A Case of Primary Bone Marrow Diffuse Large B-cell Lymphoma Presenting with Polyarthritis

Polyarthritis is a common manifestation of rheumatologic disorders; however, paraneoplastic arthropathies also arise as polyarthritis or polymyalgia, particularly in patients with myelomas, lymphomas, acute leukemia, and solid tumors. Because paraneoplastic syndromes, in some instances, might be manifested before a cancer diagnosis, they are difficult to diagnose and are often misdiagnosed. We experienced a 63-year-old female patient who had nonspecific arthritis on both hands and feet accompanied by fever. She had been diagnosed as rheumatoid arthritis and treated with prednisolone and disease modifying anti-rheumatic drugs (DMARDs) including methotrexate and anti-tumor necrosis factor agents. Her arthritis did not respond with anti-rheumatic treatment and diffuse large B-cell lymphoma was diagnosed by bone marrow biopsy. After 6 cycles of chemotherapy, her arthritis was improved as well as underlying lymphoma.

Development of a Poikilocyte Measuring Method Using Image Analysis Software

BACKGROUND: To achieve consistency in poikilocytes grading in peripheral blood cell examinations, we made an image-based differential count (IDC) software to measure the degree of abnormalities in individual red blood cells (RBCs) and relative fractions of poikilocytes. METHODS: Thirty peripheral blood samples were analyzed. Smear slides were examined on a microscope with charge-coupled device (CCD) camera. To verify this program, we compared the IDC results with the results of manual differential counting (MDC). Relative fractions of schistocytes, echinocytes, and elliptocytes were measured by IDC and MDC. The error rate of IDC was measured by confirming the final processed images of IDC. Correlations of IDC and MDC results were compared using linear regression analysis and the time required for each test was measured. For presentation of the mathematical decision criteria of poikilocytes, IDC algorithms for recognizing schistocytes, echinocytes, and elliptocytes were made using simple geometrical or mathematical formulas. RESULTS: The error rate of IDC was 2.8%. For analysis of 1,000 RBCs, MDC took 7.3 minutes and IDC took 2.7 minutes. Linear regression coefficients were 0.776 (P<0.001) for schistocytes, 0.895 (P<0.001) for echinocytes, and 1.001 (P<0.001) for elliptocytes. CONCLUSIONS: It was possible to define poikilocytes with geometrical or mathematical formulas using image analysis programs. The IDC program would be helpful for consistent grading of poikilocytes.

A Case of Therapy-Related Acute Myeloid Leukemia Following 5-Fluorouracil Chemotherapy

No abstract available.

Bone Marrow Findings, and TNF-alpha, IL-18 Expression in Bone Marrow of Adult Onset Still's Disease Patients / 대한류마티스학회지

OBJECTIVE: Inflammatory cytokines may play important roles in the pathogenesis of adult onset Still's disease. The enhanced expression of IL-18 was reported in the bone marrow of a Japanese systemic onset juvenile rheumatoid arthritis patient but not in the other organs. To date, there are very few studies relating the bone marrow and AOSD. This study examined the bone marrow findings as well as TNF-alpha and IL-18 expression in the bone marrow of AOSD patients. METHODS: A retrospective study was performed on 15 AOSD patients who had undergone a bone marrow examination at a university hospital. The clinical and laboratory findings, as well as the bone marrow findings, were analyzed. Immunohistochemistry of IL-18 and TNF-alpha in bone marrow was performed. RESULTS: The bone marrow cellularity and myeloid/erythroid cell ratio showed no correlation with the clinical and laboratory findings. TNF-alpha was expressed at 0.8~9.8% and IL-18 was expressed at 0.4~9.8% of bone marrow cells. Cytokine expression was not associated with the clinical patterns of AOSD. The platelet count correlated with the bone marrow TNF-alpha expression but TNF-alpha did not correlate with IL-18 expression. CONCLUSION: TNF-alpha and IL-18 expression in bone marrow were observed in some AOSD patients but there was no correlation with the other clinical and laboratory findings except for the platelet count.

