Significance of Neutrophil Gelatinase-Associated Lipocalin Level as an Acute-Phase Reactant in Patients with Systemic Inflammatory Response Syndrome

BACKGROUND: We investigated the significance of plasma neutrophil gelatinase-associated lipocalin (pNGAL) level as an acute-phase reactant and an index for an increase in serum creatinine (sCr) level in patients with inflammatory diseases. METHODS: A total of 63 patients with systemic inflammatory response syndrome (SIRS) and 149 without SIRS were evaluated, and pNGAL level was determined using a fluorescence immunoassay. sCr levels were measured daily during three days, and the difference between the initial and follow-up sCr levels was defined as a delta sCr value. Serum albumin/sCr ratio (sACR) was calculated. High-sensitivity C-reactive protein (hsCRP) level was determined using a latex turbidometric method. RESULTS: The median pNGAL level in the SIRS group (154 ng/mL) was significantly higher than that in the non-SIRS (86 ng/mL) and control (62 ng/mL) groups (P<0.001, respectively). The area under the ROC curve (AUC) of pNGAL for diagnosing SIRS was 0.725 (95% CI, 0.664-0.781), which was not significantly different from that of hsCRP (0.749; 95% CI, 0.685-0.809; P=0.375). Multivariate regression analyses revealed that log-pNGAL was significantly associated with hsCRP (beta=0.546, P<0.001) and sACR (beta=0.351, P<0.001). The AUC of pNGAL for the positive delta sCr in 48-72 hr was 0.649 (95% CI, 0.542-0.746, P=0.023) in the SIRS group. CONCLUSIONS: pNGAL is comparable to hsCRP as an inflammation-related parameter, and its measurement may provide additional information for a potential increase in sCr during 48-72 hr in patients with SIRS.

Klebsiella Pneumoniae Associated Extreme Plasmacytosis / 감염과화학요법

Infection-associated plasmacytosis is not uncommon; however, marked plasmacytosis in both peripheral blood and bone marrow that mimicks plasma cell leukemia is a very rare condition. We encountered a case of extreme plasmacytosis associated with Klebsiella pneumoniae sepsis in an aplastic anemia patient. A 42-year-old man presented with high fever of 5 days' duration. Hematological analysis revealed severe neutropenia and thrombocytopenia; his white blood cell count was 900/mm3, with 26% of plasma and plasmacytoid cells in peripheral blood. Bone marrow biopsy and aspiration showed 25% cellularity with marked plasmacytosis (80%), highly suggestive of plasma cell leukemia. On the eighth hospital day, K. pneumoniae was identified in blood and sputum cultures. Fever improved after switching antibiotics, although his hematological condition worsened. His bone marrow cellularity (plasma cell proportion) progressively decreased: the values were 25% (80%), 10% (26%), 10% (11%), and < 10% (< 4%) on the 8th, 30th, 60th, and 90th hospital day, respectively. His plasmacytosis was extremely severe but was confirmed to be reactive with polyclonality. The present case represents the first report of strong suspicion of K. pneumoniae sepsis-associated marked plasmacytosis in an aplastic anemia patient.

Serum glycated albumin as a new glycemic marker in pediatric diabetes

PURPOSE: Serum glycated albumin (GA) has been recently used as another glycemic marker that reflects shorter term glycemic control than glycated hemoglobin (HbA1c). Insulin secretory function and glycemic fluctuation might be correlated with the ratio of GA to HbA1c (GA/HbA1c) in diabetic adult patients. This study investigated the association of GA and GA/HbA1c ratio with the levels of fasting C-peptide, fasting plasma glucose in type 1 and type 2 pediatric diabetes. METHODS: Total 50 cases from 42 patients were included. The subjects were classified into type 1 diabetes mellitus (T1DM) (n=30) and type 2 diabetes mellitus (T2DM) (n=20) group. The associations among HbA1c, GA, and GA/HbA1c ratio were examined. The relationship between the three glycemic indices and fasting glucose, fasting C-peptide were analyzed. RESULTS: Mean values of GA, the GA/HbA1c ratio were significantly higher in T1DM than T2DM. GA (r=0.532, P=0.001), HbA1c (r=0.519, P=0.002) and the GA/HbA1c ratio (r=0.409, P=0.016) were correlated with the fasting plasma glucose. Fasting C-peptide level arranged 4.22+/-3.22 ng/mL in T2DM, which was significantly above the values in T1DM (0.26+/-0.49 ng/mL). There were no significant correlation between HbA1c and fasting C-peptide level. However, GA and the GA/HbA1c ratio exhibited inverse correlations with fasting C-peptide level (r=-0.214, P=0.002; r=-0.516, P<0.001). CONCLUSION: GA seems to more accurately reflects fasting plasma glucose level than HbA1c. GA, GA/HbA1c ratio appear to reflect insulin secretory function.

