Hepatozoon pyramidumi sp. n. (Apicomplexa: Adeleorina) from the blood of Echis pyramidum: morphology and SSU rDNA sequence / Hepatozoon pyramidumi sp. n. (Apicomplexa: Adeleorina) do sangue de Echis pyramidum: morfologia e sequência de SSU rDNA

Abstract Hepatozoon pyramidumi sp. n. is described from the blood of the Egyptian saw-scaled viper, Echis pyramidum, captured from Saudi Arabia. Five out of ten viper specimens examined (50%) were found infected with Hepatozoon pyramidumi sp. n. with parasitaemia level ranged from 20-30%. The infection was restricted only to the erythrocytes. Two morphologically different forms of intraerythrocytic stages were observed; small and mature gamonts. The small ganomt with average size of 10.7 × 3.5 μm. Mature gamont was sausage-shaped with recurved poles measuring 16.3 × 4.2 μm in average size. Infected erythrocytes were hypertrophied; their nuclei were deformed and sometimes displaced from their central position in the normal uninfected cell. Merogonic stages were observed in the lung endothelial cell and the liver parenchyma cells. Mature meront was 17.8 × 13.6 µm and contained banana-shaped merozoites with average size of ~15 × 2 µm. Phylogenetic analysis based on the SSU rDNA sequence clustered Hepatozoon pyramidumi sp. n with previously sequenced Hepatozoon spp., most of them infected reptilian hosts without geographic consideration. The morphological and molecular comparison with closely related species proved the taxonomic uniqueness and novelty of the present form.

Resumo Hepatozoon pyramidumi sp. n. é descrito a partir do sangue da víbora em escamas e quilhas serrilhadas, Echis pyramidum, capturada na Arábia Saudita. Cinco de dez espécimes de víbora examinadas (50%) foram encontradas infectadas com Hepatozoon pyramidumi sp. n. com nível de parasitemia de 20% a 30%. A infecção foi restrita apenas aos eritrócitos. Foram observadas duas formas morfologicamente diferentes de estágios intra-eritrocíticos: gamontes de tamanho pequeno e madura. As formas menores de gamontes apresentaram média de 10,7 × 3,5 μm. Os gamontes maduros apresentaram forma de salsicha, com pequenos polos recurvados, medindo 16,3 × 4,2 μm, em média. Os eritrócitos infectados estavam aumentados de tamanho; seus núcleos encontravam-se deformados e, algumas vezes, deslocados de sua posição central, quando comparados às células normais não-infectadas. Foram observados estágios merogônicos em células endoteliais pulmonares e nas células do parênquima hepático. Os merontes maduros apresentavam 17,8 × 13,6 µm e continham merozoítos em forma de banana com tamanho médio de ~ 15 × 2 µm. A análise filogenética baseada nas sequências SSU rDNA agrupou Hepatozoon pyramidumi sp. n com Hepatozoon spp. detectados em répteis de várias regiões geográficas. Por meio de análises morfológicas e moleculares com espécies intimamente relacionadas, demonstrou-se a singularidade dessa nova espécie de Hepatozoon.

Granulomatous pigmented purpuric dermatosis: report of a Latin-American case with blaschkoid distribution

Abstract Granulomatous pigmented purpuric dermatosis clinically manifests as hyperpigmented maculae and petechiae, predominantly on the lower extremities. Histopathologically, it is characterized by a lymphocytic infiltrate in the upper dermis, extravasated erythrocytes, and hemosiderin deposits. There is an infrequent variant called granulomatous pigmented purpuric dermatosis, which histologically is characterized by the presence of non-necrotizing granulomas associated with the classic findings of other pigmented purpuric dermatoses. It more frequently affects middle-aged women of Asian origin, and predominantly on the lower extremities. The authors present the case of a female patient with granulomatous pigmented purpuric dermatosis on the lower extremities with blaschkoid distribution.

