Diseases, Diagnosis and Treatment (The Hematological System Book 12)

The Hematologist
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In the past decade, H. Hepcidin is a hormone of hepatic origin that regulates iron absorption at the enterocyte level in the small intestine and the liberation of stored iron from the macrophages of reticuloendothelial system [ 80 ]. Hepcidin is elevated, as an acute phase reactant, in response to inflammation in the gastric mucosa. This in turn translates into a physiological iron deficiency, known clinically as anemia of chronic inflammation [ 81 - 85 ].

Preliminary studies show that serum hepcidina levels are elevated in patients infected with H. Other possible causes of iron imbalance in patients infected with H. This condition can generate bleeding when transforms into erosive gastritis [ 89 ], especially in patients with bleeding duodenal or gastric peptic ulcers [ 90 , 91 ] and in patients who chronically consume non-steroidal anti-inflammatory drugs NSAIDs , including aspirin, for the purpose of cardioprotection [ 92 - 95 ]. Other mechanisms invoked to explain iron deficiency in patients infected with H.

Beyond the aforementioned evidence, certain highly virulent strains of H. This situation could explain, in part, the marked differences from one region to another and the large discrepancies observed in different studies. Regarding to the management of iron deficiency in the post- Helicobacter era, it is important to clarify that H. These situations are particular to each region, according to prevalence of iron deficiency and H.

Thanks to over referenced studies in the literature aiming to clarify different aspects of the association between H. These analyses have enabled the scientific community, particularly the consensus and management guides, to incorporate iron deficiency of unexplained origin as an indication to evaluate and eradicate H. Before initiating treatment for a patient with iron deficiency, an assessment of the prevalence of H.

Generally, the prevalence is low in developed countries; these cases should proceed with conventional management of iron deficiency [ 32 , 35 ]. In developing countries, the rate of H. If the patient is negative for H. After 6—8 weeks of treatment, the infection eradication must be confirmed using a non-invasive test, ideally with 13 C-urea breath test [ 27 ]. If eradication is not achieved, it is mandatory to establish a new therapy scheme until eradication is achieved. Once H. If there is no response, it must establish a conventional management of iron deficiency [ 32 , 35 ].

http://bbmpay.veritrans.co.id/arroyomolinos-de-len-speed-dating-opiniones.php Figure 1 shows a diagnostic and management algorithm of iron deficiency in the post- Helicobacter era, taking into account the prevalence of infection and H. Algorithm for the study and management of iron deficiency, with or without anemia, in the post-Helicobacter era. Generally, it is high in developing countries and low in developed countries [1]. Vitamin B 12 , also known as cobalamin, is a coenzyme necessary for the metabolism of amino acids, such as methionine, threonine, and valine, and for DNA synthesis through the conversion of methyl-tetrahydrofolate to tetrahydrofolate [ 99 ].

Vitamin B 12 is synthesized in mammals, but for humans, their provision depends exclusively of diet intake of animal products [ 99 ]. Again, as with iron deficiency, it should be noted that vitamin B 12 deficiency is a chronic process, with very slow establishment. It may manifest clinically through neuropsychiatric symptoms or through hemogram parameters, such as morphological alterations of erythrocytes or anemia, according to the WHO criteria [ 32 ].

Four stages of vitamin B 12 deficiency are clearly established: Stage I, reduction of vitamin B 12 levels in blood; Stage II, low amount of vitamin B 12 cellular levels and metabolic disorders; Stage III, increase in homocysteine and methylmalonic acid levels and decrease in DNA synthesis with onset of neuropsychiatric symptoms; and Stage IV, macrocytic anemia [ ]. Vitamin B 12 deficiency is defined in terms of the serum values of vitamin B 12 and two components of its metabolic pathway, homocysteine and methylmalonic acid [ ].

