Hemorrhage General

Dog or monkey (a) MTD, the maximum tolerated dose, determined with 2-4 animals at each dose level, spaced by twofold increments. In all instances individual doses which killed 0 and 100% were used. The highest dose killing 0% was considered the MTD (b) dose-related, hematopoietic effects, localized gastrointestinal hemorrhages, generalized hemorrhagic lesions, stimulation of the central nervous system, others. 

Clinically, GM-CSF or G-CSF have been used to accelerate recovery after chemotherapy and total body or extended field irradiation, situations that cause neutropenia and decreased platelets, and possibly lead to fatal septic infection or diffuse hemorrhage, respectively. G-CSF and GM-CSF reproducibly decrease the period of granulocytopenia, the number of infectious episodes, and the length of hospitalization in such patients (152), although it is not clear that dose escalation of the cytotoxic agent and increased cure rate can be rehably achieved. One aspect of the effects of G-CSF and GM-CSF is that these agents can activate mature cells to function more efficiently. This may, however, also lead to the production of cytokines, such as TNF- a, that have some toxic side effects. In general, both cytokines are reasonably well tolerated. The side effect profile of G-CSF is more favorable than that of GM-CSF. Medullary bone pain is the only common toxicity. 

Stroke. A general term commonly used to denote a sudden paralysis resulting from a cerebral hemorrhage. 

Generally, the major adverse effects associated with colloids are fluid overload, dilutional coagulopathy, and anaphy-lactoid/anaphylactic reactions.24,32 Although derived from pooled human plasma, there is no risk of disease transmission from commercially available albumin or PPF products since they are heated and sterilized by ultrafiltration prior to distribution.24 Because of direct effects on the coagulation system with the hydroxyethyl starch and dextran products, they should be used cautiously in hemorrhagic shock patients. This is another reason why crystalloids maybe preferred in hemorrhagic shock. Furthermore, hetastarch can result in an increase in amylase not associated with pancreatitis. As such, the adverse-effect profiles of the various fluid types should also be considered when selecting a resuscitation fluid. 

Disseminated intravascular coagulation is common in AML M3 and is associated with generalized bleeding or hemorrhage. 

Platelet transfusions are used to prevent hemorrhage. Patients with uncomplicated thrombocytopenia can be transfused when the platelet count falls below 10,000/pL (10 x 109/L). Patients who are either highly febrile or actively bleeding may require transfusions at higher levels. Red blood cell transfusions generally are not necessary for a hemoglobin concentration greater than 8 g/dL (80 g/L, 4.96 mmol/L). 

Postmortem findings include edema in the periorbital tissue, neck muscles, ligamentum nuchae, intermuscular and lungs hemorrhage of the tongue, intestinal serosa, kidneys, and pericardium and general subcutaneous edema and hemorrhage. 

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