RESUMO
Venous thromboembolism (VTE) including deep vein thrombosis (DVT) and pulmonary embolism (PE) is commonly encountered in daily clinical practice. After diagnosis, its management frequently carries significant challenges to the clinical practitioner. Treatment of VTE with the inappropriate modality and/or in the inappropriate setting may lead to serious complications and have life-threatening consequences. As a result of an initiative of the Ministry of Health of the Kingdom of Saudi Arabia, an expert panel led by the Saudi Association for Venous Thrombo-Embolism (a subsidiary of the Saudi Thoracic Society) and the Saudi Scientific Hematology Society with the methodological support of the McMaster University Guideline working group, this clinical practice guideline was produced to assist health care providers in VTE management. Two questions were identified and were related to the inpatient versus outpatient treatment of acute DVT, and the early versus standard discharge from hospital for patients with acute PE. The corresponding recommendations were made following the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach.
Assuntos
Humanos , Embolia Pulmonar/tratamento farmacológico , Assistência Hospitalar , Tromboembolia Venosa/tratamento farmacológico , Assistência Ambulatorial , Arábia Saudita , Heparina/administração & dosagem , Fatores de Risco , Anticoagulantes/administração & dosagemRESUMO
Biphenotypic acute leukemia (BAL) is a rare, difficult to diagnose entity. Its identification is important for risk stratification in acute leukemia (AL). The scoring proposal of the European Group for the Classification of Acute Leukemia (EGIL) is useful for this purpose, but its performance against objective benchmarks is unclear. Using the EGIL system, we identified 23 (3.4%) BAL from among 676 newly diagnosed AL patients. Mixed, small and large blast cells predominated, with FAB M2 and L1 constituting the majority. All patients were positive for myeloid (M) markers and either B cell (B) (17 or 74%) or T cell (T) (8 or 34%) markers with two exceptional patients demonstrating trilineage phenotype. Six (50%) of studied M-B cases were positive for both IGH and TCR. In six (26%) patients myeloid lineage commitment was also demonstrable by electron cytochemistry. Abnormal findings were present in 19 (83%) patients by cytogenetics/FISH/molecular analysis as follows: t(9;22) (17%); MLL gene rearrangement (26%); deletion(6q) (13%); 12p11.2 (9%); numerical abnormalities (13%), and three (13%) new, previously unreported translocations t(X;6)(p22.3;q21); t(2;6)(q37;p21.3); and t(8;14)(p21;q32). In conclusion, the EGIL criteria for BAL appear robust when compared against molecular techniques that, if applied routinely, could aid in detecting BAL and help in risk stratification.
Assuntos
Aberrações Cromossômicas , Cromossomos Humanos/genética , Análise Citogenética/métodos , Leucemia/diagnóstico , Leucemia/genética , Doença Aguda , Adolescente , Adulto , Idoso , Linhagem da Célula , Criança , Pré-Escolar , Estudos de Coortes , Análise Mutacional de DNA , Feminino , Rearranjo Gênico , Guias como Assunto , Humanos , Hibridização in Situ Fluorescente/métodos , Técnicas In Vitro , Lactente , Leucemia/classificação , Masculino , Proteína de Leucina Linfoide-Mieloide/genética , Fenótipo , Fatores de Risco , Sensibilidade e EspecificidadeRESUMO
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