Significance of Serum Eosinophil Cationic Protein and High-Sensitivity C-reactive Protein Levels in Patients with Allergic and Non-Allergic Inflammatory Diseases

BACKGROUND: This study was conducted to evaluate the significance of serum eosinophil cationic protein (ECP) and high-sensitivity C-reactive protein (hs-CRP) levels in children with allergic diseases and non-allergic inflammatory diseases, and to assess the relationships between serum ECP levels and inflammatory parameters. METHODS: In this study, we included 146 children with allergic diseases, 76 children with non-allergic inflammatory diseases, and 25 control subjects. Serum concentrations of ECP, hs-CRP, total IgE, and allergen-specific IgE were measured. RESULTS: Serum ECP levels (77.5+/-88.2 microg/L) of patients with allergic diseases were significantly higher than those of the patients with non-allergic inflammatory diseases (42.2+/-58.8 microg/L) and control subjects (12.7+/-4.2 microg/L) (P0.05). CONCLUSIONS: Measurement of serum ECP and hs-CRP concentrations can be helpful in the clinical evaluation and monitoring of patients with allergic diseases. No significant correlation was observed between serum ECP and hs-CRP levels in allergic patients, thereby suggesting that elevated levels of ECP do not necessarily reflect the degree of systemic inflammation in allergic diseases.

Chronic Myelogenous Leukemia with a Variant Philadelphia Translocation: t(11;22)(q25;q11.2) / 대한진단검사의학회지

We report a case of chronic myelogenous leukemia displaying a variant Philadelphia translocation t(11;22)(q25;q11.2). Breakpoint 11q25 has not previously been reported. Reverse transcriptase polymerase chain reaction and fluorescence in-situ hybridization demonstrated the BCR/ABL rearrangement.

Revaluation of Neonatal Screening Test for Congenital Adrenal Hyperplasia / 대한소아내분비학회지

PURPOSE: Newborn screening based on measurement of 17alpha-hydroxyprogesterone (17-OHP) in a dried blood spot on filter paper is an effective tool for early diagnosis of congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency. High levels of 17-OHP are frequently observed in premature infants without CAH. The purpose of this study is to evaluate cut-off limits of 17-OHP on the basis of gestational age and birth weight. METHODS: A total of 1,218 newborn were screened for CAH by measuring blood spot 17-OHP concentration. An enzyme linked immunosorbent assay (ELISA) method (Bayer(TM), Neonate 17-OHP Kit, Tokyo, Japan) was used. The values were analyzed on the basis of birth weight and gestational age at birth to decide the appropriate cut-off limits in neonatal mass screening for 21-hydroxylase deficiencies. RESULTS: In the neonatal mass screening for CAH, the median value of 17-OHP in the subject population was 3.13 ng/mL (0-62.3 ng/mL). Median values of 17-OHP of full term infants and premature infants were 2.44 ng/mL (0.03-27.1 ng/mL) and 4.85 ng/mL (0.06-62.3 ng/mL). 17-OHP levels are higher in preterm infants, and decrease in relation to gestational age (P or =2,500 g] infants and low birth weight (BW<2,500 g) infants were 2.57 ng/mL (0-32.40 ng/mL) and 5.02 ng/mL (0.06-62.30 ng/mL). 17-OHP levels increased with decreasing birth weight (P<0.01). When we applied 99.5 percentile, the cutoff levels were 18.33 ng/mL in normal birth weight infants and 56.46 ng/mL in low birth weight infants. Recall rates were markedly decreased when these cutoff levels were applied; 30.2-fold decrease in gestational age <30 wks and 8.2-fold decrease in birth weight <1,000 g. CONCLUSION: The screening for CAH using 17-OHP should be considered on the basis of gestational age and birth weight. Recall rate and false positive rate markedly decrease in preterm infants and low birth weight infants when new cutoff levels of 17-OHP are applied.

