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Caimi G, Presti RL, Mancuso S, Siragusa S, Carlisi M. Erythrocyte deformability profile evaluated by laser diffractometry in patients with multiple myeloma: Re-examination of our cases. Microvasc Res 2023; 146:104473. [PMID: 36587651 DOI: 10.1016/j.mvr.2022.104473] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/26/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Multiple myeloma is a complex pathology which represents about 10 % of all hematological neoplasms. It can often present changes in the hemorheological profile and, in relation to this last topic, our aim is to evaluate the hemorheological profile in a group of multiple myeloma patients, with reference to erythrocyte deformability. METHODS We have examined the profile of the erythrocyte deformability in multiple myeloma enrolling 29 patients; this profile, expressed as elongation index at several shear stress, has been obtained using the diffractometric method. RESULTS By comparing normal controls and MM patients, a significant decrease in erythrocyte deformability, especially at low shear stresses, but we did not observe any significant differences about this profile subdividing the whole group of MM patients according to the degree of bone marrow plasma cell infiltration, to the red blood cell distribution width and to the serum values of LDH. CONCLUSIONS In this paper we have taken in consideration all the hypothesis for a possible explanation of the behaviour of this a reduced erythrocyte deformability in multiple myeloma. Erythrocyte deformability interferes with the physiological release of oxygen to tissues, with several clinical implications.
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Affiliation(s)
- Gregorio Caimi
- Department of Health Promotion and Child Care, Internal Medicine and Medical Specialties, Università degli Studi di Palermo, Palermo, Italy.
| | - Rosalia Lo Presti
- Department of Psychology, Educational Science and Human Movement, Università degli Studi di Palermo, Palermo, Italy
| | - Salvatrice Mancuso
- Department of Health Promotion and Child Care, Internal Medicine and Medical Specialties, Università degli Studi di Palermo, Palermo, Italy
| | - Sergio Siragusa
- Department of Health Promotion and Child Care, Internal Medicine and Medical Specialties, Università degli Studi di Palermo, Palermo, Italy
| | - Melania Carlisi
- Department of Health Promotion and Child Care, Internal Medicine and Medical Specialties, Università degli Studi di Palermo, Palermo, Italy
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Balbuena-Merle R, West FB, Tormey CA, Hendrickson JE. Fatal acute hemolytic transfusion reaction due to anti-B from a platelet apheresis unit stored in platelet additive solution. Transfusion 2019; 59:1911-1915. [PMID: 30865314 DOI: 10.1111/trf.15240] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 02/20/2019] [Accepted: 02/21/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hemolytic transfusion reactions from out-of-group plasma in platelet (PLT) transfusions are uncommon, with most involving passive transfer of anti-A. Only rare reactions have ever been reported due to anti-B. STUDY DESIGN AND METHODS An apheresis PLT product was donated by a blood group O male, processed using PLT additive solution, and pathogen reduced. Postreaction recipient testing included an antibody screen using gel technology, a direct antiglobulin test (DAT) using immunoglobulin G and C3, and an eluate against group O and B cells. Postreaction donor testing included measuring anti-B titers in saline, with and without anti-human globulin. RESULTS A 60-year-old blood group B patient with relapsed acute myeloid leukemia developed confusion, fever, and hypotension within hours after a blood group O PLT transfusion. The posttransfusion reaction evaluation was remarkable for a positive DAT 3+ for C3; the eluate showed anti-B. Rapid extravascular hemolysis occurred, with a 50% decline in hemoglobin, a high lactate dehydrogenase, and a high bilirubin. She was resuscitated with fluids, blood products, pressors, and oxygen and died of asystole 60 hours later. The donor's anti-B titers were 128 by tube testing at immediate spin and 512 at the anti-human globulin phase. Notably, a group B patient at a different hospital received a split of the same apheresis unit, with no reaction. CONCLUSION To our knowledge, this is the first fatality reported from passively transfused anti-B. The fact that one transfusion recipient died whereas another did not have any reported reaction highlights the potential importance of recipient variables in isohemagglutinin-mediated hemolysis.
