COVID-19 convalescent plasma as long-term therapy in immunodeficient patients?

OBJECTIVES: The patients with hematological malignancies are a vulnerable group to COVID-19, due to the immunodeficiency resulting from the underlying disease and oncological treatment that significantly impair cellular and humoral immunity. Here we report on a beneficial impact of a passive immunotherapy with convalescent plasma to treat a prolonged, active COVID-19 infection in a patient with a history of nasopharyngeal diffuse large B-cell lymphoma treated with the therapy inducing substantial impairment of particularly humoral arm of immune system. The specific aim was to quantify SARS-CoV2 neutralizing antibodies in a patient plasma during the course of therapy. MATERIALS AND METHODS: Besides the standard of care treatment and monitoring, neutralizing antibody titers in patient's serum samples, calibrated according to the First WHO International Standard for anti-SARS-CoV-2 immunoglobulin (human), were quantified in a time-dependent manner. During the immunotherapy period peripheral blood flow cytometry immunophenotyping was conducted to characterize lymphocyte subpopulations. RESULTS: The waves of clinical improvements and worsening coincided with transfused neutralizing antibodies rises and drops in the patient's systemic circulation, proving their contribution in controlling the disease progress. Besides the patient's lack of own humoral immune system, immunophenotyping analysis revealed also the reduced level of helper T-lymphocytes and immune exhaustion of monocytes. CONCLUSION: Therapeutic approach based on convalescent plasma transfusion transformed a prolonged, active COVID-19 infection into a manageable chronic disease.

Warm red blood cell autoantibodies and clinical diagnoses in patients with or without autoimmune hemolysis.

OBJECTIVES: Red blood cell autoantibodies (RBC autoAbs) of IgG class are found in the majority of patients with warm autoimmune hemolytic anemia (wAIHA) but sometimes also during the pretransfusion testing of patients with different diagnoses but without hemolysis. The aim of the study was to identify the main differences between these two groups of patients according to age, gender, subclass and titer of IgG RBC autoAbs and diagnosis. MATERIAL AND METHODS: In the 9-year retrospective study, data were collected from records of 291 patients with IgG RBC autoAbs detected by gel technique, from which 111 with wAIHA. RESULTS: More than 85% of patients in both groups were over 40 years old, with male to female ratio 1:1.9 in wAIHA vs 1:1.3 in patients without hemolysis (P=0.0916). The main characteristics of patients with wAIHA vs patients without hemolysis were: IgG only 38% vs 70%, IgG+Complement 62% vs 30%, total IgG1 79% vs 55%, IgG1+IgG3 35% vs 11%, titer of 100 for IgG1+IgG3 17% vs 3% (P<0.0001), respectively, while titer of 100 for IgG1 18% vs 9% (P=0.0241). The underlying diagnosis in wAIHA vs patients without hemolysis: hematologic disorders 41% vs 22% (P=0.0006), autoimmune disorders 12% vs 13% (P=0.8033), solid tumors 5% vs 14% (P=0.0154) and surgery procedures 6% vs 26% (P<0.0001). CONCLUSION: We observed more wAIHA patients with high titer of IgG1 and high prevalence of IgG1+IgG3 and consider that patients without hemolysis having identical results might be interesting to find out how they are protected from damage by RBC autoAbs.

Combined cell index in assessing blood donor iron stores.

OBJECTIVES: The aim of this study was to assess the appropriateness of using combined cell index (CCI) in the assessment of iron stores in blood donors. This index is calculated by the formula: red blood cell distribution width (RDW) × 104 × mean corpuscular volume (MCV)-1 × mean corpuscular haemoglobin (MCH)-1 . BACKGROUND: Ferritin measurement is a reliable method for estimating iron stores in blood donors. The sensitivity of red blood cell (RBC) parameters of complete blood count in detecting non-anaemic iron deficiency is significantly lower. Consequently, there were several attempts to increase the detection sensitivity by combining these parameters in different indices. METHODS: This study included 1084 male and 792 female whole blood donors accepted for blood donation. For six RBC parameters with the highest level of correlation relative to ferritin [Hgb, MCV, MCH, mean corpuscular haemoglobin concentration (MCHC), RDW and CCI], diagnostic efficacy in the detection of iron depletion (ferritin <12 µg L-1 ) was assessed using receiver operating characteristic (ROC) analysis. RESULTS: CCI showed the highest degree of correlation with ferritin (r = -0·373 for men and r = -0·590 for women) and the highest area under the curve (0·961 for men and 0·864 for women). Using the cut-off value of 52·6 for men and 50·6 for women, the corresponding Youden index was the highest for CCI in both genders (0·851 for men and 0·612 for women). The sensitivity and specificity of CCI in the population of male donors were higher in comparison to female donors (0·941 and 0·910 vs 0·851 and 0·761, respectively). CONCLUSIONS: Study results confirmed the satisfactory diagnostic value of CCI in detecting depleted iron stores in blood donors.

