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Aim: To improve the results of treatment of gastroesophageal variceal bleeding (GEVB) in cirrhotic patients with thrombocytopenia., Material and Methods: A total experience of the clinic includes 338 GEVB patients, endoscopic variceal ligation (EVL) and transjugular intrahepatic portosystemic shunt (TIPS) were performed in 162 and 157 cases respectively. Nevertheless, just the efficacy of initial pharmacological hemostatic therapy was analyzed., Results: Administration of serotonin adipinate 30-50 mg/day during 3-5 days in addition to standard initial therapy allowed us to achieve permanent hemostasis during initial treatment if EVL was impossible. Serotonin adipinate induces thrombocytes' adhesion and improves fibrin clot strength. This therapy markedly decreases mortality (33.3% vs 46.7%), incidence of recurrent bleeding (46.4% vs 60.0%). Also it contributes successful hemostasis with endoscopic ligation and effective portal decompression by TIPS procedure.

Hemostatic disorders are typically associated with prolonged bleeding after or during surgical procedures. The aim of the study was to increase the efficiency of oral surgery in these patients using erbium laser. Selected 46 patients receiving oral surgery were randomly divided in 2 groups: 43 patients with thrombocytopenia, trombocytemia and other platelet disorders treated with erbium laser and a control group of 43 patients without concomitant pathology determined for conventional surgical treatment. No postoperative bleeding was seen in group 1. Conventional procedures were associated with significantly more postoperative pain and epithelization took 1-3 days longer. Erbium laser radiation is an up-to-date method which can be successfully used for oral surgery in patients with hemostatic disorders.

The diagnostic significance of new indices of hemogram under liver cirrhosis associated with thrombocytopenia (n=64) was analyzed. It is established that in comparison with control group the patients with cirrhosis are characterized by statistically valuable increasing of content of immature cells of three germs of hematopoiesis: reticulocytes up to 1.99±1.54%, granulocytes up to 0.44±0.77%, immature thrombocytes up to 3.23±1.7%. Under liver pathology, the following occurrences are detected: "left shift" of reticulocyte and leukocyte formula; reliable decreasing of content of hemoglobin in reticulocytes. The increasing of both of content of fragmentary erythrocytes (Frg) up to 0.83±1.21% and level of delta-hemoglobin (D-He>4 ng) were interpreted as additional markers of hemolysis. At that, negative values of delta-hemoglobin (D-He<0 ng) in 6.3% of patients are associated with concomitant inflammation. As a result of study, new data was obtained concerning characteristics of hematopoiesis under liver cirrhosis increasing quality of laboratory monitoring of patients with the given pathology.

Reperfusive hepatic damage, one of the severe complications after hepatic transplantation, occurs immediately after inclusion of the donor organ into the blood circulation of a recipient. It is considered one of principal causes of early rejection of the transplant. Connection between thrombocytopenia in a patient and duration of period of a donor's "cold" hepatic ischemia was studied. The changes in microcirculation due to the thrombocytes accumulation (sequestration) in a sinusoid vessels constitutes a main target in the ischemic-reperfusive damage of the liver. During the first days after hepatic transplantation the thrombocytes quantity have reduced, the correlation dependence between this process and duration of a "cold" ischemia and functional activity of a liver transplanted was established.

The review deals with an analysis of the use of recombinant activated factor clotting VII (rFVIIa) for the treatment of hemorrhagic syndrome in patients with thrombocytopenia. The review discusses cases of rFVIIa use during bleeding of different localization and different invasive interventions, a frequency of thrombotic complications and causes of the rFVlIIa insufficiency.

Unlabelled: Research objective was to develop an algorithm of the recombinant activated Factor VII (rFVIIa) prophylactic use for the bleeding implications prevention during central venous catheterization in Pediatric patients with acute leucosis and thrombocytopenia., Methods: 30 Pediatric patients with acute leucosis and thrombocytopenia received rFVIIa 30-120 microg kg(-1) before the internal jugular vein catheterization with ultrasound control. Comparative group 1 included 39 Pediatric patients without preventive haemostatic treatment; comparative group 2 included 30 patients received platelet concentrate., Results: the first attempt catheterization numbers increased, the time of the catheterization was reduced, platelet aggregation was improved and the bleeding implications frequency was 6.6% in patients received rFVIIa before the internal jugular vein catheterization. 23.1%--in the comparative group 1; 26.7% in the comparative group 2., Conclusion: Ultrasound navigation and rFVIIa preventive use together improve internal jugular vein catheterization results.

This paper describes the onset of a generalized form of myasthenia in a patient presenting with essential thrombocytopenia. Clinical features of myasthenia are considered. It is hypothesized that immunological disorders in the preceding period play an important role in the mechanisms triggering the onset of myasthenia.

