ISRN Hematology最新文献

18-Fluorodeoxyglucose (FDG-PET/CT) is an established imaging modality that has been proven to be of benefit in the management of aggressive B-cell non-Hodgkin's lymphoma, such as diffuse large B-cell lymphoma and advanced stage follicular lymphoma. The combination of anatomic and functional imaging afforded by FDG-PET/CT has led to superior sensitivity and specificity in the primary staging, restaging, and assessment of response to treatment of hematological malignancies when compared to FDG-PET and CT alone. The use of FDG-PET/CT for posttreatment surveillance imaging remains controversial, and further study is needed to ascertain whether this modality is cost effective and appropriate for use in this setting.

Heart failure is a very common disease, with severe morbidity and mortality, and a frequent reason of hospitalization. Anemia and a concurrent renal impairment are two major risk factors contributing to the severity of the outcome and consist of the cardio renal anemia syndrome. Anemia in heart failure is complex and multifactorial. Hemodilution, absolute or functional iron deficiency, activation of the inflammatory cascade, and impaired erythropoietin production and activity are some pathophysiological mechanisms involved in anemia of the heart failure. Furthermore other concomitant causes of anemia, such as myelodysplastic syndrome and chemotherapy, may worsen the outcome. Based on the pathophysiology of cardiac anemia, there are several therapeutic options that may improve hemoglobin levels, tissues' oxygenation, and probably the outcome. These include administration of iron, erythropoiesis-stimulating agents, and blood transfusions but still the evidence provided for their use remains limited.

We looked into the statistical association of prothrombin time (PT) and activated partial thromboplastin time (APTT) with disseminated intravascular coagulation (DIC) score calculated using the International society for thrombosis and haemostasis (ISTH) scoring system. The PT, APTT, PT + APTT, and PT/APTT ratios were evaluated against the DIC score by linear regression analysis in fifty inpatients with suspected DIC. The PT, PT + APTT, and PT/APTT ratios were all found to be statistically significant in predicting DIC scores with P values of 0.02, 0.03, and 0.02, respectively. The APTT alone was not found to be statistically significant in predicting DIC score and had a P value of 0.09. This scoring system does not need d-dimer levels and the platelet count.

Background. Continuous veno-venous hemofiltration (CVVH) has aroused great concern in recent years because its effect on clearing inflammatory mediators and its mechanism of clinical effects in the treatment of critical illness has also become a research direction. Objective. To evaluate the efficacy of continuous blood purification for systemic inflammatory response syndrome (SIRS)/multiple organ dysfunction syndrome (MODS) patients. Methods. A systematic review of the literature was undertaken to assess randomized controlled trials on CVVH. Results. 11 RCTs involving a total of 414 patients were included. Compared with the control group, CVVH for SIRS/MODS patients has several advantages including better effects on clearing the plasma inflammatory mediators IL-6 [SMD(3d) = -0.45, 95%CI, (-0.83, -0.07), SMD(7d) = -1.07, 95%CI, (-1.52, -0.62)], on plasma TNF-alfa [SMD(3d) = -0.87, 95%CI, (-1.69, -0.04), SMD(7d) = -1.42, 95%CI, (-2.49, -0.35)], lower white blood cell (WBC) count [MD = 2.61, 95%CI, (1.49, 3.73)], shorter hospital stays [MD = -7.21 days, 95%CI, (-10.68, -3.74)] and better stability of hemodynamics. However, there is no significant difference in the mortality rate [MODS:RR = 0.62, 95%CI, (0.38, 1.01), SIRS:RR = 0.75, 95%CI, (0.57, 1.08)]. Conclusions. The study showed that CVVH was able to eliminate inflammatory mediators (TNF-alfa, IL-6) in plasma effectively, lower WBC count and shorter hospital stays than conventional therapeutic measures.

Background. This study was aimed at comparing angiogenesis, seen as microvessel density (MVD) in subtypes of non-Hodgkin's lymphoma (NHL). Methods. In this study, 64 cases of NHL diagnosed over a three-year period were included along with 15 lymph node biopsies of reactive hyperplasia. NHLs were classified using REAL classification, and immunohistochemistry was performed for CD34 in all cases. CD34-stained sections were evaluated for "hot spots," where MVD was assessed and expressed as per mm(2). Appropriate statistical methods were applied. Results. There were 6 cases of well-differentiated lymphocytic lymphoma (SLL), 21 diffuse large B-cell lymphoma (DLBCL), 15 follicular lymphoma, 10 lymphoblastic lymphoma, 7 MALToma, and 5 peripheral T-cell lymphoma (PTCL). Mean MVD was highest in reactive hyperplasia (191.92 ± 12.16 per mm(2)) compared to all NHLs. Among NHLs, PTCL demonstrated the highest MVD (183.42 ± 8.24) followed by DLBCL (149.91 ± 13.68). A significant difference was found in MVD between reactive and individual lymphoma groups. SLL had significantly lower MVD than other lymphoma subtypes. Conclusion. Angiogenesis, assessed by MVD, showed significant differences among subtypes of NHL, especially the indolent types like SLL. The higher MVD in aggressive lymphomas like PTCL and DLBCL can potentially be utilized in targeted therapy with antiangiogenic drugs.

