Reticulocytosis in screen-printing workers exposed to 2-butoxyethanol and 2-ethoxyethanol

BACKGROUND: Studies on the hematologic toxicity of ethylene glycol ethers in humans are limited. Therefore, the aim of this study was to examine the association between exposure to solvents (containing 2-butoxyethanol and 2-ethoxyethanol) and hematological effects. METHODS: Thirty-four screen-printing workers who were exposed to 2-butoxyethanol and 2-ethoxyethanol and 37 non-exposed clerical workers were selected using data from the health care facilities that provided regular health screening services. Student's t-tests and Pearson's chi-square tests were used to compare differences in hematological parameters between the exposed and the control groups. A multivariate analysis was performed using the multiple logistic regression models to adjust for other variables. RESULTS: The chi-square test showed the reticulocyte percentages and corrected reticulocyte counts to be significantly higher in the exposed group. The t-tests showed a significant increase in white blood cell counts, reticulocyte percentages, and corrected reticulocyte count (i.e., reticulocyte index) in the exposed group, with p-values of 0.002, 0.004, and 0.002, respectively. Multivariate analysis showed the odds ratio for the corrected reticulocyte counts to be 16.30 for the exposed group, when compared with that of the control group. CONCLUSIONS: Exposure to 2-butoxyethanol and 2-ethoxyethanol was significantly associated with reticulocytosis, necessitating the implementation of preventive measures for workers prone to occupational exposure to ethylene glycol ethers.

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.

Evaluation of red cell and reticulocyte parameters as indicative of iron deficiency in patients with anemia of chronic disease

Objective: The purpose of this study was to evaluate the effectiveness of mature red cell and reticulocyte parameters under three conditions: iron deficiency anemia, anemia of chronic disease, and anemia of chronic disease associated with absolute iron deficiency. Methods: Peripheral blood cells from 117 adult patients with anemia were classified according to iron status, and inflammatory activity, and the results of a hemoglobinopathy investigation as: iron deficiency anemia (n = 42), anemia of chronic disease (n = 28), anemia of chronic disease associated with iron deficiency anemia (n = 22), and heterozygous β thalassemia (n = 25). The percentage of microcytic red cells, hypochromic red cells, and levels of hemoglobin content in both reticulocytes and mature red cells were determined. Receiver operating characteristic analysis was used to evaluate the accuracy of the parameters in differentiating between the different types of anemia. Results: There was no significant difference between the iron deficient group and anemia of chronic disease associated with absolute iron deficiency in respect to any parameter. The percentage of hypochromic red cells was the best parameter to discriminate anemia of chronic disease with and without absolute iron deficiency (area under curve = 0.785; 95% confidence interval: 0.661–0.909, with sensitivity of 72.7%, and specificity of 70.4%; cut-off value 1.8%). The formula microcytic red cells minus hypochromic red cells was very accurate in differentiating iron deficiency anemia and heterozygous β thalassemia (area under curve = 0.977; 95% confidence interval: 0.950–1.005; with sensitivity of 96.2%, and specificity of 92.7%; cut-off value 13.8). Conclusion: The indices related to red cells and reticulocytes have a moderate performance in identifying absolute iron deficiency in patients with anemia of chronic disease...

Effects of hypoxia on epididymal sperm parameters and protective role of ibuprofen and melatonin

Hypobaric hypoxia is of interest due to an increase of human populations working at high altitude. Testicular damage is related to the physiological response (neoangiogenesis) to increased intrascrotal blood flow as temperature rises. Hypoxia is a stress factor with overproduction of reactive oxygen species (ROS). The effect of hypoxia in mice reproductive parameters is analyzed. Animals were exposed to simulated hypoxia of 4,200 meters above sea level (m.a.s.l.) in a chamber for 33.2 days, both to continuous (HH) or intermittent hypoxia (HI) with an intermittency period of 4 days hypoxia /4 days normoxia (500 m.a.s.l.). The anti-inflammatory drug Ibuprofen was administered to a group of mice to control vasodilation and increased blood flow. Melatonin was administered to another group of mice as a potent ROS scavenger. Animals in both HH and HI exposure were compared to normoxic non-treated controls. There was a hematological response in hypoxia, with an increase in hematocrit and reticulocytosis. There was also increased teratozoospermia. This damage was more pronounced in HH than HI, suggesting that alternating normoxic periods permits compensation for the effects of hypoxia. In both hypoxia systems, the level of lipoperoxidation and the instability of DNA increased. In HH, there was a reduction of teratozoospermia in melatonin-treated mice. Ibuprofen presented a protective effect on the same parameters as melatonin with both HI and HH. The quality of sperm DNA, fragmentation, unpacking and DNA stability diminished. In conclusion, reproductive damage elicited by HH or HI was partially ameliorated by simultaneous treatment with antiflogistic and/or antioxidant agents.

