Alterações no VCM e suas correlações com os valores de RDW-SD e RDW-CV em caninos e felinos / Variation in MCV and its correlation with RDW-SD and RDW-CV values in dogs and cats

A anemia é uma síndrome caracterizada pela diminuição do número de hemácias, hematócrito e/ou concentração de hemoglobina. Conforme o Volume Corpuscular Médio (VCM), as anemias podem ser classificadas em microcíticas, normocíticas ou macrocíticas. O RDW (Amplitude de Distribuição dos Eritrócitos) também é utilizado para ajudar na classificação das anemias, refletindo a anisocitose da população eritrocitária. Neste estudo retrospectivo objetivou-se determinar a correlação entre o RDW-SD (Desvio Padrão), RDW-CV (Coeficiente de Variação), macrocitose e microcitose em caninos e felinos atendidos na rotina clínica do Hospital Veterinário da Universidade Luterana do Brasil. Para a realização deste estudo, selecionou-se 662 laudos de hemogramas realizados (434 caninos e 228 felinos), com faixa etária de seis meses até 10 anos, foram divididos em dois grupos: Grupo 1 ­ Anemia microcítica (255 caninos e 61 felinos); Grupo 2 ­ Anemia macrocítica (179 caninos e 167 felinos). Posteriormente, correlacionou-se os grupos com os valores de RDW-SD e RDW-CV. As análises de correlação foram realizadas utilizando o teste Spearman, para a análise de significância foi utilizado o T Student, no programa IBM SPSS®Statistics. Na análise estatística do grupo canino, não houve correlação da microcitose com o RDW-SD, enquanto o RDW-CV apresentou uma correlação inversamente proporcional, razoável. No grupo macrocítico canino, a análise de correlação com o RDW-SD foi moderada e diretamente proporcional, e com o RDW-CV foi moderada e diretamente proporcional. No grupo felino, não houve correlação entre microcitose e RDW-SD, e com o RDW-CV houve uma correlação razoável e inversamente proporcional. Entre macrocitose em felinos e o RDW-SD houve uma correlação moderada e diretamente proporcional, já o RDW-CV apresentou uma correlação razoável e diretamente proporcional. Conclui-se que os caninos e felinos do grupo microcítico apresentam uma correlação com o RDW-CV. Contudo, os caninos com macrocitose apresentaram correlação tanto para o RDW-CV quanto para o RDW-SD, e os felinos apresentaram uma maior correlação com o RDW-SD.

Anemia is a syndrome characterized by a low red blood cell count, hematocrit and/or hemoglobin concentration. According to the Mean Corpuscular Volume (MCV), anemias can be classified as microcytic, normocytic or macrocytic. The RDW (Red Cell Distribution Width) is also used to help classify anemias, reflecting the anisocytosis of the erythrocyte population. This retrospective study aimed to determine the correlation between RDW-SD (Standard Deviation), RDW-CV (Coefficient of Variation), macrocytosis and microcytosis in canines and felines treated in the clinical routine of the Veterinary Hospital of Universidade Luterana do Brasil. To carry out this study, 662 blood count reports were selected (434 canines and 228 felines), aged between six months and 10 years, divided into two groups: Group 1 ­ Microcytic anemia (255 canines and 61 felines); Group 2 ­ Macrocytic anemia (179 canines and 167 felines). Subsequently, the groups were correlated with the values of RDW-SD and RDW-CV. Correlation analyzes were performed using the Spearman test, for the analysis of significance the T Student was used, in the IBM SPSS® Statistics program. In the statistical analysis of the canine group, there was no correlation between microcytosis and the RDW-SD, while the RDW-CV showed a reasonable, inversely proportional correlation. In the canine macrocytic group, correlation analysis with RDW-SD was moderate and directly proportional, and with RDW-CV it was moderate and directly proportional. In the feline group, there was no correlation between microcytosis and RDW-SD, and with RDW-CV there was a reasonable and inversely proportional correlation. There was a moderate and directly proportional correlation between macrocytosis in felines and RDW-SD, whereas RDW-CV presented a reasonable and directly proportional correlation. It is concluded that the canines and felines of the microcytic group present a correlation with the RDW-CV. However, canines with macrocytosis showed a correlation for both RDW-CV and RDW-SD, and felines showed a greater correlation with RDW-SD.

