Anormalidades hematológicas en enfermedad hepática, fisiopatología y consideraciones terapéuticas / Hematologic disorders in liver failure: pathophysiology and therapeutic considerations

RESUMEN Las alteraciones en los recuentos celulares sanguíneos representan los hallazgos clínicos más notorios y recurrentes en pacientes que padecen enfermedad hepática, tanto aguda como crónica. Estos cambios constituyen un marcador importante de la disfunción hepática y, a menudo, desempeñan un papel crucial en la evaluación y manejo de estos pacientes. En conjunto con el alargamiento de las pruebas de coagulación, la trombocitopenia es la irregularidad más prevalente en estos individuos. Esta condición, así como las leucopenias, se le atribuye en gran medida al hiperesplenismo, una alteración en la que el bazo retiene y destruye las células sanguíneas, incluidas las plaquetas. Sin embargo, cuando el conteo plaquetario desciende por debajo de 10 x 103/µl, es fundamental considerar otras causas, como factores autoinmunitarios que pueden estar contribuyendo con la trombocitopenia. La anemia, definida como una disminución en el número de glóbulos rojos o en los niveles de hemoglobina, es otra característica constante que acompaña a la enfermedad hepática. Aunque en la mayoría de los casos la anemia es macrocítica, en algunas situaciones puede ser secundaria a eventos hemolíticos, como lo observado en el síndrome de Zieve. Esta diversidad en las manifestaciones de la anemia en pacientes hepáticos subraya la complejidad de las interacciones entre el hígado y los componentes sanguíneos. A pesar de los avances en la comprensión de las causas subyacentes de estas citopenias, las opciones del tratamiento siguen siendo limitadas. Generalmente, las opciones terapéuticas se enfocan en la administración de transfusiones de hemocomponentes para compensar las deficiencias en los recuentos celulares o en el uso de análogos de trombopoyetina (TPO) para estimular temporalmente la producción de las plaquetas en la medula ósea. No obstante, estos tratamientos tienden a abordar los síntomas más que las causas fundamentales de las alteraciones hematológicas en la enfermedad hepática. La persistencia y el empeoramiento de estas alteraciones pueden servir como indicadores tempranos de la progresión de la disfunción hepática. La relación intrincada entre el hígado y la homeostasis hematológica continúa siendo objeto de investigación, la compresión más profunda de estos mecanismos podría abrir potencialmente la puerta hacia enfoques terapéuticos más específicos y efectivos para abordar las citopenias en el contexto de la enfermedad hepática.

ABSTRACT Alterations in blood cell counts are the most prominent and recurrent clinical findings among patients suffering from both acute and chronic liver disease. These changes are an important marker of liver failure and often play a key role in the evaluation and management of these patients. Together with the prolongation of coagulation tests, thrombocytopenia is the most common disorder among these individuals. This condition, as well as leukopenia, is largely attributable to hypersplenism, a disorder in which the spleen retains and destroys blood cells, including platelets. However, when the platelet count drops below 10x103/µl, it is essential to consider other causes, such as autoimmune factors that may be contributing to the development of thrombocytopenia. Anemia, defined as a decrease in red blood cell count or hemoglobin levels, is another common characteristic of liver disease. Although in most cases macrocytic anemia occurs, in some situations it can be secondary to hemolytic events, as observed in Zieve's syndrome. This wide range of manifestations of anemia among liver patients highlights the complex interaction between liver and blood components. Despite advances in understanding the underlying causes of these cytopenias, treatment options remain limited. Therapeutic options generally focus on the transfusion of blood products to compensate for deficiencies in cell counts or on the use of thrombopoietin (TPO) analogues to temporarily stimulate platelet production in the bone marrow. However, these treatments tend to address the symptoms rather than the root causes of hematologic disorders in liver disease. The persistence and worsening of these disorders may serve as early indicators of the progression of liver failure. The complicated relationship between liver and hematological homeostasis remains the subject of research. A deeper understanding of these mechanisms could potentially open the door toward more targeted and effective therapeutic approaches to address cytopenias in the context of liver disease.

Aseptic meningitis associated with primary Sj?gren′s syndrome: a case report / 中华神经科杂志

Sj?gren′s syndrome is a chronic autoimmune inflammatory disease characterized by exocrine gland and extraglandular involvement. Cases of Sj?gren′s syndrome-associated aseptic meningitis (SS-AM) are relatively rare, and a case of recurrent aseptic meningitis with leukopenia and mild anemia associated with primary Sj?gren′s syndrome is reported, whose symptoms basically disappeared after treatment with prednison and hydroxychloroquine. The purpose of reporting this case is to raise awareness of SS-AM among fellow clinicians.

Treatment Strategy of Leukopenia After Chemotherapy with Traditional Chinese Medicine from the Generation and Transmission of Defense Qi / 中医杂志

By analysing the similarity between defense qi and leukocytes in terms of function， site of action， and circadian rhythm， it is proposed that in traditional Chinese medicine （TCM）， the pathogenesis of leukopenia is defense qi deficiency. By analyzing the relevant discussions on the generation and transmission of defense qi in TCM classics， it is believed that the original qi in lower jiao （焦） is the source of defense qi， while the water and grain qi in middle jiao enriches defense qi， and the upper jiao transmits and distributes defense qi to the whole body. Therefore， when treating leukopenia after chemotherapy with TCM， Guilu Erxian Gelatin （龟鹿二仙胶） and Yougui Pill （右归丸） are often used to tonify the kidney and supplement essence， and moxibustion at Guanyuan （CV 4） and Qihai （CV 6） is usually accompanied to replenish the original qi in lower jiao and enrich the source of defense qi. Guipi Decoction （归脾汤）， Buzhong Yiqi Decoction （补中益气汤）， Shenling Baizhu Powder （参苓白术散）， and Sijunzi Decoction （四君子汤） are often suggested to strengthen spleen and replenish qi， in combination with moxibustion at Zhongwan （CV 12） and Zusanli （ST 36） to transport the spleen and stomach in the middle jiao to enrich the defense qi. Modified Guizhi Decoction （桂枝汤） to harmonize nutrient and defensive aspects is often used， and moxibustion at Dazhui （GV 14） and Feishu （BL 13） or scraping is added to dredge the striae and interstice in the upper jiao and promote transmission and dissemination of the defense qi. Considering the whole process of generation and distribution of defense qi， it is suggested to choose the most appropriate treatment modality flexibly， and combine internal treatment with external treatment， in order to provide ideas for the treatment of leukopenia in tumour patients.

