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Liu Y, Yang Y, Zhao C, Liu M, Xu D, Wu H, Lei J, Deng Y, Xie W, Huang J, Wu S, Zhang Y, Zhang H, He Y, Peng Z, Wang Y, Shen H, Wang Q, Zhang Y, Yan D, Wang L, Ma X. An immune window of opportunity to prevent spontaneous abortion: prepregnancy peripheral leukocytes and subsets were associated with a decreased risk of spontaneous abortion. Hum Reprod 2024; 39:326-334. [PMID: 38166353 DOI: 10.1093/humrep/dead261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 11/17/2023] [Indexed: 01/04/2024] Open
Abstract
STUDY QUESTION Do prepregnancy peripheral leukocytes (PPLs) and their subsets influence the risk of spontaneous abortion (SAB)? SUMMARY ANSWER PPLs and their subsets are associated with the risk of SAB. WHAT IS KNOWN ALREADY Compelling studies have revealed the crucial role of maternal peripheral leukocytes in embryo implantation and pregnancy maintenance. Adaptive changes are made by PPLs and their subsets after conception. STUDY DESIGN, SIZE, DURATION This population-based retrospective cohort study was based on data from the National Free Pre-pregnancy Check-up Project (NFPCP) in mainland China. Couples preparing for pregnancy within the next six months were provided with free prepregnancy health examinations and counseling services for reproductive health. The current study was based on 1 310 494 female NFPCP participants aged 20-49 who became pregnant in 2016. After sequentially excluding 235 456 participants lost to follow-up, with multiple births, and who failed to complete blood tests, a total of 1 075 038 participants were included in the primary analysis. PARTICIPANTS/MATERIALS, SETTING, METHODS PPLs and their subset counts and ratios were measured. The main outcome was SAB. A multivariable logistic regression model was used to estimate the odds ratio (OR) and 95% CI of SAB associated with PPLs and their subsets, and restricted cubic spline (RCS) was used to estimate the nonlinear exposure-response relationship. MAIN RESULTS AND ROLE OF CHANCE Of the included pregnant participants, a total of 35 529 SAB events (3.30%) were recorded. Compared to participants with reference values of PPLs, the ORs (95% CIs) of leukopenia and leukocytosis for SAB were 1.14 (1.09-1.20) and 0.74 (0.69-0.79), respectively. The RCS result revealed a monotonous decreasing trend (Pnonlinear < 0.05). Similar relationships were observed for the neutrophil count and ratio, monocyte count, and middle-sized cell count and ratio. The lymphocyte ratio showed a positive and nonlinear relationship with the risk of SAB (Pnonlinear < 0.05). Both eosinophils and basophils showed positive relationships with the risk of SAB (eosinophil Pnonlinear > 0.05 and basophil Pnonlinear < 0.05). LIMITATIONS, REASONS FOR CAUTION Chemical abortion events and the cause of SAB were not collected at follow-up. Whether women with abnormal PPLs had recovered during periconception was not determined. WIDER IMPLICATIONS OF THE FINDINGS PPLs and their subsets are associated with the risk of SAB. Leukopenia and neutropenia screening in women preparing for pregnancy and developing a feasible PPL stimulation approach should be emphasized to utilize the immune window of opportunity to prevent SAB. STUDY FUNDING/COMPETING INTEREST(S) This study was approved by the Institutional Research Review Board of the National Health and Family Planning Commission. This study was supported by the National Key Research and Development Program of China (grants 2021YFC2700705 [Y.Y.] and 2016YFC100307 [X.M.]) and the National Natural Science Foundation of China (grant no. 82003472 [L.W.]). The funding source was not involved in the study design, data collection, analysis and interpretation of the data, writing the report, or the decision to submit this article for publication. No competing interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Youhong Liu
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Ying Yang
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resources Centre, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
| | - Chuanyu Zhao
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resources Centre, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
| | - Meiya Liu
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Die Xu
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Hanbin Wu
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resources Centre, Beijing, China
| | - Jueming Lei
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resources Centre, Beijing, China
| | - Yuzhi Deng
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resources Centre, Beijing, China
| | - Wenlu Xie
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Jiaxin Huang
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Siyu Wu
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Ya Zhang
- National Research Institute for Family Planning, Beijing, China
| | - Hongguang Zhang
- National Research Institute for Family Planning, Beijing, China
| | - Yuan He
- National Research Institute for Family Planning, Beijing, China
| | - Zuoqi Peng
- National Research Institute for Family Planning, Beijing, China
| | - Yuanyuan Wang
- National Research Institute for Family Planning, Beijing, China
| | - Haiping Shen
- Department of Maternal and Child Health, National Health Commission of the PRC, Beijing, China
| | - Qiaomei Wang
- Department of Maternal and Child Health, National Health Commission of the PRC, Beijing, China
| | - Yiping Zhang
- Department of Maternal and Child Health, National Health Commission of the PRC, Beijing, China
| | - Donghai Yan
- Department of Maternal and Child Health, National Health Commission of the PRC, Beijing, China
| | - Long Wang
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Xu Ma
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resources Centre, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
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Hata K, Kotani T, Matsuda S, Fujiki Y, Suzuka T, Kiboshi T, Wada Y, Shiba H, Shoda T, Kagitani M, Takeuchi T. Aggressive multi-combination therapy for anti-MDA5 antibody-positive dermatomyositis-rapidly progressive interstitial lung disease. Int J Rheum Dis 2024; 27:e14999. [PMID: 38063858 DOI: 10.1111/1756-185x.14999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 10/20/2023] [Accepted: 11/23/2023] [Indexed: 01/31/2024]
Abstract
OBJECTIVES To elucidate the efficacy and safety of aggressive multi-combination therapy with mycophenolate mofetil, rituximab, and plasma exchange or polymyxin B immobilized fiber column direct hemoperfusion followed by conventional therapy with corticosteroids, calcineurin inhibitors, and intravenous pulse cyclophosphamide in patients with rapidly progressive interstitial lung disease (RPILD) with anti-melanoma differentiation-associated gene 5 (MDA5)-antibody-positive dermatomyositis (DM). METHODS A total of 23 patients with anti-MDA5 antibody-positive DM-RPILD were enrolled, with nine patients in Group A (treated conventionally before March 2015) and 14 patients in Group B (received aggressive treatment after April 2015). RESULTS Pretreatment severity of interstitial lung disease (ILD) did not differ between the two groups. However, Group B exhibited a higher cumulative survival rate at 48 weeks than Group A (64.3% vs. 33.3%). The corticosteroid dose, divided by the initial dose at 3 months and 12 months, was significantly lower in Group B than in Group A (p = .046 and .026, respectively). Among the ILD-related deaths in Group B, there was a tendency toward a higher proportion of males and more severe ILD. The incidence of infection did not differ between the groups, but leukopenia was more common in Group B. CONCLUSION This aggressive multi-combination therapy may improve the survival outcome of patients with anti-MDA5 antibody-positive DM-RPILD. However, careful management of complications, such as opportunistic infections and leukopenia, is essential. Future refinement through longitudinal investigations tracking the long-term efficacy, safety, and cost-effectiveness of this treatment strategy is needed.
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Affiliation(s)
- Kenichiro Hata
- Department of Internal Medicine (IV), Division of Rheumatology, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Takuya Kotani
- Department of Internal Medicine (IV), Division of Rheumatology, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Shogo Matsuda
- Department of Internal Medicine (IV), Division of Rheumatology, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Youhei Fujiki
- Department of Internal Medicine (IV), Division of Rheumatology, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Takayasu Suzuka
- Department of Internal Medicine (IV), Division of Rheumatology, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Takao Kiboshi
- Department of Internal Medicine (IV), Division of Rheumatology, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Yumiko Wada
- Department of Internal Medicine (IV), Division of Rheumatology, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Hideyuki Shiba
- Department of Internal Medicine (IV), Division of Rheumatology, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Takeshi Shoda
- Department of Internal Medicine (IV), Division of Rheumatology, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Maki Kagitani
- Blood Purification Center, Osaka Medical and Pharmaceutical University Hospital, Takatsuki, Japan
| | - Tohru Takeuchi
- Department of Internal Medicine (IV), Division of Rheumatology, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
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Bibi S, Naveed K, Haq A. Thrombocytopenia Caused by Iron Infusion in a Patient with End-Stage Kidney Disease. J Coll Physicians Surg Pak 2023; 33:1337. [PMID: 37926895 DOI: 10.29271/jcpsp.2023.11.1337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 06/05/2023] [Indexed: 11/07/2023]
Affiliation(s)
- Shaheen Bibi
- Department of Nephrology, Liaquat National Hospital, Karachi, Pakistan
| | - Kunwer Naveed
- Department of Nephrology, Liaquat National Hospital, Karachi, Pakistan
| | - Abdul Haq
- Department of Nephrology, Liaquat National Hospital, Karachi, Pakistan
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Shobha V, Rajasekhar L, Bhat V, Mathew AJ, Kavadichanda C, Rathi M, Gupta R, Selvam S, Aggarwal A. Severe thrombocytopenia is associated with high mortality in systemic lupus erythematosus-analysis from Indian SLE Inception cohort for Research (INSPIRE). Clin Rheumatol 2023; 42:2279-2285. [PMID: 37270720 DOI: 10.1007/s10067-023-06641-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/18/2023] [Accepted: 05/20/2023] [Indexed: 06/05/2023]
Abstract
Thrombocytopenia in patients with systemic lupus erythematosus (SLE) is associated with higher morbidity and mortality. We report frequency, associations and short-term outcome of moderate-severe thrombocytopenia in a prospective inception cohort from India (INSPIRE). We evaluated consecutive SLE patients classified per SLICC2012 for the occurrence of thrombocytopenia and its associations. The outcomes assessed included bleeding manifestations, kinetics of thrombocytopenia recovery, mortality and recurrence of thrombocytopenia. Among a total of 2210 patients in the cohort, 230 (10.4%) had incident thrombocytopenia, of whom moderate (platelet count [PC] 20-50 × 109/L) and severe thrombocytopenia (PC < 20 × 109/L) were noted in 61 (26.5%) and 22 (9.5%), respectively. Bleeding manifestations were generally limited to the skin. Compared to controls, cases had a higher proportion of autoimmune haemolytic anaemia (p < 0.001), leukopenia (p < 0.001), lymphopenia (p < 0.001), low complement (p < 0.05), lupus anticoagulant (p < 0.001), higher median SLEDAI 2 K (p < 0.001) and lower proportion of anti-RNP antibody (p < 0.05). There was no significant difference in these variables between moderate and severe thrombocytopenia. There was a sharp rise in PC by 1 week that was sustained in the majority through the period of observation. There was three times higher mortality in the severe thrombocytopenia group as compared to moderate thrombocytopenia and controls. The thrombocytopenia relapse and lupus flare rates were similar across categories. We report a low occurrence of major bleeds and higher mortality in those with severe thrombocytopenia as compared to moderate thrombocytopenia and controls. Key Points • Severe thrombocytopenia occurs in 1% of patients with SLE; however, major bleeds are uncommon. • Thrombocytopenia has a strong association with other lineage cytopenias and lupus anticoagulants. • Response to initial glucocorticoids therapy is quick and is well sustained with additional immunosuppressants. • Severe thrombocytopenia increases mortality threefold in SLE.
