Enzymatic Immunohistochemistry.

Immunohistochemistry (IHC) is a powerful laboratory technique that is widely used in a variety of settings, including clinical medicine and research. Enzymatic immunohistochemistry refers to the process of detecting cell surface proteins or antigens using enzyme-labeled antibodies. The site and specificity of the antibody binding may be identified using direct labeling techniques or through secondary labeling methods. The antibody-antigen interaction is ultimately visualized using a chromogenic detection process, in which the enzyme conjugated to the antibody cleaves a substrate to produce a stable, colored precipitate.

Nasopharyngeal amyloidoma with osteolytic lesions leading to diagnosis of systemic light-chain amyloidosis.

Amyloidomas of the head and neck region are uncommon and generally considered a benign localized form of amyloidosis. Here, we describe "the unusual case of a young man" with a nasopharyngeal mass and osteolytic lesions caused by systemic light-chain amyloidosis treated successfully with a combined surgical and chemotherapy approach.

Chronic Lymphocytic Leukemia with Translocation (2;14)(p16;q32): A Case Report and Review of the Literature.

We report the case of a young African American male with no significant past medical history presenting with low back and bilateral leg pain; presenting CBC and chemistries revealed elevated white blood cell count of 250,000, with anemia (Hb 6.8 g/dL) and thrombocytopenia (platelets 9 K/µL), and elevated LDH, 1008. Physical examination findings were notable for diffuse lymphadenopathy and lower extremity skin nodules. Interestingly the bone marrow biopsy revealed involvement by CLL/SLL with translocation (2;14)(p16;q32) and trisomy 12. The patient was treated with fludarabine-based chemotherapy and steroids for CLL-related ITP with excellent response. After three cycles of chemotherapy, all the enlarged lymph nodes and skin nodules disappeared, and patient had achieved complete hematologic response. In this paper we also reviewed the available literature of CLL patients with translocation (2;14).

Intravenous immunoglobulin-related hemolysis in patients treated for Kawasaki disease.

BACKGROUND: Kawasaki disease (KD) is an idiopathic, multisystem disorder characterized by vasculitis of arteries, veins, and capillaries, affecting pediatric patients, and is the leading cause of acquired heart disease in childhood. The mainstays of therapy for KD are high-dose intravenous immunoglobulin (IVIG) and aspirin, which are thought to prevent or modify the most serious cardiac sequelae. A well-documented complication of high-dose IVIG infusion in adults is hemolytic anemia due to passive transfer of anti-A and anti-B. Risk factors for hemolysis in another case series included patient blood group (group A, B, or AB), a high cumulative dose of IVIG, and concomitant inflammation documented by one or more markers like ferritin, fibrinogen, erythrocyte sedimentation rate, or C-reactive protein. STUDY DESIGN AND METHODS: A 3-year retrospective case review of patients previously recognized with apparent IVIG-related hemolytic anemia identified by standard blood bank testing was performed at a tertiary care pediatric hospital. RESULTS: Five patients were identified with severe anemia each requiring RBC transfusion for anemia. All five patients demonstrated a positive direct antiglobulin testing. Four of five patients had anti-A, anti-B, and/or anti-A1 with elution assays. All patients had signs of extravascular hemolysis with reticulocytosis, spherocytosis, and other hemolysis markers. One child died. CONCLUSION: Our cases represent dose-dependent hemolysis caused by IVIG in association with severe anemia requiring transfusion with an average yearly incidence rate of 0.36%. Hemolysis is an underrecognized complication of IVIG administration. KD patients are at greater risk for anemia because of their lower baseline hemoglobin concentration, underlying acute inflammation, and oxygen requirements during acute illness.