Vertigo associated with Chiari I malformation and syringomyelia.

We report a rare case of a patient with late onset of Chiari I malformation with associated syringomyelia that was successfully treated with foramen magnum decompression. Our patient is presenting initially with vertigo and gradual weakening of the left-hand gross motor ability, gradual hypesthesia. Magnetic resonance imaging demonstrated a Chiari I malformation with syringomyelia. Posterior fossa decompression, C1 laminectomy and duroplasty were performed. After surgery, the vertigo completely resolved (Fig. 2, Ref. 13). Full Text (Free, PDF) www.bmj.sk.

Auditory evoked potentials (AEP)--an important help in early diagnosis of Schwannoma originating from vestibular nerve.

Early diagnosis of expansive formations enables efficient therapy and maximal reduction of remaining neurological damage. Schwannoma situated entirely within the inner auditory canal with free pontocerebellar angle is a rather rare event. Of significant diagnostical help are auditory evoked potentials (AEP), computerised tomography (CT) of the temporal bone pyramid with measuring the inner auditory canal diameter, and magnetic resonance (MRI). In this paper we present a case of a 56-year-old woman with gradually advancing noise in the right ear, weakening of hearing and occasional instability while walking. AEP register no evoked response at the right side, whereas at the left side the latencies and amplitudes of evoked acoustic responses are adequate. CT of the temporal bone pyramid shows a difference in the inner auditory canal diameters of 0.04 cm. MRI shows a Schwannoma tumorous formation in the inner auditory canal, situated entirely within the canal with free pontocerebellar angle (Fig. 3, Ref. 16). Full Text (Free, PDF) www.bmj.sk.

An acute headache and hydrocephalus caused by the dermoid cyst.

We present a case report of a 41-year-old man with an acute headache and hydrocephalus caused by the dermoid cyst. The dermoid cyst of the third brain ventricle caused an acute hydrocephalus and an increased intracranial pressure (with neurological signs such as nausea, vomiting, oedema papilae n. optici) and, consequently, an acute intensive headache. Computed tomography scans demonstrated a mass in the third ventricle extending into the prepontine cistern, whereas any initially established cerebrospinal fluid ventriculoperitoneal shunt required further revision (Fig. 2, Ref. 12). Full Text (Free, PDF) www.bmj.sk.

Somatosensory-evoked potentials and MRI in tuberculous spondylodiscitis.

Early diagnosis of spondylodiscitis is a condition of efficient conservative treatment. Somatosensory-evoked potentials with clinical examination results are used in assessing the diagnosis, as well as in monitoring the course of disease and healing. MRI clearly shows the inflammatory process, healing and scars. We report a 46-year-old woman suffering from non-specific interscapular pains. The evoked somatosensory potentials of the tibial nerveshow potential conductivity being slowed down through the thoracic spine, which is clearly evident from the prolonged latency and the decreased amplitude of the evoked response. The performed thoracic spine MRI shows spondylodiscitis at the Thl0-11 level. The subject is a nurse administering BCG therapy at a urology clinic, due to the fact of which this was deemed to have been a case of tuberculous spondylodiscitis. Due to the possibility of scattering the causative agent by needle, the biopsy was given up and antituberculous therapy was administered ex juvantibus. The disease was followed up by clinical examinations, somatosensory-evoked potentials and MRI up to fully successful and final recovery from spondylodiscitis. The above examinations are of great help in diagnosing the tuberculous spondylodiscitis and monitoring the recovery (Fig. 6, Ref. 16).

Neurocysticercosis--non-specific clinical and neuroradiological presentation.

Neurocysticercosis (cysticercosis cerebri) is a rare neurological diagnosis in Croatia. It is classically divided into four types: intraparenchymal, basilar cisternal, ventricular and diffuse. Computerized tomography (CT) and magnetic resonance imaging (MRI) established the diagnosis by demonstrating cysticercosis disseminated throughout the cerebral parenchyma. The authors emphasize the potential of the ELISA test to detect anticysticercosis antibodies in blood and cerebrospinal liquor (CSF). Diagnostics of neurocysticercosis is enabled jointly by clinical signs, neuroradiological, serum and liquor tests. We report the case of a 70-year old man with clinical and neuroradiological signs of cysticercosis cerebri. The neurological status is dominated by ataxia, corticospinal pathways damages and cognitive capacity impairments. CT of the brain shows calcificated and cystic lesions of various sizes. MRI of the brain enables the final diagnosis of the cysticercosis cerebri with multiple and multicentric lesions that indicate various stages of the cerebral cysticercosis (Fig. 2, Ref 20). Full Text (Free, PDF) www.bmj.sk.