Lupus anticoagulant laboratory diagnosis by applying the 2020 ISTH-SSC guidelines.

BACKGROUND: The ISTH-SSC guidelines for lupus anticoagulant (LA) testing recommend using in-house determined cut-off values, pooled normal plasma (PNP) for ratio normalization, and a ratio for the mixing test interpretation. They strongly support the mixing step role in the diagnostic process. OBJECTIVES: To investigate and compare the LA testing results and interpretations obtained following the ISTH-SSC guidelines or the available alternatives. PATIENTS/METHODS: Blood samples for LA testing from 462 consecutive patients were evaluated for screening, mixing and confirmatory tests. The analysis focused on the interpretation differences between using (1) the in-house cut-off values versus the manufacturer's cut-off values, (2) a normalized ratio calculated using PNP at each run versus the mean of the reference interval, (3) a normalized ratio versus the index of circulating anticoagulant to interpret the mixing step, and (4) a two-step versus three-step procedure. RESULTS: LA testing outcomes were comparable when using the in-house and manufacturer's cut-off values. More positive dilute Russell's viper venom (DRVV) time results were obtained with the normalized ratio based on PNP than with the mean of the reference interval. Overall, the mixing test results obtained with the normalized ratio and the index of circulating anticoagulant showed a good agreement. Among the 97 DRVV Screen test-positive samples, 33 and 89 were classified as LA-positive with the 3-step and the 2-step procedure, respectively. CONCLUSIONS: The cut-off value used and the way to normalize ratios had a limited impact. Conversely, it is important to understand the mixing test characteristics to maximize its diagnostic potential.

[Fatal intracerebral hemorrhage in a patient with chronic neutrophilic leukemia: About one case and literature review]. / Hémorragie intracérébrale fatale chez un patient atteint d'une leucémie chronique à polynucléaires neutrophiles : à propos d'un cas et revue de la littérature.

INTRODUCTION: Chronic neutrophilic leukemia (CNL) is a rare myeloproliferative syndrome characterized by a significant increase in mature neutrophils. One of the most serious complications is the occurrence of bleeding events, which may sometimes lead to death. CASE REPORT: A 75-year-old patient presented with CNL, complicated by a severe bleeding phenotype. Biological investigations revealed platelet function defect and increase in neutrophil elastase. The follow-up was marked by an intracranial hemorrhage leading to the patient's death 7 months after diagnosis. CONCLUSION: This bleeding phenotype has been reported several times in patients with CNL. However, the pathophysiological mechanisms that cause bleeding are not yet fully understood.

Avalanches dynamics in reaction fronts in disordered flows.

We report on numerical studies of avalanches of an autocatalytic reaction front in a porous medium. The front propagation is controlled by an adverse flow resulting in upstream, static, or downstream regimes. In an earlier study focusing on front shape, we identified three different universality classes associated with this system by following the front dynamics experimentally and numerically. Here, using numerical simulations in the vicinity of the second-order transition, we identify an avalanche dynamics characterized by power-law distributions of avalanche sizes, durations, and lateral extensions. The related exponents agree well with the quenched-Kardar-Parisi-Zhang theory, which describes the front dynamics. However, the geometry of the propagating front differs slightly from that of the theoretical one. We show that this discrepancy can be understood in terms of the nonquasistatic correction induced by the finite front velocity.

CHEMO-hydrodynamic coupling between forced advection in porous media and self-sustained chemical waves.

Autocatalytic reaction fronts between two reacting species in the absence of fluid flow, propagate as solitary waves. The coupling between autocatalytic reaction front and forced simple hydrodynamic flows leads to stationary fronts whose velocity and shape depend on the underlying flow field. We address the issue of the chemico-hydrodynamic coupling between forced advection in porous media and self-sustained chemical waves. Towards that purpose, we perform experiments over a wide range of flow velocities with the well characterized iodate arsenious acid and chlorite-tetrathionate autocatalytic reactions in transparent packed beads porous media. The characteristics of these porous media such as their porosity, tortuosity, and hydrodynamics dispersion are determined. In a pack of beads, the characteristic pore size and the velocity field correlation length are of the order of the bead size. In order to address these two length scales separately, we perform lattice Boltzmann numerical simulations in a stochastic porous medium, which takes into account the log-normal permeability distribution and the spatial correlation of the permeability field. In both experiments and numerical simulations, we observe stationary fronts propagating at a constant velocity with an almost constant front width. Experiments without flow in packed bead porous media with different bead sizes show that the front propagation depends on the tortuous nature of diffusion in the pore space. We observe microscopic effects when the pores are of the size of the chemical front width. We address both supportive co-current and adverse flows with respect to the direction of propagation of the chemical reaction. For supportive flows, experiments and simulations allow observation of two flow regimes. For adverse flow, we observe upstream and downstream front motion as well as static front behaviors over a wide range of flow rates. In order to understand better these observed static state fronts, flow experiments around a single obstacle were used to delineate the range of steady state behavior. A model using the "eikonal thin front limit" explains the observed steady states.

