ABSTRACT
UNLABELLED: The direct manual Polybrene test (DPT) and the direct antiglobulin tests (DAT) were employed to detect antibody sensitizing red blood cell (RCB) in patients with clinical and laboratorial findings of autoimmune hemolytic anemia (AIHA). PURPOSE: To compare the sensitivity and specificity of DPT and DAT in the diagnosis of AIHA. METHODS: Eighteen consecutive patients with diagnosis of AIHA were evaluated. The control group consisted of 20 normal volunteers blood donors and 20 patients with sickle cell anemia. All patients and controls were submitted to DPT and DAT. All DAT positive samples were further tested using monospecific reagents (anti-IgG heavy chain and anti-C3d). Positive samples for either DPT or DAT were evaluated by eluate technique using. The dichloromethane (DCM). RESULTS: The DAT was positive in 14 patients and negative in 4 subjects, while the DPT was positive in 17 patients and negative in 1 individual who had a positive DAT owing to complement (C3d). All positive eluates performed with DCM showed RBC autoantibodies with presumed "anti-Rh" specificity. The sensitivity rate of the DPT (94%) was significantly (p < 0.05) higher than the sensitivity rate of DAT (78%) to determine whether IgG was bound in vivo, but no difference was found regarding the specificity of the two tests. CONCLUSION: 1) The DPT is more sensitive than the DAT in detecting IgG autoantibody on the RBCs of patients with AIHA; 2) because of its simplicity and rapidity, the DPT is a useful additional screening test for the investigation of Coombs-negative AIHA.
Subject(s)
Anemia, Hemolytic, Autoimmune/diagnosis , Coombs Test , Hexadimethrine Bromide , Serologic Tests/methods , Adult , Aged , Anemia, Sickle Cell/diagnosis , Female , Humans , Immunoglobulin G , Male , Middle Aged , Sensitivity and SpecificityABSTRACT
O teste manual direto do Polybreneâ (TDP) e o teste de Coombs direto (TCD) foram utilizados para a detecçäo de IgG na superfície de hemácias de pacientes com diagnóstico clínico e laboratorial de anemia hemolítica auto-imune (AHAI). Objetivo. Comparar a sensibilidade e especificidade do TPD e do TCD no diagnóstico da AHAI. Método. Foram estudados 18 pacientes com diagnóstico clínico-laboratorial de AHAI. Como indivíduos controles, foram testados 20 doadores de sangue assintomáticos e 20 pacientes com anemia falciforme. Resultados. O TCD foi positivo em 14 pacientes e negativo em quatro indivíduos, enquanto o TDP foi positivo em 17 pacientes e negativo em um indivíduo que apresentava TCD positivo devido a fixaçäo de complemento (C3d) nas hemácias. Todos os eluatos positivos realizados com a técnica de diclorometano revelaram anticorpos quentes com especificidade "anti-Rh". A sensibilidade do TDP (94 por cento) para detectar fixaçäo de IgG in vivo foi significantemente maior (p<0,05) que a do TCD (78 por cento), enquanto os dois testes apresentaram a mesma especificidade (100 por cento). Conclusäo. O presente estudo permite concluir que, além de apresentar maior sensibilidade que o TCD, o TDP é um método rápido e de baixo custo, sendo, dessa forma, um teste auxiliar útil no diagnóstico de AHAI, especialmente nos pacientes com TCD negativo.
Subject(s)
Adult , Middle Aged , Female , Humans , Coombs Test , Serologic Tests/methods , Hexadimethrine Bromide , Anemia, Hemolytic, Autoimmune/diagnosis , Immunoglobulin G , Sensitivity and Specificity , Anemia, Sickle Cell/diagnosisABSTRACT
OBJECTIVE: To evaluate the score systems of Cassano and Sanz and suggest a new one. DESIGN: Case series. LOCATION: Teaching hospitals: EPM UNIFESP and Faculdade de Medicina de Botucatu. PARTICIPANTS: 59 patients diagnosed from 1979 to 1992. INTERVENTION: Evaluation of clinical-laboratorial data. MEASUREMENT: Statistical comparison, uni and multivariate analysis and actuarial survival curves. RESULTS: Cassano's system divided the patients into high and low risk (p = 0.0966) while Sanz's gave high, intermediate and low risk (p = 0.0108). The univariate analysis showed hemoglobin, WBC count, E/M ratio, liver size and blast percentage in BM as statistically significant. The multivariate analysis showed blast percentage in BM (p = 0.004) and Hb (p = 0.050) as significant. Our system, considering the multivariate analysis data, divided the patients into high, intermediate and low risk (p = 0.0038). CONCLUSIONS: Sanz's system was more functional than Cassano's, while ours showed predictive survival value and ease of use in clinical practice.
