A Case of Primary Bone Marrow Diffuse Large B-cell Lymphoma Presenting with Polyarthritis

Polyarthritis is a common manifestation of rheumatologic disorders; however, paraneoplastic arthropathies also arise as polyarthritis or polymyalgia, particularly in patients with myelomas, lymphomas, acute leukemia, and solid tumors. Because paraneoplastic syndromes, in some instances, might be manifested before a cancer diagnosis, they are difficult to diagnose and are often misdiagnosed. We experienced a 63-year-old female patient who had nonspecific arthritis on both hands and feet accompanied by fever. She had been diagnosed as rheumatoid arthritis and treated with prednisolone and disease modifying anti-rheumatic drugs (DMARDs) including methotrexate and anti-tumor necrosis factor agents. Her arthritis did not respond with anti-rheumatic treatment and diffuse large B-cell lymphoma was diagnosed by bone marrow biopsy. After 6 cycles of chemotherapy, her arthritis was improved as well as underlying lymphoma.

Development of a Poikilocyte Measuring Method Using Image Analysis Software

BACKGROUND: To achieve consistency in poikilocytes grading in peripheral blood cell examinations, we made an image-based differential count (IDC) software to measure the degree of abnormalities in individual red blood cells (RBCs) and relative fractions of poikilocytes. METHODS: Thirty peripheral blood samples were analyzed. Smear slides were examined on a microscope with charge-coupled device (CCD) camera. To verify this program, we compared the IDC results with the results of manual differential counting (MDC). Relative fractions of schistocytes, echinocytes, and elliptocytes were measured by IDC and MDC. The error rate of IDC was measured by confirming the final processed images of IDC. Correlations of IDC and MDC results were compared using linear regression analysis and the time required for each test was measured. For presentation of the mathematical decision criteria of poikilocytes, IDC algorithms for recognizing schistocytes, echinocytes, and elliptocytes were made using simple geometrical or mathematical formulas. RESULTS: The error rate of IDC was 2.8%. For analysis of 1,000 RBCs, MDC took 7.3 minutes and IDC took 2.7 minutes. Linear regression coefficients were 0.776 (P<0.001) for schistocytes, 0.895 (P<0.001) for echinocytes, and 1.001 (P<0.001) for elliptocytes. CONCLUSIONS: It was possible to define poikilocytes with geometrical or mathematical formulas using image analysis programs. The IDC program would be helpful for consistent grading of poikilocytes.

A Case of Therapy-Related Acute Myeloid Leukemia Following 5-Fluorouracil Chemotherapy

No abstract available.

T-cell Large Granular Lymphocytic Leukemia: A Case Report

T cell large granular lymphocytic leukemia (T-LGL leukemia) is defined as a clonal proliferative disorder of CD3+ cytotoxic T cells. T-LGL leukemia usually expresses CD3+, CD4-, CD8+, CD16+, CD56- and CD57+ cell markers, and this represents a rearrangement of the T cell receptor (TCR) gene. The clinical course is indolent in most cases, but on rare occasions, when CD3+ and CD56+ are expressed on the leukemic cells, it can be more aggressive. We experienced a patient with T-LGL leukemia and the disease was indolent at the time of diagnosis, and so any specific treatment was not required. Two years after the initial diagnosis, her clinical course became quite aggressive as the CD 56+ cell surface antigen was expressed. We report here on the first case of T-LGL leukemia in Korea and we review the relevant literature.

Bone Marrow Findings, and TNF-alpha, IL-18 Expression in Bone Marrow of Adult Onset Still's Disease Patients / 대한류마티스학회지