The study was undertaken to determine a possible association of retinal vascular lesion in systemic lupus erythematosus (SLE) with the antiphospholipid syndrome (APS). A hundred and ninety-four patients (160 females and 34 males, whose mean age was 30.7+/-8.9 years) with verified SLE were examined. Group I comprised 67 patients with retinal vascular lesions (Subgroup la (n = 13) with retinal vascular occlusions and Subgroup 1b (n = 54) without occlusions). Group 2 included 127 patients without retinal vascular lesions. APS was detected in 86 patients. Retinal vascular occlusions more frequently occurred in patients with APS (13.9%) than in those without APS (0.9%) (p = 0.0009) and more frequently in patients with APS and thrombocytopenia (24.3%) than in those with APS without thrombocytopenia (6.1%) (p = 0.0359). Extraocular thromboses were more frequently encountered in Subgroup 1a (69.2%) than in Subgroup 1b (33.3%) (p = 0.0399) and in Group 2 (22.8%), (p = 0.0010). Cerebral circulatory disorder (CCD) was observed in 30.7% in Subgroup la, in 14.8% in Subgroup 1b, and in 7.9% in Group 2 (p = 0.0268). Transient ischemic attack (TIA) occurred in 46.2% in Subgroup la, in 24.1% in Subgroup 2a, and in 14.9% in Group 2 (p = 0.0129). Thrombocytopenia was identified in 69.2% in Subgroup 1a, in 22.2% in Subgroup 2a (p = 0.0021), and in 12.6% in Group 2 (p < 0.0000). The frequency of elevated IgG of anticadiolipin (aCL) in Subgroup 1a (80%) exceeded that in Subgroup 1b (37.9%) (p = 0.0309) and Group 2 (30.7%) (p = 0.0096). Another isotype of aCL (IgM 80%) was observed in patients with retinal vascular occlusions, but the differences in this index were insignificant in the groups and subgroups. The association of pathological changes in retinal vessels in the presence of lupus anticoagulant (LA) was particularly noticeable (91.7 and 52% in Subgroup la and Subgroup 1b, respectively (p = 0.0191) and 47.1% in Group 2 (p = 0.0088). There was an association of amaurosis fugax with eyeground occlusions (p < 0.004), CCD and TIA (p < 0.0002), APS (p < 0.0003), and essential hypertension (p < 0.05). Thus, occlusive lesions in the fundus of the eye are a common manifestation of thrombogenesis in SLE in the presence of APS. The frequency of concomitance of retinal vascular occlusions with cerebral circulatory disorders should be referred to as severe manifestations of SLE. Amaurosis fugas is a manifestation of retinal vascular lesion and associated with the presence of APS and elevated blood pressure in patients with SLE. There is an association of an occlusive process in the fundus of the eye with different symptoms of APS and primarily with IgG of aCL, LA, and thrombocytopenia.

Chronic adenoiditis (CA) prevails among ENT diseases in children. It often demands surgical intervention. Frequent hemorrhagic complications during adenotomy necessitate assessment of the patient's hemostasis. A preoperative examination of 43 children has detected primarily dysaggregation thrombocytopathies. Streptococcus pneumoniae is a dominating etiological agent. Chronic focal infection is involved in pathogenesis of systemic disorders in CA including those provoking coagulatory disturbances. An algorithm of hemostatic disorders diagnosis in CA children is proposed as well as an effective program of targeted pre- and intraoperative hemostatic therapy.

This paper describes hemostatic changes in patients who had undergone aortic surgery under conditions of extracorporeal circulation. The changes in the hemostatic system are marked by the thrombophilic condition made up for activation ox blood fibrinolytic activity in the preoperative period. The basic amount of blood loss falls within the first 6 hours after operation. Prolonged hypothermic extracorporeal circulation and the high intraoperative blood loss (over 35 ml/kg bw) lead to an appreciable decrease in antithrombin III and protein C activity which results in activation of disseminated intravascular blood coagulation in the early postoperative period and ineffectiveness of heparin therapy. Secondary hyperfibrinolysis together with combined thrombocytopenia and platelet dysfunction are the basic causes of higher than usual bleeding in patients after aortic surgery under conditions of extracorporeal circulation.

The paper describes a clinical case of successful transsphenoidal removal of sphenoidal sinus tumor in a patient with severe thrombocytopenia. It also discusses the problems of infusion-transfusion therapy policy in such patients during surgery.

