We describe here the first case of classical homozygous beta-thalassaemia in a part-Aboriginal child. The child came from Bourke, New South Wales, and is the product of a consanguineous mating. ⋯ From the family studies, we have found that there are now 17 carriers of beta-thalassaemia in the Aboriginal community in northwestern New South Wales, and it is anticipated that more part-Aboriginal children with thalassaemia major will be identified. The presence of numerous carriers of beta-thalassaemia in the Aboriginal population would suggest that care should be taken in the administration of iron for the treatment of anaemias found in Aboriginal children.