ABSTRACT
Acquired von Willebrand syndrome (AvWS) is a relatively rare bleeding disorder. It has been reported in association with myeloproliferative disorders, autoimmune diseases, plasma cell dyscrasias and certain drugs. Cefotaxime is a third generation cephalosporin widely used for surgical prophylaxis and as empirical treatment of bacterial meningitis. We report a case of a transient AvWS in association with cefotaxime therapy.
Subject(s)
Cefotaxime/adverse effects , von Willebrand Diseases/chemically induced , Adult , Cefotaxime/therapeutic use , Follow-Up Studies , Humans , Male , Treatment Outcome , von Willebrand Diseases/diagnosis , von Willebrand Diseases/drug therapyABSTRACT
In a formal study, we have identified increasing age, pretreatment renal impairment and diabetes mellitus as risk factors for the development of intravenous immunoglobulin-induced renal failure. Identification of these characteristics in potential recipients should alert clinicians to the associated increased risk of this serious complication.
Subject(s)
Acute Kidney Injury/etiology , Hematologic Diseases/therapy , Immunoglobulins, Intravenous/adverse effects , Acute Kidney Injury/epidemiology , Age Factors , Aged , Anemia, Hemolytic, Autoimmune/complications , Anemia, Hemolytic, Autoimmune/therapy , Confidence Intervals , Diabetes Complications , Hematologic Diseases/complications , Hemophilia A/complications , Hemophilia A/therapy , Humans , Incidence , Kidney Diseases/complications , Odds Ratio , Purpura, Thrombocytopenic, Idiopathic/complications , Purpura, Thrombocytopenic, Idiopathic/therapy , Purpura, Thrombotic Thrombocytopenic/complications , Purpura, Thrombotic Thrombocytopenic/therapy , Risk FactorsABSTRACT
Interleukin-1beta(IL-1beta) and tumour necrosis factor-alpha (TNF-alpha) are potent bone resorbing cytokines that may contribute to the development of the osteolytic bone disease observed in patients with multiple myeloma (MM). Although these factors have been identified in cultures of bone marrow mononuclear cells isolated from patients, the identity of the cells responsible for producing IL-1beta and TNFalpha remains unclear. Using a sensitive dual-colour fluorescence in situ hybridization (FISH) technique and a two-colour immunofluorescence method we have investigated the expression of the mRNA and protein, for IL-1beta and TNFalpha, by individual bone marrow plasma cells from patients with MM and monoclonal gammopathy of undetermined significance (MGUS). The mRNA for IL-1beta and TNFalpha was identified in all cells expressing the immunoglobulin light chain from all patients with MM and MGUS. However, the IL-1beta protein could not be detected in cytoplasmic light chain positive cells in any of the patients examined. In contrast, the TNFalpha protein was detected in clonal plasma cells from patients with both MM and MGUS. Interestingly, the IL-1beta and TNFalpha mRNA and proteins were readily detected within a small proportion of the non-plasma cells from patients with both MM and MGUS. These data suggest that myeloma cells in vivo are able to produce TNFalpha but not IL-1beta. In addition, a small proportion of accessory cells are likely to be able to contribute to the production of both ILbeta and TNFalpha.
Subject(s)
Interleukin-1/metabolism , Paraproteinemias/metabolism , Plasma Cells/metabolism , Tumor Necrosis Factor-alpha/metabolism , Aged , Aged, 80 and over , Female , Fluorescent Antibody Technique , Humans , Male , Middle Aged , Multiple Myeloma/metabolism , RNA, Messenger/metabolismSubject(s)
Adenocarcinoma/complications , Autoantibodies/immunology , Autoimmune Diseases/etiology , Factor VIII/immunology , Hemophilia A/etiology , Neoplasm Recurrence, Local/complications , Prostatic Neoplasms/complications , Adenocarcinoma/immunology , Aged , Aged, 80 and over , Autoimmune Diseases/immunology , Fatal Outcome , Hemophilia A/immunology , Hemorrhage/etiology , Humans , Male , Neoplasm Recurrence, Local/immunology , Prostatic Neoplasms/immunologyABSTRACT
Interleukin-6 (IL-6) is an important growth factor for human myeloma cells in vitro and in vivo. However, the identity of the cells producing IL-6 in vivo in patients with multiple myeloma (MM) remains the subject of debate. We have developed a sensitive dual-colour fluorescence in situ hybridization (FISH) technique to investigate the expression of IL-6 mRNA by individual bone marrow plasma cells from patients with multiple myeloma, monoclonal gammopathy of undetermined significance (MGUS) and healthy subjects. IL-6 mRNA could be identified in all immunoglobulin light chain (IgLC) expressing cells from all patients with MM and MGUS. The IL-6 protein could also be detected by direct immunofluorescence in all plasma cells (cytoplasmic light chain positive) from all patients with MM and MGUS. Furthermore, it was also possible to demonstrate cytoplasmic IL-6 staining of plasma cells from patients with MM by flow cytometric analysis. In contrast, neither the IL-6 mRNA or protein could be detected in normal plasma cells from healthy bone marrow donors. These data demonstrate that plasma cells from patients with MM and MGUS express the IL-6 mRNA and synthesize the IL-6 protein and support the hypothesis that autocrine synthesis of IL-6 is of importance in patients with MM.