The prevalence of vitamin B 12 deficiency is highly variable and represents a serious public health problem, depending on the populations analyzed. The prevalence of vitamin B 12 deficiency expressed as pernicious anemia is higher in Latin American countries than in the rest of the world; furthermore, in Latin America, the disease occurs in younger persons [ ], while it is associated with advanced age in remaining countries [ ].

The possibility that pernicious anemia, rather than vitamin B 12 deficiency, was associated with H. Despite this premature interest, the association has been difficult to sustain and, rather, has been denied by many authors. Fong and colleagues performed what is considered the first well-founded study to clarify the probable link between H. In this study, the authors concluded that patients that suffer pernicious anemia are protected against H.

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These data were ratified in a Japanese study made by Saito et al. It is currently known that when vitamin B 12 deficiency becomes clinically relevant, the bacteria are no longer at the site of the lesion due to changes in the gastric mucosa that result in a hostile environmental niche. In cases of vitamin B 12 deficiency and pernicious anemia, H. These changes can be evidenced by the presence of antibodies against parietal cells and intrinsic factor after the bacteria have left the gastric mucosa [ , ].

Infection with H. A systematic review and meta-analysis of 17 studies with patients demonstrated a significant reduction in serum vitamin B 12 levels in patients infected with H. Marino et al. The intimately association of pernicious anemia with the probability to develop stomach cancer was widely recognized by scientific community many years before the relationship between H. Recently, Vanella et al. The pathophysiological mechanism by which H.

Possible explanations aiming to clarify the association of H. It is not yet known why this association occurs in some patients but not in others, where a different association is presented or the course of the infection is asymptomatic, as happens in most cases [ 78 ]. Vitamin B 12 deficiency manifests as antibodies against intrinsic factor and the parietal cells in the stomach, achlorhydria, and decreased pepsinogen I and gastrin, thereby presenting an histological picture of chronic type A gastritis autoimmune [ ].

The lack of intrinsic factor, which occurs as result of these changes in the gastric mucosa, reduces the absorption and transport of vitamin B 12 that comes from the diet. Chronic atrophic gastritis, induced immunologically, evolves over a period of 10—30 years, until reaching gastric atrophy and the development of pernicious anemia, to the extent that the stores of vitamin B 12 are depleted [ ]. Vitamin B 12 deficiency, parallel to the development of pernicious anemia, causes peripheral neuropathy and lesions in the posterior and lateral columns of the spinal cord, known as subacute combined degeneration, that progresses with demyelination and axial degeneration and eventually neural death [ ].

Helicobacter pylori and Hematologic Diseases

Respect to the management of vitamin B 12 deficiency in the post- Helicobacter era, it must be clarified that H. These situations are particular to each region, according to the prevalence of vitamin B 12 deficiency and H. A recent systematic review and meta-analysis with the aim of clarifying the association between H. This study revealed that serum vitamin B 12 levels are significantly lower in infected patients than in uninfected patients and that H. This has enabled the inclusion of vitamin B 12 deficiency in the consensus and management guides of H.

Before initiating treatment for a patient with vitamin B 12 deficiency, an assessment of the prevalence of H. Generally, the prevalence is low in developed countries; in these cases should proceed with conventional management of vitamin B 12 deficiency [ ]. After 6—8 weeks of the treatment, the infection eradication must be confirmed using a non-invasive test, ideally with 13 C-urea breath test [ 27 ].

If there is no response, it must establish a conventional management of vitamin B 12 deficiency [ ]. Figure 2 shows a diagnostic and management algorithm of vitamin B 12 deficiency in the post- Helicobacter era, taking into account the prevalence of the infection and H. Algorithm for the study and management of vitamin B12 deficiency in the post-Helicobacter era. Generally, prevalence is high in developing countries and low in developed countries [1]. ITP is the most frequent immunological disease in hematology [ ].