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Affiliation(s)
- Vineeta Shobha
- Department of Clinical Immunology and Rheumatology, St. John's Medical College Hospital, Bengaluru, India
| | - Liza Rajasekhar
- Department of Clinical Immunology & Rheumatology, Nizam Institute of Medical Sciences, Hyderabad, India
| | - Vasudha Bhat
- Department of Clinical Immunology and Rheumatology, St. John's Medical College Hospital, Bengaluru, India
| | - Ashish J Mathew
- Department of Clinical Immunology & Rheumatology, Christian Medical College, Vellore, India
| | - Chengappa Kavadichanda
- Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | - Manish Rathi
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ranjan Gupta
- Department of Rheumatology, All India Institute of Medical Sciences, New Delhi, India
| | - Sumithra Selvam
- Division of Epidemiology and Biostatistics, St. John's Research Institute, Bengaluru, India
| | - Amita Aggarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
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Wang LL, Noe MH, Micheletti RG. Prevalence of Leukopenia and Associated Outcomes in Patients With Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis. JAMA Dermatol 2022; 158:1212-1214. [PMID: 35976636 PMCID: PMC9386600 DOI: 10.1001/jamadermatol.2022.3011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 06/03/2022] [Indexed: 11/14/2022]
Abstract
This case series compares the factors, comorbidities, and complications associated with leukopenia between patients with and without leukopenia on hospital admission.
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Affiliation(s)
- Leo L. Wang
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia
| | - Megan H. Noe
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Robert G. Micheletti
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia
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6
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Costa E, Giuliani A, Corradi V, Caprara C, Rigato M, Milan Manani S, Tantillo I, Ronco C, Gastaldon F, Zanella M. [Lymphocytic leukopenia in two patients affected by polycystic kidney disease waiting for renal transplantation]. G Ital Nefrol 2022; 39:2022-vol2. [PMID: 35470994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary kidney disease, responsible for 10% of patients on renal replacement therapy. The disease is well known to be associated with many extrarenal manifestations. Leukopenia may also be present, even if it is not commonly identified as a typical extrarenal manifestation. Herein we describe two case reports of ADPKD patients with leukopenia. The first case is about a 47-year-old patient affected by ADPKD, regularly treated with peritoneal dialysis, who showed a progressive reduction of white blood cell count, mostly of lymphocytes. Lymphocytic leukopenia was so severe that, when he was called for transplantation from a deceased donor, he was considered temporarily not eligible. We then describe a second ADPKD patient regularly treated with peritoneal dialysis, who had stable lymphopenia for years. Six years after starting PD, it was necessary to perform bone marrow aspirate to investigate the simultaneous presence of hypogammaglobulinemia together with M-protein and to exclude monoclonal gammopathy. All the exams performed did not show any significant results, the patients were re-included in the waiting list and one of them was transplanted. Given our experience and what is reported in the literature, there seems to be enough evidence to consider leukopenia as an extrarenal manifestation of ADPKD. However, the clinical significance of leukopenia in ADPKD patients is not known. It could be interesting to investigate the leucocytes' function and if ADPKD patients with leukopenia are more susceptible to infection, or not. Moreover, it would be very useful to analyze the relationship between such manifestation and genotype/phenotype.
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Affiliation(s)
- Elisa Costa
- Clinica Nefrologica, Dialisi e Trapianto, IRCCS Ospedale Policlinico San Martino, Genova, Italia; International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy
| | - Anna Giuliani
- Dipartimento di Nefrologia, Dialisi e Trapianto, Ospedale San Bortolo, Vicenza, Italia; International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy
| | - Valentina Corradi
- Dipartimento di Nefrologia, Dialisi e Trapianto, Ospedale San Bortolo, Vicenza, Italia; International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy
| | - Carlotta Caprara
- International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy
| | - Matteo Rigato
- Dipartimento di Nefrologia, Dialisi e Trapianto, Ospedale San Bortolo, Vicenza, Italia; International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy
| | - Sabrina Milan Manani
- Dipartimento di Nefrologia, Dialisi e Trapianto, Ospedale San Bortolo, Vicenza, Italia; International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy
| | - Ilaria Tantillo
- Dipartimento di Nefrologia, Dialisi e Trapianto, Ospedale San Bortolo, Vicenza, Italia; International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy
| | - Claudio Ronco
- International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italia; DIMED, Università di Padova, Padova, Italy
| | - Fiorella Gastaldon
- Dipartimento di Nefrologia, Dialisi e Trapianto, Ospedale San Bortolo, Vicenza, Italia; International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy
| | - Monica Zanella
- Dipartimento di Nefrologia, Dialisi e Trapianto, Ospedale San Bortolo, Vicenza, Italia; International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy
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Leeman R, Shoag J, Borchetta M, Mitchell C, Davis JA, Corrales-Medina FF. Clinical Implications of Hematologic and Hemostatic Abnormalities in Children With COVID-19. J Pediatr Hematol Oncol 2022; 44:e282-e286. [PMID: 33930009 DOI: 10.1097/mph.0000000000002176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/16/2021] [Indexed: 11/26/2022]
Abstract
Leukopenia, thrombocytopenia, elevated D-dimer, and prolonged prothrombin time are considered poor prognostic factors in adults with acute Coronavirus Disease 2019. The prognostic significance of these abnormalities among pediatric patients remains underreported in the literature. This retrospective cohort study evaluates the prognostic implications of hematologic and hemostatic derangements in patients younger than 22-years-of-age who were admitted to a tertiary-care referral institution for management of acute Coronavirus Disease 2019 infection. Leukopenia and thrombocytopenia were identified as independent prognostic factors of disease severity. Although the majority of children, with available results, had elevated D-dimer or prolonged prothrombin time upon initial presentation, these markers were not found to be associated with the development of severe clinical complications.
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Affiliation(s)
- Rachel Leeman
- Holtz Children's Hospital, Jackson Memorial Medical Center
| | - Jamie Shoag
- Holtz Children's Hospital, Jackson Memorial Medical Center
- Department of Pediatrics, Division of Pediatric Hematology-Oncology
| | - Michael Borchetta
- Holtz Children's Hospital, Jackson Memorial Medical Center
- Department of Pediatrics, Division of Pediatric Infectious Disease, University of Miami-Miller School of Medicine
| | - Charles Mitchell
- Holtz Children's Hospital, Jackson Memorial Medical Center
- Department of Pediatrics, Division of Pediatric Infectious Disease, University of Miami-Miller School of Medicine
| | - Joanna A Davis
- Department of Pediatrics, Division of Pediatric Hematology-Oncology
- University of Miami-Hemophilia Treatment Center, Miami, FL
| | - Fernando F Corrales-Medina
- Holtz Children's Hospital, Jackson Memorial Medical Center
- Department of Pediatrics, Division of Pediatric Hematology-Oncology
- University of Miami-Hemophilia Treatment Center, Miami, FL
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Arpáš T, Doubek M. Differential diagnosis of leukocytosis and leukopenia. Vnitr Lek 2022; 68:28-35. [PMID: 36402557 DOI: 10.36290/vnl.2022.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The blood cell count is often examined in routine clinical praxis. Physiologic leucocyte count is in range 4-10 × 109 in liter of blood. Abnormal values of leukocytes and subtypes of leukocytes in differential count are often present. Changes in leukocytes counts are caused by variety of benignant or malignant conditions. It is important in clinical praxis to interpret changes in blood cell count correctly and choose adequate approach in investigation process. In general, leukocytosis and leukocytopenia may present in primary hematologic disorder or secondary/reactive states, caused by reaction of hematopoiesis to underlying condition. This article review common causes of leukocytosis or leucopenia and give basic advice how to investigate patients with changes in leukocytes count.
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Bisetegn H, Ebrahim H. The prevalence of thrombocytopenia and leucopenia among people living with HIV/AIDS in Ethiopia: A systematic review and meta-analysis. PLoS One 2021; 16:e0257630. [PMID: 34543340 PMCID: PMC8452017 DOI: 10.1371/journal.pone.0257630] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 09/05/2021] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Thrombocytopenia and leucopenia are frequently encountered hematological disorders among people living with HIV/AIDS. This systematic review and meta-analysis were aimed to indicate the national prevalence of thrombocytopenia and leucopenia among HIV/AIDS patients. METHODS This systematic review and meta-analysis was conducted following the preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines. A systematic search was conducted from February 01, 2021 to April 02, 2021 using electronic databases Google Scholar, PubMed, Web of Sciences, Google, EMBASE, SCOPUS and ResearchGate. The quality of the included studies was assessed using Newcastle-Ottawa Quality Assessment Scale (NOS) adapted for cross-sectional studies. Data analysis was done using STATA version 14 using metan commands. Random effect meta-analysis was used to estimate the pooled prevalence of thrombocytopenia and leucopenia among people living with HIV/AIDS in Ethiopia. RESULT Of the 349 initially searched articles, 90 were assessed for eligibility and only 13 articles published from 2014 to 2020 were included in the final meta-analysis. A total of 3854 participants were involved in the included studies. The pooled prevalence of thrombocytopenia was 9.69% (95%CI; 7.40-11.97%). Significant heterogeneity was observed with I2 value of 84.7%. Thrombocytopenia was 11.91% and 5.95% prevalent among HAART naive and HAART exposed HIV/AIDS patients, respectively. The pooled prevalence of leucopenia among HIV/AIDS patients was 17.31% (95%CI: 12.37-22.25%). CONCLUSION This study showed a high prevalence of thrombocytopenia and leucopenia among people living with HIV/AIDS, indicating the necessity of regular screening of HIV seropositive patients for different hematological parameters and providing treatment.
