Our unique TPE-IVIG protocol was successful at preventing the onset of severe fetal anemia in a patient with high titer anti-D. Since IUT may be fatal, our approach offers a safer and less-invasive treatment regime that can adequately sustain a fetus until term.
T-cell Prolymphocytic leukemia (T-PLL) is a rare post-thymic T-cell malignancy that follows an aggressive clinical course. The classical presentation includes an elevated white blood cell (WBC) count with anemia and thrombocytopenia, hepatosplenomegaly, and lymphadenopathy. T-PLL is a disease of the elderly and to our knowledge it has never been described in the pediatric age group. We report a case of T-PLL in a 9 year old male who was initially diagnosed with T-cell acute lymphoblastic lymphoma (ALL), the diagnosis was later refined to T-PLL following additional analysis of bone marrow morphology and immunophenotype. Two unusual findings in our patient included CD117 expression and an isolated chromosomal 12(p13) deletion. The patient failed to respond to standard ALL induction chemotherapy, but achieved complete remission following treatment with a fludarabine and alemtuzumab-based regimen.
B cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma (DLBCL) and Burkitt’s lymphoma (BL) (B-UNC/BL/DLBCL) is a new category of tumors that have features resembling both DLBCL and BL. These tumors have large and medium sized cells with greater irregularity of nuclei and more prominent nucleoli than BL. Approximately 35% to 50% have C-MYC rearrangements, although half are non-immunoglobulin variants. We identified six cases of B-UNC/BL/DLBCL with low-level IGH amplification. Four patients died with a median survival of 7 months (range, 6–20). In conclusion, to our knowledge low-level IGH amplification has not been previously described and should be evaluated for in this patient population.
Discrepancy between rRBC and EBL and high percentages of cases with no rRBC suggests that PBR technique and case selection need optimization. Identification of procedure types and variables associated with PBR efficacy (≥1 rRBC) should improve utilization of PBR. Association of autoLog use with higher rRBC warrants further investigation.
We have previously reported that the point-of-care i-STAT method for cardiac troponin I, performed on whole blood, generally agreed well with a central laboratory method performed on plasma (Siemens TnI-Ultra), except that a few percent of positive i-STAT results could not be confirmed on plasma testing and were apparently false positives (Am J Clin Pathol. 2008;130:132Y5). Because of that finding, we modified our troponin testing protocol for the emergency department to confirm initial positive results on whole blood by retesting on the i-STAT using plasma. We report here on results of that protocol with 12,366 specimens serially received during a 1-year period. Eight hundred seventy-one (7.0%) of those specimens initially tested positive. Of those, 863 could be retested on plasma, and 803 of those (93.0%) were confirmed positive. Of the 60 (7.0%) that were not confirmed positive, in 28 cases the quantitative difference exceeded 0.10 ng/mL, and these were arbitrarily considered ''discrepant'' whole-blood results (3.4% of positive results, 0.2% of all results). Seven hundred seventy-one specimens that were confirmed positive on the i-STAT were retested again using the central laboratory method, and results were positive in all but 2 cases (0.26%). In comparing discrepant whole-blood results with nondiscrepant controls matched for demographic characteristics, the discrepant cases were associated with significantly higher white blood cell counts (14.0 vs 8.5 Â 10 9 /L) and absolute neutrophil counts (7.97 vs 5.7 Â 10 9 /L), but not with any other differences in routine test results. It is concluded that the i-STAT troponin method is vulnerable to an interference that occurs with whole blood but not plasma and that this interference may be mediated in some manner by white blood cells.
RESULTSDuring the study period, 12,366 heparinized whole-blood specimens were collected in the ED for rapid cTn testing. The ORIGINAL ARTICLE
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