scholarly journals Diabetic Ketoacidosis, Hypertriglyceridemia and Abdominal Pain due to Acute Pancreatitis Complicated by Non-immune Haemolytic Anaemia

2020 ◽  
Author(s):  
Monica Joustra ◽  
Janneke Raidt ◽  
Florens Droog ◽  
Thiemo Veneman
Keyword(s):  
Acute Pancreatitis ◽  
Diabetic Ketoacidosis ◽  
Haemolytic Anaemia ◽  
Mortality Rates ◽  
Blood Transfusions ◽  
Red Cell ◽  
Supportive Treatment ◽  
Intravenous Insulin ◽  
Immune Haemolytic Anaemia ◽  
Red Cell Membranes

The triad of diabetic ketoacidosis, acute pancreatitis and hypertriglyceridemia is a rare phenomenon, with mortality rates of up to 80%. A unique characteristic of the described case is the co-occurrence of non-immune haemolytic anaemia (NIHA) with the complex triad. It is suggested that this presentation is secondary to hyperlipidemia which leads to increased fragility of erythrocytes due to destabilization of red cell membranes. Supportive treatment with intravenous insulin and blood transfusions is the cornerstone of treatment.

scholarly journals Prevalence of Anti-Red Cell Antibodies in Repeatedly Transfused Patients

2019 ◽  
Vol 14 (1) ◽  
pp. 73-77
Author(s):  
Masuma Ahmed Salsabil ◽  
Ashesh Kumar Chowdhury ◽  
Debashish Saha ◽  
Arif Ahmed Khan ◽  
Sazia Sultana
Keyword(s):  
Haemolytic Anaemia ◽  
Armed Forces ◽  
Cross Sectional Study ◽  
Red Cell ◽  
Cross Sectional ◽  
Transfusion Therapy ◽  
Female Ratio ◽  
Medical College ◽  
Male Female Ratio ◽  
Immune Haemolytic Anaemia

Introduction: The development of anti-RBC antibodies (alloantibodies and/or autoantibodies) can significantly complicate transfusion therapy, particularly in patients needed repeated transfusion. Objectives: To find out the prevalence of alloantibodies and autoantibodies in repeatedly transfused patients so that serious hazards due to immune reaction may be avoided. Materials and Methods: This descriptive cross-sectional study was carried out in Department of Immunology, BIRDEM and Armed Forces Institute of Pathology (AFIP) during the period of July 2015 to June 2016. Total 370 patients who had received at least five units of transfusions were enrolled in this study but known patients of auto immune haemolytic anaemia, patients in whom antibody was previously detected and pregnant women were excluded from the study. Blood grouping and Direct Anti-globulin Test (DAT) were performed with cell suspension using a poly-specific Coombs reagent. In cases of a positive DAT, further investigation using specific monoclonal reagents to detect IgG or a complement (C3d) was carried out. Serum was used to detect red cell alloantibodies using standard blood bank methods. Antibody identification was performed in antibody screening positive samples using red cell Identicells. Results: Maximum 132 (35.7%) patients were in the age group 1-10 years. The male-female ratio was 1.2:1. Among 370 total patients 290 were HHA and 80 were non-HHA. Antibody was detected in only 17(4.59%) patients. Among the Hereditary Haemolytic Anaemia (HHA) patients it was 11 (3.79%) but among the non-HHA patients it was 6(7.5%). Out of 8 auto-antibodies, 5 were anti IgG followed by 3 were anti C3d. Out of 14 alloantibodies, 4(28.6%) were anti E, 3(21.4%) were anti K and in 3(21.4%) cases specificity of alloantibody was not detected. Conclusion: Prevalence of anti-RBC antibodies was not so uncommon in multiple transfused patients. Journal of Armed Forces Medical College Bangladesh Vol.14(1) 2018: 73-77

scholarly journals Reticulocytopenia and "absence" of red cell autoantibodies in immune haemolytic anaemia.

