DOCSLIB.ORG

Monoclonal Gammopathy Without Hyperglobulinemia in 2 Dogs with Iga Secretory Neoplasms Davis M

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Monoclonal Gammopathy Without Hyperglobulinemia in 2 Dogs with Iga Secretory Neoplasms Davis M Veterinary Clinical Pathology ISSN 0275-6382 CASE REPORT Monoclonal gammopathy without hyperglobulinemia in 2 dogs with IgA secretory neoplasms Davis M. Seelig1, James A. Perry2, Anne C. Avery1, Paul R. Avery1 Departments of 1Microbiology, Immunology, and Pathology and 2Clinical Sciences, Veterinary Medical Center, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA Key Words Abstract: Two dogs, an 8.5-year-old intact male Golden Retriever and a 10- B-cell lymphoma, immunofixation, year-old spayed female English Springer Spaniel, each with varied clinical immunoglobulin quantification, multiple histories, were referred to the Colorado State University Veterinary Teaching myeloma, serum protein electrophoresis Hospital for evaluation of hypercalcemia and severe anemia, respectively. In each dog, serum total protein and globulin concentrations were within refer- Correspondence Dr. Davis M. Seelig, Department of ence intervals. Cytologic examination of bone marrow aspirates from both Microbiology, Immunology, and Pathology, dogs revealed moderate to marked numbers of atypical lymphoid cells with Veterinary Medical Center, College of plasma cell features. Using serum immunofixation and serum immunoglob- Veterinary Medicine and Biomedical Sciences, ulin (Ig) quantification, a monoclonal Ig protein was identified. In conjunc- Colorado State University, 1619 Campus tion with other clinicopathologic and molecular findings, IgA secretory Delivery, Fort Collins, CO 80523, USA neoplasms, B-cell lymphoma with plasmacytoid features and multiple mye- E-mail: [email protected] loma (MM), were diagnosed. To our knowledge, these cases represent the first descriptions of IgA-secreting neoplasms in dogs that lacked hyper- DOI:10.1111/j.1939-165X.2010.00262.x globulinemia. In cases of suspected B-cell lymphoma or MM in dogs, serum proteins should be fully evaluated for the presence of a monoclonal Ig even in dogs that lack characteristic hyperproteinemia or hyperglobulinemia. This evaluation will aid in the diagnosis of secretory B-cell lymphoma or MM leading to appropriate clinical and therapeutic case management. Case Presentations 805, Radiometer America, Copenhagen Denmark). Urine was submitted for urinalysis. CBC abnormalities included moderate thrombocy- Dog 1 topenia (73,000/mL, reference interval [RI] 200,000– An 8.5-year-old intact male Golden Retriever of 500,000/mL) with occasional platelet clumps and giant 27.5 kg was presented to the internal medicine service platelets seen on the blood smear, moderately increased at the Colorado State University Veterinary Teaching mean platelet volume (24.8 fL, RI 7.5–14.6 fL), and Hospital (CSU-VTH) for evaluation of anorexia, leth- mild metarubricytosis characterized by 1 nucleated argy, polyuria, polydipsia, hypercalcemia, and throm- RBC (nRBC)/100 WBC (reference value 0 nRBCs/100 bocytopenia. Detailed history revealed that the dog WBC). Platelet clumping may have affected validity of had become increasingly lethargic, polyuric, and poly- the platelet count, but the interpretation of moderate dipsic over the previous 2 weeks and anorectic 3 days thrombocytopenia was supported by smear review. Fur- before presentation. On presentation, the dog was thermore, identification of giant platelets and increased quiet and no abnormalities were detected on physical mean platelet volume suggested increased thrombopoie- examination. Blood collected in tubes containing sis.1 The most significant biochemical result was EDTA and in plain tubes was submitted to the CSU- severe hypercalcemia (18.3 mg/dL, RI 9.2–11.7 mg/dL), Clinical Pathology Department for a CBC (Bayer Advia which was confirmed by an ionized calcium concentra- 120 analyzer, Seimens Corporation, New York, NY, tion of 2.2 mmol/L (RI 1.2–1.5 mmol/L). Other abnor- USA), serum biochemical profile (Hitachi 911, Roche- malities included mild azotemia, characterized by Boehringer Mannheim, Indianapolis, IN, USA), and increased urea (47 mg/dL, RI 7–32 mg/dL) and creati- measurement of ionized calcium concentration (ABL nine (1.6 mg/dL, RI 0.4–1.5 mg/dL) concentrations, mild Vet Clin Pathol 39/4 (2010) 447–453 c 2010 American Society for Veterinary Clinical Pathology 447 IgA secretory neoplasms in 2 dogs Seelig