[Soluble transferrin receptor and erythropoietin in chronic disease anemia with or without iron deficiency]. / Receptor soluble de transferrina y eritropoyetina en la anemia de los procesos crónicos con y sin deficiencia de hierro.

The regulation of transferrin receptor (RTF) is related to intracellular iron stores and with the soluble receptor is present in plasma. It has already been demonstrated that in iron deficiency anemia (IDA), receptor expression increases when iron stores decrease. In anemia of chronic diseases (ACD) it is difficult to establish the real iron status because of the influence exerted by inflammatory or infectious diseases on iron metabolism. We studied 30 healthy normal subjects and 42 anemic patients (hemoglobin less than 120 g/L) affected with ACD divided into two groups with and without iron deficiency, in order to establish the diagnostic value of measuring the soluble transferrin receptor (sRTF). We correlated erythropoietin (EPO) (as an erythropoietic stimulating factor) with the decreased hemoglobin values observed in both groups. The results were analysed with an ANOVA statistic test of one way analysis of variance, and there were no significant differences in sRTF values between the ACD groups with or without iron deficiency. The ratio log EPO vs hemoglobin showed a remarkably significant inverse correlation in both groups. We can conclude that sRTF levels are within the normal reference values in these patients and are not related to organic iron. Consequently, sRTF cannot be considered a good parameter for making a diagnosis of iron deficiency in chronic diseases.

Receptor soluble de transferrina y eritropoyetina en la anemia de los procesos crónicos con y sin deficiencia de hierro. / [Soluble transferrin receptor and erythropoietin in chronic disease anemia with or without iron deficiency]

The regulation of transferrin receptor (RTF) is related to intracellular iron stores and with the soluble receptor is present in plasma. It has already been demonstrated that in iron deficiency anemia (IDA), receptor expression increases when iron stores decrease. In anemia of chronic diseases (ACD) it is difficult to establish the real iron status because of the influence exerted by inflammatory or infectious diseases on iron metabolism. We studied 30 healthy normal subjects and 42 anemic patients (hemoglobin less than 120 g/L) affected with ACD divided into two groups with and without iron deficiency, in order to establish the diagnostic value of measuring the soluble transferrin receptor (sRTF). We correlated erythropoietin (EPO) (as an erythropoietic stimulating factor) with the decreased hemoglobin values observed in both groups. The results were analysed with an ANOVA statistic test of one way analysis of variance, and there were no significant differences in sRTF values between the ACD groups with or without iron deficiency. The ratio log EPO vs hemoglobin showed a remarkably significant inverse correlation in both groups. We can conclude that sRTF levels are within the normal reference values in these patients and are not related to organic iron. Consequently, sRTF cannot be considered a good parameter for making a diagnosis of iron deficiency in chronic diseases.

[Immunocytochemistry techniques for the diagnosis of hematologic neoplasms]. / Aplicación de técnicas inmunocitoquímicas para el diagnóstico de neoplasias hematólogicas.

We studied 22 patients with hematological neoplasias which included: 12 patients with a diagnosis of Acute Myeloblastic Leukemia (AML) following the morphology and cytochemistry criteria established by FAB (French, American and British Committee), a Myeloblastic Leukemia secondary to MDS (Myelodysplastic Syndromes) and a biphenotypic acute leukemia where we established the relationship between the traditional peroxidase reaction with the anti-MPO by APAAP. We also carried out the nonspecific esterase reaction and determined the immunologic phenotype by FACS technology. The same procedure was used for the cellular analysis of the light chains kappa (kappa) and lambda (lambda) in 3 cases of hairy cell leukemia, one lymphoma and 4 cases of plasma cell neoplasia and reactive plasma cell disease. We conclude that immunocytochemical reactions must be used when morphology and traditional cytochemical reactions need to be confirmed in order to establish a correct diagnosis and this is specially important for B and T lymphomas. Their prognostic value is restricted and the results are useful as a complement to morphology, cytochemistry and immunological determinations.

[Red cell distribution width (RDW): its use in the characterization of microcytic and hypochromic anemias]. / Indice de distribución de glóbulos rojos (RDW): su aplicación en la caracterización de anemias microcíticas e hipocrómicas.

With the widespread use of cell counters we have now acquired new red cell indices complementary of the old ones, like the HDW and RDW (Red Cell Distribution Width) which detect the heterogeneity of red cell size and anisocytosis in the blood smear. We studied 90 patients with the following results. 1) in the control group of healthy volunteers (n = 50) RDW results were (mean +/- ES) 13.90 +/- 0.10% and MCV (mean +/- ES) 90 +/- 5 fl; 2) the iron deficiency patients (IDA) (n = 20) gave a MCV of (mean +/- ES) 68.60 +/- 1.77 fl., and RDW (mean +/- ES) 20.20 +/- 1.21%; 3) the beta-thalassemic patients (n = 20) had an MCV of (mean +/- ES) 66.45 +/- 1.95 fl, and RDW (mean +/- ES) 17.08 +/- 0.40%. We compared the results of MCV between IDA and thalassemics and against the control group with the following results: control vs IDA and control vs thalassemic with significant differences with p < 0.01, and no significant difference when we compared IDA vs thalassemics. Then we compared the results of RDW between IDA and thalassemics and against the control group with the following results: control vs IDA and control vs thalassemic with significant differences with p < 0.001 and with significant differences when we compared IDA vs thalassemics p < 0.001. The statistical results were obtained with the one-way analysis of variance (ANOVA). The results show that RDW is a more sensitive indicator than MCV to establish the possible origin of microcytic hypochromic anemias and that both should be used together in early diagnosis.