Infusion pumps and red blood cell damage in transfusion therapy: an integrative revision of the academic literature / Bombas de infusão e lesão celular em hemácias na terapia transfusional: revisão integrativa da literatura / Bombas de infusión y lesión celular en glóbulos rojos en la terapia transfusional: revisión integradora de la literatura

ABSTRACT Objectives: to obtain information from scientific literature concerning infusion pumps used in administering erythrocyte (red blood cells) and to evaluate the implications in the practical use of this equipment by nurses when conducting transfusions. Method: an integrative revision of the following scientific databases: Pubmed/Medline, Scopus, the Virtual Library for Health, SciELO, Web of Science and Cochrane. The following descriptors were used: "infusion pumps", "blood transfusion", "transfused erythrocyte" and "hemolyis". There were no restrictions on the scope of the initial data and it was finalized in December 2014. 17 articles were identified in accordance with the inclusion and exclusion criteria. Results: all of the publications included in the studies were experimental in vitro and covered the use of infusion pumps in transfusion therapy. A summary of the data was presented in a synoptic chart and an analysis of it generated the following categories: cellular damage and the infusion mechanism. Conclusion: infusion pumps can be harmful to erythrocytes based on the infusion mechanism that is used, as the linear peristaltic pump is more likely to cause hemolysis. Cellular damage is related to the plasmatic liberation of markers that largely dominate free hemoglobin and potassium. We reiterate the need for further research and technological investments to guide the development of protocols that promote safe practices and that can contribute to future clinical studies.

RESUMO Objetivos: identificar na literatura a produção científica acerca dos efeitos de bomba de infusão na administração de hemácias e avaliar as implicações do uso desses equipamentos na prática transfusional de enfermagem. Método: revisão integrativa de literatura nas bases de dados Pubmed/Medline, Scopus, Biblioteca Virtual em Saúde, SciELO, Web of Science e Cochrane, utilizando os descritores "bombas de infusão", "transfusão de sangue", "transfusão de eritrócitos" e "hemólise". A data inicial não foi delimitada e a final foi dezembro de 2014. Foram identificados 17 artigos de acordo com os critérios de inclusão e exclusão. Resultados: Todas as publicações incluídas eram estudos experimentais in vitro e abordavam o uso de bombas de infusão na terapêutica transfusional. A síntese dos dados foi apresentada em quadro sinóptico e a análise gerou duas categorias relevantes: lesão celular e mecanismo de infusão. Conclusão: bombas de infusão podem ser deletérias às hemácias de acordo o mecanismo de infusão, sendo que as peristálticas lineares foram mais predisponentes à hemólise. A lesão celular foi relacionada à liberação plasmática de marcadores, predominando a hemoglobina livre e potássio. Reitera-se a necessidade de pesquisas adicionais e investimentos tecnológicos para nortear o desenvolvimento de protocolos que promovam prática segura e que subsidiem futuros estudos clínicos.

RESUMEN Objetivos: identificar en la literatura la producción científica acerca de los efectos de la bomba de transfusión en la administración de glóbulos rojos y evaluar las implicaciones del uso de esos equipos en la práctica transfusional de enfermería. Método: revisión integradora de literatura en las bases de datos Pubmed/Medline, Scopus, Biblioteca Virtual en Salud, SciELO, Web of Science y Cochrane, utilizando los descriptores "bombas de infusión", "transfusión de sangre", "transfusión de eritrocitos" y "hemolisis". La fecha inicial no fue delimitada y la final fue en diciembre de 2014. Fueron identificados 17 artículos de acuerdo con los criterios de inclusión y exclusión. Resultados: todas las publicaciones incluidas eran estudios experimentales in vitro y abordaban el uso de bombas de infusión en la terapéutica transfusional. La síntesis de los datos se presenta en un cuadro sinóptico y el análisis generó dos categorías relevantes: lesión celular y mecanismo de transfusión. Conclusión: las bombas de infusión pueden ser perjudiciales para los glóbulos rojos de acuerdo el mecanismo de transfusión, siendo que las peristálticas lineares fueron más predisponentes para la hemolisis. La lesión celular fue relacionada a la liberación plasmática de marcadores, predominando la hemoglobina libre y el potasio. Se reitera la necesidad de realizar investigaciones adicionales e inversiones tecnológicas que puedan orientar el desarrollo de protocolos que promuevan la práctica segura y que ayuden a futuros estudios clínicos.

A hundred years after the first article, a recollection: Cabot ring

No abstract available.