et al Figure 1. (A) Bone marrow aspirate from an 8.5-year-old intact male Golden Retriever (case 1) with hypercalcemia. Note many atypical, large immature lymphocytes with plasmacytoid features. Modified Wright–Giemsa stain; bar = 25 mm. (B) Immunofixation electrophoresis of serum from the Golden Retriever. There is a single restricted band in the IgA (A) well. The less intense, but identically migrating, band in the IgG lane is interpreted as cross- reactivity between IgG antisera and the light chain of the IgA monoclonal protein, as the antisera in the IgG lane is directed against both heavy and light chains. This interpretation is supported by the Ig quantification data. The remaining IgM well is devoid of an appreciable band. WS, anti-whole serum; G, anti-canine IgG (heavy plus light chain); A, anti-canine IgA (heavy chain); M, anti-canine IgM (heavy chain). (C) PCR for antigen receptor rearrangement performed on blood and bone marrow from the Golden Retriever. A clonal Ig gene rearrangement in bone marrow and blood is shown. Lanes 1 and 4, positive control for DNA; lanes 2 and 5, Ig primers indicating the presence of a single discrete PCR product in blood and bone marrow, respectively, consistent with a monoclonal population of B-cells; lanes 3 and 6, T-cell receptor gamma primers, showing multiple different PCR products, consistent with a polyclonal population of T-cells. hypomagnesemia (1.8 mg/dL, RI 1.9–2.7 mg/dL), and presumptive diagnosis was B-cell lymphoma. Determi- mildly increased total CO2 concentration (28 mmol/L, nation of immunophenotype by flow cytometric anal- RI 16–25 mmol/L). Total protein (7.0 g/dL, RI 5.3–7.2 g/dL) ysis or PCR for antigen receptor rearrangement (PARR) and globulin (3.1 g/dL, RI 2.0–3.8 g/dL) concentrations was recommended. Fine-needle aspirates of the popli- were within reference intervals. Urinalysis performed teal lymph nodes were nondiagnostic, containing only on urine obtained by cystocentesis demonstrated iso- mature adipocytes and blood. Based on the plasma- sthenuria (specific gravity 1.008) with rare RBC, WBC, cytoid features of the atypical cells, multiple myeloma and granular casts. Proteinuria was not detected using (MM) was also a differential diagnosis, and survey a standard reagent strip (Multistix, Bayer Corp., Elk- skeletal radiographs and evaluation of serum for hart, IN, USA) or with sulfosalicylic acid precipitation. monoclonal gammopathy were also recommended. The dog was admitted to CSU-VTH and intra- Skeletal survey radiographs and flow cytometric venous 0.9% NaCl was administered overnight. The analysis were not performed, but consent was given following morning the ionized calcium concentration for PARR and evaluation of serum for a monoclonal was unchanged. Parathyroid hormone-related peptide gammopathy. Serum was submitted for immunoglob- (PTHrP) concentration in plasma sent to the Michigan ulin (Ig) quantification and immunofixation electro- State University Diagnostic Center was 0 pmol/L phoresis. Ig quantification (Kent Laboratories, (RI, 0–1.0 pmol/L). Bellingham, WA, USA) revealed a marked increase Cytologic evaluation of a bone marrow aspirate in IgA concentration (1035 mg/dL, RI 40–60 mg/dL) collected from the proximal aspect of the right femur concurrent with moderately decreased concentrations revealed highly cellular spicules with orderly matura- of IgG (414 mg/dL, RI 1000–2000 mg/dL) and IgM tion of erythroid and myeloid cells. In addition, atyp- (40 mg/dL, RI 100–200 mg/dL). Immunofixation elec- ical large mononuclear cells accounted for 43% of all trophoresis (HYDRASYS Agarose Gel Electrophoresis nucleated cells (Figure 1A). These cells exhibited large System, Sebia Inc., Norcross, GA, USA; anti-Ig anti- nuclei that were ovoid to round to irregularly shaped bodies, Bethyl Laboratories Inc., Montgomery, TX, with finely stippled chromatin and variable numbers USA) revealed a dense and discrete single band within of large nucleoli. The cells had scant to moderate the IgA lane, indicative of an IgA monoclonal protein amounts of deeply basophilic cytoplasm. Occasional (M-protein) (Figure 1B). The PARR assay was per- cells displayed prominent paranuclear clear zones, ec- formed at CSU on both blood and bone marrow in centrically located nuclei with condensed chromatin, order to increase the likelihood of detecting neoplastic or bi- and trinucleation, with marked anisokaryosis cells. Analysis revealed a clonal B-cell population in and anisocytosis. Based upon cytomorphologic