Observation on the outcome of occupational chronic benzene poisoning treated with acupuncture combined with Du-Moxibustion / 中国职业医学

ObjectiveTo investigate the effects of acupuncture combined with Du-Moxibustion (ADM) on peripheral blood cell count and levels of immune factors in patients with occupational chronic benzene poisoning. Methods A total of 70 patients with occupational chronic benzene poisoning (leukopenia and neutropenia) were selected as the research subjects by judgement sampling method. They were randomly divided into a control group and an ADM group using a random number table method, with 35 cases in each group. Patients in the control group were treated with conventional Western medicine such as leukocyte boosting and symptomatic treatment. While patients in the ADM group were treated with ADM treatment in addition to treatments of the control group, once per week for five consecutive weeks. Peripheral blood samples of patients were collected before and after treatment from both groups, to detect cell counts and serum levels of immune factors. Results The white blood cell count, red blood cell count, absolute lymphocyte count, absolute neutrophil count, platelet count, and levels of hemoglobin, immunoglobulins (Ig) A, IgM, IgG, complement C3 and complement C4 of patients in both groups improved after treatment compared with those before treatment (all P<0.05). The white blood cell count, levels of IgA, IgM, IgG, complement C3 and complement C4 of patients in the ADM group were higher than those in the control group after treatment (all P<0.05). Conclusion ADM treatment can increase peripheral blood white blood cells and serum levels of immune factor in patients with occupational chronic benzene poisoning (leukopenia, neutropenia), which helps improve patient recovery and can be promoted clinically.

Mielopatía por déficit de cobre: serie de casos y revisión de la literatura / Myelopathy due to copper deficiency: A case series and review of the literature

El déficit de cobre puede presentarse como una mielopatía y manifestarse como una ataxia sensorial secundaria a una desmielinización de los cordones posteriores de la médula espinal. Puede acompañarse de citopenias, principalmente anemia y leucopenia. Se presenta una serie de casos de tres pacientes con mielopatía por déficit de cobre, diagnosticados y manejados desde el año 2020 al 2022 en un hospital universitario de alta complejidad en Colombia. Dos de los casos eran mujeres. El rango de edad fue entre 57 y 68 años. En los tres casos, los niveles séricos de cobre estaban disminuidos y en dos de ellos, se descartaron diferentes causas de mielopatía que afectan los cordones posteriores de la médula espinal como el déficit de vitamina B12, vitamina E y ácido fólico, tabes dorsal, mielopatía por virus de la inmunodeficiencia humana, esclerosis múltiple e infección por el virus linfotrópico humano de tipo I y II, entre otras. Sin embargo, un paciente tenía deficiencia de vitamina B12 asociada con de cobre en el momento del diagnóstico de la mielopatía. En los tres casos hubo ataxia sensitiva y en dos, la paraparesia fue el déficit motor inicial. Se deben incluir siempre la determinación de los niveles de cobre dentro del abordaje diagnóstico de todo paciente con enfermedad gastrointestinal crónica, con diarrea crónica, síndrome de mala absorción o reducción significativa de la ingestión en la dieta, y que desarrolle síntomas neurológicos sugestivos de compromiso de los cordones, ya que se ha reportado que el retraso en el diagnóstico de las mielopatías se asocia con pobres desenlaces neurológicos.

Copper deficiency can present as myelopathy by the manifestation of sensory ataxia, secondary to demyelination of the posterior cords of the spinal cord, accompanied by cytopenia, mainly anemia, and leukopenia. Case series study of three patients with myelopathy due to copper deficiency, diagnosed and managed from 2020 to 2022 in a highly complex university hospital in Colombia. Regarding gender, two cases were female patients. The age range was between 57 and 68 years. In all three cases serum copper levels were decreased, and in two of these, different causes of myelopathy affecting the posterior cords of the spinal cord were ruled out, such as vitamin B12, vitamin E and folic acid deficiency, tabes dorsalis, myelopathy due to human immunodeficiency virus, multiple sclerosis and infection by the human lymphotropic virus type I and II, among others. However, at the moment of the myelopathy diagnosis, one patient had vitamin B12 deficiency associated with copper insufficiency. All three cases presented sensory ataxia, and in two, paraparesis was the initial motor deficit. The diagnostic approach must include copper levels assessment in every case of patients with chronic gastrointestinal pathology, chronic diarrhea, malabsorption syndrome, or significant reduction in dietary intake; and the development of neurological symptoms that may suggest cord involvement. It has been reported that a delay in diagnosis can lead to poor neurological outcomes.

Effective components and mechanism of Qijiao Shengbai Capsules based on fingerprinting and network pharmacology / 中国中药杂志

Qijiao Shengbai Capsules(QJ) can invigorate Qi and replenish the blood, which is commonly used clinically for adjuvant treatment of cancer and leukopenia due to chemoradiotherapy. However, the pharmacological mechanism of QJ is still unclear. This work aims to combine the high-performance liquid chromatography(HPLC) fingerprints and network pharmacology to clarify the effective components and mechanism of QJ. The HPLC fingerprints of 20 batches of QJ were established. The similarity evaluation among 20 batches of QJ was performed by using Similarity Evaluation System for Chromatographic Fingerprint of Traditional Chinese Medicine(version 2012), resulting in a similarity greater than 0.97. Eleven common peaks were identified by reference standard, including ferulic acid, calycosin 7-O-glucoside, ononin, calycosin, epimedin A, epimedin B, epimedin C, icariin, formononetin, baohuoside I, and Z-ligustilide. The "component-target-pathway" network was constructed by network pharmacy, and 10 key components in QJ were identified, such as ferulic acid, calycosin 7-O-glucoside, ononin, and calycosin. The components were involved in the phosphoinositide 3 kinase-protein kinase B(PI3K-Akt), mitogen-activated protein kinase(MAPK), and other signaling pathways by regulating potential targets, including EGFR, RAF1, PIK3R1, and RELA, to auxiliarily treat tumors, cancers, and leukopenia. The molecular docking conducted on the AutoDock Vina platform confirmed the high binding activity of 10 key effective components with core targets, with the binding energy less than-5 kcal·mol~(-1). In this study, the effective components and mechanism of QJ have been preliminary revealed based on HPLC fingerprint and network pharmacology, which provided a basis for quality control of QJ and a refe-rence for further study on its mechanism.

