A case series: Association of anaphylaxis with a significant decrease in platelet levels and possible secondary risk of thrombosis.

Autor: Peppers BP; Adult and Pediatric ACGME Osteopathic Recognized Allergy and Immunology Fellowship, University Hospitals, Cleveland Medical Center, Cleveland, Ohio., Vatsayan A; Department of Pediatrics, Hematology/Oncology and Bone Marrow Transplant Fellowship Rainbow Babies and Children's Hospital, Cleveland, Ohio., Dalal J; Department of Pediatrics, Hematology/Oncology and Bone Marrow Transplant Fellowship Rainbow Babies and Children's Hospital, Cleveland, Ohio., Bonfield T; Department of Immunology, Case Western Reserve University, Cleveland, Ohio., Tcheurekdjian H; Adult and Pediatric ACGME Osteopathic Recognized Allergy and Immunology Fellowship, University Hospitals, Cleveland Medical Center, Cleveland, Ohio.; Allergy/Immunology Associates, Inc, Mayfield Heights, Ohio., Hostoffer R; Adult and Pediatric ACGME Osteopathic Recognized Allergy and Immunology Fellowship, University Hospitals, Cleveland Medical Center, Cleveland, Ohio.; Allergy/Immunology Associates, Inc, Mayfield Heights, Ohio.
Jazyk: angličtina
Zdroj: Immunity, inflammation and disease [Immun Inflamm Dis] 2018 Sep; Vol. 6 (3), pp. 377-381. Date of Electronic Publication: 2018 Apr 26.
DOI: 10.1002/iid3.224
Abstrakt: Introduction: Anaphylaxis is a life threatening systemic inflammatory process that share mediators involved in the coagulation cascade. Platelet activating factor, known to increase platelet aggregation, has also been implicated as an important mediator of anaphylaxis. Although other inflammatory reactions are associated with an increased risk of thrombosis, anaphylaxis is currently not reported as one of them. Furthermore the role platelets may have in the perianaphylaxis period is not well understood. We here in present a retrospective case series of three patients that had platelet aberrations suggestive of PAF involvement and clinically significant thrombosis in close relationship with anaphylaxis.
Objective: To investigate platelet response before and after anaphylaxis and indirect observation evidence of platelet activating factors involvement with possible increased risk of thrombosis.
Methods: A retrospective investigation into medical records including medication administrations times, laboratory, and radiology results. Platelet levels pre- and post- anaphylaxis were statistically analyzed.
Results: Case 1, a 44 year old man had an anaphylactic reaction shortly after envenomation and subsequently suffered an acute infarction with thrombus in a cerebral artery. Case 2 is a 49 year old man with idiopathic anaphylaxis who developed a deep vein thrombosis after a protracted anaphylaxis event. Case 3 involved an 18 year old female with acute myeloid leukemia was found to have a thrombus in the celiac trunk following anaphylaxis. A paired two-tailed Wilcoxon test on the subjects pre and post anaphylactic platelet levels resulted in a overall P < 0.0001.
Conclusions and Clinical Relevance: These three cases illustrate the potential role platelets may have in anaphylaxis and possible increased secondary risk for the development of thrombosis. Larger studies are required to determine incidence and risk factors for blood clots following anaphylaxis in order to provide management or screening recommendations.
(© 2018 The Authors. Immunity, Inflammation and Disease Published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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