fea- both blood and bone marrow (Figure 1C) even though tures, the neoplastic cells were tentatively identified abnormal lymphocytes were not detected in the CBC. as lymphocytes with plasmacytoid features and the Based upon these findings, the final diagnosis was 448 Vet Clin Pathol 39/4 (2010) 447–453 c 2010 American Society for Veterinary Clinical Pathology Seelig et al IgA secretory neoplasms in 2 dogs secretory IgA B-cell lymphoma, although MM was evaluation of a nasal adenocarcinoma diagnosed 3 considered a possibility. months previously by histopathologic evaluation, The dog was initially treated with intravenous epistaxis, and severe anemia. On presentation, the dexamethasone sodium phosphate (0.2 mg/kg), sub- dog was quiet and alert with normal body temperature
Load more

Recommended publications
  • Hemolytic Disease of the Newborn
    Intensive Care Nursery House Staff Manual Hemolytic Disease of the Newborn INTRODUCTION and DEFINITION: Hemolytic Disease of the Newborn (HDN), also known as erythroblastosis fetalis, isoimmunization, or blood group incompatibility, occurs when fetal red blood cells (RBCs), which possess an antigen that the mother lacks, cross the placenta into the maternal circulation, where they stimulate antibody production. The antibodies return to the fetal circulation and result in RBC destruction. DIFFERENTIAL DIAGNOSIS of hemolytic anemia in a newborn infant: -Isoimmunization -RBC enzyme disorders (e.g., G6PD, pyruvate kinase deficiency) -Hemoglobin synthesis disorders (e.g., alpha-thalassemias) -RBC membrane abnormalities (e.g., hereditary spherocytosis, elliptocytosis) -Hemangiomas (Kasabach Merritt syndrome) -Acquired conditions, such as sepsis, infections with TORCH or Parvovirus B19 (anemia due to RBC aplasia) and hemolysis secondary to drugs. ISOIMMUNIZATION A. Rh disease (Rh = Rhesus factor) (1) Genetics: Rh positive (+) denotes presence of D antigen. The number of antigenic sites on RBCs varies with genotype. Prevalence of genotype varies with the population. Rh negative (d/d) individuals comprise 15% of Caucasians, 5.5% of African Americans, and <1% of Asians. A sensitized Rh negative mother produces anti-Rh IgG antibodies that cross the placenta. Risk factors for antibody production include 2nd (or later) pregnancies*, maternal toxemia, paternal zygosity (D/D rather than D/d), feto-maternal compatibility in ABO system and antigen load. (2) Clinical presentation of HDN varies from mild jaundice and anemia to hydrops fetalis (with ascites, pleural and pericardial effusions). Because the placenta clears bilirubin, the chief risk to the fetus is anemia. Extramedullary hematopoiesis (due to anemia) results in hepatosplenomegaly.
    [Show full text]
  • Evaluation of Anemia Survey (NHANES III) Data- 9 10-28% of Patients Over 65 Years Are Anemic Mark Wurster, M.D., F.A.C.P
    Anemia - Definition • National Health and Nutrition Examination Evaluation of Anemia Survey (NHANES III) data- 9 10-28% of patients over 65 years are anemic Mark Wurster, M.D., F.A.C.P. 9 One third of these are due to iron, folate, B12 The Ohio State University deficiency alone or in combination 9 One third are due to renal disease, or other chronic inflammatory response 9 One third are due to various primary marrow disorders, malignancies or other disorders Anemia Anemia - Definition Classification Schemes • A simplified approach to anemia, • Most common hematologic disorder emphasizing information already included • Decrease from normal levels of Hgb, Hct, RBC: in the CBC: 9 FlFemales – MHb14/dlMean Hgb = 14 g/dl; -2SD = 12 g /dl • Mean Cellular Volume (MCV) 9 Males – Mean Hgb = 15.5 g/dl; -2SD = 13.5 g/dl • Red Cell Distribution Width (RDW) • Caveat – Anemia is a syndrome, not a disease. • Retic count An abnormal Hgb or Hct should ALWAYS be investigated if confirmed on repeat testing. 1 Anemia Anemia Classification Schemes Classification Schemes • Mean Cellular Volume (MCV) • Red blood cell Distribution Width (RDW) • Decreased MCV (microcytic); < 80 fL 9 A numerical expression of • Normal MCV (normocytic); 80 – 99 fL anisocytosis, or variation in RBC size • Increased MCV (macrocytic); > 100 fL Anemia Anemia Classification Schemes Classification Schemes • Red blood cell Distribution Width (RDW) 9 Normal RDW - representing a uniform population • Red blood cell Distribution Width (RDW) of RBCs with respect to size (actually the standard deviation of red blood cell volume divided by the mean volume) 9 Normal; < or = to app.
