Assuntos
Hiperplasia do Linfonodo Gigante/diagnóstico , Biomarcadores , Biópsia , Contagem de Células Sanguíneas , Hiperplasia do Linfonodo Gigante/etiologia , Hiperplasia do Linfonodo Gigante/terapia , Análise Mutacional de DNA , Feminino , Humanos , Imuno-Histoquímica , Linfonodos/patologia , Pessoa de Meia-Idade , Mutação , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios XAssuntos
Proteínas de Fusão bcr-abl/genética , Janus Quinase 2/genética , Mutação , Transtornos Mieloproliferativos/enzimologia , Transtornos Mieloproliferativos/genética , Idoso , Idoso de 80 Anos ou mais , Células Clonais , Feminino , Proteínas de Fusão bcr-abl/metabolismo , Humanos , Janus Quinase 2/metabolismo , Masculino , Pessoa de Meia-IdadeAssuntos
Eritroblastos/metabolismo , Leucemia Mieloide Aguda/genética , Síndromes Mielodisplásicas/genética , Proteínas de Neoplasias/genética , Segunda Neoplasia Primária/genética , Fosfoproteínas/genética , Fatores de Processamento de RNA/genética , Proteína Supressora de Tumor p53/genética , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Medula Óssea/metabolismo , Medula Óssea/patologia , Estudos de Coortes , Eritroblastos/patologia , Feminino , Perfilação da Expressão Gênica , Regulação da Expressão Gênica , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Ferro/metabolismo , Leucemia Mieloide Aguda/metabolismo , Leucemia Mieloide Aguda/mortalidade , Leucemia Mieloide Aguda/patologia , Masculino , Pessoa de Meia-Idade , Mutação , Síndromes Mielodisplásicas/metabolismo , Síndromes Mielodisplásicas/mortalidade , Síndromes Mielodisplásicas/patologia , Proteínas de Neoplasias/metabolismo , Segunda Neoplasia Primária/metabolismo , Segunda Neoplasia Primária/mortalidade , Segunda Neoplasia Primária/patologia , Fosfoproteínas/metabolismo , Fatores de Processamento de RNA/metabolismo , Análise de Sobrevida , Proteína Supressora de Tumor p53/metabolismoRESUMO
We report the case of a previously healthy 49-year-old woman who presented with upper gastrointestinal bleeding, which was found at laparotomy to be due to high-grade B cell gastric lymphoma. CT scans showed that this was partially adherent to the spleen, with erosion of the gastric wall and suggested impending perforation. Given the risk of perforation, further surgical intervention (gastrectomy and splenectomy) was considered; however, after multidisciplinary team discussion, we chose to offer chemotherapy and careful inpatient observation instead.Our patient made a full recovery with no perforation.The message from our experience and literature review is that medical management may lead to a more favourable outcome in gastric lymphoma than surgery, despite radiological appearances suggesting impending perforation. This approach avoids the risk of the lymphoma progressing at other anatomical sites secondary to delays in giving chemotherapy. If this approach is followed, the patient must be carefully monitored.
Assuntos
Linfoma de Células B , Linfoma não Hodgkin , Neoplasias Gástricas , Feminino , Gastrectomia , Humanos , Pessoa de Meia-Idade , Neoplasias Gástricas/complicações , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/cirurgiaRESUMO
A 35-year-old woman presented with a widespread petechial rash and pancytopenia. She underwent simultaneous pancreas and kidney transplantation for type 1 diabetes 8 years previously followed by a renal transplant 1 year prior to presentation, and was taking tacrolimus as long-term immunosuppression. The full blood count showed haemoglobin 97 g/L, platelet count 2×109/L and neutrophil count 0.22×109/L. Peripheral blood film examination confirmed genuine thrombocytopenia in the absence of any haemolytic or malignant features. Serological testing identified autoantibodies against all three blood lineages, consistent with a diagnosis of autoimmune pancytopenia. Treatment with steroids, intravenous immunoglobulins, romiplostim and mycophenolate mofetil achieved only fleeting remissions. Blood counts eventually normalised following the administration of rituximab and a change from tacrolimus to ciclosporin immunosuppression. Cytopenias are a well-recognised complication of post-transplantation care but we believe this to be the first reported case of autoimmune pancytopenia following solid organ transplantation. In this case report, we discuss the approach to investigation of haematological abnormalities post-transplant and the rationale for, and outcome of, the management of this rare case.
