ABSTRACT
Este relato teve como objetivo apresentar um caso de elderly onset rheumatoid arthritis associada à trombocitose reacional significativa. À admissão, o paciente apresentava quadro de poliartrite de pequenas e grandes articulações associado à rigidez matinal. Após exames solicitados, evidenciaram-se trombocitose de 1.697.000 cel./mm³ e anticorpos antipeptídeos citrulinados positivos, sendo diagnosticado com artrite reumatoide do tipo elderly onset rheumatoid arthritis.
This report aimed at presenting a case of elderly-onset rheumatoid arthritis associated with significant reactive thrombocytosis. On admission, the patient presented polyarthritis of small and large joints associated with morning stiffness. After the performance of the requested tests, thrombocytosis of 1,697,000 cells/mm3 and positive anti-CCP were evidenced, and the patient was diagnosed with elderly-onset rheumatoid arthritis.
Subject(s)
Humans , Male , Middle Aged , Arthritis, Rheumatoid/diagnosis , Thrombocytosis/diagnosis , Arthritis, Rheumatoid/complications , Arthritis, Rheumatoid/blood , Rheumatoid Factor/analysis , Thrombocytosis/complications , Thrombocytosis/blood , Blood Cell Count , Blood Sedimentation , C-Reactive Protein/analysis , Edema/etiology , Anti-Citrullinated Protein Antibodies/isolation & purificationABSTRACT
Introducción: Las alteraciones cuantitativas de plaquetas son producidas por el incremento o disminución de los conteos globales de plaquetas. El incremento o trombocitosis se produce por redistribución o aumento de la producción medular; la disminución puede ser el resultado de una reducción de la producción, redistribución o acortamiento de la sobrevida de las plaquetas en circulación. Objetivo: Describir los hallazgos citomorfológicos más importantes en las alteraciones cuantitativas de plaquetas. Métodos: Se realizó una revisión de la literatura, en inglés y español, en la base de datos PubMed y el motor de búsqueda Google Académico de artículos publicados en los últimos 10 años. Se hizo un análisis y resumen de la bibliografía revisada. Análisis y síntesis de la información: Las alteraciones cuantitativas de plaquetas se caracterizan por variaciones en el número y morfología de estas células. Estas se asocian a causas congénitas o adquiridas, en la que la detallada anamnesis de los pacientes es un elemento importante en el diagnóstico. En la trombocitosis se debe diferenciar una trombocitosis reactiva de una enfermedad medular primaria; mientras que en la trombocitopenia se debe considerar el origen étnico de los pacientes y la morfología de los leucocitos. Son numerosas las causas hereditarias de trombocitopenia con anomalías morfológicas de plaquetas y granulocitos. Conclusiones: Las alteraciones cuantitativas de plaquetas son un amplio número de entidades con semejanzas y diferencias en cuanto a presentación y manifestaciones clínicas. Los exámenes de laboratorio constituyen una herramienta importante en el diagnóstico, pronóstico y el seguimiento de los pacientes afectados(AU)
Introduction: Quantitative platelet alterations are produced by the increase or decrease in global platelet counts. Platelet count increase or thrombocytosis is produced by redistribution or increased marrow production. Platelet decrease may result from production, redistribution, or shortened survival of circulating platelets. Objective: To describe the most significant cytomorphological findings in quantitative platelet alterations. Methods: A literature review was carried out, in English and in Spanish, in the database PubMed and with the search engine of Google Scholar, of articles published in the last ten years. An analysis and summary of the revised bibliography was made. Information analysis and synthesis: Quantitative platelet alterations are characterized by variations in the number and morphology of these cells. These are associated with congenital or acquired causes, in which detailed anamnesis of patients is an important element in the diagnosis. In thrombocytosis, reactive thrombocytosis must be differentiated from primary marrow disease; while in thrombocytopenia, the ethnic origin of the patients and the morphology of the leukocytes must be considered. Hereditary causes of thrombocytopenia with morphological abnormalities of platelets and granulocytes are numerous. Conclusions: Quantitative platelet alterations are a large number of entities with similarities and differences in terms of presentation and clinical manifestations. Laboratory tests are an important tool for diagnosis, prognosis, and follow-up of affected patients(AU)
Subject(s)
Humans , Male , Female , Platelet Count/methods , Thrombocytopenia/diagnosis , Thrombocytosis/diagnosis , Cells/cytology , Blood Platelets/pathologySubject(s)
Humans , Male , Middle Aged , Thrombocytosis/diagnosis , Myelodysplastic Syndromes , Anemia , Anemia, Sideroblastic , Myeloproliferative DisordersABSTRACT
No abstract available.