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Affiliation(s)
- Habtye Bisetegn
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Hussien Ebrahim
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Patel PP, Weller JH, Westermann CR, Cappiello C, Garcia AV, Rhee DS. Appendectomy and Cholecystectomy Outcomes for Pediatric Cancer Patients with Leukopenia: A NSQIP-pediatric Study. J Surg Res 2021; 267:556-562. [PMID: 34261006 DOI: 10.1016/j.jss.2021.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/27/2021] [Accepted: 06/08/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Children with cancer often develop leukopenia which may impair wound healing and increase surgical complication rates. When leukopenic children with cancer develop an acute surgical condition, the optimal management strategy remains unclear. This study examined the effect of preoperative leukopenia on postoperative outcomes in children with cancer who underwent an appendectomy or cholecystectomy. METHODS We retrospectively identified cancer patients undergoing an appendectomy or cholecystectomy from the National Surgical Quality Improvement Program-Pediatric database from 2012-2018. Demographics and perioperative characteristics were compared by leukopenia status (WBC <4 vs. ≥4 × 10^3/mL). Postoperative length of stay (LOS) and 30-day composite complications, including infections, reoperations, and readmissions, were analyzed for each procedure using multivariate regression. RESULTS There were 227 children who underwent an appendectomy and 101 children who underwent a cholecystectomy. Leukopenia was seen in 93 (41.0%) appendectomy and 57 (56.4%) cholecystectomy cases. Nineteen (8.4%) appendectomy patients and six (5.9%) cholecystectomy patients developed a postoperative complication. The median postoperative LOS was 2 days (IQR 1-6 days) for appendectomy and 1 day (IQR 1-2.5 days) for cholecystectomy cases. After multivariate analyses, leukopenia was not associated with increased postoperative complications after an appendectomy (OR 0.55, P = 0.36) or cholecystectomy (OR 0.39, P = 0.37). There was no significant difference in postoperative LOS based on leukopenia status for children who underwent an appendectomy (P = 0.82) or cholecystectomy (P = 0.37). CONCLUSION In pediatric cancer patients, leukopenia was not associated with increased short-term postoperative complications or longer postoperative LOS after either an appendectomy or cholecystectomy. These results support that operative management can be performed safely in pediatric appendicitis and cholecystitis in leukopenic cancer patients.
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Affiliation(s)
- Palak P Patel
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jennine H Weller
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore Maryland
| | - Carly R Westermann
- Virginia Polytechnic State Institution and University, Blacksburg, Virginia
| | - Clint Cappiello
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore Maryland
| | - Alejandro V Garcia
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore Maryland
| | - Daniel S Rhee
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore Maryland.
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Abstract
BACKGROUND Rheumatic diseases have many hematological manifestations. Blood dyscrasias and other hematological abnormalities are sometimes the first sign of rheumatic disease. In addition, novel antirheumatic biological agents may cause cytopenias. SUMMARY The aim of this review was to discuss cytopenias caused by systemic lupus erythematosus and antirheumatic drugs, Felty's syndrome in rheumatoid arthritis, and autoimmune hemolytic anemia, thrombosis, and thrombotic microangiopathies related to rheumatological conditions such as catastrophic antiphospholipid syndrome and scleroderma renal crisis. Key Message: The differential diagnosis of various hematological disorders should include rheumatic autoimmune diseases among other causes of blood cell and hemostasis abnormalities. It is crucial that hematologists be aware of these presentations so that they are diagnosed and treated in a timely manner.
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Affiliation(s)
- Alina Klein
- Department of Internal Medicine C, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel,
| | - Yair Molad
- Institute of Rheumatology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Lin YD, Garner SE, Lau JSY, Korman TM, Woolley IJ. Prevalence of HIV indicator conditions in late presenting patients with HIV: a missed opportunity for diagnosis? QJM 2019; 112:17-21. [PMID: 30295832 DOI: 10.1093/qjmed/hcy223] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Indexed: 12/29/2022] Open
Abstract
AIM To evaluate prior prevalence of HIV indicator conditions in late-presenters with HIV infection. DESIGN Retrospective cohort study between 2000 and 2014 in a healthcare network in Melbourne, Australia comparing patients presenting with late diagnosis of HIV infection (CD4 < 350 cells/ml) to those patients who had a CD greater than or equal to 350 cells/ml at presentation. METHOD The European AIDS Clinical Society guidelines on HIV indicator guided testing were used to assess for any indicator conditions in their prior medical history which may have represented a missed opportunity for earlier diagnosis. Main outcome measures: Descriptive statistics and prevalence of HIV indicator conditions. RESULTS Of 436 patients with HIV infection, 82 were late presenters. Late presenters were more commonly male (83% vs. 75%, P = 0.11), older (mean age 45 vs. 39 years), born overseas (61% vs. 58%, P = 0.68) and report heterosexual transmission as their exposure risk (51% vs. 31%, P < 0.001). Of 80 patients with late presentation of HIV infection, 54 (55%) had at least one, 29 (36%) at least 2, 12 (15%) at least 3 and 5 (6%) had 4 or more previous HIV indicator conditions which would have triggered HIV testing according to guidelines. The most common indicator conditions were: unexplained loss of weight (31%), herpes zoster (10%), thrombocytopenia or leukopenia (10%), oral or oesophageal candidiasis (10%) and community acquired pneumonia (9%). Twenty patients (25%) had HIV indicator conditions diagnosed at least 12 months before the eventual diagnosis of HIV infection. DISCUSSION/ CONCLUSION Patients diagnosed with late-presenting HIV often had an HIV indicator condition prior to presentation, presenting a missed opportunity for earlier diagnosis.
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Affiliation(s)
- Y D Lin
- Monash Infectious Diseases, 246 Clayton Road, Clayton, VIC, Australia
| | - S E Garner
- Monash Infectious Diseases, 246 Clayton Road, Clayton, VIC, Australia
- Walter and Eliza Hall Institute, University of Melbourne, Royal Parade, Parkville, VIC, Australia
| | - J S Y Lau
- Monash Infectious Diseases, 246 Clayton Road, Clayton, VIC, Australia
| | - T M Korman
- Monash Infectious Diseases, 246 Clayton Road, Clayton, VIC, Australia
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, 246 Clayton Rd, Clayton, VIC, Australia
| | - I J Woolley
- Monash Infectious Diseases, 246 Clayton Road, Clayton, VIC, Australia
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, 246 Clayton Rd, Clayton, VIC, Australia
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Ahmad AM, Ahmed Z, Khushdil A, Waqar T. Granulocyte-colony stimulating factor in neonatal sepsis with leukopenia: A prospective cohort study. J PAK MED ASSOC 2018; 68:1613-1617. [PMID: 30410138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To observe the duration for normalization of the Total Leucocyte Count (TLC) with adjuvant Granulocyte-Colony Stimulating Factor (G-CSF) treatment in leukopenic neonatal sepsis, and to compare the neutrophilic response to G-CSF in neutropenic vs non-neutropenic subgroups. METHODS This prospective cohort study was carried out at the Neonatal Intensive Care Unit at Military Hospital Rawalpindi (NICU) from 1st August 2015 to 25th January 2017. Fifty one newborns with sepsis and leucopenia were sampled judgmentally from a population of 5666 admitted to NICU during the study period. The sample was then divided into neutropenic (exposed) and non-neutropenic (non-exposed) subgroups on basis of the absolute neutrophil count (ANC). Adjuvant G-CSF was given to all subjects and stopped once TLC normalized. SPSS v22 was used to calculate mean G-CSF treatment duration and rise in ANC. A Pearson correlation coefficient and simple linear regression were computed to assess the relationship between pre-GCSF ANC and the duration of treatment with GCSF. Comparison of subgroups with respect to rise in ANC was done using independent samples T-test. RESULTS The mean duration of G-CSF treatment was 1.82±0.81 days (1.0 - 4.0). Neutropenic neonates constituted 49% (n=25). The Pearson correlation coefficient showed a positive but negligible and non-significant correlation between the two variables, r = 0.070, n = 51, p = 0.625. A non-significant regression equation was found (F(1,49) = 0.242,p=0.625) with an R2 of 0.005. There was a 7.06±4.5 fold rise in ANC in the neutropenic subgroup compared to the 4.5±3.1 fold rise in the non-neutropenic subgroup (p=0.04). CONCLUSIONS The mean duration for recovery from leukopenia with G-CSF treatment in neonatal sepsis was less than 2 days and had no significant relationship with pre-GCSF absolute neutrophil count. The neutrophilic response was significantly higher in neutropenic compared to non-neutropenic neonates. As GCSF made no difference to the outcome in terms of mortality, its routine use is not recommended in leukopenic neonatal sepsis. .
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Affiliation(s)
| | | | | | - Talal Waqar
- Combined Military Hospital, Rawalpindi (Army Medical Corps), Rawalpindi, Pakistan
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Huang X, Wang S, Wang X, Lyu Y, Jiang M, Chen D, Li K, Liu J, Xie S, Lyu T, Sun J, Xu P, Cao M, Liang M, Li D. Estimation of the incidence of severe fever with thrombocytopenia syndrome in high endemic areas in China: an inpatient-based retrospective study. BMC Infect Dis 2018; 18:66. [PMID: 29402229 PMCID: PMC5800001 DOI: 10.1186/s12879-018-2970-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 01/18/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Severe fever with thrombocytopenia syndrome (SFTS) is a severe viral disease caused by SFTSV. It is important to estimate the rate of missed SFTS diagnosis and to further understand the actual incidence in high endemic areas in China. METHODS This study was conducted in two high SFTS endemic provinces in 2015. Patients hospitalized in 2014 or within 1 year before investigation were selected after considering their clinical manifestations, specifically, fever, platelet, and white blood cell. During retrospective investigation, sera were collected to detect SFTSV antibodies to assess SFTSV infection. To further understand SFTSV infection, acute phase sera were detected; SFTSV infection rate among a healthy population was also investigated to determine the basic infection level. RESULTS In total, 246 hospitalized cases were included, including 83 cases (33.7%) with fever, thrombocytopenia and leukopenia, 38 cases (15.4%) with fever and thrombocytopenia but without leukopenia, and 125 cases (50.8%) without fever but with thrombocytopenia and leukopenia. In total, 13 patients (5.3%) were SFTSV IgM antibody-positive, 48 (19.5%) were IgG-positive. Of the 13 IgM-positive cases, 11 (84.6%) were IgG-positive (9 with titres ≥1:400). Seropositive rates of antibodies were high (8.4% for IgM and 30.1% for IgG) in patients with fever, thrombocytopenia and leukopenia. Furthermore, among IgG-positive cases in this group, 76% (19/25) of patients' IgG antibody titres were ≥1:400. Additionally, 28 of 246 cases were initially diagnosed with suspected SFTS and were then excluded, and 218 patients were never diagnosed with SFTS; the seropositive rates of IgM and IgG in these two groups were 25% and 67.9% and 2.8% and 13.3%, respectively. These rates were 64.3% and 21.4% in 14 sera collected during acute phase of the 28 cases mentioned above. Seropositive rate of SFTSV IgG was only 1.3% in the patient-matched healthy group, and no IgM antibody was detected. A preliminary estimate of 8.3% of SFTS cases were missed in SFTS high endemic provinces. CONCLUSIONS The actual SFTS incidence was underestimated. Effective measures such as adding a new SFTS case category - "SFTS clinical diagnosis cases" or using serological detection methods during acute phase should be considered to avoid missed diagnoses.
