Amit Nisal

Abstract

Introduction: Coagulopathy has a high prevalence among critically ill patients and is the result of the derangement of both procoagulant and anticoagulant components of the coagulation system. Liver and renal function tests are some of the most commonly performed blood tests which assess the liver and kidney injury and these are one of the commonest causes of deranged coagulation parameters in these patients. Materials and Methods: This prospective observational study was conducted for two years in Department of Pathology in a tertiary care hospital in university medical college in western India. 219 cases with underlying liver and renal disorders were included in this study. Complete blood counts and coagulation studies including Prothrombin time (PT), Activated Partial Thromboplastin time (APTT), Fibrinogen were done. Statistical analysis was done to evaluate the correlation between various parameters. Results: In our study, hepatic encephalopathy was the commonest cause followed by alcoholic liver disease and liver cirrhosis. Chronic kidney disease was common cause in patients with renal disorders. Deranged Bilirubin levels had a significant statistical association with PT while APTT had a significant association with blood urea levels. Advanced diagnostic and laboratory methods, early recognition of the signs and symptoms of coagulopathy and the complicating factors in liver and renal disorders in these patients is possible today. Conclusion: Liver and renal disorders are one of the important underlying causes for development of coagulopathies in criticially ill patients. Prompt and correct identification of these disorders and associated coagulopathy is important for proper management and improving outcome in these patients. Keywords: Coagulopathy, Prothrombin time, Activated Partial Thromboplastin, Time, Fibrinogen.

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Abstract

Introduction: Hemophagocytic syndrome also known as Hemophagocytic Lymphohistiocytosis (HLH) is a potentially fatal hyperinflammatory condition. It can be primary or a secondary disorder associated with a variety of underlying conditions. These disorders feature severe cytopenias due to uncontrolled hemophagocytosis and clinical symptoms result from disordered immune regulation and cytokine storm. Materials and Methods: The present study was done at the tertiary care centre attached to University Medical College in western India. Forty five patients with cytopenias who were suspected to have secondary HLH were included in this study. Clinical details and routine investigations, tests necessary to diagnose HLH i.e. Ferritin, Triglyceride, LDH, Fibrinogen levels were done. Bone marrow aspirate in these patients showed evidence of hemophagocytosis. Statistical analysis was done using the appropriate software and statistical tests. Results: Infection was the commonest cause associated with secondary HLH in our study. 95.5% patients had anaemia while 42.2% patients had fever along with other clinical manifestations. Elevated Serum Ferritin levels were found in 55.5% patients. 82.1% and 63.0% patients had elevated Lactate Dehydrogenase and elevated triglycerides levels respectively while only 35.6% patients had low fibrinogen levels. Higher levels of ferritin were associated with severe cytopenias and with poor outcome of the patients. PT and APTT were also deranged in a significant proportion of patients. We have also observed raised APTT values correlating with abnormal ferritin levels and cytopenias in our study. This could be because most of these cases were associated with sepsis. We found significant association of elevated serum Ferritin, Triglyceride and LDH levels with HLH. Conclusion: Hemophagocytic syndromes should be considered in unexplained cytopenias. A bone marrow aspiration or organ biopsy revealing hemophagocytosis along with Serum Ferritin, Triglyceride, fibrinogen and LDH levels are helpful to confirm the diagnosis. Overall survival rate of Hemophagocytic syndrome is low without treatment. Early diagnosis and prompt treatment helps in improved outcome. Keywords: Hemophagocytic syndrome, Cytopenias, Ferritin.

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