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Caimi G, Presti RL, Mancuso S, Siragusa S, Carlisi M. Erythrocyte deformability profile evaluated by laser diffractometry in patients with multiple myeloma: Re-examination of our cases. Microvasc Res 2023; 146:104473. [PMID: 36587651 DOI: 10.1016/j.mvr.2022.104473] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/26/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Multiple myeloma is a complex pathology which represents about 10 % of all hematological neoplasms. It can often present changes in the hemorheological profile and, in relation to this last topic, our aim is to evaluate the hemorheological profile in a group of multiple myeloma patients, with reference to erythrocyte deformability. METHODS We have examined the profile of the erythrocyte deformability in multiple myeloma enrolling 29 patients; this profile, expressed as elongation index at several shear stress, has been obtained using the diffractometric method. RESULTS By comparing normal controls and MM patients, a significant decrease in erythrocyte deformability, especially at low shear stresses, but we did not observe any significant differences about this profile subdividing the whole group of MM patients according to the degree of bone marrow plasma cell infiltration, to the red blood cell distribution width and to the serum values of LDH. CONCLUSIONS In this paper we have taken in consideration all the hypothesis for a possible explanation of the behaviour of this a reduced erythrocyte deformability in multiple myeloma. Erythrocyte deformability interferes with the physiological release of oxygen to tissues, with several clinical implications.
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Affiliation(s)
- Gregorio Caimi
- Department of Health Promotion and Child Care, Internal Medicine and Medical Specialties, Università degli Studi di Palermo, Palermo, Italy.
| | - Rosalia Lo Presti
- Department of Psychology, Educational Science and Human Movement, Università degli Studi di Palermo, Palermo, Italy
| | - Salvatrice Mancuso
- Department of Health Promotion and Child Care, Internal Medicine and Medical Specialties, Università degli Studi di Palermo, Palermo, Italy
| | - Sergio Siragusa
- Department of Health Promotion and Child Care, Internal Medicine and Medical Specialties, Università degli Studi di Palermo, Palermo, Italy
| | - Melania Carlisi
- Department of Health Promotion and Child Care, Internal Medicine and Medical Specialties, Università degli Studi di Palermo, Palermo, Italy
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Carlisi M, Mancuso S, Caimi G, Siragusa S. Thrombotic risk in paroxysmal nocturnal hemoglobinuria-like (PNH-like) phenotype. Clin Hemorheol Microcirc 2020; 79:491-503. [PMID: 32116238 DOI: 10.3233/ch-190735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The complement system is an essential component of the innate immune defence that, if overly activated, may damage organs and tissues. For this reason, there is a fine complement regulatory system. The complement modulation system includes two proteins with important regulatory activity, CD55 or decay accelerating factor (DAF) and CD59 or membrane inhibitor of reactive lysis (MIRL).The paroxysmal nocturnal hemoglobinuria (PNH) is a clonal and non-neoplastic disease characterized by intravascular haemolysis, occurrence of thrombosis and bone marrow failure.In clinical practice, in opposition to PNH, a variety of pathological conditions have been observed with an acquired and non-genetic deficiency of the regulatory proteins CD55 and CD59. This abnormal, non-clonal, reduced expression of complement regulatory proteins configures what we may define as PNH-like phenotype.Similarly to PNH, even in the PNH-like phenotype diseases there has been a greater exposure to the mediated complement cellular lysis and, a likely increased risk of thromboembolic events.Therefore, the knowledge of the potential roles of the complement system becomes necessary for a deeper understanding of several pathological conditions and for an improved clinical management of the patients.
