RESUMO
La fase leucémica como presentación de un linfoma folicular es rara y debe ser considerada factor de mal pronóstico. Por otra parte, la asociación entre linfoma folicular y síndrome mielodisplásico no se ha descrito. Se presenta el caso de una paciente en la que se detectó marcada leucocitosis y a la que se diagnosticó un linfoma folicular. Recibió quimioterapia con R-CHOP y FCR cuando recayó. Meses después, se realizó un aspirado medular en el cual se observaron cambios compatibles con mielodisplasia, únicamente recibió terapia de soporte y finalmente evolucionó a leucemia mieloide aguda. Aunque se conoce que la mielodisplasia puede ser secundaria al uso de quimioterapia, la paciente presentó además trisomía del cromosoma 11, descrita previamente en mielodisplasia y linfoma tipo Burkitt, la cual pudiera estar en relación con la evolución a leucemia mieloide aguda(AU)
Follicular lymphoma rarely presents with a leukemic phase and this should be considered a negative prognostic factor. Also, follicular lymphoma and myelodysplastic syndrome association has not been previously reported. Herein we present a patient who debuted with marked hyperleukocytosis and was diagnosed with follicular lymphoma, receiving CHOP-R and FCR after she relapsed. Several months later, secondary myelodysplastic changes were observed in her bone marrow. She received supportive therapy and finally progressed into acute myeloid leukemia. Although secondary myelodysplasia is known to be produced by chemotherapy, this patient additionally had trisomy 11, previously described in myelodysplasia and Burkitt's lymphoma, which could be linked to progression to acute myeloid leukemia(AU)
Assuntos
Humanos , Feminino , Adulto , Trissomia , Leucemia/mortalidade , Linfoma Folicular/complicações , Leucocitose/complicações , Linfoma Folicular/tratamento farmacológicoRESUMO
La fase leucémica como presentación de un linfoma folicular es rara y debe ser considerada factor de mal pronóstico. Por otra parte, la asociación entre linfoma folicular y síndrome mielodisplásico no se ha descrito. Se presenta el caso de una paciente en la que se detectó marcada leucocitosis y a la que se diagnosticó un linfoma folicular. Recibió quimioterapia con R-CHOP y FCR cuando recayó. Meses después, se realizó un aspirado medular en el cual se observaron cambios compatibles con mielodisplasia, únicamente recibió terapia de soporte y finalmente evolucionó a leucemia mieloide aguda. Aunque se conoce que la mielodisplasia puede ser secundaria al uso de quimioterapia, la paciente presentó además trisomía del cromosoma 11, descrita previamente en mielodisplasia y linfoma tipo Burkitt, la cual pudiera estar en relación con la evolución a leucemia mieloide aguda(AU)
Follicular lymphoma rarely presents with a leukemic phase and this should be considered a negative prognostic factor. Also, follicular lymphoma and myelodysplastic syndrome association has not been previously reported. Herein we present a patient who debuted with marked hyperleukocytosis and was diagnosed with follicular lymphoma, receiving CHOP-R and FCR after she relapsed. Several months later, secondary myelodysplastic changes were observed in her bone marrow. She received supportive therapy and finally progressed into acute myeloid leukemia. Although secondary myelodysplasia is known to be produced by chemotherapy, this patient additionally had trisomy 11, previously described in myelodysplasia and Burkitt's lymphoma, which could be linked to progression to acute myeloid leukemia(AU)
Assuntos
Humanos , Feminino , Adulto , Leucemia/mortalidade , Linfoma Folicular/complicações , Leucocitose/complicações , Linfoma FolicularRESUMO
Las tasas de supervivencia del cáncer infantil han mejorado considerablemente en las últimas décadas. Sin embargo, las emergencias relacionadas con la propia enfermedad o complicaciones derivadas del tratamiento implican un alto grado de morbimortalidad. El personal de salud de un servicio de emergencia debe identificar y tratar en forma temprana estas situaciones clínicas que ponen en riesgo la vida del paciente. Revisaremos aquellas urgencias oncológicas que reconocidas y tratadas de inmediato mejoran drásticamente el pronóstico del paciente.
Survival rates for child cancer have significantly improved in the last decades. However, emergencies in connection with the disease itself or complications arising from the treatment imply a high morbimortality. The health staff at an emergency service needs to identify and treat as early as posible these clinical situations that result in the patient’s risk of life.