Transitory response of a myelodysplastic syndrome with deletion of chromosome 5q to thalidomide. Report of one case

ABSTRACT Myelodysplastic syndrome with deletion of chromosome 5q (5q-syndrome) has a favorable prognosis and a low risk of transformation to acute myeloid leukemia, when treated with lenalidomide. Azacitidine leads to complete remission even as second-line therapy and in patients with clonal evolution. We report a 70 years old female without previous exposure to myelotoxic drugs, presenting with three weeks with fatigue and dyspnea. She had anemia with normal white blood cell and platelet count. Bone marrow biopsy showed 50% cellularity and the karyotype analysis revealed a (5) (q33q34) deletion in 22% of the metaphases. A diagnosis of 5q-syndrome with low risk calculated using the Revised International Prognostic Scoring System (IPSS-R), was made. Since lenalidomide was not affordable, thalidomide 100 mg/day was initiated, achieving transfusion independence for three years. Afterwards, she developed pancytopenia and a bone marrow biopsy showed erythroid and megakaryocyte dysplasia with a complex karyotype, which worsened prognosis (IPSS-R of five points). Therefore, azacitidine (by donation) was administered. She achieved complete remission with a normal karyotype and completed 12 cycles of treatment. Thereafter, she relapsed and received only supportive care for a year. She suffered an ischemic stroke and died two weeks later.

El síndrome mielodisplásico con deleción del cromosoma 5q (síndrome 5q) tiene un pronóstico favorable y riesgo bajo de transformación a leucemia aguda en pacientes que son tratados con lenalidomida (tratamiento estándar). El uso Azactidina tiene respuestas completas incluso como segunda línea de tratamiento en pacientes con evolución clonal. Presentamos una mujer de 71 años, sin exposición a mielotóxicos que debutó con un síndrome anémico. Se realizó biopsia de medula ósea que mostró celularidad del 50% y en el análisis citogenético se detectó una deleción del cromosoma 5 en 22% de las metafases analizadas, lo que llevó al diagnóstico de Síndrome 5q- de riesgo bajo de acuerdo con el puntaje IPSS-R (Revised International Prognostic Scoring System). Ya que no se pudo costear lenalidomida, se trató con talidomida (100 mg/día). Permaneció tres años sin requerir soporte transfusional. Posteriormente, presentó pancitopenia y en el nuevo aspirado de médula ósea se observó displasia de la serie roja y megacariocitos, con cariotipo complejo y peor pronóstico (IPSS-R 5 puntos). Se trató con 12 ciclos de azacitidina con lo que logró respuesta completa. Recayó 12 meses después y continuó manejo de soporte por un año. Finalmente falleció debido a un accidente vascular cerebral.

Etiologyical Analysis of 133 Patients with Elderly Macrocytic Anemia and Diagnostic Significance of Laboratory Tests / 中国实验血液学杂志

OBJECTIVE@#To study the etiology of macrocytic anemia in elderly patients and to evaluate the diagnostic significance of laborotory tests.@*METHODS@#133 elderly macrocytic anemia patients, whose age>60 years old, hemoglobin100 fL, and bone marrow cell test was performed, and these patients were grouped according to diseases, and the bilirubin, lactate dehydrogenase, folic acid, vit B12 and serum ferritin were tested, then the results of tests were compared and analyzed.@*RESULTS@#The majority of the cases were diagnosed as megaloblastic anemia (MA), myelodysplasia syndrome (MDS), acute leukemia/multiple myeloma (AL/MM) and hemolytic anemia (HA). Usually HA was a simple anemia, while others were accompanied by decrease of other 1 or 2 series. HA patients were often with significant high level of well volume (MCV), red cell distribution width(RDW), reticulocytes (RC) and indirect bilirubin (IBIL) (P<0.01). However, MA patients were often with high level of LDH. Serum ferritin (SF) level was significantly higher in both MDS and AL/MM groups (P<0.01).@*CONCLUSION@#Common causes of macrocytic anemia in elderly patients are MA, MDS, AL/MM and HA. The combination detection of MCV, RDW, RC, LDH, IBIL and SF contributes to enhancing the accuracy of diagnosis.