The annual incidence of ITP is 5. The chronic form of ITP increases with age, being twice as high in people older than 60 years with respect to those younger than 60 years [ , ], with a higher incidence in women than in men [ ]. Primary ITP, formerly known as idiopathic thrombocytopenic purpura ITP and autoimmune thrombocytopenic purpura, has recently been redefined and adjusted in light of new knowledge represented in the Vicenza Consensus [ ].

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Diseases, Diagnosis and Treatment (The Hematological System Book 12) eBook: Solomon Barroa R.N.: zyfalycigiko.cf: Kindle Store. [KINDLE] Diseases, Diagnosis and Treatment (The Hematological System Book 12) by Solomon. Barroa R.N.. Book file PDF easily for everyone and every.

Primary ITP diagnosis continues to be one of the exclusions due to current lack of robust clinical and laboratory parameters, with high accuracy to establish its diagnosis [ ]. The main clinical concern of primary ITP is the elevated risk of bleeding; however, bleeding symptoms are not present all the time [ ]. For example, for the cases possibly initiated by H. The association of H. The medical literature subsequently reported similar cases in Japan [ - ], Italy [ - ], and Turkey [ ]. In Italy, in , Gasbarrini et al.

Recombinant human erythropoietin can be given, weekly or biweekly, and usually indefinitely. The erythropoietins are also useful in other types of anemia in which there is an underproduction of red blood cells in the bone marrow, such as chemotherapy-induced anemia, myelodysplastic syndrome, and aplastic anemia. They are particularly useful in the anemia of kidney disease which is caused by an underproduction of erythropoietin in certain specialized cells of the kidney.

If nutritional deficiencies are the cause, oral iron tablets , vitamin B12 injections, or and oral folic acid may be prescribed.

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For patients who have anemia due to autoantibodies against their own red cells autoimmune hemolytic anemia , steroids suppress the immune system and interrupt red cell destruction. Prednisone given orally at moderately high doses is usually successful in slowing the process and increasing the hemoglobin level. However, steroids cannot be continued indefinitely without causing long-term side effects such as osteoporosis. The majority of patients respond, but in those who relapse, other agents such as intravenous immunoglobulin IVIG , cyclophosphamide or cyclosporine are sometimes used. The spleen may need to be removed in some cases.

Sickle cell anemia often is difficult to treat. If an underlying cause of a sickle cell crisis such as infection can be identified, prompt treatment will lessen the severity or duration of the crisis. The management of a severe pain episode requires potent pain-relieving narcotic medications.

Transfusions are frequently given for severe anemia that compromises normal heart and lung function or when patients are going into surgery. They are also used in children and adults who have had strokes, since it's been demonstrated that regular transfusion or exchange transfusion prevents recurrence of stroke in patients with sickle cell disease.

Laboratories and Blood Tests: blood, tests, coagulation, blood count, anemia, smear

Unfortunately, chronic transfusion leads to problems with iron overload which results in the deposition of iron into the liver, heart and other sites, and this causes problems with those organs. Another drug, hydroxyurea, has been found to lessen the frequency and severity of sickle cell crises. Unlike anemia, there is no agent available that reliably increases the platelet count for conditions involving underproduction of platelets in the bone marrow. However, even a relatively low number of platelets may not require treatment because it does not cause life-threatening bleeding.

In patients who have bone marrow conditions that result in severely low platelet counts or if severe thrombocytopenia and bleeding occur after chemotherapy, platelet transfusions must be given to either lessen the risk of bleeding or stop bleeding. Because transfused platelets do not last long in the circulation average days , and anti-platelet antibodies can develop upon repeated exposure to transfused or "foreign" cells, platelet transfusion is only used briefly to see the patient through a period of highest risk.

Patients who have autoantibodies against platelets may develop severe thrombocytopenia idiopathic thrombocytopenic purpura or ITP. This requires therapy to interrupt the destruction of platelets or to suppress the immune system. The first treatment usually consists of steroids, but other therapies such as intravenous immunoglobulin IVIG , anti-Rh antibody WinRhoSD , and rituximab Rituxan have been used successfully. Splenectomy is used in selected cases, resulting in long-term periods of remission of the disease.