Assuntos
Humanos , Pediatria , Medicina de Emergência , Oncologia , Neoplasias/complicações , Traumatismos da Medula Espinal , Síndrome da Veia Cava Superior , Síndrome de Lise Tumoral , Hipertensão Intracraniana , Neutropenia Febril , LeucocitoseRESUMO
ANTECEDENTES: La Leucemia Linfoblástica Aguda (LLA) es el tipo de cáncer más común en los niños, que afec-ta la sangre y la médula ósea como consecuencia de la proliferación clonal anormal de un grupo celular y que, a diferencia de lo que se cree, no siempre debuta con leucocitosis (Glóbulos Blancos> 10.000).MÉTODOS: Estudio de tipo descriptivo en el cual fueron evaluados los hemogramas de un total de 110 pacien-tes con LLA, de 1 a 18 años de edad, tratados en la So-ciedad de Lucha Contra el Cáncer (SOLCA) Cuenca, entre enero de 2009 y abril de 2014. Se analizó sus ca-racterísticas demográficas (edad, sexo, procedencia) así como su número de glóbulos blancos (GB), hemog-lobina (Hb), plaquetas, niveles de deshidrogenasa lác-tica (DHL), grupo de riesgo, presencia de cromosoma Philadelphia e inmunofenotipo (T o B).RESULTADOS: El 53% de los pacientes fueron niños. La edad promedio fue de 7.9 años. La mayor parte de ni-ños atendidos pertenecieron a la provincia del Azuay. El 50% de los pacientes presentaron leucocitosis al momento del diagnóstico, el 42% Hb menor de 8g/dL y el 80% plaquetas menores a 150 000/L. La totalidad de los niños (100%) tuvieron una DHL por encima del valor nor-mal (234 U/L). El rango de GB estuvo entre 600 y 556 000 GB/L siendo el promedio de 48 000 GB/L. El 95% presen-tó un inmunofenotipo B y el 5% de los pacientes fueron positivos para cromosoma Philadelphia. CONCLUSIONES: Tras el análisis se concluyó que la mi-tad de los pacientes no presentaron leucocitosis. La mayor parte presentó trombocitopenia y anemia. Esta información debe ser considerada al momento de re-visar un hemograma de un niño, ya que como se ha demostrado y a diferencia de lo que se pensaba, la leucocitosis no siempre está presente en la leucemia.
BACKGROUND: The acute lymphoblastic leukemia (ALL) is the most common type of childhood cancer that affects the blood and bone marrow as a result of ab-normal clonal proliferation of a cell group, and contrary to what is popularly believed, it not always debuts with leukocytosis (white blood cells> 10,000).METHODS: it is a descriptive study in which they were evaluated the blood counts from a total of 110 pa-tients with ALL, from 1 to 18 years, treated at the Society for Fight against Cancer (SOLCA) Cuenca, between January 2009 and April 2014. Their demographic cha-racteristics (age, sex, origin) and its number of white blood cells (WBCs), hemoglobin (Hb), platelet, levels of lactate dehydrogenase (LDH), risk group, presence of Philadelphia chromosome and immunophenotype (T or B) were analyzed.RESULTS: The 53% of the patients were children. The ave-rage age was 7.9 years. Most served children belonged to the Azuay province. The 50% of patients had leuko-cytosis at the moment of diagnosis, the 42% Hb less than 8g / dL and 80% lower than 150 000 platelets / L. All children (100%) had a LDH above the normal value (234 U / L). The range was between 600 and 556000 GB/ L with an average of 48 000 GB / L. The 95% presented an im-munophenotype B and 5% of patients were positive for Philadelphia chromosome.CONCLUSIONS: After the analysis it was concluded that half of the patients had leukocytosis. Most presented thrombocytopenia and anemia. This information should be considered when reviewing a child's blood count, because as has been shown and unlike what was thou-ght, leukocytosis is not always present in leukemia.
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Contagem de Células Sanguíneas , Leucemia , Diagnóstico , Trombocitopenia , Anemia , NeoplasiasRESUMO
The diagnosis and treatment of respiratory failure is a part of the anaesthesist's daily practice, as well as the hypoxaemia that is one of its physiological and analytical consequences. Patients with an extreme leucocytosis secondary to leukaemia can suffer an incorrect diagnosis of hypoxemia, called "pseudohypoxaemia". This is basically due to the rapid in vitro oxygen consumption, and is characterized by a low partial pressure of oxygen in arterial blood (PaO2) despite a normal oxygen saturation (SpO2) measured by pulse oximetry. Pseudohypoxaemia appears in patients with thrombocytosis or hyper-leucocytosis occurring during blastic crisis of a leukaemia. It must be suspected in patients with a discrepancy between the SpO2 measured by oximetry and the PaO2. In this context, pulse oximetry is the most accurate way to establish the diagnosis and to avoid unnecessary actions. We report the case of a patient with chronic myeloid leukaemia and extreme leucocytosis requiring emergency surgery, and diagnosed with pseudohypoxaemia during the perioperative period that led to a delay in the extubation of the patient.