Perfil hematológico de idoso com dengue internado em unidade de terapia intensiva / Hematological profile of elderly people with dengue hospitalized in an intensive care unit / Perfil hematológico de ancianos con dengue hospitalizados en una unidad de cuidados intensivos

Introdução: A dengue é considerada a arbovirose mais comum no mundo, sendo hoje um problema crescente de saúde pública. Objetivo: Por ser considerada de alta prevalência, foi realizada a avaliação hematológica de um paciente hospitalizado na Unidade de Terapia Intensiva na cidade de Umuarama-PR. Metodologia: Tratou-se de um estudo descritivo retrospectivo, do qual foram analisados os resultados de hemogramas obtidos por um laboratório local, considerando que o paciente constava como sorologia positiva para NS1. Foram avaliados 09 laudos de hemograma emitidos durantes 5 dias de internamento do paciente. Os resultados foram comparados entre os laudos e com os valores de referência disponibilizados pelo próprio laudo. Resultados: Com base na análise dos hemogramas pode-se verificar a redução do hematócrito em 33,33%, macrocitose em 88,9%, leucopenia em 27,3%, trombocitopenia em 27,3%. Conclusão: Conclui-se que através dos laudos avaliados foram encontrados plaquetopenia, leucopenia, linfocitopenia, eosinopenia, neutropenia, monocitopenia. Evidenciando o hemograma como uma ferramenta laboratorial de grande auxílio na avaliação do paciente.

Introduction: Dengue is considered the most common arbovirus in the world, and is now a growing public health problem. Objective: Due to its high prevalence, a hematological evaluation of a patient hospitalized in the Intensive Care Unit in the city of Umuarama-PR was carried out. Methodology: This was a retrospective descriptive study, in which the results of blood counts obtained by a local laboratory were analyzed, considering that the patient had positive serology for NS1. 09 blood count reports issued during the 5 days of the patient's hospitalization were evaluated. The results were compared between the reports and with the reference values provided by the report itself. Results: Based on the analysis of blood counts, it was possible to verify a reduction in hematocrit in 33.33%, macrocytosis in 88.9%, leukopenia in 27.3%, thrombocytopenia in 27.3%. Conclusion: It is concluded that through the evaluated reports, thrombocytopenia, leukopenia, lymphocytopenia, eosinopenia, neutropenia, monocytopenia were found. Evidencing the blood count as a laboratory tool of great help in the evaluation of the patient.

Introducción: El dengue es considerado el arbovirus más común en el mundo, y actualmente es un problema creciente de salud pública. Objetivo: Debido a su alta prevalencia, se realizó una evaluación hematológica de un paciente hospitalizado en la Unidad de Cuidados Intensivos de la ciudad de Umuarama-PR. Metodología: Se trató de un estudio descriptivo retrospectivo, en el cual fueron analizados los resultados de los hemogramas obtenidos por un laboratorio local, considerando que el paciente tenía serología positiva para NS1. Fueron evaluados 09 informes de hemogramas emitidos durante los 5 días de internación del paciente. Los resultados se compararon entre los informes y con los valores de referencia proporcionados por el propio informe. Resultados: A partir del análisis de los hemogramas, fue posible verificar reducción del hematocrito en 33,33%, macrocitosis en 88,9%, leucopenia en 27,3%, trombocitopenia en 27,3%. Conclusiones: Se concluye que a través de los reportes evaluados se encontró trombocitopenia, leucopenia, linfocitopenia, eosinopenia, neutropenia, monocitopenia. Evidenciando el hemograma como una herramienta de laboratorio de gran ayuda en la evaluación del paciente.

Síndrome de plaquetas grises y embarazo: reporte de un caso y revisión de la bibliografía / Grey platelet syndrome and pregnancy: case report and literature review

Resumen ANTECEDENTES: Las repercusiones del embarazo en el síndrome de plaquetas grises no están definidas, la bibliografía reporta pocos casos; por tanto, los desenlaces no son muy conocidos. OBJETIVO: Describir el caso de una paciente con síndrome de plaquetas grises y embarazo para proponer pautas de atención y recomendaciones para el seguimiento antenatal, peri y posparto en este grupo de pacientes. Además, revisar la bibliografía más reciente. CASO CLÍNICO: Paciente primigesta de 29 años, con diagnóstico de trombocitopenia a partir de los 6 años. Durante el embarazo se consideró de origen genético por lo que se solicitó el exoma clínico que reportó una variante en el gen NBEAL2 c 7244G>T p G1y2415Val homocigoto, con diagnóstico de síndrome de plaquetas grises. Permaneció en seguimiento en los servicios de Hematología y Obstetricia, sin complicaciones mayores; cerca del parto requirió transfusión de plaquetas. A las 39 semanas de embarazo ingresó para atención del parto, se dio prueba de trabajo de parto; sin embargo, por indicación obstétrica (detención de la dilatación) se decidió la finalización mediante cesárea. METODOLOGÍA: Se revisaron las bases de datos de PubMed, LILACS, Medline, Clinical trials de los últimos 20 años. Los MeSH de búsqueda fueron "grey platelet" "syndrome" "pregnancy". Se encontraron 11 artículos de los que se descartaron 2 por estar fuera del rango de tiempo, un artículo duplicado y otros excluían embarazadas. En total se revisaron 9 artículos. CONCLUSIÓN: Este caso muestra que las mujeres con síndrome de plaquetas grises, si son debidamente acompañadas por un equipo interdisciplinario con experiencia pueden tener un embarazo y parto seguros.