Anemia grave en un paciente con infección por el virus de inmunodeficiencia humana / Severe anemia in a patient with human immunodeficiency virus infection

La anemia es relativamente frecuente en pacientes con infección avanzada por VIH. La aplasia pura de la serie roja (APSR) asociada a la infección por Parvovirus B19 (PVB19) se caracteriza por la ausencia de precursores eritroides en la médula ósea que produce anemia grave normocítica, normocrómica, con un bajo recuento de reticulocitos. Este artículo describe un paciente con infección por VIH con inmunosupresión grave y en fracaso virológico que desarrolló APSR asociada a PV B19.

Severe anemia is quite frequently seen in HIV infected patient with advanced disease. Pure red cell aplasia associated to Parvovirus B19 (PVB 19) infection is characterized by the absence of erythroid precursors in the bone marrow resulting in severe normocytic-normochromic anemia with a low reticulocyte count. This article reports a patient with advanced HIV and virological failure, who developed pure red cell aplasia associated to PVB19.

Pseudoreticulocytosis in a Case of Myelodysplastic Syndrome / 대한혈액학회지

Myelodysplastic syndrome (MDS) is a group of hematopoietic disorders characterized by ineffective hematopoiesis and peripheral cytopenia associated with dysplastic hypercellular marrow. Anemia is a frequent finding and reticulocytes are usually normal or slightly decreased in the patients with MDS. "Pseudoreticulocytosis" is a rare abnormality of patients with MDS. In these patients, the delayed maturation of reticulocytes is revealed and unusual reticulocytosis occurs with the decreased red cell production. We report a case of MDS characterized by the anemia associated with high reticulocyte count. 'In vitro reticulocyte survival test' showed that the reticulocytosis was a consequence of delayed maturation.

Red Cell Depletion from the Bone Marrow Aspirates for the ABO Incompatible Transplantation by Apheresis Separations / 대한혈액학회지

BACKGROUND: Allogeneic bone marrow transplantation across ABO incompatibility barriers may result in immune mediated hemolysis. Hemolysis may be avoided by RBC depletion from the graft. In vitro graft manipulations carry the risk of hematopoietic stem cell loss, a factor that may be most important in graft failure. We report 16 major ABO blood group incompatible allogeneic bone marrow transplants using erythrocyte depletion of marrow prior to infusion. METHODS: From March 1997 to July 2001 in Yonsei University College of Medicine, 16 patients underwent ABO blood group incompatible allogeneic BMT: 5 for acute myelocytic leukemia, 5 for severe aplastic anemia, 3 for acute lymphocytic leukemia, 2 for chronic myelocytic leukemia, and 1 for myelodysplastic syndrome. RBC depletions were done with automatic cell separator, COBE Spectra (COBEBCT Inc., Lakewood, USA). RBC removal rates and mononuclear cell recovery rates were calculated. And the evidence of successful engraftment and intravascular hemolysis were also evaluated. RESULTS: The RBC removal rate was 99.1+/-0.0% and a mean of 1% of the original red cell volume was contained in the final infusate. The mononuclear cell recovery rate was 70.0+/-16.3% from the original MNCs. Fourteen patients tolerated the infusion of the marrow concentrates without any adverse effects. Two patients experienced hemoglobinuria, but disappeared within 2 days by continued observation. After transplantation, absolute neutrophil counts exceeded 500/nL by 10.8+/-1.9 days, platelet counts exceeded 50,000/nL by 30.5+/-8.5 days, and reticulocytosis sustained at >1% was by 25.8+/-13.9 days. CONCLUSION: RBC depletion from ABO major mismatched bone marrow aspirates by the automatic cell separator is a safe and effective technique.