    [Show full text]
  • Anemia and the QT Interval in Hypertensive Patients
    2084 International Journal of Collaborative Research on Internal Medicine & Public Health Anemia and the QT interval in hypertensive patients Ioana Mozos 1*, Corina Serban 2, Rodica Mihaescu 3 1 Department of Functional Sciences, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania 2 Department of Functional Sciences, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania 3 1st Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania * Corresponding Author ; Email: [email protected] Abstract Introduction: A prolonged ECG QT interval duration and an increased QT dispersion (QTd) are predictors of sudden cardiac death. Anemia is known as a marker of adverse outcome in cardiovascular disease. Objective: The aim was to assess the relationship between anemia and QT intervals in hypertensive patients. Method: A total of 72 hypertensive patients underwent standard 12-lead ECG. QT intervals and QT dispersions were manually measured. Complete blood count was also assessed. Result: Linear regression analysis revealed significant associations between prolonged QTc and increased QTd and anemia and macrocytosis, respectively. Multiple regression analysis revealed a significant association between red cell distribution width (RDW) >15% and prolonged heart rate corrected maximal QT interval duration (QTc) and QT interval in lead DII (QTIIc). The most sensitive and specific predictor of prolonged QTc and QTIIc was anisocytosis. Anemia was the most sensitive predictor of
    [Show full text]
  • SEED Haematology Sysmex Educational Enhancement and Development October 2012
    SEED Haematology Sysmex Educational Enhancement and Development October 2012 The red blood cell indices The full blood count has been used in conjunction with the traditional red The complete blood count (CBC) is central to clinical deci- cell indices in order to narrow down the possible causes sion making. This makes it one of the commonest laboratory of anaemia in an individual patient. investigations performed worldwide. Whilst the definition of what constitutes an CBC is influenced by the number Impedance technology and type of parameters measured by different haematology The RBC, HCT and MCV are all closely interrelated as they analysers, the traditional red cell indices that are widely are derived from information obtained from the passage used to classify anaemias are common to all. of cells through the aperture of the impedance channel of an automated haematology analyser. The impedance The laboratory approach to anaemia technology is based on the principle that an electrical field, Anaemia is an extremely common global healthcare prob- created between two electrodes of opposite charge, can lem. However, anaemia is merely a symptom which can be used to count and determine the size of cells. Blood result from a multitude of causes. Effective treatment is cells are poor conductors of electricity. The diluent in which only possible if the underlying cause is correctly identified. they are suspended as they pass through the aperture To this end, several classification systems have been devis- during counting is an isotonic solution which is a good ed. The most useful and widely used classification system conductor of electricity.