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Affiliation(s)
- Xiaoxia Huang
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206 People’s Republic of China
| | - Shiwen Wang
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206 People’s Republic of China
| | - Xianjun Wang
- Shandong Center for Disease Control and Prevention, Jinan, Shandong Province People’s Republic of China
| | - Yong Lyu
- Lu’an Center for Disease Control and Prevention, Lu’an, Anhui Province People’s Republic of China
| | - Mei Jiang
- Yantai Center for Disease Control and Prevention, Yantai, Shandong Province People’s Republic of China
| | - Deying Chen
- Weihai Center for Disease Control and Prevention, Weihai, Shandong Province People’s Republic of China
| | - Kaichun Li
- Lu’an Center for Disease Control and Prevention, Lu’an, Anhui Province People’s Republic of China
| | - Jingyu Liu
- Yantai Center for Disease Control and Prevention, Yantai, Shandong Province People’s Republic of China
| | - Shaoyu Xie
- Lu’an Center for Disease Control and Prevention, Lu’an, Anhui Province People’s Republic of China
| | - Tao Lyu
- Weihai Center for Disease Control and Prevention, Weihai, Shandong Province People’s Republic of China
| | - Jie Sun
- Lu’an Center for Disease Control and Prevention, Lu’an, Anhui Province People’s Republic of China
| | - Pengpeng Xu
- Lu’an Center for Disease Control and Prevention, Lu’an, Anhui Province People’s Republic of China
| | - Minghua Cao
- Anhui Center for Disease Control and Prevention, Hefei, Anhui Province People’s Republic of China
| | - Mifang Liang
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206 People’s Republic of China
| | - Dexin Li
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206 People’s Republic of China
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Michelini S, Cardone M, Haag M, Agga O, Bruson A, Maltese PE, Bonizzato A, Bertelli M. A Rare Case of Emberger Syndrome Caused By a De Novo Mutation in the GATA2 Gene. Lymphology 2016; 49:15-20. [PMID: 29906059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Emberger syndrome, or primary lymphedema with myelodysplasia, is a severe rare disease characterized by early primary lymphedema and blood anomalies including acute childhood leukemia. The syndrome is associated with heterozygous mutations in the GATA2 gene. We report on a 13-year-old boy who developed lymphedema of the right lower limb at age 6 years which was accompanied by severe panleukopenia and repeated episodes of erysipelas. The suspicion of Emberger syndrome was confirmed by detection of a new germinal line GATA2 mutation c.414_417del, p.Ser139Cysfs*78. Clinical treatment included a bone marrow transplant from the father.This case is one of a very limited number of Emberger syndrome cases documented in the literature, and genetic testing proved fundamental for definition of the condition and its association with a de novo mutation in the GATA2 which is reported here for the first time.
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Bollyky JB, Xu P, Butte AJ, Wilson DM, Beam CA, Greenbaum CJ. Heterogeneity in recent-onset type 1 diabetes - a clinical trial perspective. Diabetes Metab Res Rev 2015; 31:588-94. [PMID: 25689602 PMCID: PMC4815427 DOI: 10.1002/dmrr.2643] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 02/09/2015] [Indexed: 01/10/2023]
Abstract
BACKGROUND Type 1 diabetes (T1D) TrialNet is a National Institutes of Health-sponsored clinical trial network aimed at altering the disease course of T1D. The purpose of this study is to evaluate age-dependent heterogeneity in clinical, metabolic and immunologic characteristics of individuals with recent-onset T1D, to identify cohorts of interest and to aid in planning of future studies. METHODS Eight hundred eighty-three individuals with recent-onset T1D involved in five TrialNet studies were categorized by age as follows: ≥18 years, 12-17 years, 8-12 years and <8 years. Data were compared with healthy age-matched subjects in the National Health and Nutrition Examination Survey. RESULTS Only 2.0% of the individuals overall were excluded from trial participation because of insufficient C-peptide values (<0.2 pmol/mL). A disproportionate number of these subjects were <8 years old. Leukopenia was present in 21.2% of individuals and lymphopenia in 11.6%; these frequencies were markedly higher than age-matched healthy National Health and Nutrition Examination Survey population. Of the cohort, 24.5% were overweight or obese. Neither high-risk human leukocyte antigen type DR3 nor DR4 was present in 31% of adults and 21% of children. CONCLUSIONS The ability of recent-onset T1D patients to meet key entry criteria for TrialNet studies, including C-peptide >0.2 pmol/mL, varies by age. Lower C-peptide level requirements for younger participants and other aspects of heterogeneity of recent-onset T1D patients, such as white blood cell count abnormalities and body mass index should be considered in the design of future clinical studies.
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Affiliation(s)
- Jennifer B. Bollyky
- Stanford University, Department of Medicine, Division of Endocrinology, Stanford, CA
| | - Ping Xu
- University of South Florida, Pediatric Epidemiology Center, Tampa, FL
| | - Atul J. Butte
- Stanford University, Department of Pediatric, Division of Endocrinology, Stanford, CA
| | - Darrell M. Wilson
- Stanford University, Department of Pediatrics, Division of Systems Medicine, Stanford, CA
| | - Craig A. Beam
- Western Michigan University Homer Stryker, MD School of Medicine, Kalamazoo, MI
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Jeleniewicz R, Suszek D, Majdan M. Clinical picture of late-onset systemic lupus erythematosus in a group of Polish patients. ACTA ACUST UNITED AC 2015; 125:538-44. [PMID: 26075796 DOI: 10.20452/pamw.2963] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The prevalence of late-onset systemic lupus erythematosus (SLE) diagnosed in patients over the age of 50 years is estimated at 10% to 20%. SLE in elderly patients has specific features with misleading signs and symptoms, but its clinical course seems milder compared with that in younger patients. OBJECTIVES The aim of the study was to assess clinical manifestations of late-onset SLE in a group of patients treated in Poland. PATIENTS AND METHODS From a group of 230 consecutive patients with SLE, individuals with late-onset disease were selected. We retrospectively analyzed the incidence of clinical features of SLE, concomitant diseases, and treatment. The incidence of clinical features in late-onset patients was compared with that in a group of 108 patients with early-onset SLE. RESULTS Late-onset SLE was confirmed in 20 patients (8.7%) including 16 women (80%) and 4 men (20%). A delay in diagnosis was 31.7 months (0-144). The most common SLE features were arthritis (50%), rash (40%), nephropathy (40%), photosensitivity (30%), mouth ulcerations (30%), interstitial lung disease (30%), fever (25%), leukopenia (65%), and thrombocytopenia (35%). Kidney involvement was present in all men and in 25% of women. Thrombotic complications were noted in 38.8% of the patients. Concomitant diseases were common in our study group. CONCLUSIONS The clinical picture of late-onset SLE differs from that of early-onset SLE. Arthritis, leukopenia, and thrombotic complications are frequent, while skin manifestations, photosensitivity, nephropathy, vasculitis, and central nervous system involvement are less common in late-onset SLE. The diagnosis of late-onset SLE is often delayed, and treatment is determined by the presence of concomitant diseases.
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Peña C, Sepúlveda C, Melo J, Guerra C. [Secondary acute myeloid leukemia in a lung allograft recipient. Report of one case]. Rev Med Chil 2015; 143:262-5. [PMID: 25860370 DOI: 10.4067/s0034-98872015000200015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 11/18/2014] [Indexed: 11/17/2022]
Abstract
Secondary acute myeloid leukemia is a very rare complication in patients with solid organ transplantation. We report a 62 years old female who received a right single lung allograft for idiopathic pulmonary fibrosis. Her immunosuppression scheme consisted in prednisone, azathioprine, and tacrolimus. Two years after the transplantation, she presented with progressive pancytopenia. Bone marrow aspiration was informed as a M4 acute myeloid leukemia, confirmed by flow cytometry. Cytogenetic study was complex, including alterations in chromosome 5. A secondary acute myeloid leukemia was diagnosed. The patient developed nosocomial pneumonia and died a few days after the diagnosis, without specific treatment. The pathogenesis of acute myeloid leukemia is probably related to the intensive exposure to immunosuppressant, especially azathioprine, in these patients.
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Çatal F, Topal E, Ermiştekin H, Yildirim Acar N, Sinanoğlu MS, Karabiber H, Selimoğlu MA. The hematologic manifestations of pediatric celiac disease at the time of diagnosis and efficiency of gluten-free diet. Turk J Med Sci 2015; 45:663-667. [PMID: 26281336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND/AIM To determine the hematologic manifestations at the time of diagnosis of celiac disease in children and the effects of a gluten-free diet on hematologic signs upon follow-up. MATERIALS AND METHODS The records ofpatients with celiac disease who received a follow up examination at the Pediatric Gastroenterology Clinic between June 2006 and June 2013 were retrospectively examined. RESULTS Ninety-one patients were included in the study. The mean age at diagnosis was 8.1 ± 4.21 years and 59 patients (64.8%) were female. Thirty-two patients (35.2%) had hematologic signs at the time of diagnosis. Anemia (24.2%) was the most common hematologic sign, followed by thrombocytosis (16.5%) and leukopenia (4.4%). The tTG IgA titers were screened in 80 of the 91 patients during diagnosis. Follow-up examinations found that remission for anemia (P = 0.0 17), thrombocytosis (P = 0.039), and decreases in tTG IgA titers (P = 0.034) were more prominent in patients who had followed a strict gluten-free diet. CONCLUSION Approximately one-third of the celiac disease patients had hematologic manifestations at the time of diagnosis. Remission in hematologic signs and decrease in tTG IgA titers were more prominent in patients who had adhered to a gluten-free diet.