BMJ ◽  
1977 ◽  
Vol 2 (6100) ◽  
pp. 1444-1447 ◽  
Author(s):  
U M Hegde ◽  
E C Gordon-Smith ◽  
S M Worlledge
Keyword(s):  
Haemolytic Anaemia ◽  
Red Cell ◽  
Immune Haemolytic Anaemia

scholarly journals SAT-684 A Deadly Triad: Coexistence of Acute Pancreatitis, Hypertryglyceridemia and Diabetic Ketoacidosis

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Marina T Torres Torres ◽  
Kimberly C Padilla Rodriguez ◽  
Norma Vergne-Santiago ◽  
Michelle Marie Mangual Garcia
Keyword(s):  
Acute Pancreatitis ◽  
Mortality Rate ◽  
Diabetic Ketoacidosis ◽  
False Negative ◽  
Lipid Lowering ◽  
Bowel Habit ◽  
Intravenous Insulin ◽  
Glucose And Lipid Metabolism ◽  
Lipid Panel ◽  
Upper Abdominal

Abstract The coexistence of diabetic ketoacidosis (DKA), hypertriglyceridemia and acute pancreatitis (AP) represent a complex phenomenon described as the enigmatic triad. The exact initial culprit and pathophysiologic mechanism of this chain of events are still unclear posing a challenge in management. DKA may lead to glucose and lipid metabolism dysregulation which can result in hypertriglyceridemia leading to AP. On the other hand, hypertriglyceridemia may induce AP which may decompensate diabetes and lead to DKA. In both scenarios, this triad results in an uncommon clinical presentation with up to 80% mortality rate. Most frequently reported in children, this entity accounts for only a handful of cases reported in the literature. Case of an obese, non alcoholic 57 year old male without history of systemic illness who visits the emergency room due to mid-upper abdominal pain for the past day. Pain radiates to the back, worsens upon laying flat, and is associated with bloating and nausea. He denies previous similar episodes, vomiting, fever or bowel habit changes. Laboratory workup revealed lipidemic sample with hyperglycemia, metabolic acidosis, positive serum ketones, and normal amylase and lipase. Lipid panel revealed hypertriglyceridemia at 6,260 mg/dL (35-150). Glycated hemoglobin at 14.7%. Abdominal computed tomography showed peripancreatic inflammation consistent with pancreatitis. Given clinical and imaging criteria the diagnosis of severe hypertriglyceridemia induced AP and DKA were made. The patient was admitted to ICU and treated with intravenous insulin drip and supportive management. Resolution of DKA and successful decrease in triglycerides to less than 500 mg/dL was achieved by the third day of admission. After six days, the patient was discharged home with insulin and lipid lowering regimens. This case demonstrates an extremely rare initial presentation of diabetes mellitus. This triad is the result of a toxic chain of events that may be lethal if not promptly identified. This case makes an exemplary lesson as to always take under consideration atypical etiologies to potentially life threatening conditions and also remarks that while uncommon, pancreatitis with normal pancreatic enzymes is a possible phenomenon. Even though false negative amylase has been associated with hypertriglyceridemia induced AP, only a few cases with negative lipase have been described. While no definite explanation has been yet discovered, negative lipase may be explained by early acinar cell apoptosis in AP. More research efforts are necessary in order to improve early diagnosis, treatment, and mortality rate for this rare but potentially deadly triad and to better understand the mechanisms underlying AP and the role that digestive enzymes play.

scholarly journals Heparin and Insulin for Hypertriglyceridemia-Induced Pancreatitis: Case Report

2009 ◽  
Vol 9 ◽  
pp. 1230-1232 ◽  
Author(s):  
Deepika Jain ◽  
John Zimmerschied
Keyword(s):  
Fatty Acids ◽  
Acute Pancreatitis ◽  
Case Report ◽  
Serum Triglyceride ◽  
Serum Triglyceride Level ◽  
Supportive Treatment ◽  
Lipoprotein Lipase Activity ◽  
Heparin Infusion ◽  
Intravenous Insulin ◽  
Time Of Admission

Hypertriglyceridemia is the etiology of acute nonbiliary pancreatitis in up to 3% of patients. Along with the supportive treatment of acute pancreatitis, treating the precipitating cause is important as well. There have been reports where heparin and insulin have been used for acute reduction of triglycerides, although there are no established guidelines for efficacy of these modalities. Heparin and insulin decrease triglycerides by stimulating lipoprotein lipase activity, which degrades triglycerides into fatty acids and glycerol. We present a case where a 54-year-old male presented with hypertriglyceridemia-induced acute pancreatitis. The serum triglyceride level was 10,320 mg/dl (normal: 0–15 mg/dl) at the time of admission. We started the patient on intravenous insulin and heparin infusion, and within 24 h of induction of treatment, the levels decreased by 50% to 5407 mg/dl. Thus, heparin and insulin can be considered a safe treatment modality for rapidly reducing triglyceride levels.