OBJECTIVE: Inflammatory cytokines may play important roles in the pathogenesis of adult onset Still's disease. The enhanced expression of IL-18 was reported in the bone marrow of a Japanese systemic onset juvenile rheumatoid arthritis patient but not in the other organs. To date, there are very few studies relating the bone marrow and AOSD. This study examined the bone marrow findings as well as TNF-alpha and IL-18 expression in the bone marrow of AOSD patients. METHODS: A retrospective study was performed on 15 AOSD patients who had undergone a bone marrow examination at a university hospital. The clinical and laboratory findings, as well as the bone marrow findings, were analyzed. Immunohistochemistry of IL-18 and TNF-alpha in bone marrow was performed. RESULTS: The bone marrow cellularity and myeloid/erythroid cell ratio showed no correlation with the clinical and laboratory findings. TNF-alpha was expressed at 0.8~9.8% and IL-18 was expressed at 0.4~9.8% of bone marrow cells. Cytokine expression was not associated with the clinical patterns of AOSD. The platelet count correlated with the bone marrow TNF-alpha expression but TNF-alpha did not correlate with IL-18 expression. CONCLUSION: TNF-alpha and IL-18 expression in bone marrow were observed in some AOSD patients but there was no correlation with the other clinical and laboratory findings except for the platelet count.

Annual Report on External Quality Assessment in Hematology in Korea (2008) / 임상검사와정도관리

Four trials of external quality assessment in diagnostic hematology were performed in 2008 with average 822 participating laboratories in Korea. We performed quality assessment for white blood cell count, hemoglobin, hematocrit, red blood cell count, platelet count, blood cell morphology, prothrombin time and activated partial thromboplastin time. The response rate was more than 96.5%. The coefficients of variation in hemoglobin, hematocrit and RBC was stable but variable in platelet count and WBC count according to measuring cell count. Test results of blood cell morphology showed variation among various cell morphologies.

Annual Report on External Quality Assessment in Hematology in Korea (2007) / 임상검사와정도관리

Four trials of external quality assessment in diagnostic hematology were performed in 2007 with average 722 participating laboratories in Korea. We performed quality assessment for white blood cell count, hemoglobin, hematocrit, red blood cell count, platelet count, blood cell morphology, prothrombin time and activated partial thromboplastin time. The response rate was more than 95.2%. The coefficients of variation in hemoglobin, hematocrit and RBC were stable but variable in platelet count and WBC count according to measuring cell counters. Test results of blood cell morphology showed variation among various cell morphologies.

Annual Report on External Quality Assessment in Hematology in Korea (2007) / 임상검사와정도관리

Four trials of external quality assessment in diagnostic hematology were performed in 2007 with average 722 participating laboratories in Korea. We performed quality assessment for white blood cell count, hemoglobin, hematocrit, red blood cell count, platelet count, blood cell morphology, prothrombin time and activated partial thromboplastin time. The response rate was more than 95.2%. The coefficients of variation in hemoglobin, hematocrit and RBC were stable but variable in platelet count and WBC count according to measuring cell counters. Test results of blood cell morphology showed variation among various cell morphologies.

Annual Report on External Quality Assessment in Hematology in Korea (2005) / 임상검사와정도관리

Four trials of external quality assessment in diagnostic hematology were performed in 2005 with about 500 participating laboratories in Korea. We performed quality assessment for white blood cell count, hemoglobin, red blood cell count, platelet count, white cell differential count, red blood cell morphology. The response rate was more than 97%. The coefficients of variation in hemoglobin and RBC number was stable but variable in platelet number and WBC number according to measuring cell counts. Test results showed wide variation according to measuring machine and reagents.

Annual Report on External Quality Assesment in Hematology in Korea (2004) / 임상검사와정도관리

Four trials of external quality assessment in diagnostic hematology were performed in 2004 with about 440 participating laboratories in Korea. We performed quality assessment for white blood cell count, hemoglobin, red blood cell count, platelet count, white cell differential count, red blood cell morphology and coagulation test. The response rate was more than 96%. The coefficients of variation in hemoglobin and RBC number was stable but variable in platelet number and WBC number according to measuring cell counts. Blood coagulation study was performed twice. Test results show wide variation according to measuring machine and reagents.

Annual Report on External Quality Assesment in Hematology in Korea (2003) / 임상검사와정도관리

Four trials of external quality assessment in diagnostic hematology were performed in 2003 with about 430 participating laboratories in Korea. We performed quality assessment for white blood cell count, hemoglobin, red blood cell count, platelet count, white cell differential count, red blood cell morphology and coagulation test. The response rate was more than 95%. The performance of quality assessment appeared to be gradually improved year by year.