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Strle F, Bogovič P, Cimperman J, Maraspin V, Ogrinc K, Rojko T, Stupica D, Lusa L, Avšič-Županc T, Smrdel KS, Jelovšek M, Lotrič-Furlan S. Are patients with erythema migrans who have leukopenia and/or thrombocytopenia coinfected with Anaplasma phagocytophilum or tick-borne encephalitis virus? PLoS One 2014; 9:e103188. [PMID: 25057802 PMCID: PMC4110002 DOI: 10.1371/journal.pone.0103188] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 06/30/2014] [Indexed: 12/30/2022] Open
Abstract
Lyme borreliosis (LB), tick-borne encephalitis (TBE) and human granulocytic anaplasmosis (HGA) are endemic in central part of Slovenia. We tested the hypothesis that patients with erythema migrans (EM) from this region, who have leukopenia and/or thrombocytopenia (typical findings in HGA and in the initial phase of TBE but not in patients with LB) are coinfected with Anaplasma phagocytophilum and/or with TBE virus, i.e. that cytopenia is a result of concomitant HGA or the initial phase of TBE. Comparison of clinical and laboratory findings for 67 patients with EM who disclosed leukopenia/thrombocytopenia with the corresponding results in sex- and age-matched patients with EM and normal blood cell counts revealed no differences. In addition, patients with typical EM and leukopenia and/or thrombocytopenia tested negative for the presence of IgM and IgG antibodies to TBE virus by ELISA as well as for the presence of specific IgG antibodies to A. phagocytophilum antigens by IFA in acute and convalescent serum samples. Thus, none of 67 patients (95% CI: 0 to 5.3%) with typical EM (the presence of this skin lesion attests for early Lyme borreliosis and is the evidence for a recent tick bite) was found to be coinfected with A. phagocytophilum or had a recent primary infection with TBE virus. The findings in the present study indicate that in Slovenia, and probably in other European countries endemic for LB, TBE and HGA, patients with early LB are rarely coinfected with the other tick-transmitted agents.
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Affiliation(s)
- Franc Strle
- Department of Infectious Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia
- * E-mail:
| | - Petra Bogovič
- Department of Infectious Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Jože Cimperman
- Department of Infectious Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Vera Maraspin
- Department of Infectious Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Katarina Ogrinc
- Department of Infectious Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Tereza Rojko
- Department of Infectious Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Daša Stupica
- Department of Infectious Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Lara Lusa
- Institute for Biostatistics and Medical Informatics, Faculty of Medicine Ljubljana, Ljubljana, Slovenia
| | - Tatjana Avšič-Županc
- Institute of Microbiology and Immunology, Faculty of Medicine Ljubljana, Ljubljana, Slovenia
| | - Katja Strašek Smrdel
- Institute of Microbiology and Immunology, Faculty of Medicine Ljubljana, Ljubljana, Slovenia
| | - Mateja Jelovšek
- Institute of Microbiology and Immunology, Faculty of Medicine Ljubljana, Ljubljana, Slovenia
| | - Stanka Lotrič-Furlan
- Department of Infectious Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia
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Ogawa Y, Adachi A, Tomita Y. The Successful Use of Topical Tacrolimus Treatment for a Chronic Actinic Dermatitis Patient with Complications of Idiopathic Leukopenia. J Dermatol 2014; 30:805-9. [PMID: 14684938 DOI: 10.1111/j.1346-8138.2003.tb00482.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2002] [Accepted: 07/08/2003] [Indexed: 11/30/2022]
Abstract
Chronic actinic dermatitis (CAD) is a photosensitivity disorder marked by severe eczematous lesions on exposed areas. Although associations with contact dermatitis, atopic dermatitis, and human immunodeficiency virus (HIV) have been suggested, its pathogenesis remains unknown. CAD is often refractory, and systemic administration of cyclosporin A has been the treatment of choice. Recently, topical tacrolimus therapy has been reported to be effective. We report the efficacy of topical tacrolimus treatment in a CAD patient who also had the complication of idiopathic leukopenia. A phototest showed marked suppression of erythema formation in the skin pre-treated with tacrolimus before UVB radiation but not in the skin treated after the irradiation. Therefore, it is suggested that tacrolimus may prevent UV-B induced erythema by suppressing a very early phase of the inflammatory process in CAD.
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Affiliation(s)
- Yasushi Ogawa
- Department of Dermatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Inamura J, Ikuta K, Toki Y, Hatayama M, Ito S, Shindo M, Sato K, Torimoto Y, Kohgo Y. [Case report; Two cases of paroxysmal nocturnal hemoglobinuria with preceding cytopenia]. Nihon Naika Gakkai Zasshi 2014; 103:1385-1387. [PMID: 25151804 DOI: 10.2169/naika.103.1385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Nicolato RDC, de Abreu RT, Roatt BM, Aguiar-Soares RDDO, Reis LES, Carvalho MDG, Carneiro CM, Giunchetti RC, Bouillet LEM, Lemos DS, Coura-Vital W, Reis AB. Clinical forms of canine visceral Leishmaniasis in naturally Leishmania infantum-infected dogs and related myelogram and hemogram changes. PLoS One 2013; 8:e82947. [PMID: 24376612 PMCID: PMC3871677 DOI: 10.1371/journal.pone.0082947] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 11/08/2013] [Indexed: 11/29/2022] Open
Abstract
Hematological analysis has limited applications for disease diagnosis in Leishmania infantum–infected dogs, but it can be very important in evaluating the clinical forms of the disease and in understanding the evolution of canine visceral leishmaniasis (CVL) pathogenesis. Recently, we demonstrated that alterations in leucopoiesis and erythropoiesis are related to clinical status and bone marrow parasite density in dogs naturally infected by L. infantum. To further characterize these alterations, we evaluated the association between the hematological parameters in bone marrow and peripheral blood alterations in groups of L. infantum–infected dogs: asymptomatic I (AD-I: serum negative/PCR+), asymptomatic II (AD-II: serum positive), oligosymptomatic (OD), and symptomatic (SD). Results were compared with those from noninfected dogs (NID). The SD group was found to present a decrease in erythropoietic lineage with concomitant reductions in erythrocytes, hemoglobin, and hematocrit parameters, resulting in anemia. The SD group also had increased neutrophils and precursors and decreased band eosinophils and eosinophils, leading to peripheral blood leucopenia. In the AD-II group, lymphocytosis occurred in both the peripheral blood and the bone marrow compartments. The SD group exhibited lymphocytosis in the bone marrow, with lymphopenia in the peripheral blood. In contrast, the AD-I group, showed no significant changes suggestive of CVL, presenting normal counts in bone marrow and peripheral blood. Our results showed for the first time that important changes in hematopoiesis and hematological parameters occur during ongoing CVL in naturally infected dogs, mainly in symptomatic disease. Taken together, our results based on myelogram and hemogram parameters enable better understanding of the pathogenesis of the anemia, lymphocytosis, and lymphopenia, as well as the leucopenia (eosinopenia and monocytopenia), that contribute to CVL prognosis.
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Affiliation(s)
- Roney de Carvalho Nicolato
- Laboratório de Imunopatologia, Núcleo de Pesquisas em Ciências Biológicas/NUPEB, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
- Laboratório de Pesquisas Clinicas, Departamento de Análises Clínicas, Escola de Farmácia, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
| | - Raquel Trópia de Abreu
- Laboratório de Imunopatologia, Núcleo de Pesquisas em Ciências Biológicas/NUPEB, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
| | - Bruno Mendes Roatt
- Laboratório de Imunopatologia, Núcleo de Pesquisas em Ciências Biológicas/NUPEB, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
- Laboratório de Pesquisas Clinicas, Departamento de Análises Clínicas, Escola de Farmácia, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
| | - Rodrigo Dian de Oliveira Aguiar-Soares
- Laboratório de Imunopatologia, Núcleo de Pesquisas em Ciências Biológicas/NUPEB, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
- Laboratório de Pesquisas Clinicas, Departamento de Análises Clínicas, Escola de Farmácia, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
| | - Levi Eduardo Soares Reis
- Laboratório de Imunopatologia, Núcleo de Pesquisas em Ciências Biológicas/NUPEB, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
- Laboratório de Pesquisas Clinicas, Departamento de Análises Clínicas, Escola de Farmácia, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
| | - Maria das Graças Carvalho
- Laboratório de Hematologia Clínica, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Cláudia Martins Carneiro
- Laboratório de Imunopatologia, Núcleo de Pesquisas em Ciências Biológicas/NUPEB, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
- Laboratório de Pesquisas Clinicas, Departamento de Análises Clínicas, Escola de Farmácia, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
| | - Rodolfo Cordeiro Giunchetti
- Laboratório de Imunopatologia, Núcleo de Pesquisas em Ciências Biológicas/NUPEB, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
- Laboratório de Biologia das Interações Celulares, Departamento de Morfologia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Leoneide Erica Maduro Bouillet
- Laboratório de Imunopatologia, Núcleo de Pesquisas em Ciências Biológicas/NUPEB, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
- Laboratório de Pesquisas Clinicas, Departamento de Análises Clínicas, Escola de Farmácia, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
| | - Denise Silveira Lemos
- Laboratório de Imunologia e Genômica de Parasitos – Departamento de Parasitologia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Wendel Coura-Vital
- Laboratório de Imunopatologia, Núcleo de Pesquisas em Ciências Biológicas/NUPEB, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
- Laboratório de Pesquisas Clinicas, Departamento de Análises Clínicas, Escola de Farmácia, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
- Laboratório de Epidemiologia das Doenças Infecto Parasitárias - Pós-graduação em Infectologia e Medicina Tropical, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Alexandre Barbosa Reis
- Laboratório de Imunopatologia, Núcleo de Pesquisas em Ciências Biológicas/NUPEB, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
- Laboratório de Pesquisas Clinicas, Departamento de Análises Clínicas, Escola de Farmácia, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
- * E-mail:
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Shvidel L, Tadmor T, Braester A, Bairey O, Rahimi-Levene N, Herishanu Y, Klepfish A, Shtalrid M, Berrebi A, Polliack A. Pathogenesis, prevalence, and prognostic significance of cytopenias in chronic lymphocytic leukemia (CLL): a retrospective comparative study of 213 patients from a national CLL database of 1,518 cases. Ann Hematol 2012; 92:661-7. [PMID: 23274356 DOI: 10.1007/s00277-012-1663-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2012] [Accepted: 12/17/2012] [Indexed: 11/25/2022]
Abstract
Utilizing the database of the Israeli CLL Study Group, we investigated the prevalence and prognostic significance of anemia and thrombocytopenia in patients with chronic lymphocytic leukemia (CLL). Of 1,477 patients, 113 had anemia and thrombocytopenia associated with "infiltrative" marrow failure, median survival of 41 and 86 months, respectively. Autoimmune cytopenias were diagnosed in 100 patients, autoimmune hemolytic anemia (AIHA) in 80, and immune thrombocytopenia (ITP) in 31, while 11 had both co-existent. Median survival of patients with AIHA and ITP, from CLL diagnosis, was 96 and 137 months, respectively, but 29 and 75 months from onset of cytopenia. Patients with AIHA from the time of CLL diagnosis had a significantly shorter survival than those without anemia (p < .0001). Survival was similar for patients with AIHA or anemia due to "infiltrative" bone marrow failure (p = .44). The presence of positive antiglobulin test even without hemolysis was associated with worse outcome. Overall survival of patients with ITP and those without cytopenias (p = 0.94) were similar. In conclusion, laboratory or clinical evidence of AIHA has a significant negative impact on the survival of patients with CLL. Outcome for cases with ITP and patients without cytopenias was similar.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Algorithms
- Cytogenetic Analysis
- Databases, Factual/statistics & numerical data
- Female
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/epidemiology
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Leukopenia/complications
- Leukopenia/diagnosis
- Leukopenia/epidemiology
- Male
- Middle Aged
- Pancytopenia/complications
- Pancytopenia/diagnosis
- Pancytopenia/epidemiology
- Prevalence
- Prognosis
- Registries/statistics & numerical data
- Retrospective Studies
- Survival Analysis
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Affiliation(s)
- Lev Shvidel
- Kaplan Medical Center, Rehovot, affiliated with Hebrew University Medical School, Jerusalem, Israel.
