ABSTRACT
La policitemia Vera se encuentra entre las neoplasias mieloides según la clasificación más reciente de la Organización Mundial de la Salud (OMS). Sus criterios diagnósticos han tenido variaciones en los últimos años y en este trabajo se realiza un análisis de estos criterios, así como de la respuesta a los tratamientos empleados en 349 pacientes atendidos en el Instituto de Hematología e Inmunología en los últimos 40 años. Se sugiere, dada su factibilidad y eficacia, continuar utilizando por el momento la clasificación OMS del 2001, y de acuerdo con la experiencia acumulada, se propone el tratamiento con medicamentos de primera y segunda líneas según la edad y las características clínicas de cada enfermo
The Polycythemia vera is located among the myeloid neoplasms according to the more recent classification of the HWO. Its diagnostic criteria have underwent variations in past years and in present paper authors made an analysis of such criteria, as well as of the response to treatments applied in 349 patients seen in the Institute of Hematology and Immunology during the past 40 years. Due to feasibility and effectiveness, for the moment, is has been suggested to carry on with the use of the classification of WHO of 2001, and according to the experience gained, it is proposed the treatment with first and second line drugs by age and the clinical features of each patient
Subject(s)
Humans , Male , Female , International Classification of Diseases/standards , Polycythemia Vera/diagnosis , Polycythemia Vera/therapy , Case Reports , International Classification of Diseases/methodsABSTRACT
Two cases of autoimmune hemolytic anemia that occurred during the treatment of chronic hepatitis C with pegylated alpha-2a interferon and ribavirin, in HIV coinfected patients, are presented and described. The late occurrence (after six months of therapy) of this severe hemolytic anemia leads to the recommendation that hemoglobin levels should be monitored throughout the treatment period, even among patients who presented stable hemoglobin levels in the preceding months.
São apresentados e discutidos dois casos de anemia hemolítica auto-imune que ocorreram durante o tratamento da hepatite crônica pelo vírus C, com interferon peguilado alfa 2a e ribavirina, em pacientes co-infectados pelo HIV. A ocorrência de anemia hemolítica grave em etapa tardia, após o sexto mês da terapêutica, recomenda que o controle dos níveis de hemoglobina deva ser feito durante todo o período do tratamento , mesmo nos pacientes que apresentam níveis estáveis de hemoglobina nos meses precedentes.
Subject(s)
Humans , Male , Middle Aged , Anemia, Hemolytic, Autoimmune/chemically induced , Antiviral Agents/adverse effects , HIV Infections/drug therapy , Hepatitis C, Chronic/drug therapy , Interferon-alpha/adverse effects , Ribavirin/adverse effects , Anemia, Hemolytic, Autoimmune/diagnosis , Antiviral Agents/therapeutic use , Drug Therapy, Combination , HIV Infections/complications , Hepatitis C, Chronic/complications , Interferon-alpha/therapeutic use , Ribavirin/therapeutic useABSTRACT
BACKGROUND/AIMS: The aim of this study was to evaluate the effect of alpha-interferon (IFN) on liver histology as well as on activation of hepatic stellate cell ( HSC) and trans for ming growth fact or beta-1 (TGF beta-1) expression. We had also investigated the clinical usefulness of TGFbeta-1 and alpha-smooth muscle actin (alpha-SMA) expression in liver tissue for predicting a response to alpha-IFN therapy in chronic hepat it is B. METHODS: We studied the expression of TGFbeta-1 and alpha-SMA in liver biopsys pecimens from 51 chronic hepatitis B pat ients. Using immunohistochemical staining and a semiquant it ative scoring met hod, we also evaluated TGF-beta1 and alpha-SMA expression in liver stellate cells before and after alpha-IFN therapy in liver tissue from rebiopsys pecimen of the 12 chronic hepatitis B pat ients. Recombinant IFN alpha-2b (Intron A) in doses of 6 MU/ d was given to patients intramus cularly three times per week for 6 months (total doses , 432 MU). The patients were divided into two groups according to serum alanine aminotransferase levels as well as HBV- DNA and HBeAg s eroconversion stat e. Histological grading and staging scores were according to modified Histological Activity Index (HAI) grading systems of Ishak (1995). RESULTS: The index of portal inflammation and total scores of HAI grading significantly decreased in biopsies after alpha-IFN treatment, but the scores of fibrosis staging showed no significant change in biopsies after IFN treatment. A significant decrease in alpha-SMA expression, especially in periportal area, was found, but the change of TGFbeta-1 expression was not significant. The immunoreactivity of alpha-SMA was significantly lower in responders than in non-responders, whereas the diffference of immunoreactivity of TGF-beta1 between these two groups was not found. CONCLUSIONS: These findings suggest that alpha-IFN therapy may reduce the necroinflammatory activity in liver tissues of chronic B viral hepatitis and that the degree of alpha-SMA expression before treatment may be employed as a pottent predicting indicator for the therapeutic efficacy of IFN-alpha.