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American Journal of Hematology Jul 2017Monocytosis (absolute monocyte count, AMC ≥ 1 × 10 /L) might accompany a spectrum of myeloid neoplasms, other than chronic myelomonocytic leukemia (CMML). In the...
Monocytosis (absolute monocyte count, AMC ≥ 1 × 10 /L) might accompany a spectrum of myeloid neoplasms, other than chronic myelomonocytic leukemia (CMML). In the current study, we examined the prevalence, laboratory and molecular correlates, and prognostic relevance of monocytosis in polycythemia vera (PV). Among 267 consecutive patients with World Health Organization (WHO)-defined PV, 55 (21%) patients displayed an AMC of ≥1 × 10 /L and 18 (7%) an AMC of ≥1.5 × 10 /L. In general, PV patients with monocytosis were significantly older and displayed higher frequencies of leukocytosis (81% vs. 50% at AMC ≥1 × 10 /L) and TET2/SRSF2 mutations (57%/29% vs. 19%/1% at AMC ≥ 1.5 × 10 /L). In univariate analysis, AMC ≥1.5 × 10 /L adversely affected overall (OS; P = .004; HR 2.6, 95% CI 1.4-4.8) and myelofibrosis-free (MFFS; P = .02; HR 4.4, 95% CI 1.3-15.1) survival; during multivariable analysis, significance was borderline sustained for OS (P = .05) and MFFS (P = .06). Other independent risk factors for OS included unfavorable karyotype (P = .02, HR 3.39, 95% CI 1.17-9.79), older age (P < .0001, HR 3.34 95% CI 1.97-5.65), and leukocytosis ≥15 × 10 /L (P = .004, HR 2.04, 95% CI 1.26-3.29). In conclusion, in the current study, we encountered a higher than expected prevalence of monocytosis in patients with PV and the mutation profile and age distribution of PV patients with monocytosis is akin to those of patients with CMML and might partly contribute to their worse prognosis.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; DNA Mutational Analysis; Female; Humans; Kaplan-Meier Estimate; Karyotyping; Leukocyte Count; Leukocytosis; Male; Middle Aged; Monocytes; Mutation; Phenotype; Polycythemia Vera; Prognosis; Young Adult
PubMed: 28370365
DOI: 10.1002/ajh.24740 -
Blood Cancer Journal Jan 2024We describe 1000 patients with essential thrombocythemia seen at the Center Research and Innovation of Myeloproliferative Neoplasms (CRIMM), Florence, Italy, between...
We describe 1000 patients with essential thrombocythemia seen at the Center Research and Innovation of Myeloproliferative Neoplasms (CRIMM), Florence, Italy, between 1980 and 2023: median age 59 years (18-95), females 65%, JAK2/CALR/MPL-mutated 66%/19%/4%, triple-negative (TN) 11%. Extreme thrombocytosis (ExT, platelets ≥1000 × 10/L) in 16%, leukocytosis (leukocytes >11 × 10/L) in 16%, and at least one cardiovascular risk factor in 52% of cases. JAK2-mutated patients were older (median 62 years) and CALR-mutated and TN (53 years for both) younger (p < 0.001). Female gender clustered with TN (76%) and JAK2 (67%) vs CALR (46%) mutations (p < 0.001). ExT clustered with CALR (type-2 more than type-1), TN and MPL, and leukocytosis with JAK2 mutation (p < 0.001). In multivariable analysis, risk factors for arterial thrombosis-free survival were age ≥60 years (HR 2.0; p < 0.001) and JAK2 mutation (HR 1.3; p = 0.02) with borderline significance for male gender (p = 0.08) and cardiovascular risk factors (p = 0.08); for venous thrombosis-free survival, JAK2 mutation (HR 1.9; p = 0.03) with borderline significance for venous thrombosis history (p = 0.07); for overall survival, older age (p < 0.001), male gender (HR 1.9; p < 0.001), absolute neutrophil count (ANC) ≥ 8 × 10/L (HR 1.8; p = 0.01), absolute lymphocyte count (ALC) < 1.7 × 10/L (HR 1.2; p = 0.03); for myelofibrosis-free survival, CALR mutation (HR 2.7; p < 0.001, particularly for CALR type 1/1-like, HR 3.3) and MPL mutation (HR 3.9; p = 0.001); for leukemia-free survival, older age (p = 0.03). Cytoreductive therapy appeared to mitigate both venous (HR 0.3; p = 0.01) and arterial thrombosis (HR 4; p = 0.04); there was a trend for aspirin in preventing arterial thrombosis recurrence. The current study provides real-world observations in essential thrombocythemia, representing a valid source document for interpreting current literature and planning future studies.