Subject(s)
Adult , Humans , Male , Middle Aged , Alleles , Fusion Proteins, bcr-abl/genetics , Heterozygote , Hydroxyurea/therapeutic use , Janus Kinase 2/genetics , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis , Leukocytes, Mononuclear/pathology , Leukocytosis/diagnosis , Mutation , Myeloproliferative Disorders/drug therapy , Phenotype , Splenomegaly/diagnosis , Thrombocytosis/diagnosis , Translocation, GeneticABSTRACT
La trombocitosis esencial (TE) es una panmielopatía clonal de escasa frecuencia, que está incluida dentro de los síndromes mieloproliferativos crónicos. Se caracteriza por la proliferación anormal de los megacariocitos, y las manifestaciones clínicas principales son: hemorragia y/o diátesis tromboembólica, en cuyo caso se presentan fenómenos necróticos y ulcerosos. Se presentan dos pacientes de sexo masculino de 54 y 80 años, cuyas primeras manifestaciones fueron lesiones úlcero-necróticas cutáneas. Con recuentos plaquetarios mayores a 1.000.000 mm3 y la punción biopsia de médula ósea que reveló hiperplasia megacariocítica, se arriba al diagnóstico de TE.
Essential thrombocytosis (ET) is a rare, clonal panmyelopathy and one of a group of disordersknown as chronic myeloproliferative diseases.ET is associated with sustained megakaryocyte proliferation, and clinically presents hemorrhage orthrombosis with ulcerative or necrotic lesions.We report two male patients aged 54 and 80-years-old, respectively, with ulcerative and necroticlesions on the skin as the first manifestation of this disease. The platelet count was higher than1.000.000 mm3 and the bone marrow aspirate biopsy showed megakaryocytic hyperplasiadiagnostic of ET.
Subject(s)
Humans , Male , Middle Aged , Thrombocythemia, Essential/complications , Thrombocythemia, Essential/diagnosis , Thrombocythemia, Essential/drug therapy , Skin/pathology , Thrombocytosis/complications , Thrombocytosis/diagnosis , Thrombocytosis/drug therapyABSTRACT
Paraneoplastic syndromes are common in mesotheliomas but there is no report from India. Two cases of pleural mesothelioma with paraneoplastic haematologic syndromes, one with neutrophilic leukemoid reaction and the other with thrombocytosis, are presented in this report.
