Syndrome of heaptitis and aplastic anemia

Acute and Sub-acute Oral Toxicity Assessment of Ferrum phosphoricum in Rats

BACKGROUND

 Ferrum phosphoricum (FP) has been used by traditional medicine practitioners for various ailments since ancient times. However, scientific evidence on the safety of FP is still unavailable. Thus, the current study aimed to investigate the acute and sub-acute oral toxicity of homeopathic FP in experimental rats.

METHODS

 In an acute toxicity investigation, a single dose of 2,000 µL/kg of FP 6c, 30c and 200c was administered to female Wistar rats, which were monitored for up to 14 days according to the Organization for Economic Cooperation and Development (OECD) guideline 423. For a sub-acute toxicity study, FP 6c, 30c and 200c (200 µL/kg) were administered to male and female rats for 28 days as per the OECD guideline 407. All the animals were observed for mortality, clinical signs and body weight during the study. At the end of the experiment, hematological, biochemical and histopathological assessments were performed.

RESULTS

 During the acute toxicity study, no mortality was observed in rats administered with FP, and thus the median lethal dose (LD50) was identified as >2,000 µL/kg. In the sub-acute study, no mortality or adverse clinical signs were noticed with FP treatment. Moreover, weekly body weight gain was normal. Hematological and biochemical investigations revealed no abnormalities. Furthermore, histological analysis of FP-treated rats' vital organs revealed no pathological changes.

CONCLUSION

 Overall, our findings imply that FP 6c, 30c and 200c potencies are safe and do not cause toxicity when given orally to Wistar albino rats for an extended period at a dose of 200 µL/kg.

Acute and Subacute Toxicity Assessment of Oxyclozanide in Wistar Rats

Oxyclozanide is an effective anthelmintic and has shown good properties in other ways including anti-adenovirus, anti-biofilm, antifungal, and antibacterial activity. This study aimed to investigate the acute and subacute 28-days repeated dose oral toxicity of an oxyclozanide suspension in Wistar rats. A high oral lethal dose (LD₅₀) of 3,707 mg/kg was observed in the acute toxicity test. During the 28-days time period, no obvious adverse effects or death were detected. Histopathological changes were observed in the heart, liver, and kidney of animals treated with high dose of oxyclozanide. Based on the hematological parameters, there were no statistical differences between the oxyclozanide-treated group and the control group. For biochemistry assays, ALP, AST, GLU, TBIL, GLO, TG, BUN, UA, LDH, and CK were statistically changed in the treatment groups. These data suggested that the LD₅₀ of oxyclozanide was ~3,707 mg/kg body weight (BW), and the lowest observed adverse effect level (LOAEL) of oxyclozanide was at a dose of 74 mg/kg in rats.

Acute hepatitis A induction of precursor B-cell acute lymphoblastic leukemia: a causal relationship?

Background

Precursor B-cell acute lymphoblastic leukemia accounts for 2% of all lymphoid neoplasms in the United States and occurs most frequently in childhood, but can also occur in adults with a median age of 39 years. It is more commonly seen in males and in Caucasians.

Case Report

We present a case of a 51-year-old Caucasian female with the development of precursor B-cell acute lymphoblastic leukemia after suffering acute hepatitis A 4 weeks prior to her diagnosis. She presented with malaise for a month without spontaneous bruising/bleeding, infections, or B-symptoms, such as fevers, night sweats, or unintentional weight loss.

Conclusion

Nonspecific viral transformation of bone marrow has been discussed in the literature, but we specifically describe hepatitis A-induced adult-onset precursor B-cell acute lymphoblastic leukemia, which is the first reported case in the literature.

Successful bone marrow transplant and re-growth of hair in a patient with posthepatic aplastic anemia complicated by alopecia totalis

Bone marrow transplant was performed in a child with posthepatic aplastic anemia complicated by alopecia totalis. The procedure was successful, as the graft was apparently "taken" by the recipient and hair started to grow on the head. The hair has not been lost since, and is still growing as of the date of this report. Although nonA nonB hepatitis virus was found to be the cause of hepatitis in this patient, the reason for the alopecia totalis which developed 7 years previously is unclear. The postoperative growth of the hair was attributed to restoration of normal immunologic function through bone marrow transplant.