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Affiliation(s)
- Melania Carlisi
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - Salvatrice Mancuso
- Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) Department, University of Palermo, Palermo, Italy
| | - Gregorio Caimi
- Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) Department, University of Palermo, Palermo, Italy
| | - Sergio Siragusa
- Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) Department, University of Palermo, Palermo, Italy
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Caimi G, Carlisi M, Montana M, Gallà E, Hopps E, Lo Presti R, Siragusa S. Red blood cell deformability in multiple myeloma1. Clin Hemorheol Microcirc 2018; 69:233-238. [DOI: 10.3233/ch-189121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Gregorio Caimi
- Dipartmento Biomedico di Medicina Interna e Specialistica, Università degli Studi di Palermo, Italy
| | - Melania Carlisi
- Dipartmento Biomedico di Medicina Interna e Specialistica, Università degli Studi di Palermo, Italy
| | - Maria Montana
- Dipartmento Biomedico di Medicina Interna e Specialistica, Università degli Studi di Palermo, Italy
| | - Eleonora Gallà
- Dipartmento Biomedico di Medicina Interna e Specialistica, Università degli Studi di Palermo, Italy
| | - Eugenia Hopps
- Dipartmento Biomedico di Medicina Interna e Specialistica, Università degli Studi di Palermo, Italy
| | - Rosalia Lo Presti
- Dipartmento Biomedico di Medicina Interna e Specialistica, Università degli Studi di Palermo, Italy
| | - Sergio Siragusa
- Dipartmento Biomedico di Medicina Interna e Specialistica, Università degli Studi di Palermo, Italy
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Caimi G, Canino B, Lo Presti R, Urso C, Hopps E. Clinical conditions responsible for hyperviscosity and skin ulcers complications. Clin Hemorheol Microcirc 2017; 67:25-34. [DOI: 10.3233/ch-160218] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Gregorio Caimi
- Dipartimento Biomedico di Medicina Interna eSpecialistica, Università di Palermo, Italy
| | - Baldassare Canino
- Dipartimento Biomedico di Medicina Interna eSpecialistica, Università di Palermo, Italy
| | - Rosalia Lo Presti
- Dipartimento Biomedico di Medicina Interna eSpecialistica, Università di Palermo, Italy
| | - Caterina Urso
- Dipartimento Biomedico di Medicina Interna eSpecialistica, Università di Palermo, Italy
| | - Eugenia Hopps
- Dipartimento Biomedico di Medicina Interna eSpecialistica, Università di Palermo, Italy
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Caimi G, Carlisi M, Urso C, Lo Presti R, Hopps E. Clinical disorders responsible for plasma hyperviscosity and skin complications. Eur J Intern Med 2017; 42:24-28. [PMID: 28390781 DOI: 10.1016/j.ejim.2017.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 03/30/2017] [Accepted: 04/03/2017] [Indexed: 12/17/2022]
Abstract
In this brief review, we have examined some clinical disorders which are associated to an altered hemorheological profile and at times accompanied by skin ulcers. This skin condition may be, in fact, observed in patients with primary plasma hyperviscosity such as multiple myeloma, Waldenstrom macroglobulinemia, cryoglobulinemia, cryofibrinogenemia, dysfibrinogenemia and connective tissue diseases. It must be underlined that the altered hemorheological pattern is not the only responsible for this skin complication but, as it worsens the microcirculatory flow, it contributes to determine the occurrence of the skin ulcers.
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Affiliation(s)
- Gregorio Caimi
- Dipartimento Biomedico di Medicina Interna e Specialistica, Università di Palermo, Italy.
| | - Melania Carlisi
- Dipartimento Biomedico di Medicina Interna e Specialistica, Università di Palermo, Italy
| | - Caterina Urso
- Dipartimento Biomedico di Medicina Interna e Specialistica, Università di Palermo, Italy
| | - Rosalia Lo Presti
- Dipartimento Biomedico di Medicina Interna e Specialistica, Università di Palermo, Italy
| | - Eugenia Hopps
- Dipartimento Biomedico di Medicina Interna e Specialistica, Università di Palermo, Italy
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Expression of CD55, CD59, and CD35 on red blood cells of β-thalassaemia patients. Cent Eur J Immunol 2017; 42:78-84. [PMID: 28680334 PMCID: PMC5470617 DOI: 10.5114/ceji.2017.67321] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 10/17/2016] [Indexed: 01/07/2023] Open
Abstract
AIM OF THE STUDY β-thalassaemia (β-Thal) is considered a severe, progressive haemolytic anaemia, which needs regular blood transfusions for life expectancy. Complement-mediated erythrocyte destruction can cause both intravascular and extravascular haemolysis. Complement regulatory proteins protect cells from such effects of the complement system. We aimed to perform quantitative analysis of membrane-bound complement regulators, CD55 (decay accelerating factor - DAF), CD35 (complement receptor type 1 - CR1), and CD59 (membrane attack complex inhibitory factor - MACIF) on peripheral red blood cells by flow cytometry. MATERIAL AND METHODS The present study was carried out on 47 β-thalassemia major (β-TM) patients, 20 β-thalassaemia intermedia (β-TI) patients, and 17 healthy volunteers as control subjects. RESULTS CD55 levels of β-TM patients (58.64 ±17.06%) were significantly decreased compared to β-TI patients (83.34 ±13.82%) and healthy controls (88.57 ±11.69%) (p < 0.01). CD59 levels of β-TM patients were not significantly different than β-TI patients and controls, but CD35 levels were significantly lower in the β-TM patients (3.56 ±4.87%) and β-TI patients (12.48 ±9.19%) than in the control group (39.98 ±15.01%) (p < 0.01). CONCLUSIONS Low levels of CD55 and CD35 in thalassaemia major patients indicates a role for them in the aetiopathogenesis of haemolysis in this disease, and also this defect in a complement system may be responsible for the chronic complications seen in these patients.