The article contains a description of the clinical-and-immunological specific features of the secondary (concomitant with systemic lupus erythematosus-SLE) and primary anti-phospholipid syndrome (APS). We followed up a total of 280 patients with SLE and 74 patients with primary APS; 96 of 280 SLE patients were males and 184 of them were females, mean age--31.2 +/- 11.1, mean disease duration--8.6 +/- 7.2 years. The APS group consisted of 15 males and 59 females, mean age--35.6 +/- 7.2, mean disease duration--11.9 +/- 8.5 years. Antibodies to cardiolipin (aCL) and lupous anticoagulant (LA) were determined for all patients. Antibodies to IgM beta 2-GP I (IgM anti-beta-GP I) were determined for 102 patients and antibodies to IgG anti beta 2-GP I were determined for 153 patients. The level of antibodies to beta 2 GP I in blood serum was found by immune-enzyme assay (QUNTA Life). The secondary APS was diagnosed in 115 (41%) patients from among 280 SLE patients. The group of patients with SLE and without APS and the group with primary APS were age-matched, however, patients with APS were older and had a longer disease duration. The diagnosis was made in one half of patients with primary APS in 6 and more years after the disease onset. Thrombotic complications were found in 117 (42%) from among 280 SLE patients. They were encountered reliably more often in APS versus SLE (chi 2 = 131, p < 0.0001). Venous thrombosis in veins of lower extremities prevailed in APS, while thrombophlebitis of the surface shin veins was predominant in patients without APS. An important features of APS is occlusion of veins located in the liver with a subsequent development of Budd-Chiari syndrome (9 patients); in retinal veins (13 patients); thrombophlebitis in axillary veins (7 patients) and in abdominal-cavity veins (2 patients). Loss of pregnancy at various gestational stages was registered in medical histories of 83 (76%) from among 109 pregnant women. The frequency rate of fetus loss was higher in primary APS (32 of 40 cases) versus its secondary variation (49 of 75 cases) with chi 2 = 8.3, p = 0.004. Thrombocytopenia was detected reliably more often in patients with secondary APS (chi 2 = 36, p < 0.0001). The clinical signs of both primary and secondary APS were found to be similar. However, arterial and venous thromboses combined with the relapsing syndrome of fetus loss were more often registered in primary APS. The detection of highly positive aCL titers is of a significant diagnostic value versus the detection of its low- and mean-positive values. The study of anti-beta 2-GP I is also of certain importance for a more reliable diagnosis of APS.

Aim: To develop and introduce X-ray endovascular preocclusion of the splenic artery in general surgical patients with different forms of cytopenias as preparation for further surgical treatment., Materials and Methods: Data on 12 splenic arterial occlusions in patients with different diseases of the blood system., Results: Despite the severity of the underlying process, the use of X-ray endovascular preocclusion of the splenic artery in patients with different hematological diseases made it possible to make the so-called bloodless splenectomy on short notice, then a required cavitary operation or in the immediate postembolization period if there were emergency indications or some time later if the patient's status allowed., Conclusion: When patients with blood system diseases attended by thrombocytopenia, anemia, leukopenia are indicated to have surgical treatment of some contaminant diseases, it is necessary to perform X-ray endovascular splenic arterial occlusion at the first stage, then make a major intervention when blood parameters have improved.

Seventeen patients aged 26-52 with recurrent thromboembolism of the veins and disturbances of cerebral and coronary circulation (3 and 2 cases, respectively) treated by unfractionated heparin developed thrombocytopenia in the presence of enhanced platelet aggregation. Despite heparin therapy, fresh thrombi of different sites appeared in 5 patients. A cross to fraxiparin (France) resulted in correction of thrombocytopenia, normalization of spontaneous platelet aggregation in two thirds of the patients. In 5 patients thrombocytopenia persisted. It is stated that in most cases low-molecular heparin allows continuation of antithrombotic therapy in heparin-induced thrombocytopenia. Neither transplacental passage nor hemostatic abnormalities in the newborns were recorded after administration of fraxiparin to 6 pregnant women.

The clinical course of hypoplastic anemia (HA) has been assessed in 21 patients with uterine bleedings. The disease was associated with severe onset and progress, profound pancytopenia and myelodepression or even critical states. Superimposed infectious inflammatory and other diseases aggravated HA by promoting hemorrhagic events, especially uterine bleedings. An initial treatment using packed erythrocyte transfusions and glucocorticoid hormones reversed anemia and hemorrhages in 11 of 21 patients with HA. Splenectomy was performed in 8 and ovariectomy in 1 of 11 patients whose blood and bone marrow tests improved after the treatment. The other 12 patients were maintained on transfusion and drug regimens. The efficacy of splenectomy and other interventions for HA in women with uterine bleedings depends on an response to received treatments.

On the basis of an analysis of results of the surgical treatment of 97 patients with different forms of acute leukosis with the hemorrhagic syndrome the authors make a conclusion that the application of hemostatic means of the general and local action, the thrombotic mass included, allows preventing hemorrhage in operative procedures in the maxillofacial area (extraction of teeth, opening of abscesses and phlegmons, interventions on the maxillary sinus etc).

Clinical and angiographic examination of 20 patients with stenoses in the system of the internal carotid artery before and after operations for the formation of extra-intracranial microvascular anastomoses (EICMA), and during EICMA functioning demonstrated the evolution of the stenoses. It was characterized both by their increase (even up to the occurrence of thrombosis) and by their regression. No evolution of the stenoses occurred when EICMA failed to function. The character of evolution of the stenosis was determined by its localization. The trend of the evolution was dependent on the etiology of the stenosis. The degree of EICMA functioning differed and was determined by the character of stenosis evolution. With the development of stenosis into thrombosis, the neurological symptom complex was characterized both by marked augmentation followed by regression as well as by the absence of any changes or positive dynamics of the neurological changes.