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Acta Haematologica 2021Rheumatic diseases have many hematological manifestations. Blood dyscrasias and other hematological abnormalities are sometimes the first sign of rheumatic disease. In... (Review)
Review
BACKGROUND
Rheumatic diseases have many hematological manifestations. Blood dyscrasias and other hematological abnormalities are sometimes the first sign of rheumatic disease. In addition, novel antirheumatic biological agents may cause cytopenias.
SUMMARY
The aim of this review was to discuss cytopenias caused by systemic lupus erythematosus and antirheumatic drugs, Felty's syndrome in rheumatoid arthritis, and autoimmune hemolytic anemia, thrombosis, and thrombotic microangiopathies related to rheumatological conditions such as catastrophic antiphospholipid syndrome and scleroderma renal crisis. Key Message: The differential diagnosis of various hematological disorders should include rheumatic autoimmune diseases among other causes of blood cell and hemostasis abnormalities. It is crucial that hematologists be aware of these presentations so that they are diagnosed and treated in a timely manner.
Topics: Anemia, Hemolytic; Antirheumatic Agents; Felty Syndrome; Glucocorticoids; Granulocyte Colony-Stimulating Factor; Hematologic Diseases; Leukopenia; Lupus Erythematosus, Systemic; Protein Kinase Inhibitors; Rheumatic Diseases
PubMed: 33221805
DOI: 10.1159/000511759 -
Mayo Clinic Proceedings Jul 2005A complete blood cell count (CBC) is one of the most common laboratory tests in medicine. For example, at our institution alone, approximately 1800 CBCs are ordered... (Review)
Review
A complete blood cell count (CBC) is one of the most common laboratory tests in medicine. For example, at our institution alone, approximately 1800 CBCs are ordered every day, and 10% to 20% of results are reported as abnormal. Therefore, it is in every clinician's interest to have some understanding of the specific test basics as well as a structured action plan when confronted with abnormal CBC results. In this article, we provide practical diagnostic algorithms that address frequently encountered conditions associated with CBC abnormalities including anemia, thrombocytopenia, leukopenia, polycythemia, thrombocytosis, and leukocytosis. The objective is to help the nonhematologist recognize when a subspecialty consultation is reasonable and when it may be circumvented, thus allowing a cost-effective and intellectually rewarding practice.
Topics: Adult; Algorithms; Anemia; Blood Cell Count; Cost-Benefit Analysis; Diagnosis, Differential; Hematologic Diseases; Hematology; Humans; Leukocytosis; Leukopenia; Polycythemia; Practice Patterns, Physicians'; Referral and Consultation; Thrombocytopenia; Thrombocytosis
PubMed: 16007898
DOI: 10.4065/80.7.923 -
Experimental and Clinical... Oct 2021Renal transplant is considered the best therapeutic option for suitable patients with end-stage kidney failure. Hematological complications that occur after kidney... (Review)
Review
Renal transplant is considered the best therapeutic option for suitable patients with end-stage kidney failure. Hematological complications that occur after kidney transplant include posttransplant anemia, leukopenia, neutropenia, and thrombocytopenia. Severely persistent leukopenia and neutropenia events predispose patients to infection, including opportunistic infections. The mainstay tactic for such complications is to reduce the burden of the immunosuppression by the offending agent, but this tactic is associated with increased risk of acute rejection. Given the absence of laboratory investigations to specifically identify the culprit, a complete withdrawal of these agents may be the ultimate diagnostic option. Future therapeutic strategies, however, should focus on reducing the immunosuppressive burden, the introduction of less myelotoxic agents, early recognition, and prompt treatment of infectious episodes. This will help in the optimization of the myelopoietic function and normalization of the hematological profile, resulting in better allograft and patient survival.
Topics: Anemia; Graft Rejection; Humans; Immunosuppressive Agents; Kidney Transplantation; Neutropenia; Treatment Outcome
PubMed: 33736582
DOI: 10.6002/ect.2020.0100 -
British Medical Journal Jun 1969
Topics: Asparaginase; Bone Marrow; Bone Marrow Cells; Humans; Leukemia, Lymphoid; Leukopenia
PubMed: 5254206
DOI: 10.1136/bmj.2.5660.823 -
MMW Fortschritte Der Medizin Feb 2022
Review
Topics: Anemia; Humans; Leukopenia; Thrombocytopenia; Thrombosis; Vaccines
PubMed: 35088323
DOI: 10.1007/s15006-022-0747-9 -
Journal of Anesthesia Feb 2022Inflammation after stent graft surgery is known as postimplantation syndrome (PIS) and it causes leukocytosis. However, we have experienced leukopenia in the very early...
PURPOSE
Inflammation after stent graft surgery is known as postimplantation syndrome (PIS) and it causes leukocytosis. However, we have experienced leukopenia in the very early postoperative phase of endovascular surgery at our institution. We investigated leukopenia, an under-recognized phenomenon that occurred after transcatheter aortic valve implantation (TAVI), endovascular aortic repair (EVAR), and thoracic endovascular aortic repair (TEVAR).