T-cell Large Granular Lymphocytic Leukemia: A Case Report

T cell large granular lymphocytic leukemia (T-LGL leukemia) is defined as a clonal proliferative disorder of CD3+ cytotoxic T cells. T-LGL leukemia usually expresses CD3+, CD4-, CD8+, CD16+, CD56- and CD57+ cell markers, and this represents a rearrangement of the T cell receptor (TCR) gene. The clinical course is indolent in most cases, but on rare occasions, when CD3+ and CD56+ are expressed on the leukemic cells, it can be more aggressive. We experienced a patient with T-LGL leukemia and the disease was indolent at the time of diagnosis, and so any specific treatment was not required. Two years after the initial diagnosis, her clinical course became quite aggressive as the CD 56+ cell surface antigen was expressed. We report here on the first case of T-LGL leukemia in Korea and we review the relevant literature.

Annual Report on External Quality Assessment in Hematology in Korea (2008) / 임상검사와정도관리

Four trials of external quality assessment in diagnostic hematology were performed in 2008 with average 822 participating laboratories in Korea. We performed quality assessment for white blood cell count, hemoglobin, hematocrit, red blood cell count, platelet count, blood cell morphology, prothrombin time and activated partial thromboplastin time. The response rate was more than 96.5%. The coefficients of variation in hemoglobin, hematocrit and RBC was stable but variable in platelet count and WBC count according to measuring cell count. Test results of blood cell morphology showed variation among various cell morphologies.

Annual Report on External Quality Assessment in Hematology in Korea (2007) / 임상검사와정도관리

Four trials of external quality assessment in diagnostic hematology were performed in 2007 with average 722 participating laboratories in Korea. We performed quality assessment for white blood cell count, hemoglobin, hematocrit, red blood cell count, platelet count, blood cell morphology, prothrombin time and activated partial thromboplastin time. The response rate was more than 95.2%. The coefficients of variation in hemoglobin, hematocrit and RBC were stable but variable in platelet count and WBC count according to measuring cell counters. Test results of blood cell morphology showed variation among various cell morphologies.

Annual Report on External Quality Assessment in Hematology in Korea (2007) / 임상검사와정도관리

Four trials of external quality assessment in diagnostic hematology were performed in 2007 with average 722 participating laboratories in Korea. We performed quality assessment for white blood cell count, hemoglobin, hematocrit, red blood cell count, platelet count, blood cell morphology, prothrombin time and activated partial thromboplastin time. The response rate was more than 95.2%. The coefficients of variation in hemoglobin, hematocrit and RBC were stable but variable in platelet count and WBC count according to measuring cell counters. Test results of blood cell morphology showed variation among various cell morphologies.

Annual Report on External Quality Assessment in Hematology in Korea (2005) / 임상검사와정도관리

Four trials of external quality assessment in diagnostic hematology were performed in 2005 with about 500 participating laboratories in Korea. We performed quality assessment for white blood cell count, hemoglobin, red blood cell count, platelet count, white cell differential count, red blood cell morphology. The response rate was more than 97%. The coefficients of variation in hemoglobin and RBC number was stable but variable in platelet number and WBC number according to measuring cell counts. Test results showed wide variation according to measuring machine and reagents.

Annual Report on External Quality Assesment in Hematology in Korea (2004) / 임상검사와정도관리

Four trials of external quality assessment in diagnostic hematology were performed in 2004 with about 440 participating laboratories in Korea. We performed quality assessment for white blood cell count, hemoglobin, red blood cell count, platelet count, white cell differential count, red blood cell morphology and coagulation test. The response rate was more than 96%. The coefficients of variation in hemoglobin and RBC number was stable but variable in platelet number and WBC number according to measuring cell counts. Blood coagulation study was performed twice. Test results show wide variation according to measuring machine and reagents.

