Open Access Review Article

Osteoporosis in Hemophilia

E. Carlos Rodriguez-Merchan

International Blood Research & Reviews, Page 48-55
DOI: 10.9734/IBRR/2014/7122

Aim: The aim of this paper is to review the pathophysiology, risk factors, prevention and treatment of osteoporosis in persons with hemophilia (PWH).

Study Design and Methodology: In a search of PubMed up to September 24, 2013 using as keywords "osteoporosis" and "hemophilia" the author found 61 references, of which only the 22 focused on the aim of this study were revised.

Results: Prevention of osteoporosis in PWH is crucial. Risk factors are lack of hematological prophylaxis and development of an inhibitor (antibody) against the deficient coagulation factor, lack of exercise due to chronic pain and loss of joint function (hemophilic arthropathy), low body mass index and abnormal liver function because of viral infection (HIV, HCV). It has not been demonstrated that hemophilia has any effect on osteoclast development and/or osteoblast loss. Hemophilia does not impair mineral Ca/P/K mobilizations and metabolisms. Hemophilia does not have any general effects on the endocrine system. Substitution treatment with clotting factors does not interfere with the treatment of osteoporosis.

Conclusion: Continuous primary hematological prophylaxis and rehabilitation and exercise are paramount in PWH. PWH over the age of 50 should have routine screening for detection of osteoporosis. In PWH prevention should encourage good habits (such as a diet adequate in calcium and vitamin D) and discourage harmful habits (such as tobacco, alcohol and immobilization). Osteoporosis is multi-facial. Osteoporosis ought to be promptly treated regardless of the underlying cause.


Open Access Original Research Article

Type the Characteristics of Pacemaker (PM) Patients Admitted in Stroke Unit: The Stroke Pacemaker Study (SPACES)

M. Spinelli, G. Silvestrelli, S. Micheli, M. Paciaroni, G. Agnelli, A. Lanari, F. Corea

International Blood Research & Reviews, Page 56-68
DOI: 10.9734/IBRR/2014/5693

Aims: According to recent surveys, despite health care authority’s budget reductions, the total amount of PM implants increased worldwide. Even if the diffusion of these devices is large no data are available concerning the characteristics of PM patients hospitalized for stroke.

Study Design: The SPACES study is a retrospective observational study conducted in 3 hospital centres including paced patients consecutively admitted for acute stroke. The objective is to determine the characteristics of patients with PM admitted in the stroke units.

Place and Duration of Study: In 3 Italian general hospital (Perugia, Milano, Mantova), from January 2005 to September 2008.

Method: At admission all patients underwent non-contrast computed tomography (CT), routine biological tests, 12-lead ECG. The ECG was categorized in following subgroups: a) sinus rhythm; b) AF rhythm; c) PM-induced activity (when was not possible to state the underlying rhythm).

Results: In the study population were recorded 73 ischemic strokes, 10 hemorrhagic events and 19 TIA. At the basal ECG a “pacemaker-induced” rhythm was diagnosed in 37 cases, sinus rhythm in 28, AF in 32 subjects. At the univariate analysis patients with an ECG-detected AF rhythm at admission were more often those with positive AF medical history (p<.001) and treated with aspirin prior to the index event (p=.023). Patients with an ECG-detected AF at admission more often suffered a Total Anterior Cerebral Infarction (TACI) subtype of stroke (p=.038) having cardioembolism as cause (p<.001).

Conclusions: Our survey suggests that paced patients suffer more often, than unselected case-series, of ischemic strokes due to cardioembolic events. Moreover AF is the leading risk factor in PM subjects. Probably PM-induced electric activity may further confound the detection of the baseline ECG, with an underestimation of AF.


Open Access Original Research Article

Isolation and Antibiotic Susceptibility Pattern of Bacteria Associated with Blood Stream Infections

Oladejo Peter Ogunlowo, Babatunde David Arimah, James John Olajubutu, Christiana Jesumirhewe

International Blood Research & Reviews, Page 69-81
DOI: 10.9734/IBRR/2014/8033

Aim: To determine the pattern of bacterial agents responsible for blood stream infection and determine the antibiotic susceptibility pattern of the bacterial isolates.

Study Design: Experimental

Place and Duration of Study: blood samples were collected from general out patient clinic of the University College Hospital, Ibadan, Oyo-State, Nigeria between February 2013 July 2010.