Topics: Humans; Male; Female; Middle Aged; Thrombocythemia, Essential; Leukocytosis; Myeloproliferative Disorders; Thrombocytosis; Thrombosis; Mutation; Janus Kinase 2; Calreticulin
PubMed: 38238287
DOI: 10.1038/s41408-023-00968-7 -
BMC Research Notes Feb 2016Herpes simplex virus (HSV) is the most common cause of sporadic encephalitis worldwide. The high mortality rate (70-80 %) of herpes simplex encephalitis (HSE) can be...
BACKGROUND
Herpes simplex virus (HSV) is the most common cause of sporadic encephalitis worldwide. The high mortality rate (70-80 %) of herpes simplex encephalitis (HSE) can be reduced to 20-30 % by antiviral therapy. However, normocellular CSF can lure physicians to look for non-infectious causes, resulting in delayed treatment. This study aimed to investigate, characterize and differentiate HSE patients, with normocellular and pleocytosis CSF, according to neuroimaging patterns, underlying disease, CSF viral load and clinical outcome. Patients with proven (by PCR positive CSF) or presumed viral infections of the CNS admitted to King Chulalongkorn Memorial Hospital between January 2002 and 2011 were analyzed.
RESULTS
HSV was detected in the CSF of 43 patients but only 23 patients had encephalitis. Among these 23 patients, 6 cases (26.1 %) had normal CSF WBC (<5 cells/mm(3)). One patient in this normocellular CSF group had HIV infection. Although this patient had low CD4 counts (<200 cells/mm(3)), the peripheral WBC counts showed only mild leukopenia. The CSF HSV viral load in the pleocytosis group was higher than the normocellular group, with an average of 12,200 vs 3027 copies/ml respectively. There was no correlation between the viral load and the clinical outcome. With respect to neuroimaging, 4 (66.7 %) patients in the normocellular group had unremarkable/non-specific results.
CONCLUSIONS
Normocellular CSF in HSE is not rare, and can be seen in normal as well as immunocompromised hosts. Clinicians should not exclude CNS infection, especially HSE, merely based on the absence of CSF pleocytosis and/or unremarkable neuroimaging study.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Demography; Encephalitis, Herpes Simplex; Female; Humans; Infant; Leukocytosis; Male; Middle Aged; Young Adult
PubMed: 26879928
DOI: 10.1186/s13104-016-1922-9 -
Journal of Ayub Medical College,... 2020Anaplastic thyroid carcinoma is a high-grade tumour with poor prognosis. Most of the cases are easily diagnosed on cytology and some of these are associated with...
BACKGROUND
Anaplastic thyroid carcinoma is a high-grade tumour with poor prognosis. Most of the cases are easily diagnosed on cytology and some of these are associated with increased neutrophils in cytology specimen as well as in the blood. The objective of the study is to determine the frequency of neutrophilia with fever in anaplastic thyroid carcinoma.
METHODS
This descriptive cross-sectional study was performed in the Department of Pathology Ayub Teaching Hospital Abbottabad as well as in association with Advance lab Abbottabad. All the cases diagnosed as anaplastic thyroid carcinoma on cytology were included, histopathological examination was done only in 5 cases. The duration of study was from October 2016 to October 2019 were included in the study.
