ABSTRACT
Late-onset hemorrhagic cystitis (HC) after allogeneic hematopoietic stem cell transplantation (HSCT) has been associated with BK virus (BKV). Antiviral drugs are of limited efficacy and the optimal treatment for HC has not yet been established. Hyperbaric oxygen (HBO) may benefit these patients. We, therefore, retrospectively evaluated the effectiveness of HBO therapy in 16 patients with HC after allogeneic HSCT. All 16 patients had macroscopic hematuria and BKV infection. Patients received 100% oxygen in a hyperbaric chamber at 2.1 atmospheres for 90 min, 5 days per week, with a median 13 treatments (range, 4-84). Fifteen patients (94%) showed complete resolution of hematuria. Median urinary DNA BKV titers declined after HBO (P<0.05). Patients started on HBO earlier after diagnosis of HC responded sooner (P<0.05). HBO was generally well tolerated and proved to be a reliable option for this difficult to manage condition.
Subject(s)
BK Virus , Bone Marrow Transplantation , Cystitis/therapy , Hemorrhage/therapy , Hyperbaric Oxygenation/methods , Polyomavirus Infections/therapy , Adolescent , Adult , Cystitis/diagnosis , Cystitis/etiology , Female , Hematologic Diseases/diagnosis , Hematologic Diseases/therapy , Hemorrhage/diagnosis , Hemorrhage/etiology , Humans , Infant , Male , Middle Aged , Polyomavirus Infections/diagnosis , Polyomavirus Infections/etiology , Retrospective Studies , Time Factors , Transplantation, HomologousABSTRACT
BACKGROUND: Prospective testing for posttransplant circulating anti-HLA antibodies seems to be a critical noninvasive tool, but confirmatory data are lacking. MATERIALS AND METHODS: Over the last 3 years, peritubular capillary (PTC) C4d deposition was prospectively sought by an immunofluorescence technique applied to frozen tissue in biopsies obtained for allograft dysfunction. Screening for circulating anti-HLA class I/II alloantibodies (AlloAb) by the flow cytometric test was performed simultaneously. RESULTS: We evaluated 132 sets of biopsies and simultaneous serum samples. PTC C4d deposition was demonstrated in 15.9% (21/132) of biopsies. Circulating anti-HLA I/II AlloAb were detected in 25% (33/132) of serum samples. Employing receiver-operator characteristic (ROC) curves for all C4d-positive biopsies, screening for AlloAb showed a global specificity of 82% and sensitivity of 61.9%. When this analysis was restricted to biopsies obtained in the first month posttransplantation, the sensitivity increased to 81.8%, but the specificity decreased to 76.9%. After the first month posttransplantation, we observed sensitivity of 40.0% and a specificity of 86.4%. In the first month posttransplantation, all patients with a diagnosis of acute antibody-mediated rejection displayed circulating anti-HLA class I/II, but not always at the same time as the C4d-positive biopsy. CONCLUSIONS: In the first month posttransplantation, prospective monitoring of anti-HLA antibodies may be useful. The high sensitivity allows the identification of patients at risk, affording an earlier diagnosis of antibody-mediated rejection. After the first month, the test can be used to evaluate allograft dysfunction episodes, since positivity is highly suggestive of an antibody-mediated process.
Subject(s)
HLA Antigens/immunology , Isoantibodies/blood , Kidney Transplantation/pathology , Transplantation, Homologous/pathology , Adult , Biomarkers/blood , Biopsy , Complement C4b/analysis , Female , Flow Cytometry , HLA-D Antigens/immunology , Histocompatibility Antigens Class I/immunology , Humans , Kidney Transplantation/immunology , Male , Middle Aged , Peptide Fragments/analysis , Reoperation/statistics & numerical data , Sensitivity and Specificity , Transplantation, Homologous/immunologyABSTRACT
The clinical pathologist often faces the request for the research of dysmorphism in urinary erythrocytes for evaluation of hematuria. Red cells with a different shape in the urinary sediment is usual but it is difficult to know when its presence has really diagnostic meaning. The last concepts about dysmorphic erythrocytes in urine, mainly the acanthocyte, and its importance in the differential diagnosis of hematuria are presented in this review.
