Hematology

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Hematology

Resources for managing hematology patients

13  articles in this collection
Written by Mathias Castonguay, Audrey Mathieu, Philippe Mercier, 

Treating Severe Cases with Convalescent Plasma

According to the experience with other strains of coronavirus, antibodies from convalescent plasma would neutralize the virus. 3,4 Patients who received convalescent plasma transfusion had a clinical improvement as assessed by decreased body temperature, increased PaO2/FiO2, radiologic improvement and lower inflammation blood markers. (Caution: Other treatments (steroid and antiviral treatment) were administered at the same […]

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04/01/2020

Coagulopathy: What We Know So Far

About coagulation and inflammation biochemical parameters: Markedly decreased fibrinogen, high FDP (fibrin degradation product), high D-dimers and increased PT/PTT are observed in COVID-19 non survivors.1,2,3,4,5,6 Rapidly rising FDP may be correlated with disease progression and may be a better surrogate marker than D-dimers.1,4,5 Plasminogen levels tend to be higher in severe disease and may play […]

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05/03/2020

Multiple Myeloma : Management Suggestions

Regarding smoldering multiple myeloma (SMM): Standard-risk patients should be monitored without active intervention, as usual. For high-risk patients, the possibility of enrollment in clinical trials might be limited; consider a conservative approach with close monitoring and observation. Regarding newly diagnosed active multiple myeloma (MM): All patients should be screened for COVID-19 before starting induction therapy. […]

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05/03/2020

Impacts on Patients with Acute Leukemia

Missed or delayed diagnosis In the context of SARS-CoV-2 screening/diagnosis, full blood counts are performed only in a minority of symptomatic patients, as they are generally reserved to those with confirmed SARS-CoV-2 infection with associated signs of severity. The presenting symptoms of hematologic malignancies can be similar to those of COVID-19 infection; in fact, 50-75% […]

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04/17/2020

A Case of Immune Thrombocytopenic Purpura (ITP)

COVID-19 may potentially represent a novel etiology for ITP, although we cannot exclude other causes of thrombocytopenia in this case (e.g. thrombocytopenia related to amoxicillin–clavulanic acid exposure).   A 65-year-old woman with hypertension and autoimmune hypothyroidism was admitted with COVID-19 pneumonia in Strasbourg, France. Laboratory tests performed at admission showed a normal full blood count […]

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04/27/2020

The Attack on Hemoglobin: a Distraction or a Virulence?

This study suggests that structural and transcribed proteins of the virus may attack the β1-chain of hemoglobin leading it to release its porphyrin (just like the heme oxidase)1, 2. It also suggests that the virus can capture the free porphyrin and use it to enter the human cells, rather than only using the ACE2 and […]

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04/07/2020

DIC a Prognostic Factor of Mortality

DIC (Disseminated Intravascular Coagulation) is highly associated with death, as the majority of patients (71%) who died from NCP (novel coronavirus pneumoniae) met the criteria for DIC (with median time of four days after admission) compared to few survivor (0.6% developing DIC). Coagulation parameters (mainly D-dimers) should be done at baseline and followed throughout the […]

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03/27/2020

Does Sickle Cell Disease Need Special Considerations?

About Immunocompetency: Functional hyposplenism in SCD (sickle cell disease) is not reported to increase the risk of viral infection in literature.1 However, infected patients with SCD may be more at risk of severe events. 2,3 About SCD treatments in patients without COVID-19 infection: Currently, no special adjustment of patient’s current medication is suggested4. It is […]

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04/12/2020

Hematologic Parameters and Need of ICU Care

Lymphopenia is frequent1,2 and severe lymphopenia may be useful to identify patients that will need ICU care1,2,3. Patients requiring ICU tend to have higher LDH (lactate dehydrogenase) and higher ANC (absolute neutrophil count)1,2,3. Thrombocytopenia is frequent2,3, but does not seem to correlate the need of ICU care.1,2,3. Hemoglobin, monocyte, prothrombin time, activated partial thromboplastin time […]

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04/01/2020

Lymphopenia as a Classification and Prediction Tool

The LYM% (blood lymphocyte percentage) can be used as a reliable indicator to classify the infection as moderate, severe and critical independently of any other auxiliary indicators. TML (Time-LYM%-model) is a tool of classification and prognosis prediction. TML-1 is defined as the LYM% at day 10-12 after symptom onset and TML-2 is the LYM% at […]

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04/01/2020

Prophylactic Anticoagulation in Sepsis Induced Coagulopathy

LMWH (low molecular weight heparin) at a prophylactic dose may reduce mortality in patient with markedly elevated D-dimers (6 upper limit normal) or  a SIC (sepsis-induced-coagulopathy criteria) ≥4, as 28-day mortality rates were statistically lower for patients meeting these criterias. Higher doses should be considered in patient with a high body mass index.  Rationale of […]

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04/07/2020

G6PD-Deficiency: Risk of Infection and Treatment Related Adverse Events

G6PD (glycose-6-phosphate dehydrogenase) deficiency may be associated with an increase risk of infection to COVID-19.1,2,3 In vitro studies show that G6PD-deficient cells are more vulnerable to coronavirus 229E, which as a lot of similarities with novel coronavirus 2019.1 Viral replication was significantly higher in G6PD-deficient cells2,3, and it is postulated that oxidative stress may explain […]

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04/26/2020

Critical Clinical Presentation : The Cytokine Storm Syndrome

Before COVID-19  Cytokine storm, also known as secondary haemophagocytic lymphohistiocytosis (sHLH), refers to an hyperinflammation state of excessive and uncontrolled release of pro-inflammatory cytokine (interferons, interleukins, chemokines, colony-stimulating factors and tumor necrosis factors) which regulate immune and inflammatory responses sHLH can be caused by a variety of infectious agents, such as Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis, […]

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04/11/2020