    [Show full text]
  • Complete Blood Count in Primary Care
    Complete Blood Count in Primary Care bpac nz better medicine Editorial Team bpacnz Tony Fraser 10 George Street Professor Murray Tilyard PO Box 6032, Dunedin Clinical Advisory Group phone 03 477 5418 Dr Dave Colquhoun Michele Cray free fax 0800 bpac nz Dr Rosemary Ikram www.bpac.org.nz Dr Peter Jensen Dr Cam Kyle Dr Chris Leathart Dr Lynn McBain Associate Professor Jim Reid Dr David Reith Professor Murray Tilyard Programme Development Team Noni Allison Rachael Clarke Rebecca Didham Terry Ehau Peter Ellison Dr Malcolm Kendall-Smith Dr Anne Marie Tangney Dr Trevor Walker Dr Sharyn Willis Dave Woods Report Development Team Justine Broadley Todd Gillies Lana Johnson Web Gordon Smith Design Michael Crawford Management and Administration Kaye Baldwin Tony Fraser Kyla Letman Professor Murray Tilyard Distribution Zane Lindon Lyn Thomlinson Colleen Witchall All information is intended for use by competent health care professionals and should be utilised in conjunction with © May 2008 pertinent clinical data. Contents Key points/purpose 2 Introduction 2 Background ▪ Haematopoiesis - Cell development 3 ▪ Limitations of reference ranges for the CBC 4 ▪ Borderline abnormal results must be interpreted in clinical context 4 ▪ History and clinical examination 4 White Cells ▪ Neutrophils 5 ▪ Lymphocytes 9 ▪ Monocytes 11 ▪ Basophils 12 ▪ Eosinophils 12 ▪ Platelets 13 Haemoglobin and red cell indices ▪ Low haemoglobin 15 ▪ Microcytic anaemia 15 ▪ Normocytic anaemia 16 ▪ Macrocytic anaemia 17 ▪ High haemoglobin 17 ▪ Other red cell indices 18 Summary Table 19 Glossary 20 This resource is a consensus document, developed with haematology and general practice input. We would like to thank: Dr Liam Fernyhough, Haematologist, Canterbury Health Laboratories Dr Chris Leathart, GP, Christchurch Dr Edward Theakston, Haematologist, Diagnostic Medlab Ltd We would like to acknowledge their advice, expertise and valuable feedback on this document.
    [Show full text]
  • Red Blood Cell Morphology in Patients with Β-Thalassemia Minor
    J Lab Med 2017; 41(1): 49–52 Short Communication Carolin Körber, Albert Wölfler, Manfred Neubauer and Christoph Robier* Red blood cell morphology in patients with β-thalassemia minor DOI 10.1515/labmed-2016-0052 Keywords: β-thalassemia minor; erythrocytes; red blood Received July 11, 2016; accepted October 20, 2016; previously published cells; red blood cell morphology. online December 10, 2016 Abstract In β-thalassemias, the examination of a peripheral blood (PB) smear may provide relevant clues to initial diagnosis. Background: A systematic analysis of the occurrence of Complete laboratory investigation consists of the determina- red blood cell (RBC) abnormalities in β-thalassemia minor tion of the complete blood count, assessment of red blood has not been performed to date. This study aimed to iden- cell (RBC) morphology, high performance liquid chroma- tify and quantify the frequency of RBC abnormalities in tography (HPLC), hemoglobin electrophoresis and, where patients with β-thalassemia minor. necessary, DNA analysis [1]. Especially in the clinically Methods: We examined blood smears of 33 patients with severe forms referred to as β-thalassemia major and interme- β-thalassemia minor by light microscopy for the occur- dia, RBC abnormalities are often markedly apparent [2]. In rence of 15 defined RBC abnormalities. In the case of posi- β-thalassemia minor, also called β-thalassemia trait, the car- tivity, the abnormal cells/20 high power fields (HPF) at riers are usually clinically asymptomatic, showing persistent 1000-fold magnification were counted. microcytosis and hypochromia or mild microcytic anemia [1, Results: Anisocytosis, poikilocytosis and target cells 3]. The PB smear may show microcytosis, hypochromia and, (median 42/20 HPF) were observed in all, and ovalocytes infrequently, poikilocytosis [2].