RESULTS
Out of 150 cases of thyroid cytology 09 were diagnosed as anaplastic thyroid carcinoma. The mean age of patients was 65.7±6.96. Gender distribution was 5/9 (55.6%) males and 4/9 (44.4%) were females. Out of which 05 were confirmed on histopathology 3 patients died within a month and 1 patient refused a biopsy. All of these cases were associated with an increased number of neutrophils on cytology and WBC count is 04 cases showed leucocytosis. All of them presented with rapidly growing mass in long-standing goitre with a median duration of 2 months. Weight loss was seen in 4/9 (44.44%), 3/9 (33.33%) presented with hoarseness of voice while only 1/9 (11.1%) patient presented with superior vena caval syndrome.
CONCLUSION
In long-standing goitre rapid increase in size with fever and leucocytosis are suggestive of anaplastic thyroid carcinoma which should be investigated promptly.
Topics: Aged; Cross-Sectional Studies; Female; Fever; Humans; Leukocytosis; Male; Middle Aged; Thyroid Carcinoma, Anaplastic; Thyroid Neoplasms
PubMed: 33754530
DOI: No ID Found -
Respiratory Care Jan 2016Spurious hypoxemia has been described in case reports during extreme hyperleukocytosis and has led to recommendations for immediate cooling and analysis of arterial...
BACKGROUND
Spurious hypoxemia has been described in case reports during extreme hyperleukocytosis and has led to recommendations for immediate cooling and analysis of arterial blood gases (ABGs). We sought to determine, in samples processed as recommended, the magnitude of spurious hypoxemia in acute leukemia subjects with hyperleukocytosis.
METHODS
A retrospective chart review was conducted of all subjects admitted between 2003 and July 2014 for acute leukemia, who presented with white blood cell (WBC) count > 50 × 10(9) cells/L and had ABGs performed. For each ABG, we collected PaO2 , SaO2 , simultaneous WBC count, and SpO2 when available. Bland and Altman analysis was used to assess the agreement between SpO2 and SaO2 .
RESULTS
One-hundred forty-six samples (from 45 subjects) were included, of which 57 samples (from 18 subjects) had data available for Bland and Altman analysis. Mean (SpO2 - SaO2 ) was 2.5%, and 95% CI for limits of agreement between SpO2 and SaO2 was (-10.1,15.1)%. The mean (SpO2 - SaO2 ) was significantly higher for WBC count > 100 × 10(9)/L as compared with WBC count < 100 × 10(9)/L (3.8% vs 0.4%, P = .04), and the 95% CIs for limits of agreement were (-10.3,18)% versus (-7.9,8.6)%. SpO2 and SaO2 were poorly correlated (r(2) = 0.19), whereas the difference (SpO2 - SaO2 ) was fairly correlated with WBC count (r(2) = 0.44). Overall, 11 of 19 samples with WBC count > 150 × 10(9)/L had PaO2 < 55 mm Hg whereas SpO2 was > 94%, the proportion being 5 of 62 samples for WBC count < 150 × 10(9)/L (P < .001). Three subjects with WBC count > 150 × 10(9)/L exhibited large SpO2 to SaO2 differences (10-20%) before leukapheresis, which decreased to below 5% afterward.
CONCLUSIONS
In subjects with acute leukemia and hyperleukocytosis, despite cooling and quickly analyzing the samples, we observed poor correlation and agreement between SpO2 and SaO2 , unacceptably low for WBC count > 100 × 10(9)/L. Our results suggest that current guidelines may not totally prevent the diagnosis of spurious hypoxemia.
Topics: Aged; Blood Gas Analysis; Female; Humans; Hypoxia; Leukapheresis; Leukemia, Myeloid, Acute; Leukemia, Promyelocytic, Acute; Leukocyte Count; Leukocytosis; Male; Middle Aged; Oxygen; Partial Pressure; Retrospective Studies; Severity of Illness Index
PubMed: 26420901
DOI: 10.4187/respcare.04196 -
Haematologica Jun 2018Patients with acute myeloid leukemia and a high white blood cell count are at increased risk of early death and relapse. Because mediators of inflammation contribute to...
