Life-threatening delayed hyperhemolytic transfusion reaction in a patient with sickle cell disease: effective treatment with eculizumab followed by rituximab.

BACKGROUND: Hyperhemolysis in sickle cell disease is a rare and potentially life-threatening complication of transfusion. STUDY DESIGN AND METHODS: In this article we report a case of delayed hemolytic transfusion reaction with resultant hyperhemolysis triggered by an anti-IH autoantibody with alloantibody behavior. RESULTS: The anti-IH was reactive at room temperature as well as 37 °C, but only weakly reactive with autologous red blood cells. Initial cold agglutinin titer was 512. The profound, life-threatening, intravascular hemolysis was rapidly and dramatically reduced with the Complement 5 (C5) inhibitory antibody, eculizumab. The auto/allo cold agglutinin was subsequently suppressed with rituximab treatment. CONCLUSIONS: Eculizumab, a potent C5 inhibitory antibody, can be a rapid and effective therapy for hyperhemolytic transfusion reactions when given in a sufficient dose to fully block the activation of complement C5.

Change of serum transferrin receptor due to malarial infection, an experiment in Plasmodium gallinaceum infected chicken model.

BACKGROUND & OBJECTIVES: The serum transferrin receptor (sTfR) concentration in an individual reflects the extent of erythropoietic activity and is considered as an useful marker of iron deficiency independent of concurrent inflammation or infection. However, data on the impact of malaria on this parameter are ambiguous. METHODS: Here we performed an animal experiment to study the chronological change of serum transferrin receptor due to infection of Plasmodium gallinaceum. In this pilot study, we performed control experimental infection of P. gallinaceum to four newborn chicken from the same batch. We collected the venous blood samples from all chicken on Day 7 and 14. All samples were analysed for sTfR level by the immunoturbidimetric assay. RESULTS: The average level of sTfR level of the control chicken was 1.24 +/- 1.58 mg/L (range 0.18 to 3.52 mg/L). The average level of sTfR level of the experimental chicken on Day 7 was 5.42 +/- 2.19 mg/L (range 3.22 to13.94 mg/L). CONCLUSION: Although the trend of increase was observed but no significance was observed (p > 0.05). The results from this pilot study can be a good basic data for the further study in this area.

Serum erythropoietin levels in pediatric patients with beta-thalassemia/hemoglobin E.

Presently, the assays for serum erythropoietin (EPO) seem valuable tools for clinical research, but their roles in routine clinical practice remain undefined. Some studies mentioned that serum EPO measurements, which are now easily and reliably performed, should be used in monitoring the therapy of beta-thalassemia major. Here, we report our experience in the determination of serum EPO in children with beta-thalassemia/Hb E and also compared the results with those in hemoglobin E trait, beta-thalassemia/Hb E as well as healthy non-anemic controls of similar age. Fifty five transfusion-dependent beta-thalassemia/Hb E, fifteen hemoglobin E trait, five beta-thalassemia trait cases and twenty five controls were studied for their serum EPO levels. The mean (S.D.) EPO concentrations were 19.94 (17.40) U/L for the controls, 16.13 (8.47) U/L for the hemoglobin E trait, 24.40 (8.20) U/L for the beta-thalassemia trait and 372.19 (432.04) U/L for the beta-thalassemia/Hb E cases. The mean EPO concentration for the normal controls was near to that of the hemoglobin E trait (P = 0.06) and beta-thalassemia trait (P = 0.25) but eighteen times less than that for the beta-thalassemia major cases (P<0.0005).

Expected value of serum soluble transferrin receptor, erythropoietin and ferritin and their correlation among healthy non-anemic Thai children.

Transferrin receptor (TfR) is a glycoprotein which mediates the entry of ferric transferrin from the extracellular compartment into the cells. The measurement of sTfR has become a widely used tool in assessing erythropoiesis but its use has mainly been restricted to research laboratory settings. In Thailand, there are only a few reports concerning the sTfR. The authors studied the expected value of sTFR as well as other basic parameters for monitoring of erythropoiesis as erythropoietin (EPO) and ferritin among a sample of non-anemic healthy Thai children. In addition, correlation was done between each pair of studied parameters. Expected range for sTfR level for the healthy controls in this study was 1.761 to 2.034 mg/L. Expected range for serum EPO level for the healthy controls in this study was 19.445 to 34.176 mU/ml. Expected range for serum ferritin level for the healthy control from this study was 67.895 to 96.692 ng/ml. Of interest, poor correlation among the three studied parameters, sTfR, serum EPO and serum ferritin was observed in this study.

Evaluation of the Sysmex UF-100 automated urinalysis analyzer and comparative study with JCCLS reference method.

