Immune complexes and persistent high levels of serum vitamin B12.

INTRODUCTION: Patients with persistent high levels of serum vitamin B12 were often referred to Hematology departments. In this study, characteristic of patients with serum vitamin B12 levels higher than 2500 pmol/L (high B12) were studied. METHODS: Prevalence of high B12 was evaluated during a 10-month period. Samples with high B12 were incubated with polyethylene glycol (PEG) and a new measurement of vitamin B12 was carried out using the supernatant. As a pilot study, 26 frozen samples with high B12 were evaluated for changes in vitamin B12 after PEG. Moreover, a prospective study was carried out during three consecutive months. Size exclusion chromatography was employed to demonstrate the presence of immune complexes (ICs) with plasma vitamin B12-binding proteins in some serum samples with high B12. RESULTS: Prevalence of high B12 was 1.3%. Results from 26 frozen samples and from a prospective study (28 cases) showed that undergoing vitamin B12 treatment was the main cause of high B12. However, ICs were detected in 10 frozen samples and in seven cases (25%) of the prospective study, respectively. Serum vitamin B12 decreased to normal values after precipitation with PEG, and size exclusion chromatography confirmed ICs. An association with autoimmune or hematological disorders was observed. CONCLUSIONS: In patients with repeatedly high B12 levels, ICs were detected in approximately 25% of samples. Precipitation with PEG is an easy method to confirm the presence of ICs and to evaluate serum vitamin B12 levels in these patients.

Role of serum holotranscobalamin (holoTC) in the diagnosis of patients with low serum cobalamin. Comparison with methylmalonic acid and homocysteine.

Plasma holotranscobalamin (holoTC) transports active cobalamin. Decreased levels of holoTC have been considered to be the earliest marker of cobalamin (Cbl) deficiency. In this work, holoTC was evaluated in low or borderline serum Cbl (LB12) and a concordance analysis was carried out with methylmalonic acid (MMA) and homocysteine (Hcy). Levels of Cbl, holoTC, MMA, and Hcy were investigated in a reference group in 106 patients with LB12 (≤200 pmol/l) and in 27 with folate deficiency (FOL). HoloTC levels were evaluated by an automated immunoassay (Active B12, Abbott Lab, Abbott Park, IL, USA). Lower levels of holoTC were observed in both LB12 and FOL groups (reference group vs LB12; p < 0.0001. Reference group vs FOL; p = 0.002). HoloTC levels were lower in LB12 than in FOL (p = 0.001). In LB12, concordance between Hcy and MMA was 82.1 % (chi-square test, p < 0.001; Kappa Index, 0.64, p < 0.0001). Concordance between Hcy and holoTC was 62 % (chi-square test, p = 0.006; Kappa index, 0.245, p = 0.006). Concordance between holoTC and MMA was 55.6 % (p = 0.233). Some cases with LB12 and elevated MMA did not show decreased holoTC. By contrast, MMA and Hcy were not increased in some patients with low holoTC and LB12. In conclusion, levels of holoTC were decreased in LB12 and FOL. In LB12 patients, holoTC concordance with MMA was poor. MMA/Hcy levels were not increased in a significant number of subjects with LB12 and low holoTC. This profile was found in iron deficiency. The significance of these changes remains to be clarified.

Combined cobalamin and iron deficiency anemia: a diagnostic approach using a model based on age and homocysteine assessment.

Macrocytosis, the hallmark of cobalamin/folate deficiency anemia, is frequently absent. Clinicians have to be aware of coexisting conditions that can mask the macrocytosis expression of megaloblastic anemia, especially iron deficiency. The objective of this work was to investigate the degree of overlap between iron deficiency anemia (IDA) and cobalamin deficiency and to develop a predictive model for differentiating IDA from combined deficiency. A prospective case and control study was carried out to investigate vitamin B12 and folate status in iron deficiency anemia. A total of 658 patients were recruited, 41 of whom (6.2 %) were excluded. The remaining 617 subjects consisted of 130 controls and 487 with IDA. Low vitamin B12 (LB12) was considered when serum vitamin B12 was ≤200 pmol/L. High serum homocysteine (Hcy) was defined by Hcy >17 µM/L. A multivariate analysis (including a logistic regression) was performed to develop a diagnostic model. Low vitamin B12 levels were found in 17.8 % of IDA subjects. Ten out of 11 subjects (91 %) with IDA and serum vitamin B12 (B12) ≤100 pmol/L showed vitamin B12 deficiency. Moreover, vitamin B12 deficiency was demonstrated in 48 % of cases with IDA and B12 between 101 and 150 pmol/L and in 40 % with IDA and B12 between 151 and 200 pmol/, respectively. As a result of multivariate logistic analysis, neutrophil counts and age predicted subjects with vitamin B12 ≤200 and Hcy >17 µmol/L, [Formula: see text]. Using the age of 60 as a cutoff, sensitivity was 91 % (39 out of the 43 patients with vitamin B12 deficiency and IDA were identified). In summary, low vitamin B12 was found in 18 % of patients with IDA. Vitamin B12 deficiency was demonstrated in many patients with LB12 and IDA. Age over 60 years was used to separate patients with combined deficiency (sensitivity 91 %). Therefore, for a diagnostic purpose, serum vitamin B12 should be evaluated in IDA patients over 60 years. This diagnostic model needs to be validated in a different population.