Patients with acute myeloid leukemia and a high white blood cell count are at increased risk of early death and relapse. Because mediators of inflammation contribute to leukostasis and chemoresistance, dexamethasone added to chemotherapy could improve outcomes. This retrospective study evaluated the impact of adding or not adding dexamethasone to chemotherapy in a cohort of 160 patients with at least 50×10 white blood cells. studies, primary samples, leukemic cell lines, and xenograft mouse models were used to explore the antileukemic activity of dexamethasone. There was no difference with respect to induction death rate, response, and infections between the 60 patients in the dexamethasone group and the 100 patients in the no dexamethasone group. Multivariate analysis showed that dexamethasone was significantly associated with improved relapse incidence (adjusted sub-HR: 0.30; 95% CI: 0.14-0.62; =0.001), disease-free survival (adjusted HR: 0.50; 95% CI: 0.29-0.84; =0.010), event-free survival (adjusted HR: 0.35; 95% CI: 0.21-0.58; <0.001), and overall survival (adjusted HR: 0.41; 95% CI: 0.22-0.79; =0.007). In a co-culture system, dexamethasone reduced the frequency of leukemic long-term culture initiating cells by 38% and enhanced the cytotoxicity of doxorubicin and cytarabine. In a patient-derived xenograft model treated with cytarabine, chemoresistant cells were enriched in genes of the inflammatory response modulated by dexamethasone. Dexamethasone also demonstrated antileukemic activity in -mutated samples. Dexamethasone may improve the outcome of acute myeloid leukemia patients receiving intensive chemotherapy. This effect could be due to the modulation of inflammatory chemoresistance pathways and to a specific activity in acute myeloid leukemia with mutation.
Topics: Adolescent; Adult; Aged; Antineoplastic Agents, Hormonal; Dexamethasone; Drug Resistance, Neoplasm; Female; Gene Expression Regulation, Leukemic; Humans; Kaplan-Meier Estimate; Leukemia, Myeloid, Acute; Leukocytosis; Male; Middle Aged; Mutation; Nuclear Proteins; Nucleophosmin; Prognosis; Recurrence; Remission Induction; Treatment Outcome; Young Adult
PubMed: 29519869
DOI: 10.3324/haematol.2017.184267 -
Pediatrics in Review Nov 2014
Topics: Aorta, Abdominal; Arterial Occlusive Diseases; Child, Preschool; Down Syndrome; Eosinophilia; Epistaxis; Feeding and Eating Disorders; Female; Gastric Outlet Obstruction; Humans; Hypertension; Infant; Leukocytosis; Magnetic Resonance Angiography; Male; Pancreas; Recurrence; Toxocariasis
PubMed: 25361908
DOI: 10.1542/pir.35-11-487 -
Archives of Pathology & Laboratory... Mar 2020Transient abnormal myelopoiesis is a hematopoietic disorder that occurs in up to 10% of neonates with Down syndrome. It is characterized by leukocytosis and the presence... (Review)
Review
Transient abnormal myelopoiesis is a hematopoietic disorder that occurs in up to 10% of neonates with Down syndrome. It is characterized by leukocytosis and the presence of circulating blast cells harboring truncating mutations with variable multiorgan system involvement. Placental involvement of transient abnormal myelopoiesis is infrequently described. Placental examination and identifying features related to transient abnormal myelopoiesis could be one of the early, if not the only, means of diagnosis of this condition in affected stillbirths, premature infants, and a subset of asymptomatic neonates. This article provides an overview of the placental pathology in transient abnormal myelopoiesis with review of the literature, and also discusses the important differential diagnoses.