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Morado M, Freire Sandes A, Colado E, Subirá D, Isusi P, Soledad Noya M, Belén Vidriales M, Sempere A, Ángel Díaz J, Minguela A, Álvarez B, Serrano C, Caballero T, Rey M, Pérez Corral A, Cristina Fernández Jiménez M, Magro E, Lemes A, Benavente C, Bañas H, Merino J, Castejon C, Gutierrez O, Rabasa P, Vescosi Gonçalves M, Perez-Andres M, Orfao A. Diagnostic screening of paroxysmal nocturnal hemoglobinuria: Prospective multicentric evaluation of the current medical indications. CYTOMETRY PART B-CLINICAL CYTOMETRY 2016; 92:361-370. [PMID: 27598686 DOI: 10.1002/cyto.b.21480] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 08/29/2016] [Accepted: 09/01/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND Although consensus guidelines have been proposed in 2010 for the diagnostic screening of paroxysmal nocturnal hemoglobinuria (PNH) by flow cytometry (FCM), so far no study has investigated the efficiency of such medical indications in multicentric vs. reference laboratory settings. METHODS Here we evaluate the efficiency of consensus medical indications for PNH testing in 3,938 peripheral blood samples submitted to FCM testing in 24 laboratories in Spain and one reference center in Brazil. RESULTS Overall, diagnostic screening based on consensus medical indications was highly efficient (14% of PNH+ samples) both in the multicenter setting in Spain (10%) and the reference laboratory in Brazil (16%). The highest frequency of PNH+ cases was observed among patients screened because of bone marrow (BM) failure syndrome (33%), particularly among those with aplastic anemia (AA; 45%) and to a less extent also a myelodysplastic syndrome (MDS; 10%). Among the other individuals studied, the most efficient medical indications for PNH screening included: hemolytic anemia (19%), hemoglobinuria (48%) and unexplained cytopenias (9%). In contrast, only a minor fraction of the patients who had been submitted for PNH testing because of unexplained thrombosis in the absence of cytopenia, were positive (0.4%). CONCLUSIONS In summary, our results demonstrate that the current medical indications for PNH screening by FCM are highly efficient, although improved screening algorithms are needed for patients presenting with thrombosis and normal blood cell counts. © 2016 International Clinical Cytometry Society.
