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Essay: Effect of platelet transfusion in treatment of Hemolytic Uremic Syndrome

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  • Published: 22 September 2015*
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  • Words: 650 (approx)
  • Number of pages: 3 (approx)

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HUS is the most common cause of acute renal damage in children. It’s a systemic disease characterized by damage of vascular endothelial cells that has two clinical forms; a typical form called post diarrheal hemolytic syndrome(D+ HUS) and atypical form ,the typical form is caused by a toxin in the circulation most commonly produced by Shiga toxin producing E-coli. This damage occurs mainly in the renal, gastrointestinal and central nervous systems. The damage caused by the toxin initiates a thrombotic reaction mediated by platelets and fibrin. The classical presentation of this disease is a triad including: Platelets thrombi, thrombocytopenia and hemolytic anemia. The management of this disease is mainly supportive including fluid and electrolytes replacement, renal dialysis in case renal failure occurs and antihypertensive agents.
Aim :
to determine role of platelet transfusion in treatment of Hemolytic Uremic Syndrome.
After revising some randomized clinical trials, systematic reviews, meta-analysis and case control studies which discuss treatment of hemolytic uremic syndrome and the role of platelet transfusion in improving the treatment using systematic search of 4 electronic databases and journals including PubMed and cochrane databases.
According to a case -control study conducted on a 23 hemolytic uremic syndrome patient received platelet transfusion and 59 controls who did not receive it, they suggested that platelet transfusion does not worsen the course of the disease. Yet, with those who did not receive it, there were not any hemorrhagic complications. Other systematic reviews found no evidence that any specific therapy like platelet transfusion have any superiority to the supportive treatment as the disease is self limiting. Another one suggested that platelet transfusion should be only indicated in hemolytic uremic syndrome patients with severe hemorrhages or major procedures and is not required in asymptomatic thrombocytopenia or minor procedures. A meta-analysis of 7 randomized clinical trials showed that the only effective treatment in typical forms of HUS is supportive therapy. However, Studies showed that the complications of platelet transfusion in typical form of this disease are rare, they found no evidence of its value in treatment.
Evidence has shown no value of platelet transfusion in treatment of hemolytic uremic syndrome. So, I will not recommend it unless there is a major bleeding or according to an individual case basis.
‘ Hemolytic uremic syndrome -platelet transfusion- thrombotic microangiopathies- thrombocytopenia- shiga toxin producing E-coli.
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