1
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Pires-Gonçalves L, Henriques Abreu M, Ferrão A, Guimarães Dos Santos A, Aguiar AT, Gouvêa M, Henrique R. Patient perspectives on repeated contrast-enhanced mammography and magnetic resonance during neoadjuvant chemotherapy of breast cancer. Acta Radiol 2022; 64:1816-1822. [PMID: 36575580 DOI: 10.1177/02841851221144021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The burden perceived by the patient of repeated imaging required for neoadjuvant chemotherapy (NAC) monitoring warrants attention due to the increased use of NAC and imaging. PURPOSE To evaluate and compare the experienced burden associated with repeated contrast-enhanced mammography (CEM) and magnetic resonance imaging (MRI) during NAC for breast cancer from the patient perspective. MATERIAL AND METHODS Approval from the ethics committee and written informed consent were obtained. In this prospective study, CEM and MRI were performed on 38 patients with breast cancer before, during, and after NAC in a tertiary cancer center. The experienced burden was evaluated with a self-reported questionnaire addressing duration, comfort, anxiety, positioning, and intravenous contrast administration, each measured on a 5-point Likert scale. The participants were asked their preference between CEM or MRI. Statistical comparisons were performed and P<0.05 was considered significant. RESULTS Most participants (n = 29, 76%) preferred CEM over MRI (P = 0.0008). CEM was associated with a significantly shorter duration (P < 0.001), greater overall comfort (P < 0.01), more comfortable positioning (P = 0.01), and lower anxiety (P = 0.03). Intravenous contrast administration perception revealed no significant difference. Only 4 (10%) participants preferred MRI over CEM, due to the absence of breast compression. CONCLUSION In the hypothetical scenario of equal diagnostic accuracy, most participants preferred CEM and compared CEM favorably to MRI in all investigated features at repeated imaging required for NAC response assessment. Our results indicate that repeated examinations with CEM is well tolerated and constitutes a patient-friendly alternative for NAC imaging monitoring in breast cancer.
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Affiliation(s)
- Lígia Pires-Gonçalves
- Department of Radiology, Instituto Português de Oncologia do Porto (IPO-Porto), Porto, Portugal
| | - Miguel Henriques Abreu
- Department of Medical Oncology, Instituto Português de Oncologia do Porto (IPO-Porto), Porto, Portugal
| | - Anabela Ferrão
- Department of Radiology, Instituto Português de Oncologia do Porto (IPO-Porto), Porto, Portugal
| | | | - Ana Teresa Aguiar
- Department of Radiology, Instituto Português de Oncologia do Porto (IPO-Porto), Porto, Portugal
| | - Margarida Gouvêa
- Department of Radiology, Instituto Português de Oncologia do Porto (IPO-Porto), Porto, Portugal
| | - Rui Henrique
- Department of Pathology and Cancer Biology and Epigenetics Group - Research Centre (CI-IPOP), Instituto Português de Oncologia do Porto (IPO-Porto), Porto, Portugal.,Department of Pathology and Molecular Immunology, Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
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2
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Mantas P, Félix N, Oliveira E, Malcata C, Palaré MJ, Ferrão A. Neonatal Thrombocytopenia Due to Dual Alloimmune and Autoimmune Mechanisms. J Pediatr Hematol Oncol 2022; 44:e310-e312. [PMID: 35200219 DOI: 10.1097/mph.0000000000002352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 09/16/2021] [Indexed: 11/26/2022]
Abstract
Alloantibody-mediated and autoantibody-mediated immune destruction are common causes of early neonatal thrombocytopenia. The authors report a case of severe, early-onset thrombocytopenia with mucocutaneous bleeding in an otherwise well-appearing full-term neonate. Recurrence of thrombocytopenia following initial treatment and its persistence after 2 weeks of life suggested a dual immune mechanism. This is a rare case of immune thrombocytopenia caused by human platelet antigen-5b alloimmunization and passive transfer of maternal antiplatelet antibodies. Appropriate, timely treatment and absence of severe bleeding complications, namely intracranial hemorrhage, conferred a good overall prognosis.