Microscopic urine sediment analysis has been accepted as the mainstay test for examining urine cells and particles. Although it provides essential information for clinicians about disease states in the patients, it is a high-volume and laborious procedure. Therefore, an automated analyzer was developed recently and has just been introduced to Thailand. In this study, the authors evaluated the analytical performance of this new automated urine analyze. Also a comparative study was performed between the UF-100 test results and those of JCCLS reference method. In evaluation of the Sysmex UF-100 automated urinalysis analyzer, both precision and linearity studies were performed. Between-run CVs for RBCs (mean = 182.46/microl), WBCs (mean = 193.37/microl), ECs (mean = 70.05/microl) and casts (mean = 12.21/microl) were 7.74 per cent, 5.52 per cent, 21.32 per cent and 7.69 per cent, respectively. Concerning the within-run CVs for the RBC analysis, the CV ranged from 16.28 per cent for low numbers of RBCs (35.67/microl) to 2.93 per cent at RBC concentrations (712.13/microl). Concerning within-run precision for the WBC analysis, the CV ranged from 22.31 per cent for low numbers of WBCs (WBCs 12.53/microl) to 2.07 per cent at a WBC count of 211.01/microl. Within-run precision ranged from 11.36 per cent at 24.99 ECs/microl to 6.18 per cent at 53.08 ECs/microl. Within-run precision for casts varied from 35 per cent for samples with 1.33 casts/microl to 12.38 per cent for samples with 4927.35 casts/microl. From the comparative study, good agreements (p < 0.05) were obtained between UF-100 and JCCLS reference method for RBCs counts (p = 0.000, r = 0.974) and WBCs counts (p = 0.000, r = 0.913). However, fair agreement (p > 0.05) was obtained between UF-100 and JCCLS reference method for ECs counts (p = 0.017, r = 0.212) and casts counts (p = 0.624, r = 0.044). In conclusion, the UF-100 analyzer is a new useful analyzer although it cannot be a substitute for microscopic sediment examination.

Squamous cell cancer of the head and neck with distant metastasis at presentation.

BACKGROUND: Current literature reports widely different rates of distant metastasis at presentation for squamous cell carcinoma of the head and neck (SCCHN). We used the Surveillance Epidemiology and End Results (SEER) database to determine the rate of and risk factors for distant metastasis. METHODS: We identified patients with SCCHN diagnosed between 1988 and 2003. The rate of distant metastasis was determined and then stratified by tumor site, size, and nodal status. To evaluate the contribution of each individual factor, both univariate and multivariate analyses were performed. RESULTS: Among 73,247 patients identified, 2066 patients (2.82%, 95% confidence interval [CI] 2.70-2.94%) had distant metastasis. Independent risk factors for distant metastasis included primary site, nodal status, tumor size, age, and race. CONCLUSIONS: In SCCHN, there is a relationship between the risk of distant metastasis and tumor site, size, and nodal status. This information can be used to guide the evaluation and treatment of SCCHN.

Diagnostic value and cost utility analysis for urine Gram stain and urine microscopic examination as screening tests for urinary tract infection.

The aim of this study was to evaluate the diagnostic properties of urine Gram stain and urine microscopic examination for screening for urinary tract infection (UTI), and to perform an additional cost utility analysis. This descriptive study was performed on 95 urine samples sent for urine culture to the Department of Microbiology, Faculty of Medicine, Chulalongkorn University. The first part of the study was to determine the diagnostic properties of two screening tests (urine Gram stain and urine microscopic examination). Urine culture was set as the gold standard and the results from both methods were compared to this. The second part of this study was to perform a cost utility analysis. The sensitivity of urine Gram stain was 96.2%, the specificity 93.0%, the positive predictive value 94.3% and the negative predictive value 95.2%. False positives occurred with a frequency of 7.0% and false negatives 3.8%. For the microscopic examination, the sensitivity was 65.4%, specificity 74.4%, positive predictive value 75.6% and negative predictive value 64.0%. False positives occurred with a frequency of 25.6% and false negatives 34.6%. Combining urine Gram stain and urine microscopic examination, the sensitivity was 98.1%, specificity 74.4%, positive predictive value 82.3% and negative predictive value 97.0%. False positives occurred with a frequency of 25.6% and false negatives 1.9%. However, the cost per utility of the combined method was higher than either urine microscopic examination or urine Gram stain alone. Urine Gram stain provided the lowest cost per utility. Economically, urine Gram stain is the proper screening tool for presumptive diagnosis of UTI.

Comparative study on serum iron determination by different methods.

Iron is an important trace element in humans. Depletion or overload iron status can result in a number of aberrant physiological functions. Determination of serum iron is one of the valuable test panels for iron status assessment. A comparative study was performed on 3 different methods of serum iron determination, nonprecipitating ferrozine colorimetric method, precipitating ferrozine colorimetric method, and iron liquicolor cleaning factor colorimetric agar-based (CAB) method (Human, Taunusstein, Germany). The correlation coefficients between nonprecipitating ferrozine colorimetric method and precipitating ferrozine colorimetric method, between nonprecipitating ferrozine colorimetric method and iron liquicolor cleaning factor CAB method, and between precipitating ferrozine colorimetric method and iron liquicolor cleaning factor CAB method were found to be 0.998 (P = .067), 0.999 (P = .067), and 0.951 (P = .934), respectively. For a setting with limited resources such as Thailand, use of the first analytical technique, nonprecipitating ferrozine colorimetric method, is recommended because of its low cost and ease of performance.