Numerical simulations of a buoyant autocatalytic reaction front in tilted Hele-Shaw cells.

We present a numerical analysis of solutal buoyancy effects on the shape and the velocity of autocatalytic reaction fronts, propagating in thin tilted rectangular channels. We use two-dimensional (2D) lattice Bathnagar-Gross-Krook (BGK) numerical simulations of gap-averaged equations for the flow and the concentration, namely a Stokes-Darcy equation coupled with an advection-diffusion-reaction equation. We do observe stationary-shaped fronts, spanning the width of the cell and propagating along the cell axis. We show that the model accounts rather well for experiments we performed using an Iodate Arsenous Acid reaction propagating in tilted Hele-Shaw cells, hence validating our 2D modelization of a three-dimensional problem. This modelization is also able to account for results found for another chemical reaction (chlorite tetrathionate) in a horizontal cell. In particular, we show that the shape and the traveling velocity of such fronts are linked with an eikonal equation. Moreover, we show that the front velocity varies nonmonotonically with the tilt of the cell, and nonlinearly with the width of the cell.

Lock-exchange experiments with an autocatalytic reaction front.

A viscous lock-exchange gravity current corresponds to the reciprocal exchange of two fluids of different densities in a horizontal channel. The resulting front between the two fluids spreads as the square root of time, with a diffusion coefficient reflecting the buoyancy, viscosity, and geometrical configuration of the current. On the other hand, an autocatalytic reaction front between a reactant and a product may propagate as a solitary wave, namely, at a constant velocity and with a stationary concentration profile, resulting from the balance between molecular diffusion and chemical reaction. In most systems, the fluid left behind the front has a different density leading to a lock-exchange configuration. We revisit, with a chemical reaction, the classical situation of lock-exchange. We present an experimental analysis of buoyancy effects on the shape and the velocity of the iodate arsenous acid autocatalytic reaction fronts, propagating in horizontal rectangular channels and for a wide range of aspect ratios (1/3 to 20) and cylindrical tubes. We do observe stationary-shaped fronts, spanning the height of the cell and propagating along the cell axis. Our data support the contention that the front velocity and its extension are linked to each other and that their variations scale with a single variable involving the diffusion coefficient of the lock-exchange in the absence of chemical reaction. This analysis is supported by results obtained with lattice Bathnagar-Gross-Krook (BGK) simulations Jarrige et al. [Phys. Rev. E 81, 06631 (2010)], in other geometries (like in 2D simulations by Rongy et al. [J. Chem. Phys. 127, 114710 (2007)] and experiments in cylindrical tubes by Pojman et al. [J. Phys. Chem. 95, 1299 (1991)]), and for another chemical reaction Schuszter et al. [Phys. Rev. E 79, 016216 (2009)].

Measurement of the temperature profile of an exothermic autocatalytic reaction front.

Autocatalytic reactions may propagate as solitary waves, namely, at a constant front velocity and with a stationary concentration profile, resulting from a balance between molecular diffusion and chemical reaction. When the reaction is exothermic, a thermal wave is linked to the chemical front. As the thermal diffusivity is nearly two orders of magnitude larger than the molecular one, the temperature profile spreads over length scales (mm) two orders of magnitude larger than the concentration one. Using an infrared camera, we measure the temperature profiles for a chlorite-tetrathionate autocatalytic reaction. The profiles are compared quantitatively to lattice Bhatnagar-Gross-Krook (BGK) numerical simulations. Our analysis also accounts for the lack of observation of the thermal wave for the iodate arsenous acid reaction.

Crossing the elliptic region in a hyperbolic system with change-of-type behavior arisingin flow between two parallel plates.

Change-of-type behavior from hyperbolic to elliptic is common to quasilinear hyperbolic systems. This issue is addressed here for the particular case of miscible flow of three fluids between two parallel plates. Change of type occurs at the leading edge of the displacement front and reflects the failing of the equilibrium assumption, necessary for the quasilinear hyperbolic formalism, at the front. To cross the elliptic region requires the solution of the full, higher-dimensionality problem, obtained here using lattice gas simulations. For the specific example, it is found that the system self-selects a front structure independent of injection conditions.