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MESH Headings
- Antigens, Human Platelet
- Humans
- Infant, Newborn
- Infant, Newborn, Diseases/etiology
- Infant, Newborn, Diseases/therapy
- Intracranial Hemorrhages/etiology
- Isoantibodies
- Purpura, Thrombocytopenic, Idiopathic/complications
- Purpura, Thrombocytopenic, Idiopathic/therapy
- Thrombocytopenia, Neonatal Alloimmune/etiology
- Thrombocytopenia, Neonatal Alloimmune/therapy
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Affiliation(s)
- Pedro Mantas
- Pediatric Department, Hospital Santarém, Santarém
| | - Nuno Félix
- Pediatric Department, Hospital Santarém, Santarém
| | | | | | - Maria J Palaré
- Pediatric Department, Hospital Santa Maria, Lisbon, Portugal
| | - Anabela Ferrão
- Pediatric Department, Hospital Santa Maria, Lisbon, Portugal
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3
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Bernardo M, Martins J, Martins M, Prata F, Costa-Reis P, Ferrão A, João Palaré M. Autoimmune haemolytic anaemia following SARS-CoV-2 infection in a child: A clue to a systemic autoimmune disease. Pediatr Blood Cancer 2022; 69:e29481. [PMID: 34842350 DOI: 10.1002/pbc.29481] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/07/2021] [Accepted: 11/08/2021] [Indexed: 01/14/2023]
Affiliation(s)
- Miguel Bernardo
- Haematology Unit, Paediatrics Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.,Paediatrics Department, Hospital São Pedro de Vila Real, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Joana Martins
- Infectious Diseases and Immunodeficiency Unit, Paediatrics Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.,Paediatrics Department, Hospital Garcia de Orta, EPE, Almada, Portugal
| | - Miguel Martins
- Haematology Unit, Paediatrics Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.,Paediatrics Department, Centro Hospitalar Universitário Cova da Beira EPE, Covilhã, Portugal
| | - Filipa Prata
- Infectious Diseases and Immunodeficiency Unit, Paediatrics Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.,Clínica Universitária de Pediatria, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Patrícia Costa-Reis
- Clínica Universitária de Pediatria, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Paediatric Rheumatology Unit, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Anabela Ferrão
- Haematology Unit, Paediatrics Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.,Clínica Universitária de Pediatria, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Maria João Palaré
- Haematology Unit, Paediatrics Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.,Clínica Universitária de Pediatria, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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4
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Pires-Gonçalves L, Abreu MH, Aguiar AT, Guimarães Dos Santos A, Ferrão A, Henrique R. Size reduction and decreased enhancement of benign breast fibroadenoma on contrast-enhanced mammography during neoadjuvant chemotherapy. Diagn Interv Imaging 2021; 103:121-122. [PMID: 34836831 DOI: 10.1016/j.diii.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 11/01/2021] [Accepted: 11/07/2021] [Indexed: 11/20/2022]
Affiliation(s)
| | | | | | | | - Anabela Ferrão
- Department of Radiology, IPO-Porto, 4200-072 Porto, Portugal
| | - Rui Henrique
- Department of Pathology and Cancer Biology and Epigenetics Group-CI-IPOP, IPO-Porto, 4200-072 Porto, Portugal; Department of Pathology and Molecular Immunology, ICBAS, University of Porto, 4200-072 Porto, Portugal
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5
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Abstract
Nephropathy is a common under-recognised complication of sickle cell disease (SCD) and one of the main factors of poor prognosis in these patients. The association between nephrotic syndrome and SCD in children is rare. Strategies for sickle cell nephropathy prevention are still poorly established. Blood pressure control as well as monitoring of microalbuminuria and renal function are mandatory. The use of antiproteinuric drugs, such as anti-ACE inhibitors (ACEis) and hydroxyurea, should be considered in early stages. Here, we report a case of a female adolescent with SCD and inaugural nephrotic syndrome who, after an initial treatment failure with corticotherapy, had a remarkable recovery after treatment with hydroxyurea and ACEis.
