A Case of Near Total Rh(D) Expression Loss in a Sickle Cell Patient Following Aplastic Anemia and Development of a Transient Auto-Anti-D

Introduction/Objective

Red blood cell (RBC) antigens are inherited traits and, and their expression is consistent throughout the life of most individuals. Changes in RBC antigen expression rarely occur in association with hematologic malignancies. We report a case of Rh(D) antigen change in a patient with sickle cell disease (HbSS) after developing aplastic anemia (AA).

Methods/Case Report

Patient is a 21-year-old female with HbSS who developed progressively worsening anemia and severe thrombocytopenia over 1 month requiring frequent RBC and platelet transfusions. She was initially treated for idiopathic thrombocytopenic purpura with no significant improvement. Bone marrow examination demonstrated severe AA; additional viral, rheumatological, and hematologic studies were all non-informative. Subsequently, she was treated with corticosteroids, cyclosporin, anti-thymocyte immunoglobin and eltrombopag with minimal improvement. She has been non-compliant with maintenance cyclosporine and continued to be transfusion dependent in the past 2.5 years. She had always strongly typed 4+ Rh(D) positive at immediate spin (IS) before this event, but approximately about 1.5 years after the AA diagnosis her reactions became weaker (2-3+ at IS). She had a short-lived auto-anti-D identified on one occasion which has never been re-identified, but she has had very weak Rh(D) typings since this time with negative reactions at IS and only microscopically positive reactions at the anti-human globulin phase. The same pattern of reaction is present across a variety of commercial anti-D reagents. Molecular analysis reveals a normal RHD*01 hemi- or homozygous allele and no mutations known to cause a weak or partial Rh(D) type. No other antigen change is detected, and her extended phenotype matches a recently obtained genotype. She has been treated as both type O+ and O- in the last year by different facilities and transfused both types of RBCs without incident.

Results (if a Case Study enter NA)

NA.

Conclusion

We believe this is the first reported case of decreased Rh(D) expression following aplastic anemia and a transient auto-anti-D.

Serum Chemerin Concentration Is Associated with Proinflammatory Status in Chronic Coronary Syndrome

Background: Chemerin is an adipokine and a chemoattractant for leukocytes. Increased chemerin levels were observed in patients with coronary artery disease (CAD). We investigated associations between chemerin and biochemical measurements or body composition in CAD patients. Methods: In the study, we included patients with stable CAD who had undergone percutaneous coronary intervention (PCI) in the past. All patients had routine blood tests, and their insulin and chemerin serum levels were routinely measured. Body composition was assessed with the DEXA method. Results: The study group comprised 163 patients (mean age 59.8 ± years, 26% of females, n = 43). There was no significant difference in serum chemerin concentrations between patients with diabetes and the remaining ones: 306.8 ± 121 vs. 274.15 ± 109 pg/mL, p = 0.1. Chemerin correlated positively with the white blood cell (WBC) count, the neutrophil to lymphocyte ratio, hsCRP, all fractions of cholesterol, triglycerides, platelet count, fasting insulin, and c-peptide. Chemerin levels were also correlated with total fat mass but only in a subgroup with normal glucose metabolism. Conclusion: In patients with CAD, serum chemerin levels are correlated with inflammation markers, insulin resistance, and an unfavorable lipid profile. Correlation with fat mass is dependent on glucose metabolism status. Depending on the presence of diabetes/prediabetes, the mechanisms regulating chemerin secretion may be different.

Chemerin in coronary artery disease patients

Background

Chemerin – a recently described hormone is secreted by adipose tissue. It exerts proinflammatory action, leads to insulin resistance, but also has potentially favorable effects: it increases eNOS activity and is pro-angiogenic. Increased serum concentrations of chemerin was observed in patients with coronary artery disease (CAD). The role of chemerin in pathogenesis of CAD is not well understood.

Purpose

The aim of this pilot study was to assess the role of chemerin in pathogenesis of atherosclerosis, its impact on condition of large arteries and prognosis in CAD.

Methods

We included in the study patients with stable CAD who underwent percutaneous coronary intervention (PCI) in the past. Chemerin levels were measured with ELISA method. All patients had routine blood tests and insulin levels measured. Patients without history of diabetes also had OGTT. Status of large arteries was evaluated with carotid ultrasound, pulse-wave velocity (PWV) and ankle-brachial index (ABI). Body composition was assessed wit DEXA method. Anatomical severity of CAD was evaluated with SYNTAX score. One-year composite endpoint included death, myocardial infarction, revascularization, stroke and hospitalization for cardiovascular reasons.

Results

The study group comprised 163 patients (mean age 59.8± years, 26% of females, n=43). Mean chemerin level was 284.8 ng/ml. There was no significant difference in chemerin concentrations between patients with diabetes and remaining ones (with prediabetes and with normal glucose levels) 306.8±121 vs 274.15±109 pg/ml, p=0.1. In Spearman test chemerin level correlated with total fat mass (R=0.15, p=0.047), trunk fat mass (R=0.16, p=0.039), android fat mass (R=0.16, p=0.036), and BMI (R=0.18, p=0.028). Chemerin also correlated with white blood cells (WBC) count (R=0.34, p<0.0001), hsCRP (R=0.16, p=0.03), total cholesterol (R=0.17, p=0.028), LDL cholesterol (R=0.19, p=0.01), HDL cholesterol (R=−0.21, p=0.006), triglicerides (R=0.3, p<0.0001), platelet count (R=0.23, p=0.002), fasting insulin (R=0.22, p=0.004) and c-peptide (R=0.26, p=0.0005). There was no significant difference in chemerin levels between patients with carotid atherosclerosis (n=93) and patients with normal carotid arteries (n=70), (300±124 vs 263±94 ng/ml, p=0.07). There were no significant associations between chemerin levels and PWV, ABI measurements, SYNTAX score, or 1-year prognosis.

