Hemic and Lymphatic Diseases Commons^™

Spur Cell Hemolytic Anemia: An Uncommon Etiology Of Anemia In Liver Cirrhosis, Hanan Gruhonjic, Austin Van Vliet, Maxwell Tague, Masi Javeed

West Florida Division GME Research Day 2023

No abstract provided.

Pancytopenia, Enterovirus Infection, And Pcr Testing, Stephen Mock, Salome Herzstein, Andrea Horbey

East Florida Division GME Research Day 2023

Introduction: This is a case of a patient presenting with fever, rash, and vomiting. Upon further studies, patient was found to have pancytopenia which started an extensive hospital work up.

Case Description: A previously healthy 9- year-old female presented to the emergency department with 3 days of tactile fever, 2 days of rash, and 1 day of nonbilious nonbloody emesis. The rash initially appeared on the trunk and by the day of admission, had begun to spread peripherally to the extremities. The rash on the abdomen was described as mild, generalized, blanchable and maculopapular. The rash on the extremities was …

Paraneoplastic Leukemoid Reaction In Uterus Carcinosarcoma, Xiaolan Tang, Ashali Jain, Uma Iyer, Jennifer Reppucci

North Florida Division GME Research Day 2023

No abstract provided.

Atypical Hemolytic Uremic Syndrome: A Diagnostic Conundrum, Rebecca Kurian, William Zvagelsky, Suleiman A. Daifallah

Continental, MidAmerica, & Mountain Divisions GME Research Day 2023

No abstract provided.

Hairy Cell Leukemia Presenting As Group B Streptococcus Cellulitis And Abscesses, Hannah Berrett, Mattias D'Anna, Ajay Iyer, Zachary Hancock, Meg Laures, Muzaffar Iqbal

Continental, MidAmerica, & Mountain Divisions GME Research Day 2023

No abstract provided.

Atypical Lymphoma And Monospot Testing: Malignant Deception, Jacob Keeling, Kavanya Feustel, Changlee Pang, Kevin Ky, Jennifer Griffith, Alexander Enurah

Continental, MidAmerica, & Mountain Divisions GME Research Day 2023

No abstract provided.

A Case Of Hemophagocytic Lymphohistiocytosis(Hlh) Secondary To Cytomegalovirus Infection In An Immunocompetent Patient, Marcarthur Limpiado, Simerun Singh, Ajay Iyer, William Zvagelsky, Shruti Verma, Minar Rane, Emadeldeen Elgwairi

Continental, MidAmerica, & Mountain Divisions GME Research Day 2023

No abstract provided.

Opioid-Induced Intrathecal Catheter Tip Granuloma Via Pain Pump In A Patient With Chronic Pain Syndrome: A Case Report, Katherine David, R Blake Kline, Jon Halling

South Atlantic Division GME Research Day 2023

No abstract provided.

Monoclonal Gammopathy Of Renal Significance: A Likely Underrecognized Problem, Ajay Iyer, Angad Singh, Thomas Pritchard, Manoj Khamuani, Minar Rane, Joseph Stilwill, Max Glaser

Continental, MidAmerica, & Mountain Divisions GME Research Day 2023

No abstract provided.

Follicular Lymphoma Presenting As A Small Bowel Obstruction: A Case Report, Erica Roma, Kelsey Staudinger, Emmett Mcguire, Katrina Lancaster Shorts

Continental, MidAmerica, & Mountain Divisions GME Research Day 2023

No abstract provided.

Hyperviscosity Syndrome Induced Bilateral Visual And Auditory Impairment In Therapy Resistant Waldenström Macroglobulinemia With Myd88 And Cxcr4 Mutations, Marie M Plante, Erinmarie O Kimbrough, Amit K Agarwal, Liuyan Jiang, Kirk Bourgeois, Greta C Stamper, Michael W Stewart, Han W Tun

Faculty, Staff and Student Publications

Hyperviscosity syndrome (HVS) is an emergent complication of Waldenström macroglobulinemia (WM) characterized by visual, neurologic, and rarely auditory impairment. We report a 69-year-old female with MYD88 and CXCR4-mutant WM who developed HVS resulting in bilateral blindness and deafness associated with neurologic manifestations including confusion, severe generalized weakness, and imbalance. Ophthalmologic evaluation revealed bilateral central retinal vein occlusion (CRVO), diffuse retinal hemorrhages, macular edema, and serous macular detachments (SMD). Magnetic resonance imaging of the brain showed bleeding in the inner ears. Management was challenging as her WM was resistant to systemic therapies including bendamustine + rituximab (BR) and rituximab + bortezomib …

