ABSTRACT
Pneumocystis Carinii and Trichosporon beigelii are opportunistic infections in immunocompromised patients. We report a case of a young lady who underwent haemopoeitic stem cell transplantation for relapsed acute lymphoblastic leukemia. This 25 years old female developed fever, dry cough and rapidly progressive dyspnoea during post transplant neutropenia and was found to be suffering from Pneumocystis carinii pneumonia. She was successfully treated with Co-trimoxazole. The patient again presented with similar symptoms on day 55 post transplant. This time Trichosporon beigelii was isolated from bronchoalveolar lavage and she responded to prompt antifungal therapy. Other complications encountered during the subsequent course were extensive subcutaneous emphysema and spontaneous pneumothorax that required chest intubation and brief hospitalization. The patient is presently nine months post transplant and is asymptomatic
Subject(s)
Humans , Female , Pneumonia, Pneumocystis , Pneumocystis carinii/isolation & purification , Lung Diseases, Fungal/microbiology , Hematopoietic Stem Cell Transplantation , Immunocompromised Host , Trichosporon/isolation & purificationABSTRACT
To determine the frequency of HLA DR2 in Pakistani patients with severe and very severe aplastic anaemia. Introduction: In many cases aplastic anaemia is mediated by the immune mechanisms. Increased frequency of certain HLA haplotypes in patients with autoimmune diseases have led to the investigation of HLA subtypes in aplastic anaemia. HLA DR2 was found to be the most frequently encountered allele in aplastic anaemia. It has been reported that patients of aplastic anaemia, who possess HLA DR2 show a good response to immunosuppressive treatment. This study has been designed to establish frequency of HLA DR2 in patients of aplastic anaemia in our population. Setting: Armed Forces Institute of Pathology and Armed Forces Bone Marrow Transplant Centre, Rawalpindi-Pakistan. Materials and Fifty two cases of aplastic anaemia diagnosed at AFIP/AFBMTC during last 03 years [March 2001 to December 2003] were included in the study. Laboratory investigations to establish the diagnosis included blood complete picture, reticulocyte count, bone marrow aspiration and bone marrow trephine biopsy. Cytogenetic studies were carried out in selected cases to exclude possibility of hypoplastic myelodysplastic syndrome/Fanconi's anaemia. LAP score, ham's test, sucrose lysis test, urine for haemosiderin and CD59 analysis were carried out in suspected cases to exclude paroxysmal nocturnal haemoglobinuria. All cases were tested for HLA DR2 by standard National Institute of Health two stage microlymphocytotoxicity assay. Out of 52 patients, 35 were males and 17 were females [M: F 2:1]. Median age of the patients was 17 years [3-35 years]. Twenty eight [54%] of the patients were of severe aplastic anaemia and 24 [46%] were of very severe aplastic anaemia. HLA DR2 was positive in 31[60%] patients compared to 4,1% in healthy population [p. 0.007]. An increased frequency of HLA DR2 is also seen in Pakistani patients of aplastic anaemia which is associated with a good response to immunosuppressive therapy
Subject(s)
Humans , Male , Female , Anemia, Aplastic , Bone Marrow Examination , Biopsy, Fine-NeedleABSTRACT
To evaluate the frequency and outcome of graft versus host disease after allogeneic stem cell transplant in haematological disorders at Armed Forces Bone Marrow Transplant Centre, Rawalpindi from July 2001 to December 2004. Eighty-six patients with various haematological disorders namely aplastic anaemia [n=32], b-Thalassaemia [n=25], CML [n=22], ALL [n=3], AML [n=1] Fanconi's anaemia [n=2], and Gaucher's disease [n=1], underwent allogeneic stem cell transplantation. All patients received cyclosoprin, prednisolone and short course of methotrexate as GvHD prophylaxis. The patients who developed acute GvHD > grade-II or chronic extensive GvHD received steroids at a starting dose of 2 mg/kg body weight along with gradual increase in cyclosporine dosage [max dose 12.5 mg/kg]. The overall incidence of acute GvHD grade-II to IV was 44.2% [n=38/86] where as the incidence of chronic extensive GvHD was 14% [n=12/86]. Acute GvHD was 68% [n=17/25] in = -Thalassaemia, 50% [n=11/22] in CML, 50% [n=2/4] in Acute Leukaemias and 25% [n=8/32] in Aplastic Anaemia. Chronic GvHD was 25% [n=1/4] in Acute Leukaemias, 18.8% [n=6/32] in Aplastic Anaemia, 18.2% [n=4/22] in CML and 4% [n=1/25] in = -Thalassaemia. The overall survival in acute GvHD was 84.2% [n=32] where as the overall survival in chronic GvHD was 50% [n=6]. The overall mortality in acute GvHD was 15.8% [n=6] and 50% in chronic GvHD [n=6]. The morbidity and mortality due to severe acute and chronic GvHD remains high despite standard prophylaxis against GvHD. New strategies are needed to prevent and treat GvHD