Hepatitis-associated aplastic anemia with systemic plasmacytosis

An autopsy case of hepatitis associated aplastic anemia was presented. A 58-year-old Japanese female with non-A, non-B hepatitis was admitted on August 2, 1983. Moderate grade of fever and hemorrhagic diathesis appeared on September 16, when hepatitis was evaluated as being under resolving. The peripheral blood and bone marrow findings were consistent with aplastic anemia. Since infection was suggested by increased levels of serum gammaglobulin and CRP, treatment with antibiotics as well as prednisolone and blood transfusion was initiated. Since September 21, gradual tenderness and edema on the right lower abdominal wall appeared. She died on October 3. On postmortem examination, systemic plasmacytosis with lymphadenopathy and septic monilial infection was revealed. Numerous plasma cells were atypical, but were immunohistochemically proved to be polyclonal. The bone marrow showed a massive and diffuse plasma cell proliferation with extremely scarce myeloid cells and megakaryocytes. There was a large granulomatous lesion with monilial infection in the wall of the ileocecum. By these findings, systemic plasmacytosis was suspected to be due to chronic monilial infection. The pathogenesis of systemic plasmacytosis in aplastic anemias and in other diseases were discussed with relation to the present case.

Adverse prognostic influence of hepatitis B virus infection in acute lymphoblastic leukemia

Liver function test abnormalities were examined in a retrospective survey in a population of 90 children with acute lymphoblastic leukemia (ALL) treated in a similar fashion with therapy, using primarily methotrexate, mercaptopurine, vincristine, and prednisone. A twofold or greater elevation of serum glutamyl pyruvic transaminase (SGPT) was found in 80% of the patients during induction therapy, in 63% of the patients during maintenance therapy, and 31% of the patients who completed therapy. Circulating hepatitis B virus surface antigen (HBsAg) was noted in 26% of patients with liver function test abnormalities during maintenance therapy, and 45% of patients with liver function test abnormalities after the completion of therapy. Hepatitis B virus infection was therefore, the most important single cause of abnormal liver function during remission in our patient population. Though others have asserted that hepatitis B virus infection is relatively benign in immunosuppressed individuals, in our population, this agent often caused severe pathological and clinical sequelae. This may be related to the high frequency (50%) of co-infection with the delta agent in our HBsAg-positive patients. Furthermore, hepatitis B virus surface antigenemia conferred an adverse prognostic influence for these children in terms of their leukemia-free survival.

Posttransfusion hepatitis in acute nonlymphocytic leukemia: lack of a beneficial influence

Thirty-five patients with acute nonlymphocytic leukemia (ANNL) entered complete remission (CR) and survived 16 weeks following induction therapy with high-dose timed sequential chemotherapy without maintenance therapy. These patients were analyzed to test the hypothesis that acute posttransfusion hepatitis (APTH) has a beneficial influence on the course of ANNL. Ten patients developed evidence of APTH while 25 did not. Median length of CR was 22 weeks for both groups while median survival was longer in patients not developing APTH (75 weeks vs 58 weeks) (P greater than 0.5). Possible explanations for the discrepancy between these results and those previously reported are discussed.

Virus-associated hemophagocytic syndrome: a benign histiocytic proliferation distinct from malignant histiocytosis

Nineteen patients whose bone marrow smears showed histiocytic hyperplasia with prominent hemophagocytosis were found to have a clinicopathologic syndrome associated with active viral infection. High fever, constitutional symptoms, liver function, and coagulation abnormalities and peripheral blood cytopenias were characteristic findings. Hepatosplenomegaly, lymphadenopathy, bilateral pulmonary infiltrates, and skin rash were often present. Fourteen of the patients were immunosuppressed. Active infection by herpes group viruses was documented in 14 patients and by adenovirus in 1. The bone marrow of most patients also showed decreased granulopoiesis and erythropoiesis with normal to increased numbers of megakaryocytes. Treatment generally consisted of supportive therapy and withdrawal of immunosuppressive drugs. Thirteen patients recovered. Lymph node biopsy and autopsy material showed generalized histiocytic hyperplasia with hemophagocytosis. The relationship of this disorder to familial hemophagocytic reticulosis, familial erythrophagocytic lymphohistiocytosis, histiocytic medullary reticulosis, and malignant histiocytosis is discussed. Immunosuppressive and cytotoxic therapy may be contraindicated in the treatment of this virus-associated syndrome.

Hypoimmunoglobulinaemia and aplastic anaemia

Serum immunoglobulin levels were estimated in 19 patients with aplastic anaemia. Although the mean levels for IgG, IgA and IgM for the group as a whole were within the normal range, 8 individual cases showed low levels of one or more immunoglobulin class, suggesting a disturbance in immunoglobulin production. One of these patients had a thymoma, and another positive tests for anti-nuclear factor, but there was no evidence of auto-immune disease in the others. It is suggested that 'aplastic anaemia' may sometimes be a disease due to injury of a stem cell subserving both haemopoietic and immunological function.

Persistent haemolysis after infectious hepatitis

Images