Myelodysplastic Syndrome with Delayed Maturation of Reticulocytes: A Report of Three Cases / 대한임상병리학회지

Anemia in myelodysplastic syndrome (MDS) is accompanied by reticulocytopenia in most patients. Reticulocytosis, when present, is generally less than appropriate to the degree of anemia and rarely exceeds 10%. In this report, three patients with MDS with persistent reticulocytosis are presented. In vitro reticulocyte survival studies have suggested that the reticulocytosis was caused by delay in maturation of the reticulocytes. Anemia with reticulocytosis, mimicking hemolytic disease, may be an unusual presentation of myelodysplastic syndrome, but, we emphasize that MDS should be included in the differential diagnosis of every patient presenting with anemia and high reticulocyte count. In vitro reticulotye survival study is easy to assess and valuable to diagnose this disease entity.

A Case of Coexistence with Myelodysplastic Syndrome and Paroxysmal Nocturnal Hemoglobinuria: Confirmed by Reticulocytes Survival Test and Glycosylphosphatidylinositol (GPI)-linked Protein Test / 대한혈액학회지

A patient presenting paroxysmal nocturnal hemoglobinuria (PNH) cloned cells in the course of myelodysplastic syndrome (MDS) with reticulocytosis is described. The bone marrow biopsy demonstrated erythroid hyperplasia and moderate dysplasia. Mild hemoglobinuria was detected but the Ham test was negative. The reticulocyte survival test revealed sustained survival curve indicating delayed reticulocyte maturation regarded as the characteristic of MDS cloned erythroid cells. The glycosylphosphatidylinositol-linked protein deficient neutrophils and erythrocytes population regarded as PNH clones were identified by flow cytometric analysis using monoclonal antibody. From these results, we concluded that MDS and PNH cloned cells were coexisited in this patient. In this patient, long-term follow-up observation could clarify whether MDS and PNH were arising from the same clone or from two distinct clones.

Comparison Study of Reticulocyte Enumeration by H*3 RTX(TM), FACScan(TM), and Manual Counting / 대한임상병리학회지

BACKGROUND: Reticulocyte counts provide clinically useful informations and the most widely used method for counting reticulocytes is a manual microscopic procedure. Although manual method is inexpensive and relatively simple to perform, it is labor intensive and imprecise. So, more rapid and more reproducible methods are needed. METHODS: Reticulocyte counts on 96 blood samples were performed by conventional manual method, H*3 RTX(TM)(Bayer, U.S.A.), and FACScan(TM)(Beckon Dickinson, U.S.A.). The changes of reticulocyte count after storage of samples and certain time intervals after preparation were also examined. RESULTS: Reticulocyte counts(%) by manual method, H*3 RTX(TM), and FACScanM were 2.05+/-2.16, 1.95+/-2.24 and 2.51+/-1.94, respectively. There was no statistically significant differences between manual counting and H*3 RTX(TM)(P>0.05). However, there were significant differences between H*3 RTX(TM) and FACScan(TM), manual counting and FACScan(TM)(P<0.05). Correlation coefficients of three comparisons were all above 0.920. Statistically not confirmed the reticulocytosis sample showed decreasing tendency of reticuocyte count by H*3 RTX(TM) after storage of the sample and prepared sample and others were relatively stable in H*3 RTX(TM)and FACScan(TM). CONCLUSIONS: The result of the mean difference between H*3 RTX(TM) and manual counting is statistically insignificant. So, the H*3 RTX(TM)can be used interchangeably with manual counting atter consideration of cost-effectiveness.

Splenectomy in Hereditary Spherocytosis in Childhood / 영남의대학술지

Among the erythrocyte membrane defects, hereditary spherocytosis is the most common. The erythrocyte membrane defect results from a deficiency of spectrin, the most important structural protein in red cell. Hereditary spherocytosis often presents with hemolytic anemia, jaundice, moderate splenomegaly. Diagnosis is established by the presence of spherocytes in the peripheral blood, reticulocytosis, an increased osmotic fragility, and a negative Coombs test. In children, splenectomy is usually performed after age 6 years but can be done at a younger age if warranted by the severity of the anemia and the need for frequent transfusions. In the period December 1987 to Agust 1993, 9 patients with hereditrary spherocytosis underwent splenectomy and the following results were obtained. 1. Nine patients were comprised of five males and four females. 2. Five patients(55.6%) had been admitted to our hospital during age 6-10 years. 3. Four of the nine patients had autosomal dominant inheritance with variable expression. The other five patients had no known inheritance. 4. The diagnosis of the spherocytosis was based on the increased osmotic fragility and increased autohemolysis of the erythrocytes, as well as on the appearance of spherocytes in the peripheral blood smear. 5. In all cases splenectomy was performed. Two patients had concomitant gall stones and choledocholithiasis, respectively. One patient with concomitant gall stones underwent simultaneous cholecystectomy and splenectomy. The other patients associated with choledocholithiasis underwent splenectomy, cholecystectomy, choledocholithotomy, and T-tube drainage. 6. Complete hematologic recovery was obtained by the splenectomy in all cases. 7. Postoperative complication was not occurred.

