Search PubMed⌕ Search

Biomedical subjects

T Baglin

Publications and source records attributed to T Baglin.

49 records · Page 3Linked to original sources
PubMed1997

Reliability of delayed INR determination: implications for decentralized anticoagulant care with off-site blood sampling.

In order to develop decentralized anticoagulant care by off-site blood sampling and transport of samples to a centralized laboratory for International Normalized Ratio (INR) determination we have performed a direct comparative study of INR stability. Analysis was performed daily for 5 d using nine thromboplastins. The overall mean difference of INR after 3d was only 0.05 INR units for samples with a therapeutic INR. After 5 d there was a mean difference of 0.11 INR units with 'non-Manchester' reagents and 0.44 INR units with 'Manchester' reagents. With over-anticoagulated samples mean differences of 0.55-0.72 INR units were observed after 3 d and 1.16-2.46 INR units after 5 d. Although there was some variation in stability of results with different thromboplastins, the difference over time with each thromboplastin was much less than the difference between thromboplastins. In conclusion, there is no clinically significant change in INR when analysis is delayed for up to 3 d. Off-site blood sampling can accommodate a large increase in patient workload without a major revenue increase in primary care and with continued total quality management and central expert advice.

Blood Coagulation Disorders↗
PubMed1996

Effect of platelet phospholipid exposure on activated protein C resistance: implications for thrombophilia screening.

The effect of platelet contamination and freeze-thawing on the activated protein C sensitivity ratio (APCsr) was determined. With increasing platelet count there was a progressive reduction in the ratio. Filtration of samples through a 0.2 microm filter before or after freeze-thawing abolished the development of resistance to the addition of activated protein C indicating that the phenomenon is due to the presence of a particulate factor. Contamination of normal plasma with platelets from a patient with homozygous factor V (FV) deficiency was also associated with the same development of resistance to activated protein C, indicating that the phenomenon was not due to exposure of platelet-derived factor V that might be inaccessible to APC. 82% (96/117) of FVQ506 and 32% (138/430) of FVR506 individuals had APC resistance on analysis of unfiltered plasma. However, 85% (42/50) of FVQ506 individuals had APC resistance on analysis of filtered plasma, whilst only 1/50 FV R506 individuals had APC resistance after filtration. For the purpose of identifying individuals at increased risk of venous thromboembolism due to the presence of the FVQ506 and associated APC resistance a PCR-based genotypic analysis is recommended.

Base Sequence↗
PubMed1996

Unresolved issues in the prevention of venous thromboembolism.

Venous thromboembolism is a potentially fatal complication of surgery. The use of graded pressure stockings in combination with unfractionated heparin (UFH) or a low molecular weight heparin (LMWH) appears to be the safest and most effective method of prevention. With some LMWHs, the risk of venous thromboembolism appears to be lower than that associated with the use of standard UFH. A comparison of heparin given before versus after surgery (with all patients receiving graded pressure stockings) is justified. More information on the benefit-risk ratio of minidose warfarin is also required. The risk of pulmonary embolism (PE) following discharge from hospital after general surgery is relatively low and the extended use of heparin may not be justified. The value of graded pressure stockings and minidose warfarin for the prevention of PE should be determined. The risk of late PE after orthopaedic surgery is unknown and also needs to be determined.

Anticoagulants↗
PubMed1995

Altered platelet phospholipid-dependent thrombin generation in thrombocytopenia and thrombocytosis.

Platelet phospholipid dependent thrombin generation was determined in 20 patients with thrombocytosis, 18 with thrombocytopenia, and 25 normal controls, using a quantitative chromogenic assay. Platelets from patients with myeloproliferative disorders displayed normal lag times to 20 nM thrombin concentration but increased thrombin potentials, even when corrected for platelet size. Platelets from patients with reactive thrombocytosis supported normal thrombin generation. ITP platelets were large, with a proportionate increase in thrombin potentials, but very short lag times to 20 nM thrombin concentration. Following marrow ablation there was a progressive loss of activation-induced enhancement of thrombin generation. Platelets from patients with idiopathic aplastic anaemia supported normal thrombin generation. These findings indicate that platelet phospholipid-dependent thrombin generation is altered in many patients with a variety of quantitative platelet disorders, and this may be an important determinant of the clinical expression of these disorders.

Anemia, Aplastic↗
PubMed1994

Markers of thrombin and plasmin generation in patients with inherited thrombophilia.