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Affiliation(s)
- Margarida Cunha
- Pediatria, Hospital de Santa Maria, Lisboa, Lisboa, Portugal
| | - Carla Simão
- Pediatria, Hospital de Santa Maria, Lisboa, Lisboa, Portugal
| | - Anabela Ferrão
- Pediatria, Hospital de Santa Maria, Lisboa, Lisboa, Portugal
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6
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Limão R, Spínola Santos A, Araújo L, Cosme J, Inácio F, Tomaz E, Ferrão A, Santos N, Sokolova A, Môrete A, Falcão H, Cunha L, Ferreira A, Bras A, Ribeiro F, Lozoya C, Leiria Pinto P, Prates S, Plácido J, Coimbra A, Taborda-Barata L, Pereira Santos MC, Pereira Barbosa M, Pineda F. Molecular Sensitization Profile to Dermatophagoides pteronyssinus Dust Mite in Portugal. J Investig Allergol Clin Immunol 2020; 32:33-39. [PMID: 32732183 DOI: 10.18176/jiaci.0533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To analyze component resolved diagnosis to Dermatophagoides pteronyssinus (Der p) in patients with respiratory allergy and its relationship with clinical severity in different geographical areas. METHODS 217 patients (mean age 25.85±12.7 years; 51.16% females) were included, selected from 13 centers in Portugal (5 from North, n=65). All had allergic rhinitis, with or without asthma, and had positive skin prick tests to at least one dust mite. Specific IgE (sIgE) to Der p, Dermatophagoides farinae, Lepidoglyphus destructor, Der p1, Der p 2, Der p 10 and Der p 23 were determined by ImmunoCAP. Statistical analysis (Mann Whitney U test) compared patients with rhinitis vs rhinitis and asthma; mild vsmoderate-to-severe rhinitis; North vs South. RESULTS Prevalence of sensitization was 98.2% to Der p, and 72.4%, 89.4%, 9.7% and 77% to Der p 1, Der p 2, Der p 10 and Der p 23, respectively. Corresponding median sIgE levelswere 8.56, 17.7, 0.01 and 3.95 kUA/L. sIgE to all allergens was higher in patients with moderate-to-severe rhinitis and rhinitis with asthma but not statistically significant (NSS). sIgE to Der p 2 was significantly higher in the South when compared with the North (p=0.0496). CONCLUSIONS sensitization to Der p is the most common in Portugal. Der p 2 had the highest prevalence and median sIgE levels. All sIgE to molecular components were higher in more symptomatic patients (NSS). sIgE to Der p 2 was higher in the South, which may be related to the warmer temperature and/or the larger sample size.