Molecular detection of hemoplasma infection among cats from São Luís island, Maranhão, Brazil

Hemoplasmas are bacteria that infect erythrocytes, attaching to the red blood cell. There is a need for more reports of hemoplasma infection prevalence and molecular characterization among cats in Brazil since there are only few published reports. The present work aimed to detect and molecularly characterize the presence of hemotrophic mycoplasmas in domestic cats with outdoor access from São Luís, Maranhão, Brazil. Twenty cats (10%) were positive for Candidatus M. haemominutum, five (2.5%) for M. haemofelis, and four (2.%) for M. turicensis based on 16S rRNA gene PCRs. Five cats (2.5%) were co-positive for Candidatus M. haemominutum and M. haemofelis. PCR diagnosis was confirmed by sequencing; and phylogenetic analysis was based on 16S rRNA and rnpb genes.

A biochemical and histopathological evaluation of generalized pulp calcification in young permanent teeth.

Pulp calcifications are a frequent finding on bitewing and periapical radiographs in older age-groups but their occurrence in the entire dentition in young subjects is unusual. We report such an unusual occurrence of generalized pulp calcification in a 13-year-old Indian female. Radiographic examination of the dentition revealed pulp calcifications in all permanent teeth, located mostly in the pulp chamber but with some in the root canals. The patient's dental, medical, and family history was noncontributory. Biochemical analysis of the removed pulp calcification from one of the teeth during endodontic treatment showed large amounts of calcium, phosphorus, and carbonate. However, metabolic evaluation of patient through liver and kidney function tests and other blood investigations did not reveal any metabolic disorder. The patient was also evaluated for any systemic, syndromic, or genetic involvement but this was also noncontributory. Therefore, we propose that this unusual case of generalized pulp calcification is of idiopathic origin. In this work, histopathological and biochemical evaluations of the pulp calcification was done to try and understand the initiation and progress of calcifications in pulpal tissue.

Pathophysiological insights in sickle cell disease.

The first coherent pathophysiological scheme for sickle cell disease (SCD) emerged in the sixties-seventies based on an extremely detailed description of the molecular mechanism by which HbS in its deoxy-form polymerises and forms long fibres within the red blood cell that deform it and make it fragile. This scheme explains the haemolytic anaemia, and the mechanistic aspects of the vaso-occlusive crises (VOCs), but, even though it constitutes the basic mechanism of the disease, it does not account for the processes that actually trigger VOCs. This paper reviews recent data which imply: red blood cell dehydration, its abnormal adhesion properties to the endothelium, the participation of inflammatory phenomenon and of a global activation of all the cells present in the vessel, and finally, abnormalities of the vascular tone and of nitric oxide metabolism. These data altogether have shed a new light on the pathophysiology of the first molecular disease i.e. sickle cell disease.

Effect of carbonated drink on excisional palatal wound healing: A study on Wistar rats.

Background: Millions of people worldwide consume carbonated drinks every day. The effects of these drinks on hard tissues in the mouth have been proved beyond doubt. Only a little has been done so far to assess the effects of carbonated drinks on oral soft tissues. This study was an attempt to assess the effect of carbonated drinks on oral wound healing. Materials and Methods: Twenty female Wistar rats were considered for the study. A circular wound was created on the palate and the animals were divided into two groups (experimental and control group). The experimental group animals were fed with a commercially available carbonated drink instead of water, and two animals from each group were euthanized at 3, 7, 14 and 21 days. Wound site was assessed morphometrically and histologically. Results: There was a marked difference in the healing pattern between the experimental group and control group animals. Control group animals showed a normal healing pattern with formation of a fibrous connective tissue at the end of 21 days. In the experimental group, healing was delayed and disrupted. The wound site showed a definite palatal perforation in experimental group animals after 14 days, but osteoclasts were not noticed in the histological sections. Conclusion: Consumption of carbonated drinks can disrupt oral wound healing. Results suggest that the bone changes seen in experimental group samples are not mediated by osteoclasts, and acidity of the carbonated drinks could be one of the reasons for these changes.