Neutrophil function is thought to be regulated, in large part, by limitation of lifespan by apoptosis. A number of studies suggest that circulating neutrophils have a half-life of approximately 6 hours, although contradictory evidence exists. Measuring tissue neutrophil lifespan, however, is more problematic. It is thought that tissue neutrophils survive longer, perhaps with a half-life in the order of 3-5 days, but this has never been directly measured. Zebrafish are an emerging model organism, with several advantages for the study of vertebrate immunity. In zebrafish, neutrophils constitutively assume tissue locations allowing their direct study in vivo. Using a transgenic approach, neutrophils were labelled with a photoconvertible pigment, Kaede. Photoconversion parameters were optimised and the stability of the Kaede confirmed. Individual neutrophils were photoconverted by scanning a confocal 405 nm laser specifically over each cell and their survival monitored for 48 hours, revealing an in vivo half-life for zebrafish tissue neutrophils of around 120 hours (117.7 hrs, 95% CI 95.67-157.8). Laser energy did not extend neutrophil lifespan, and we conclude that this represents a lower bound for the lifespan of a resting tissue neutrophil in the developing zebrafish larva. This is the first direct measurement of the lifespan of an in vivo tissue neutrophil.

Thalassemia and other structural haemoglobinopathies are the major erythrocyte formation disorder prevalent in certain parts of the world including Bangladesh. We investigated 600 cases of anaemic patients referred from various parts of the country for diagnosis and counselling during 3 months (April to June 2011) of time. The most common form of haemoglobin (Hb) formation disorder observed in 600 subjects studied was β-thalassemia minor (21.3%). Two other conditions, such as E-β-Thalassemia and HbE trait, were also fairly common (13.5 and 12.1%, resp.) in the total subjects studied. Other forms of haemoglobin formation disorders observed were HbE disease (9.2%), Hb D/S trait (0.7%), β-thalassemia major (0.5%), and δ-β-thalassemia (0.5%). The majority of the haemoglobinopathies belonged to neonatal to childhood period (0-15 years), followed by reproductive age group (16-45 years). Few old-age (46+ years) cases were also detected in course of clinical complications.

Pulmonary hypertension is an emerging complication of sickle cell anaemia with associated increased risk of mortality. In order to evaluate the clinical and electrocardiographic findings in adult sickle-cell patients with pulmonary hypertension, a cross sectional study was conducted on sixty two sickle cell anaemia patients and sixty two age and sex matched normal controls. Elevated pulmonary artery pressures (PAP), defined by PAP ≥ 30 mm Hg on echocardiography, was demonstrated in 41.9% of patients with sickle cell anaemia and in 3.2% of the controls; χ(2) = 26.571, P < 0.001. Right ventricular hypertrophy, increased P-wave duration, QTc interval, and QTc dispersion were significantly associated with pulmonary hypertension. Significant correlation was found between mean PAP and (1) Frequency of crisis (Spearman correlation = 0.320; P = 0.011), (2) body mass index (Pearson's correlation = -0.297; P = 0.019), and (3) QTc interval (Pearson's correlation 0.261; P = 0.040). Pulmonary hypertension in adult sickle anaemia patients is associated with electrocardiographic evidence of right ventricular hypertrophy, and correlates significantly with frequency of vaso-occlusive crisis, and QTc interval. The observations by this study tend to suggest that these parameters could be useful for early detection and prevention of pulmonary hypertension in patients with sickle cell anaemia.

Venous thromboembolism (VTE) is categorised as deep venous thrombosis (DVT) and pulmonary embolism (PE). VTE is associated with high morbidity and causes a huge financial burden on patients, hospitals, and governments. Both acquired and hereditary risks factors contribute to VTE. To diagnose VTE, noninvasive cost-effective diagnostic algorithms including clinical probability assessment and D-dimer measurement may be employed followup by compression ultrasonography for suspected DVT patients and multidetector computed tomography angiography for suspected PE patients. There are pharmacological and mechanical interventions to manage and prevent VTE. The pharmacological approaches mainly target pathways in coagulation cascade nonspecifically: conventional anticoagulants or specifically: new generation of anticoagulants. Excess bleeding is one of the major risk factors for pharmacological interventions. Hence, nonpharmacological or mechanical approaches such as inferior vena cava filters, graduated compression stockings, and intermittent pneumatic compression devices in combination with pharmacological interventions or alone may be a good approach to manage VTE.

Cation exchange-high performance liquid chromatography (CE-HPLC) is increasingly being used as a first line of investigation for hemoglobinopathies and thalassemias. Together with a complete blood count, the CE-HPLC is effective in categorizing hemoglobinopathies as traits, homozygous disorders and compound heterozygous disorders. We carried out a one year study in Apollo Hospitals, Chennai (Tamil Nadu, South India) during which 543 abnormal chromatogram patterns were seen. The commonest disorder we encountered was β-thalassemia trait (37.9%), followed by HbE trait (23.2%), homozygous HbE disease (18.9%), HbS trait (5.3%), HbE β-thalassemia (4.6%), HbS β-thalassemia (2.5%), β-thalassemia major (2.3%), HbH (1.6%), homozygous HbS (1.4%), HbD trait (0.7%). The average value of HbA2 in β-thalassemia minor was 5.4%. β-thalassemia major had an average HbF of 88% and in HbH the mean A2 was 1.4%. Among the HbE disorders the HbA2 + HbE was 30.1% in the heterozygous state, 90.8% in the homozygous state and 54.8% in HbE β-thalassemia. In the sickle cell disorders, HbS varied from 30.9% in the trait to 79.9% in the homozygous state to 65.6% in HbS β-thalassemia.