Evaluación y seguimiento hematológico del paciente con diagnóstico de esquizofrenia / Hematological Evaluation and Monitoring in Adult Patients Diagnosed With Schizophrenia

Objetivos: Ayudar al clínico en la toma de decisiones sobre las estrategias de evaluación y el seguimiento por el riesgo de alteraciones hematológicas en adultos con diagnóstico de esquizofrenia en tratamiento farmacológico. Método: Se elaboró una guía de práctica clínica bajo los lineamientos de la Guía Metodológica del Ministerio de Salud y Protección Social para identificar, sintetizar, evaluar la evidencia y formular recomendaciones respecto al manejo y seguimiento de los pacientes adultos con diagnóstico de esquizofrenia. Se adoptó y actualizó la evidencia de la guía NICE 82, que contestaba la pregunta acá planteada. Se presentó la evidencia y su graduación al grupo desarrollador de la guía (GDG) para la formulación de las recomendaciones siguiendo la metodología propuesta por el abordaje GRADE. Resultados: Un evento conocido con el uso de antipsicóticos es la disminución en el conteo de leucocitos y el riesgo de agranulocitosis, este asociado al uso de clozapina, que aunque es un evento raro (0,8%), puede tener consecuencias fatales; este efecto se presenta con mayor frecuencia en las primeras doce semanas y se mantiene el riesgo hasta un año aproximadamente. Conclusión: se consideraron como recomendaciones fuertes todas las relacionadas con el seguimiento hematológico, se recomienda la toma de un hemograma al inicio del tratamiento farmacológico. Si el paciente inicia clozapina debe realizar uno semanal durante los tres primeros meses, mensual hasta el ano y cada seis meses a partir del primer año. Si se encuentra una disminución del conteo de leucocitos se debe hacer un seguimiento periódico, suspenderlo si hay un recuente menor a 3.500 células/mm³ y se recomienda la suspensión y remisión si el recuento es menor a 2.000 células/mm³.

Objectives: To guide the clinician in taking decisions on the best strategies for assessing and monitoring the risk of blood disorders in adults diagnosed with schizophrenia in pharmacological treatment. Method: A clinical practice guideline was developed following the guidelines of the Methodological Guide of the Ministry of Social Protection to collect evidence and grade recommendations. De novoliterature researchwas performed. Results:With the use of antipsychotics there isriskofreducción in the leukocyte count and the risk of agranulocytosis,the later associated with the use of clozapine, although it is a rare event(0.8%) can be fatal; this effect occurs most frequently in the first twelve weeks of treatment and the risk is maintained aroundthe first year of it. Conclusion: The recommendations were considered strongin all hematologic related moni-toring.A blood count should be taken at the start of pharmacological treatment. If the patient is started on clozapine one shouldbe taken weekly during the first three months, monthly until completing one year and every six months thereafter. If there is a decrease in white blood cell count the patient should be monitored regularly, stopping if is a less than 3,500 cells/mm³ and consider referral if is less than 2,000 cells/mm³.

Clinical significance of detection of iron metabolism indexes in patients with hematologic malignant disease before and after treatment / 中国医师进修杂志

Objective To explore the changes and clinical significance of iron metabolism indexes such as serum ferritin (sFn),serum transferritin (sTf),serum transferritin receptor (sTfR) in patients with hematologic malignant disease before and after treatment.Methods Fifty-nine patients with hematologic malignant disease were enrolled.We measured the blood routine,bone marrow routine and iron bound of bone marrow cells and sFn、sTf、sTfR before and after treatment.The control group was 43 healthy Volunteers.Result Before treatment the level of patients sFn increased obviously,which was higher than that of control significantly (P ＜ 0.05).After chemotherapy,the level of sFn in remission group decreased obviously,which was still higher than that of normal control.sFn expression in non-remission group was not different from that before therapy or normal control (P ＞ 0.05).The level of sTf was lower than that of control significantly pretreatment and aftertreatment (P ＜ 0.05).While there was no different between remission group and nonremission group after chemotherapy (P ＞ 0.05).The level of sTfR in non-remission group after chemotherapy was higher than that of control.Correlation analysis showed that there was positive correlation between the serum level of sFn and the original and naive bone marrow cells (r =0.347).And there was negative correlation between sFn and hemoglobin (r =-0.207).But there was no significant correlation between sFn and bone marrow iron.Conclusions It is possible to predict treatment response and prognosis in hematologic malignant disease by the decrease of sFn after chemotherapy.But sTf and sTfR are not good indexes to predict treatment response in a short time.Prevalence of anemia among patients with tumor was not only because of iron deficiency.So iron supplementation should be cautious.

A importância da integração de dados do diagnóstico das hemopatias / The importance of integrating results of several techniques in the diagnosis of hematological diseases

A análise diagnóstica da medula óssea compreende classicamente a citologia. Mais recentemente, tornou- se rotina o estudo histológico. Desde o início, tentou- se integrar estes dados, pois, enquanto a citologia fornece uma análise mais detalhada das características das células e permite quantificá- las, a biópsia, por analisar o tecido como um todo, permite o estudo da estrutura do tecido hemopoético, seu estroma e a ocorrência de estruturas estranhas à medula, como granulomas, fibrose e metástases de neoplasias. Com o desenvolvimento de novas tecnologias e o melhor conhecimento das diversas entidades, principalmente em onco- hematologia, além do desenvolvimento de terapias alvo- específicas, tornou- se importante o estudo citogenético/molecular em algumas patologias. Nas leucemias agudas e síndromes linfoproliferativas, a imunofenotipagem tem contribuído de modo decisivo para a classificação correta das diversas neoplasias pelos critérios da OMS. Assim, o diagnóstico hematológico se tornou uma atividade multidisciplinar que integra profissionais de diversas especialidades. Assim se consegue tratar os pacientes de modo mais adequado, além de poder rastrear a doença residual após o tratamento. Isto levou a novas definições de remissão: hematológica, fenotípica, citogenética e molecular. O estudo da medula óssea é importante em algumas hemopatias benignas, como anemias carenciais, que podem se manifestar como pancitopenias. Este estudo deve ser complementado com exames sorológicos e bioquímicos. A mielocultura tem permitido o diagnóstico de infecções, especialmente nos indivíduos imunossuprimidos.

The diagnosis of hematologic diseases has traditionally been based on features of peripheral blood and bone marrow (BM) cytology. Histologic examination of the BM has been used for the staging of neoplasias when aspiration is not possible due to fibrosis. Cytology permits a better evaluation of cell morphology and a quantitative analysis of the different BM lineages. Histology shows the BM structure, topology of cells and the microenvironment, besides identifying pathologic structures such as granulomas, fibrosis, and metastases. More recently, several new technologies have been developed, and the pathophysiology of diseases has been better elucidated. The WHO classification of hematologic malignancies describes entities based on morphology, phenotype, and in many cases, cytogenetic and molecular features. This has made targeted therapy feasible. Therefore, there is need to confirm the diagnosis using data from different techniques. Some methods are also useful to quantify residual disease after treatment, and confirm cure. Thus, several kinds of remission have been defined, such as " hematologic" , " phenotypic" , " cytogenetic" and " molecular" remission. In benign diseases, presenting with cytopenias other than anemia, BM examination is useful together with biochemical and serological tests.