Identificación de &-talasemia en anemias microcíticas hipocrómicas refractarias al tratamiento con hierro en Nicaragua / Identification of &-thalassemia in hypochromic microcytic anemias refractory to iron treatment in Nicaragua

Resumen Justificación y objetivo: gran parte de los casos descritos de anemias microcíticas-hipocrómicas corresponden a anemias ferropénicas y síndromes talasémicos. El diagnóstico diferencial se complementa con pruebas de laboratorio como el hierro sérico, ferritina, entre otras; sin embargo, estas son de baja disponibilidad en países en vías de desarrollo. En Nicaragua, el diagnóstico de estas patologías se basa en el historial clínico y análisis hematológicos de rutina. El objetivo de este trabajo fue la implementación de la técnica de cuantificación de hemoglobina A2 en el diagnóstico clínico de β-talasemia. Métodos: se realizó un estudio transversal con 30 pacientes que mostraban microcitosis e hipocromía después de 3 meses de tratamiento con sales de hierro. Se realizó electroforesis de hemoglobina y se utilizó el kit de la casa comercial Beta-Thal HbA2 Quik Column para cuantificar la hemoglobina A2 en cada paciente. El análisis estadístico utilizado fue la prueba de t de student. Se consideraron significativas las diferencias a p<0,05. Esta investigación respetó los principios éticos que conciernen. Se contó con la aprobación del Comité de Ética Institucional, UNAN-Managua. Los participantes dieron su consentimiento informado. Resultados: al aplicar el método para cuantificación de hemoglobina A2, se obtuvo que el 67 % de las muestras presentaron una concentración de hemoglobina A2 mayor al valor de referencia establecido (3,3 %), siendo pacientes diagnosticados para β-talasemia menor. El 33 % restante presentó valores normales de hemoglobina A2 con microcitosis e hipocromía. Se encontraron diferencias estadísticamente significativas entre las medias de glóbulos rojos, volumen corpuscular medio, hemoglobina corpuscular media y hemoglobina A2, entre ambos grupos. Conclusión: el diagnóstico diferencial de anemias microcíticas hipocrómicas refractarias al tratamiento con hierro, se realiza inicialmente por el historial clínico del paciente, pero es necesario contar con pruebas diagnósticas como la cuantificación de hemoglobina A2 que permitan identificar las diversas patologías que cursan con microcitosis e hipocromía.

Abstract Justification and objective: much of the described cases of microcytic-hypochromic anemias are ferropenic anemias and Thalassemia syndromes. The differential diagnosis is complemented by laboratory tests as serum iron, ferritin, among others; However, these are of low availability in developing countries. In Nicaragua, the diagnosis of these diseases is based on clinical history and routine blood analysis. The objective of this work was to implement a technique for quantification of hemoglobin A2 in the clinical diagnosis of β-Thalassemia. Methods: We conducted a cross-sectional study with 30 patients showing hypochromia and microcytosis after 3 months of treatment with iron salts. Hemoglobin electrophoresis was performed, a kit from Beta-Thal HbA2 Quik Column was used to quantify the hemoglobin A2 in each patient. The statistical analysis used was the student's t test. The differences were considered significant at p < 0.05. This research respected ethical principles that concern. It had the approval of the committee of ethics institutional, UNAN-Managua and the participants gave their informed consent. Results: when applying the method for quantification of hemoglobin A2, 67% of samples presented a concentration of hemoglobin A2 greater than the reference value set at 3.3%, these patients were diagnosed with β-Thalassemia minor. The remaining 33% presented normal values of hemoglobin A2 with hypochromia and microcytosis. Statistically significant differences between the averages of red blood cells, mean corpuscular volume, mean corpuscular hemoglobin and hemoglobin A2 between the two groups was observed. Conclusion: The differential diagnosis of microcytic hypochromic anemias refractory to treatment with iron, is initially performed by the clinical history of the patient, but it is necessary to have diagnostic tests such as the quantification of hemoglobin A2, which allow the identification of patients with β-Thalassemia minor within this group. In our study 67% of the studied samples were identified as β-Thalassemia minor.

Prevalence of low folate deficiency after wheat flour supplementation - should we still measure serum folate?

ABSTRACT Objectives: To determine the frequency of folic acid deficiency in consecutive serum folate determinations and to determine whether there was a significant decrease in serum folate deficiency after folate was added to wheat flour. Methods: A retrospective descriptive observational study was performed of consecutive folate measurements at the Hospital Privado Universitario, Cordoba, Argentina. Results: Two cohorts were analyzed: 1197 folate measurements between 2001 and 2008 (before supplementation) and 3335 folate measurements from 2009 to 2014 (after supplementation). Folate deficiency was found in 84/1197 (7%) subjects in the pre-supplementation group and in 58/3335 (1.73%) after supplementation. The prevalence of folate deficiency was 12% between 2001 and 2003 when folate was not added to flour compared to 4% in 2004-2007 (p-value < 0.0001) when folate was added to the flour but no widespread use was documented. Conclusions: In the studied population, the prevalence of serum folic acid deficiency after folate supplementation was low at 1.73%. There was a significant decrease in folate deficiency after folate was added to wheat flour. Given the low prevalence of folic acid deficiency observed in this and similar studies, and the observed change with supplementation, we conclude that routine measurement of serum folate is of limited clinical use.

