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Browsing by Author "Berquist, Margaret"
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Item Type B Lactic Acidosis in a Patient with Mantle Cell Lymphoma(Hindawi, 2023-08-16) Nzenwa, Ikemsinachi C.; Berquist, Margaret; Brenner, Toby J.; Ansari, Aida; Al-Fadhl, Hamid D.; Aboukhaled, Michael; Patel, Shivani S.; Peck, Ethan E.; Al-Fadhl, Mahmoud D.; Thomas, Anthony V.; Zackariya, Nuha; Walsh, Mark M.; Bufill, Jose A.; Medicine, School of MedicineType B lactic acidosis is an uncommon medical emergency in which acid production overwhelms hepatic clearance. This specific etiology of lactic acidosis occurs without organ hypoperfusion and has been most commonly described in patients with hematologic malignancies but also in patients with solid tumors. The mechanism by which cancer cells switch their glucose metabolism toward increasingly anaerobic glycolytic phenotypes has been described as the "Warburg effect." Without treating the underlying malignancy, the prognosis for patients diagnosed with malignancy-related type B lactic acidosis is extremely poor. Here, we present a case of a 66-year-old male who was diagnosed with type B lactic acidosis secondary to mantle cell lymphoma. Bicarbonate drip was started to correct the lactic acidosis. The patient was also immediately treated with rituximab chemotherapy combined with rasburicase to avoid the hyperuricemia associated with tumor lysis syndrome. He responded to the early treatment and was discharged with normal renal function. Type B lactic acidosis secondary to hematologic malignancy is important to recognize. In order to successfully treat this syndrome, early diagnosis and simultaneous treatment of the imbalance of lactic acid levels and the underlying malignancy are necessary.Item Viscoelastic Hemostatic Assays for Postpartum Hemorrhage(MDPI, 2021-08-31) Liew-Spilger, Alyson E.; Sorg, Nikki R.; Brenner, Toby J.; Langford, Jack H.; Berquist, Margaret; Mark, Natalie M.; Moore, Spencer H.; Mark, Julie; Baumgartner, Sara; Abernathy, Mary P.; Obstetrics and Gynecology, School of MedicineThis article discusses the importance and effectiveness of viscoelastic hemostatic assays (VHAs) in assessing hemostatic competence and guiding blood component therapy (BCT) in patients with postpartum hemorrhage (PPH). In recent years, VHAs such as thromboelastography and rotational thromboelastometry have increasingly been used to guide BCT, hemostatic adjunctive therapy and prohemostatic agents in PPH. The three pillars of identifying hemostatic competence include clinical observation, common coagulation tests, and VHAs. VHAs are advantageous because they assess the cumulative contribution of all components of the blood throughout the entire formation of a clot, have fast turnaround times, and are point-of-care tests that can be followed serially. Despite these advantages, VHAs are underused due to poor understanding of correct technique and result interpretation, a paucity of widespread standardization, and a lack of large clinical trials. These VHAs can also be used in cases of uterine atony, preeclampsia, acute fatty liver of pregnancy, amniotic fluid embolism, placental abruption, genital tract trauma, surgical trauma, and inherited and prepartum acquired coagulopathies. There exists an immediate need for a point-of-care test that can equip obstetricians with rapid results on developing coagulopathic states. The use of VHAs in predicting and treating PPH, although in an incipient state, can fulfill this need.