Hematology Reports

4 pages, 608 KiB

Open AccessReview

Application of Innovative Hemocytometric Parameters and Algorithms for Improvement of Microcytic Anemia Discrimination

by Margreet Schoorl, Marianne Schoorl, Johannes van Pelt and Piet C. M. Bartels

Hematol. Rep. 2015, 7(2), 5843; https://doi.org/10.4081/hr.2015.5843 - 23 Jun 2015

Cited by 22 | Viewed by 746

Hemocytometric parameters like red blood cell (RBC) count, mean red blood cell volume (MCV), reticulocyte count, red blood cell distribution width (RDW-SD) and zinc protoporphyrin (ZPP) are frequently established for discrimination between iron-deficiency anemia and thalassemia in subjects with microcytic erythropoiesis. However, no [...] Read more.

Hemocytometric parameters like red blood cell (RBC) count, mean red blood cell volume (MCV), reticulocyte count, red blood cell distribution width (RDW-SD) and zinc protoporphyrin (ZPP) are frequently established for discrimination between iron-deficiency anemia and thalassemia in subjects with microcytic erythropoiesis. However, no single marker or combination of tests is optimal for discrimination between iron-deficiency anemia and thalassemia. This is the reason why many algorithms have been introduced. However, application of conventional algorithms, only resulted in appropriate classification of 30–40% of subjects. In this mini-review the efficacy of innovative hematological parameters for detection of alterations in RBCs has been considered. It refers to parameters concerning hemoglobinization of RBCs and reticulocytes and the percentages microcytic and hypochromic RBCs, for discrimination between subjects with iron-deficiency anemia (IDA) or thalassemia as well as a combination of both. A new discriminating tool including the above mentioned parameters was developed, based on two precondition steps and discriminating algorithms. The percentage microcytic RBCs is considered in the first pre-condition step. MCV, RDW-SD and RBC count are applied in the second precondition step. Subsequently, new algorithms, including conventional as well as innovative hematological parameters, were assessed for subgroups with microcytic erythropoiesis. The new algorithms for IDA discrimination yielded results for sensitivity of 79%, specificity of 97%, positive and negative predictive values of 74% and 98% respectively. The algorithms for beta-thalassemia discrimination revealed similar results (74%, 98%, 75% and 99% respectively). We advocate that innovative algorithms, including parameters reflecting hemoglobinization of RBCs and reticulocytes, are integrated in an easily accessible software program linked to the hematology equipment to improve the discrimination between IDA and thalassemia. Full article

4 pages, 607 KiB

Open AccessArticle

Prognostic Factors and Outcomes of Adult-Onset Hemophagocytic Lymphohistiocytosis: A Retrospective Analysis of 34 Cases

by Masafumi Oto, Kanako Yoshitsugu, Shima Uneda, Michiko Nagamine and Minoru Yoshida

Hematol. Rep. 2015, 7(2), 5841; https://doi.org/10.4081/hr.2015.5841 - 18 Jun 2015

Cited by 7 | Viewed by 526

Abstract

Adult-onset hemophagocytic lymphohistiocytosis (HLH) has features that are distinct from that of HLH in pediatric patients. The clinical records at the Japanese Red Cross Kumamoto Hospital were reviewed. We retrospectively analyzed 34 patients who fulfilled the diagnostic criteria of HLH-2004. The median age [...] Read more.

Adult-onset hemophagocytic lymphohistiocytosis (HLH) has features that are distinct from that of HLH in pediatric patients. The clinical records at the Japanese Red Cross Kumamoto Hospital were reviewed. We retrospectively analyzed 34 patients who fulfilled the diagnostic criteria of HLH-2004. The median age of patients was 60.0 (range 15–86). Underlying diseases were diagnosed in 17 patients. They consisted of malignant lymphoma (n = 3), other neoplastic disease (n = 3), viral infection (n = 4), collagen vascular disease (n = 3), Kikuchi’s disease (n = 3) and drug (n = 1). Underlying diseases were not diagnosed in 17 patients despite examination. The treatments were steroids (n = 18), dexamethasone + cyclosporine A (CSA) + etoposide (n = 4), multidrug chemotherapy (n = 2), steroids and CSA (n = 3). Eleven patients died during observation. In a multivariate analysis, the significant predictor for death was age at onset (hazard ratio, 1.22; 95%CI, 1.02–1.44; P = 0.027). Autopsy was performed in 4 cases, but the underlying disease remained unknown in 3 of those cases. Adult-onset HLH has high diversity and various outcomes. The mechanism of adult-onset HLH is not fully understood and further research is required. Full article

3 pages, 594 KiB

Open AccessCase Report

Chalazia Development in Multiple Myeloma: A New Complication Associated with Bortezomib Therapy

by Charles Yun, Nikhil Mukhi, Valerie Kremer, Roman Shinder, Vaibhav Verma and Olcay Batuman

Hematol. Rep. 2015, 7(2), 5729; https://doi.org/10.4081/hr.2015.5729 - 09 Jun 2015

Cited by 9 | Viewed by 421

Abstract

Multiple myeloma (MM) is a neoplasm of plasma cells within the bone marrow. A major impact on improving survival in MM has been the use of the boronic acid-derived proteasome inhibitor bortezomib, a first-in-class selective inhibitor of the 26S proteasome. Ocular side effects [...] Read more.