Comprehensive Laboratory Analysis of Korean Acute Alcoholic Intoxication Patients Reveals the Need for a National Hepatitis B Virus Vaccination Program in Korea / 가정의학회지

BACKGROUND: Acute alcoholic intoxication patients (AAIP) are a common public health problem. The aim of this study was to perform a comprehensive laboratory analysis for these patients to investigate the co-morbid medical problem. METHODS: We retrospectively reviewed laboratory findings of AAIP who were transferred to the emergency department (ED) from January 2017 to June 2017. RESULTS: A total of 160 male patients were enrolled. Sixteen patients (16/160, 10.0%) and three patients (3/160, 1.9%) had macrocytic anemia and microcytic anemia, respectively. A total of 33 patients (33/160, 20.6%) showed thrombocytopenia ( 7.0%). Positive rates of hepatitis B surface antigen and anti-HBs antibody (anti-HBs Ab) were 3.5% (5/141) and 49.0% (68/141), respectively. CONCLUSION: Patients with AAIP who were transferred to ED had various laboratory abnormalities (anemia, thrombocytopenia, high HbA1c). They had low positive rate of anti-HBs Ab. This might be a public health problem, suggesting the need of hepatitis B virus vaccination program for AAIP. Our data suggest the need of further nationwide studies.

Pruebas bioquímicas para el diagnóstico de anemia megaloblástica / Biochemical tests for diagnosis of megaloblastic anemias / Testes bioquímicos para o diagnóstico de anemia megaloblástica

Es intención de este trabajo hacer un breve repaso sobre el metabolismo de la Vitamina B12 y del Folato o Vitamina B9. Estas dos vitaminas hidrosolubles juegan un papel importante en el metabolismo celular. Son cofactores de reacciones metabólicas de transferencia de grupos monocarbonados, esenciales para el mantenimiento de la vida. Además se describen las nuevas determinaciones de laboratorio, se evalúan cuáles son los estudios necesarios para arribar a un correcto diagnóstico del paciente con Anemia Macrocítica (AM), su etiología y cómo muchas drogas de uso frecuente en medicina producen AM. Se realiza también la evaluación del conjunto de metodologías que se pueden efectuar como rutina en el laboratorio especializado en hematología y se propone un algoritmo para el diagnóstico del paciente con AM.

The aim of this article is to make a little review on Vitamin B12 and Folate or Vitamin B9 metabolism. These hydrosoluble vitamins have a very important role in cell metabolism. They are cofactors in metabolic reactions of methyl group transfer, essential for life maintaining. Furthermore, new laboratory tests are described, and it is evaluated which the necessary studies are to arrive at a correct diagnosis for macrocytic anemia (MA) patients, their etiology, and how many drugs frequently used in medicine originate MA. Also, the set of methodologies that can be carried out routinely in the laboratory specialized in hematology is evaluated. Finally, a diagnosis algorithm to detect MA in patients is proposed.

Este trabalho visa a realizar uma breve revisão sobre o metabolismo da Vitamina B12 e do Folato ou Vitamina B9. Estas duas vitaminas hidrossolúveis têm um papel importante no metabolismo celular. São cofatores de reações metabólicas de transferência de grupos monocarbonados, essenciais para manter a vida. Também são descritas novas determinações de laboratório, avaliam-se quais são os estudos necessários para chegar a um diagnóstico correto do paciente com Anemia Macrocítica (AM), sua etiologia e de qué maneira muitas drogas de uso frequente em medicina produzem AM. Realiza-se também a avaliação do conjunto de metodologias que podem realizar-se como rotina no laboratório especializado em hematologia e se propõe um algoritmo para o diagnóstico do paciente com AM.