External Quality Control for PT and aPTT in a Peer Group Using In-house / 대한진단검사의학회지

BACKGROUND: Coagulation studies are affected by the reagents and coagulometers that are used in the tests and it is therefore essential to compare the results within a peer group that uses the same reagents and coagulometer for an external quality control program. Because the domestic quality control program encompasses many different groups using different reagents and coagulometers, no comparison has been made among peer groups. Therefore, the authors performed a quality control program using in-house lyophilized plasma in a selected peer group. METHODS: Prothrombin times (PT) and activated partial thromboplastin times (aPTT) were tested using in-house normal and oral anticoagulant lyophilized plasma; the tests were performed for 50 consecutive days in four hospitals that were using the same coagulometer. The same PT reagents were used in all four hospitals. The international sensitivity index (ISI) was 1.32 for three hospitals and 1.47 for one hospital. Three hospitals used the same aPTT reagent. RESULTS: After lyophilization, there was no change in the PT results, but aPTT results were greatly prolonged. At four hospitals, the average international normalized ratio (INR) of normal lyophilized plasma was 0.94, 0.94, 0.95, and 0.82, while the average INR of oral anticoagulant lyophilized plasma was 2.18, 2.28, 2.21, and 1.87. The mean normal PT (MNPT) of three hospitals with ISI of 1.32 were 12.4s, 11.2s, and 12.3s, while the MNPT of one hospital with ISI of 1.47 was 12.5s. Average aPTT of normal plasma were 32.1s, 45.9s, 44.7s, and 44.3s while that of the oral anticoagulant plasma were 42.6s, 61.3s, 57.8s, and 55.6s. CONCLUSIONS: Since there are a great deal of difference in the results of coagulation study among the hospitals using the same reagents and coagulometers, it is utmost necessary to enforce a national level coagulation study quality control program in order to adopt proper oral anticoagulation therapy.

Annual Report on External Quality Assesment in Hematology in Korea (2002) / 임상검사와정도관리

Four trials of external quality assessment in diagnostic hematology were performed in 2002 with about 400 participating laboratories in Korea. We performed quality assessment for white blood cell count, hemoglobin, red blood cell count, platelet count, reticulocyte count, white cell differential count, and red blood cell morphology test. The response rate was more than 90%. The performance of quality assessment appeared to be gradually improved year by year.

Chronic neutrophilic leukemia / 대한내과학회지

No abstract available.

Latex Agglutination Test for Differentiating Neonatal Blood from the Maternal Blood in the Meconium / 대한진단검사의학회지

BACKGROUND: The Apt test is used for differentiating neonatal blood from the maternal blood in the meconium. The test requires a sufficient amount of blood to be detectable to the naked eyes. But many of the specimens in the hospital laboratory contain only a small amount of blood and is not detectable to the naked eyes and usually the results are reported 'impossible to determine' due to the small amount of blood. We developed a latex agglutination test to solve this problem and to differentiate the neonatal blood from the maternal blood in a small amount that was not detectable with the naked eyes. METHODS: Latex reagents for hemoglobin A (Hb A) and hemoglobin F (Hb F) were made. Ten milligrams of meconium were dissolved in 1mL of deionized water (DW). Ten milligrams of meconium that had shown negative results for both of the above reagents were mixed, each with 10microL of whole blood (WB) from 10 pregnant women and 10 neonates who had various hemoglobin concentrations (10-17 g/dL). Each of the 20 mixtures was dissolved in 1 mL of DW (WB 10microL/mL). Then, serial dilutions were made at a ratio of 1:10 until the final concentration of 10 pL/mL. Each of the six dilutes were tested with the two latex reagents. RESULTS: The dilutes of WB 10microL/mL looked red, WB 1microL/mL looked pink and all other dilutes showed no colors to the naked eyes. The reagent for Hb A showed agglutination in dilutes from WB 1microL to 1 nL/mL DW from all of the 20 persons. The reagent for Hb F reacted with dilutes from WB 1microL to 1 nL/mL DW from the ten neonates but did not react with those from any pregnant women. CONCLUSIONS: The latex agglutination test can be applied to the specimen with no color detectable to the naked eyes after dilution. The specimen reacted with both the Hb A and Hb F reagents could be determined as fetal blood and the one that reacted with the reagent only for Hb A could be determined as maternal blood.

28-year old Polycythemia Vera patient presenting with Cerebral Infarction / 대한내과학회지

No abstract available.