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Affiliation(s)
- Raisa Balbuena-Merle
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut
| | | | - Christopher A Tormey
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut.,Pathology & Laboratory Medicine Service, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Jeanne E Hendrickson
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut.,Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
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Caimi G, Carlisi M, Montana M, Gallà E, Hopps E, Lo Presti R, Siragusa S. Red blood cell deformability in multiple myeloma1. Clin Hemorheol Microcirc 2018; 69:233-238. [DOI: 10.3233/ch-189121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Gregorio Caimi
- Dipartmento Biomedico di Medicina Interna e Specialistica, Università degli Studi di Palermo, Italy
| | - Melania Carlisi
- Dipartmento Biomedico di Medicina Interna e Specialistica, Università degli Studi di Palermo, Italy
| | - Maria Montana
- Dipartmento Biomedico di Medicina Interna e Specialistica, Università degli Studi di Palermo, Italy
| | - Eleonora Gallà
- Dipartmento Biomedico di Medicina Interna e Specialistica, Università degli Studi di Palermo, Italy
| | - Eugenia Hopps
- Dipartmento Biomedico di Medicina Interna e Specialistica, Università degli Studi di Palermo, Italy
| | - Rosalia Lo Presti
- Dipartmento Biomedico di Medicina Interna e Specialistica, Università degli Studi di Palermo, Italy
| | - Sergio Siragusa
- Dipartmento Biomedico di Medicina Interna e Specialistica, Università degli Studi di Palermo, Italy
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Caimi G, Hopps E, Carlisi M, Montana M, Gallà E, Lo Presti R, Siragusa S. Hemorheological parameters in Monoclonal Gammopathy of Undetermined Significance (MGUS). Clin Hemorheol Microcirc 2018; 68:51-59. [DOI: 10.3233/ch-170289] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- G. Caimi
- Dipartimento Biomedico di Medicina Interna e Specialistica, Università di Palermo, Palermo, Italy
| | - E. Hopps
- Dipartimento Biomedico di Medicina Interna e Specialistica, Università di Palermo, Palermo, Italy
| | - M. Carlisi
- Dipartimento Biomedico di Medicina Interna e Specialistica, Università di Palermo, Palermo, Italy
| | - M. Montana
- Dipartimento Biomedico di Medicina Interna e Specialistica, Università di Palermo, Palermo, Italy
| | - E. Gallà
- Dipartimento Biomedico di Medicina Interna e Specialistica, Università di Palermo, Palermo, Italy
| | - R. Lo Presti
- Dipartimento di Scienze Psicologiche, Pedagogiche e della Formazione, Università di Palermo, Palermo, Italy
| | - S. Siragusa
- Dipartimento Biomedico di Medicina Interna e Specialistica, Università di Palermo, Palermo, Italy
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Caimi G, Carlisi M, Urso C, Lo Presti R, Hopps E. Clinical disorders responsible for plasma hyperviscosity and skin complications. Eur J Intern Med 2017; 42:24-28. [PMID: 28390781 DOI: 10.1016/j.ejim.2017.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 03/30/2017] [Accepted: 04/03/2017] [Indexed: 12/17/2022]
Abstract
In this brief review, we have examined some clinical disorders which are associated to an altered hemorheological profile and at times accompanied by skin ulcers. This skin condition may be, in fact, observed in patients with primary plasma hyperviscosity such as multiple myeloma, Waldenstrom macroglobulinemia, cryoglobulinemia, cryofibrinogenemia, dysfibrinogenemia and connective tissue diseases. It must be underlined that the altered hemorheological pattern is not the only responsible for this skin complication but, as it worsens the microcirculatory flow, it contributes to determine the occurrence of the skin ulcers.
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Affiliation(s)
- Gregorio Caimi
- Dipartimento Biomedico di Medicina Interna e Specialistica, Università di Palermo, Italy.
