Introduction: Extracorporeal photopheresis (ECP) is a procedure used to influence T-cell activity in patients suffering from immune-mediated cellular damage secondary to activated lymphocytes. Although well-tolerated, iron deficiency anemia (IDA) has been described. The goal herein is to describe IDA in patients who received extracorporeal photopheresis (ECP) treatment using UVAR (Therakos Inc) and CELLEX (Therakos Inc) instruments. Design and Methods: Patients treated with ECP from 2015 to 2019 were retrospectively analyzed. IDA was defined by a decrease in hemoglobin following treatment with concomitant decrease in mean cell volume, mean corpuscular hemoglobin concentration, increased RBC distribution width, and/or iron studies compatible with IDA. Results: During the four-year study period, thirty-four patients received ECP. Thirteen (38%) underwent treatment with the previous UVAR device while 21 (62%) received treatment on the newer CELLEX instrument. Nineteen (56%) of the cohort developed clinical and laboratory evidence of IDA with an average of 3.2 g/dL decrease in hemoglobin. Patients who developed IDA treated on the CELLEX instrument experienced a significantly greater drop in hemoglobin (P = .04) than those treated on the UVAR. Examining the CELLEX-treated patients, those who received the procedure at greater frequency experienced significantly greater drops in hemoglobin (P = .03). Conclusions: IDA is a risk of chronic ECP therapy and is likely secondary to retained blood components in the instrument. The temporal relationship between anemia and ECP treatment has a direct correlation with the treatment schedule. Patients undergoing ECP treatment should be closely monitored for the development of IDA.
Objectives
Patients with coronavirus disease 2019 (COVID-19) have thromboembolic complications. Assessment of coagulation and other markers could be useful to understand their coagulopathy.
Methods
We performed a retrospective study of inflammatory and coagulation parameters, including prothrombin fragment 1.2 (PF1.2), thrombin-antithrombin complexes (TATs), fibrin monomers, and D-dimer, in hospitalized patients with COVID-19. We compared the markers in patients with thrombosis, admission to the intensive care unit (ICU), and poor outcome.
Results
Of the 81 patients, 9 (11%) experienced an acute thrombotic event (4 with pulmonary embolism, 3 with venous thrombosis, and 2 with stroke). PF1.2 was elevated in 32 (39%) patients, TATs in 54 (67%), fibrin monomers in 49 (60%), and D-dimer in 76 (94%). Statistically significant elevation in PF1.2 and TATs was seen in patients admitted to the ICU, while D-dimer and fibrin monomers were significantly elevated in patients with poor outcomes. The presence of multiple abnormal coagulation parameters was associated with ICU admission. Other parameters with statistically significant results included abnormal WBC counts and elevated C-reactive protein, which were associated with ICU admission and poor outcomes.
Conclusions
Our data demonstrate that abnormalities of biomarkers of hemostasis activation and inflammatory markers are associated with poor outcomes in patients with COVID-19.
Background
Although 10% formalin is a standard preservative in pancreatic FNAs, the effect of CytoLyt on pancreatic tissue preservation has not been systematically explored.
Methods
Smears and cell blocks from CytoLyt‐fixed (CF‐CBs) and formalin‐fixed (FF‐CBs) pancreatic FNAs were blindly reviewed without knowledge of the fixative used, and the presence of tissue/tumor autolysis was noted. Controls included FF‐CBs from pancreatic FNAs, CF‐CBs from nonpancreatic FNAs, and 4 pancreatic FNAs with matched CF‐CBs and FF‐CBs.
Results
We found that 62 of 85 (73%) pancreatic FNAs with CF‐CBs showed significant autolysis, which was most pronounced in acinar cells and/or tumor cells with benign acinar cells in the background, compared with 2 of 46 (4%) FF‐CBs (P < .0001) and 3 of 26 (12%) CF‐CBs from nonpancreatic FNAs (73% vs 12%; P < .0001). Of the 4 pancreatic FNAs with matched CF‐CBs and FF‐CBs, all 4 CF‐CBs showed marked autolysis versus none of the matched FF‐CBs. Of the 23 (27%) pancreatic FNAs with CF‐CBs that did not show autolysis, 10 had no acinar cells, and 7 had only minute tissue fragments on CB.
Conclusion
While CytoLyt is a useful fixative for nonpancreatic FNAs it is a suboptimal fixative for pancreatic FNAs and is associated with tissue/tumor autolysis in the majority of cases, influencing morphologic evaluation, and potentially immunocytochemical staining. Autolysis appears to be due to acinar enzymes whose effect is likely interrupted/inhibited by formalin fixation. Cytopathologists and cytotechnologists should be mindful of this pitfall and should avoid using CytoLyt as a fixative for pancreatic FNAs.
We present two cases of keratitis due to Metarhizium anisopliae in geographically separated areas of the United States. The isolates were microscopically similar but morphologically different and were identified by ribosomal DNA sequencing. Both isolates had low minimum inhibitory concentration (MIC) values to caspofungin and micafungin, but high MIC values to amphotericin B. The morphologic and antifungal susceptibility differences between the two isolates indicate possible polyphylogeny of the group.
Brain metastases from renal cell carcinoma (RCC) are associated with significant morbidity and mortality. However, there are only few large series in the pathology literature specifically analyzing the clinicopathologic and immunohistochemical features in comparison with primary brain tumors with clear cell features. We identified 34 cases of metastatic RCC to the brain from the Urologic Pathology and Neuropathology files of 2 institutions between 2000 and 2018. Mean patient age at diagnosis of primary RCC was 59 years (range: 37 to 82 y). The mean size of 34 primary RCC was 7.9 cm (range: 2.5 to 19.5 cm). Twenty of 34 (59%) cases of brain metastases had primary RCC categorized as pT3. Brain imaging showed a solitary, well circumscribed, enhancing lesion in 18 of 34 (53%) patients and multifocal lesions in 16 of 34 (47%) patients. The mean size of metastatic RCC to the brain was 2.3 cm (range: 0.3 to 5.5 cm). Fifteen of 34 (44%) cases had isolated brain metastases and 19 of 34 (56%) cases had concomitant extracerebral metastases. The histologic subtypes were clear cell RCC 29 of 34 (85%) cases, RCC unclassified 4 of 34 (12%) cases, and papillary RCC 1 of 34 (3%) cases. We also included primary brain tumors with clear cell features including hemangioblastoma (30 cases), microcystic meningioma (11 cases), and clear cell meningioma (3 cases). The utility of an immunohistochemical panel that includes PAX8, carbonic anhydrase IX, SST2Ra, and inhibin is very useful in the distinction of these entities in a subset of patients.
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