RESUMO
During a blood test, the discovery of thrombocytosis is a frequent phenomenon with multiple origins. False thrombocytosis linked to analytical interferences is rare but must be eliminated before confirming the anomaly. The reaction origin, often very easily demonstrated by the context and/or the presence of a biological inflammatory syndrome, is the most frequent. More rarely, the diagnosis is oriented towards a clonal hematological pathology not limited to essential thrombocythemia. Currently, many biological tools, which have largely contributed to the recommendations of the latest WHO classification of chronic myeloid neoplasms, are available to classify these pathologies as precisely as possible, allowing optimal management.
Assuntos
Transtornos Mieloproliferativos , Trombocitemia Essencial , Trombocitose , Adulto , Humanos , Trombocitemia Essencial/diagnóstico , Trombocitose/diagnósticoRESUMO
Gardnerella vaginalis (G. vaginalis) is a commensal bacterium of the vaginal flora, facultative anerobic with Gram-variable, frequently implicated in cases of vaginosis or even infections of the genitourinary tract, rarely responsible for systemic infections and very exceptionally isolated in bronchopulmonary damage. We report here a case of G. vaginalis pneumonia in a 45-year-old man admitted to the intensive care unit for cardiorespiratory arrest (CRA) by hanging, whose course was unfavorable following severe post-anoxic encephalopathy. During his hospitalization, the patient presented ventilator-associated pneumonia (VAP) with identification of G. vaginalis at a significant threshold on the protected distal bronchial sampling (PDBS). Antibiotic therapy with cefotaxime and metronidazole had a good response to this infection. In this observation, we discuss the pathogenic role and identification of G. vaginalis at the pulmonary level.
RESUMO
Sideroblastic anemias in adults are often quickly labeled as myelodysplasias. We report two unfrequent observations of secondary acquired forms. The first one is a 15-year-old girl presented with severe cytopenias. The myelogram revealed the presence of vacuolated myeloid and erythroblastic precursors, with ring sideroblasts. Copper deficiency has been demonstrated in front of the association with collapsed cupremia and ceruleoplasminemia, with normal cupruria. The second case is a 70-year-old man, treated for 1 month with several lines of antibiotics for a skin infection, referred for cytopenias. The myelogram found vacuolated erythroblastic precursors and ring sideroblasts. Linezolid's responsibility has been proposed, with a favorable development after treatment has been stopped. These two observations, which describe unfrequent sideroblastic anemias, point out that this discovery should not lead to the diagnosis of myelodysplasia before having considered the many other etiologies.
Assuntos
Anemia Sideroblástica , Síndromes Mielodisplásicas , Adolescente , Idoso , Anemia Sideroblástica/diagnóstico , Feminino , Humanos , Masculino , Síndromes Mielodisplásicas/complicações , Síndromes Mielodisplásicas/diagnósticoRESUMO
The discovery of eosinophilia above 1.5 G/L should not be considered innocuous, requiring monitoring for etiology and possible secondary organ damage. Among these, cardiac localization is the most worrying, sometimes indolent, to be systematically sought by ultrasound and magnetic resonance. The potential etiologies are very numerous, mostly reactive and corticosensitive, much more rarely clonal in relation to a malignant hemopathy usually chronic and myeloid, sometimes sensitive to tyrosine kinase inhibitors.
Assuntos
Técnicas de Laboratório Clínico/métodos , Eosinofilia/diagnóstico , Eosinofilia/etiologia , Testes Hematológicos/métodos , Técnicas de Laboratório Clínico/história , Técnicas de Laboratório Clínico/normas , Diagnóstico Diferencial , Eosinofilia/história , Testes Hematológicos/história , Testes Hematológicos/normas , História do Século XXI , HumanosRESUMO
Immunosuppression is a well known risk factor for the development of lymphoid pathologies. The classification of these neoplasias is becoming more precise and complex, some features being common to all immunocompromised patients, primarily the important influence of Epstein-Barr virus. Whatever the origin of the immunodepression, these lymphoid proliferations are very heterogeneous, constituting a wide range between polymorphic aspects and clearly lymphomatous morphologies indistinguishable from those observed in immunocompetent subjects. It is important to detect precisely these different categories of proliferation within each group of immunosuppression, to better individualize the prognosis and the management of patients.