Ex vivo Expansion and Clonal Maintenance of CD34+ Selected Cells from Cord Blood and Peripheral Blood / 소아과

PURPOSE: Because of the unavailability of marrow transplantation, umbilical cord blood (CB) is increasingly being used. We evaluated the potential of ex vivo expansion and clonality in CD34+ cells separated from cord blood source and mobilized peripheral blood (PB) in a serum-free media. METHODS: The CD34+ cells, selected from CB and mobilized PB, were expanded with hematopoietic growth factors. They were then cultured for burst-forming units of erythrocytes (BFU-E), colony-forming units of granulocytes and monocytes (CFU-GM) and colony-forming units of megakaryocytes (CFU-Mk) at culture days 0, day 4, day 7, and day 14 with various growth factors. RESULTS: The CB-selected CD34+ cells showed significantly higher total cell expansion than those from the PB at day 7 (2 fold increase than PB). The CB-selected CD34+ cells produced more BFU-E colonies than did the PB on culture at days 7 and at day 14. Also, the CB-selected CD34+ cells produced more CFU-Mk colonies than did the PB on culture at day 4 and at day 7. CONCLUSION: The ex vivo expansion of the CB cells may be promising in producing total cellular expansion, CFU-Mk and BFU-E compared with PB for 7 to 14 days. The growth factors combination including megakaryocyte growth and development, flt3-ligand and interleukin-3 showed more expansion in the view of total cells and clonal maintenance compared with less combination.

Iron Status in Korean Middle School Students and Possible Association with Obesity

BACKGROUND: Iron deficiency (ID) in Korean adolescents still remains a problem. This study aimed to assess the prevalence of iron status and investigate the relationship between the iron status and obesity. METHODS: Hematological examinations were performed on apparently healthy 12~14 year old students (M:F=451:442) living in Incheon during September, 2004. ID was defined as a serum ferritin concentration <10ng/mL. The diagnosis of iron deficiency anemia (IDA) was established when anemia (male <12.5g/dL, female <12g/dL) was associated with a ferritin level <10ng/mL and/or transferrin saturation <16%. Using age- and gender-specific BMI percentiles, overweight was defined as a BMI=85th percentile. RESULTS: The prevalence of ID and IDA were 8.4 and 15.6% and 0.9 and 4.5% in males and females, respectively. Using an analysis based on the BMI, the prevalence of obesity were 21.8 and 16.2% in males and females, respectively. The prevalence of ID in male students was decreased in the obesity (0.0%) compared with the non-obesity group (11.4%). In female students, ID showed a higher frequency in the non-obesity (20.4%) compared with the obesity group (12.0%). CONCLUSIOM: Iron deficiency still remains a major nutritional problem in adolescent females, with the prevalence of obesity significantly increasing. Although no association between the prevalence of iron deficiency and obesity was shownin this study, it is important to screen for iron deficiency and obesity, and provide effective nutritional education. Furthermore, the association of obesity with iron deficiency in relation to eating behavior should be investigated.