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Affiliation(s)
- R Limão
- Immunoallergology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Portugal.,Allergen and Immunotherapy Interest Group, Sociedade Portuguesa de Alergologia e Imunologia Clínica, Portugal
| | - A Spínola Santos
- Immunoallergology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Portugal.,Allergen and Immunotherapy Interest Group, Sociedade Portuguesa de Alergologia e Imunologia Clínica, Portugal
| | - L Araújo
- Allergen and Immunotherapy Interest Group, Sociedade Portuguesa de Alergologia e Imunologia Clínica, Portugal.,Immunoallergology Department, Faculdade de Medicina da Universidade do Porto, Portugal
| | - J Cosme
- Immunoallergology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Portugal.,Allergen and Immunotherapy Interest Group, Sociedade Portuguesa de Alergologia e Imunologia Clínica, Portugal
| | - F Inácio
- Allergen and Immunotherapy Interest Group, Sociedade Portuguesa de Alergologia e Imunologia Clínica, Portugal.,Immunoallergology Department, Hospital de São Bernardo, Setúbal, Portugal
| | - E Tomaz
- Immunoallergology Department, Hospital de São Bernardo, Setúbal, Portugal
| | - A Ferrão
- Immunoallergology Unit, Hospital do Espírito Santo de Évora, Portugal
| | - N Santos
- Immunoallergology Unit, Hospital de Portimão, Centro Hospitalar Universitário do Algarve, Portugal
| | - A Sokolova
- Allergen and Immunotherapy Interest Group, Sociedade Portuguesa de Alergologia e Imunologia Clínica, Portugal.,Immunoallergology Unit, Hospital Professor Doutor Fernando Fonseca, Amadora-Sintra, Portugal
| | - A Môrete
- Immunoallergology Unit, Hospital de Aveiro, Centro Hospitalar Baixo Vouga, Portugal
| | - H Falcão
- Immunoallergology Department, Hospital de Santo António, Centro Hospitalar do Porto, Portugal
| | - L Cunha
- Immunoallergology Department, Hospital de Santo António, Centro Hospitalar do Porto, Portugal
| | - A Ferreira
- Immunoallergology Unit, Hospital das Forças Armadas, Lisboa, Portugal
| | - A Bras
- Immunoallergology Unit, Hospital de Faro, Centro Hospitalar Universitário do Algarve, Portugal
| | - F Ribeiro
- Immunoallergology Unit, Hospital de Faro, Centro Hospitalar Universitário do Algarve, Portugal
| | - C Lozoya
- Immunoallergology Unit, Unidade Local de Saúde de Castelo Branco, Portugal
| | - P Leiria Pinto
- Immunoallergology Department, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Portugal
| | - S Prates
- Immunoallergology Department, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Portugal
| | - J Plácido
- Immunoallergology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - A Coimbra
- Immunoallergology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - L Taborda-Barata
- Immunoallergology Department, Centro Hospitalar Universitário Cova da Beira, Covilhã, Portugal
| | - M C Pereira Santos
- Allergen and Immunotherapy Interest Group, Sociedade Portuguesa de Alergologia e Imunologia Clínica, Portugal.,Clinical Immunology Laboratory, Faculdade de Medicina, Instituto de Medicina Molecular, Universidade de Lisboa, Portugal
| | - M Pereira Barbosa
- Immunoallergology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Portugal.,Clinical Immunology Laboratory, Faculdade de Medicina, Instituto de Medicina Molecular, Universidade de Lisboa, Portugal.,University Clinic of Immunoallergology, Faculdade de Medicina da Universidade de Lisboa, Portugal
| | - F Pineda
- Diater Laboratorio de Diagnostico y Aplicaciones Terapeuticas SA, Madrid, Spain
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7
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Oliveira I, Teles H, Seixo F, Ferrão A. [Sinus Tachycardia in the Adolescent: The Importance of Differential Diagnosis]. ACTA MEDICA PORT 2019; 32:545-548. [PMID: 31445536 DOI: 10.20344/amp.10719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 09/03/2018] [Indexed: 11/20/2022]
Abstract
Sinus tachycardia is common in pediatric age, and is usually related to benign physiological conditions, such as somatoform disorders. Nevertheless, it can also be a presenting sign of a disease with an ominous prognosis. We present a case of a previously healthy 15-year-old girl, admitted for syncope. She had been well until one week before admission, when thoracic pain developed. One month prior to the admission she had started oral contraceptives. On examination, she had persistent sinus tachycardia, despite hemodynamic stability and no other associated sign or symptom. Thoracic computed tomography angiography revealed thrombi in the main pulmonary arteries, which confirmed bilateral pulmonary embolism. She was started on anticoagulation with unremarkable clinical course evolution. Pediatric pulmonary embolism is rare, although probably underdiagnosed, given the nonspecific presentation in most cases. Maintaining a high level of clinical suspicion of pulmonary embolism avoids delay in the diagnosis, allows early appropriate treatment and improves prognosis.