Abstract BACKGROUND: The repercussions of pregnancy in grey platelet syndrome are undefined, with few cases reported in the literature; therefore, outcomes are not well known. OBJECTIVE: To describe the case of a patient with grey platelet syndrome and pregnancy in order to propose care guidelines and recommendations for antenatal, peri- and postpartum follow-up in this group of patients. In addition, to review the most recent literature. CLINICAL CASE: A 29-year-old primigravida patient diagnosed with thrombocytopenia since the age of 6. During pregnancy it was considered to be of genetic origin, so the clinical exome was requested, which reported a variant in the NBEAL2 c 7244G>T p G1y2415Val homozygous gene, with a diagnosis of grey platelet syndrome. She remained under follow-up in the haematology and obstetrics departments, without major complications; close to delivery she required platelet transfusion. At 39 weeks of pregnancy, she was admitted for delivery care, proof of labour was given; however, due to obstetric indications (arrest of dilatation) it was decided to terminate the pregnancy by caesarean section. METHODOLOGY: The databases of PubMed, LILACS, Medline, Clinical trials of the last 20 years were reviewed. The MeSH search terms were "grey platelet" "syndrome" "pregnancy". Eleven articles were found of which two were discarded for being out of time range, one article duplicated and others excluded pregnant women. In total 9 articles were reviewed. CONCLUSION: This case shows that women with grey platelet syndrome, if properly supported by an experienced interdisciplinary team, can have a safe pregnancy and delivery.

Study of Clinical and Outcome Profile of Neonatal Sepsis with Thrombocytopenia Patients Admitted at Tertiary health care Centre Nanded

Background: Thrombocytopenia is a frequent problem in neonatal sepsis and is among the most predic?ve, independent risk factors for sepsis-associated mortality. The present study was undertaken to correlate neonatal sepsis and thrombocytopenia in terms of severity, clinical course, organism specificity and outcome. Method: Total 384 neonates age <28 days with sepsis and thrombocytopenia were studied and analyzed with their clinical profile, symptoms, lab findings and outcomes. Results: Male babies (55.86%), age <72 hrs (80.35%), preterm (68.70%) and LBW babies (85.58%) were more prone to sepsis. Maternal fever (67.44%), foul smelling liquor (53.79%) and PROM >18 hrs (66.74%) make babies more prone to neonatal sepsis. The Commonest clinical features were not accepting feed (69.95%), lethargy (67.85%) and breathing difficulty (79.04%). Early onset sepsis (82.54%) and probable sepsis (40.26%) were more common and associated with preterm and LBW babies. Leucocytosis was seen in 64.57%, thrombocytopenia moderate degree 45.67% and severe degree 34.65%, MPV >12 69.11%, ANC <1800 47.50%, micro ESR >15 mm 72.16% and CRP posi?vity 28.60%. Severe degree thrombocytopenia (<50000) was more common with PROM >18 hrs (83.02%), maternal fever (83.09%) and gram-nega?ve organism(61.29%). Leucopenia (<4000) was more common with maternal fever (75.79%), proven sepsis (43.16%) and gram-nega?ve organism (70.31%). Severe degree thrombocytopenia (61.29%), leucopenia (70.31%) and mortality (64.51%) were more commonly associated with gram-nega?ve organism. Outcome was bad with severe degree of thrombocytopenia (62.32%), leucopenia (73.91%), and gram-nega?ve organism (64.51%). Conclusion: Proper antenatal mother care, hygiene and early evalua?on for illness can prevent early onset of sepsis in neonates. Severity of degree of thrombocytopenia directly propor?onal to the worst outcome.

The hematologic profile of Filipino HIV-infected individuals and its association with CD4 counts

ABSTRACT Introduction: Hematologic abnormalities are common in HIV and involve all blood cell lineages. A study on cytopenias, as correlated with disease progression, can be valuable in resource-limited settings. This study aimed to determine the hematologic profile of HIV patients and its association with CD4 count and antiretroviral (ARV) treatment. Methods: This is a retrospective cohort study involving adult Filipino HIV patients with complete blood count (CBC) and CD4 count determinations prior to the initiation of ARV treatment and after ≥6 months of ARV treatment. Logistic regression was performed to determine the association between cytopenias and a CD4 count <200 cells/μL. Results: The study included 302 patients. Anemia was the most common cytopenia. Anemia and leukopenia were associated with an increased likelihood of having a CD4 count <200 cells/μL in ARV-naïve patients. In ARV-treated patients, leukopenia was associated with an increased probability of having a CD4 count <200 cells/μL. An increase in hemoglobin, white blood cell (WBC) and platelet counts was observed after ≥6 months of ARV treatment. Conclusion: Anemia and leukopenia can be used as markers of immune status in HIV-infected individuals and improvement in the CBC parameters can be used to assess response to ARV treatment. Routine monitoring of hematologic parameters is recommended.

Asociación entre la variación de glóbulos blancos y las manifestaciones clínicas, anticuerpos e infecciones en adultos con lupus eritematoso sistémico / White blood cells count variation in systemic lupus erythematosus: its association to disease manifestations, antibodies and risk of infections