Influence of Serum TRAIL Concentrations on Disease Activity in RA Patients / 대한류마티스학회지

OBJECTIVE: TNF-alpha related apoptosis inducing ligand (TRAIL) is a member of TNF superfamily that promotes apoptosis by binding to the transmembrane receptors. The effects of TRAIL in patients with rhematoid arthritis (RA) are still debatable. This study was performed to evaluate the effects of TRAIL on RA by measuring serum concentration of TRAIL in patients with RA and assessing relationships between the TRAIL concentration and various clinical parameters of RA. METHODS: A total of 105 patients with RA, 34 patients with osteoarthritis (OA), and 35 age- and gender-matched healthy controls were enrolled in this study. Data from the RA patients included subject's age, duration of disease, daily steroid doses, ESR, CRP, rheumatoid factor, leukocyte count, lymphocyte count, tender joint count, swollen joint count, and serum TRAIL concentration. Serum TRAIL concentration was measured by enzyme immunoassay (EIA) method. The serum concentration of TRAIL in RA patients was compared to those of OA patients and healthy controls. Relationships of TRAIL concentration with various clinical parameters were evaluated. RESULTS: Serum concentration of TRAIL in patients with RA was significantly decreased compared to that in healthy controls (RA: 42.60+/-26.39 pg/mL, control: 57.21+/-19.49 pg/mL, p=0.029). Serum concentration of TRAIL in patients with OA (50.79+/-15.92 pg/mL) was not different from that in normal controls (p=0.115). There were no significant differences in serum TRAIL concentration between patients with RA and those with OA (p=0.360). In patients with RA, serum TRAIL concentration showed no difference between high- and normal ESR subgroups, as well as high- and normal CRP subgroups. Serum TRAIL concentration correlated significantly with ESR (r=0.406, p<0.001). However, other clinical parameters, such as subject's age, duration of disease, daily steroid doses, CRP, leukocyte count, lymphocyte count, tender joint count, swollen joint count revealed no significant correlation with serum TRAIL concentration. CONCLUSION: Serum concentrations of TRAIL in RA patients were significantly lower than those in healthy controls, suggesting that apoptotic ability is decreased in the patients with RA. Serum TRAIL concentration does not seem to reflect disease activity of RA.

Double Minutes Containing C-MYC oncogene with a Normal Karyotype in Acute Myelogenous Leukemia: A Case Report / 대한진단검사의학회지

We report a case of a female karyotype that was normal except for double minutes (dmin) in acute myeloid leukemia. Using fluorescence in situ hybridization, the amplification of C-MYC was detected in both interphase and metaphase cells. The patient of the present case had received only limited therapy with cytosine arabinoside, but lived for more than one year. It supports the recent notion that dmin may not necessarily be associated with a poor outcome.

Balantidium coli in an Asymptomatic Patient: A Case Report / 대한진단검사의학회지

Balantidium coli is widely distributed in hogs, particularly in warm and temperate climates, and in monkeys in the tropics. B. coli is the only pathogenic ciliate and is the largest protozoan parasitizing humans. Some individuals with B. coli infections are totally asymptomatic, whereas others have symptoms of severe dysentery similar to those seen in patients with amebiasis. We report a 5-year-old girl with asymptomatic balantidiasis. The patient was suffering from herpes zoster for several days. She did not have symptoms of dysentery or urinary tract infection. Motile trophozoites of B. coli were observed in the urinary sediment. This is the first report of asymptomatic balantidiasis in Korea.

Iron Status in Adolescent Female Athletes / 대한혈액학회지

BACKGROUND: This study was aimed at assessing iron nutrition and lipid panel in adolescent female athletes, which were compared with those in general adolescent students. MATERIALS AND METHODS: Physical measurement and blood examination were done from adolescent female athletes (N=83) and apparently healthy students (N=758). Anemia was defined as a hemoglobin less than 12g/dL. Iron deficiency was defined as a serum ferritin concentration<10ng/mL. The diagnosis of iron deficiency anemia (IDA) was established when a low hemoglobin level (Hb<12g/dL) was associated with ferritin<10ng/mL and/or transferrin saturation<10%. RESULTS: The prevalence of anemia in female athletes aged 11 to 14 years was 22.2%, which was significantly higher than that of comparison group (10.1%). However, there were no significant differences in proportion of iron deficiency (20% vs. 27.4%) and IDA (15.6% vs. 8.9%) between two groups. The prevalence of anemia in female athletes aged 15 to 19 years was 26.3%. The prevalence of iron deficiency and IDA were 31.6% and 21.1%, respectively, which were not significantly different from the comparison group. The mean triglyceride level in the athlete girls was lower than the comparison group. And the mean HDL cholesterol level was higher than the comparison group. CONCLUSION: As the prevalence of iron deficiency and IDA is relatively common in adolescent female athletes, the measurement of iron nutrition is warranted in these groups with nutritional education.