Spontaneous Remission of Pernicious Anemia / 대한내과학회지

Pernicious anemia is a macrocytic anemia that is caused by vitamin B12 deficiency, itself a result of the absence of intrinsic factors due to autoimmune destruction of parietal cells. We report here the case of a 43-year-old female with spontaneous remission of pernicious anemia. The patient presented with fatigue. Her serum vitamin B12 level was low, hemoglobin level was 7.6 g/dL, and serologic tests for anti-intrinsic factor and anti-parietal cell antibodies were positive. We diagnosed her with pernicious anemia, but did not administer vitamin B12 because her hemoglobin level increased spontaneously. Since then, the patient's hemoglobin and serum vitamin B12 levels have been within the normal range.

Autoimmune hemolytic anemia revealing classical Hodgkin lymphoma: Two case reports and literature review

BACKGROUND: Hodgkin Lymphoma (HL) is rarely associated with autoimmune hemolytic anemia. We report here two cases of such association: Case 1: 57 years old man who presented with tiredness and pallor. Physical examination revealed multiple left cervical lymph nodes. Blood count showed regenerative macrocytic anemia with signs of hemolysis. Auto immune hemolytic anemia was confirmed by a positive direct antiglobulin test for IgG and C3d; lymph node biopsy revealed lymphocytic rich HL. Case 2: a 50 year old man being treated for HL for few months presented to the emergency room for dyspnea and pallor. Blood count showed regenerative macrocytic anemia with positive direct antiglobulin test for IgG and C3d confirming the diagnosis of AIHA as a relapse of the lymphoma. These two cases show that clinicians should be aware of such association revealing the diagnosis or the relapse of the lymphoma to distinguish it from anemia of chronic disease.

Acquired Pure Red Cell Aplasia following Autoimmune Hemolytic Anemia in Systemic Lupus Erythematosus / 대한내과학회지

Pure red cell aplasia (PRCA) is a rare hematological disorder characterized by severe normochromic normocytic anemia and reticulocytopenia due to erythroid progenitor depletion in an otherwise normal bone marrow. Autoimmune hemolytic anemia (AIHA) is caused by autoantibodies directed against red blood cells with normocytic or macrocytic anemia with reticulocytosis. Both diseases can develop in conjunction with various underlying diseases, such as immunological disorders. Although rare, there have been a few cases of AIHA followed by PRCA. Here, we report a patient who developed PRCA following AIHA and was later diagnosed with systemic lupus erythematosus.

Anemia in Individuals over Age 80: Unattended Issue in Clinical Practice / 이화의대지

OBJECTIVES: To assess the current state of anemia evaluation in the elderly over 80 years of age. METHODS: Patients who were more than 80 years old and visited Dongguk University Ilsan Hospital from April 2005 to February 2014 were included. Statistical analysis were assessed using the logistic regression model. RESULTS: Total 548 patients, who had anemia according to WHO criteria, were identified. The median age was 85 years old (range, 82 to 99 years) and median hemoglobin level was 11.0 g/dL (range, 2.7 to 12.9 g/dL). Twenty-eight, 468, and 52 patients were classified as microcytic anemia, normocytic anemia, and macrocytic anemia, respectively. Among them, 397 patients (72.4%) did not undergo proper evaluation for the cause anemia i.e., 8 cases (28.5%) of microcytic anemia, 361 cases (77.1%) of normocytic anemia, and the 28 cases (53.84%) of 52 macrocytic anemia patients. The remaining 151 patients (27.6%) had completed the evaluation, and 24 patients (15.9%) were diagnosed as solid malignancies. In the assessment of iron deficiency anemia, hemoglobin levels, and age had no effect on whether or not to perform esophagogastroduodenoscopy. CONCLUSION: This finding showed that physicians often neglected anemia in individuals over 80 years of age. Though these patients have limited life expectancy, physicians should carefully discriminate the sub-population who will be benefit from adequate evaluation and treatment.

Acidosis láctica y leucemia aguda: presentación de un caso clínico y revisión de la literatura / Lactic acidosis and acute leukemia: a case report and review of the literature

Se presenta el caso clínico de una paciente mujer de 17 años de edad con diagnóstico de leucemia linfoblástica aguda, quien ingreso por astenia, hiporexia, síndrome consuntivo y anemia severa macrocítica, sin evidencia de compromiso del sistema reticuloendotelial. En el laboratorio se evidencio acidosis láctica severa, hipokalemia, proteinuria e hipovitaminosis B 12, se amplió el diagnóstico diferencial y se planteó la posibilidad de neoplasia hematológica asociada a acidosis láctica...

