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1.
Rev. bras. ter. intensiva ; 20(1): 99-102, jan.-mar. 2008. ilus
Artigo em Português | LILACS | ID: lil-481174

RESUMO

JUSTIFICATIVA E OBJETIVOS: A hiperleucocitose (> 100 x 10(9)/L) em leucemia mielóide crônica não é uma apresentação comum e pode determinar manifestações clínicas de hiper-viscosidade. As perdas auditiva e visual observadas em pacientes com leucemia são consideradas sintomas incomuns, mas fortemente associados à síndrome da hiper-viscosidade. O objetivo deste estudo foi relatar o caso de um paciente que apresentou perda da audição como manifestação inicial de leucemia mielóide crônica e síndrome de hiper-viscosidade e rever aspectos relacionados a seu tratamento em Medicina Intensiva. RELATO DO CASO: Paciente do sexo masculino, 41 anos, com queixa de tontura havia seis meses sem resposta ao tratamento sintomático, foi admitido no serviço de emergência com perda auditiva aguda. Ao exame físico encontrava-se normal, exceto por perda auditiva bilateralmente. Os exames laboratoriais demonstraram leucocitose importante (645.000), com 66,4 por cento de blastos com características mielóides, 13,6 por cento bastões, 15,3 por cento segmentados, 1,4 por cento linfócitos, 3,3 por cento eosinófilos e plaquetas de 225.000. Devido à suspeição de leucemia com risco elevado para síndrome de hiper-viscosidade, o paciente foi admitido para tratamento na unidade de terapia intensiva. Realizado mielograma e biópsia de medula óssea que confirmaram o diagnóstico de leucemia mielóide crônica. Iniciadas hidratação, hidroxiuréia, alopurinol e dexametasona. A leucoaferese foi realizada uma semana após a admissão, quando a contagem leucocitária estava em torno de 488.000. Dez dias após o procedimento, o paciente não apresentou melhora da audição, apesar da leucometria de 10.000. Recebeu alta hospitalar em duas semanas para continuidade do tratamento ambulatorial. CONCLUSÕES: As freqüências das manifestações sensitivas em pacientes com leucemia incluem além das perdas auditiva e visual, vertigem, paralisia facial e infecções. A síndrome de hiper-viscosidade decorrente...


BACKGROUND AND OBJECTIVES: Hyperleukocytosis (> 100 x 10(9)/L) is an uncommon presentation of chronic leukemias and it can present clinical symptoms of hyperviscosity syndrome. Hearing loss and blindness rarely occurs in patients with leukemia; however, it can be strong association with hyper-viscosity syndrome. The purpose of this paper is to report a case of acute hearing loss as the initial manifestation of acute leukemia and hyper-viscosity syndrome and also mainly aspects of the intensive care treatment. CASE REPORT: A 41 year-old, male patient, who has been complaining about dizziness for six months with no response to symptomatic medications, was admitted to the emergency department with acute hearing loss. The physical examination was normal except for a bilateral hearing loss without an apparent cause. Laboratory exams showed total leukocyte: 645.000 with 66.4 percent blasts, hemoglobin: 7.0, hematocrit: 20.5, urea: 94, creatinine: 1.59, K: 5.6, Na: 138, INR: 1.38, TTPa: 0.89, troponin lower than 0.2, CK: 218, CKMB: 50, uric acid: 11.1. After a first hypothesis of leukemia with a high risk of hyper-viscosity complications, the patient was admitted to the Intensive Care Unit for monitoring and treatment. A bone marrow biopsy was performed and than started hidratation, hydroxyurea, allopurinol, dexamethasone. According to hematologists the patient had a chronic myeloid leukemia. Leukopheresis was performed one week after admission when total blood leukocytes were around 488.000. Ten days after the procedure the patient had no improvement of the hearing loss but total leukocytes were 10.100. He was discharge to the ward and 2 weeks later went home to continue ambulatory treatment. CONCLUSIONS: The frequency of sensitive manifestations in patients with leukemia include not only visual and hearing loss but also many others manifestations such as conductive vertigo, facial palsy and infections. Hyperviscosity syndrome due to hyperleukocytosis...


Assuntos
Humanos , Masculino , Adulto , Leucemia Mielogênica Crônica BCR-ABL Positiva/complicações , Viscosidade Sanguínea/imunologia
2.
Acta Med Indones ; 2005 Oct-Dec; 37(4): 205-9
Artigo em Inglês | IMSEAR | ID: sea-47111

RESUMO

AIM: To determine the role of persistent ACA and hyperviscosity as risk factor of ischemic stroke. Methods: A study was conducted on 76 subjects whose age 40 to 70 years. Subjects consisted of 38 patients of post ischemic stroke and 38 controls with diagnosis other than stroke. Fresh blood samples were taken and mixed with EDTA for viscosity examination and serum for ACA IgM and IgG examination. The laboratory examination for persistent ACA IgM and IgG used ELISA method, while viscosity analysis was using viscometer. Statistic analysis used chi-square and multivariate analysis with logistic regression. RESULTS: In this study we found persistent ACA IgG in 25% of case group , and 2.63% in control group. Multivariate analysis showed persistent ACA IgG as risk factor for ischemic stroke with p < 0.05 and OR 14.11 (CI 95%:1.64;121.11). We found persistent ACA IgM in 2.78% of case group and 5.26% in control group. High blood viscosity was found in 15.79% case group and 10.53% in a control group. Statistical analysis showed no significant difference of viscosity (p = 0.740) and persistent ACA IgM (p = 1.000) between case and control group. CONCLUSION: study showed that persistent ACA IgG in stroke ischemic was higher than in control subjects. Blood viscosity examination and persistent ACA IgM did not show significant difference. While persistent ACA IgG with OR 14.11 (CI: 1.64; 121.11) was the risk factor for ischemic stroke. Blood viscosity and persistent ACA IgM were not risk factors for ischemic stroke.


Assuntos
Adulto , Idoso , Anticorpos Anticardiolipina/sangue , Biomarcadores/sangue , Viscosidade Sanguínea/imunologia , Isquemia Encefálica/sangue , Estudos de Casos e Controles , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Imunoglobulina A/sangue , Imunoglobulina M/sangue , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Acidente Vascular Cerebral/sangue , Fatores de Tempo
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