Alternation of Cytokine mRNA Expression in Human Blood Samples before and after Allogeneic Transfusions / 대한진단검사의학회지

BACKGROUND: Despite proposing clonal depletion, anergy, and alternation of cytokines in peripheral tolerance, the precise mechanism for the immunosuppressive effect of blood transfusion remains unknown. Here, we evaluated the effect of transfusion on the immune system indirectly via quantitation of leukocyte cytokine mRNA expression before and after allogeneic transfusion. METHODS: Samples were obtained from eight patients, being ordered one to four units of leukocytefree erythrocytes, before, 1, and 7 days after transfusion, from November to December, 2002 at Inha University Hospital. We explored the changes in mRNA expression of interleukin-2 (IL-2), IL-4, IL-10, tumor necrosis factor alpha (TNF-alpha) and interferon gamma (IFN-gamma). RESULTS: In four patients who received blood transfusions among eight, significant changes were observed in the blood mRNA levels of INF-gamma and IL-10. The amounts of IFN-gamma mRNA were significantly decreased a day after transfusion to 78.5% and then recovered to 110.9% 7 days later (P=0.032), whereas, that of IL-10 was increased to 151.5% a day after and recovered to 119.1% 7 days later (P=0.034). mRNA expressions of IL-2, IL-4, and TNF-alpha were not detected in all patients. CONCLUSIONS: We observed a significant decrease in leukocyte IFN-gamma mRNA expression and an increase in IL-10 mRNA after transfusion. These findings indirectly represent that down-regulation of the Th1 cells and the up-regulation of the Th2 cells could be caused by allogeneic transfusion.

A Novel-Thalassemic Mutation, Codons 89/90-TG, Found in Two Korean Families / 대한임상병리학회지

We describe a novel-thalassemia mutation, the deletion of TG at codons 89/90 of the globin gene, found in two unrelated Korean families. Their hematological findings varied, but some patients showed prominent anemia. This mutation would introduce a premature stop codon (TGA) at codon 93. But a RNA study revealed that the / ratio was within normal range, and the amount of the mutant -globin RNA was comparable to that of normal-globin RNA. These data suggests this novel mutation as a dominant type. The haplotype and frameworks linked to the mutation were different between the two families.

Iron Status in Adolescents and University Students in Incheon / 대한혈액학회지

BACKGROUND: Iron deficiency anemia (IDA) frequently occurs in adolescents because of accelerated physical growth in boys and girls. This was aimed at assessing the prevalence of iron deficiency and IDA in apparently healthy Korean adolescents according to the gender and age. METHODS: Apparently healthy students(M: F=1: 1.2) aged 11 to 24 years were included in this study and blood samples were obtained from April to May, 2000. Hemoglobin, hematocrit, red blood cell indices, serum ferritin, iron and total iron-binding capacity were measured. RESULTS: In males, the prevalence of iron deficiency was 15.7% in the 11~12 years group, 16.1% in the 13~14 years group, 9.9% in the 15~16 years group, and 6.4% in the 17~18 years group. In females, the prevalence of iron deficiency was 26.8% in 11~12 years group, 27.9% in the 13~14 years group, 38.8% in the 15~16 years group, 36.0% in the 17~18 years group, 30.9% in the 19~24 years group. The prevalence of IDA in males was 3.6% in 11~12 years, 2.1% in 13~14 years group, 1.9% in 15~16 years group, and 0.6% in 17~18 years group. The prevalence of IDA in females was 4.2% in 11~12 years, 9.7% 13~14 years, 20.4% in 15~16 years, 16.2% in 17~18 years group, and 12.4% in 19~24 years group. CONCLUSION: As the prevalence of iron deficiency and IDA were substantially greater than expected, studies of iron state in adolescent girls, especially middle to high school age, should be undertaken to assess iron deficiency.