Evaluación genotóxica del D-004, extracto del fruto de Roystonea regia, mediante el ensayo de micronúcleos / Genotoxic assessment of D-004, extract from Roystonea regia fruit, by means of micronuclei assays

El D-004 es un extracto lipídico del fruto de la palma real (Roystonea regia), que ha demostrado ser eficaz en prevenir la hiperplasia prostßtica inducida por testosterona y por fenilefrina en modelos experimentales en ratas. El objetivo fue determinar si el D-004 induce cambios en la frecuencia de aparición de micronúcleos al realizar la administración oral a dosis repetida durante 8 semanas. Se formaron 5 grupos experimentales (7 animales/grupo): un grupo control solvente, tres tratados con D-004 (500, 1 000 y 1 500 mg/kg) y un control positivo tratado con ciclofosfamida. No ocurrieron muertes ni se detectaron signos clínicos de toxicidad. No hubo diferencias significativas entre controles y tratados en cuanto a la frecuencia de eritrocitos policromatófilos micronucleados y el índice de citotoxicidad. En conclusión, el D-004 administrado por vía oral a las dosis empleadas no presenta actividad clastogénica ni citotóxica en médula ósea de ratones OF-1 machos in vivo.

D-004 is a lipid extract from the real palm fruit (Roystonea regia), which has demonstrated that is effective to prevent prostatic hyperplasia from testosterone and from phenylephrine in rats' experimental models. Aim of this paper was to determine if D-004 provoke changes in appearance frequency of micronuclei during oral administration of repeated doses for 8 weeks. Five experimental groups were created (7animals/group): a solvent control-group, three treated with D-004(500, 1 000, and 1 500 mg/kg), and a positive control-group treated with cyclophosphamide. There were no deaths or clinical signs of toxicity neither significant differences among controls and treated ones as regards the frequency of micronucleated polychromatophils erythrocytes, and the cytotoxic index. In conclusion, D-004 administered per os at doses used has neither clastogenic nor cytotoxic activity in bone marrow male OF-1mice in vivo.

Protective effect of liposomal formulation of tuftsin (a naturally occurring tetrapeptide) against cyclophosphamide-induced genotoxicity and oxidative stress in mice.

Tuftsin, a naturally occurring tetrapeptide with a sequence Thr-Lys-Pro-Arg was evaluated for its in vivo protective effect against cyclophosphamide-induced genotoxicity and oxidative stress in Swiss albino mice. The anticancer drug cyclophosphamide (CP) was administered intra-peritonially to induce mutagenic effect. The drug treatment caused significant increase in chromosomal aberrations, formation of micronucleated polychromatic erythrocytes (MNPCE's), as well as oxidative stress and decrease in lipid peroxidation in liver of the animals. The pretreatment with tuftsin abolished such effects in dose-dependent manner and also increased mitotic index in the experimental animals. Results of the present study validated chemo-preventive properties of tuftsin against CP-induced chromosomal mutations and cellular injury of liver by oxidative stress.

Utilidad clínica del extendido de sangre periférica: los eritrocitos / Extended clinical utility of peripheral blood: red blood cells

A pesar de los grandes avances tecnológicos relacionados con el hemograma, y en particular los derivados de los autoanalizadores de hematología, cada vez más sofisticados y completos, el extendido de sangre periférica continúa siendo el “estándar de oro” del diagnóstico de hematología. De acuerdo con las buenas prácticas de hematología, el extendido de sangre periférica está indicado en todos los hemogramas que muestren alguna desviación en los recuentos directos, indirectos o calculados, o cuando se sospeche clínicamente de una enfermedad de origen hematológico o de origen no hematológico con manifestaciones hematológicas, aun con parámetros entre rangos esperados para la edad y el género. En el extendido de sangre periférica es posible observar alteraciones relacionadas con la morfología de los eritrocitos, leucocitos y las plaquetas. En este módulo se analizarán los aspectos más importantes de la morfología de los eritrocitos, teniendo en cuenta las interacciones entre ellos como el fenómeno de rouleaux y la hemaglutinación, y los conceptos de anisocitosis, poiquilocitosis, anisocromasia y dimorfismo; variaciones en el tamaño, en particular la macrocitosis y la microcitosis; variaciones en la forma de los eritrocitos tales como los dianocitos, estomatocitos, dacriocitos, drepanocitos, ovalocitos, esferocitos, células en champiñón, células espiculadas, queratocitos y esquistocitos; inclusiones eritrocitarias como eritroblastos circulantes, punteado basófilo, cuerpos de Howell-Jolly; y variaciones de la hemoglobina, en particular la hipocromía y la policromatofilia. Se analizan con detalle las características específicas de cada uno de los elementos y se hace una correlación clínica con las enfermedades asociadas. Este primer módulo, dedicado al análisis de la morfología de los eritrocitos en el extendido de sangre periférica, provee al profesional de laboratorio elementos que le permiten identificar adecuadamente las diferentes alteraciones de los eritrocitos, en tanto que al médico le proporciona información para que relacione los hallazgos en la morfología de estas células con la clínica.