    [Show full text]
  • 2012 CKD Guideline
    OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF NEPHROLOGY KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease VOLUME 3 | ISSUE 1 | JANUARY 2013 http://www.kidney-international.org KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease KDIGO gratefully acknowledges the following consortium of sponsors that make our initiatives possible: Abbott, Amgen, Bayer Schering Pharma, Belo Foundation, Bristol-Myers Squibb, Chugai Pharmaceutical, Coca-Cola Company, Dole Food Company, Fresenius Medical Care, Genzyme, Hoffmann-LaRoche, JC Penney, Kyowa Hakko Kirin, NATCO—The Organization for Transplant Professionals, NKF-Board of Directors, Novartis, Pharmacosmos, PUMC Pharmaceutical, Robert and Jane Cizik Foundation, Shire, Takeda Pharmaceutical, Transwestern Commercial Services, Vifor Pharma, and Wyeth. Sponsorship Statement: KDIGO is supported by a consortium of sponsors and no funding is accepted for the development of specific guidelines. http://www.kidney-international.org contents & 2013 KDIGO VOL 3 | ISSUE 1 | JANUARY (1) 2013 KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease v Tables and Figures vii KDIGO Board Members viii Reference Keys x CKD Nomenclature xi Conversion Factors & HbA1c Conversion xii Abbreviations and Acronyms 1 Notice 2 Foreword 3 Work Group Membership 4 Abstract 5 Summary of Recommendation Statements 15 Introduction: The case for updating and context 19 Chapter 1: Definition, and classification
    [Show full text]
  • Complete Blood Count
    Print Entire Test Page 1 of 6 Close Window email this page print this page Complete Blood Count Also known as: CBC, Hemogram, CBC with differential Related tests: Blood smear, Hemoglobin, Hematocrit, Red blood cell (RBC) count, White blood cell (WBC) count, White blood cell differential count, Platelet count At A Glance Why get tested? To determine general health status and to screen for a variety of disorders, such as anemia and infection When to get tested? As part of a routine medical exam or as determined by your doctor Sample required? A blood sample drawn from a vein in the arm or a fingerstick or heelstick (newborns) The Test Sample What is being tested? The Complete Blood Count (CBC) test is an automated count of the cells in the blood. It provides information about the white blood cell (WBC), red blood cell (RBC), and platelet populations present. This information includes the number, type, size, shape, and some of the physical characteristics of the cells. In only a minute or two, the hematology instrument (the machine that is used to run the test) can measure thousands of RBCs, WBCs, and platelets and compare them against established normal ranges. Any abnormalities found are noted, and the clinical laboratory scientist (CLS) running the instrument then uses his or her expertise and experience to accept the automated findings and/or to target the sample for further analysis. In most cases, the automated CBC is very accurate and the test is complete at this point. If, however, there are significant abnormalities in one or more of the cell populations, a blood smear test may be performed.
    [Show full text]
  • Red Blood Cell Distribution Width, Disease Severity, and Mortality in Hospitalized Patients with SARS-Cov-2 Infection: a Systematic Review and Meta-Analysis
    Journal of Clinical Medicine Article Red Blood Cell Distribution Width, Disease Severity, and Mortality in Hospitalized Patients with SARS-CoV-2 Infection: A Systematic Review and Meta-Analysis Angelo Zinellu 1 and Arduino A. Mangoni 2,* 1 Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy; [email protected] 2 Discipline of Clinical Pharmacology, College of Medicine and Public Health, Flinders University and Flinders Medical Centre, Adelaide, SA 5042, Australia * Correspondence: arduino.mangoni@flinders.edu.au; Tel.: +61-8-8204-7495; Fax: +61-8-8204-5114 Abstract: The identification of biomarkers predicting disease severity and outcomes is the focus of intense research in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 infection). Ideally, such biomarkers should be easily derivable from routine tests. We conducted a systematic review and meta-analysis of the predictive role of the red blood cell distribution width (RDW), a routine hematological test, in patients with SARS-CoV-2 infection. We searched the electronic databases PubMed, Web of Science and Scopus, from January 2020 to November 2020, for studies reporting data on the RDW and coronavirus disease 2019 (COVID-19) severity, defined as severe illness or admission to the intensive care unit (ICU), and mortality. Eleven studies in 4901 COVID-19 patients were selected for the meta-analysis. Pooled results showed that the RDW values were significantly higher in patients with severe disease and non-survivors (standard mean difference, SMD = 0.56, 95% CI 0.31 to 0.81, p < 0.001). Heterogeneity between studies was extreme 2 (I = 80.6%; p < 0.001).
    [Show full text]
  • Erythronoclastic) Anaemias of Later Infancy and Childhood: with Special Reference to the Acute Heemolytic Anemia of Lederer and the Anvemia of Von Jaksch
    Arch Dis Child: first published as 10.1136/adc.8.45.184 on 1 June 1933. Downloaded from Part V.-The hamolytic (erythronoclastic) anaemias of later infancy and childhood: with special reference to the acute heemolytic anemia of Lederer and the anvemia of von Jaksch BY LEONARD G. PARSONS, M.D., F.R.C.P., AND J. C. HAWKSLEY, M.D., M.R.C.P. The destructive diseases of the erythron which fall for consideration under this heading show many points of general similarity although individual variations are frequent. In Part IV emphasis has been laid upon the fact that the erythron may be affected adversely either in the bone marrow or in the circulation; further, that for this reason the term haemolytic anaemia was probably incorrect because it stressed the destruction of red blood cells, but that the title of erythronoclastic ansemia was more correct http://adc.bmj.com/ because it indicated that the erythron may be affected in the circulation or in the marrow or in both situations. Moreover, this is not the whole story, because not only may the erythron itself be affected in either the circulation, the marrow or both, but also the other elements of the blood, the thrombocyte system and the myeloid leucocyte system, may suffer damage. in child's of iron Again, the latter months of the lactation period the supply on September 27, 2021 by guest. Protected copyright. for haemoglobin-building is somewhat precarious; a disturbance of the erythron is therefore likely to render manifest any iron deficiency and thus a deficiency anaemia may develop in the course of a haemolytic ansemia.