External Quality Control for PT and aPTT in a Peer Group Using In-house / 대한진단검사의학회지

BACKGROUND: Coagulation studies are affected by the reagents and coagulometers that are used in the tests and it is therefore essential to compare the results within a peer group that uses the same reagents and coagulometer for an external quality control program. Because the domestic quality control program encompasses many different groups using different reagents and coagulometers, no comparison has been made among peer groups. Therefore, the authors performed a quality control program using in-house lyophilized plasma in a selected peer group. METHODS: Prothrombin times (PT) and activated partial thromboplastin times (aPTT) were tested using in-house normal and oral anticoagulant lyophilized plasma; the tests were performed for 50 consecutive days in four hospitals that were using the same coagulometer. The same PT reagents were used in all four hospitals. The international sensitivity index (ISI) was 1.32 for three hospitals and 1.47 for one hospital. Three hospitals used the same aPTT reagent. RESULTS: After lyophilization, there was no change in the PT results, but aPTT results were greatly prolonged. At four hospitals, the average international normalized ratio (INR) of normal lyophilized plasma was 0.94, 0.94, 0.95, and 0.82, while the average INR of oral anticoagulant lyophilized plasma was 2.18, 2.28, 2.21, and 1.87. The mean normal PT (MNPT) of three hospitals with ISI of 1.32 were 12.4s, 11.2s, and 12.3s, while the MNPT of one hospital with ISI of 1.47 was 12.5s. Average aPTT of normal plasma were 32.1s, 45.9s, 44.7s, and 44.3s while that of the oral anticoagulant plasma were 42.6s, 61.3s, 57.8s, and 55.6s. CONCLUSIONS: Since there are a great deal of difference in the results of coagulation study among the hospitals using the same reagents and coagulometers, it is utmost necessary to enforce a national level coagulation study quality control program in order to adopt proper oral anticoagulation therapy.

Prognostic Significance of Tumor Markers in Sera and Peritoneal Washings in Gastric Cancer Patients

BACKGROUND: Despite progress in surgical techniques and adjuvant treatments, the prognosis for advanced gastric cancer has not improved. Knowledge of the kinds of tumor markers that might indicate the postoperative prognosis for gastric cancer is important in detecting microscopic residual cancers but still needs to be developed. METHODS: The serum levels of carcinoembryonic antigen (sCEA) and carbohydrate antigen 19-9 (sCA19-9), as well as the CEA, the CA19-9, and the tissue-type plasminogen activator levels in peritoneal washings (pCEA, pCA19-9, pTPA) were measured in 57 patients with gastric cancer who had undergone laparotomies from Oct. 1996 to Mar. 1997. The relationships between the positivity of tumor markers and several clinicopathological factors were evaluated by using a univariate analysis. Also, the significance of tumor markers in predicting the survival and the recurrence of disease was analyzed. RESULTS: The positivity of pCEA and pCA19-9 increased according to the stage (p<0.01) and the presence of serosal invasion (P<0.01). When pCEA or pCA19-9 is positive, the rate of curative surgery in those patients was lower than it was in the patients with negative tumor markers (p<0.01 and p<0.05, respectively). The positivities of pCEA, sCA19-9, pCA19-9 were higher in recurring cases than in nonrecurring cases after curative surgery (p<0.01, p<0.01, and p<0.05, respectively). The positivities of the tumor markers pCEA and pCA19-9 in the 4 cases with peritoneal seeding at the laparotomy were significantly different from those in the 53 cases with no peritoneal seeding (p<0.01) and (p<0.01), respectively pCEA. The risk of peritoneal recurrence after curative surgery was higher in pCEA positive cases than in negative cases (p=0.016) and in serosal positive and pCEA positive cases than in the other cases (p=0.016). CONCLUSION: pCEA and pCA19-9 are useful prognostic factors and an adjuvant treatment to prevent peritoneal recurrence should be considered, especially, in patients presenting positive pCEA with positive serosal invasion.