Subject(s)
Adult , Cisplatin/therapeutic use , Cytokines/therapeutic use , Humans , India , Magnetic Resonance Imaging , Male , Paraneoplastic Syndromes/blood , Paraneoplastic Syndromes/diagnosis , Paraneoplastic Syndromes/drug therapy , Solitary Fibrous Tumor, Pleural/diagnosis , Solitary Fibrous Tumor, Pleural/drug therapy , Thrombocytosis/diagnosis , Thrombocytosis/drug therapyABSTRACT
BACKGROUND: For the diagnosis of essential thrombocythemia (ET), no single clinical or laboratory finding of diagnostic value is available and a differential diagnosis of other myeloproliferative neoplasms or reactive thrombocytosis (RT) is needed. Following recent developments in automated blood cell analyzers, various platelet indices can now be measured. In this study, we analyzed whether platelet counts and 6 platelet indices can be used for the differentiation of ET from RT in patients with a platelet count of 600x10(3)/microliter or more. METHODS: The subjects studied were 31 patients with ET and 224 patients with RT. The platelet counts, mean platelet volume (MPV), plateletcrit (PCT), platelet distribution width (PDW), mean platelet mass (MPM), mean platelet component concentration (MPC) and large platelets (LPLT) were measured by ADVIA 120 (Bayer Diagnostics, USA). The mean values of each item were compared between the two patient groups and the sensitivity and specificity of each item in the diagnosis of ET were determined by ROC curve analysis. RESULTS: In essential thrombocythemia, all parameters except MPC were significantly higher than in reactive thrombocytosis. For the diagnosis of ET, the sensitivity and specificity were: 74.2% and 84.4%, when the platelet count was > or = 820x10(3)/microliter; 80.6% and 80.0%, when the plateletcrit was > or =0.63%; and 64.5% and 99.1%, respectively, when LPLT was > or = 23x10(3)/microliter. CONCLUSIONS: The platelet counts and platelet indices are useful for the differential diagnosis of thrombocytosis. The plateletcrit and LPLT are particularly useful for the diagnosis of ET when the platelet count is markedly increased.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Diagnosis, Differential , Platelet Count/instrumentation , ROC Curve , Sensitivity and Specificity , Thrombocythemia, Essential/diagnosis , Thrombocytosis/diagnosisABSTRACT
Infantile cortical hyperostosis (Caffey disease) is characterized by radiological evidence of cortical hyperostosis, soft tissue swellings, fever and irritability. We report a case of Caffey disease highlighting its presentation with thrombocytosis and high serum immunoglobulin level to alert physicians to use steroids cautiously in view of the known thrombocythemic effect of the drug. Raised Immunoglobulin also suggests that this syndrome could be infectious in origin.
Subject(s)
Diagnosis, Differential , Female , Humans , Hyperostosis, Cortical, Congenital/diagnosis , Immunoglobulin G/blood , Immunoglobulin M/blood , Infant , Mandible/diagnostic imaging , Thrombocytosis/diagnosisABSTRACT
To identify the etiology of thrombocytosis in various age groups and to evaluate the effectiveness of platelet indices in differentiating reactive and clonal thrombocytosis, an observational, prospective review of patients with platelet count of 600 x 10(9)/L or more performed by using coulter counter STKS (Coulter Electronic, Kerfeld, Germany). Extreme thrombocytosis defined as platelet count of 1000 x 10(9)/L or more. Of 1068 patients, 91.8% had reactive and 8.2% had clonal thrombocytosis. Frequent causes of reactive thrombocytosis were infections (44.9%), tissue injury (11.4%) and rebound thrombocytosis (10.2%). Fifty-five patients had extreme thrombocytosis, main aetiologies were secondary and clonal thrombocytosis that seen in 72.7% and 27.3% of cases respectively. Comparison of platelet indices showed; that cases with reactive thrombocytosis had low mean platelet volume and platelet distribution width. We concluded that thrombocytosis could be a response to various physiological and pathological processes. Low MPV and PDW in patients with high platelet counts strongly suggest reactive etiology.
Subject(s)
Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Blood Platelets/cytology , Blood Volume , Child , Child, Preschool , Diagnosis, Differential , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Myeloproliferative Disorders/diagnosis , Platelet Count , Thrombocytosis/diagnosisABSTRACT
O objetivo é relatar um caso de trombose de seio venoso cerebral causando síndrome de pseudotumor, onde a principal manifestação clínica foi uma perda visual bilateral grave. Homem de 24 anos apresentando perda visual bilateral grave, obscurecimentos transitórios da visão, cefaléia, papiledema bilateral e campos visuais constrictos. Tomografia computadorizada, bem como exame neurológico, apresentavam-se normais. Punção lombar mostrou um aumento da pressão liquórica inicial e o hemograma mostrou aumento do número de plaquetas. A ressonância magnética de crânio apresentava sinais característicos de papiledema crônico e sinais sugestivos de trombose de seio sagital superior. A venorressonância magnética de crânio mostrou trombose de seios sagital superior, transversos e sigmóides. Paciente foi tratado com descompressão de bainha de nervo óptico do olho esquerdo, acetazolamida e anticoagulação. O exame oftalmológico após o tratamento mostrou redução do papiledema, mas com persistência de perda visual acentuada. O pseudotumor cerebral com perda visual severa pode ser um sinal de apresentação de trombose venosa cerebral secundária a doença hematológica grave.