We report the case of a 17 year-old patient with acute lymphoblastic leukemia with asthenia, hiporexia with severe malnutrition, marked macrocitic anemia and consuming syndrome. There was no reticuloendothelial system compromise. In the laboratory presented severe lactic acidosis as a metabolic complication, hipokalemia, proteinuria and vitamin B 12 deficiency, These factors delayed the diagnosis when the differential diagnosis was increased, the suspicion of lactic acidosis-associated hematologic neoplasia was considered...

Pernicious anemia in patients with macrocytic anemia and low serum B12

The current research evaluated the prevalence of pernicious anemia [PA] in patients with macrocytic anemia [high MCV] and low serum B12 in Riyadh. Blood testing was done in 77 patients [males: 45.5%, females: 54.5%] with macrocytic anemia; 84 patients; [males: 23.8%, females: 76.2%] with low serum B12 and 30 healthy subjects. Complete blood count, differential count, folic acid, vitamin B12, intrinsic factor, gastric parietal cell antibodies and holotranscobalamin II were assessed. A total of five subjects from 161 patients had PA; three of these patients had macrocyticanemia [3.90%] and two patients had low serum B12 [2.38%]. Significant differences [p<0.05] in some hematological, immunological, biochemical parameters were found in subjects with macrocytic anemia and low serum B12 compared to controls. Pernicious anemia in patients with macrocytic anemia and low serum B12 was for the selected sample size can be assumed to be uncommon in Riyadh, Saudi Arabia

Aplastic anemia with macrocytic anemia: a study based on long-term follow-up / 中华血液学杂志

<p><b>OBJECTIVE</b>To elucidate the clinical features, response rate, prognosis and clonal evolution of aplastic anemia (AA) with macrocytic anemia (mAA).</p><p><b>METHODS</b>The clinical features at initial diagnosis and data in follow up of mAA hospitalized from January 2000 to October 2011 were analyzed retrospectively.</p><p><b>RESULTS</b>(1) Of 153/568 (26.9%) cases of mAA at initial diagnosis, 114(74.5%)were non-severe AA (NSAA), 39(25.5%)severe AA (SAA) and 0 very severe AA (VSAA), while the proportion was 16.2%, 45.2%, and 38.6% in 376 normocytic anemia AA (nAA), and the difference is statistically significant(χ(2) = 181.390; P = 0.000). The median age of mAA was significantly higher than that of nAA \[30(4 - 70)years vs 19 (3 - 68) years, P = 0.001\]. (2) There were no statistical difference in hemoglobin, absolute neutrophil count (ANC), platelet count (PLT), response rate after 6 months treatment and overall survival (OS) between mAA and nAA grouped in SAA and NSAA respectively. In SAA, the reticulocyte count (Ret) of mAA was significantly higher than that of nAA \[23.90(2.99 - 61.00)×10(9)/L vs 13.1(0 - 70.60)×10(9)/L, P = 0.000\] and the proportion of erythroid cells in bone marrow of mAA was also higher \[23.5 (0 - 58) vs 14.5 (0 - 65), P = 0.043\], while they did not differ significantly in NSAA. (3) The proportion of AA with PNH clones or abnormal cytogenetics did not differ significantly in mAA and nAA groups before treatment. The incidences of AA evolved to PNH in mAA and nAA was not statistically significant (7/153 vs 9/376, χ(2) = 1.099, P = 0.294) and so was the incidence of evolution to MDS/AML(3/153 vs 13/376, χ(2) = 0.399, P = 0.528).</p><p><b>CONCLUSION</b>In presented with macrocytic anemia at initial diagnosis of AA, higher proportion of NSAA, elderly age, higher Ret and proportion of erythroid cells are features, but being no statistical difference in the response rate, OS, and proportion of clonal evolution.</p>

Manejo integral de un paciente con secuelas neuropsiquiátricas por consumo crónico de alcohol / Integral Treatment of a Patient with Neuropsychiatric Symptoms in a city in the Central-South Region of Chile