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26
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Otsubo K, Horie S, Nomura K, Miyawaki T, Abe A, Kanegane H. Acute promyelocytic leukemia following aleukemic leukemia cutis harboring NPM/RARA fusion gene. Pediatr Blood Cancer 2012; 59:959-60. [PMID: 22573339 DOI: 10.1002/pbc.24199] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Accepted: 04/23/2012] [Indexed: 01/10/2023]
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27
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Liu Y, Huang XY, Du YH, Wang HF, Xu BL. [Survey on ticks and detection of new bunyavirus in some vect in the endemic areas of fever, thrombocytopenia and leukopenia syndrome (FTLS) in Henan province]. Zhonghua Yu Fang Yi Xue Za Zhi 2012; 46:500-504. [PMID: 22943894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To investigate the distribution, species, seasonal fluctuation of ticks and detect new bunyavirus in some hematophagus in the endemic areas of fever thrombocytopenia and leukopenia syndrome (FTLS) in Henan province. METHODS From March to December 2011, the free ticks were collected manually with white cloth from the grassland and the parasitic ticks were collected from the host skin by hand searching in Xinyang and Jiyuan. The density and seasonal fluctuation of ticks were analyzed after classification of the specimen. The hematophagus were collected including gadfly (38 in 16 groups), cattle lice (224 in 16 groups), mosquitoes (238 in 17 groups) and ticks (825 in 77 groups), then RNA of new bunyavirus were detected by RT-PCR. RESULTS A total of 12 388 ticks were collected in Xinyang and Jiyuan, consisting of 2 families, 5 geniuses and 6 species. In Xinyang city, 622 ticks were identified, consisting of 2 families, 3 geniuses and 3 species, including 2 (0.32%) Ornithodoros lahorensis, 451 (72.51%) Haemaphysalis longicornis and 117 (18.81%) Boophilus microplus. In Jiyuan city, 11 766 ticks were identified, consisting of 1 family, 4 geniuses and 5 species, including 7718 (65.60%) Haemaphysalis longicornis, 164 (1.39%) H.anatolicum anatolicum and 710 (6.03%) other ticks such as H. detritum, Boophilus microplus and Rhipicephalus sanguineus. Haemaphysalis longicornis were found in both districts as the predominant species in Henan province. Ticks were active from March to October. The average density was 160 per person hour and the peak was from May to July with density 278, 209 and 542 per person hour respectively. The results was positive in RNA detection of new bunyavirus in 11 groups of tick and 3 groups of gadfly by RT-PCR. The results were negative in all other hematophagus. CONCLUSION Ornithodoros lahorensis, Haemaphysalis longicornis, Boophilus microplus, H.anatolicum anatolicum, Rhipicephalus sanguineus and H. detritum were found in Henan province. Haemaphysalis longicornis was the predominant species. The density of ticks varied with the seasons. The detection of new bunyavirus by PCR was positive in some ticks and gadflies.
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Affiliation(s)
- Yang Liu
- College of Public Health, Zhengzhou University, Zhengzhou 450001, China
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28
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Meert AP, Berghmans T, Markiewicz E, Hardy M, Nayer N, Paesmans M, Sculier JP. Invasive mechanical ventilation in cancer patients. Prior non invasive ventilation is a poor prognostic factor. J BUON 2011; 16:160-165. [PMID: 21674869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
PURPOSE Prior non invasive ventilation (NIV) is associated with an increased mortality in patients with haematological malignancies and acute respiratory failure treated by invasive mechanical ventilation (IMV). We have assessed whether NIV failure is an independent prognostic factor for hospital discharge in a general cancer population treated by IMV. METHODS 106 patients with solid tumors and 58 patients with haematological malignancies were eligible for this retrospective study; 41 were treated by NIV before IMV. RESULTS The main indications for mechanical ventilation were sepsis/shock (35%), acute respiratory failure (33%), cardiopulmonary resuscitation (16%) and neurologic disease (10%). Respectively, 35%, 28% and 24% of the patients were extubated, discharged from the intensive care unit (ICU) and from the hospital. For patients treated with NIV prior to IMV, the rates were 22%, 17% and 10%, respectively. In multivariate analysis, 3 variables were independently associated with a decreased probability of being discharged from the hospital: NIV use before IMV (odds ratio/OR=0.30, 95% confidence interval/CI: 0.09-0.95; p=0.04); leukopenia (OR=0.21, 95% CI: 0.06-0.77; p=0.02) and serum bilirubin >1.1 mg/dl (OR=0.38, 95% CI: 0.16-0.94; p=0.04). CONCLUSION NIV failure before IMV is an independent poor prognostic factor in cancer patients treated by IMV.
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Affiliation(s)
- A P Meert
- Département de Soins Intensifs et Oncologie Thoracique et Data Centre, Institut Jules Bordet, Centre des tumeurs de l'Université Libre de Bruxelles (ULB), Bruxelles, Belgium.
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von Schéele C. Light chain myeloma with features of the adult Fanconi syndrome: six years remission following one course of melphalan. Acta Med Scand 2009; 199:533-7. [PMID: 820162 DOI: 10.1111/j.0954-6820.1976.tb06777.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
A 41-year-old woman, presenting with renal failure, renal glucosuria and moderate anemia, was found to have light chain myeloma, indicated by a kappa chain M-component in the serum, heavy urinary excretion of kappa chains and plasma cell infiltration of the bone marrow. After administration of one course of melphalan, resulting in transient pancytopenia, the light chains disappeared completely, renal function returned to normal, glucosuria disappeared and the Hb concentration normalized. During an observation period of six years she has remained in good health and there has been no sign of relapse.
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30
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Abstract
In the present study, we have evaluated prophylactic role of various immunomodulators viz. lipopolysachharide, protein A and tuftsin to impart protection against experimental candidiasis in leukopenic mice. Both free as well as liposomised form of nystatin was not effective enough in offering complete cure against less susceptible isolate of Candida albicans (JNMCR) infection in immunodebilitant mice. Interestingly, the pretreatment of leukopenic mice with immunomodulators before challenging them with C. albicans increased therapeutic efficacy of the nystatin against systemic candidiasis. Efficacy of the treatment was evaluated on the basis of survival of the animals as well as fungal load in systemic circulation and various organs viz. liver, kidney, spleen and lungs of the treated animals.
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Affiliation(s)
- M Alam Khan
- Interdisciplinary Biotechnology Unit, Aligarh Muslim University, Aligarh, India
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31
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Ohuchi M, Inoue S, Hanaoka J, Igarashi T, Tezuka N, Ozaki Y, Teramoto K. Good syndrome coexisting with leukopenia. Ann Thorac Surg 2007; 84:2095-7. [PMID: 18036947 DOI: 10.1016/j.athoracsur.2007.06.070] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2007] [Revised: 06/15/2007] [Accepted: 06/25/2007] [Indexed: 11/18/2022]
Abstract
A 61-year-old man was admitted to our hospital for further examinations of a mediastinal mass. He had underwent an extended thymothymectomy, and had a tumor that was diagnosed as a type B1 thymoma, according to the World Health Organization. One year after surgery he was admitted again for recurrent diarrhea and pneumonia. Laboratory data revealed severe hypogammaglobulinemia with leukopenia. He was diagnosed with Good syndrome with leukopenia. Regular gamma globulin and figrastim injections were successful in keeping the patient symptom free. The prognosis of patients with Good syndrome and leukopenia is very poor; therefore, immediate diagnosis is important. The development of infectious diseases in a patient with thymoma or after the resection of thymoma mandates early and comprehensive immunologic investigation.
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Affiliation(s)
- Masatsugu Ohuchi
- Department of Thoracic Surgery, National Hospital Organization Shiga Hospital, Shiga, Japan.
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32
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Nagao K. What's your diagnosis? Wilson disease (hepatolenticular degeneration) with Keyser-Fleischer ring. J Pediatr Ophthalmol Strabismus 2007; 44:84, 111. [PMID: 17410957 DOI: 10.3928/01913913-20070301-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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33
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Blumberg N, Gettings KF, Turner C, Heal JM, Phipps RP. An association of soluble CD40 ligand (CD154) with adverse reactions to platelet transfusions. Transfusion 2006; 46:1813-21. [PMID: 17002639 DOI: 10.1111/j.1537-2995.2006.00979.x] [Citation(s) in RCA: 115] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Removal of stored supernatant abrogates most transfusion reactions to leukoreduced platelets (PLTs), suggesting that PLT-derived soluble mediators are involved. PLTs are the primary source of soluble CD40 ligand (sCD40L). Engagement of the receptor for CD40L induces synthesis of proinflammatory mediators including interleukin (IL)-6, IL-8, and monocyte chemotactic protein-1 (MCP-1). STUDY DESIGN AND METHODS Supernatants from poststorage leukoreduced PLT concentrates were assayed for white cell- (IL-6, IL-8, MCP-1) and PLT-derived (sCD40L, RANTES) inflammatory mediators. These levels were correlated with clinical outcomes. RESULTS Of 534 transfusions, there were 12 reported (2.2%) and 2 unreported reactions (0.4%)--10 febrile and 4 allergic. Transfusions with reactions had significantly higher levels of IL-6 (2.3-fold higher; p = 0.005), IL-8 (2.2-fold higher; p = 0.001), MCP-1 (2.6-fold higher; p = 0.002), and sCD40L (1.24-fold higher; p = 0.015), but not RANTES. (1.14-fold higher; p = 0.22). The vast majority (>93%) of patients transfused with mediator levels in the highest quintile had no reactions. When levels of all five mediators were summed, the reaction rates in the first through fifth quintiles increased from 1 to 7 percent (p = 0.027). All but one reaction occurred in patients with hematologic malignancies (13 reactions/380 transfusions; 3.4%; p = 0.04 vs. other diagnoses). CONCLUSIONS These are the first data demonstrating that a PLT-derived mediator, sCD40L, is associated with adverse transfusion events. Existing clinical factors, for example, inflammation or leukopenia, may influence whether infused mediators cause reactions.