New agents are being developed for ITP, and we are participating in clinical trials to test new medications. Another disorder causing severe thrombocytopenia is thrombotic thrombocytopenic purpura or TTP. TTP is an acute illness affecting multiple organ systems. TTP causes platelets to aggregate and obstruct blood flow in small arterial vessels.

This leads to neurological and kidney dysfunction as well as a type of anemia called microangiopathic hemolytic anemia. TTP is treated by exchanging the patient's own plasma for new plasma. Plasma exchange is usually available only in referral centers that have the sophisticated equipment and trained personnel required to perform this procedure in a safe and expeditious manner.

Myeloproliferative diseases-polycythemia vera, essential thrombocythemia, and primary myelofibrosis. Myeloproliferative disorders all result in the overproduction of blood cells. Because of the detrimental effects of high numbers of blood cells of all types, treatment is directed towards lowering their numbers. Polycythemia vera is treated with phlebotomy, a simple technique that involves removal of units of blood at appropriate intervals. This keeps the red cell count hematocrit within the normal range, lessening the risk of stroke or heart attack.

In essential thrombocythemia, and in some cases of polycythemia vera, the high platelet count needs to be lowered, also to prevent stroke, heart attack, or life-threatening blood clotting. The optimal platelet count in this situation is unknown, largely because the degree of platelet activation, and therefore increased potential for clotting, cannot be routinely measured. If the patient is experiencing a life-threatening thrombotic event, the platelet count can be brought down very rapidly by mechanical means plateletpheresis. Both of these drugs suppress the bone marrow cells that make platelets megakaryocytes and platelet production, although hydroxyurea has a more global effect on bone marrow function.

Severe inherited bleeding disorders usually come to light in childhood, when parents observe excessive bleeding with mild or no obvious cause. If the diagnosis is hemophilia, therapy is directed toward replacing the clotting factor that's missing. With the range of factor VIII and IX concentrates available today, either purified from human plasma or produced by molecular techniques recombinant , this is a relatively straightforward process. There are, however, several caveats to be taken into account.

First, the dosage has to calculated correctly and adjusted for the type of bleeding episode. Second, patients or their parents must be taught to administer the factor at home, since prompt administration after a bleed into a joint or soft tissue limits the total amount of bleeding and prevents further tissue damage. Third, some patients develop inhibitors antibodies to the infused factor product.

Please call Mrs. Olga Fradkin at In certain types of anemia, the body destroys its own red blood cells. The haptoglobin level is a test which can help determine if this is occurring. The plasma hemoglobin level is a test which can help determine if this is occurring. In certain cases, it appears that the body is destroying its own red blood cells, and quantification is needed. The red blood cell survival test can determine the lifespan of the patient's red blood cells.

Erythropoietin is a substance which is made by the body to stimulate the production of red blood cells. Its level can be measured in the blood. Erythropoietin is synthesized by the kidney. If the bone marrow is unable to make the normal amount of red blood cells, the kidney responds by producing more erythropoietin meant to stimulate the bone marrow to work harder. This blood test can be used to determine if anemia is due to a bone marrow problem or a kidney problem.

In certain diseases, the body produces an excess of red blood cells in the absence of the erythropoietin signal. This can be proven using cultures of erythroid precursor cells from peripheral blood, in the presence and absence of erythropoietin. The autonomous function of the bone marrow proves the diagnosis of polycythemia vera. This is a specialized and labor intensive procedure and requires notification in advance to Mrs.

Aliza Treves at In certain diseases, the production of white blood cells by the bone marrow is abnormal and their development can be studied using cultures in the laboratory. This special stain of the peripheral blood is used to determine the amount of a particular enzyme in the patient's white blood cells. It is used to diagnose certain blood diseases characterized by overactivity of the bone marrow myeloproliferative diseases , which are manifested by an elevated level of the enzyme. If the levels are abnormally low, this suggests that the patient may have chronic myeloid leukemia, and further testing may be required.

