Teng Sung Shin, Joyce Lam Ching Mei, 20180903000000
Bleeding disorders in children can be divided into acquired and congenital conditions, with the acquired being far more common than the congenital. Clinical bleeding manifestations can vary in severity. Identifying the root cause early is crucial to control and halt bleeding as well as to prevent the risk of future bleeding in a vulnerable age group. This can be achieved by a thorough and salient history, physical evaluation, and appropriate investigations. This review will describe the common causes of bleeding disorders in children and will suggest an approach to the workup and diagnosis of such disorders.
Thrombocytopenia, defined as a platelet count of less than 150,000/microL, is clinically suspected when there is a history of increased bruising or bleeding, or when there is petechiae noted which is often referred to as a “rash”. Thrombocytopenia is usually asymptomatic until platelet counts fall below 50,000/microL, and may also be detected incidentally in a full blood count (FBC) during routine evaluation of an asymptomatic patient or during investigations performed for other reasons.1
Chronic hepatitis B virus (HBV) infection is a global problem. Chronic
HBV infection is probably the most common maternal infection encountered
in Hong Kong, China, and Southeast Asia. In Hong Kong, which is one of
the endemic areas, immunisation against HBV was first provided in 1983
to infants born to mothers who were screened positive for hepatitis B
surface antigen (HBsAg). Immunisation became widespread since November
1988, but HBsAg-positive mothers are still encountered frequently.1
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Daily use of the selective oral Bruton’s tyrosine kinase inhibitor evobrutinib in the treatment of patients with relapsing multiple sclerosis helps reduce the number of gadolinium-enhancing lesions, according to the results of a phase II trial.
Entecavir and lamivudine demonstrate comparable effects on the mortality rate of patients with chronic hepatitis B virus (HBV)-related acute exacerbation with or without acute-on-chronic liver failure (ACLF), reports a study. In patients with ACLF, however, entecavir delivers a more favourable long-term outcome and is associated with greater clinical improvements.
The combination of emtricitabine and dolutegravir with either a tenofovir alafenamide fumarate (TAF) or tenofovir disoproxil fumarate (TDF)-based regimen fared similarly to a TDF-emtricitabine-efavirenz regimen in reducing HIV-1 RNA levels, according to results of the phase III ADVANCE* study presented at IAS 2019.