METHODS
Records of patients who underwent TAVI, EVAR, and TEVAR between March 2018 and February 2019 were retrospectively reviewed. Primary outcomes were the decline rate of white blood cell count (DR-WBC) in the immediate postoperative period and its differences among surgical procedures. The secondary endpoint was the relationship between DR-WBC and infectious complications. Furthermore, the incidence of PIS and its differences among the procedures and associations with DR-WBC were evaluated.
RESULTS
A total of 108 patients (TAVI 41, EVAR 37, TEVAR 30) were included. DR-WBC immediately after surgery was higher in the TAVI group when compared with other groups (TAVI, 43.1 ± 22.6%; EVAR, 27.6 ± 17.3%; TEVAR, 25.4 ± 27.4%; P < 0.01). DR-WBC was not significantly different regardless of postoperative infection (P = 0.45) or PIS (P = 0.62). The incidence rate of PIS was higher in the EVAR group compared with the TAVI group, and was not associated with DR-WBC.
CONCLUSIONS
Leukopenia was a common phenomenon immediately after endovascular surgery, especially TAVI. It resolved a day after surgery and was not associated with PIS or infectious complications. Therefore, it seems to be a transient abnormal hematological finding and a self-limiting condition.
Topics: Aortic Aneurysm, Abdominal; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Endovascular Procedures; Humans; Leukopenia; Postoperative Complications; Retrospective Studies; Risk Factors; Stents; Treatment Outcome
PubMed: 34773505
DOI: 10.1007/s00540-021-03020-9 -
Medicine Oct 2022Leukopenia is one of most common types of myelosuppression secondary to chemotherapy. The main methods used to treat leukopenia after chemotherapy have various... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Leukopenia is one of most common types of myelosuppression secondary to chemotherapy. The main methods used to treat leukopenia after chemotherapy have various limitations. Several studies have reported the role of acupuncture in the prevention and treatment of leukopenia, but the quality of the study is uneven. Here, we used a systematic review and meta-analysis to evaluate the efficacy and safety of acupuncture in the treatment of leukopenia after chemotherapy.
METHODS
We searched the databases of the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Library, Medline (via PubMed), EMBASE (via embase.com), the China National Knowledge Infrastructure Database (CNKI), the Chinese Biomedical Literature Database (CBM), the Chinese Scientific Journal Database (VIP database) and the Wanfang database to collect randomized clinical trials (RCTs) on acupuncture in the treatment of leukopenia after chemotherapy. Cochrane systematic reviewer manual 5.2 was used for bias risk assessment. RevMan5.3 statistical software was applied for statistical analysis.
RESULTS
Fifteen RCTs were included in this study, with a total of 1130 patients. Meta-analysis results showed that acupuncture can increase white blood cell (WBC) count after chemotherapy [MD = 1.18, 95% CI (0.80, 1.57), P < .00001], reduce the incidence of myelosuppression [RR = 0.38, 95% CI (0.23, 0.63), P = .0002], and improve the clinical treatment effectiveness [RR = 1.20, 95% CI (1.00, 1.43), P = .05]. The differences were statistically significant.
CONCLUSION
It is recommended to use acupuncture in the treatment of leukocytopenia after chemotherapy, but this result needs further research for verification.
Topics: Humans; Acupuncture; Acupuncture Therapy; Leukopenia; Leukocyte Count; Antineoplastic Agents
PubMed: 36281119
DOI: 10.1097/MD.0000000000030995 -
Einstein (Sao Paulo, Brazil) 2022To examine serum C-reactive protein levels and the prevalence of leukopenia in patients with Crohn's disease or ulcerative colitis undergoing treatment with azathioprine... (Observational Study)
Observational Study
OBJECTIVE
To examine serum C-reactive protein levels and the prevalence of leukopenia in patients with Crohn's disease or ulcerative colitis undergoing treatment with azathioprine and/or mesalazine.
METHODS
Retrospective observational study based on clinical and laboratory data collected from medical records of 76 adult patients with inflammatory bowel disease treated with azathioprine, mesalazine or both. Sex, age, diagnosis, number of blood samples and elevated serum C-reactive protein levels during the follow-up period were recorded. The following variables were analyzed in terms of C-reactive protein levels and leukopenia episodes: sex, age, diagnosis of inflammatory bowel disease and type of drug. Statistical analyses included multiple logistic regression and the Fisher's exact test for qualitative variables.
RESULTS
Leukopenia was observed in 18.4% of patients and was associated with older age and higher doses of medication. In 44% of patients, C-reactive protein levels were high. However, symptoms were not associated with abnormal levels of this marker.
