RESUMO
BACKGROUND: Hyperleukocytosis is commonly seen in acute and chronic leukemias. Therapeutic leukocytapheresis using an automatic cell separator can help to achieve prompt leukoreduction to reduce the rate of thrombotic events and early mortality as well as to prevent tumor lysis syndrome. AIM: In this study, we report a single center's experience in managing leukemia patients with therapeutic leukocytapheresis prior to chemotherapy. MATERIALS AND METHODS: Leukocytapheresis procedures were performed in 192 leukemia patients (including acute myeloid leukemia [AML], acute lymphoblastic leukemia [ALL], and chronic myeloid leukemia [CML]) with hyperleukocytosis between January and December 2016. RESULTS: Median % reduction of white blood cell (WBC) count was 30.5% and median % removal efficiency was 46.7% for 75 procedures where the waste bag was sampled. WBC removal efficiency strongly depended on diagnosis (and was 71%, 66%, and 39% for ALL, AML, and CML, respectively). Procedures were generally well tolerated with only 9 out of 192 patients having mild adverse effects. DISCUSSION AND CONCLUSION: In the absence of specific guidelines for the management of hyperleukocytosis, leukocytapheresis in association with chemotherapy should be considered early in clinical practice.
Assuntos
Leucemia Mielogênica Crônica BCR-ABL Positiva/terapia , Leucemia Mieloide Aguda/terapia , Leucocitose/terapia , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/farmacologia , Criança , Terapia Combinada , Tratamento Farmacológico/métodos , Feminino , Humanos , Leucaférese/métodos , Contagem de Leucócitos , Leucócitos/citologia , Leucocitose/fisiopatologia , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Síndrome de Lise Tumoral/terapia , Adulto JovemAssuntos
Endoscopia Gastrointestinal , Hemorragia Gastrointestinal/diagnóstico , Tumores do Estroma Gastrointestinal/diagnóstico , Intestino Delgado/patologia , Adulto , Feminino , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/cirurgia , Tumores do Estroma Gastrointestinal/complicações , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Intestino Delgado/cirurgia , PrognósticoRESUMO
BACKGROUND: The stability of Clostridium difficile toxins is an important factor in determining the accuracy of the enzyme immunoassay (EIA). The Centers for Disease Control has stated that C. difficile toxins may become undetectable in unrefrigerated stool specimens within 2 h after collection. PURPOSE: The purpose of our study was to determine how the unrefrigerated handling time of human fecal specimens affects the results of C. difficile infection (CDI) testing. METHODS: A retrospective review of CDI testing with Premier™ Toxins A and B kit was conducted in northern New Jersey, USA. Stool collection times and receiving times were recorded for each specimen. The unrefrigerated handling time was calculated for each. RESULTS: A total of 1126 fecal specimens were submitted. We excluded 72 fecal specimens due to incomplete documentation. We included 1054 fecal specimens collected from 636 hospitalized patients. A total of 132 out of 1054 specimens (12.5%) tested positive for C. difficile toxins. Nine hundred and fifty-four specimens were unrefrigerated for 13 h or less, of which 127 (13.3%) tested positive. Five (5%) of the 100 specimens that were unrefrigerated for more than 13 h tested positive (p = 0.02). CONCLUSION: C. difficile toxins can still be detected up to 13 h after collection in unrefrigerated human fecal specimens. However, fecal specimens should be processed according to the current recommendations to ensure the reliability of EIA testing until the results of our study are confirmed with prospective studies.