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Affiliation(s)
- Inês Oliveira
- Serviço de Pediatria. Hospital de São Bernardo. Centro Hospitalar de Setúbal. Setúbal. Portugal
| | - Hugo Teles
- Serviço de Pediatria. Hospital de São Bernardo. Centro Hospitalar de Setúbal. Setúbal. Portugal
| | - Filipe Seixo
- Serviço de Cardiologia. Hospital de São Bernardo. Centro Hospitalar de Setúbal. Setúbal. Portugal
| | - Anabela Ferrão
- Unidade de Hematologia Pediátrica. Departamento de Pediatria. Hospital de Santa Maria. Centro Hospitalar Lisboa Norte. Lisboa. Portugal
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8
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Oliveira JA, Moeda S, Contreiras M, Costa-Lima S, Ferrão A. Extreme reactive thrombocytosis in an infant: Much ado about nothing? Pediatr Blood Cancer 2019; 66:e27467. [PMID: 30251331 DOI: 10.1002/pbc.27467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 08/25/2018] [Accepted: 08/30/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Joana A Oliveira
- Department of Pediatrics, Hospital Santa Maria (CHLN), Lisbon, Portugal
| | - Sofia Moeda
- Department of Pediatrics, Hospital Beatriz Ângelo, Loures, Portugal
| | - Marta Contreiras
- Department of Pediatrics, Hospital Beatriz Ângelo, Loures, Portugal
| | - Sofia Costa-Lima
- Department of Pediatrics, Hospital Beatriz Ângelo, Loures, Portugal
| | - Anabela Ferrão
- Unit of Hematology, Department of Pediatrics, Hospital Santa Maria (CHLN), Lisbon, Portugal
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9
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Sousa R, Gonçalves C, Guerra IC, Costa E, Fernandes A, do Bom Sucesso M, Azevedo J, Rodriguez A, Rius R, Seabra C, Ferreira F, Ribeiro L, Ferrão A, Castedo S, Cleto E, Coutinho J, Carvalho F, Barbot J, Porto B. Increased red cell distribution width in Fanconi anemia: a novel marker of stress erythropoiesis. Orphanet J Rare Dis 2016; 11:102. [PMID: 27456001 PMCID: PMC4960735 DOI: 10.1186/s13023-016-0485-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 07/12/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Red cell distribution width (RDW), a classical parameter used in the differential diagnosis of anemia, has recently been recognized as a marker of chronic inflammation and high levels of oxidative stress (OS). Fanconi anemia (FA) is a genetic disorder associated to redox imbalance and dysfunctional response to OS. Clinically, it is characterized by progressive bone marrow failure, which remains the primary cause of morbidity and mortality. Macrocytosis and increased fetal hemoglobin, two indicators of bone marrow stress erythropoiesis, are generally the first hematological manifestations to appear in FA. However, the significance of RDW and its possible relation to stress erythropoiesis have never been explored in FA. In the present study we analyzed routine complete blood counts from 34 FA patients and evaluated RDW, correlating with the hematological parameters most consistently associated with the FA phenotype. RESULTS We showed, for the first time, that RDW is significantly increased in FA. We also showed that increased RDW is correlated with thrombocytopenia, neutropenia and, most importantly, highly correlated with anemia. Analyzing sequential hemograms from 3 FA patients with different clinical outcomes, during 10 years follow-up, we confirmed a consistent association between increased RDW and decreased hemoglobin, which supports the postulated importance of RDW in the evaluation of hematological disease progression. CONCLUSIONS This study shows, for the first time, that RDW is significantly increased in FA, and this increment is correlated with neutropenia, thrombocytopenia, and highly correlated with anemia. According to the present results, it is suggested that increased RDW can be a novel marker of stress erythropoiesis in FA.