Analysis of Blood Spot 17-Hydroxyprogesterone Concentration According to Gestational Age and Birth Weight / 대한임상병리학회지

BACKGROUND: High levels of 17-hydroxyprogesterone (17-OHP) are frequently observed in premature infants without congenital adrenal hyperplasia. The purpose of this study is to set cut-off limits of 17-OHP on the basis of gestational age at birth and birth weight. METHODS: Blood spot 17-OHP concentrations were measured in 1,000 infants on the 3th day of life at Inha University Hospital. An enzyme-linked immunosorbent assay (ELISA) method (ICN Neoscreen ELISA 17-hydroxyprogesterone kit, ICN Pharmaceuticals. Inc., Japan) was used. The values obtained were analyzed with respect to birth weight and gestational age at birth in order to decide the appropriate cut-off limits in a neonatal mass screening for 21-hydroxylase deficiency. RESULTS: In the neonatal mass screening for CAH, the cut-off limits for determining the 17-OHP for recall, were decided as follows: (1) 57.65, 39.88, 33.52 ng/mL for gestational age at birth of 35 weeks or less, 36-37, and 38 weeks or more, respectively, and (2) 54.88, 43.86, 32.92 ng/mL for birth weight of 2.49 or less, 2.50-2.99, 3.00 kg or more, respectively. CONCLUSIONS: The cut-off limits on the basis of gestational age at birth and birth weight should be used in the screening for congenital adrenal hyperplasia. We believe that the false positive rate in premature infants can be reduced using this method.

Change of Erythropoiesis and Serum Transferrin Receptor Levels with Gestational Age in Healthy Pregnant Women / 대한혈액학회지

BACKGROUND: To investigate the change of iron dynamics, erythropoiesis, and serum transferrin receptor (sTfR) concentration during pregnancy, we measured the reticulocyte subpopulations, reticulocyte maturity index (RMI) and sTfR concentration in normal pregnant women. Also we determined which parameter among sTfR, serum iron, or serum ferritin is more representative for clinical features and erythropoiesis in pregnant women. Method: A total of 283 pregnants were examined for reticulocyte subpopulations, sTfR, and a battery of iron parameters. Reticulocytes and their subpopulations were automatically analyzed by flow cytometry (R-3000; Sysmex, Toa, Japan). Serum iron and TIBC were assayed with the automatic chemical analyzer (Hitachi 747; Hitachi, Tokyo, Japan) and serum ferritin was measured by the chemiluminescence method (ACS 180; Chiron, USA). Soluble transferrin receptor was measured by the immunoenzymometric method (ELISA ; Orion Diagnostica, Finland). RESULTS: There was no significant difference in sTfR concentration between pregnant women in the 1st trimester (2.29+/-0.45 mg/L) and non-pregnant women (2.18+/-0.46 mg/L). However, the sTfR concentration gradually increased with gestational age from the 2nd trimester of pregnancy and reached maximal concentration (5.76+/-1.12 mg/L) in the 3rd trimester. The mean sTfR in postpartum 12 weeks was similar to that in the 1st trimester. RMI in the 3rd trimester was three- to four- fold higher than that in the 1st trimester. The sTfR correlated better with RMI (r=0.62, P<0.01), MCH (r=-0.61, P<0.01) and gestational age (r=0.51, P<0.01) than to serum iron and ferritin. CONCLUSIONS: The sTfR concentration increases with gestational age during pregnancy and returns to normal at 12 weeks after delivery. Elevated sTfR concentration during pregnancy seems to be more influenced by erythroid TfR turnover than by iron depletion. The sTfR is a more reliable predictor of erythropoiesis and iron status during pregnancy than serum iron or ferritin.