Assuntos
Hospedeiro Imunocomprometido , Linfoma/etiologia , Transformação Celular Viral/fisiologia , HIV/fisiologia , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Infecções por HIV/imunologia , Infecções por HIV/patologia , Humanos , Hospedeiro Imunocomprometido/imunologia , Síndromes de Imunodeficiência/complicações , Síndromes de Imunodeficiência/epidemiologia , Imunossupressores/efeitos adversos , Linfoma/epidemiologia , Linfoma/imunologia , Transtornos Linfoproliferativos/induzido quimicamente , Transtornos Linfoproliferativos/epidemiologia , Transtornos Linfoproliferativos/imunologia , Transplante de Órgãos/efeitos adversos , Transplante de Órgãos/estatística & dados numéricos , Condicionamento Pré-Transplante/efeitos adversos , Condicionamento Pré-Transplante/estatística & dados numéricosRESUMO
The discovery of a monocytosis is a frequent phenomenon, requiring confirmation by reading under a microscope by an experimented biologist, to overcome usual cytological traps such as the presence of hairy cells, promonocytes or monoblasts. In the vast majority of cases the secondary origin is very easily found by the context and/or the presence of a biological inflammatory syndrome. More rarely the diagnosis is directed towards an eosinophilic pathology or an acute leukemia. In other cases, CMML, MPN or MDS with monocytosis may be highlighted. In the absence of any pathognomonic element and the presence of "borderline" forms the differential diagnosis between these 3 entities is not always straightforward, requiring, according to WHO, molecular investigations and elimination of any reactive cause of monocytosis. Although histological, immunohistochemical and phenotypic flow cytometric studies are not currently recommended by WHO, these investigations could be of interest in the evaluation of difficult cases.
Assuntos
Técnicas de Laboratório Clínico/métodos , Monócitos/patologia , Síndromes Mielodisplásicas/diagnóstico , Adulto , Idade de Início , Algoritmos , Diagnóstico Diferencial , Humanos , Contagem de Leucócitos , Síndromes Mielodisplásicas/epidemiologia , Síndromes Mielodisplásicas/patologiaRESUMO
The etiological assessment of a monoclonal gammopathy is currently standardized, the decisional algorithms allowing a sufficiently precise classification to consider the care, wait or therapeutic. The purpose of this review is to recall the difficulties concerning the interpretation of certain biological investigations and to point out the potential complications of monoclonal gammopathies labeled as "benign". The cooperation between clinicians and biologists is in all cases essential, allowing to propose on a case-by-case basis the best adapted explorations.
Assuntos
Serviços de Laboratório Clínico/normas , Técnicas de Laboratório Clínico , Gamopatia Monoclonal de Significância Indeterminada/diagnóstico , Gamopatia Monoclonal de Significância Indeterminada/etiologia , Tomada de Decisão Clínica , Técnicas de Laboratório Clínico/normas , Técnicas de Laboratório Clínico/estatística & dados numéricos , Confiabilidade dos Dados , Interpretação Estatística de Dados , Diagnóstico Diferencial , Humanos , Gamopatia Monoclonal de Significância Indeterminada/complicaçõesRESUMO
Adult neutropenia, defined as a blood neutrophil count below 1.5 G/L, is a common condition. The most common cause of acute neutropenia is a drug-related reaction or an acute infectious disease. In chronic forms many etiologies are possible, sometimes poorly-defined, requiring precise explorations. The purpose of this article is to recall the required criteria for exploring neutropenia and to point out the algorithm of explorations in order to find the cause. Etiologies of acute and chronic forms are also detailed.
Assuntos
Neutropenia/diagnóstico , Neutropenia/etiologia , Adulto , Idade de Início , Lista de Checagem , Diagnóstico Diferencial , Humanos , Neutropenia/epidemiologia , Fatores de RiscoRESUMO
The most frequent causes of hemolytic anemias are immune or infectious diseases, drug induced hemolysis, thrombotic microangiopathies, hereditary spherocytosis, glucose-6-phosphate dehydrogenase or pyruvate kinase deficiencies, thalassemia's and sickle cell disease. Sometimes no cause is found because a rarer etiology is involved. The goal of this review is to remember some unfrequent constitutional or acquired causes and to point out difficulties to avoid wrong interpretations of analysis results.
Assuntos
Anemia Hemolítica/diagnóstico , Anemia Hemolítica/etiologia , Anemia Hemolítica/sangue , Anemia Hemolítica Congênita não Esferocítica/sangue , Anemia Hemolítica Congênita não Esferocítica/complicações , Anemia Hemolítica Congênita não Esferocítica/diagnóstico , Anemia Falciforme/sangue , Anemia Falciforme/complicações , Anemia Falciforme/diagnóstico , Diagnóstico Diferencial , Deficiência de Glucosefosfato Desidrogenase/sangue , Deficiência de Glucosefosfato Desidrogenase/complicações , Deficiência de Glucosefosfato Desidrogenase/diagnóstico , Testes Hematológicos/métodos , Testes Hematológicos/normas , Humanos , Piruvato Quinase/sangue , Piruvato Quinase/deficiência , Erros Inatos do Metabolismo dos Piruvatos/sangue , Erros Inatos do Metabolismo dos Piruvatos/complicações , Erros Inatos do Metabolismo dos Piruvatos/diagnóstico , Esferocitose Hereditária/sangue , Esferocitose Hereditária/complicações , Esferocitose Hereditária/diagnóstico , Microangiopatias Trombóticas/sangue , Microangiopatias Trombóticas/complicações , Microangiopatias Trombóticas/diagnósticoRESUMO
IgE myeloma is an extremely rare disease characterized by frequent plasma cell leukemia, little monoclonal-spike on electrophoresis, an high incidence of t(11;14) translocation and a worse survival than those with common myelomas. We report here a new case of IgE myeloma and discuss clinical presentation, biological features and therapeutic option.