A Comparative Study on a Home-made Thromboplastin / 대한혈액학회지

BACKGROUND: Thromboplastin extracted from human brain has been replaced by other animal sources due to the risk of infection. However, there is a variation in sensitivity according to the animal it was extracted from, making the monitoring of the prothrombin time (PT) in patients on anticoagulant therapy particularly difficult. Standardization of PT is made by comparing each thromboplastin with an international reference preparation, calculating the ISI (International sensitivity index), and expressing the PT in INR (International Normalized Ratio). Thromboplastins that are currently available commercially are from rabbit brain, human placenta, or bovine brain. This study was undertaken to find the best animal source by comparing the precision of thromboplastins derived from different animals, ISI, and the sensitivities to factor VII deficeint plasma. METHODS: The thromboplastin was extracted from the animal's brain with normal saline. The precision of the thromboplastin and the sensitivity to factor VII deficient plasma were measured. Fresh plasmas from 108 healthy individuals and 69 patients on oral anticoagulant therapy were obtained to measure the PT using the thromboplastin from human or animal brain. From the results, the ISI and CV (correlation of variation) were calculated. RESULTS: The average PT for normal individuals using thromboplastins from human (HBT), rabbit (RBT), bovine (OBT), swine (PBT), and canine (DBT) brain were 13.8, 18.3, 26.7, 26.2, and 37.3 seconds, respectively. Thromboplastin from chicken brain failed to induce coagulation. The prolongation of PT with factor VII deficient plasma for HBT, RBT, OBT, PBT, and DBT were 2.96, 2.96, 2.69, 2.47, and 3.08 respectively. The ISI for RBT, OBT, PBT, and DBT were 1.37, 1.39, 1.54, and 1.20 and the CV were 0.9, 0.9, 0.82, and 1.04, respectively. CONCLUSION: The precisions were high for all thromboplastins with the exception ofDBT. The thromboplastins were all sensitive to factor VII depleted plasma. The ISI were less than 1.6 and the CV were all less than 3%. The average PT of healthy individuals was shortest using RBT and the ISI was also low (1.4), indicating that rabbit brain is a suitable source of thromboplastin.

The Role of CD34 in the Immunophenotyping Panel of Leukemia / 대한임상병리학회지

BACKGROUND: CD34 is expressed by early hematopoietic (myeloid & lymphoid) progenitor cells, endothelial cells, and bone marrow stromal cells. Recent studies have suggested that the expression of the hematopoietic antigen CD34 is predictive of outcome. But the functional importance of CD34 antigen has not yet been fully elucidated, and CD34 antigen has not yet been included in the routine immunophenotyping panel. We designed this experiment to evaluate the significance of including CD34 antigen in the routine immunophenotyping panel. MATERIALS AND METHODS: We have included CD34 antigen in the immunophenotyping panel from 1994 to 1997. Seventy eight patients with acute leukemia and 7 patients with chronic leukemia and CML-blast crisis were analyzed by direct immunofluorescence using monoclonal antibodies. RESULTS: CD34 was positive in 64% (50/78) of cases with acute leukemia and 100% (3/3) of cases with CML-blast crisis, but negative in 100% (4/4) of cases with chronic lymphocytic leukemia. Seventeen (63%) of 27 patients that belonged to AML FAB subtype M0, M1, M2, M4, M5, M7 were CD34-positive, but all of the 9 patients (100%) that belonged to AML FAB M3 were CD34-negative. Thirty-one patients of CD34-positive non-T-ALL belonged to immunologic group II, III, or IV, and all 2 patients of CD34-positive T-ALL belonged to immunologic group I. There are no significant correlations of CD34 with the remission rate and the survival rate of acute leukemia. CONCLUSIONS: CD34 facilitates the rapid diagnosis of acute promyelocytic leukemia (APL) different from the other AML subtypes in clinical course and therapeutic plan. It is also helpful for the immunologic grouping of ALL, and differentiation of chronic leukemia from CML-blast crisis or acute leukemia. We concluded that it is desirable to include CD34 in the routine immunophenotyping panel.

