Asunto(s)
Enfermedad de Castleman/diagnóstico , Biomarcadores , Biopsia , Recuento de Células Sanguíneas , Enfermedad de Castleman/etiología , Enfermedad de Castleman/terapia , Análisis Mutacional de ADN , Femenino , Humanos , Inmunohistoquímica , Ganglios Linfáticos/patología , Persona de Mediana Edad , Mutación , Tomografía de Emisión de Positrones , Tomografía Computarizada por Rayos XAsunto(s)
Proteínas de Fusión bcr-abl/genética , Janus Quinasa 2/genética , Mutación , Trastornos Mieloproliferativos/enzimología , Trastornos Mieloproliferativos/genética , Anciano , Anciano de 80 o más Años , Células Clonales , Femenino , Proteínas de Fusión bcr-abl/metabolismo , Humanos , Janus Quinasa 2/metabolismo , Masculino , Persona de Mediana EdadAsunto(s)
Eritroblastos/metabolismo , Leucemia Mieloide Aguda/genética , Síndromes Mielodisplásicos/genética , Proteínas de Neoplasias/genética , Neoplasias Primarias Secundarias/genética , Fosfoproteínas/genética , Factores de Empalme de ARN/genética , Proteína p53 Supresora de Tumor/genética , Enfermedad Aguda , Adulto , Anciano , Anciano de 80 o más Años , Médula Ósea/metabolismo , Médula Ósea/patología , Estudios de Cohortes , Eritroblastos/patología , Femenino , Perfilación de la Expresión Génica , Regulación de la Expresión Génica , Secuenciación de Nucleótidos de Alto Rendimiento , Humanos , Hierro/metabolismo , Leucemia Mieloide Aguda/metabolismo , Leucemia Mieloide Aguda/mortalidad , Leucemia Mieloide Aguda/patología , Masculino , Persona de Mediana Edad , Mutación , Síndromes Mielodisplásicos/metabolismo , Síndromes Mielodisplásicos/mortalidad , Síndromes Mielodisplásicos/patología , Proteínas de Neoplasias/metabolismo , Neoplasias Primarias Secundarias/metabolismo , Neoplasias Primarias Secundarias/mortalidad , Neoplasias Primarias Secundarias/patología , Fosfoproteínas/metabolismo , Factores de Empalme de ARN/metabolismo , Análisis de Supervivencia , Proteína p53 Supresora de Tumor/metabolismoRESUMEN
We report the case of a previously healthy 49-year-old woman who presented with upper gastrointestinal bleeding, which was found at laparotomy to be due to high-grade B cell gastric lymphoma. CT scans showed that this was partially adherent to the spleen, with erosion of the gastric wall and suggested impending perforation. Given the risk of perforation, further surgical intervention (gastrectomy and splenectomy) was considered; however, after multidisciplinary team discussion, we chose to offer chemotherapy and careful inpatient observation instead.Our patient made a full recovery with no perforation.The message from our experience and literature review is that medical management may lead to a more favourable outcome in gastric lymphoma than surgery, despite radiological appearances suggesting impending perforation. This approach avoids the risk of the lymphoma progressing at other anatomical sites secondary to delays in giving chemotherapy. If this approach is followed, the patient must be carefully monitored.
Asunto(s)
Linfoma de Células B , Linfoma no Hodgkin , Neoplasias Gástricas , Femenino , Gastrectomía , Humanos , Persona de Mediana Edad , Neoplasias Gástricas/complicaciones , Neoplasias Gástricas/tratamiento farmacológico , Neoplasias Gástricas/cirugíaRESUMEN
A 35-year-old woman presented with a widespread petechial rash and pancytopenia. She underwent simultaneous pancreas and kidney transplantation for type 1 diabetes 8 years previously followed by a renal transplant 1 year prior to presentation, and was taking tacrolimus as long-term immunosuppression. The full blood count showed haemoglobin 97 g/L, platelet count 2×109/L and neutrophil count 0.22×109/L. Peripheral blood film examination confirmed genuine thrombocytopenia in the absence of any haemolytic or malignant features. Serological testing identified autoantibodies against all three blood lineages, consistent with a diagnosis of autoimmune pancytopenia. Treatment with steroids, intravenous immunoglobulins, romiplostim and mycophenolate mofetil achieved only fleeting remissions. Blood counts eventually normalised following the administration of rituximab and a change from tacrolimus to ciclosporin immunosuppression. Cytopenias are a well-recognised complication of post-transplantation care but we believe this to be the first reported case of autoimmune pancytopenia following solid organ transplantation. In this case report, we discuss the approach to investigation of haematological abnormalities post-transplant and the rationale for, and outcome of, the management of this rare case.