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Affiliation(s)
- Neil Blumberg
- Transfusion Medicine Unit and Clinical Laboratories, Department of Pathology and Laboratory Medicine, Hematology-Oncology Unit, the University of Rochester Medical Center, Rochester, New York 14642, USA.
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Abstract
Hamartoma is a neoplasm-like lesion composed of an abnormal mixture of tissues native to the area. We report on an unusual example of a hamartomatous lesion that showed an abnormal mixture of elements of the folliculosebaceous-apocrine unit and arrector pili muscle. A 13-year-old female presented with two nodules situated 2 cm apart on the lower leg that were present since birth. The patient reported some enlargement and slight pain of the otherwise asymptomatic lesions during 2 years, before they were surgically removed. The patient obviously had no skin problems afterwards; her 12-year follow-up was significant for leucopenia and nephrolithiasis. The biopsies from both lesions looked identical. Each lesion was biphasic, i.e. composed of a predominant mesenchymal component and epithelial elements. The mesenchymal part resembled a leiomyoma, or in minor areas, the constituting cells had a myofibroblastic appearance. Encased within the mesenchymal component were large infundibulocystic structures and plentiful grouped and scattered roundish solid epithelial nodules, duct-like, glandular, and tubular elements. Some of the epithelial structures were reminiscent of those seen in tubular apocrine adenoma; others resembled syringomatous elements. We interpreted this unusual lesion as a hamartoma of the folliculosebaceous-apocrine unit.
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Affiliation(s)
- Dmitry V Kazakov
- Sikl's Department of Pathology, Charles University, Medical Faculty Hospital, Pilsen, Czech Republic.
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Ferreira PG, Costa-e-Silva A, Oliveira MJR, Monteiro E, Cunha EM, Aguas AP. Severe leukopenia and liver biochemistry changes in adult rabbits after calicivirus infection. Res Vet Sci 2006; 80:218-25. [PMID: 16002110 DOI: 10.1016/j.rvsc.2005.05.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2004] [Revised: 04/15/2005] [Accepted: 05/13/2005] [Indexed: 11/16/2022]
Abstract
Calicivirus infection is the major cause of the severe decrease in the stocks of wild and farm rabbits that has occurred worldwide during the last two decades. Adult rabbits (10-weeks-old) were experimentally infected with a calicivirus inoculum that killed all animals by causing rabbit haemorrhagic disease (RHD) within 24-62 h of infection. The rabbits were used to evaluate blood cell numbers and serum biochemistry every 6h, starting 12h after the inoculation of the caliciviruses. No significant changes in blood parameters were observed in most of the rabbits up to 18 h of infection. Severe leukopenia was seen 6h before death of the infected rabbits; both heterophils and lymphocytes contributed to the decrease in circulating white blood cells. Platelets were also severely decreased in number. Marked enhancement in liver enzymes was seen 6-12 h before death of the infected rabbits. There was also evidence both for cholestasis, as expressed by the elevated levels of direct (conjugated) bilirubin, and for hypoglycemia, an alteration that it is likely to contribute for the seizures that rabbits show during the late stages of RHD. Liver ultrastructure of rabbits that died from RHD revealed extensive hepatocyte vacuolization, severe changes in mitochondrial structure, and depletion of glycogen granules. We conclude that: (i) severe leukopenia characterizes the final hours of calicivirus-induced RHD; (ii) hypoglycemia and cholestasis precede death of rabbits from RHD; (iii) the kinetics of liver enzymes allows an accurate prediction of the time of death of rabbits from calicivirus-induced RHD.
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Affiliation(s)
- P G Ferreira
- Department of Anatomy, ICBAS (Abel Salazar Institute for Biomedical Sciences), University of Porto, Largo Professor Abel Salazar, 2, Porto 4099-003, Portugal.
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Kawagishi N, Satoh K, Enomoto Y, Akamatsu Y, Sekiguchi S, Satomi S. Usage of Deoxyspergualin on Steroid-Resistant Acute Rejection in Living Donor Liver Transplantation. TOHOKU J EXP MED 2006; 208:225-33. [PMID: 16498230 DOI: 10.1620/tjem.208.225] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Deoxyspergualin (DSG) is an immunosuppressive agent used to treat steroid-resistant acute rejection after kidney transplantation. But in the case of acute rejection after liver transplantation, DSG was reported effective in just a few cases. From July 1991 to November 2005, 96 patients underwent living donor liver transplantation (LDLTx) in our institution. Of them, 9 patients, including 4 ABO incompatible recipients, are presented. Rejection symptoms that did not respond to steroid pulse therapy (methylprednisolone, 10-20 mg/kg/day for 3 days) and were treated with DSG (3 or 5 mg/kg/day) for 4 to 14 days together with a maintenance dose of the steroid. Among them, five responded to treatment with DSG, two did not respond and the other two patients were not evaluated. Six of the nine patients are symptom free at present. Complications such as leukopenia and thrombocytopenia were successfully treated with granulocyte-colony stimulating factor or by platelet transfusion. No recipient died as a direct consequence of the complications induced by DSG. DSG proved effective and safe for some of the LDLTx recipients with steroid-resistant acute rejection but it was not effective for the treatment of accelerated humoral rejection in ABO incompatible recipients.
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Affiliation(s)
- Naoki Kawagishi
- Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, Sendai, Japan.
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Ferrand H, Tamburini J, Mouly S, Bouscary D, Bergmann JF. Listeria monocytogenes Meningitis Following Imatinib Mesylate-Induced Monocytopenia in a Patient with Chronic Myeloid Leukemia. Clin Infect Dis 2005; 41:1684-5. [PMID: 16267747 DOI: 10.1086/498031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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38
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Sugito M, Tsukada J, Higashi T, Ohta T, Matsuura A, Kubota A, Mizobe T, Mouri F, Morimoto H, Tanaka Y. [Generalized erythema triggered by a rapid decrease of basophils in chronic myeloid leukemia treated with imatinib]. Rinsho Ketsueki 2005; 46:1226-8. [PMID: 16440809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
A 57-year-old woman with chronic myeloid leukemia showing severe basophilia (WBC 17.1 X 10(9)/L, basophils 23%) was treated with 400mg imatinib in June 2003. A high basophil count (WBC 10.6 X 10(9)/L, basophils 31%) was still observed after 1 week of therapy. After 9 days of therapy, she developed generalized pruritic skin erythema, chills and high fever. After terminating imatinib treatment, prednisolone therapy was initiated. The rash quickly disappeared. Four days after withdrawal of imatinib, leukocyte count was 13.0 X 10(9)/L with 3% of basophils, suggesting the possibility that rapid decrease in basophils following imatinib therapy may induce severe cutaneous reactions.
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Affiliation(s)
- Motoko Sugito
- First Department Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu
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Serwint JR, Dias MM, Chang H, Sharkey M, Walker AR. Outcomes of febrile children presumed to be immunocompetent who present with leukopenia or neutropenia to an ambulatory setting. Clin Pediatr (Phila) 2005; 44:593-600. [PMID: 16151565 DOI: 10.1177/000992280504400707] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
UNLABELLED To determine significant medical outcomes in febrile children presenting to an ambulatory setting with neutropenia and/or leukopenia. METHODS Retrospective medical record review conducted on febrile patients who had a blood culture drawn, with white blood cell counts less than 5,000/mm3 and/or an absolute neutrophil count less than 1000/mm3. Ninety-one patients were identified; 5 with positive blood culture results, 13 with significant non-oncologic disease, and 3 patients with leukemia who had involvement of 2 or more cell lines. CONCLUSIONS In the majority of patients, clinical judgment, physical findings, and review of all cell lines of the complete blood cell count identified those with significant disease.
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Affiliation(s)
- J R Serwint
- Department of Pediatrics, Division of General Pediatrics, Johns Hopkins Hospital, Baltimore, MD 21287, USA
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Khan MA, Nasti TH, Owais M. Incorporation of amphotericin B in tuftsin-bearing liposomes showed enhanced efficacy against systemic cryptococcosis in leucopenic mice. J Antimicrob Chemother 2005; 56:726-31. [PMID: 16126780 DOI: 10.1093/jac/dki307] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The role of the immunomodulator tuftsin in enhancing the antifungal activity of liposomal amphotericin B against Cryptococcus neoformans in leucopenic mice was assessed. METHODS In the present study, we investigated the antifungal activity of amphotericin B liposomes with tuftsin grafted on the surface. Mice were treated with free amphotericin B as well as liposomal formulations after C. neoformans infection. For prophylactic studies, mice were pre-treated with liposomal tuftsin (50 microg/mL) for three consecutive days prior to C. neoformans infection (7 x 10(5) cfu/mouse). Chemotherapy, with tuftsin-free and tuftsin-bearing amphotericin B liposomes, was started 24 h post C. neoformans infection. The role of tuftsin in immunoaugmentative therapy was assessed by survival and cfu of treated mice. RESULTS Amphotericin B entrapped in tuftsin-bearing liposomes showed increased anticryptococcal activity in the murine model. Moreover, tuftsin pre-treatment further augmented the antifungal activity of liposomal amphotericin B in leucopenic mice. Incorporation of tuftsin in liposomes resulted in increased anticryptococcal activity of liposomal amphotericin B compared with amphotericin B deoxycholate and conventional liposomal amphotericin B formulations. CONCLUSIONS The enhanced anticryptococcal activity of amphotericin B in tuftsin-liposomes can be attributed to the immune-stimulating property of tuftsin. Tuftsin activates the key immune cells, due to the presence of its receptors on macrophages and neutrophils, for a better fight against pathogens. Simultaneous liposome-mediated delivery of amphotericin B to the site of infection kills the pathogens more effectively.