Refractory Thrombocytopenia During Liver Transplantation Requiring Splenectomy, Ivana Wrobleski Wilder, Alexander Reskallah, Catherine M Pivalizza, John S Bynon, Evan G Pivalizza

Faculty, Staff and Student Publications

Although thrombocytopenia is common in end-stage liver disease, severe, refractory thrombocytopenia during liver transplantation is rare, and if immune based, usually presents months or years later. This case describes an adult woman in whom preoperative evaluation had not determined an immune-related cause of thrombocytopenia. Clot strength was dramatically impaired as measured by thrombelastography during the transplant. Following a lack of response to repeat platelet transfusions, splenectomy was performed after graft reperfusion with rapid temporal restoration of clot strength. This case shows a severe manifestation of perioperative thrombocytopenia during liver transplantation and clinically guided management when measured clot strength is too …

Hypofibrinogenemia Following Injury In 186 Children And Adolescents: Identification Of The Phenotype, Current Outcomes, And Potential For Intervention, Justin Gerard, Jan-Michael Van Gent, Jessica Cardenas, Christian Gage, David E Meyer, Charles Cox, Charles E Wade, Bryan A Cotton

Faculty, Staff and Student Publications

OBJECTIVES: Recent studies evaluating fibrinogen replacement in trauma, along with newly available fibrinogen-based products, has led to an increase in debate on where products such as cryoprecipitate belong in our resuscitation strategies. We set out to define the phenotype and outcomes of those with hypofibrinogenemia and evaluate whether fibrinogen replacement should have a role in the initial administration of massive transfusion.

METHODS: All patients/17-4/21 were reviewed. We then evaluated all patients who received emergency-release and massive transfusion protocol (MTP) products. Patients were defined as hypofibrinogenemic (HYPOFIB) if admission fibrinogen(r-TEG) angleHYPOFIB, the impact on outcomes, and whether early replacement improved mortality. …

Quadricuspid Aortic Valve With Guarded Left Coronary Artery Ostium In An Infant With Myocardial Infarction, Anne Aurelie Tedga, Frank Pigula, Latasha Lewis, Thomas Richard Kimball

Faculty, Staff and Student Publications

• Anatomical variations of the aortic valve include unicuspid, bicuspid, and quadricuspid.
• The bicuspid aortic valve is most common and affects 1%-2% of the general population.
• QAV is generally an isolated malformation, and adults most commonly present with AR.
• Coronary anomalies have been reported in up to 10% of patients with QAV.
• Prompt and accurate imaging will lead to corrective surgery.

Addition Of Aspirin To Venous Thromboembolism Chemoprophylaxis Safely Decreases Venous Thromboembolism Rates In Trauma Patients, Daniel Lammers, Michelle Scerbo, Annamaria Davidson, Matthew Pommerening, Jeffrey Tomasek, Charles E Wade, Jessica Cardenas, Jan Jansen, Charles C Miller, John B Holcomb

Faculty, Staff and Student Publications

Background: Trauma patients exhibit a multifactorial hypercoagulable state and have increased risk of venous thromboembolism (VTE). Despite early and aggressive chemoprophylaxis (CP) with various heparin compounds ("standard" CP; sCP), VTE rates remain high. In high-quality studies, aspirin has been shown to decrease VTE in postoperative elective surgical and orthopedic trauma patients. We hypothesized that inhibiting platelet function with aspirin as an adjunct to sCP would reduce the risk of VTE in trauma patients.

Methods: We performed a retrospective observational study of prospectively collected data from all adult patients admitted to an American College of Surgeons Level I Trauma center from …

Not Just A Pain: A Medical Simulation Case About Biased Communication And Osteomyelitis In Pediatric Sickle Cell Anemia, Adeola A Kosoko, Yakira R Alford, Karl A Upplegger, Gowri S Stevens

Faculty, Staff and Student Publications

Introduction

Biases in communication can be harmful to patient perceptions of care and the medical team's decision-making. Optimal communication must be taught and practiced similarly to the optimal management of the complex medical conditions associated with sickle cell disease (SCD). This simulation is designed to teach about biases, optimizing communication to and about a patient with SCD, and appropriately diagnosing and managing pediatric osteomyelitis as a complication of SCD.

