[Disseminated intravascular coagulation: clinical and biological diagnosis]. / La coagulation intravasculaire disséminée : diagnostic clinique et biologique.

Disseminated intravascular coagulation (DIC) is a syndrome characterized by the systemic activation of blood coagulation. Its pathophysiological mechanisms are complex and dependent on the underlying pathology, making the clinical and biological expression of quite variable DIC. Among the various biological parameters disrupted, most are not specific, and none of them allows in itself to make the diagnosis. All this does not facilitate the task of the practitioner for diagnosis of overt DIC, much less that of the non-overt DIC, early stage whose treatment would improve the prognosis. These considerations have led to develop scores, combining several parameters depending on their availability in daily practice, as well as their diagnostic relevance. Of all the scores, the ISTH (International society of thrombosis and hemostasis) remains the most used.

[Another case of the rare complications of chronic lymphocytic leukemia: angioedema]. / Encore un cas de complication rare des leucémies lymphoïdes chroniques : l'œdème angioneurotique.

Angioedema is a rare but may be serious (laryngeal edema). This is a recurrent edema, subcutaneous and/or submucosal, whose cause is a hereditary or acquired deficiency in C1 inhibiteur (C1 inhibitor fraction of complement). We present the case of a 56 years old patient who showed recurrent episodes of swelling of the face and hands in association with chronic lymphocytic leukemia stage A. The exploration of the complement pathway has allowed retaining the diagnosis of acquired angioedema type I. The association of angioedema and lymphoproliferative syndrome is rare; we present this interesting case to discuss it from the literature data.

[Laboratory diagnostic and prognostic factors: Multiple myeloma in Morocco]. / Éléments du diagnostic biologique et pronostique du myélome multiple : place d'une étude marocaine.

ObjectivesThe purpose of this retrospective study was to clarify the factors for a laboratory diagnosis of multiple myeloma (Kahler's disease) and assess their prognostic value.MethodsThe study of all 10 patients with multiple myeloma seen during 2009 in the department of internal medicine and the haematology laboratory of HASSAN II University Hospital Centre in Fez. Work-ups for all patients included hemograms, sedimentation speed, electrophoresis of serum and urinary proteins, myelograms, creatinemia, calcemia, ß2-microglobulin, LDH and CRP.ResultsIn this series, the average age of the patients was 59 years and the sex ratio 1.3 (men). The laboratory tests showed anemia below 12 g/dl in 80% of the cases, with IgG accounting for 50% of the cases. The median concentration of the monoclonal component was 28 g/l. The prognostic assessments showed an increase in ß2-microglobulins and creatinemia in one case. CRP was elevated in all patients.ConclusionThe results from this study are consistent with those from other series. Protein electrophoresis and myelography results are major diagnostic elements, because they make it possible to rule out a monoclonal gammopathy of undetermined significance, for which treatment differs completely from that for multiple myeloma. ß2-microglobulin and CRP are independent prognostic factors providing important information about survival.