This test is used to diagnose a rare bone marrow disorder called paroxysmal nocturnal hemoglobinuria PNH. Marrow examination complements clinical and laboratory information in determining the cause of anemia, leukopenia, leukocytosis, thrombocytopenia and thrombocytosis. It also contributes to the staging of lymphoproliferative disease and various solid tumors. Bone marrow is the tissue found within your bones where blood cells are made. In infants, all the bone marrow is capable of manufacturing blood cells.

However, in adults, blood cells are made only in the flat bones of the pelvis, sternum breast bone and skull. The bone marrow is like a blood cell factory. It contains stem cells that have the capacity to evolve into all three types of blood cells. A stem cell can develop into a red cell and carry oxygen, or it can evolve into a white cell and fight infection.

The bone marrow is responsible for maintaing the normal number of the three types of cells by replacing old cells as they naturally die off. It also increases production of any type of blood cell if there is a special demand for it, such as more white blood cells if you are fighting an infection. The bone marrow is a place where cells divide very quickly in order to keep up with your body's constant demand for blood cells. Since chemotherapy affects the cells that divide quickly like cancer cells , it temporarily affect your bone marrow. Unlike cancer cells, your bone marrow will recover and resume its normal production of blood cells.

Chemotherapy doesn't affect the blood cells that are already in circulation, since these cells are not dividing themselves. Only the production of new cells in the bone marrow is slowed down. Chemotherapy's effect on your bone marrow usually shows up in your blood cell count about a week to ten days after your treatment, which it is noticeable that blood cells have not been replaced at the normal rate.

But in another week or so, the number of blood cells in circulation will return to normal. Your chemotherapy treatments are timed to allow your bone marrow to recover. Your doctor will always check your blood cell count before each treatment to be sure that your bone marrow is back on the job of producing blood cells.

This is the preferred method for examining the cytogenetics or bone marrow morphology. Examination of the marrow aspirate is a useful method to review cellular morphology and focal lesions. The technique lends itself to special stains which cannot be done on decalcified material. These stains are essential for properly diagnosing acute leukemia. In patients with anemia, iron stains can determine the etiology of the anemia. Marrow Biopsy This is the preparation of choice for assessment of cellularity and marrow architecture.

The technique lends itself to the evaluation of cellular distribution, as well as the pattern and extent of fibrosis or of infiltrative processes. Granulomata can be examined for microorganisms with special stains. Biopsies evaluate some forms of anemia, but it is a routine procedure for staging of all the lymphomas. Immunophenotyping is used as an adjunct study for diagnosis and classification of most lymphoproliferative diseases and acute leukemias. The technique complements peripheral blood analysis and may replace marrow examination in some disorders. The flow cytometry laboratory utilizes highly advanced equipment which is applied toward patient care needs as well as scientific research goals.

The laboratory offers its services to other departments upon request with remuneration on a fee for service basis. Flow cytometry analyzes cells in liquid suspension i. The antibodies are directed against specific cellular antigens. A number of different antibody panels are available, depending on the clinical question. The instrument is capable of examining up to four different antigens simultaneously. Several thousands cells are counted with each antibody combination, with the percentage of positive cells calculated.

The relative fluorescence intensity of the positive cells indicates the amount of antigen studied. The specific panel of antibodies used is selected based on the patient's clinical history, referring physician information, and the morphologic appearance of the cells present in the specimen. Antibodies of particular interest may be requested by the referring physician.

A written report and interpretation for each case are issued. In addition, printouts of flow histograms are provided upon request. Specimen requirements: Generally, 5 ml heparin-anticoagulated green top tube blood or bone marrow. The acute leukemia panel is designed to determine whether leukemic blasts are of myeloid or lymphoid origin, and to further classify the cells as B or T cell, monocytic, megakaryocytic, etc. Each antibody combination includes three antibodies directed against lineage-specific antigens and a third antibody against CD45, which is present on all hematopoietic cells.