A Case of Congenital Malaria due to Plasmodium vivax / 감염

No abstract available.

Study of the Characteristics of Coagulase in Staphylococcus aureus for Establishment of an in-vitro Model for Disseminated Intravascular Coagulation / 대한임상병리학회지

BACKGROUND: Disseminated intravascular coagulation (DIC) is a clinicopathologic syndrome for widespread intravascular coagulation. DIC occurs when the processes that regulate coagulation break down. Staphylococcal infection is one of the causes of DIC. Staphylococcus aureus produces coagulase that can clot plasma. There are two different tests to detect the coagulase; a tube test for free coagulase and a slide test for bound coagulase or clumping factor. The goal of the present study is to evaluate the characteristics of coagulase in Staphylococcus aureus for establishment of an in-vitro model for DIC. METHODS: Coagulase tests were performed by mixing plasma with two-fold diluted culture broths, culture supernatant and culture filtrates. Coagulase activity was expressed as the reciprocal of the highest dilution titer. Cell pellets treated with normal saline, ethyl alcohol, and aceton were used for the clumping tests. Platelet aggregation tests were conducted using a culture broth and a concentrated culture supernatant. A fibrinogen binding protein was isolated from sonificated bacteria and thus, determined the molecular weight. RESULTS: Coagulase activity was higher in the broth culture than in the culture supernatant and culture filtrate. Coagulase activity decreased after incubation at 37degrees C for 24 hours but culture filtrates were clumped after boiling at 100degrees C for 10 minutes. Alcohol and aceton did not inhibit the clumping test. S. aureus induced platelet aggregation but a concentrated culture filtrate did not induce platelet aggregation. Molecular weight of fibrinogen binding protein was 57 kDa. CONCLUSIONS: It is suggested that the plasma clot was due to free coagulase or a clumping factor. Free coagulase is different from a clumping factor. We concluded that the pathogenesis of DIC in the staphylococcal infection was due to platelet aggregation triggered by a clumping factor or coagulase with other substances.

Clinical significance of microvessel density in multiple myeloma patients

To investigate the role of angiogenesis in multiple myeloma (MM), bone marrow biopsy from 75 adults with newly diagnosed, untreated MM were evaluated. Microvessels were scored in at least 3 areas ( x 200 fields) of the highest microvessel density in representative sections of each bone marrow specimen using immunohistochemistry for CD34. Prognostic variables were also evaluated for the overall survival. Microvessel counts were significantly higher in patients with MM (n=69.42+/-9.67), compared with control (n=26.81+/-2.85). Microvessel density had a weak correlation with percentage of bone marrow plasma cells. By univariate analysis, age, beta2-microglobulin, serum albumin, serum creatinine, serum calcium, hemoglobin, platelet count, and bone marrow plasma cell percentage were correlated with survival. By multivariate analysis, age, serum albumin, serum creatinine, hemoglobin, platelet count and bone marrow plasma cell percentage were correlated with overall survival, whereas microvessel density was not. In summary, microvessel density in bone marrow of MM is significantly increased compared to control, but was not correlated with overall survival. Further studies regarding angiogeneic molecules are needed to determine the functional role of angiogenesis in MM.

Pure Red Cell Aplasia Due to Parvovirus B19 in Renal Transplants / 대한신장학회잡지

Parvovirus B19 infection is known to cause chronic anemia in immunocompromised hosts, including organ transplant recipients. We report a case of pure red cell aplasia caused by parvovirus B19 in renal transplants. The patient was 16-year-old male who was diagnosed as chronic renal failure 7 years ago and had been on hemodialysis twice a week. He got renal transplantation in June 1999. But anemia was not improved in first postoperative period. On admission hemoglobin was 43.0 g/L, hematocrit was 12.7%. The bone marrow biopsy revealed severe erythroid hypoplasia with giant pronormoblasts. The pronormoblasia with giant prominent intranuclear inclusions, characteristic of parvovirus B19 infection. The parvovirus B19 PCR and anti-parvovirus B19 IgM were positive. The patient was treated with intravenous immunoglobulin and then reticulocyte count was increased 5 days later. Hemoglobin level restored to 104 g/L teo months later.