Relationships between platelet counts, platelet volumes and reticulated platelets in patients with ITP: evidence for significant platelet count inaccuracies with conventional instrument methods.

The platelet count has a primary role in the diagnosis and treatment of idiopathic thrombocytopenic purpura (ITP). This study analysed the accuracy of ITP patient platelet counts determined by Abbott CD-Sapphire (impedance/optical) and Bayer Advia 120 (optical) analyses, compared with a reference immunoplatelet method. Instrument platelet estimates showed broad equivalence in the higher range of observed values, but significant discrepancies against the immunoplatelet count were seen when platelet counts were <10 x 10(9)/l. CD-Sapphire mean platelet volume (MPV) results revealed increased (>12 fl) platelet volumes in eight of eight ITP patients with counts of <20 x 10(9)/l compared with 6/6 and 5/13 patients with platelet counts of 20-50 and >50 x 10(9)/l. In contrast, Bayer Advia MPV values showed no relationship with the platelet count. Increased reticulated platelets were associated with an increasing CD-Sapphire MPV (R(2) = 0.61) and a decreasing platelet count. High (>40%) reticulated platelet values were seen in 9/9 patients with immunoplatelet counts of <20 x 10(9)/l compared with 0/19 patients with platelet counts above 20 x 10(9)/l. There may be a need for caution in the interpretation of platelet counts in ITP patients obtained with conventional instrument methods, and therapeutic decisions should ideally be validated by reference immunoplatelet procedures.

Double diagnostic meaning of serum transferrin receptor in hemodialysis patients: two case reports.

Hemodialysis patients on maintenance erythropoietin need an adequate supply of iron to optimize therapy and achieve and maintain target levels of hemoglobin. Evaluation of iron stores and early detection of iron deficiency are essential for management of erythropoiesis in chronic renal failure, but there is still no single biochemical or hematological parameter that is sensitive or specific enough to completely describe the distribution of iron in the body. Serum transferrin receptor (sTfR) is a marker of iron that is available for erythropoiesis. We selected 2 clinical cases in which hemodialysis patients were receiving maintenance erythropoietin. To suggest how sTfR can be used in its double diagnostic meaning according to the clinical context of the patient, sTfR was evaluated in one case as a marker of iron deficiency and in the other as a marker of erythropoiesis. The association of sTfR with hematological parameters of iron-deficient erythropoiesis (reticulocyte hemoglobin content, percentage of hypochromic erythrocytes, ratio of reticulocyte hemoglobin content to hemoglobin content) and parameters of stimulated erythropoiesis (absolute reticulocyte count, immature reticulocyte fraction) increases the accuracy of sTfR in its double diagnostic power.

Urinary NMP22 for the detection of recurrence after transurethral resection of transitional cell carcinoma of the bladder: experience on 137 patients.

OBJECTIVES: To evaluate the nuclear matrix protein 22 (NMP22) test in the management of patients after transurethral resection (TUR) of recurrent transitional cell carcinoma of the bladder. METHODS: The NMP22 test was performed in 137 patients: in 42 patients, a bladder recurrence was detected by cystoscopy and histologically confirmed; 95 patients were recurrence-free at cytology and cystoscopy performed at least 3 months after TUR. RESULTS: In patients with tumoral recurrence, the mean NMP22 value was 54.8 U/mL. The false-negative rate was 28.5%. In recurrence-free patients, the mean NMP22 value was 22.8 U/mL. The specificity of the NMP22 test was 61%. Higher NMP22 mean values (29.6 versus 15.8 U/mL) were found in patients who underwent intravesical chemotherapy or immunotherapy. CONCLUSIONS: Despite its good sensitivity, the NMP22 test cannot be adopted as a routine tool in the surveillance after TUR of patients with superficial bladder cancer because of its low specificity.

Amikacin-induced liver toxicity: correlations between biochemical indexes and ultrastructural features in an experimental model.

In previous studies, aminoglycosides (AG) as gentamicin (G), dibekacin (D), tobramycin (T), netilmicin (N) and Sysomicin (S) were proved to induce ultrastructural alterations in the liver of experimental animals. The aim of this studies is to investigate the effect of amikacin (AK) on rabbit liver which is commonly used in infections resistant to other AG; this was done studying both the common blood parameters and ultrastructural changes. The study was accomplished in 24 New-Zealand rabbits, twelve received 20 mg/kg AK every 12 hours for 2 weeks. Thereafter the animals were anesthesized and liver slices were obtained for transmission electron microscopy. As results obvious signs of primary and secondary microcholestasis associated to mitochondrial cristae detachment and phospholipid aggregations were noted; this last finding was less marked when compared to previous studies employing other AG. In the AK treated group, blood tests showed a significant increased in only Blood Urea Nitrogen (BUN) and an insignificant rise in AST levels. Our findings are consistent with an AK induced liver toxicity albeit less evident with respect to the other AG.

[Ultrastructural study of the liver in rabbits treated with diclofenac]. / Studio ultrastrutturale epatico in conigli trattati con diclofenac.

The existence of alterations of common indexes of hepatic function, and the case-reports of acute hepatitis after the use of diclofenac sodium are the rationale for this experimental study, in which 8 rabbits were given 15 mg/kg day of diclofenac, to check ultrastructural modifications with respect to a control group. The analysis showed the typical signs of primary and secondary microcholestasis, indicating the existence of liver distress. This finding, from a clinical standpoint, suggests caution in the administration of this drug, chiefly in the hepatopathic patients.