The inclusion of this third antibody allows the identification of small numbers of blasts in the presence of large numbers of nonmalignant cells, and is based on the blasts' lower expression of CD If the routine panel is insufficient to adequately characterize the leukemic cells, additional antibodies may be used to determine the expression of other marker combinations. The lymphoma panel is designed to characterize lymphoproliferative disorders, which usually are comprised of mature B or T cells.

For B cell malignancies, demonstration of the presence of a monoclonal population by restricted kappa or lambda immunoglobulin light chain expression is diagnostic. For T cell malignancies, in many cases the finding of an abnormal T cell phenotype is strong evidence for a T cell malignancy. To prove clonality for T cell malignancies, gene rearrangement studies need to be done. Based on the results of this initial panel, additional B or T cell markers are added to help further classify B cell processes or to try to demonstrate an abnormal phenotype in T cell processes.

To follow the immunologic status of patients our panel includes the T cell markers CD3, CD4, and CD8, and the pan-hematopoietic marker CD45 which is used for gating and quality control. The percentage of cells bearing each marker is determined by this method. This method eliminates the need for a separate lymphocyte count and allows determinations on up to 3 day old specimens. The immunologic status of post-transplant renal, cardiac, liver, pancreas, heart-lung patients receiving immunosuppressive treatment is routinely followed by lymphocyte counts.

The rejection antibody panel determines only the total number of T cells based on CD3 staining, and is generally used to follow the therapeutic efficacy of the therapy. Bone marrow, mobilized peripheral blood and neonatal cord blood harvests are evaluated by staining with antibodies to CD34, CD45, CD38 surface antigens, as well as other antigens as requested. Measurement of RBC with high content of HbF RBC of fetal origin in the blood of pregnant women helps evaluate the severity of fetal-maternal hemorrhaging.

Measurement of HbF-containing cells of the patient's origin is important for diagnosis of chronic hereditary anemias, e. HbF-containing reticulocytes are specifically informative in transfusion-dependent patients, and patients undergoing treatment with agents, e. In these assays, peripheral blood cells are fixed and permeabilized, followed by staining with HbF-specific antibodies.

Sickle cell anemia - causes, symptoms, diagnosis, treatment & pathology

Paroxysmal Nocturnal Hemoglobinuria PNH Assay In PNH, a clonal marrow stem cell population gives rise to mature blood cells lacking the expression of a variety of different cell surface proteins. The feature common among these proteins is their link to the cell membrane via a glycosyl-phosphatidyl-inositol GPI link. Flow cytometry can be used to detect the loss of GPI-linked proteins e. For the erythroid cell line, preferential analysis of reticulocytes increases the sensitivity of the assay.

The loss of GPI-linked proteins in some cases of aplastic anemia having features of PNH may be useful for precise diagnosis. Customized antibody panels for research or clinical use can be designed. Issues such as cell activation, expression of adhesion molecules etc, can be addressed with special panels. Sorting including aseptic sorting of specific subpopulation can be accomplished using the sorter module. Please inquire by calling This adjunctive method provides diagnostic and prognostic information in a wide range of malignant hematologic disorders.

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Screening for circulating galactomannan as a noninvasive diagnostic tool for invasive aspergillosis in prolonged neutropenic patients and stem cell transplantation recipients: a prospective validation. Bacterial and fungal bloodstream infections cannot be clinically differentiated. These are special tests which use specific chemicals to determine the cellular characteristics of the bone marrow cells. Differences in attitudes and beliefs toward end-of-life care between hematologic and solid tumor oncology specialists. The test is performed by adding a substance which activates the clotting system and measuring the time it takes to form fibrin, the primary protein of which the blood clot is made. Article history Submitted:.

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