Acute Splenic Artery Thrombosis and Infarction Associated with COVID-19 Disease

Coronavirus 2019 disease (COVID-19) is a viral illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It emerged in Wuhan, China, in December 2019 and has caused a widespread global pandemic. The symptoms of COVID-19 can vary from mild upper respiratory symptoms to severe pneumonia with hypoxemic respiratory failure. Multiple studies and reports have reported a hypercoagulable state associated with this disease, and various recommendations have emerged to guide the use of anticoagulants for prophylaxis. We are reporting a case of symptomatic acute splenic thrombosis causing splenic infarction in a patient suffering from a severe case of COVID-19 and despite the use of an intermediate dose of low-molecular-weight heparin (LMWH). The patient was treated with full-dose anticoagulation and was eventually discharged home on a direct oral anticoagulant.

Pregnancy Complications in a-Thalassemia (Hemoglobinopathy H): A Case Study

Thalassemia intermedia (TI) is a clinical definition which represents a wide spectrum of thalassemia genotypes but mainly includes patients who do not require or only occasionally require transfusion. An uncommon case of a 32-year-old Greek woman, para 1, at the 22nd week + day 3 of gestation with thalassemia intermedia (she was splenectomized), where her pregnancy was complicated with portal vein thrombosis, splenic thrombosis, and partial HELLP, is described. This is a generally uncommon event in thalassemia intermedia. She had no transfusion as her hematologist consulted and she took anticoagulation therapy. Thus, we present for the first time in the literature a case of HbH a-thalassemia pregnant woman whose pregnancy was complicated with portal vein thrombosis, splenic vein thrombosis, and partial HELLP; she was treated with anticoagulation therapy and she had a successful outcome.

Isolated Gastric Varices and Use of Balloon-occlusive Retrograde Transvenous Obliteration: A Case Report and Literature Review*

Isolated gastric varices are far less prevalent in Western countries where the rate of splenic thrombosis is much lower. However, in Asian countries the entity is more common and therefore a more robust treatment approach has been developed. Balloon-occlusive retrograde transvenous obliteration (BRTO) was first described in 1984 and then revived in 1996. The procedure, while uncommon in the U.S. and not recognized by the AASLD practice guidelines, allows for direct exclusion from the portosystemic system. Here we describe the case of a patient with alcoholic cirrhosis decompensated by bleeding gastric varices treated with BRTO. Abbrevations: BRTO: balloon-occlusive retrograde transverse obliteration; EGD: esophagogastro-duodenoscopy; HE: hepatic encephalopathy; MELD: Model for End Stage Liver Disease; TIPS: transjugular intrahepatic portosystemic shunt.

Estados hipercoagulables primario y deficiencia de proteínas "C" y "S". Reporte de un caso y revisión de la literatura.

We present a patient with upper gastrointestinal bleeding and gastric varices due to mesenteric and splenic thrombosis related with a hypercoagulable state secondary to protein C and proteins S deficiency. We also did a review of the literature about deficiency of these proteins and their importance as a cause of venous thrombosis not well recognize yet. KEY WORDS: Protein C, Protein S, hypercoagulable state, venous thrombosis, upper gastrointestinal bleeding.

Mesenteric and splenic venous thrombosis in a female patient with essential thrombocytosis and the resistance to activated protein C

Splenic venous thrombosis is a rare disease in which an underlying hypercoagulable state can often be found. A 27-years old female patient with recurrent mesenteric venous and splenic thrombosis as a severe complication of an association of resistance to activated protein C and essential thrombocythemia is presented in this report. Establishing the diagnosis of essential thrombocytosis was particularly difficult because this was the case of the so called "silent" myeloproliferative disorder. The number of thrombocytes was almost normal before the splenectomy performed because of the splenic venous thrombosis. Thus, spontaneous growth of erythroid and megakaryocyte colonies in vitro and the clinical course of the disease were the clues for establishing the diagnosis, because the number of thrombocytes reached the values over 1500?109/l after only 1.5 years of the follow-up. The case of this patient was interesting particularly from the surgical point of view because of the management strategy.

Expression of viral hemorrhagic septicemia virus in prespawning Pacific herring (Clupea pallasi) exposed to weathered crude oil

Expression of subclinical viral infection in response to toxicant exposure has not previously been reported, but evidence presented herein indicates that activation of viral hemorrhagic septicemia virus (VHSV) may occur in Pacific herring (Clupea pallasi) exposed to crude oil encountered after an oil spill. Decreased incidence of hepatic inflammatory cells as a function of total polynuclear aromatic hydrocarbon (TPAH) concentration was evidence for immunosuppression in exposed fish, and decreased immune surveillance is a possible mechanism by which subclinical VHSV could be reactivated. Adult Pacific herring of unknown status regarding infection by VHSV were captured from the wild and exposed to weathered crude oil for 16-18 days. TPAH concentration in tissue, VHSV prevalence, and mortality were correlated with dose. Histopathologic lesions were significantly correlated with TPAH concentration and prevalence of VHSV, but not gender or length. Significant lesions included increased hepatocellular necrosis, splenic thrombosis, and decreased inflammation in the liver.