    [Show full text]
  • 11. Hematology
    PBW11 2/6/03 1:49 PM Page 185 11. Hematology I. Introduction A. EMBRYOLOGY 1. Hematopoiesis begins in yolk sac during first month 2. At third month it begins in liver & spleen 3. Fourth month hematopoiesis begins in the bone marrow 4. At birth, liver & spleen hematopoiesis ØØ B. HEMATOPOIESIS 1. 3 stages: 1) proliferation of stem cells, 2) differentiation of blast cells, 3) maturation to final cell type 2. Common stem cell (preblast) expresses CD34 surface protein 3. CD34+ cells differentiate into 1) myeloid & 2) lymphoid blasts 4. Mutations in stem cell Æ myeloproliferative dz [see Section V] 5. Mutations in blast cell Æ acute leukemias [see Section VI] 6. Myelopoiesis a. Myeloblast differentiates Æ progenitors of 1) erythrocyte, 2) megakaryocyte, 3) mast cell, 4) monocyte & 5) granulocyte b. Granulocyte matures Æ neutrophil, eosinophil, basophil c. 90% of neutrophils die within marrow, last 6hr in circulation d. Monocyte circulates for 6–10hr, then matures in tissue e. Megakaryocytes become multinucleate due to endomitotic reduplication (nucleus multiplies without cell division), matured cells split off platelets, which circulate for 7 days f. Proerythrocyte nucleus shrinks & then is extruded, with Wright stain cytoplasm first Æ blue during RNA transcription, then Æ pink as hemoglobin is translated g. Mature RBCs circulate for 120 days 7. Lymphoid blast matures Æ B cells, T cells, natural killer cells (See Color Plate 14) C. DISORDERS 1. ≠ risk infection if absolute neutrophil count <1000/mm3 2. All blood cell disorders are of 3 general types a. Altered production: clonal proliferation or bone marrow failure b. Altered destruction: can be ≠ or Ø (Ø apoptosis Æ cancer) c.
    [Show full text]
  • Tuberculosis Induced Autoimmune Haemolytic Anaemia
     Rathish and Siribaddana Allergy Asthma Clin Immunol (2018) 14:11 Allergy, Asthma & Clinical Immunology https://doi.org/10.1186/s13223-018-0236-y REVIEW Open Access Tuberculosis induced autoimmune haemolytic anaemia: a systematic review to fnd out common clinical presentations, investigation fndings and the treatment options Devarajan Rathish1* and Sisira Siribaddana2 Abstract Background: Tuberculosis induced autoimmune haemolytic anaemia is a rare entity. The aim of this study was to explore its common presentations, investigation fndings and treatment options through a systematic review of pub- lished reports. Methods: PubMed, Trip, Google Scholar, Science Direct, Cochrane Library, Open-Grey, Grey literature report and the reference lists of the selected articles were searched for case reports in English on tuberculosis induced auto-immune haemolytic anaemia. PRISMA statement was used for systematic review. Quality assessment of the selected reports was done using the CARE guidelines. Results: Twenty-one articles out of 135 search results were included. Thirty-three percent of patients were reported from India. More than half had fever and pallor. The mean haemoglobin was 5.77 g/dl (SD 2.2). Positive direct coombs test was seen in all patients. Pulmonary tuberculosis (43%) was most prevalent. Twenty-nine percent of patients needed a combination of anti-tuberculosis medicines, blood transfusion and steroids. Higher percentage of dissemi- nated TB induced AIHA (67%) needed steroids in comparison to the other types of TB induced AIHA (13%). Conclusions: Rarer complications of tuberculosis such as auto-immune haemolytic anaemia should be looked for especially in disease-endemic areas. Blood transfusion and steroids are additional treatment options along with the anti-tuberculosis medicines.
    [Show full text]