| | - Melania Carlisi
- Dipartimento Biomedico di Medicina Interna e Specialistica, Università di Palermo, Italy
| | - Caterina Urso
- Dipartimento Biomedico di Medicina Interna e Specialistica, Università di Palermo, Italy
| | - Rosalia Lo Presti
- Dipartimento Biomedico di Medicina Interna e Specialistica, Università di Palermo, Italy
| | - Eugenia Hopps
- Dipartimento Biomedico di Medicina Interna e Specialistica, Università di Palermo, Italy
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Asimakopoulos JV, Terpos E, Papageorgiou L, Kampouropoulou O, Christoulas D, Giakoumis A, Samarkos M, Vaiopoulos G, Konstantopoulos K, Angelopoulou MK, Vassilakopoulos TP, Meletis J. The presence of CD55- and/or CD59-deficient erythrocytic populations in patients with rheumatic diseases reflects an immune-mediated bone-marrow derived phenomenon. Med Sci Monit 2014; 20:123-39. [PMID: 24463881 PMCID: PMC3915003 DOI: 10.12659/msm.889727] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Complement has the potential to provoke severe impairment to host tissues, as shown in autoimmune diseases where complement activation has been associated with diminished CD55 and/or CD59 expression on peripheral blood cell membranes. The aim of this study was to evaluate the presence of CD55- and/or CD59-deficient erythrocytic populations in patients with different rheumatic diseases and to investigate possible correlations with clinical or laboratory parameters. Material/Methods CD55 and CD59 expression was evaluated in erythrocytes of 113 patients with rheumatic diseases, 121 normal individuals, and 10 patients with paroxysmal nocturnal hemoglobinuria (PNH) using the Sephacryl gel microtyping system. Ham and sucrose tests were also performed. Results Interestingly, the majority of patients (104/113, 92%) demonstrated CD55- and/or CD59-deficient erythrocytes: 47 (41.6%) with concomitant deficiency of CD55 and CD59, 50 (44.2%) with isolated deficiency of CD55, and 6 (6.2%) with isolated deficiency of CD59. In normal individuals, only 2 (1%) had concomitant CD55/CD59 negativity and 3 (2%) had isolated CD55 or CD59 deficiency. All PNH patients exhibited simultaneous CD55/CD59 deficiency. Positive Ham and sucrose tests were found only in PNH patients. There was no association between the CD55- and/or CD59-deficient erythrocytes and hemocytopenias or undergoing treatment. However, CD55 expression significantly influenced hemoglobin values (F=6.092, p=0.015). Conclusions This study provides evidence supporting the presence of erythrocytes with CD55 and/or CD59 deficiency in patients with rheumatic diseases. Moreover, CD55 deficiency on red cells influences hemoglobin concentration. Further studies using molecular techniques will clarify the exact pathophysiological mechanisms of this deficiency.
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Affiliation(s)
- John V Asimakopoulos
- Department of Hematology and Bone Marrow Transplantation Unit, National and Kapodistrian University of Athens, School of Medicine, "Laiko" General Hospital, Athens, Greece
| | - Evangelos Terpos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, "Alexandra" General Hospital, Athens, Greece
| | - Loula Papageorgiou
- Department of Hematology and Bone Marrow Transplantation Unit, National and Kapodistrian University of Athens, School of Medicine, "Laiko" General Hospital, Athens, Greece
| | - Olga Kampouropoulou
- 1st Department of Internal Medicine, National and Kapodistrian University of Athens, School of Medicine, "Laiko" General Hospital, Athens, Greece
| | - Dimitris Christoulas
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, "Alexandra" General Hospital, Athens, Greece
| | - Anastasios Giakoumis
- 1st Department of Internal Medicine, National and Kapodistrian University of Athens, School of Medicine, "Laiko" General Hospital, Athens, Greece
| | - Michael Samarkos
- 1st Department of Internal Medicine, National and Kapodistrian University of Athens, School of Medicine, "Laiko" General Hospital, Athens, Greece
| | - George Vaiopoulos
- 1st Department of Internal Medicine, National and Kapodistrian University of Athens, School of Medicine, "Laiko" General Hospital, Athens, Greece
| | - Konstantinos Konstantopoulos
- Department of Hematology and Bone Marrow Transplantation Unit, National and Kapodistrian University of Athens, School of Medicine, "Laiko" General Hospital, Athens, Greece
| | - Maria K Angelopoulou
- Department of Hematology and Bone Marrow Transplantation Unit, National and Kapodistrian University of Athens, School of Medicine, "Laiko" General Hospital, Athens, Greece
| | - Theodoros P Vassilakopoulos
- Department of Hematology and Bone Marrow Transplantation Unit, National and Kapodistrian University of Athens, School of Medicine, "Laiko" General Hospital, Athens, Greece
| | - John Meletis