Multiple myeloma (MM) is a neoplasm of plasma cells within the bone marrow. A major impact on improving survival in MM has been the use of the boronic acid-derived proteasome inhibitor bortezomib, a first-in-class selective inhibitor of the 26S proteasome. Ocular side effects of bortezomib are rare. In this report, we present 2 patients with active MM in whom persistent chalazia became a therapy-interfering complication of treatment with bortezomib. Both patients had relapsed ISS III B kappa light chain myeloma, and they were responding to treatment with bortezomib until chalazia−which caused intolerable discomfort−started. In both patients discontinuation of bortezomib was necessary for chalazia to heal, and restarting of bortezomib was associated with relapse of chalazia. Full article

4 pages, 662 KiB

Open AccessCase Report

Differential Diagnosis of Isolated Myeloid Sarcoma: A Case Report and Review of the Literature

by Patrick A. Hagen, Charanjeet Singh, Melissa Hart and Anne H. Blaes

Hematol. Rep. 2015, 7(2), 5709; https://doi.org/10.4081/hr.2015.5709 - 09 Jun 2015

Cited by 19 | Viewed by 347

Abstract

Myeloid sarcoma (MS) is a rare disease entity identified as a variety of manifestations defined by the occurrence of extramedullary myeloid cell masses with or without bone marrow involvement. This case describes an unusual presentation of isolated MS in a 60-year-old otherwise healthy [...] Read more.

Myeloid sarcoma (MS) is a rare disease entity identified as a variety of manifestations defined by the occurrence of extramedullary myeloid cell masses with or without bone marrow involvement. This case describes an unusual presentation of isolated MS in a 60-year-old otherwise healthy male, who initially presented to his primary care physician with vague abdominal pain. After extensive workup including three omental biopsies, umbilical core biopsy, and inguinal lymph node biopsy, he was ultimately diagnosed with isolated MS with extensive extramedullary tumor burden. Despite advanced extramedullary disease, peripheral cell counts were normal and bilateral bone marrow biopsies unremarkable with normal cellular lineages, morphology, and cytogenetics. The patient underwent induction chemotherapy and is now greater than 100 days post myeloablative unrelated donor marrow transplantation with no evidence of disease recurrence and 100% donor status with full chimerism. This case demonstrates that making a prompt diagnosis with rapid initiation of treatment in myeloid sarcoma can be challenging due to its varied clinical presentation, cytomorphology, cytochemistry, and cytogenetic overlap with other lymphoid malignancies. Once a diagnosis of MS has been made, moving quickly to induction therapy is important. Several studies have shown that improved overall survival is attained when MS is treated as acute myeloid leukemia and increased survival is noted for patients undergoing bone marrow transplantation. Further prospective studies are needed to elucidate the many remaining questions in regards to the natural history, prognosis, and optimal treatment strategies for this deadly disease. Full article

3 pages, 760 KiB

Open AccessCase Report

Inflammatory Pseudotumor of the Spleen

by Georgia McMahon, Kirsty Rady and Henry Miles Prince

Hematol. Rep. 2015, 7(2), 5905; https://doi.org/10.4081/hr.2015.5905 - 08 Jun 2015

Cited by 6 | Viewed by 401

Abstract

Isolated splenic inflammatory pseudotumors (IPT) are extremely rare, typically benign, inflammatory lesions with varied clinical presentations that pose a diagnostic challenge to clinicians due to their similarity in appearance to neoplasms. We present the case of a young woman diagnosed with a splenic [...] Read more.

Isolated splenic inflammatory pseudotumors (IPT) are extremely rare, typically benign, inflammatory lesions with varied clinical presentations that pose a diagnostic challenge to clinicians due to their similarity in appearance to neoplasms. We present the case of a young woman diagnosed with a splenic IPT following investigation for persistent anemia, raised inflammatory markers, and polyclonal hyper-gammaglobulinemia, whose symptoms resolved completely following splenectomy. This case highlights the need to consider this diagnosis when evaluating patients with a splenic mass of unknown etiology. Full article