Methods

We designed and implemented a simulation case targeting emergency medicine residents and fellows to raise awareness about biases associated with SCD care and the complication of osteomyelitis in children with …

Good Outcome Associated With Blood-Brain Barrier Disruption And Lower Blood Pressure After Endovascular Therapy, Parth Upadhyaya, Amit Mehta, Marie Luby, Saeed Ansari, John K Lynch, Amie W Hsia, Lawrence L Latour, Yongwoo Kim

Faculty, Staff and Student Publications

OBJECTIVES: To evaluate the association between post-endovascular thrombectomy (EVT) blood-brain barrier (BBB) disruption on MRI or CT and average systolic blood pressure (SBP) with favorable 90-day functional outcome. Observational studies have found elevated SBP associated with worse outcomes post-EVT, while recent randomized trials found no difference in targeted BP reduction. There may be a subgroup of patients who benefit from targeted BP reduction post-EVT.

METHODS: This is a single-center study of 1) anterior large vessel occlusion stroke patients treated with EVT from 2015 to 2021, 2) achieved mTICI grade 2b or 3. Hyperintense acute reperfusion marker (HARM), hemorrhagic transformation (HT), …

Case Report: Navigating The Challenges: Successful Mechanical Thrombectomy In A Case Of Persistent Primitive Hypoglossal Artery, Kamran Ahmed Khan, Irfan Amjad Lutfi, Jehangir Ali Shah, Salman Farooq, Shahnoor Ahmed, Bashir Ahmed Solangi, Ayan Ahmed Khan, Fazal Zaidi, Ali Ammar, Nadeem Qamar

Faculty, Staff and Student Publications

Persistent primitive hypoglossal artery (PPHA) is a highly uncommon abnormal connection between the internal carotid artery (ICA) and vertebral artery (VA), with reported incidences ranging from 0.027 to 0.26%. Attempting endovascular intervention in such cases presents a considerable challenge as it carries a higher risk of embolization and other procedure-related complications that may affect a wide area of the brain. We present a case study involving the utilization of mechanical thrombectomy (MT) to treat an ischemic stroke in the M1 segment of the middle cerebral artery (MCA) despite the presence of PPHA. Performing mechanical thrombectomy in an anomalous vascular connection …

Development And Validation Of Early Death Risk Score Model For Emergency Status Prediction In Very Severe Aplastic Anemia, Xu Liu, Wenrui Yang, Li Zhang, Liping Jing, Lei Ye, Kang Zhou, Yuan Li, Jianping Li, Huihui Fan, Yang Yang, Youzhen Xiong, Xin Zhao, Fengkui Zhang

Faculty, Staff and Student Publications

This study developed and validated the Early Death Risk Score Model for early identification of emergency patients with very severe aplastic anemia (VSAA). All 377 patients with VSAA receiving first-line immunosuppressive therapy (IST) were categorized into training (n=252) and validation (n=125) cohorts. In the training cohort, age >24 years, absolute neutrophil count ≤0.015×109/L, serum ferritin >900ng/mL and times of fever before IST >1 time were significantly associated with early death. Covariates were assigned scores and categorized as: low (score 0-4), medium (score 5-7) and high (score ≥8) risk. Early death rate was significantly different between risk groups and the validation …

Strengthening Deep-Learning Models For Intracranial Hemorrhage Detection: Strongly Annotated Computed Tomography Images And Model Ensembles, Dong-Wan Kang, Gi-Hun Park, Wi-Sun Ryu, Dawid Schellingerhout, Museong Kim, Yong Soo Kim, Chan-Young Park, Keon-Joo Lee, Moon-Ku Han, Han-Gil Jeong, Dong-Eog Kim

Faculty, Staff and Student Publications

BACKGROUND AND PURPOSE: Multiple attempts at intracranial hemorrhage (ICH) detection using deep-learning techniques have been plagued by clinical failures. We aimed to compare the performance of a deep-learning algorithm for ICH detection trained on strongly and weakly annotated datasets, and to assess whether a weighted ensemble model that integrates separate models trained using datasets with different ICH improves performance.

METHODS: We used brain CT scans from the Radiological Society of North America (27,861 CT scans, 3,528 ICHs) and AI-Hub (53,045 CT scans, 7,013 ICHs) for training. DenseNet121, InceptionResNetV2, MobileNetV2, and VGG19 were trained on strongly and weakly annotated datasets and …