Hyperleukocytosis with marked hypereosinophilia. Morphologic and cytochemical pathologic aspects of eosinophils. Eosinophilic leukaemia?

Excluding the most frequent pathologies that cause hypereosinophilia, we report a case of a patient with hyperleukocytosis and marked hypereosinophilia that showed morphological abnormalities in conjunction with cytochemical pathologic aspects. Physical examination, laboratory results and cytochemical abnormalities induced us, although a normal karyotype, to consider the possibility of eosinophilic leukaemia.

Platelet aggregation in presence of anticoagulants dependent pseudothrombocytopenia.

We report a case of pseudothrombocytopenia anticoagulants dependence in a healthy woman. Platelet count was performed on the automated impedance haematological analyzer utilizing peripheral blood samples anticoagulated with ethylene diamine tetra-acetate, heparin and sodium citrate. We pointed out that the severe thrombocytopenia was principally time and ethylene diamine tetra-acetate dependent. As regard both the temperature (37 degrees C) and the other anticoagulants (heparin, sodium citrate), the phenomenon was variable. The phenomenon "in vitro" was confirmed by the normal aggregation, moreover we showed that the platelets of a normal subject aggregated with plasma and ethylene diamine tetra-acetate of pseudothrombocytopenic subject. We report this case because often, in a healthy subject, it is possible to make a mistake in diagnosis and to employ more sophisticated and expansive investigations. Moreover it is very important to point out the pseudothrombocytopenia in case of heparinic therapy because it is possible to have a dilated thrombocytopenia.

[Role of laboratory monitoring in oral anticoagulant therapy]. / Ruolo del laboratorio nel monitoraggio della terapia con anticoagulanti orali.

The aim of oral anticoagulant therapy is to administer an amount of drug such that, without the induction of severe hemorrhagic complications, thrombi will not develop, or any existing thrombus will stop growing and resolve. For the laboratory control of oral anticoagulant therapy, the prothrombin time is used universally as the primary measurement. The expression of the prothrombin time as "percentage coagulation activity" or "ratio" is not useful as international measures of oral anticoagulant intensity because they are thromboplastin dependent. With the conversion of the "ratio" in International Normalized Ratio, at present it is possible to give a universal measure of oral anticoagulant intensity. It is important to underline that the application of the International Normalized Ratio to situations other than oral anticoagulant monitoring is not useful. Moreover there are other important factors contributing to the imprecision of the International Normalized Ratio: the imprecision of the International Sensitivity Index, the biological variation of the International Normalized Ratio. New approaches to oral anticoagulant therapy and its management are being explored. Immunologic assays have been developed with potential responsiveness to minimal warfarin-induced anticoagulant effects. Use of antibody reagents are in progress to document the clinical usefulness of the methods for monitoring oral anticoagulant therapy.

[Increase of beta 2-microglobulin in drug addicts with anti-HIV antibodies and high risk of AIDS]. / Incremento della beta 2-microglobulina in soggetti tossicodipendenti con anticorpi anti-HIV e ad alto rischio per AIDS.

The beta 2-Microglobulin is a polypeptide present on the surface membrane of both B and T cells and is integrated into the structure of HLA antigenes. The beta 2-Microglobulin concentration have been used as a reliable indicator of glomerular and tubular function of the kidney. Increased serum concentration of beta 2-Microglobulin are observed also in lymphoproliferative disorders with high cell proliferation rates. More recently, increased concentration of beta 2-Microglobulin was shown in patients with anti-HIV antibodies with or without symptomatic AIDS. We have determined beta 2-Microglobulin in 61 subjects: 40 between the ages of 25 and 35 and seemingly healthy, 21 patients between the ages of 22 and 32 and intravenous drug abuser with anti-HIV antibodies and at high-risk for AIDS. In all subjects we have tested: BUN, creatinine, beta 2-Microglobulin and T4/T8 ratio. In 40 subjects as normal controls, beta 2-Microglobulin average was means = 1.07 mg/L (SD = 0.39), T4/T8 ratio average: means = 1.06 (SD = 0.119). In 21 patients drug abuser with anti-HIV antibodies, the beta 2-Microglobulin average was cleanly increased: means = 4.72 mg/L (SD = 2.23), the T4/T8 ratio average cleanly decreased: means = 0.54 (SD = 0.21). We believe the beta 2-Microglobulin quantitation, even if not specific for patient with symptomatic AIDS, used in conjunction with other laboratory tests, principally T4/T8 ratio, will be a useful marker for recognizing persons with possible asymptomatic AIDS who are members of populations known to be at high-risk for AIDS.