Subject(s)
Humans , Male , Adult , Pseudotumor Cerebri/etiology , Vision Disorders/etiology , Sinus Thrombosis, Intracranial/complications , Diagnosis, Differential , Pseudotumor Cerebri/diagnosis , Syndrome , Vision Disorders/diagnosis , Thrombocytosis/complications , Thrombocytosis/diagnosis , Sinus Thrombosis, Intracranial/diagnosisABSTRACT
Essential thrombocythemia is an increase of the initial platelet, which frequency tends to increase with the generalization of platelet counts on automat, allowing a positive diagnosis. The objective of this study is to compare platelet parameters of the ADVIA 120@ [Bayer Diagnostic, Tarrytown USA] between two populations of essential thrombocythemia [ET] and Secondary Thrombocythemia [ST] and to establish threshold values for these analyzed platelet parameters. This study include 210 patients, hospitalized at service of internal medicine, and whose selection criteria were an platelet count > 400G/L and/or diagnosis of Essential thrombocythemia. Then, the formula composed with threshold values of platelet parameters that we have found was applied on other groups of patients with a hyper-platelet count >400G/L and whose diagnosis was undetermined. Six platelet parameters out of nine present a significant difference between Et and ST [Mean platelet volume [VPM], variation Coefficient of the platelet of the platelet volume [CV Plat], Mean Platelet, Concentration [CPM], Standard deviation of the platelet concentration [ETCP], big platelet and Aggregate count], and the combination of at least four parameters, gives a sensitive [65 percent] and specific [95 percent] diagnosis Key for ET. These preliminary results show a major interest for ETCP parameters and big platelet parameters. Their association with other platelet parameters and the platelet count higher than 600 G/L should allow to better direct the diagnosis of ET
Subject(s)
Humans , Male , Female , Thrombocytosis/diagnosis , Thrombocytosis/etiologyABSTRACT
El hallazgo de un recuento plaquetario elevado tiene importantes implicaciones para el diagnóstico, pronóstico y tratamiento del paciente. En el presente estudio, se pudo comprobar la utilidad de los índices plaquetarios como el VPM, (volumen plaquetar medio ) y el PDW (rango de la distribución plaquearia), en unión del cómputo de plaquetas, para el diagnóstico de trombocitosis reactiva en pacientes pediátricos. Un 45 por ciento de los pacientes estudiados presentaron alteraciones en el VPM, en el PDW o en ambos, en comparacón con los valores que se obtuvieron en el grupo control. Se observó en que los niños con trombocitosis reactiva, tendían a presentar plaquetas de menor tamaño y con mayor heterogeneidadd. Es importante considerar estos parámetros disponibles actualmente, como una orientación diagnóstica de primera línea para las trombocitosis. (Rev Cost Cienc Med 1999; 20(3,4): 185-191) Palabras claves: plaquetas, volumen plaquetar, heterogeneidad plaquetaria, trombocitosis
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Blood Platelets , Platelet Count , Thrombocytosis/diagnosis , Thrombocytosis/therapy , Blood , Blood Chemical Analysis , Costa RicaABSTRACT
Con la incorporación generalizada de los contadores electrónicos al laboratorio clínico es frecuente el hallazgo de trombocitosis. Como en la anemia u otro signo clínico, el aumento de plaquetas no es una enfermedad sino que debe considerarse como la expresión de varias situaciones clínicas y en este caso el médico debe identificar la enfermedad de fondo. Se definen dos tipos de trombocitosis: la trombocitosis maligna o mieloproliferativa y la trombocitosis secundaria o relativa. Se hace un análisis detallado del cuadro clínico de la trombocitosis esencial primaria y se enfatiza en la necesidad y en los pasos para lograr su diagnóstico adecuado y oportuno, como punto de partida para el tratamiento. Se analizan las principales causas de trombocitosis secundaria y se definen los principales criterios para su diagnóstico. Se llama la atención para no minimizar el problema y a no administrar tratamientos empíricos sin diagnóstico etiológico, a través del estudio integral del paciente y de la utilización racional de los recursos de laboratorio.