4 pages, 594 KiB

Open AccessArticle

Favorable Event Free-Survival of High-Dose Chemotherapy followed by Autologous Hematopoietic Stem Cell Transplantation for Higher Risk Diffuse Large B-Cell Lymphoma in First Complete Remission

by Hiroto Kaneko, Yasuhiko Tsutsumi, Takahiro Fujino, Saeko Kuwahara, Muneo Ohshiro, Toshiki Iwai, Junya Kuroda, Shouhei Yokota, Shigeo Horiike and Masafumi Taniwaki

Hematol. Rep. 2015, 7(2), 5812; https://doi.org/10.4081/hr.2015.5812 - 08 Jun 2015

Cited by 8 | Viewed by 474

Abstract

High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) has been applied to patients with diffuse large B-cell lymphoma (DLBCL); it is well established that ASCT shows significant survival benefits for chemosensitive relapse. However, half of relapsed patients are resistant to salvage chemotherapy, [...] Read more.

High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) has been applied to patients with diffuse large B-cell lymphoma (DLBCL); it is well established that ASCT shows significant survival benefits for chemosensitive relapse. However, half of relapsed patients are resistant to salvage chemotherapy, indicating that they are not suitable for ASCT. We retrospectively analyzed the clinical records of 47 patients with DLBCL classified as high or high-intermediate (higher) risk, according to the International Prognostic Index, who underwent upfront ASCT in first complete remission (CR1). Compared with 10 patients with similar characteristics who did not receive ASCT, event free survival at 5-year was significantly superior in ASCT group. Toxicity of ASCT was acceptable and therapy-related death was not observed. We therefore propose that upfront ASCT for higher risk DLBCL in CR1 might provide survival benefit, probably because the high-dose therapy removes minimally resided tumor. Full article

3 pages, 637 KiB

Open AccessCase Report

A Difficult Case of Hodgkin Lymphoma with Differential Diagnosis of Tuberculosis and Sarcoidosis

by Nilüfer Göknar, Erkan Çakır, Fatma Betül Çakır, Ozgur Kasapcopur, Gulcin Yegen, Ahmet Hakan Gedik and Faruk Oktem

Hematol. Rep. 2015, 7(2), 5644; https://doi.org/10.4081/hr.2015.5644 - 08 Jun 2015

Cited by 5 | Viewed by 320

Abstract

We report here the case of a 14-year-old boy with history of fever, weight loss, and mediastinal lymphadenopathy. The clinical symptoms and laboratory findings mimicking tuberculosis and sarcoidosis complicated the diagnostic process. He was diagnosed with Hodgkin’s lymphoma after several X-rays, computed tomography, [...] Read more.

We report here the case of a 14-year-old boy with history of fever, weight loss, and mediastinal lymphadenopathy. The clinical symptoms and laboratory findings mimicking tuberculosis and sarcoidosis complicated the diagnostic process. He was diagnosed with Hodgkin’s lymphoma after several X-rays, computed tomography, positron emission tomography-computed tomography, laboratory tests and three lymph node biopsy. Clinicians should be alerted on new lesions and symptoms in high risk patients and should repeat diagnostic tests and lymph node biopsies as indicated. Full article

4 pages, 733 KiB

Open AccessCase Report

Angioimmunoblastic T-Cell Lymphoma Presenting with an Acute Serologic Epstein-Barr Virus Profile

by Timothy Beer and Patrick Dorion

Hematol. Rep. 2015, 7(2), 5893; https://doi.org/10.4081/hr.2015.5893 - 03 Jun 2015

Cited by 8 | Viewed by 344

Abstract

Angioimmunoblastic T-cell lymphoma (AITL) is an aggressive peripheral T-cell lymphoma typically characterized by prominent lymphadenopathy and B-symptoms at the time of presentation, polyclonal hypergammaglobulinemia, autoimmune hemolysis and frequent but highly variable involvement of Epstein- Barr virus (EBV). Lymph node biopsy findings typically include [...] Read more.

Angioimmunoblastic T-cell lymphoma (AITL) is an aggressive peripheral T-cell lymphoma typically characterized by prominent lymphadenopathy and B-symptoms at the time of presentation, polyclonal hypergammaglobulinemia, autoimmune hemolysis and frequent but highly variable involvement of Epstein- Barr virus (EBV). Lymph node biopsy findings typically include effacement of nodal architecture, polymorphic infiltrate, atypical T-cells (usually CD4+/CD10+/PD1+) and prominent proliferations of high endothelial venules and follicular dendritic cells. However, this classic constellation of pathologic findings is often initially obscured by a prominence of EBV+ B-immunoblasts with or without associated peripherally circulating EBV DNA. Here we document the first reported case of an acute serologic EBV profile (VCA-IgM) in a patient with AITL, and we recommend that clinicians maintain a high index of suspicion for AITL in the appropriate clinical scenario, irrespective of Epstein-Barr related findings. Full article

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Hematol. Rep., Volume 7, Issue 2 (June 2015) – 8 articles

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