Significado da presença de esquizócitos no sangue periférico de gestantes com pré-eclâmpsia / Ming of the presence of schistocytes in blood smear of preeclamptic pregnat women

OBJETIVO: avaliar o significado da presença de esquizócitos em esfregaço de sangue periférico de gestantes com pré-eclâmpsia, identificando-os e correlacionando-os com outros marcadores de hemólise e da gravidade da doença. MÉTODOS: foram avaliadas 76 lâminas de esfregaço de sangue periférico de gestantes portadoras de pré-eclâmpsia. Após a realização do esfregaço, as lâminas foram submetidas ao corante de Leishman e armazenadas até a leitura, feita em microscópio modelo DLMB, da marca Leica, com aumento de 40 vezes e imersão em óleo. O microscópio era dotado de software Qwin Lite 2.5, que permitia gravar as imagens dos campos escolhidos em CD-ROM. Em cada lâmina foram contados dez campos com aproximadamente 100 eritrócitos. Foi considerada presença de esquizócitos (fragmento irregular ou em forma de capacete, de mordida ou triângulo) quando a porcentagem dos mesmos era maior ou igual que 0,2 por cento. A presença de esquizócitos foi correlacionada com outros marcadores de hemólise (hemoglobina, bilirrubina total, desidrogenase lática e reticulócitos), marcadores da pré-eclâmpsia (proteinúria e número de plaquetas) e com a gravidade da pré-eclâmpsia. Para análise estatística foi utilizado o programa Statistical Package in Social Science (SPSS), versão 10.0, com valor de p<0,05. RESULTADOS: os esquizócitos estiveram presentes em 31,6 por cento das gestantes com pré-eclâmpsia, sendo que na maioria (75 por cento) dos esfregaços de sangue havia três ou quatro esquizócitos. Não houve correlação entre a presença de esquizócitos e outros marcadores de hemólise, marcadores da pré-eclâmpsia e a gravidade da doença. CONCLUSÕES: os esquizócitos foram identificados em pequeno número e em menos que um terço das gestantes com pré-eclâmpsia. Não houve correlação com outros parâmetros marcadores de hemólise ou com a gravidade da doença. Assim, a presença de esquizócitos não é um marcador da evolução clínica da pré-eclâmpsia.

PURPOSE: to evaluate the significance of schizocytes presence in peripheral blood smear of pregnant women with pre-eclampsia, identifying and correlating them with other markers of hemolysis and of the disease severity. METHODS: Seventh six glass slides of peripheral blood smear of pregnant women with pre-eclampsia have been evaluated. After the smear, the slides have been stained with Leishman's dye and stored till they were examined with a Leica, model DLMB microscope, provided with the Qwin Lite 2.5 software that made it possible to record the images of selected fields in CD-ROM. Ten fields with approximately 100 erythrocytes were counted in each glass slide. Schizocytes (irregular fragment or helmet-shaped, bite-shaped or triangular) were considered as present, when their percentage was equal or higher than 0.2 percent, their presence being correlated with other hemolysis markers (hemoglobin, total bilirubin, lactic desidrogenasis and reticulocytes), pre-eclampsia markers (proteinuria and platelet number). The Statistical Package in Social Science for Windows (SPSS), 10.0 version has been used for statistical analysis, at p<0.05. RESULTS: schizocytes have been present in 31.6 percent of the pregnant women with pre-eclampsia. In most (75 percent) of the blood smears there have been three or four schizocytes. There has been no correlation between schizocyte presence and any other hemolysis marker, any pre-eclampsia marker or disease severity. CONCLUSIONS: schizocytes have been identified in a small number and in less than a third of the pregnant women with pre-eclampsia. There has been no correlation with other hemolysis marker parameters or with the disease severity. This way, the presence of schizocytes is not a marker of the clinical evolution of pre-eclampsia.

Policitemia vera: relato de caso / Polycythemia vera: case report

A policitemia vera (PV) é um transtorno mieloproliferativo das células hematopoiéticas, caracterizada poruma produção anormal e acentuada de eritrócitos, leucócitos e plaquetas. É uma doença rara, com uma incidênciade 2,3/100.000 pessoas por ano. Apresentamos um relato de caso de uma paciente de 45 anos com sintomas,sinais e achados sugestivos de policitemia vera.