[Bilateral papilledema secondary to chronic lymphocytic leukaemia]. / Edema bilateral del nervio óptico por leucemia linfocítica crónica.

CASE REPORT: We present the case of a 65-year-old man who was seen in the casualty department complaining of bilateral visual loss. His past medical history was unremarkable except for chronic lymphocytic leukaemia diagnosed two years previously: he was no longer receiving treatment for this disorder. His visual acuity was 20/200 in the right eye and 20/63 in the left eye and he had a bilateral papilledema. Computed tomography and magnetic resonance imaging of the brain and orbit were performed and showed an infiltrative mass in the orbit with extension to the ethmoid bone and both optic nerves. Biopsy of the mass was compatible with chronic lymphocytic leukaemia. DISCUSSION: Leukaemic infiltration of the optic nerve and central nervous system is a rare complication of chronic lymphocytic leukaemia, although it is common in the acute forms of this disease. Optic nerve infiltration is the most important ophthalmologic manifestation of leukaemia because it threatens vision and it is treatable.

Edema bilateral del nervio óptico por leucemia linfocítica crónica / Bilateral papilledema secondary to chronic lymphocytic leukaemia

Caso clínico: Varón de 65 que consulta por pérdida de agudeza visual bilateral. Había sido diagnosticado de leucemia linfocítica crónica hacía 2 años y se encontraba sin tratamiento. Su agudeza visual era de 20/200 en el ojo derecho y 20/63 en el izquierdo y presentaba edema bilateral de papila. Se realizaron tomografía axial computerizada y resonancia magnética orbital y cerebral encontrándose una masa orbitaria con extensión al etmoides e infiltración de ambos nervios ópticos cuya biopsia reveló leucemia linfocítica crónica. Discusión: La infiltración leucémica del nervio óptico y del sistema nervioso central es extremadamente rara en la leucemia linfocítica crónica al contrario de lo que sucede en las formas agudas. La infiltración del nervio óptico es la manifestación oftalmológica leucémica que implica mayor trascendencia clínica y terapéutica por amenazar seriamente la función visual y ser tratable

Case report: We present the case of a 65-year-old man who was seen in the casualty department complaining of bilateral visual loss. His past medical history was unremarkable except for chronic lymphocytic leukaemia diagnosed two years previously: he was no longer receiving treatment for this disorder. His visual acuity was 20/200 in the right eye and 20/63 in the left eye and he had a bilateral papilledema. Computed tomography and magnetic resonance imaging of the brain and orbit were performed and showed an infiltrative mass in the orbit with extension to the ethmoid bone and both optic nerves. Biopsy of the mass was compatible with chronic lymphocytic leukaemia. Discussion: Leukaemic infiltration of the optic nerve and central nervous system is a rare complication of chronic lymphocytic leukaemia, although it is common in the acute forms of this disease. Optic nerve infiltration is the most important ophthalmologic manifestation of leukaemia because it threatens vision and it is treatable

[Amaurosis secondary to frontal traumatism]. / Amaurosis secundaria a traumatismo frontal.

CASE REPORT: We present the case of a patient diagnosed with amaurosis of the right eye secondary to a right frontal contusion. The energy of the impact was projected from the orbital ceiling to the minor wing of the sphenoid bone. This bone was fractured, thus reducing the optic canal diameter and damaging the optic nerve. DISCUSSION: In our case, we describe a mixed mechanism of injury, that is to say, a frontal contusion indirectly transmitted to the optic canal and a direct lesion of the optic nerve secondary to the movement of the minor wing of the sphenoid bone into the optic canal.