Subject(s)
Humans , Thrombocytosis/diagnosis , Thrombocytosis/etiology , Thrombocytosis/physiopathology , Myeloproliferative Disorders/diagnosis , Myeloproliferative Disorders/etiology , Myeloproliferative Disorders/physiopathologyABSTRACT
Se describe un caso de trombocitemia esencial, en una mujer mestiza de 19 años de edad tratada con hidroxiurea hasta lograr remisión y luego como mantenimiento se utilizó como única terapia interferon alfa, observando resultado en el control del número de plaquetas. Seis meses después del uso continuo de este medicamento, la paciente presenta hipertrigliceridemia con cifras de colesterol normal, y cuatro semanas después de la interrupción de éste las cifras de triglicéridos se normalizaron. Este es el primer caso reportado en Venezuela de trombocitemia esencial tratado con hidroxiurea e Interferon alfa que logra remisión hematológica total, pero luego de seis meses de uso del Interferon alfa, desarrolla hipertrigliceridemia, que remite con la interrupción del mismo. Se llama la atención sobre el desarrollo de la hipertrigliceridemia como efecto secundario del uso del Interferon alfa
Subject(s)
Adult , Humans , Female , Interferon-alpha/therapeutic use , Thrombocytosis/diagnosis , Thrombocytosis/therapy , Thrombocythemia, Essential/diagnosisABSTRACT
To study the causes of thrombocytosis in Medical City Hospital, 151 patients with such a problem were included, The were randomly taken from teaching laboratory records [any patient with platelets count of more than 450 x 109/L for the period from 1st of December to the 30th April 1992. All patients were followed in different wards and out-patient departments and were fully studied clinically with investigations to reach a final definite diagnosis. They were 77 females and 76 males with platelet count ranging from "457 x 109 / L with an average of 676 x 109/L. The cause according to their incidence were as follows: malignancies, acute infections, myeloproliferative disorders, post surgical, post splenectomy, iron deficiency anemia and miscellaneous cause. It was concluded from the study that causes of thrombocytosis at the Medical City Hospitals are not very much different from what was previously reported
Subject(s)
Humans , Male , Female , Thrombocytosis/diagnosis , Hospitals, UrbanABSTRACT
Se describe el caso de una mujer de raza blanca, de 30 años de edad, con anemia crónica de 3 años de evolución, refractaria a tratamiento médico y a esplenectomía. Los estudios citogenéticos demostraron una anomalía única, la delección parcial del brazo largo del cromosoma No. 5, defecto denominado "Síndrome del 5q-" descrito en aproximadamente 15 pacientes en la literatura mundial. Este síndrome aparentemente adquirido se caracteriza por anemia refractaria, moderada leucopenia, trombosistosis e hipolobulación de los megacariocitos. La anemia es resistente a los tratamientos conocidos y no evoluciona a leucemia aguda. La mayor parte de los pacientes fallecen por las complicaciones de la hemosiderosis producida por la gran cantidad de transfusiones que requieren para mantener una hemoglobina adecuada. La terapia quelante de hierro con desferroxamina, utilizando minibombas de infusión continua, es, hasta el momento, la única forma de prevenir la muerte por falla cardíaca en los pacientes dependientes de transfusiones. Este es el primer caso del "Síndrome del 5q-" informado en la literatura médica colombiana