A rare presentation of type 2 diabetes: diabetic ketoacidosis, acute pancreatitis, and hypertriglyceridaemia

2014 ◽  
Author(s):  
Abdulghani Al-Saeed ◽  
Ahmad Alobedallah ◽  
Ayman Al-Hayek ◽  
Sohail Inam ◽  
Rim Braham ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Acute Pancreatitis ◽  
Diabetic Ketoacidosis ◽  
Rare Presentation

VALUE OF COMBINATION OF HAP SCORE AND BISAP SCORE IN PREDICTING SEVERITY IN PATIENTS OF ACUTE PANCREATITIS

2019 ◽  
pp. 96-100
Author(s):  
Thi Ngoc Suong Le ◽  
Pham Chi Tran ◽  
Van Huy Tran
Keyword(s):  
Acute Pancreatitis ◽  
Positive Predictive Value ◽  
Roc Curve ◽  
Predictive Value ◽  
Prognostic Value ◽  
Acute Inflammation ◽  
Clinical Symptoms ◽  
Mortality Rates ◽  
Multiple Organ ◽  
Central Hospital

Acute pancreatitis (AP) is an acute inflammation of the pancreas, usually occurs suddenly with a variety of clinical symptoms, complications of multiple organ failure and high mortality rates. Objectives: To determine the value of combination of HAP score and BISAP score in predicting the severity of acute pancreatitis of the Atlanta 2012 Classification. Patients and Methods: 75 patients of acute pancreatitis hospitalized at Hue Central Hospital between March 2017 and July 2018; HAP and BISHAP score is calculated within the first 24 hours. The severity of AP was classified by the revised Atlanta criteria 2012. Results: When combining the HAP and BISAP scores in predicting the severity of acute pancreatitis, the area under the ROC curve was 0,923 with sensitivity value was 66.7%, specificity value was 97.1%; positive predictive value was 66.7%, negative predictive value was 97.1%. Conclusion: The combination of HAP and BISAP scores increased the sensitivity, predictive value, and prognostic value in predicting the severity of acute pancreatitis of the revised Atlanta 2012 classification in compare to each single scores. Key words: HAPscore, BiSAP score, acute pancreatitis, predicting severity

Haemolytic Anaemia: A Diagnostic Dilemma

2018 ◽  
Vol 2 (01) ◽  
pp. 29-31
Author(s):  
Md. Rezaul Karim Chowdhury ◽  
Mohammad Quamrul Hasan ◽  
Md. Haroon Ur Rashid
Keyword(s):  
Haemolytic Anaemia ◽  
Clinical Suspicion ◽  
Diagnostic Dilemma ◽  
High Clinical Suspicion ◽  
Immune Haemolytic Anaemia

It is sometime difficult to find out the cause of haemolysis in haemolytic anaemia due to inconclusive results of investigation. Diagnosis of immune haemolytic anaemia is often difficult when Coomb’s test is negative. Here we present such a case of fourteen years old girl who presented with haemolytic anaemia with negative Coomb’s test. Due to high clinical suspicion we labelled her as a case of Coomb’s negative immune haemolytic anaemia and she responded well to steroid.

scholarly journals Rhinocerebral mucormycosis secondary to severe acute pancreatitis and diabetic ketoacidosis: a case report

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Jinjing Wang ◽  
Yao Li ◽  
Shuai Luo ◽  
Hong Zheng
Keyword(s):  
Acute Pancreatitis ◽  
Diabetic Ketoacidosis ◽  
Severe Acute Pancreatitis ◽  
Clinical Findings ◽  
Severe Form ◽  
Optimal Treatment ◽  
Diabetic Patients ◽  
Rhinocerebral Mucormycosis ◽  
Patient Prognosis ◽  
Treatment Window

Abstract Introduction Rhinocerebral mucormycosis is a rare and severe form of opportunistic fungal infection that can develop rapidly and cause significant mortality, particularly among diabetic patients suffering from ketoacidosis. Diagnosing rhinocerebral mucormycosis during the early stages of infection is challenging. Case presentation We describe a case of rhinocerebral mucormycosis secondary to severe acute pancreatitis in a patient suffering from diabetic ketoacidosis. In this case, the condition was not diagnosed during the optimal treatment window. we therefore provide a thorough overview of related clinical findings and histopathological characteristics, and we discuss potential differential diagnoses. Conclusions In summary, we described a case of rhinocerebral mucormycosis secondary to severe acute pancreatitis in a patient suffering from diabetic ketoacidosis, with the optimal treatment window for this condition having been missed. This report suggests that a definitive mucormycosis diagnosis can be made based upon tissue biopsy that reveals the presence of characteristic hyphae. Early diagnosis and treatment are essential in order to improve patient prognosis.

Sign in / Sign up

Export Citation Format

Share Document