Alcohol induced burr cell (echinocytic) haemolytic anaemia and haemochromatosis

Alcohol use disorders in multidrug resistant tuberculosis (MDR-TB) patients and their non-tuberculosis family contacts in Nigeria

Introduction

the main aim of this study was to determine the prevalence and associated factors of alcohol use disorder (AUD) in patients with Multi-Drug Treatment-Resistant Tuberculosis (MDR-TB) compared with their non-tuberculosis control, and its association with disease pattern and associated medical comorbidities.

Methods

MDR-TB patients (128) and their respective caregivers were interviewed in a treatment unit in Nigeria. Diagnosis of AUD was made using the Structured Clinical Interview for DSM-IV Axis I Disorder, information was obtained on the severity of the TB and associated health problems.

Results

prevalence of AUD was (21.9%) and was significantly higher among cases than in controls (2.3%), p = 0.006. Severe TB, OR = 3.33 (1.56-6.83), hematological diseases, OR = 2.34 (1.06-4.33) and HIV/AIDS, OR = 3.01 (1.67-7.01) were the strongest predictors of AUD at 95% CI. Conclusion: AUD was highly prevalent in MDR-TB and was associated with certain medical comorbidities and increased severity of the illness.

Pentachlorophenol-induced cytotoxicity in human erythrocytes: enhanced generation of ROS and RNS, lowered antioxidant power, inhibition of glucose metabolism, and morphological changes

Pentachlorophenol (PCP) is a class 2B human carcinogen that is used as an insecticide, herbicide, and wood preservative. PCP is rapidly absorbed and enters the blood where it can interact with erythrocytes. We have examined the effect of PCP on human erythrocytes. Treatment of erythrocytes with PCP increased the intracellular generation of reactive oxygen and nitrogen species. It also increased lipid and protein oxidation accompanied by decrease in glutathione levels and total sulfhydryl content. The activities of all major antioxidant enzymes were altered. The antioxidant power was significantly impaired resulting in lower free radical quenching and metal reducing ability of the PCP-treated cells. PCP exposure also inhibited the activities of enzymes of glycolysis and pentose phosphate shunt, the two pathways of glucose metabolism in erythrocytes. Heme degradation was enhanced leading to the release of free iron. Incubation of erythrocytes with PCP caused significant cell lysis suggesting plasma membrane damage which was also evident from inhibition of bound enzymes. Scanning electron microscopy of erythrocytes confirmed these biochemical results and showed that PCP treatment converted the normal biconcave discoids to echinocytes and other irregularly shaped cells. Thus, PCP induces oxidative and nitrosative stress in erythrocytes, alters the enzymatic and nonenzymatic antioxidant defense systems, inhibits glucose metabolism, and causes significant modifications in cellular morphology.

[Diagnosis of anemia in alcoholic cirrhosis]

PURPOSE

Anemia in patients with alcoholic liver cirrhosis is a common issue. The diagnosis could be difficult because of the multiplicity of causes, usually associated, and specificities in the diagnostic approach. This subject has not been reviewed for almost two decades. We propose a review based upon analysis of the literature and our clinical experience.

CURRENT KNOWLEDGE AND KEY POINTS

Because of the alcoholism and the biological consequences of the liver disease, laboratory findings, especially the mean corpuscular volume, should be interpreted with caution in the diagnostic approach. Despite these drawbacks, the diagnosis of anemia is detailed according to the usual plan: normocytic, macrocytic and microcytic anemias. Finally, we propose practical guidelines.

FUTURE PROSPECTS AND PROJECTS

Further prospective studies should assess the real burden of nutritional deficiencies, easily treatable. The prognostic significance of hemolytic anemias in patients with alcoholic liver cirrhosis should be studied.

Echinocytosis--an unusual manifestation of hemangioma

The case of a 21 year-old female with echinocytosis and a littoral cell hemangioma is reported. The patient had no significant past medical history and presented with abdominal pain and splenomegaly. A large percentage of echinocytes were noted on her peripheral smear in the absence of any known causes. A CT-recognized splenic mass led to splenectomy and a benign hemangioma was found. Red blood cell abnormalities resolved immediately after the surgery. This is the first case reported in the literature of echinocytosis as a consequence of a hemangioma.

Liver alcoholic cirrhosis and spur-cell (acanthocytic) anaemia. A study of erythrocyte ghost composition and fluidity

BACKGROUND

The occurrence of spur-cell anaemia in the course of cirrhosis is rare. Alterations of the lipid composition and fluidity of erythrocyte (RBC) ghosts may be present and participate in the phenomenon.

METHODS

A 59-year-old male patient with alcoholic cirrhosis developed severe spur-cell haemolytic anaemia before death. We compared his RBC ghosts with those of 10 cirrhotic patients and used a group of 9 healthy subjects as controls.

RESULTS

The cholesterol to protein ratio was higher in cirrhotic patients; besides, they had less unsaturated fatty acid. The ratio of phospholipid phosphorus to protein did not change; yet, the distribution of phosphorus among phospholipid classes was altered. No difference in 1,6-diphenyl-1,3,5-hexatriene fluorescence anisotropy (membrane fluidity) was observed between the ghosts of cirrhotic patients and those of healthy people. However, the ghosts of the patient with spur-cell anaemia were more rigid than those of either group.

CONCLUSIONS

The values of most variables of cirrhotic patients' ghosts lay between those of healthy subjects and those of the one who developed spur-cell anaemia. It is concluded that some homeostatic mechanisms must control fluidity during cirrhosis; in some cases alterations are particularly great, and fluidity cannot be maintained.