Methodology: The study population was drawn from patients attending the General Out patient clinic of the University College Hospital, Ibadan, Oyo-State, Nigeria. Total blood samples of One hundred and fourty (140) were collected from adultsand children. Samples were immediately dispensed into blood culture bottles and incubated at 37ºC for six days. On the bottles were indicated Name, Age, Sex,and Time of collection. The samples were analysed, all the patientshad clinical evidence of varying degree of illness such as ferbrile illiness, sepsis, bilateral discharge, head injury, endocarditis, pyrexia, gastroenteritis, pneumonia, and poorly treated pnuemonia.Those  patients who have been on antibiotics therapy were excluded from the study.

Results: from 140 samples collected, only 100 samples showed turbidityindicating an incidence rate of71.43%. When plated on blood agar, 60 showed microbial growth, 35 samples showed no growth and 5 were contaminated. The difference in prevalence among different sex groups was observed to be significant. The females (77/140, 55%) appeared to be more susceptible to blood stream infection than the males (66/140, 47.1%) in all the age groups. The commonest pathogenic bacteria in blood stream infection was seen to be Staphylococcus aureus having the highest frequency of 58.3%, while Pseudomonas aeruginosa was the least with the frequency of 1.7%. The bacteria harvested were subjected to In-vitro antibiotic susceptibility test using standardized disc agar diffusion methodand showed resistance to one or more of the ten (10) antibiotics used for the study.The lowest resistance of 40% and 60% (36 out of 60) sensitivity was observed in the organisms to Ofloxacin and amoxicillin. Conversely, the highest resistance of 85% (51 out of 60) and 15% (9 out of 60) was observed with Cefuroxime  and Erythromycin. However some of the S. aureus (6) and E.coli (3) strains were multidrug resistance.

Conclusion: The study confirmed the diverse nature of bacteria causing blood stream infection and the increase in drug-resistant pathogens needs to be periodically reviewed for epidemiologically data and clinical prescription.


Open Access Original Research Article

Effect of Momordica charantia (Bitter Melon) Leaves on Haemoglobin Concentration in Male Albino Rats

Adedeji G. Temitope, Ojulari S. Lekan

International Blood Research & Reviews, Page 82-86
DOI: 10.9734/IBRR/2014/8139

This research work was carried out to investigate the effect of the aqueous extract of Momordica charantia on haemoglobin concentration in albino rats. The aqueous extract of Momordica charantia was prepared from the leaves of the Momordica charantia plant and given orally to the experimental animals. Haemoglobin concentration was determined after two weeks of administration. The aqueous extract was prepared and given orally at doses of 80, 100, 120 and 140 mg/kg body weight daily to the experimental animals. This study was carried out at the Department of Physiology, College of Medicine, University of Ilorin between July and August 2010. The results of the work showed that there was significant decrease in mean haemoglobin concentration in test animals in comparison with the control (p<0.05). Oral administration of aqueous extract of Momordica charantia causes a decrease in haemoglobin concentration which can lead to anaemia.


Open Access Original Research Article

Effects of Co-infusion of Plasma, Whole Blood and Anticogulants on Their Clotting Activities

Hiroshi Fujita, Yumiko Ishihama, Shigeko Nishimura

International Blood Research & Reviews, Page 87-94
DOI: 10.9734/IBRR/2014/8146

Aims: Nafamostat mesilate (NM), a protease inhibitor is available for treating acute pancreatitis and disseminated intravascular coagulopathy and it is used as an anticoagulant for hemodialysis in Japan. A plasmapheresis circuit using NM can easily be blockaded. Therefore, we investigated the influence of co-infusion of fresh frozen plasma (FFP), whole blood and NM on clotting activities mainly in the static condition compared with other anticoagulants including heparin sodium and gabexate mesilate.

Study Design:  In vitro study.

Methodology: We investigated the effect of co-incubation of expired FFP and various concentrations of NM (0–0.1mg/mL). We measured the plasma fibrinogen level and activities of factor XIII, anti-thrombin III, protein C (PC) and protein S (PS). In addition, we examined the influence of NM on coagulation tests using whole blood from healthy volunteers.

Results: NM reduced PC and PS activities in FFP, although it did not affect plasma fibrinogen levels or the activities of anti-thrombin III or factor XIII. While anti-thrombin III activity and plasma fibrinogen level increased in NM-containing whole blood, PC and PS activities decreased. Gabexate mesilate, sodium heparin and citrate did not reduce the activities of PC or PS.

Conclusion: Co-infusion of FFP, whole blood and NM reduces PC and PS activities and we speculate that it may lead to the obstruction of the plasmapheresis circuit when using NM as an anticoagulant.