The polycythemia vera is a myeloproliferative disturb from haematopoietic cells characterized by abnormal and overstated production of erythrocytes, leukocytes and platelets. It is a rare disease with an incidenceof 2.3/100.000 people per year. We present a case report of a 45 years old patient with symptoms, signs andsuggestive results of polycythemia vera.

One tube osmotic fragility test: a screening test for microcytic red cells

To evaluate the usefulness of One Tube Osmotic Fragility Test [OTOFT] for detection of microcytosis. Validation study. The study was carried out from July 2004 to November 2004 at Pathology Department PNS Shifa, Karachi. Five hundred and fifteen individuals were studied who reported to the reception of Pathology Dept. for blood complete picture. One drop of finger prick blood was added to a test tube containing 5 ml of 0.36% saline. The results were read at 10 minutes interval by visualizing a written material through the contents of the test tube. Three ml of blood was collected in the EDTA tube by venepuncture for determination of Haemoglobin [Hb], Mean Cell Volume [MCV] and Mean Cell Haemoglobin [MCH] by electronic haematology counter "Sysmex 4500". Out of total 515 subjects studied, OTOFT was positive in 130 [25.2%] and negative in 385 [74.8%] cases. OTOFT positive and negative groups revealed statistically significant difference [P-value of < 0.05] in MCV, MCH and Hb. OTOFT proved to be 92.5% sensitive and 95.2% specific for screening of microcytosis. It had positive predictive value of 85.38% and negative predictive value was 97.66%. The diagnostic accuracy was 94.6%. One Tube Osmotic Fragility Test [OTOFT] is a simple and cost effective test, which is highly sensitive as well as specific for screening of microcytosis. It may prove a useful tool in targeted and/or population screening for thalassaemia

Doença, sangue e raça: o caso da anemia falciforme no Brasil, 1933-1949 / Illness, blood and race: the case of sickle cell anemia in Brazil, 1933-1949

Analisa os estudos médicos brasileiros sobre a anemia falciforme publicados nas décadas de 1930 e 1940. Esta dissertação orienta-se pela compreensão da relação entre sangue, doença e raça no pensamento médico brasileiro dos anos de 1930 e 1940, quando a anemia falciforme era considerada uma enfermidade que se observava principalmente, pela presença de hemácias falciformes no sangue e por uma variedade de sintomas clínicos, sobretudo pela anemia. Como a freqüência desta doença era maior nos negros do que nos brancos, a anemia falciforme era qualificada geralmente como uma doença racial.

Red blood cell vesicles in thalassemia.

Vesicles are part of the red blood cells membrane which can be found in a small number in normal apoptotic process and increased in some diseases. In the present study, the authors measured the percentage of red blood cell vesicles in healthy subjects (n = 7), patients with alpha-thalassemia or Hemoglobin (Hb) H disease (n = 7), beta-thal/Hb E with nonsplenectomized (n = 5) and splenectomized (n = 7) before and after induction heated at 48.6 degrees C by using flow cytometry. It was found that the percentage of vesicles in every group were not statistically significantly different (p > 0.05) between pre and post incubation at 5 min. The percentage of vesicles of healthy subjects, beta-thal/Hb E nonsplenectomized patients and splenectomized patients were highest when induced by heating for 60 min. For patients with Hb H disease, the percentage of vesicles was maximum at 30 min when compared with healthy subjects, beta-thal/Hb E nonsplenectomized patients and splenectomized patients, respectively. In the present study, the authors report the significant increase of the percentage of vesicles in Hb H disease, beta-thal/Hb E nonsplenectomized and splenectomized after induction by heat when compared with healthy subjects. These findings may support the different pathology of the red blood cells found in alpha- and beta-thalassemia.

Erythrophagocytosis by Myeloid Cells in a Patient with Myeloproliferative Disorder

This report documents a case of myeloid erythrophagocytosis in a patient with myeloproliferative disorder. The patient had pancytopenia and his marrow was hyperplastic with erythrophagocytosis by myeloid cells of various stages, including myeloblasts. He was diagnosed to have a prefibrotic stage of chronic idiopathic myelofibrosis. The erythrophagocytosis by myeloid cells persisted even after 2 months of treatment for the primary disorder.