[Serum paraprotein in a patient with chronic lymphatic leukemia]. / Paraproteina sierica in un paziente con leucemia linfatica cronica.

We report a case of chronic lymphocytic leukemia associated with paraproteinemia which proved to be a complete immunoglobulin IgM lambda. This case is reported because the process of cellular differentiation exposed to intrinsic or extrinsic stimulation may undergo morphofunctional variations which lead to the formation of plasma cells with extremely high secretionary capacities during the course of chronic lymphocytic leukemia.

[Clinical significance of the determination of lactate dehydrogenase in acute leukemia and non-Hodgkin's lymphoma]. / Significato clinico del dosaggio dell'enzima lattico deidrogenasi in corso di leucemie acute e linfomi non-Hodgkin.

The serum concentration of LDH increases in various cancers and its increase can represent a prognostic marker of the disease and a good indicator of the tumoral mass's degree of growth. In patients with acute leukaemia, LDH can show a moderate increase only in some cases of acute non-lymphoblastic leukaemia with FAB M4 and M5 cytotype, whereas in acute lymphoblastic leukaemia LDH almost always increases, an event related to the number of white cells during remission or a relapse of the disease. In non-Hodgkin lymphomas, measurement of total LDH is not on its own a useful aid for monitoring the therapeutic response and the course of the disease. In such cases it is right to also evaluate LDH isoenzymes because they pinpoint the persistence of residual lymphomatous foci which do not affect the level of total LDH and have not clinical evidence.

[Blood platelet changes in myeloproliferative disorders]. / Alterazioni piastriniche in corso di disordini mieloproliferativi.

Morphofunctional alterations to the platelets in myeloproliferative disorders (MPD), conditions featuring clonal rearrangement of the haemopoietic stem-cell, were examined. These platelet anomalies including morphological alterations, acquired storage pool disease, membrane alterations, altered arachidonic acid metabolism and structural alterations to the von Willebrand factor may cause thromboembolisms or haemorrhages that are responsible for a significant incidence of morbidity and mortality. In contrast the reduced mitogenic activity of the platelets may be of significant prognostic value since it proves the anomalous transformation of the megakaryocytic clone. The main in vivo and in vitro tests (bleeding time and the study of platelet aggregation) were investigate as indicators of platelet function. Unfortunately, these tests proved of little use for the early diagnosis of haemorrhage or thromboembolism in MPD.

[Primary non-Hodgkin's lymphoma of the breast. Description of a case]. / Linfoma non-Hodgkin primitivo della mammella. Descrizione di un caso.

A 65 year old female was admitted to Somma Lombardo Hospital (VA) for a growing mass in the right breast. Histology revealed a diffuse lymphocytic well-differentiated lymphoma. Malignant lymphoma primarily involving the breast is unusual, and its incidence is only 0.05% to 1.1% of all breast malignancies.

[Monoclonal gammopathies: classification of laboratory tests]. / Le gammopatie monoclonali: inquadramento delle indagini di laboratorio.

Monoclonal gammopathies have been examined and classified. In the field of chemico-clinical and immunological investigations, the various methods of analysing dysproteinaemia, of which the monoclonal component is a typical expression (electrophoresis, radial immunodiffusion, immunoelectrophoresis, immunofixation), and the main haematological and immunohaematological changes (lymphocyte biological markers) involved are reviewed. After describing the main histological and histo-cytochemical investigations, particularly amyloidosis, electronic microscope aspects and the most important chromosome abnormalities revealed by karyotype study are reported for their diagnostic interest.