Assuntos
Doenças Autoimunes , Transplante de Rim , Transplante de Pâncreas , Pancitopenia/imunologia , Complicações Pós-Operatórias/imunologia , Adulto , Doenças Autoimunes/diagnóstico , Doenças Autoimunes/terapia , Feminino , Humanos , Pancitopenia/diagnóstico , Pancitopenia/terapia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/terapia , Fatores de TempoRESUMO
OBJECTIVES: Preoperative anaemia is associated with increased morbidity and mortality. We sought to determine the relative frequencies of the different causes of anaemia including absolute and functional iron deficiency, and the association of different haematological parameters, including plasma hepcidin, a key protein responsible for iron regulation, with outcomes after cardiac surgery. METHODS: Prospective observational study between January 2012 and 2013; 200 anaemic cardiac surgical patients were recruited and 165 were studied. Detailed blood and bone marrow analysis was performed. Primary outcome was days alive and out of hospital. RESULTS: Mean (SD) haemoglobin (Hb) was 102 (8) g/L for women and 112 (11) g/L for men. Regarding outcomes, 137 (83%) patients were transfused at least one unit of red blood cells; 30-day mortality was 1.8% (three patients). Functional iron deficiency was diagnosed in 78 patients (47%). Plasma hepcidin concentration was the only haematological variable associated with outcome, with mean days alive and out of hospital 2.7 (95% CI 0.4 to 5.1) days less if hepcidin ≥20â ng/mL compared with <20â ng/mL (p=0.024). Multivariable analysis showed that the association between hepcidin and outcome was independent of risk (European System for Cardiac Operative Risk Evaluation), transfusion and Hb. CONCLUSIONS: Functional iron deficiency was the most common cause of anaemia but was not associated with outcome. The only haematological parameter that was associated with outcome was hepcidin concentration, which is a novel finding and introduces further complexity into our understanding of the role of iron and its regulation by hepcidin. We propose that future research should target patients with elevated hepcidin.
Assuntos
Anemia , Procedimentos Cirúrgicos Cardíacos , Cardiopatias/cirurgia , Hepcidinas , Ferro , Complicações Pós-Operatórias , Idoso , Anemia/sangue , Anemia/epidemiologia , Anemia/etiologia , Anemia/terapia , Transfusão de Sangue/métodos , Exame de Medula Óssea , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/métodos , Procedimentos Cirúrgicos Cardíacos/mortalidade , Estudos de Coortes , Feminino , Hemoglobinas/análise , Hepcidinas/análise , Hepcidinas/sangue , Humanos , Ferro/metabolismo , Deficiências de Ferro , Masculino , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Cuidados Pré-Operatórios/métodos , Fatores de Risco , Estatística como Assunto , Reino Unido/epidemiologiaRESUMO
OBJECTIVES: The differential diagnosis between iron deficiency anaemia (IDA) and anaemia of chronic disease (ACD) with or without associated iron deficiency can be challenging. We assessed the use of different parameters, both classical like ferritin, transferrin saturation and stainable bone marrow iron stores, and novel markers such as low haemoglobin density (LHD) and hepcidin to help discriminate between the three entities. This would allow the detection of patients with ACD with associated iron deficiency, which could benefit from iron supplementation that would have otherwise remained undetected. MATERIALS AND METHODS: Prospective and observational cohort study from 2012 to 2013 where 200 anaemic cardiac surgical patients were recruited and 165 were studied. Detailed blood and bone marrow analyses were performed to establish the aetiology of anaemia. RESULTS: Seventy-four patients (44.8%) had ACD and 29 (39%) of these had an elevated LHD indicating concomitant iron deficiency. Hepcidin was inappropriately normal or increased in the IDA and ACD group. Mean hepcidin was however lower in the group with IDA (4.8 ng/mL) than in the ACD group (15.0 ng/mL; p=0.002). Median hepcidin was lower in patients with ACD and iron restriction as indicated by LHD >4% (17.5 ng/mL) than on those with no iron restriction (25.9 ng/mL; p=0.045). In patients with ACD there was no concordance between Perl's stain and LHD. CONCLUSIONS: LHD was superior to hepcidin and bone marrow iron stores in identifying patients with ACD and associated iron deficiency, which would potentially benefit from parenteral iron therapy.
Assuntos
Anemia/diagnóstico , Biomarcadores/análise , Idoso , Algoritmos , Anemia/etiologia , Medula Óssea/patologia , Procedimentos Cirúrgicos Cardíacos , Estudos de Coortes , Diagnóstico Diferencial , Feminino , Cardiopatias/sangue , Cardiopatias/complicações , Hemoglobinas/análise , Humanos , Masculino , Estudos Prospectivos , Coloração e Rotulagem , Transferrina/análiseRESUMO
Renin-angiotensin system (RAS) in the bone marrow is related to proliferation and cellular differentiation. We investigated the effect of ACE inhibitors (ACEI) captopril (>1mM) and trandolapril (>0.05 mM) and losartan (0.2 mM) on K562 cell line and K562 transfected with c-myc, bcl-x and bcl-2 (KmycB, Kbclx and Kbcl2 respectively). RAS components, proliferation, apoptosis and c-myc expression were analyzed. ACEI and losartan inhibited cell growth, decreased c-myc expression and increased apoptosis. These effects seem to be associated to angiotensin II-induced Smad activation. This work offers a new possible line of treatment for some acute myeloid leukemias and a new area of clinical research.