Amaurosis secundaria a traumatismo frontal / Amaurosis secondary to frontal traumatism

Se describe el caso de un pacienteque sufre amaurosis del ojo derecho secundaria atraumatismo contuso frontal derecho. La energía seproyectó por el techo de la órbita hacia el ala menordel esfenoides, cuya fractura redujo el diámetro delcanal óptico lesionando el nervio óptico.Discusión: El mecanismo de producción en el casoclínico que se presenta es mixto al tratarse de untraumatismo frontal cerrado que se ha transmitidoindirectamente hacia el canal óptico y una lesióndirecta del nervio óptico al desplazarse el ala menordel esfenoides en el interior del canal óptico

Case report: We present the case of a patient diagnosed ;;with amaurosis of the right eye secondary to ;;a right frontal contusion. The energy of the impact ;;was projected from the orbital ceiling to the minor ;;wing of the sphenoid bone. This bone was fractured, ;;thus reducing the optic canal diameter and ;;damaging the optic nerve. ;;Discussion: In our case, we describe a mixed ;;mechanism of injury, that is to say, a frontal contusion ;;indirectly transmitted to the optic canal and a ;;direct lesion of the optic nerve secondary to the ;;movement of the minor wing of the sphenoid bone ;;into the optic canal

Pyrolysis/gas chromatography/mass spectrometry monitoring of fungal-biotreated distillery wastewater using Trametes sp. I-62 (CECT 20197).

Distillery wastewaters generated by ethanol production from fermentation of sugar-cane molasses, named vinasses, lead to important ecological impact due to their high content of soluble organic matter and their intense dark-brown color. Taking advantage of the well-known ability of white-rot fungi to degrade an extensive variety of organic pollutants, the capacity of Trametes sp. I-62 (CECT 20197) to detoxify this type of effluents was evaluated. In this work, pyrolysis/gas chromatography/mass spectrometry was applied to the chemical characterization of several fractions of Cuban distillery wastewater as well as to monitoring the changes which occurred after fungal treatment with this white-rot basidiomycete. Maximum effluent decolorization values and chemical oxygen demand reduction attained after seven days of fungal treatment were 73.3 and 61.7%, respectively, when 20% (v/v) of distillery vinasses was added to the culture medium. Under these conditions a 35-fold increase in laccase production by Trametes sp. I-62 was measured, but no manganese peroxidase activity could be detected. The pyrolysis/gas chromatography/mass spectrometry results showed a decrease in a number of pyrolysis products after seven days of fungal treatment, mainly furan derivatives. The decrease in the relative areas of these compounds could be related to the vinasse color-removal associated with melanoidin degradation. All these results indicated the potential use ofTrametes sp. I-62 in the detoxification of recalcitrant distillery vinasses.

Biotreatment of tannin-rich beer-factory wastewater with white-rot basidiomycete Coriolopsis gallica monitored by pyrolysis/gas chromatography/mass spectrometry.

Some fractions of beer-factory wastewaters represent an important environmental concern owing to their high content of polyphenols and dark-brown color. The capacity of Coriolopsis gallica to preferentially degrade lignin has been successfully applied in our laboratory to the biotreatment and decolorization of paper-industry effluents. In this work, the ability of this white-rot fungus to degrade high-tannin-containing wastewaters is evaluated. Under all the conditions studied, effluent decolorization and chemical oxygen demand reduction achieved by C. gallica at day 12 of incubation were close to 50 and 65%, respectively. No adhesion of dark color to the fungal mycelium was observed suggesting that decolorization could be ascribed to C. gallica degradation systems. Mycelium dry-weight values showed that C. gallica is tolerant to relatively high tannin content present in the effluent samples. In the sample containing the highest effluent concentration (60% v/v), dry-weight values suggested an inhibition of fungal growth at day 6 of incubation and a further adaptation of the fungus to the stressing tannin effect at day 12 of fungal treatment. Pyrolysis/gas chromatography/mass spectrometry results showed a decrease of polyphenols pyrolysis products, mainly phenol and guaiacol, with the incubation time. All these results indicate the potential use of C. gallica in bioremediation of tannin-containing industrial wastewaters and in other applications where a reduction in polyphenols content is required.