The importance of neutrophil lymphocyte ratio in patients with psoriasis.

OBJECTIVE: The aim of this study is to assess the neutrophil lymphocyte ratio (NLR) as an inflammatory marker in patients with psoriasis and to compare it with healthy subjects and to evaluate the correlation with the severity of the disease. METHODS: 104 psoriasis patients and 70 healthy persons were included as the control group. The laboratory results were recorded retrospectively from the patients' files and controls. NLR was calculated by the division of the neutrophil count to the lymphocyte count in the hemogram test. The dermatology examinations and psoriatic area severity index (PASI) scoring were performed by the same dermatologist. RESULTS: Leukocyte, neutrophil, NLR levels of the psoriasis patients were significantly elevated compared to those of the control group (p<0.05, p<0.01 and p<0.01 respectively). There were no correlation between NLR and PASI score (p>0.05) in the patient group. CONCLUSIONS: NLR, an emerging marker of inflammation, is higher in patients with psoriasis. Therefore we have suggested that this marker can be used for following of the psoriasis patients.

Rectal Carcinoma Case Causing Bicytopenia.

Although conditions leading to bicytopenia and pancytopenia secondary to infiltrative diseases of the bone marrow are seen, a profound anemia or hemorrhages are frequently observed in such cases. As bone marrow infiltrations may be associated with primary hematological diseases such as leukemia, lymphoma or myeloma, rarely they may also be associated with solid tumor metastases. Here we have presented a case of rectal carcinoma causing profound bicytopenia dependent on diffuse bone marrow involvement.

Vanishing bile duct syndrome after allogeneic bone marrow transplantation: is it the end of the road?

In this paper, we report the case of a 19-year-old male patient who presented with lymphoblastic phase of chronic myeloid leukemia and received an allogeneic bone marrow transplant from his cousin. The patient experienced severe, steroid-refractory acute graft versus-host disease of skin, gastrointestinal tract and liver that required further immunosuppression. However, hepatic graft-versus-host disease was complicated with vanishing bile duct syndrome, characterized by progressive destruction of small intrahepatic bile ducts, which was refractory to all available therapies and eventually led to end-stage liver disease. The pathogenesis and treatment of graft-versus-host disease after allogeneic hematopoietic cell transplantation is discussed with an emphasis on liver transplantation for intractable hepatic graft-versus-host disease.

Intramesenteric steroid treatment for steroid- refractory gastrointestinal graft versus host disease.

UNLABELLED: Currently, steroid-refractory severe gastrointestinal (GI) graft versus host disease (GVHD) is among the most important complications of allogeneic transplantation, and as yet there is no standard approach to its treatment. Herein we report two cases with steroid-refractory GI GVHD that received intramesenteric steroid treatment. In both cases the frequency and volume of diarrhea resolved completely following intramesenteric methylprednisolone (MP) injection. In conclusion, intra-arterial steroid injection might be an alternative treatment approach for steroid-refractory GI GVHD. CONFLICT OF INTEREST: None declared.

Hemodialysis shortens long in vitro closure times as measured by the PFA-100.

BACKGROUND: Hemorrhagic complications are commonly encountered in patients with end-stage renal disease (ESRD). Uremic patients show a bleeding diathesis mainly due to abnormalities in platelet function. There are several tests to detect and measure impairment of hemostasis in these patients, but none appear to be ideal. In recent years, the PFA-100 (platelet function analyzer) was introduced to measure primary, platelet-dependent hemostasis. In this study, the effect of hemodialysis on platelet function was evaluated using the PFA-100 in patients with ESRD. MATERIAL/METHODS: The study was performed on 45 patients with ESRD undergoing regular hemodialysis aged between 20-76 years (median: 54 years). Collagen/epinephrine (CEPI) and collagen/ADP (CADP) closure times were measured before and after the hemodialysis session using the PFA. RESULTS: CEPI (normal range: 85-165 sec) was significantly shortened from 230+/-60 to 206+/-63 sec after hemodialysis (p<0.05). The CADP (normal range: 71-118 sec) was also shortened by hemodialysis from 177+/-69 to 169+/-71 sec (p>0.05). CEPI closure times of 10 (26%) in 38 patients with long CT returned to normal after hemodialysis. CADP closure times of 9 (25%) of 36 patients with long CT returned to normal after hemodialysis. CONCLUSIONS: This study confirms the existence of a dysfunction of primary hemostasis in patients with ESRD, and hemodialysis has the ability to correct some part of the hemostatic disturbances. As a sensitive, specific, reproducible, easy to perform, and noninvasive test for platelet-related primary hemostasis, the PFA-100 system may become a useful tool for an overall evaluation of primary hemostasis in patients with ESRD.

Double dose plateletpheresis by continuous and intermittent flow devices increases platelet-neutrophil complex formation in healthy donors without noticeable neutrophil activation.

Several reports have demonstrated that during a single plateletpheresis procedure, platelets may form heterotypic aggregates which may predispose certain donors to thrombotic complications. In this study, changes in the expression of neutrophil adhesion molecules (CD11b/CD18, CD50/54, CD62L) and platelet-neutrophil complex (PNC) formation were investigated by a flow cytometric method in healthy donors following a double dose plateletpheresis (DDP) procedure. Our results show that DDP which are carried out by the Fresenius AS.TEC 204 and Haemonetics MCS+ cause a significant increase in PNC formation in donors. Additionally, the Fresenius AS.TEC 204 device caused a decrease in CD62L expression which is a sign of mild neutrophil activation. Although the clinical significance of these laboratory changes is not clear, the occurrence of neutrophil activation and increased PNC formation might predispose certain donors to thrombotic complications following DDP.

rHuG-CSF increases the platelet-neutrophil complex formation and neutrophil adhesion molecule expression in volunteer granulocyte and stem cell apheresis donors.

Several reports have shown that granulocyte colony-stimulating factor (G-CSF) administration induces a transient, mild hypercoagulable state, which might predispose certain donors to thrombotic complications. In the present study, changes in the expression of neutrophil adhesion molecules (CD11b/CD18, CD62L) and platelet-neutrophil complex formation following rHuG-CSF administration were investigated in normal granulocyte and stem cell donors. For granulocyte apheresis (N = 10), rHuG-CSF (5 microg/kg) was given subcutaneously every 12 h three times and apheresis was carried out two hours after the last dose. For stem cell apheresis (N = 8), rHuG-CSF (10 microg/kg/day) was given subcutaneously for 5 days and apheresis was carried out when peripheral CD34+ cell counts exceeded 20 cell/microL. Expression of neutrophil adhesion molecules (CD11b/CD18, CD62L) and platelet-neutrophil complex formation following rHuG-CSF administration were investigated in donors by a flow cytometric method. A significant increase in neutrophil counts (P < 0.001), and decreases in platelet counts (P < 0.01) and hemoglobin levels (P < 0.01) occurred following G-CSF administration. The expression of CD11b/CD18 significantly increased (P < 0.001) over pretreatment values with G-CSF administration and returned to baseline 1 week after stopping the drug. In contrast, CD62L expression was decreased (P < 0.01) with G-CSF and returned to normal after cessation of the drug. rHuG-CSF caused more than a two-fold increase (from 0.3 to 7.0 x 10(9)/L) in circulating platelet-neutrophil complexes (P < 0.01), which returned to normal after 1 week. Although clinical significance of these laboratory changes is not clear, the occurrence of neutrophil activation and increased platelet-neutrophil complex formation might predispose certain donors or patients to thrombotic complications following G-CSF administration.