- Department of Hematology and Bone Marrow Transplantation Unit, National and Kapodistrian University of Athens, School of Medicine, "Laiko" General Hospital, Athens, Greece
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Canalejo K, Riera Cervantes N, Felippo M, Sarandría C, Aixalá M. Paroxysmal nocturnal haemoglobinuria. Experience over a 10 years period. Int J Lab Hematol 2013; 36:213-21. [PMID: 24188430 DOI: 10.1111/ijlh.12156] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 09/09/2013] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Paroxysmal nocturnal hemoglobinuria (PNH) is a hemolytic, clonal and acquired disorder of the hematopoietic stem cell with a deficiency of all glycophosphatidyl-inositol (GPI) linked proteins. The aim of this retrospective study was to analyse haematological and biochemical data from 152 patients referred to our laboratory for diagnosis of PNH by flow cytometry (FC). METHODS Patients and healthy donor (152 and 99 respectively) were studied. Ham, sucrose, lactate dehydrogenase (LDH), Iron, haptoglobin (Hp), blood cell morphology and Kaplow cytochemical stain for leukocyte alkaline phosphatase (LAP) were carried out. GPI-proteins anti-CD55 and CD59 in erythrocytes and the former, plus anti CD16b and CD66b on neutrophils were evaluated by FC. RESULTS Anemia and/or leukopenia and/or thrombocytopenia, increased reticulocyte count and LDH were observed in patients with PNH clone. Some of them had dacriocytes, schistocytes. LAP was low. On average, we detected 50% CD59 (-) erythrocytes and 29, 83, 78% CD55/59 (-), CD16b (-), CD66b (-) neutrophils, respectively. CONCLUSION Paroxysmal nocturnal hemoglobinuria clone was detected in 20/152 patients. Negative population's percentages were high in patients with classic PNH, Hematimetry, LAP and adequate use of CF contribute to PNH clone detection in the laboratory.
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Affiliation(s)
- K Canalejo
- Apoyo Médico, Instituto de Investigaciones Hematológicas, Academia Nacional de Medicina, Buenos Aires, Argentina
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Majumder D, Banerjee D, Chandra S, Banerjee S, Chakrabarti A. Red cell morphology in leukemia, hypoplastic anemia and myelodysplastic syndrome. ACTA ACUST UNITED AC 2006; 13:217-25. [PMID: 16876391 DOI: 10.1016/j.pathophys.2006.06.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2006] [Revised: 06/20/2006] [Accepted: 06/23/2006] [Indexed: 11/24/2022]
Abstract
Leukemic patients of different classifications are associated with anemia. Such clinical conditions are often referred to as refractory anemia, paraoxymal nocturnal hemoglobinuria, hemolytic uremia and autoimmune hemolytic anemia, all of which could be categorized as the cancer cachexia. In the present work, we have studied the overall morphology of intact red cells in different leukemic patients along with patients of hypoplastic anemia (HPA) by scanning electron microscopy. We have also studied the ultrastructure of the red cell surface membranes by transmission electron microscopy. For all experiments, erythrocytes from normal individuals served as controls. We have shown direct evidence of the altered red cell (RBC) membrane morphology irrespective of the hemoglobin status of the patients which includes (1) presence of large central holes in RBCs of acute myeloid leukemia (AML), (2) presence of thorn- and horn-like structure in RBCs of acute lymphoblastic leukemia (ALL) and chronic myeloid leukemia (CML) and (3) flaccid appearance of RBCs in chronic lymphocytic leukemia (CLL) patients. A mixture of the above mentioned structures were found in the red cells of patients suffering from myelodysplastic syndrome (MDS) and in case of patients of HPA the RBCs lost the normal biconcave structures. TEM studies revealed presence of pores with diameters ranging from 100 to 200nm on the RBC membrane surface of myeloid leukemia with AML being the most prominent among others. Such pathophysiological alterations of the RBC morphology in leukemic patients could be identified as characteristic signature of the onset of anemia associated with the disease.
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Affiliation(s)
- Durjoy Majumder
- Biophysics Division, Structural Genomics Section, Saha Institute of Nuclear Physics, 1/AF Bidhannagar, Kolkata 700064, India
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Parker C, Omine M, Richards S, Nishimura JI, Bessler M, Ware R, Hillmen P, Luzzatto L, Young N, Kinoshita T, Rosse W, Socié G. Diagnosis and management of paroxysmal nocturnal hemoglobinuria. Blood 2005; 106:3699-709. [PMID: 16051736 PMCID: PMC1895106 DOI: 10.1182/blood-2005-04-1717] [Citation(s) in RCA: 489] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Charles Parker
- Division of Hematology, University of Utah School of Medicine and Hematology/Oncology Section (111H), George E. Whalen VA Medical Center, Salt Lake City, UT 84148, USA.