AIM: To determine the prevalence of a biochemically detectable hypercoagulable state, defined in terms of increased thrombin or plasmin generation, in patients with phenotypically characterised thrombophilia. METHODS: Plasma concentrations of the prothrombin activation peptide F1.2 and fibrin degradation (FbDP) and fibrinogen degradation products (FgDP) were measured by enzyme immunoassay in 104 patients deficient in natural anticoagulants, and 35 unaffected relatives. RESULTS: Increased concentrations of F1.2, FbDP, and FgDP were present in 18, 25, and 19 of 104 patients, respectively. There were no correlations between F1.2, FbDP, and FgDP concentrations, or between these parameters and concentrations of natural anticoagulants except for a negative correlation between protein C concentrations and FgDP (rho = -0.46, p = 0.009). CONCLUSION: A biochemically detectable hypercoagulable state is present in some patients with asymptomatic thrombophilia. Markers of plasmin generation may be increased more frequently in thrombophilia than markers of thrombin generation. This finding should prompt the inclusion of markers of plasmin generation in prospective longitudinal cohort studies to determine the predictive value of a hypercoagulable state, defined by either excessive thrombin or plasmin generation, for the development of venous thromboembolism.

Adult↗
PubMed1994

Autologous bone marrow transplantation for Hodgkin's disease--a five-year single centre experience.

The results from 40 patients who have undergone autologous bone marrow transplantation (ABMT) for relapsed or refractory Hodgkin's disease between March 1988 and September 1992 have been analysed. In contrast to our results in patients with relapsed HD, our results in patients with refractory HD are comparatively poor. Conventional salvage chemotherapy also seems inappropriate in these patients and we therefore believe they should be offered high-dose chemotherapy before their disease becomes refractory to conventionally scheduled regimens. Peripheral blood stem cell (PBSC) transplant now offers an attractive alternative to ABMT and may replace both intensive salvage chemotherapy and ABMT as the optimum treatment for patients who fail to respond to conventional chemotherapy regimens.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1993

Defective IgG2 response to Pneumovax in HIV seropositive patients.

OBJECTIVE: To determine whether HIV (Human Immunodeficiency Virus) antibody positive adults are capable of mounting an effective immune response when immunized with polyvalent pneumococcal vaccine. DESIGN: 28 patients (nine homosexual men, one bisexual man, three heterosexual females, 10 injecting drug abusers, five haemophiliacs) and 11 healthy volunteers, were immunised with Pneumovax II and titres of IgG1 and IgG2 specific antibody measured before and 1 month after immunisation. Magnitude of immune response was related to CD4 T-lymphocyte count at time of immunisation to establish whether responses are better in early disease. MAIN OUTCOME MEASURES: Based on our data in healthy volunteers we defined an adequate response to Pneumovax II as a post immunisation IgG2 antibody level at least 50% greater than the pre immunisation level. RESULTS: The magnitude of the response was significantly higher in the normal volunteers (U = 95; p = 0.0328). Adequate IgG2 responses were seen in 11/11 normals but in only 14/28 HIV seropositives (chi 2 = 8.58; p < 0.01). Poor responses were unrelated to the CD4 T-lymphocyte count at immunisation. Absolute IgG2 deficiency accounted for the poor response in only 1 HIV patient. CONCLUSION: 50% of HIV antibody seropositive individuals fail to mount adequate immune responses to polyvalent pneumococcal vaccine. Non responders are unlikely to be protected.

Adult↗
PubMed1991

Graft-versus-host disease in solid organ transplantation.

Graft-versus-host disease is well recognized in bone marrow transplantation, but has only recently been described in solid organ transplantation. Two such cases in liver graft recipients, proven by the demonstration of donor type HLA antigens in the peripheral blood and marrow on tissue typing, are described in this paper. The literature on this subject is reviewed and the treatment discussed. It is postulated that there is an order of risk of development of graft-versus-host disease depending on the amount of viable lymphoid tissue included with the transplanted organ as follows: small bowel greater than heart-lung greater than liver greater than kidney greater than heart. It seems likely that this condition has been substantially underdiagnosed in the past and that greater awareness of the possibility of graft-versus-host disease in solid organ recipients will lead to the recognition of further cases and allow appropriate treatment to be promptly instituted.

Adult↗
PubMed1991

Evaluation of the Ciba Corning Biotrack 512 coagulation monitor for the control of oral anticoagulation.

The Ciba Corning Biotrack 512 coagulation monitor requires a minimal degree of technical expertise to operate, and is already in use for near-patient testing. This study evaluated the monitor for possible use in decentralised control of oral anticoagulant treatment. The monitor compared well with Manchester Reagent, suggesting that it could be used in areas where this thromboplastin is used for centralised control. The inability of the monitor to allow for locally determined geometric mean normal prothrombin times in the calculation of the International Normalised Ratio (INR), and possibly the high International Sensitivity Index (ISI) of the thromboplastin used with the monitor, resulted in poor comparability with some other thromboplastins, particularly Thrombotest. These problems need to be addressed if the monitor is to be used for decentralised anticoagulant control.

Administration, Oral↗