The Usefulness of Serum Transferrin Receptor in Anemia with Rheumatoid Arthritis: Comparison with Bone Marrow Iron Store / 대한류마티스학회지

OBJECTIVE: This study was aimed at investigating the usefulness of serum transferrin receptor (sTfR) in anemic patients with rheumatoid arthritis (RA) compared with bone marrow storage iron and other tests for anemia. METHODS: Fifty-five anemic RA patients were undergone anemia study including hematologic indices, iron panel, and sTfR. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were also measured. Eighteen patients performed marrow iron stain. The sTfR and serum ferritin levels were compared with bone marrow iron store, hematologic values, iron batteries, and markers of the disease activity. RESULTS: 1) Mean sTfR concentration was 2.68+/-1.29mg/L in all patients. 2) sTfR correlated significantly with hemoglobin concentration (r=-0.491; p<0.001), hematocrit (r=-0.348; p=0.009), MCV (r=-0.597; p<0.001), RDW (r=0.696; p<0.001), serum iron (r=-0.389; p=0.003), and transferrin saturation (r=-0.451; p=0.001) 3) Ferritin did not correlated significantly with hemoglobin, hematocrit, serum iron/TIBC, MCV and RDW, except reticulocyte count (r=0.295; p=0.032) and total iron binding capacity (TIBC) (r=-0.503; p<0.001). 4) sTfR showed no significant correlation with ESR and CRP, whereas ferritin correlated with CRP (r=0.342; p=0.019). 5) Among the patients who performed iron staining from bone marrow, sTfR was higher in ?ron-depleted? group compared with ?ron replete? group (p=0.040). CONCLUSION: This study suggests that measurement of sTfR may be useful assay for anemia and the possible substitute for invasive bone marrow study in differentiating iron deficiency anemia from anemia of chronic diseases in patients with RA.

The Usefulness of Serum Transferrin Receptor in Anemia with Rheumatoid Arthritis: Comparison with Bone Marrow Iron Store / 대한류마티스학회지

OBJECTIVE: This study was aimed at investigating the usefulness of serum transferrin receptor (sTfR) in anemic patients with rheumatoid arthritis (RA) compared with bone marrow storage iron and other tests for anemia. METHODS: Fifty-five anemic RA patients were undergone anemia study including hematologic indices, iron panel, and sTfR. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were also measured. Eighteen patients performed marrow iron stain. The sTfR and serum ferritin levels were compared with bone marrow iron store, hematologic values, iron batteries, and markers of the disease activity. RESULTS: 1) Mean sTfR concentration was 2.68+/-1.29mg/L in all patients. 2) sTfR correlated significantly with hemoglobin concentration (r=-0.491; p<0.001), hematocrit (r=-0.348; p=0.009), MCV (r=-0.597; p<0.001), RDW (r=0.696; p<0.001), serum iron (r=-0.389; p=0.003), and transferrin saturation (r=-0.451; p=0.001) 3) Ferritin did not correlated significantly with hemoglobin, hematocrit, serum iron/TIBC, MCV and RDW, except reticulocyte count (r=0.295; p=0.032) and total iron binding capacity (TIBC) (r=-0.503; p<0.001). 4) sTfR showed no significant correlation with ESR and CRP, whereas ferritin correlated with CRP (r=0.342; p=0.019). 5) Among the patients who performed iron staining from bone marrow, sTfR was higher in ?ron-depleted? group compared with ?ron replete? group (p=0.040). CONCLUSION: This study suggests that measurement of sTfR may be useful assay for anemia and the possible substitute for invasive bone marrow study in differentiating iron deficiency anemia from anemia of chronic diseases in patients with RA.

A Case of Cerebral Malaria Associated with Renal Failure due to Plasmodium falciparum / 대한임상병리학회지

In recent years, the incidence of imported cases infested with Plasmodium falciparum has been increasing in Korea due to marked increase in travel to malarious area without adequate prophylaxis. Cerebral malaria is an encephalopathy, occasionally associated with infestation of P. falciparum, which can complicate some patients infected with Plasmodium falciparum leading to significant mortality. We experienced a case of 45 year-ld male with cerebral malaria, complicated with disseminated intravascular coagulation and acute renal failure. The patient was thought to be infected in travel to Indonesia, Laos, and Bangkok. Blood smear showed typical multiple intra-rythrocytic ring form trophozoites and banana-haped gametocytes of Plasmodium falciparum. The patient died after comatose state with respiration failure for 24 days despite treatment with exchange transfusion, hemodialysis and chemotherapy. We report this case with a review of the literature.