The Vital Role of Immunohematology in Diagnosing Paroxysmal Cold Hemoglobinuria: A Clinical Case Report.

Paroxysmal cold hemoglobinuria (PCH) is a rare autoimmune hemolytic anemia caused by the binding of IgG immunoglobulins to red blood cells at cold temperatures, leading to hemolysis upon rewarming. The Donath-Landsteiner test can show biphasic hemolysis, leading to diagnosis. There is no consensus, but chemoimmunotherapy with or without plasma exchange is commonly employed. We present the case of a 42-year-old male who experienced symptoms of hemolysis after cold exposure in a semi-arid, warm-climate city.

Clinical overlap between fibromyalgia and myalgic encephalomyelitis. A systematic review and meta-analysis.

Myalgic encephalomyelitis is an illness characterized by profound malaise after mental or physical effort occurring in patients already suffering from constant fatigue. On the other hand, widespread pain and widespread allodynia are the core fibromyalgia clinical features. There is controversy on these two syndromes alikeness. Through the years, different diagnostic and/or classification criteria have been put forward to appraise both fibromyalgia and myalgic encephalomyelitis. The epidemiology of these two illnesses, and their overlap, may vary accordingly to the used definition. The most recent Wolfe et al. 2016 fibromyalgia diagnostic criteria incorporates three myalgic encephalomyelitis features including fatigue, waking unrefreshed and dyscognition. The objective of this meta-analysis was to define the clinical overlap between fibromyalgia and myalgic encephalomyelitis based on a systematic literature review. METHODS: PubMed, Embase, Lilacs, and Cochrane data bases were searched on January 25, 2021 linking the medical subject heading "Fibromyalgia" to the following terms "chronic fatigue syndrome", "myalgic encephalomyelitis" and "systemic exertion intolerance disease". Our review included all original articles in which the clinical overlap between fibromyalgia and myalgic encephalomyelitis could be quantified based on recognized diagnostic or classification criteria. Articles scrutiny and selection followed the PRISMA guidelines. Each study quality was assessed according to GRADE recommendations. The global clinical overlap was calculated using a fixed effect model with inverse variance-weighted average method. RESULTS: Twenty one publications were included in the meta-analysis. Reviewed studies were highly dissimilar in their design, objectives, sample size, diagnostic criteria, and/or outcomes yielding a 98% heterogeneity index. Nevertheless, the clinical overlap between fibromyalgia and myalgic encephalomyelitis was a well defined outcome that could be reliably calculated despite the high heterogeneity value. All reviewed publications had moderate GRADE evidence level. Most evaluated articles used the old 1990 Wolfe et al. fibromyalgia diagnostic criteria. Myalgic encephalomyelitis and fibromyalgia diagnoses overlapped in 47.3% (95% CI: 45.97-48.63) of the reported cases. CONCLUSION: This meta-analysis found prominent clinical overlap between fibromyalgia and myalgic encephalomyelitis. It seems likely that this concordance would be even higher when using the most recent Wolfe et al. 2016 fibromyalgia diagnostic criteria.

Linfoma de la zona gris con características intermedias entre un linfoma difuso de células B grandes y un linfoma Hodgkin clásico. Reporte de un caso y revisión de la literatura / Grey zone lymphoma with features intermediate between diffuse large B-cell lymphoma and classical Hodgkin lymphoma. Case report and literature review

Resumen Entre los linfomas de la zona gris (LZG) encontramos neoplasias con características compartidas entre un linfoma difuso de células B grandes (LDCBG) y un linfoma de Hodgkin clásico (LHC). Lo poco habitual de la patología combinado con la heterogenicidad de la enfermedad, su reciente descripción como entidad específica que conlleva a dificultad y reto diagnóstico, así como la falta de suficiente experiencia terapéutica hacen de la enfermedad una entidad compleja de difícil diagnóstico y reto terapéutico que justifica su descripción continua. Se presenta una paciente con fiebre de un mes sin respuesta al manejo inicial, se estudió y realizó biopsia de ganglio inguinal izquierdo con resultado diagnóstico de LZG con características intermedias entre LDCBG y LHC. Aunque no existen guías establecidas para el manejo de esta entidad, la evidencia actual sugiere mejor respuesta en tratamientos dirigidos a LDCBG, misma terapia empleada en esta paciente con la cual se obtuvo respuesta favorable.

Abstract In the grey zone lymphomas (GZL), there are overlapping characteristics between diffuse large B-cell lymphoma (DLBCL) and classic Hodgkin lymphoma (CHL). The unusual nature of the pathology combined with the heterogeneity of the disease, its recent description as a specific entity, its diagnostic difficulty, and the lack of sufficient therapeutic experience justifies its continuous description. The case is presented of a patient with a fever of one month onset, with no response to initial management. A left inguinal lymph node biopsy reported a diagnosis of GZL with intermediate characteristics between DLBCL and CHL. Although there are no established guidelines for the management of this condition, the current evidence suggests a better response in treatments meant for diffuse large B-cell lymphoma. This same therapy was used in this patient, with a favourable clinical outcome.