Aplicación de técnicas inmunocitoquímicas para el diagnóstico de neoplasias hematólogicas. / [Immunocytochemistry techniques for the diagnosis of hematologic neoplasms]

We studied 22 patients with hematological neoplasias which included: 12 patients with a diagnosis of Acute Myeloblastic Leukemia (AML) following the morphology and cytochemistry criteria established by FAB (French, American and British Committee), a Myeloblastic Leukemia secondary to MDS (Myelodysplastic Syndromes) and a biphenotypic acute leukemia where we established the relationship between the traditional peroxidase reaction with the anti-MPO by APAAP. We also carried out the nonspecific esterase reaction and determined the immunologic phenotype by FACS technology. The same procedure was used for the cellular analysis of the light chains kappa (kappa) and lambda (lambda) in 3 cases of hairy cell leukemia, one lymphoma and 4 cases of plasma cell neoplasia and reactive plasma cell disease. We conclude that immunocytochemical reactions must be used when morphology and traditional cytochemical reactions need to be confirmed in order to establish a correct diagnosis and this is specially important for B and T lymphomas. Their prognostic value is restricted and the results are useful as a complement to morphology, cytochemistry and immunological determinations.

Indice de distribución de glóbulos rojos (RDW): su aplicación en la caracterización de anemias microcíticas e hipocrómicas. / [Red cell distribution width (RDW): its use in the characterization of microcytic and hypochromic anemias]

With the widespread use of cell counters we have now acquired new red cell indices complementary of the old ones, like the HDW and RDW (Red Cell Distribution Width) which detect the heterogeneity of red cell size and anisocytosis in the blood smear. We studied 90 patients with the following results. 1) in the control group of healthy volunteers (n = 50) RDW results were (mean +/- ES) 13.90 +/- 0.10

and MCV (mean +/- ES) 90 +/- 5 fl; 2) the iron deficiency patients (IDA) (n = 20) gave a MCV of (mean +/- ES) 68.60 +/- 1.77 fl., and RDW (mean +/- ES) 20.20 +/- 1.21

; 3) the beta-thalassemic patients (n = 20) had an MCV of (mean +/- ES) 66.45 +/- 1.95 fl, and RDW (mean +/- ES) 17.08 +/- 0.40

. We compared the results of MCV between IDA and thalassemics and against the control group with the following results: control vs IDA and control vs thalassemic with significant differences with p < 0.01, and no significant difference when we compared IDA vs thalassemics. Then we compared the results of RDW between IDA and thalassemics and against the control group with the following results: control vs IDA and control vs thalassemic with significant differences with p < 0.001 and with significant differences when we compared IDA vs thalassemics p < 0.001. The statistical results were obtained with the one-way analysis of variance (ANOVA). The results show that RDW is a more sensitive indicator than MCV to establish the possible origin of microcytic hypochromic anemias and that both should be used together in early diagnosis.

[Vitamin E as protective agent against hemolysis in leprosy patients under dapsone treatment]. / Vitamina E como agente protector de hemólisis en pacientes de lepra tratados con dapsona.

Dapsone (4,4'diaminodiphenyl-sulphone) commonly used in the treatment of patients who suffer from leprosy, is a strongly oxidative drug, producing damage to the red cell membrane. This study investigated whether Vitamin E would have a protective effect on the red cell membrane from oxidant damage caused by Dapsone in patients with leprosy. We have studied 16 patients for 4 months, divided into two groups. Group 1 (n = 7) dapsone (DDS): 100 mg/day; Group 2 (n = 9) dapsone: 100 mg/day in addition with Vitamin E: 800 U/day. We did not include patients with low levels of Glucose-6-Phosphate Dehydrogenase (G-6-PD) because of their sensibility to this drug. At the beginning of the treatment we determined the level of G-6-PD. All patients showed a normocytic normochromic anemia with a decrease in Haptoglobine levels (below 5 mg/dl). Statistical analyses showed that reticulocyte counts did not present significant differences between groups all through evolution. As for methemoglobin (Hi) we observed in Group 1 an increase between the first and the fourth month, which was not seen in group 2. Statistical analyses of the results suggest that oral Vitamin E confers partial protective effect and does not correct the hemolysis parameters produced by Dapsone treatment except for Hi levels which were more sensitive to the oxidant damage.