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Affiliation(s)
- Marta Morado
- Servicio Hematologia. Hospital Universitario La Paz, Madrid, Spain
| | - Alex Freire Sandes
- División de Hematología y Citometría de Flujo, Fleury Group, São Paulo, Brazil
| | - Enrique Colado
- Servicio Hematologia. Hospital Central Asturias, Oviedo, Spain
| | - Dolores Subirá
- Servicio Hematologia. Hospital Universitario Guadalajara, Guadalajara, Spain
| | - Paloma Isusi
- Servicio Hematologia. Hospital Basurto, Bilbao, Spain
| | - María Soledad Noya
- Servicio Hematologia. Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - María Belén Vidriales
- Department of Hematology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Spain; Instituto de Biología Molecular y Celular del Cáncer (CIC-CSIC), Salamanca, Spain
| | - Amparo Sempere
- Servicio Hematologia. Hospital Universitario La Fe, Valencia, Spain
| | - José Ángel Díaz
- Servicio Hematologia. Hospital Universitario Santiago de Compostela, Santiago de Compostela, Spain
| | - Alfredo Minguela
- Servicio de Inmunologia. Hospital Virgen de la Arrixaca e Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
| | | | | | - Teresa Caballero
- Servicio Hematologia. Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | - Mercedes Rey
- Laboratorio de Inmunologia, Hospital Donostia, San Sebastián, Spain
| | | | | | - Elena Magro
- Servicio Hematologia. Hospital Universitario Principe de Asturias, Alcalá de Henares, Spain
| | - Angelina Lemes
- Servicio Hematologia. Hospital Universitario Dr. Negrin. Las Palmas de Gran Canaria, Spain
| | - Celina Benavente
- Servicio Hematologia. Hospital Clínico San Carlos, Madrid, Spain
| | - Helena Bañas
- Servicio Hematologia. Hospital San Pedro Alcantara, Caceres, Spain
| | - Juana Merino
- Servicio Inmunologia. Clinica Universitaria de Navarra, Spain
| | | | | | - Pilar Rabasa
- Servicio Hematologia. Hospital San Pedro, Logroño, Spain
| | | | - Martin Perez-Andres
- Cancer Research Centre (IBMCC, USAL-CSIC), Institute for Biomedical Research of Salamanca (IBSAL) and Department of Medicine and Cytometry Service (NUCLEUS Research Support Platform), University of Salamanca (USAL), Salamanca, Spain
| | - Alberto Orfao
- Cancer Research Centre (IBMCC, USAL-CSIC), Institute for Biomedical Research of Salamanca (IBSAL) and Department of Medicine and Cytometry Service (NUCLEUS Research Support Platform), University of Salamanca (USAL), Salamanca, Spain
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Chatziantoniou V, Alexia S, Konstantopoulos K, Repousis P, Megalakaki A, Kotsopoulou M, Kylidou P, Vassilakopoulos T, Angelopoulou MK. Significance of the detection of paroxysmal nocturnal hemoglobinuria clones in patients with multiple myeloma undergoing autologous stem cell transplantation. Hematol Oncol Stem Cell Ther 2015; 8:150-9. [PMID: 26183672 DOI: 10.1016/j.hemonc.2015.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 06/19/2015] [Accepted: 06/22/2015] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE/BACKGROUND There are reports about the presence of paroxysmal nocturnal hemoglobinuria (PNH) clones in multiple myeloma (MM), but these have been demonstrated only in red blood cells (RBCs) and the previous reports utilized an obsolete diagnostic method. We carried out a study to identify the clones by flow cytometry (FC) and to understand their clinical significance. METHODS A prospective study on consecutive patients with newly diagnosed MM who were candidates for autologous stem cell transplantation (ASCT) from 2008 to 2012. We screened peripheral blood samples by FC for CD55- and/or CD59-deficient RBC, neutrophils, and monocytes. PNH testing was carried out at diagnosis, before ASCT and 3 months after ASCT, as well as sporadically during MM remission and at disease relapse. RESULTS A total of 31 patients were included in the study. PNH clones reaching a median size of 10.8% (range 4.0-18.7%) were found in 10 patients (32.3%). Clones were detected at diagnosis in nine patients and 3 months after ASCT in one patient. A correlation between the presence of the clones and subclinical hemolysis was observed. Nevertheless, the presence of the clones did not influence the overall management and prognosis of the patients. CONCLUSION We confirmed findings of previous reports with current diagnostic guidelines and showed that although the size of the clones may be relatively large, their presence is probably not detrimental. The clinical significance of these clones and the possible mechanisms underlying their expansion in MM must be a subject of further investigation.
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Affiliation(s)
| | - Stavroula Alexia
- Hematology and Flow Cytometry Laboratory, Metaxa Anticancer Hospital, Piraeus, Greece
| | | | | | | | - Maria Kotsopoulou
- Department of Hematology, Metaxa Anticancer Hospital, Piraeus, Greece
| | - Pavlina Kylidou
- Hematology and Flow Cytometry Laboratory, Metaxa Anticancer Hospital, Piraeus, Greece
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