Clinical evaluation on 5 cases of lead Poisoning / 영남의대학술지

5 cases of lead poisoning were investigated clinically. Of the 5 patients, 4 were male and 1 was female. The causes of lead poisoning in 3 cases were ingestion of herb drug pills and in 2 cases were occupational poisoning. Chief complain at admission in 4 cases were ill defined colicky abdominal pain and constipation. Only 1 case complained of dizziness and palpitation without gastrointestinal symptom. On peripheral blood, normocytic normochromic anemia (mean Hgb 9.2 gm/dl), reticulocytosis (mean 4.7%) and basophilic stippling were found in 100% of patients. Bone marrow aspiration was done in 4 cases. Erythroid hyperplasia and basophilic stippling were found in all 4 cases. Mean M:E ratio was 0.7:1. The lead concentration in serum was increased in 4 cases (80%) of patients. Lead concentration, delta aminolevulinic acid concentration in 24 hours collected urine were increased in 5 patients (100%).

Congenital Syphilis: Hematologic Findings of Early Congenital Syphilis / 대한피부과학회지

A retrospective study was made of the previous medical records of 47 infants with congenital syphilis born from mothers with untreated syphilis at Severance Hospital, Yonsei University College of Medicine during the years 1972 through 1983 The VDRL titer of these infants was higher than 1: 8 with reactive FT.A-ABS test. They were subjectd to hematologic examinations and the results were as follow s, 1. Of 46 infants with congenital syphilis, anemia was observed in thirty-one (68%) Reticulocytosis occurred in seventeen(89%) of nineteen infants with congenital syphilis having the mean value of 6. 0%. 3, Of 4.7 infants with congenital syphilis, leucocytosis was noted in seveenteen 4, Thrombocytopenia was observed in twenty (64%) of thirty-one infants with congenital syphilis.

Prednisolone-responsive Malignant Osteopetrosis: a case reveiw

The authors presented a 17 months old female with malignant osteopetrosis, who was admitted to the Pediatric Department of Kyung Hee University Hospital on May, 1981 because of epistaxis and growth retardation. Diagnosis was made by typical clinical manifestations, hematologic and radiologic findings, such as frontal bossing, opened anterior fontanel, exophalmoses, strabismus, optic atropy, marked hepatosplenomegaly, severe anemia, thrombocytopenia, reticulocytosis and typical mask sign and sun burst sign at the skull X-ray, wide dense ribs with fracture at the vertebrae, clubbings at the distal parts of the femurs and radii and at the proximal parts of the tibias and humerii transverse bands at the metaphyses, and finally increased density of the entire skeleton on the bone scanning and marked decrease uptake of 99mTc on the bone marrow scanning. Prednisolone was administrated orally, resulted in gradual improvement of hematologic abnormalities to the normal range, associated wited with increased cellularity of the bone marrow and increased uptake of 99mTc and decreased spleen size on the bone marrow scanning after one month of therapy.

Prednisolone-responsive Malignant Osteopetrosis: a case reveiw

The authors presented a 17 months old female with malignant osteopetrosis, who was admitted to the Pediatric Department of Kyung Hee University Hospital on May, 1981 because of epistaxis and growth retardation. Diagnosis was made by typical clinical manifestations, hematologic and radiologic findings, such as frontal bossing, opened anterior fontanel, exophalmoses, strabismus, optic atropy, marked hepatosplenomegaly, severe anemia, thrombocytopenia, reticulocytosis and typical mask sign and sun burst sign at the skull X-ray, wide dense ribs with fracture at the vertebrae, clubbings at the distal parts of the femurs and radii and at the proximal parts of the tibias and humerii transverse bands at the metaphyses, and finally increased density of the entire skeleton on the bone scanning and marked decrease uptake of 99mTc on the bone marrow scanning. Prednisolone was administrated orally, resulted in gradual improvement of hematologic abnormalities to the normal range, associated wited with increased cellularity of the bone marrow and increased uptake of 99mTc and decreased spleen size on the bone marrow scanning after one month of therapy.