La cronicidad de los síntomas neuropsiquiátricos aun cuando tengan etiología diversa, genera una importante discapacidad para el paciente, mayor carga familiar y altos costos de atención. Objetivos. Describir la evolución clínica y el manejo integral de un paciente con deficiencias vitamínicas asociadas al consumo de alcohol. Hallazgos clínicos. Se trata de un hombre de 55 años, residente en San Carlos, Chile, sin antecedentes psiquiátricos previos excepto por dependencia al alcohol que suspendió luego del inicio de su sintomatología psiquiátrica hace cuatro años, caracterizada por ideas delirantes de tipo paranoide, místico y nihilista, además de alucinaciones complejas de tipo auditivo, olfatorio y táctil y compromiso gradual de su estado de ánimo. Posteriormente, presenta paraparesia de extremidades superiores de predominio proximal y más tarde de las inferiores, además de alteraciones cognitivas. Se descartaron otras patologías médicas y sólo se documentó anemia macrocítica, iniciándose manejo con suplencia vitamínica (B12 y folato) y un plan de intervención integral por psiquiatría y terapia ocupacional, para tratamiento sintomático y de rehabilitación. Conclusiones. A lo largo del seguimiento de las intervenciones interdisciplinarias se observa en el paciente una mejoría progresiva especialmente de las alteraciones neurológicas y de su funcionamiento global...

Chronified neuropsychiatric symptoms even when they have diverse etiology, generate an important impairment for the patient, greater family preoccupation, and high attention cost. Objectives. Describe the clinical evolution and integral management of a patient with vitamins deficit for alcohol abuse. Clinical Signs. Subject is a male patient of 55 years of age, resides in San Carlos, Chile, without psychiatric backgrounds except for alcohol dependency that he suspended after beginning psychiatric symptoms four years ago, characterized by delirious thoughts of the paranoid, mystical and nihilistic nature, also visual, olfactory and tactile complex hallucinations and gradual compromise of mood. Afterwards he presented paralysis of the superior extremities predominately proximal, and later of the inferiors, also, cognitive alterations. Other medical pathologies where discarded and only a megaloblastic anemia was documented, beginning treatment of vitamin supplements (B12 and folate) and an integral treatment plan with psychiatry and occupational therapist, for symptomatic treatment and, rehabilitation. Conclusions. Throughout the follow up of the interdisciplinary interventions it could be observed in the patient a progressive betterment of the neurological alterations, and in his global functions...

Utilidad del citrato de galio 67 en el diagnóstico de fiebre de origen desconocido / Effectiveness of gallium 67 citrate in diagnosing fever of unkown origin

Se presenta el caso de un paciente con cuadro de 4 meses de evolución de fiebre intermitente, pérdida no cuantificada de peso y diaforesis nocturna. El examen físico reveló hepatoesplenomegalia sin otras alteraciones. Los estudios iniciales mostraron anemia macrocítica-hipocrómica, y las serologías para VIH, hepatitis B y hepatitis C fueron negativas. La TAC de cuello reportó adenomegalias cervicales subcutáneas bilaterales; a una de ellas se le tomó una biopsia, que resultó negativa para malignidad o infección. El objetivo de este reporte es ilustrar la utilidad del 67Gacitrato en el estudio de la fiebre de origen desconocido.

Presentation is made of the case of a patient with a 4-month history of intermittent fever, unquantified weight loss and night sweating. Physical examination revealed heptosplenomegaly, with no additional alterations. Initial studies showed macrocytic-hypochromic anemia; serology tests for HIV, hepatitis B, and hepatitis C were negative. CT of the neck reported bilateral subcutaneous cervical lymphadenopathy; biopsy was performed on one, which resulted negative for malignancy or infection. The purpose of this report is to illustrate the effectiveness of Ga-citrate 67 in the study of fever of unknown origin.

Impacto do tratamento antirretroviral na ocorrência de macrocitose em pacientes com HIV/AIDS do município de Maringá, Estado do Paraná / Impact of antiretroviral therapy on occurrences of macrocytosis in patients with HIV/AIDS in Maringá, State of Paraná

INTRODUÇÃO: AIDS é uma doença causada pelo HIV que compromete o sistema imune do organismo. O advento da terapia antirretroviral (TARV) altamente eficaz promoveu melhora substancial do prognóstico da doença e da qualidade de vida dos pacientes com HIV/AIDS. Durante seu tratamento prolongado, notam-se algumas alterações hematológicas, dentre elas, anemia e macrocitose, bem como carências de micronutrientes, tais como, de vitamina B12 e ácido fólico. O objetivo do presente trabalho é relacionar a macrocitose e anemia ao uso de TARV, ou à deficiência de vitamina B12 ou de ácido fólico. MÉTODOS: Foram avaliados 110 pacientes HIV positivos, comparando-se aqueles em uso de TARV com zidovudina (AZT) (grupo 1), TARV sem AZT (grupo 2) ou sem uso de TARV (grupo 3). RESULTADOS: Os pacientes dos três grupos não apresentaram diferenças estatísticas significativas quanto aos níveis de hemoglobina (p = 0,584) e de ácido fólico (p = 0,956). Os pacientes do grupo 1 (G1) apresentaram volume corpuscular médio (VCM) aumentado quando comparado ao grupo 3 (G3) (p < 0,05), bem como do grupo 2 (G2) em relação ao G3 (p < 0,001). As dosagens de vitamina B12 do G1 e G3 foram menores do que as encontradas pelo G2 (p = 0,008). CONCLUSÕES: Conclui-se que os indivíduos em uso de TARV apresentaram macrocitose, embora não pudesse ser relacionada ao tipo de TARV ou a deficiência de vitamina B12. Entretanto, a deficiência de ácido fólico não esteve relacionada ao uso de TARV e nem à macrocitose.