Chronic neutrophilic leukemia / 대한내과학회지

No abstract available.

hematoimmunologic findings in AIDS patients

No abstract available.

Diagnostic Availability of the Soluble Transferrin Receptor in RA Patients / 대한임상병리학회지

BACKGROUND: The transferrin receptor (TfR) is expressed on almost all cellular surfaces and is shedded into the blood to form the soluble transferrin receptor (sTfR). The sTfR has been known to be a good marker to reflect cellular iron status and to differentiate between iron deficiency anemia (IDA) and anemia of chronic disease (ACD) without the need for a bone marrow aspiration in rheumatoid arthritis (RA) patients. So we aimed to evaluate the diagnostic availability of sTfR in patients with RA and degenerative joint disease (DJD). METHODS: Eighty-seven outpatients visiting the Department of Rheumatology at HYUH were studied and divided into anemic and non-anemic groups according to their Hb levels (female< 12 g/dL, male< 14 g/dL). The sTfR was measured by ELISA method (Quantikine IVDTM, R&D system). To differentiate whether the anemia was due to iron deficiency or other causes, we used the RBC parameters and a discriminant index which was calculated from serum iron, ferritin and TIBC instead of a bone marrow aspiration, an invasive procedure of which interpretation can be subjective. RESULTS: The median was higher (31.09 nM) than the normal reference values (9-28 nM) only in the anemic group of RA. The medians were within normal limit in all the other groups. sTfR levels were high in 15 of the 28 RA anemic patients which were composed of 10 patients with IDA, 4 with non-anemic RA and 1 with non-anemic RA & DJD. CONCLUSIONS: In the present study, sTfR was increased not only in IDA but also in ACD of RA patients and also in non-anemic patients, which showed that sTfR cannot be used to differentiate these two types of anemia by itself and the further tests are needed. We conclude that the expression of TfR in RA patients was dependent not only on iron deficiency but also on the disease itself.

28-year old Polycythemia Vera patient presenting with Cerebral Infarction / 대한내과학회지

No abstract available.

Study of the Characteristics of Coagulase in Staphylococcus aureus for Establishment of an in-vitro Model for Disseminated Intravascular Coagulation / 대한임상병리학회지

BACKGROUND: Disseminated intravascular coagulation (DIC) is a clinicopathologic syndrome for widespread intravascular coagulation. DIC occurs when the processes that regulate coagulation break down. Staphylococcal infection is one of the causes of DIC. Staphylococcus aureus produces coagulase that can clot plasma. There are two different tests to detect the coagulase; a tube test for free coagulase and a slide test for bound coagulase or clumping factor. The goal of the present study is to evaluate the characteristics of coagulase in Staphylococcus aureus for establishment of an in-vitro model for DIC. METHODS: Coagulase tests were performed by mixing plasma with two-fold diluted culture broths, culture supernatant and culture filtrates. Coagulase activity was expressed as the reciprocal of the highest dilution titer. Cell pellets treated with normal saline, ethyl alcohol, and aceton were used for the clumping tests. Platelet aggregation tests were conducted using a culture broth and a concentrated culture supernatant. A fibrinogen binding protein was isolated from sonificated bacteria and thus, determined the molecular weight. RESULTS: Coagulase activity was higher in the broth culture than in the culture supernatant and culture filtrate. Coagulase activity decreased after incubation at 37degrees C for 24 hours but culture filtrates were clumped after boiling at 100degrees C for 10 minutes. Alcohol and aceton did not inhibit the clumping test. S. aureus induced platelet aggregation but a concentrated culture filtrate did not induce platelet aggregation. Molecular weight of fibrinogen binding protein was 57 kDa. CONCLUSIONS: It is suggested that the plasma clot was due to free coagulase or a clumping factor. Free coagulase is different from a clumping factor. We concluded that the pathogenesis of DIC in the staphylococcal infection was due to platelet aggregation triggered by a clumping factor or coagulase with other substances.

Immunological monitoring on HIV infected persons by periodic lymphocyte measurement in Korea

No abstract available.