Introducción: la asociación de leucopenia, linfopenia y neutropenia con la presencia de autoanticuerpos, manifestaciones clínicas e infecciones en pacientes con lupus eritematoso sistémico (LES) no está bien establecida. Los objetivos de este estudio fueron analizar los cambios en los recuentos de leucocitos y linfocitos en pacientes con LES y su asociación con manifestaciones clínicas, autoanticuerpos y riesgo de infecciones. Materiales y métodos: se recolectaron retrospectivamente los valores de leucocitos, linfocitos y neutrófilos. Se agruparon a los pacientes en cinco categorías: recuento de glóbulos blancos normales, leucopenia (persistente o intermitente) y linfopenia (persistente o intermitente). Se registraron las manifestaciones clínicas, los autoanticuerpos acumulados, el daño, la mortalidad, las infecciones y los tratamientos inmunosupresores recibidos de cada paciente. Resultados: se incluyeron 89 pacientes. La linfopenia (89%) fue la anormalidad más frecuente. La leucopenia intermitente y la persistente se detectaron en el 44% y en el 11% de los pacientes, respectivamente. La linfopenia intermitente y la persistente se hallaron en el 44% y en el 45% de los casos. En el análisis univariado, la presencia de rash discoide se asoció a leucopenia (20,4 vs. 5,1; p=0,059) y el tratamiento con mofetil micofenolato a un recuento normal de leucocitos (p=0,046). El compromiso neurológico se asoció a recuento normal de linfocitos (22,2% vs. 0% y 7,5%; p=0,027); los pacientes con anti-RNP (anti ribonucleoproteína nuclear) presentaron más frecuentemente linfopenia persistente (47% vs. 15,4% y 20%; p=0,007). Ninguno de los grupos se asoció a una mayor prevalencia de infecciones. En el análisis multivariado, el mofetil micofenolato se asoció negativamente a leucopenia (OR 0.33 IC 95% 0,1-0,9; p=0,042) y el compromiso neurológico se asoció negativamente a linfopenia (OR 0.08; p=0,022). Conclusiones: en el análisis univariado, el rash discoide se asoció a leucopenia y el anti-RNP a linfopenia. Al ajustar por otras variables significativas, el tratamiento con mofetil micofenolato se asoció a un recuento normal de leucocitos, mientras que las manifestaciones neurológicas se relacionaron a linfocitos normales. No se demostró asociación de las infecciones con ninguno de los grupos.

Introduction: leukopenia, lymphopenia and neutropenia association to clinical manifestations and infections in systemic lupus erythematosus (SLE) is not well defined. The objectives were to analize leucocytes and lymphocytes variations in SLE patients and their association to clinical manifestations, autoantibodies and infections risk. Materials and methods: total white blood cell (WBC) count, lymphocyte, and neutrophils counts were collected retrospectively. Data were grouped into normal WBC cell count, persistent or intermittent leucopenia and lymphopenia. Disease manifestations, accumulated autoantibodies, damage, mortality, infections and immunosuppressants ever received were registered. Results: study sample included 89 patients. Lymphopenia (89%) was the most common abnormality. Intermittent and persistent leukopenia were detected in 44% and 11% cases. Intermittent and persistent lymphopenia were found in 44% and 45% cases. In univariate analysis, discoid rash was associated to leukopenia (20.4 vs 5.1 p=0.059) and mycophenolate treatment to normal leukocyte count (p=0.046). Patients with neurological disorder tended to have normal lymphocyte counts rather than intermittent or persistent lymphopenia (22.2% vs 0% and 7.5% p=0.027); patients with anti-RNP tended to belong to the persistent lymphopenia group (47% vs 15.4% and 20% p=0.007). Infections were not associated to any of the categories. In multivariate analysis mycophenolate was negatively associated to leukopenia (OR 0.33 95% CI 0.1-0.9 p=0.042) while neurological disorder was negatively associated to lymphopenia (OR 0.08 p=0.022). Conclusions: in univariate analysis, discoid rash was associated to leukopenia and anti-RNP to lymphopenia. When adjusted to other significant variables, mycophenolate was related to normal leukocyte while neurological manifestations were to normal lymphocyte counts. Infections were not associated to any of the categories.

High dilution in Leukopenia treatment in five dogs

Leukopenia is associated with the consumption of peripheral leukocytes, decreasedproduction due to endotoxemia and septicemia, medullary hypoplasia, nutritional diseases orautoimmune reactions. In a case report by Narita et al, Echinacea angustifolia demonstrated theeffectiveness of treatment of leukopenia in penguins. Aims:Report the evolution of homeopathictreatment in 5 dogs' patients between 3 and 5 years old, presenting leukopenia. Methodology:The homeopathic treatment was chosen, using Echinaceaangustifolia due to its immunostimulant andimmunomodulatory actions, which evolution was analyzed by blood tests. The exposedinformation is consented by the tutors. Results:The same protocol was made for all of the patients, including 4 globules of Echinacea angustifolia 6 cH orally, every 12 hours for 30 days. The first dog attended on 07/21/2021, presented 4.000 leukocytes, which increased to 6.800 on 08/17/2021. Thesecond patient attend on 12/07/2021 presented 4.700 leukocytes, increasing to 6.800 on 01/25/2022. The third patient attended on 08/24/2021 presented 5.400 leukocytes, which increased to 6.800 on 10/15/2021. The fourth patient presented 4.300 leukocytes on 01/13/2022, increasing to 5.500 on 02/11/2022. The fifth patient presented on12/12/2021 4.600 leukocytes, increasing to 8.400 on 02/03/2022. Therefore, the average of the first collection was 3.681 leukocytes and in the second there was an increase to 6.860 leukocytes (T-test, p= 0,0167). Conclusion:The use of the homeopathic medicine Echinacea angustifolia shows great results, being a viableoption for the treatment of leukopenia, without the side effects.

C-reactive protein levels and prevalence of leukopenia in patients with inflammatory bowel disease treated with azathioprine and/or mesalazine: a real-life study

ABSTRACT Objective To examine serum C-reactive protein levels and the prevalence of leukopenia in patients with Crohn's disease or ulcerative colitis undergoing treatment with azathioprine and/or mesalazine. Methods Retrospective observational study based on clinical and laboratory data collected from medical records of 76 adult patients with inflammatory bowel disease treated with azathioprine, mesalazine or both. Sex, age, diagnosis, number of blood samples and elevated serum C-reactive protein levels during the follow-up period were recorded. The following variables were analyzed in terms of C-reactive protein levels and leukopenia episodes: sex, age, diagnosis of inflammatory bowel disease and type of drug. Statistical analyses included multiple logistic regression and the Fisher's exact test for qualitative variables. Results Leukopenia was observed in 18.4% of patients and was associated with older age and higher doses of medication. In 44% of patients, C-reactive protein levels were high. However, symptoms were not associated with abnormal levels of this marker. Conclusion Regardless of symptoms, serum C-reactive protein levels were not a reliable indicator of controlled inflammatory bowel disease. Leukopenia was independently associated with older age and higher doses of medication and is a common side effect, which should be routinely monitored.