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Affiliation(s)
- Masood A Khan
- Interdisciplinary Biotechnology Unit, Aligarh Muslim University, Aligarh-202002, India
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Abstract
We have conducted a thorough literature review to evaluate the relative value of the hematologic criterion in making a diagnosis of systemic lupus erythematosus (SLE), its clinical relevance, and its prognostic significance. In the updated 1982 ACR criteria, the presence of one or more of the four elements: 1) hemolytic anemia (with reticulocytosis); 2) leukopenia (<4000/microL on two or more occasions); 3) lymphopenia (< 1500/microL on two or more occasions); or 4) thrombocytopenia (< 100,000/microL in the absence of offending drugs) is now considered as a single hematologic disorder. The sensitivity and specificity of the individual elements of the hematologic criterion range from 18 to 46% and 89 to 99%, respectively. The accuracy of the hematologic criterion requires proper interpretation. For example, many studies reported the presence of anemia that was not clearly defined and likely included anemia from etiologies other than hemolytic anemia, thereby causing an overestimation of the prevalence. In addition, medications such as corticosteroids and cytotoxic agents, and viral infections, can also contribute to a reduction in lymphocyte count. Despite these limitations, the SLICC committee recommends no change in the elements of the hematologic criterion when this criterion is properly interpreted and other causes of cytopenia are excluded.
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Affiliation(s)
- A H Kao
- Department of Medicine, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, PA, USA
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Ural AU, Avcu F, Gokcil Z, Nevruz O, Cetin T. Leucopenia and thrombocytopenia possibly associated with lamotrigine use in a patient. Epileptic Disord 2005; 7:33-5. [PMID: 15741138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2004] [Accepted: 11/05/2004] [Indexed: 05/02/2023]
Abstract
Haematological side effects are rather exceptional with lamotrigine. We report the case of a 25-year-old woman with epilepsy who developed combined leucopenia and thrombocytopenia eight weeks after starting lamotrigine. Within weeks after lamotrigine was discontinued, all of the haematopoietic abnormalities had disappeared. To our knowledge, this is the first report of combined leucopenia and thrombocytopenia associated with lamotrigine treatment suggesting, in our patient, a causal reaction.
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Affiliation(s)
- Ali Ugur Ural
- Department of Haematology, Medical and Cancer Research Center, Gulhane Military Medical Academy, School of Medicine, Ankara, Turkey.
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Li HX, Bai XL, Zheng N. [A case of congenital leukopenia]. Zhonghua Er Ke Za Zhi 2005; 43:191. [PMID: 15833191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
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Abstract
Reversible leukoencephalopathy syndrome (RLS) is a rare brain disorder, characterized by diffuse attenuation of cerebral white matter, which has been most commonly observed in transplant patients receiving calcineurin inhibitors or in patients with severe hypertension. We report an episode of RLS in a 22-year-old male patient on chronic hemodialysis with well-controlled moderate hypertension who presented with de novo headache and generalized seizures. Cranial magnetic resonance image (MRI) revealed multiple areas of increased signal intensity in the white matter on T2-weighed images which resolved spontaneously at subsequent MRIs. White blood cell count showed leucopenia with normal CD4 count at flow cytometry. A viral etiology could not be demonstrated. Reversible leukoencephaolopathy syndrome symptoms remitted within 72 h but leukopenia persisted over 10 months. The patient received a kidney transplant 15 months after RLS onset and has received cyclosporine since the second post-transplant day. No recurrence of RLS symptoms has been observed. The etiology of the MRI changes in the present case seemed not to be either vasogenic or cytotoxic.
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Affiliation(s)
- Octavio J Salgado
- Center of Experimental Surgery and Medicine, University of Zulia, Apartado Postal 313, Marracaibo, Venezuela.
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Mobascher A, Boecker J, Malevani J, Arends M, Klimke A, Cordes J. Repetitive transcranial magnetic stimulation as an antidepressant monotherapy in a patient with major depression, leucocytopenia and rhabdomyolysis. Int J Neuropsychopharmacol 2004; 7:527-9. [PMID: 15315718 DOI: 10.1017/s1461145704004523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2004] [Revised: 04/28/2004] [Indexed: 11/07/2022] Open
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Islam LN, Nabi AHMN, Rahman MM, Khan MA, Kazi AI. Association of Clinical Complications with Nutritional Status and the Prevalence of Leukopenia among Arsenic Patients in Bangladesh. IJERPH 2004; 1:74-82. [PMID: 16696181 DOI: 10.3390/ijerph2004020074] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study conducted in Bangladesh reports the relationship of clinical complications with nutritional status and the prevalence of leukopenia among arsenic exposed patients living in the rural villages. A total of 115 exposed individuals diagnosed as arsenicosis patients were randomly selected from four known arsenic endemic villages, and age-matched 120 unexposed subjects were enrolled in the study program. The duration of arsenic exposure in about 37% of the patients was at least 10 yrs, while the population mean and range were 7.6 +/- 5.2 yrs, and 1 - 25 yrs, respectively. The mean arsenic concentrations in the drinking water for the exposed and unexposed (control) population were 218.1 microg/L and 11.3 microg/L, respectively. The spot urine sample of the arsenicosis patients contained an average of 234.6 microg/L arsenic. Although very few patients showed elevated WBC count, 16% had leukopenia (below normal count), and the whole population had significantly low WBC count than the control subjects. Prevalences of neutropenia and lymphocytosis were observed in patients with chronic exposure to high levels of arsenic in water. The body mass index was found to be lower than 18.5, the cut-off point for malnutrition (underweight), in about 28% of the arsenicosis cases compared to 15% of the controls. The monthly income and total calorie consumption per day showed the patients were underprivileged than the controls. Arsenical symptoms and complications were more severe in the nutritionally vulnerable (underweight) patients than the overweight ones. Also, the incidences of leukopenia and anaemia were more common in the female patients who were underweight. The findings of this research demonstrate that the poor nutritional status of patients increases the complications of chronic arsenic toxicity; suggest the possibility of other sources of arsenic contamination different from drinking water in the study area; and establish a higher prevalence of leukopenia and lymphocytosis in arsenicosis patients.
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Affiliation(s)
- Laila N Islam
- Department of Biochemistry and Molecular Biology, University of Dhaka, Dhaka-1000, Bangladesh.
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Yücesoy M, Ergon MC, Oren H, Gülay Z. [Case report: a Fusarium fungaemia]. MIKROBIYOL BUL 2004; 38:265-71. [PMID: 15490848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
In this report, a case of Fusarium fungaemia developed in an acute lymphoblastic leukemia (ALL) patient was presented. A seven year old girl who had weakness, loss of appetite, paleness and ecchymosis on legs applied to Pediatric Hematology Service and cytotoxic chemotherapy was started after she had been diagnosed as ALL-L1. Her chemotherapy was stopped because of increase in fever, leukopenia and neutropenia. Central venous catheter and peripheral blood cultures were obtained. Fusarium thapsinum was recovered from blood cultures, obtained in two consecutive days. Thereupon central venous catheter of the patient was removed and intravenous amphotericin B was added to the therapy. On the fifth day of febrile neutropenia attack, her fever was decreased after the onset of antifungal therapy. Radiological examinations were normal and no fungal growth was observed in the later blood cultures. On the 21st day of amphotericin B therapy, chemotherapy was started again and amphotericin B was changed to peroral itraconazole (200 mg/day) at the fifth week. The patient whose itraconazole therapy was stopped after three months, was still in remission and continued receiving her prolonged therapy. In conclusion, Fusarium infections which manifest with fungaemia and fever as the only symptoms, should be taken into consideration in neutropenic patients receiving immunosuppressive therapy.
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Affiliation(s)
- Mine Yücesoy
- Dokuz Eylül Universitesi Tip Fakültesi, Mikrobiyoloji ve Klinik Mikrobiyoloji Anabilim Dali, Izmir
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Aoki S, Hirakata Y, Kondoh A, Gotoh N, Yanagihara K, Miyazaki Y, Tomono K, Yamada Y, Kohno S, Kamihira S. Virulence of metallo-beta-lactamase-producing Pseudomonas aeruginosa in vitro and in vivo. Antimicrob Agents Chemother 2004; 48:1876-8. [PMID: 15105148 PMCID: PMC400588 DOI: 10.1128/aac.48.5.1876-1878.2004] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We evaluated the virulence of Pseudomonas aeruginosa carrying bla(IMP), a metallo-beta-lactamase gene, and the efficacy of ceftazidime, imipenem-cilastatin, and ciprofloxacin in the endogenous bacteremia model. The presence of bla(IMP) did not practically change the virulence of the parent strain, and ciprofloxacin was effective against infection with P. aeruginosa carrying bla(IMP).
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Affiliation(s)
- S Aoki
- Department of Laboratory Medicine, Nagasaki University School of Medicine, Nagasaki 852-8501, Japan
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49
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Abstract
We developed a novel model of invasive aspergillosis (IA) that recapitulates human disease. Mice were immunosuppressed with cyclophosphamide and cortisone acetate and then infected in an aerosol chamber. This procedure reproducibly delivered 1 x 10(3) to 3 x 10(3) conidia to the lungs. Lethal pulmonary IA developed over 2 weeks and was prevented by amphotericin B.
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Affiliation(s)
- Donald C Sheppard
- St. John's Cardiovascular Research Center, Division of Infectious Diseases, Department of Medicine, Harbor-UCLA Research and Education Institute, Torrance, California 90502, USA
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50
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Abstract
BACKGROUND Infections are one of the main causes of morbidity and mortality in patients with systemic lupus erythematosus. OBJECTIVE To analyse urinary tract infection (UTI) risk factors in lupus patients; the influence of these factors on disease activity, organ damage, and disease development; the type and prevalence of UTI; and the micro-organisms involved. METHOD 86 control subjects and 81 lupus patients were studied prospectively over a 12 month period and examined on five occasions. Epidemiological data and information on urinary symptoms, disease activity (SLEDAI), and organ damage (SLICC/ACR) data were collected. Autoantibodies, complement levels, urine culture, and antibiogram were determined; urological studies were also carried out. SPPS 10.0 and STATA 6.0. were used for statistical analysis. RESULTS The prevalence of UTI in lupus patients was 36%. Lupus influences the onset of UTI (p = 0.001), regardless of other variables. UTI risk factors in lupus patients were age (p = 0.002), previous cases of UTI (p = 0.0001), antinuclear antibodies (ANA) >1/80 IU/ml (p = 0.022), thrombocytopenia (p = 0.02), and admission to hospital due to UTI (p = 0.002). Leucopenia (p = 0.09) and the weekly administration of methotrexate (p = 0.06) had a bearing on the onset of UTI; disease development (p = 0.99), lupus activity (p = 0.32), and organ damage (p = 0.36) do not. The uropathogen most frequently isolated was E coli (60%). CONCLUSIONS Lupus patients are likely to have UTI, usually manifesting in the lower tract. They are community acquired, basically caused by E coli, and favoured by age, previous UTI, admissions to hospital due to UTI, thrombopenia, ANA, leucopenia, and methotrexate treatments.
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Affiliation(s)
- C Hidalgo-Tenorio
- Systemic Autoimmune Diseases Unit, Service of Internal Medicine, "Virgen de las Nieves" University Hospital, Granada, Spain.
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