Asunto(s)
Enfermedades Autoinmunes , Trasplante de Riñón , Trasplante de Páncreas , Pancitopenia/inmunología , Complicaciones Posoperatorias/inmunología , Adulto , Enfermedades Autoinmunes/diagnóstico , Enfermedades Autoinmunes/terapia , Femenino , Humanos , Pancitopenia/diagnóstico , Pancitopenia/terapia , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/terapia , Factores de TiempoRESUMEN
OBJECTIVES: Preoperative anaemia is associated with increased morbidity and mortality. We sought to determine the relative frequencies of the different causes of anaemia including absolute and functional iron deficiency, and the association of different haematological parameters, including plasma hepcidin, a key protein responsible for iron regulation, with outcomes after cardiac surgery. METHODS: Prospective observational study between January 2012 and 2013; 200 anaemic cardiac surgical patients were recruited and 165 were studied. Detailed blood and bone marrow analysis was performed. Primary outcome was days alive and out of hospital. RESULTS: Mean (SD) haemoglobin (Hb) was 102 (8) g/L for women and 112 (11) g/L for men. Regarding outcomes, 137 (83%) patients were transfused at least one unit of red blood cells; 30-day mortality was 1.8% (three patients). Functional iron deficiency was diagnosed in 78 patients (47%). Plasma hepcidin concentration was the only haematological variable associated with outcome, with mean days alive and out of hospital 2.7 (95% CI 0.4 to 5.1) days less if hepcidin ≥20â ng/mL compared with <20â ng/mL (p=0.024). Multivariable analysis showed that the association between hepcidin and outcome was independent of risk (European System for Cardiac Operative Risk Evaluation), transfusion and Hb. CONCLUSIONS: Functional iron deficiency was the most common cause of anaemia but was not associated with outcome. The only haematological parameter that was associated with outcome was hepcidin concentration, which is a novel finding and introduces further complexity into our understanding of the role of iron and its regulation by hepcidin. We propose that future research should target patients with elevated hepcidin.
Asunto(s)
Anemia , Procedimientos Quirúrgicos Cardíacos , Cardiopatías/cirugía , Hepcidinas , Hierro , Complicaciones Posoperatorias , Anciano , Anemia/sangre , Anemia/epidemiología , Anemia/etiología , Anemia/terapia , Transfusión Sanguínea/métodos , Examen de la Médula Ósea , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Procedimientos Quirúrgicos Cardíacos/métodos , Procedimientos Quirúrgicos Cardíacos/mortalidad , Estudios de Cohortes , Femenino , Hemoglobinas/análisis , Hepcidinas/análisis , Hepcidinas/sangre , Humanos , Hierro/metabolismo , Deficiencias de Hierro , Masculino , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Cuidados Preoperatorios/métodos , Factores de Riesgo , Estadística como Asunto , Reino Unido/epidemiologíaRESUMEN
OBJECTIVES: The differential diagnosis between iron deficiency anaemia (IDA) and anaemia of chronic disease (ACD) with or without associated iron deficiency can be challenging. We assessed the use of different parameters, both classical like ferritin, transferrin saturation and stainable bone marrow iron stores, and novel markers such as low haemoglobin density (LHD) and hepcidin to help discriminate between the three entities. This would allow the detection of patients with ACD with associated iron deficiency, which could benefit from iron supplementation that would have otherwise remained undetected. MATERIALS AND METHODS: Prospective and observational cohort study from 2012 to 2013 where 200 anaemic cardiac surgical patients were recruited and 165 were studied. Detailed blood and bone marrow analyses were performed to establish the aetiology of anaemia. RESULTS: Seventy-four patients (44.8%) had ACD and 29 (39%) of these had an elevated LHD indicating concomitant iron deficiency. Hepcidin was inappropriately normal or increased in the IDA and ACD group. Mean hepcidin was however lower in the group with IDA (4.8 ng/mL) than in the ACD group (15.0 ng/mL; p=0.002). Median hepcidin was lower in patients with ACD and iron restriction as indicated by LHD >4% (17.5 ng/mL) than on those with no iron restriction (25.9 ng/mL; p=0.045). In patients with ACD there was no concordance between Perl's stain and LHD. CONCLUSIONS: LHD was superior to hepcidin and bone marrow iron stores in identifying patients with ACD and associated iron deficiency, which would potentially benefit from parenteral iron therapy.
Asunto(s)
Anemia/diagnóstico , Biomarcadores/análisis , Anciano , Algoritmos , Anemia/etiología , Médula Ósea/patología , Procedimientos Quirúrgicos Cardíacos , Estudios de Cohortes , Diagnóstico Diferencial , Femenino , Cardiopatías/sangre , Cardiopatías/complicaciones , Hemoglobinas/análisis , Humanos , Masculino , Estudios Prospectivos , Coloración y Etiquetado , Transferrina/análisisRESUMEN
Renin-angiotensin system (RAS) in the bone marrow is related to proliferation and cellular differentiation. We investigated the effect of ACE inhibitors (ACEI) captopril (>1mM) and trandolapril (>0.05 mM) and losartan (0.2 mM) on K562 cell line and K562 transfected with c-myc, bcl-x and bcl-2 (KmycB, Kbclx and Kbcl2 respectively). RAS components, proliferation, apoptosis and c-myc expression were analyzed. ACEI and losartan inhibited cell growth, decreased c-myc expression and increased apoptosis. These effects seem to be associated to angiotensin II-induced Smad activation. This work offers a new possible line of treatment for some acute myeloid leukemias and a new area of clinical research.