RESUMO
Aims: Our study was undertaken to examine the laboratory and clinical features of pernicious anemia patients presenting initially at the Turgut Ozal Medical Center, which serves as an important tertiary health center in Eastern Anatolia. Study Design: Among patients evaluated for etiology of anemia, we analysed the clinicopathological characteristics of 300 (158 females and 142 males) patients with pernicious anemia retrospectively. Place and Duration of Study: Department of Internal Medicine and Division of Hematology, Inonu University School of Medicine, between 1996 and July 2011. Methodology: Full blood counts, thyroid hormone levels, liver function tests and LDH levels were reviewed for 300 patients with pernicious anemia retrospectively. Peripheral blood smears and bone marrow biopsies were reviewed by a hematologist. Endoscopic examination and ultrasonographic inspection were performed for atrophic gastritis, gallbladder stones and hepatosplenomegaly for all patients. Laboratory values, ages, signs and symptoms of patients at the time of diagnosis were compared between genders. Results: The mean age of the female patients was 50.56 ± 17.75 years (17–84), while that of the male patients was 57.24 ± 15.78 (20–95) years. At the time of diagnosis, the male patients were older than the females (p = 0.002). LDH levels were significantly higher for females (p = 0.043). The incidence of gallstones was significantly higher in females (25.4%) than in males (10.7%) (p = 0,001). Pancytopenia was defined as a hemoglobin level lower than 10 gr/dl, leukocytes lower than 1.500/μL and platelets lower than 150.000/μL and the incidence of pancytopenia was 41.3% (n = 65) and 50.7% (n = 71) in the female and male patients, respectively, and the difference was not statistically significant. There was no statistically significant difference for frequency of thyroid disease or symptoms and signs at the time of diagnosis between genders. Conclusions: Pernicious anemia is not a disease of only elderly women; it can be seen in both men and women of younger ages. It is seen nearly as often in women as in men. Gallstones and abnormal thyroid activity can be observed at these patients at the time of diagnosis; therefore, these findings should be considered.
RESUMO
Aims: The aim of this study was to investigate of the roles of CD5+ and CD19+ on lymphocytes, CD5+ on B lymphocytes, CD41a+ on platelets and CD55+ and CD59+ on erythrocytes in platelet destruction; and evaluate them according to the patient response status to steroid therapy and platelet counts in chronic immune thrombocytopenic purpura (ITP). Study Design: This study included 20 chronic ITP patients and 20 healthy controls. We investigated the roles of CD5+ and CD19+ expression on lymphocytes, CD5+ expression on B lymphocytes, CD41a+ expression on platelets, and CD55+ and CD59+ expression on erythrocytes, as well as the platelet counts in healthy and chronic ITP patients. Additionally, these markers were evaluated according to the patient response status to steroid therapy and platelet counts. Place and Duration of Study: This study took place at the Department of Internal Medicine and Haematology, Meram Medical Faculty at Selçuk University in Turkey, between November, 2008 and July, 2009. Methodology: A total of 40 patients (26 women, 14 men, age range: 19-79 years) were studied. The study group included 20 chronic ITP patients (12 women and 8 men, age range: 19-78 years) and the control group included 20 healthy volunteers (14 women and 6 men, age range: 22-79 years). The platelet counts and expressions of CD5+ and CD19+ on lymphocytes, CD5+ on B lymphocytes, CD41a+ on platelets, and CD55+ and CD59+ on erythrocytes were analysed in the patients and control subjects. The chronic ITP patients were evaluated according to their requirements of treatment. Five patients whose platelet counts were above 50,000 mm–3 were observed without treatment. The other 15 patients whose platelet counts were under 50.000 mm–3 and had bleeding, or whose platelet counts were under 20,000 mm–3, were given methylprednisolone treatments (1 mg/kg/day orally). Three of the 15 patients discontinued treatment for various reasons. The twelve patients who continued the methylprednisolone treatment were divided into two subgroups according to their responder status of steroid treatment. The patients whose platelet counts slowly increased above 30,000 mm–3 within three months included the steroid treatment responder subgroups. The chronic ITP patients were also divided into two subgroups according to the severity of their thrombocytopenia. The limit of the platelet count was 30,000 mm–3 for severe thrombocytopenia. These parameters were analysed according to the response status of the steroid treatment and platelet counts. The platelet counts, and the expressions of these markers, were compared between the subgroups. Results: The level of CD5+ on B lymphocyte expression (2.19 ± 1.65) in peripheral blood lymphocytes was significantly higher in the immune thrombocytopenic purpura patients than in the controls (P = .05). The CD55+ + CD59+ expression on erythrocytes (98.03 ± 1.77) was significantly higher in the ITP patients than in the controls (P = .05). There was no significant relationship between the expression of CD5+, CD19+ or CD5+ on B lymphocytes, CD41a+ expression on platelets or CD55+ and CD59+ expression on erythrocytes, according to the response status to steroid therapy in the patient group (P > 0.05). Additionally, the patients were evaluated according to platelet counts, and there was a significantly positive correlation between the level of CD41a+ expression on the platelets and the platelet count (P = .05). Conclusion: The level of CD5+ on B lymphocytes was significantly higher in the ITP patients than in the controls. A relationship between CD55+ plus CD59+ expression on erythrocytes and immune destruction of platelets was not observed in the chronic ITP patients.