Caracterización de la plaquetopenia, leucopenia y aumento del hematocrito en la evolución y gravedad de los pacientes con diagnóstico de dengue / Characterization of thrombocytopenia, leukopenia and increased hematocrit in the evolution and severity of patients with dengue diagnosis

El virus del dengue (DENV) ha frecuentado nuestro planeta por más de tres siglos. La picadura del Aedes aegypti causa el DENV. El diagnóstico clínico y laboratorial son importantes para el manejo del dengue. Objetivo: caracterizar la presencia de la plaquetopenia, leucopenia y aumento del hematocrito con la evolución y gravedad de los pacientes con Dengue, en el Hospital Univalle, en la ciudad de Cochabamba, Bolivia. Material y métodos: estudio retrospectivo, longitudinal y analítico, desde el 2017 al 2020. Resultados: se identificaron 235 pacientes, 83% el 2020; el 65% entre 19 a 45 años; 54% de sexo masculino, 80% provienen de Cercado-Cochabamba, siendo más del 95% de la zona sud. La prueba de detección de la proteína NS1Ag (AccuBio Tech Co, Ltd.) se usó en 71%; 56% se hospitalizaron; más del 50% presentaron sintomatología entre el 2do y 5to día. Dentro la clasificación del dengue, el 75% perteneció a dengue sin signos de alarma (p= 45% en varones, presentando más de 5 días de hospitalización (p=0,023). Conclusiones: plaquetopenia, leucopenia y el aumento del hematocrito son biomarcadores de severidad clínica y estancia hospitalaria, asociados a un diagnóstico precoz, empleando la sintomatología y pruebas rápidas disponibles; siendo necesario considerar la presencia de pacientes autóctonos de la zona sud de Cochabamba, Cercado.

Dengue virus (DENV) has haunted our planet for more than three centuries. The Aedes aegypti bite causes DENV. Clinical and laboratory diagnosis are important for the management of dengue. Objective: to characterize the presence of plaquetopenia, leukopenia and increased hematocrit with the evolution and severity of patients with Dengue, Hospital Univalle. Material and methods: retrospective, longitudinal and analytical study, 2017 to 2020. Results: 235 patients were identified, 83% in 2020; 65% between 19 to 45 years old; the male sex with 54%. 80% come from Cercado-Cochabamba, of these more than 95% from the southern area. The test with the detection of the NS1Ag protein (AccuBio Tech Co, Ltd.) was used in 71%; 56% were hospitalized; more than 50% presented symptoms between the 2nd and 5th day; Within the dengue classification, 75% belonged to dengue without warning signs (p = 45% in men and represented more than 5 days of hospitalization (p = 0,023). Conclusions: Plaquetopenia, leukopenia and increased hematocrit are biomarkers of clinical severity, hospital stay, associated with an early diagnosis, using the symptoms and rapid tests available; finally, consider the presence of autochthonous patients from the southern area of Cochabamba, Cercado.

Study on the correlation between serum 25-hydroxyvitamin D cystatin C and the severity of white matter / 中风与神经疾病杂志

@#Objective　To investigate the correlation between serum 25 hydroxyvitamin D ［25 (OH)D］.Cystatin C (Cys-C) and the severity of leukoaraiosis (LA).Methods　One hundred and thirty LA patients admitted to our hospital from February 2018 to February 2020 were divided into mild group (n=43),moderate group (n=45) and severe group (n= 42).In the same period.40 healthy people who had physical examination in our hospital were included as control group.All subjects were tested for serum 25(OH)D and Cys-C levels,and the MoCA score was performed for LA patients.The correlation between serum 25 (OH)D and Cys-C and the correlation between serum 25 (OH)D.Cys-C and MoCA scores were analyzed.ROC was used to analyze the AUC of serum 25 (OH)D and Cys-C to assess LA aggravation.The correlation between serum 25 (OH)D.Cys-C and the severity of La was observed.Results　The serum 25 (OH)D of mild，moderate and severe groups was lower than that of control group and the serum Cys-C of mild，moderate and severe groups was higher than that of control group (P<0.05).Pearson linear analysis showed that serum 25 (OH)D was negatively correlated with Cys-C (r=-0.767) and positively correlated with MOCA score (r=0.588).Serum Cys-C was negatively correlated with MOCA score (r=-0.694)(P<0.05).The AUC of serum 25 (OH)D and Cys-C assessment of LA exacerbation were 0.760 and 0.749，respectively.Logistic regression analysis showed that increased serum Cys-C and decreased serum 25 (OH)D were risk factors for LA exacerbation (P<0.05).Serum 25 (OH)D(r=-0.666) was negatively correlated with the degree of La.While serum Cys-C (r=0.840) was positively correlated with the degree of La (P<0.05).Conclusion　The greater the degree of LA.the lower the patient’s serum 25 (OH)D and the higher the serum Cys-C.The two are closely related to the progression of LA.

Comparison between hematological and biochemical changes caused by conventional and metronomic chemotherapies in the treatment of canine transmissible venereal tumor

ABSTRACT: This study aimed to report the hematological and biochemical changes caused by conventional and metronomic chemotherapies, using vincristine sulfate to treat canine Transmissible Venereal Tumor (TVT). Twelve dogs were selected, six of them for the group receiving conventional chemotherapy (G1), and six dogs for the group receiving metronomic chemotherapy (G2). The G1 group received vincristine sulfate once a week at the dose of 0.75mg/m² until the tumor had disappeared with treatment, and the G2 group was treated with vincristine sulfate three times a week at the dose of 0.25mg/m2 until the tumor had disappeared. Before and after chemotherapy treatment, hematological and biochemical blood tests were performed to evaluate the main alterations caused by both chemotherapeutic models. Dogs undergoing conventional chemotherapy had significant leukocyte changes (p 0.05), causing neutropenia and leukopenia. In dogs undergoing metronomic chemotherapy, leukocytes remained within the reference range. Half of the dogs in group G1 had normochromic, normocytic anemia. The only biochemical alteration observed was the increase of urea in group G2. Thus, metronomic chemotherapy for the treatment of TVT with vincristine sulfate proved to be an excellent method for treatment, with fewer adverse effects, especially in maintaining the leukogram of dogs within normal range and reducing the number of anemia in animals during treatment.