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Shaheen SP, Talwalkar SS, Simons R, Yam L. Acute Lymphoblastic Leukemic Transformation in a Patient With Chronic Idiopathic Myelofibrosis and Paroxysmal Nocturnal Hemoglobinuria: A Case Report and Review of the Literature. Arch Pathol Lab Med 2005; 129:96-9. [DOI: 10.5858/2005-129-96-alltia] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Leukemic transformation of chronic idiopathic myelofibrosis (CIMF) to acute lymphoblastic leukemia (ALL) is rare. We report a case of a patient with CIMF who developed paroxysmal nocturnal hemoglobinuria (PNH) 2 years after initial presentation. His disease eventually transformed to ALL of precursor B-cell type. In that CIMF and PNH are clonal stem cell disorders with different pathogeneses, there may be an association between them. However, leukemic transformation is a rare sequel of both disorders. Coexistence of CIMF and PNH and subsequent transformation to ALL have, to our knowledge, never been previously reported in the world literature. The simultaneous presentation of CIMF and PNH, complicated by the rare sequela of leukemic transformation, raises important issues with regard to diagnosis and treatment.
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Affiliation(s)
- Saad Paul Shaheen
- From the Departments of Pathology and Laboratory Medicine (Drs Shaheen and Talwalkar), Medicine (Dr Simons), and Medicine/Hematology (Dr Yam), University of Louisville, Louisville, Ky
| | - Sameer S. Talwalkar
- From the Departments of Pathology and Laboratory Medicine (Drs Shaheen and Talwalkar), Medicine (Dr Simons), and Medicine/Hematology (Dr Yam), University of Louisville, Louisville, Ky
| | - Ruth Simons
- From the Departments of Pathology and Laboratory Medicine (Drs Shaheen and Talwalkar), Medicine (Dr Simons), and Medicine/Hematology (Dr Yam), University of Louisville, Louisville, Ky
| | - Lung Yam
- From the Departments of Pathology and Laboratory Medicine (Drs Shaheen and Talwalkar), Medicine (Dr Simons), and Medicine/Hematology (Dr Yam), University of Louisville, Louisville, Ky
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Terpos E, Samarkos M, Meletis C, Apostolidou E, Tsironi M, Korovesis K, Mavrogianni D, Viniou N, Meletis J. Unusual association between increased bone resorption and presence of paroxysmal nocturnal hemoglobinuria phenotype in multiple myeloma. Int J Hematol 2003; 78:344-8. [PMID: 14686493 DOI: 10.1007/bf02983560] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Paroxysmal nocturnal hemoglobinuria (PNH) clones deficient in glycosylphosphatidylinositol-anchored molecules, including CD55 and CD59, have been previously described in patients with multiple myeloma (MM). The aim of this study was to investigate the possible association between existence of the PNH phenotype and myeloma bone disease. Forty-three patients with newly diagnosed MM were the subjects of the study. Radiographic evaluation of the skeleton was performed in all patients at diagnosis. The following biochemical markers were measured: bone resorption markers (tartrate-resistant acid phosphatase isoform 5b [TRACP-5b]and N-terminal cross-linking telopeptide of type-I collagen [NTX]), bone formation markers (bone alkaline phosphatase [bALP] and osteocalcin [OC]), osteoprotegerin (OPG), soluble receptor activator of nuclear factor KB ligand (sRANKL), and interleukin 6 (IL-6). Detection of CD55- and/or CD59-deficient red cell populations was performed after diagnosis. Patients with MM had elevated mean baseline NTX, TRACP-5b, sRANKL, and IL-6 levels compared with controls, whereas the mean values of bALP, OC, and OPG were significantly decreased. Four patients had no osteolytic lesions, whereas 8 patients had 1 to 3 lytic lesions, and 31 patients had more than 3 lytic lesions and/or pathologic fractures in the skeletal survey. CD55- and/or CD59-deficient red cell populations were observed in 56% of patients with MM. There was a strong correlation between the presence of PNH-like erythrocytes and increased bone resorption, as measured by NTX, TRACP-5b, and sRANKL/OPG ratio (P < .03, P < .02, and P < .02, respectively). There was also a significant correlation between PNH phenotype and severe bone disease (P < .02). These results suggest that there is a possible link between PNH phenotype and increased osteoclastic activity in MM owing to a potential effect of myeloma microenvironment on a preexisting PNH clone. Further studies are required for clarifying this phenomenon and investigating possible mechanisms of this unusual association.
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Affiliation(s)
- Evangelos Terpos
- Department of Hematology, 251 General Air Force Hospital, Athens, Greece.
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