Subject(s)
Myelodysplastic Syndromes/mortality , Actuarial Analysis , Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Multivariate Analysis , Myelodysplastic Syndromes/blood , Prognosis , Retrospective Studies , Severity of Illness Index , Survival AnalysisABSTRACT
O estudo das alteraçoes cromossômica nas leucemias mielóides agudas (LMA) vem-se tornando importante no diagnóstico e na caracterizaçao de subtipos, pois associam-se a características clínicas, morfológicas e imunológicas definidas à resposta a tratamento e à sobrevida. OBJETIVO. O presente trabalho objetiva avaliar a importância relativa das alteraçoes citogenética em portadores de LMA. MATERIAL. Foram estudados, ao diagnóstico, 13 pacientes com LMA e com idade mediana igual a 38 anos. O estudo citogenético foi realizado em material medular.RESULTADOS. Os subtipos FAB M1 e M2 foram o mais freqüentes (61,6 por cento). A análise citogenética mostrou cariótipo anormal em 61,5 por cento dos casos e, dentre estes, apenas 15,3 por cento tinham alteraçoes indicadoras de bom prognóstico [t(l5;17) e t(8;21)]. Na data de avaliaçao do estudo havia três pacientes vivos, dois em remissao completa contínua e um em segunda remissao. A sobrevida mediana global foi de 7 meses. Os pacientes foram divididos em dois grupos: um intitulado "bom prognóstico", que englobou cinco indivíduos com cariótipo normal e dois com as translocaçoes t(l5;17) e t(8;21), e outro, "mau prognóstico", com oito pacientes com alteraçoes cromossômicas desfavoráveis. O grupo "bom prognóstico" teve sobrevida mediana de nove meses, enquanto outro, de 6,2 meses, mas sem diferença estatisticamente significante (p= 0,180084), provavelmente devido ao pequeno número de casos em cada grupo. Entretanto, ao se analisar os casos em separado nota-se que os pacientes com translocaçoes (8;21) e (15;17), tidas como de bom prognóstico, tiveram sobrevidas mais longas. CONCLUSAO. Concluímos que o trabalho evidenciou sobrevida desigual entre os dois grupos, ressaltando a importância da análise citogenética que permite distinguir o paciente que terá evoluçao favorável.
Subject(s)
Adult , Humans , Female , Middle Aged , Adolescent , Leukemia, Myeloid/diagnosis , Leukemia, Myeloid/genetics , Prognosis , Acute Disease , SurvivorsABSTRACT
UNLABELLED: The study of chromosomal abnormalities in AML has become very important in the diagnosis and in the characterization of subtypes since they are related to defined clinical, morphological and immunological features as well as treatment outcome and survival. PURPOSE: To evaluate the relative importance of cytogenetic abnormalities may have in AML patients. METHODS: 13 AML patients were studied during diagnosis. Cytogenetic study was performed on bone marrow aspirate material. RESULTS: M1 and M2 FAB subtypes were the most frequent (61.6%). The patients' median age was 38 years. Cytogenetic analysis showed abnormal karyotype in 61.5% of the cases and 15.3% of whom had abnormalities considered as good prognosis [t(15;17) and t(8;21)]. At the evaluation day there were 3 patients alive, two in continuous complete remission and 1 in a second remission. The median total survival time was 7 months. Patients were divided into two groups: a "good prognosis" one, that joined 5 patients with normal karyotype and 2 with the translocations t(15;17) and t(8;21) and another, the "bad prognosis" one, with 8 patients with unfavorable chromosomal abnormalities. The good prognosis group had a median survival time of 9 months versus 6.2 months in the other, but this was not statistically significant (p = 0.18), probably owing to the small number of cases in the groups. But when one observes the cases separately see that patients with translocations (8;21) and (15;17), known as good prognosis, had longer survivals. CONCLUSION: The different survival time between the two groups showed the importance of cytogenetic study to distinguish the patient who will have favorable evolution.
Subject(s)
Leukemia, Myeloid/genetics , Acute Disease , Adolescent , Adult , Aged , Female , Humans , Leukemia, Myeloid/mortality , Leukemia, Myeloid/pathology , Male , Middle Aged , PrognosisABSTRACT
The prognostic value of different factors upon diagnosis of CML was analysed in 45 Philadelphia (Ph1)-positive patients. The median survival was 48 months. Univariate analysis showed 5 poor prognostic factors (male sex, under 45 years-old, bone marrow blasts greater than or equal to 10 percent, blood basophils greater than or equal to 6 percent and blood eosinophils greater than or equal to 6 percent) which provided for the development of a clinical staging system: Stage I with none or one factor and a two-year survival rate of 100 percent; Stage II with two or three factors and two-year survival of 72.2 percent; and Stage III with four or five factors and two-year survival of 0 percent (p = 0.00016). Multivariate survival analysis showed that combination of blood basophilia and bone marrow blasts had the strongest predictive relationship to survival time. We conclude that a combination of pretreatment factors identifies different risk subcategories in CML patients and is helpful in assessing the overall prognosis and the treatment approach.