RESUMO: Esta pesquisa teve como objetivo relatar as alterações hematológicas e bioquímicas causadas pelo tratamento quimioterápico convencional e pela quimioterapia metronômica, utilizando-se sulfato de vincristina para o tratamento do tumor venéreo transmissível canino(TVTC). Foram selecionados 12 cães, sendo seis para o grupo que recebeu quimioterapia convencional (G1) e seis cães para o grupo que recebeu quimioterapia metronômica (G2). O grupo G1 recebeu sulfato de vincristina, uma vez por semana, na dose de 0,75mg/m2, até o desaparecimento do tumor e o grupo G2 foi tratado com sulfato de vincristina, três vezes por semana, na dose de 0,25mg/m2, até o desaparecimento do tumor. Antes e após o tratamento quimioterápico foram realizados exames hematológicos e bioquímicos sanguíneos para avaliação das principais alterações causadas pelos dois modelos quimioterápicos. Os cães submetidos à quimioterapia convencional tiveram alterações leucocitárias significativas (p 0,05), causando uma leucopenia por neutropenia enquanto nos cães, submetidos à quimioterapia metronômica, os leucócitos mantiveram-se dentro do intervalo de referência. A metade dos cães do grupo G1 tiveram uma anemia do tipo normocítica normocrômica. A única alteração bioquímica observada foi o aumento da ureia no grupo G2. Desta forma, a quimioterapia metronômica para o tratamento do TVT com sulfato de vincristina, demonstrou ser um excelente método para a cura do animal, com menores reduções de efeitos adversos, sobretudo, na manutenção do leucograma dos cães e na redução de animais com anemia.

High serum superoxide dismutase activity improves radiation-related quality of life in patients with esophageal squamous cell carcinoma

OBJECTIVES: Esophageal squamous cell carcinoma (ESCC) is one of the most common malignant tumors in China. Intensity-modulated radiation therapy and volume-modulated arc therapy have become the main treatments for esophageal carcinoma; however, side effects caused by radiotherapy greatly impact the quality of life in these patients. This study aimed to explore the impact of serum superoxide dismutase (SOD) levels on the prognosis of patients with ESCC undergoing radiotherapy. METHODS: Patients aged between 18 and 80 years with lower-middle ESCC who underwent radiotherapy were eligible for this assessment. Adverse events, responses, treatment outcomes, and overall survival (OS) were assessed. Between 2012 and 2014, 195 patients were enrolled, of which 65 were assigned to the low- and high-SOD groups based on their serum SOD values. RESULTS: The baseline characteristics were similar between the two groups, except for the T staging. Adverse events in the low-SOD group were significantly higher than those in the high-SOD group (radiation esophagitis, p=0.007; radiation pneumonitis, p=0.032; leukopenia, p=0.023; thrombocytopenia, p=0.037; anemia, p=0.041). There were no significant differences in response, treatment outcomes, or OS. CONCLUSION: In conclusion, high serum SOD activity improved post-radiotherapy quality of life but did not impact the prognosis of patients with ESCC. To the best of our knowledge, this study is the first to report that serum SOD activity is associated with radiation-induced toxicity and moderately increased radiotherapeutic response in patients with ESCC undergoing radiotherapy.

Comparison between hematological and biochemical changes caused by conventional and metronomic chemotherapies in the treatment of canine transmissible venereal tumor / Comparação entre as alterações hematológicas e bioquímicas ocasionadas pela quimioterapia convencional e quimioterapia metronômica no tratamento do tumor venéreo transmissível canino

This study aimed to report the hematological and biochemical changes caused by conventional and metronomic chemotherapies, using vincristine sulfate to treat canine Transmissible Venereal Tumor (TVT). Twelve dogs were selected, six of them for the group receiving conventional chemotherapy (G1), and six dogs for the group receiving metronomic chemotherapy (G2). The G1 group received vincristine sulfate once a week at the dose of 0.75mg/m² until the tumor had disappeared with treatment, and the G2 group was treated with vincristine sulfate three times a week at the dose of 0.25mg/m2 until the tumor had disappeared. Before and after chemotherapy treatment, hematological and biochemical blood tests were performed to evaluate the main alterations caused by both chemotherapeutic models. Dogs undergoing conventional chemotherapy had significant leukocyte changes (p<0.05), causing neutropenia and leukopenia. In dogs undergoing metronomic chemotherapy, leukocytes remained within the reference range. Half of the dogs in group G1 had normochromic, normocytic anemia. The only biochemical alteration observed was the increase of urea in group G2. Thus, metronomic chemotherapy for the treatment of TVT with vincristine sulfate proved to be an excellent method for treatment, with fewer adverse effects, especially in maintaining the leukogram of dogs within normal range and reducing the number of anemia in animals during treatment.(AU)

Esta pesquisa teve como objetivo relatar as alterações hematológicas e bioquímicas causadas pelo tratamento quimioterápico convencional e pela quimioterapia metronômica, utilizando-se sulfato de vincristina para o tratamento do tumor venéreo transmissível canino(TVTC). Foram selecionados 12 cães, sendo seis para o grupo que recebeu quimioterapia convencional (G1) e seis cães para o grupo que recebeu quimioterapia metronômica (G2). O grupo G1 recebeu sulfato de vincristina, uma vez por semana, na dose de 0,75mg/m2, até o desaparecimento do tumor e o grupo G2 foi tratado com sulfato de vincristina, três vezes por semana, na dose de 0,25mg/m2, até o desaparecimento do tumor. Antes e após o tratamento quimioterápico foram realizados exames hematológicos e bioquímicos sanguíneos para avaliação das principais alterações causadas pelos dois modelos quimioterápicos. Os cães submetidos à quimioterapia convencional tiveram alterações leucocitárias significativas (p<0,05), causando uma leucopenia por neutropenia enquanto nos cães, submetidos à quimioterapia metronômica, os leucócitos mantiveram-se dentro do intervalo de referência. A metade dos cães do grupo G1 tiveram uma anemia do tipo normocítica normocrômica. A única alteração bioquímica observada foi o aumento da ureia no grupo G2. Desta forma, a quimioterapia metronômica para o tratamento do TVT com sulfato de vincristina, demonstrou ser um excelente método para a cura do animal, com menores reduções de efeitos adversos, sobretudo, na manutenção do leucograma dos cães e na redução de animais com anemia.(AU)