Topics: Down Syndrome; Female; GATA1 Transcription Factor; Humans; Infant, Newborn; Leukemoid Reaction; Mutation; Placenta; Pregnancy
PubMed: 30969155
DOI: 10.5858/arpa.2018-0248-RS -
Texas Heart Institute Journal Jul 2022Durable left ventricular assist devices (LVADs) provide circulatory support in patients with end-stage heart failure; however, complications include infection of the... (Review)
Review
Durable left ventricular assist devices (LVADs) provide circulatory support in patients with end-stage heart failure; however, complications include infection of the driveline exit site. Nontuberculous mycobacterial infections are rare in patients with LVADs, but they should be considered in those who have undergone device exchanges and have bacterial infections with driveline exit-site discharge but no fever or leukocytosis. We reviewed the charts of patients who had an LVAD implanted at our institution from January 2009 through December 2019, to identify those with a device-related nontuberculous mycobacterial infection. Collected data included patient demographics, premorbid conditions, infection type, previous device complications, treatment, and outcomes. We identified infections in 3 patients (mean age, 41 yr): Mycobacterium abscessus in 2 and M. chimaera in 1. All had a HeartMate II device and had undergone device exchanges for pump thrombosis or for driveline fault or infections. All presented with driveline exit-site discharge without fever or leukocytosis. The mean time between initial device implantation and diagnosis of a nontuberculous mycobacterial infection was 55 months. All 3 patients were treated with antibiotics and underwent localized surgical débridement; one underwent an additional device exchange. The M. abscessus infections disseminated, and both patients died; the patient with M. chimaera infection continued to take suppressive antibiotics. Nontuberculous mycobacterial infections are associated with high morbidity and mortality rates, warranting prompt diagnosis and treatment.
Topics: Adult; Anti-Bacterial Agents; Heart Failure; Heart-Assist Devices; Humans; Leukocytosis; Prosthesis-Related Infections; Retrospective Studies
PubMed: 35838643
DOI: 10.14503/THIJ-20-7498 -
Journal of Endocrinological... Jul 2021No data are currently available on the implication of amicrobial leukocytospermia in male adolescents. Therefore, the primary aim of this study was to evaluate the...
BACKGROUND
No data are currently available on the implication of amicrobial leukocytospermia in male adolescents. Therefore, the primary aim of this study was to evaluate the prevalence of amicrobial leukocytospermia among non-smoker late adolescents who were exposed to other risky lifestyles for the andrological health. The main andrological clinical features of adolescents with leukocytospermia were also reported.
METHODS
This is a cross-sectional study carried out in 80 boys. Each adolescent underwent a physical examination, and to the assessment of sperm conventional parameters, seminal leukocytes concentration and immature germ cell evaluation. A possible correlation between seminal leukocytes and immature germ cells and testicular volume (TV) was tested.
RESULTS
The adolescents enrolled in this study had 18.0 ± 0.4 (range 18.1-18.9) years. Unprotected sexual intercourse was referred by 38% of them. Sexual dysfunctions were found in 25% and isolated hypoactive sexual desire in 12.5% of boys. Low TV and penile length in flaccidity were found in 44% and 30% of them, respectively. Only 41% had normozoospermia at the sperm analysis, whereas 19% had isolated oligozoospermia, 15% oligo-asthenozoospermia, and 25% oligo-astheno-teratozoospermia. Leukocytospermia occurred in 25% (20 out of 80) of adolescents. No seminal infection was detected in 19% (15 out of 80) of them. Adolescents with leukocytospermia had lower progressive sperm motility, percentage of normal forms, TV, and a higher percentage of immature germ cells compared to those without leukocytospermia. Semen leukocyte concentration correlated negatively with TV and positively with the percentage of immature germ cells in the ejaculate.
CONCLUSION
Leukocytospermia, increased immature germ cell number, and low TV identify a distinct phenotype suggestive of testicular tubulopathy. Primary prevention of male infertility and the counselling for andrological risky lifestyles is mandatory and should be started as early as possible.
Topics: Adolescent; Cross-Sectional Studies; Follow-Up Studies; Humans; Infertility, Male; Italy; Leukocytes; Leukocytosis; Leukopenia; Male; Prognosis; Semen; Spermatozoa
PubMed: 33226627
DOI: 10.1007/s40618-020-01462-8