Conclusions

This is the first study to show that in patients with CAD chemerin levels correlate with WBC and with android fat tissue mass. Additionally, chemerin levels positively correlated with other inflammation or insulin resistance markers, and with unfavourable lipid profile.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): The National Science Centre

Possible Diagnostic Application of CXCL12 and CXCR4 as Tumor Markers in Breast Cancer Patients

BACKGROUND/AIM

Chemokines are cytokines involved not only in inflammatory but also in inappropriate response of the immune system in breast cancer (BC) progression. We examined the diagnostic usefulness of CXCL12, CXCR4 and CA 15-3 in BC patients, based on ROC curve analysis.

MATERIALS AND METHODS

The study group consisted of 100 patients with BC; the control group consisted of 35 women with benign breast disease and 35 healthy patients. The median concentration of chemokines was measured by ELISA and that of CA 15-3 by chemiluminescent microparticle immunoassay.

RESULTS

The concentrations of CXCL12 and CXCR4 in the BC group were significantly higher than those in the control groups. The AUC value of CXCL12 (0.7502) was the highest of all the chemokines measured in the BC patients.

CONCLUSION

There may be a link between CXCL12, CXCR4 and BC that can assist in the diagnosis, markedly when combined with CA 15-3.

Search of reference biomarkers reflecting orbital tissue remodeling in the course of Graves' orbitopathy

INTRODUCTION

Graves' orbitopathy (GO) is a complication in Graves' disease (GD) that causes disfigurement and sometimes blindness. The pathogenesis of GO remains unknown, while its symptoms demonstrate dependence between the thyroid gland and the orbit. The ongoing inflammatory process in retrobulbar tissue results in its remodeling characterized by increased volume of the orbital contents involving adipose tissue, with fibrosis and adipogenesis as predominant features. This study was aimed at the immunohistochemical verification of potential contribution and correlation between orbital expressions of IGF-1R, CD34, Foxp-3, PPAR-γ and CD4, CD68, TGF-β, FGF-β in severe and mild (long-lasting) GO.

MATERIAL AND METHODS

Forty-one orbital tissue specimens - 22 patients with severe GO, 9 patients with mild GO and 10 patients undergoing blepharoplasty as a control group - were processed by routine immunohistochemistry.

RESULTS

Increased IGF-1R, CD34 and Foxp-3 expression was found in both severe and mild GO, yet a significant correlation between CD34 and CD4, CD68, TGF-β, FGF-β expressions was observed in long-lasting GO.

CONCLUSIONS

CD34 expression is proposed to be the marker of orbital tissue remodeling in the course of mild GO.

First-trimester irisin and fetuin-A concentration in predicting macrosomia

Objective: We investigated the diagnostic value of first-trimester adipokines and placental markers in predicting macrosomia. Methods: Out of 328 women recruited during the prenatal diagnosis between 11th and 13th week of pregnancy and subjected to follow up until delivery, we selected 26 women who gave birth to macrosomic babies and 34 women who gave birth to normal weight neonates for the evaluation of first trimester serum levels of pregnancy associated plasma protein-A, free β-human chorionic gonadotropin, placental growth factor (PIGF), and selected adipokines. Results: The mothers of macrosomic infants had higher PIGF (p = .049) and irisin concentrations (p = .00003), and lower fetuin-A levels (p = .0002) than had the mothers of normal weight babies. Newborn's weight correlated positively with maternal irisin (R = 0.454, p = .0003) and negatively with fetuin-A concentrations (R = -0.497, p = .00005). Multiple regression analysis showed that only serum irisin concentration was a significant predictor of birth weight (β = 0.329, p = .03), explaining 14% of its variability. The sensitivity and the specificity of irisin concentration in predicting macrosomia were 0.769 and 0.794, respectively (AUC = 0.818 [95%CI: 0.708-0.928], p = .00001) with a proposed cut-off value of 1725.4 ng/ml. Conclusions: Our results suggest that mother's irisin may be an early biomarker of macrosomia.

[Plasma level of macrophage-colony stimulating factor (M-CSF) in the course of breast cancer treatment]

Macrophage-colony stimulating factor (M-CSF) is one of the glycoproteins called colony-stimulating factors (CSF). Some clinical investigations have shown an autologous production of M-CSF in various human cell lines in vitro and by tumour cells in vivo. We have investigated the plasma level of M-CSF and commonly accepted tumour marker, such as CA 15-3 in the plasma of 44 patients with breast cancer. Blood was taken before and in 30 and 180 days after surgery. The patients were divided into two groups: A (stage 1) and B (stage 11). M-CSF was determined using enzyme-linked immunosorbent assay (ELISA), CA 15-3 was measured by microparticle enzyme immunoassay (MEIA). M-CSF plasma levels were significantly higher in breast cancer patients before and after surgery comparing to the control group. The M-CSF level was higher in group B (11 stage) compared to the group A (I stage). These results suggest the potential role of M-CSF in the diagnostics and monitoring of breast cancer chemotherapy.