ABSTRACT
We report on several abnormalities of the red blood cells, in particular erythrocytic inclusions, in a 49 year old man. The blood smear presented with marked anisocytosis, target cells, acanthocytes and Howell-Jolly bodies, as well as Pappenheimer bodies and basophilic stippling. These abnormalities can be explained by the clinical context which associated splenectomy, iron overload and severe denutrition. The patient died a few weeks after from kidney and liver insufficiency. We comment on the different features of erythrocytic inclusions and the clinical situations in which they can be found.
Subject(s)
Erythrocyte Inclusions/pathology , Erythrocytes, Abnormal/pathology , Postoperative Complications/diagnosis , Splenectomy/adverse effects , Fatal Outcome , Humans , Male , Middle Aged , Multiple Organ Failure/blood , Multiple Organ Failure/pathology , Postoperative Complications/blood , Postoperative Complications/pathology , Postoperative PeriodSubject(s)
Renal Insufficiency/pathology , Splenectomy , Humans , Male , Middle Aged , Renal Insufficiency/surgeryABSTRACT
The hexylester of 5-aminolevulinic acid (HAL) is a very efficient precursor of the photosensitizer protoporphyrin IX (PpIX) for photodynamic therapy (PDT). Our previous study, performed in rat orthotopic bladder tumors, indicated an opposite effect of HAL/PpIX-PDT according to HAL concentration. The present study investigated possible reasons for this differential effect considering the impact of extracted amounts of PpIX in normal and tumor bearing bladders along with PpIX distribution in distinctive histopathological layers. High performance liquid chromatography (HPLC) analysis of tumor and normal bladder tissues after 8 mM and 16 mM HAL instillation showed that PpIX was the main porphyrin species. The PpIX production in tumor bladders instilled with 8 mM HAL was significantly higher than after 16 mM HAL. Fluorescence confocal microscopy demonstrated a punctuate bright fluorescence pattern in tumor zones of bladders instilled with 8 mM HAL, whereas a more diffuse cytoplasmatic fluorescence distribution was observed after 16 mM HAL instillation. Immunofluorescence staining together with transmission electron microscopy showed severe mitochondrial damage in tumor zones of bladders treated with 8 mM HAL/PpIX PDT, with intact mitochondria in tumor zones of bladders treated with 16 mM HAL/PpIX PDT. We conclude that the differential response to HAL/PpIX PDT in function of HAL concentrations could be attributed to diminished PpIX synthesis and differential intracellular localisation of PpIX. Mitochondria were shown to be the critical photodamaged sites of HAL/PpIX PDT and as such tissue sensitivity to treatment can be estimated through investigation of intracellular PpIX distribution.