CONCLUSION
Regardless of symptoms, serum C-reactive protein levels were not a reliable indicator of controlled inflammatory bowel disease. Leukopenia was independently associated with older age and higher doses of medication and is a common side effect, which should be routinely monitored.
Topics: Adult; Azathioprine; C-Reactive Protein; Humans; Inflammatory Bowel Diseases; Leukopenia; Mesalamine; Prevalence
PubMed: 35584442
DOI: 10.31744/einstein_journal/2022AO6500 -
International Journal of Molecular... Jul 2020Hypercholesterolemia, also called high cholesterol, is a form of hyperlipidemia, which may be a consequence of diet, obesity or diabetes. In addition, increased levels...
Hypercholesterolemia, also called high cholesterol, is a form of hyperlipidemia, which may be a consequence of diet, obesity or diabetes. In addition, increased levels of low-density lipoprotein (LDL) and reduced levels of high-density lipoprotein (HDL) cholesterol are associated with a higher risk of atherosclerosis and coronary heart disease. Thus, controlling cholesterol levels is commonly necessary, and fibrates have been used as lipid-lowering drugs. Gemfibrozil is a fibrate that acts via peroxisome proliferator-activated receptor alpha to promote changes in lipid metabolism and decrease serum triglyceride levels. However, anemia and leukopenia are known side effects of gemfibrozil. Considering that gemfibrozil may lead to anemia and that gemfibrozil acts via peroxisome proliferator-activated receptor alpha, we treated wild-type and peroxisome proliferator-activated receptor alpha-knockout mice with gemfibrozil for four consecutive days. Gemfibrozil treatment led to anemia seven days after the first administration of the drug; we found reduced levels of hemoglobin, as well as red blood cells, white blood cells and a reduced percentage of hematocrits. PPAR-alpha-knockout mice were capable of reversing all of those reduced parameters induced by gemfibrozil treatment. Erythropoietin levels were increased in the serum of gemfibrozil-treated animals, and we also observed an increased expression of () and in renal tissue, while PPAR-alpha knockout mice treated with gemfibrozil did not present increased levels of serum erythropoietin or tissue HIF-2α and erythropoietin mRNA levels in the kidneys. We analyzed bone marrow and found that gemfibrozil reduced erythrocytes and hematopoietic stem cells in wild-type mice but not in PPAR-alpha-knockout mice, while increased colony-forming units were observed only in wild-type mice treated with gemfibrozil. Here, we show for the first time that gemfibrozil treatment leads to anemia and leukopenia via peroxisome proliferator-activated receptor alpha in mice.
Topics: Anemia; Animals; Cell Count; Gemfibrozil; Hematopoietic Stem Cells; Hypercholesterolemia; Hypolipidemic Agents; Leukopenia; Male; Mice; Mice, Inbred C57BL; PPAR alpha
PubMed: 32708962
DOI: 10.3390/ijms21145050 -
Biological & Pharmaceutical Bulletin 2015Ganciclovir is a nucleoside guanosine analogue that exhibits therapeutic activity against human cytomegalovirus infection, and is primarily excreted via glomerular...
Ganciclovir is a nucleoside guanosine analogue that exhibits therapeutic activity against human cytomegalovirus infection, and is primarily excreted via glomerular filtration and active tubular secretion. The adverse effects induced by ganciclovir therapy are generally of a hematological nature and include thrombocytopenia and leukopenia. Low marrow cellularity and elevated serum creatinine have been identified as risk factors for ganciclovir-induced neutropenia. However, the risk factors for thrombocytopenia have yet to be determined. Therefore, this study investigated patients administered ganciclovir to determine the risk factors for thrombocytopenia and leukopenia. Thrombocytopenia occurred in 41 of these patients (30.6%). Multivariate logistic regression analysis identified three independent risk factors for thrombocytopenia: cancer chemotherapy (odds ratio (OR)=3.1), creatinine clearance (<20 mL/min) (OR=12.8), and the ganciclovir dose (≥12 mg/kg/d) (OR=15.1). Leukopenia occurred in 36 patients (28.6%), and white blood cell count (<6000 cells/mm(3)) (OR=3.7) and the ganciclovir dose (≥12 mg/kg/d) (OR=7.8) were identified as risk factors. These results demonstrated that several factors influenced the occurrence of ganciclovir-induced thrombocytopenia and leukopenia, and suggest that special attention should be paid to patients receiving cancer chemotherapy with a low creatinine clearance (<20 mL/min) and high dose (≥12 mg/kg/d) in order to avoid ganciclovir-induced thrombocytopenia.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Antiviral Agents; Creatinine; Cytomegalovirus Infections; Female; Ganciclovir; Humans; Leukocyte Count; Leukopenia; Male; Middle Aged; Odds Ratio; Platelet Count; Risk Factors; Thrombocytopenia; Young Adult
PubMed: 25747982
DOI: 10.1248/bpb.b14-00588