INTRODUCTION: AIDS is a disease caused by HIV that compromises the organism's immune system. The advent of highly active antiretroviral therapy (HAART) has promoted substantial improvement in the prognosis for this disease and in HIV/AIDS patients' quality of life. During prolonged treatment, certain hematological disorders are observed, such as anemia and macrocytosis, as well as deficiencies of micronutrient such as vitamin B12 and folic acid. The objective of this study was to correlate the presence of macrocytosis and anemia with HAART use or vitamin B12 and folic acid deficiencies. METHODS: 110 HIV-positive patients were included, in three groups: HAART use with zidovudine (AZT) (group 1), HAART use without AZT (group 2) and no HAART (group 3). RESULTS: None of the patients in any of the three groups presented statistically significant differences relating to hemoglobin level (p = 0.584) or folic acid level (p = 0.956). Group 1 (G1) had a higher mean corpuscular volume (MCV) than G3 (p < 0.05), and group 2 (G2) had a higher volume than group 3 (G3) (p < 0.001). Vitamin B12 levels in G1 and G3 were smaller than those in G2 (p = 0.008). CONCLUSIONS: It was concluded that patients undergoing HAART treatment presented macrocytosis, even though this could not be correlated with the type of HAART or with vitamin B12 deficiency. However, folic acid deficiency was unrelated to either HAART or macrocytosis.

Factores de riesgo asociados a la prevalencia de anemia ferropénica en niños de 24 a 59 meses de edad atendidos en el Hospital Militar Escuela Doctor Alejandro Dávila Bolaños enero a diciembre del 2009 / Risk factors related to the prevalence of iron deficiency anemia in children 24-59 months of age treated at the Military Training Hospital Doctor Alejandro Dávila Bolaños January to December 2009

El objetivo del presente estudio fue valorar los factores de riesgo que se asocian a la prevalencia de anemia ferropénica en un grupo de niños (1892) que ingresaron a la sala de hospitalización pediátrica en edades de dos a cinco años en el periodo correspondiente de Enero a Diciembre del 2009, de estos 357 presentaron hemoglobina menor de 11 gr/dl (valor de referencia por debajo del cual debe considerarse anemia según OMS) a partir de los cuales se seleccionaron 110 casos (niños anémicos) y 220 controles (no anémicos) a través del software Epi info 6.04 utilizando los siguientes parámetros: OR: 2, frecuencia de exposición entre los controles 50%, nivel de seguridad 95% y poder estadístico de 80%. El muestreo se realizó de forma aleatoria simple, tanto para los casos como para los controles. La prevalencia de anemia en el universo estudiado es de 18.9%, el 20% de los casos presentaba desnutrición con respecto a los controles los cuales tenían un 8.3%, el nivel de analfabetismo de la madre de los niños en ambos grupos alcanzó un 4.8%, la infección parasitaria en ambos grupos representó el 37.6%, de estos los más afectados son los niños anémicos (51.8%). La anemia microcítica hipocrómica fue la que predominó en el grupo casos, se observó un 5.4% de anemia moderada, con hemoglobina entre el rango de 7 a 9 gr/dl. Se concluyó que son factores de riesgo para anemia los siguientes: Presentar algún tipo de desnutrición, Ser hijo de madre que no haya estudiado o que sólo haya cursado primaria incompleta, que el niño tenga algún tipo de infección parasitaria (excepto por saprófito) y Presentar más de tres episodios en el año de enfermedad diarreica. Se recomendo Indicar tratamiento intrahospitalario y/o ambulatorio con hierro en los casos que lo ameriten y de no poderse indicar, se debe dar seguimiento por la consulta externa...