Altas dosis de cobalamina y ácido fólico en el tratamiento de leucopenias post covid-19 / High doses of cobalamin and folic acid in post-covid-19 leukopenia treatment

Introducción: La leucopenia es una de las manifestaciones observadas en pacientes que padecieron COVID-19 y sus características son similares a las observadas en deficiencia de vitamina B12 y ácido fólico. Objetivo: Mostrar la utilidad de altas dosis de vitamina B12 y ácido fólico en el tratamiento de leucopenias post COVID-19. Métodos: Estudio descriptivo transversal de tipo retrospectivo. Se recolectó datos demográficos, clínicos y laboratoriales de pacientes (n=22) con leucopenia post COVID-19 que fueron tratados con dosis de vitamina B12 y ácido fólico. Se valoró seguimiento de datos clínicos y laboratoriales correspondientes tanto al diagnóstico como a las 4 y 8 semanas del tratamiento. Resultados: El cuadro de leucopenia se revirtió totalmente, los leucocitos incrementaron hasta alcanzar valores normales. Los niveles de hemoglobina incrementaron, aunque sin alcanzar valores normales. Si bien los linfocitos no presentaron disminución al diagnóstico, estos incrementaron manteniéndose dentro de parámetros normales. El VCM se mantuvo con leves modificaciones y las plaquetas no presentaron modificaciones. La sintomatología remitió a los 2 meses. Conclusiones: Los datos obtenidos pueden servir como parte de los fundamentos para el tratamiento del síndrome post COVID-19.

Introduction: Leukopenia is one of the persistent manifestations in patients who have suffered from COVID-19 and its characteristics are similar to those patients with vitamin B12 and folic acid deficiency. Objective: To show the usefulness high doses of vitamin B12 and folic acid in post COVID-19 leukopenia treatment. Material and methods: Retrospective descriptive cross-sectional study. Demographic, clinical and laboratory data were collected from patients (n = 22) with post COVID-19 leukopenia who were treated with doses of vitamin B12 and folic acid. Follow-up of clinical and laboratory data corresponding to diagnosis as well as 4 and 8 weeks after treatment was assessed. Results: Leukopenia was totally reversed, leukocytes increased and reached normal values. Hemoglobin levels increased, although without reaching normal values. Lymphocytes increased within normal parameters though they were not decreased at diagnosis. MCV levels remained with slight modifications, and platelets without modifications. Patients symptoms subsided after 2 months treatment. Conclusion: Data obtained can serve as part of treatment rationale in post-COVID-19 syndrome.

Prognostic values of physical and hematological parameters of dogs naturally infected with parvovirus PVC-2: retrospective study of 103 cases / [Valores prognósticos de parâmetros físicos e hematológicos de cães naturalmente infectados pelo parvovírus PVC-2: estudo retrospectivo de 103 casos]

Canine parvovirosis is a high mortality disease with acute clinical picture. However, there are few available resources to help stablish prognosis accurately. This study aimed to determine the prognostic threshold values for vital and hematological parameters of dogs naturally infected by the Carnivore protoparvovirus 1 (CPV). A retrospective study of 103 canine parvovirosis cases was carried out. Twenty seven percent of these (28/103) died, 96% (27/28) of which within the first four days of hospitalization. Deceased animals had significantly higher median values for heart (HR) and respiratory (f) rates, as well as significantly lower systolic blood pressure (SBP) than survivors. Severely leukopenic animals (<1,000 cells/µL), had a significantly higher mortality rate (68%, n=13) compared to that of other patients (P<0.0007). Animals with at least two of the following findings: severe hypotension (SBP< 90mmHg), tachycardia (HR > 150 bpm) and leukopenia, represented 34% (34/101) of the cases and had a survival rate of 29% (10/34), while animals with at most one of these parameters represented 66% (67/101) and had a survival rate of 94% (63/67). The presence of two or three abnormal parameters was significantly related to the higher death risk among dogs with parvovirosis (P<0.0001).(AU)

A parvovirose canina é uma doença de alta mortalidade e de quadro clínico agudo. No entanto, existem poucos recursos para se estabelecer prognóstico de maneira precisa. Este estudo objetivou analisar os valores prognósticos de parâmetros físicos e hematológicos de cães naturalmente infectados pelo Carnivore protoparvovirus 1 (CPV). Um estudo retrospectivo de 103 casos de parvovirose canina foi realizado. Desses, 27% dos animais (28/103) foram a óbito, sendo 96% (27/28) com ocorrência nos primeiros quatro dias de internamento. Os cães que foram a óbito apresentaram medianas das frequências cardíaca (FC) e respiratória (f) significativamente maiores e pressão arterial sistólica (PAS) consideravelmente menor que a dos sobreviventes. Entre os animais mais intensamente leucopênicos (<1.000 células/(L), a taxa de mortalidade (68%, n=13) foi expressivamente maior que a dos demais pacientes (P<0,0007). Os animais com hipotensão grave (PAS<90mmHg), taquicardia (FC>150bpm) e leucopenia intensa (leucometria<1.000 células/µL), ou duas dessas alterações clínicas, representaram 34% (34/101) dos casos e tiveram taxa de sobrevida de 29% (10/34), enquanto os animais com, no máximo, um desses parâmetros alterados representaram 66% (67/101) dos animais, com taxa de sobrevida de 94% (63/67). A presença de dois ou três parâmetros alterados esteve significativamente relacionada ao maior risco de óbito de cães com parvovirose (P<0,0001).(AU)