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Affiliation(s)
- Rosa Sousa
- Laboratory of Cytogenetics, Abel Salazar Institute for Biomedical Sciences, University of Porto (ICBAS, UP), Porto, Portugal
| | - Cristina Gonçalves
- Clinical Hematology Service, Hospital Center of Porto (CHP), Porto, Portugal
| | | | - Emília Costa
- Pediatric Hematology Unity, Hospital Center of Porto (CHP), Porto, Portugal
| | - Ana Fernandes
- Pediatric Hematology-Oncology Unity, Hospital Center of S. João, Porto (CHSJ), Porto, Portugal
| | - Maria do Bom Sucesso
- Pediatric Hematology-Oncology Unity, Hospital Center of S. João, Porto (CHSJ), Porto, Portugal
| | - Joana Azevedo
- Hematology Service, Hospital and University Center of Coimbra (CHUC), Porto, Portugal
| | - Alfredo Rodriguez
- Laboratory of Cytogenetics, National Institute of Pediatrics, Ciudad de Mexico (INP), Mexico City, Mexico
| | - Rocio Rius
- Laboratory of Cytogenetics, National Institute of Pediatrics, Ciudad de Mexico (INP), Mexico City, Mexico
| | - Carlos Seabra
- Clinical Pathology Service, Infante D. Pedro Hospital, Aveiro (CHBV), Aveiro, Portugal
| | - Fátima Ferreira
- Hematology Service, Hospital Center of S. João, Porto (CHSJ), Porto, Portugal
| | - Letícia Ribeiro
- Hematology Service, Hospital and University Center of Coimbra (CHUC), Porto, Portugal
| | - Anabela Ferrão
- Pediatric Service, Hospital Center of Lisboa Norte (CHLN), Lisbon, Portugal
| | - Sérgio Castedo
- Medical Genetics and Prenatal Diagnosis Prof Doctor Sérgio Castedo, Porto (GDPN), Porto, Portugal
| | - Esmeralda Cleto
- Pediatric Hematology Unity, Hospital Center of Porto (CHP), Porto, Portugal
| | - Jorge Coutinho
- Clinical Hematology Service, Hospital Center of Porto (CHP), Porto, Portugal
| | - Félix Carvalho
- UCIBIO-REQUIMTE, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - José Barbot
- Pediatric Hematology Unity, Hospital Center of Porto (CHP), Porto, Portugal
| | - Beatriz Porto
- Laboratory of Cytogenetics, Abel Salazar Institute for Biomedical Sciences, University of Porto (ICBAS, UP), Porto, Portugal
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10
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Abecasis F, Marques I, Bento C, Ferrão A. A novel haemoglobin variant mimicking cyanotic congenital heart disease. BMJ Case Rep 2016; 2016:bcr-2015-213615. [PMID: 26823361 DOI: 10.1136/bcr-2015-213615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Screening for critical congenital heart defects in newborn babies can aid in early recognition, with the prospect of improved outcome. However, as this universal newborn screening is implemented, there will be an increasing number of false-positive results. In order to avoid multiple investigations and uncertainty, an haemoglobin (Hb) variant must be included in the differential diagnosis in otherwise well newborns with low oxygen saturation by pulse oximetry. We describe a novel fetal Hb variant (heterozygous γ-globin gene (HBG1) mutation in exon 2 c.202G>A (p.Val68Met)) identified in a newborn with positive pulse oximetry screening for congenital heart disease.
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Affiliation(s)
- Francisco Abecasis
- Department of Paediatrics, Paediatric Intensive Care Unit, Hospital Santa Maria, Lisbon Academic Medical Centre, Lisboa, Portugal
| | - Inês Marques
- Department of Paediatrics, Paediatric Intensive Care Unit, Hospital Santa Maria, Lisbon Academic Medical Centre, Lisboa, Portugal Department of Paediatrics, Centro Hospitalar Barreiro-Montijo, Barreiro, Portugal
| | - Celeste Bento
- Clinical Haematology Service, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Anabela Ferrão
- Department of Paediatrics, Haematology Unit, Hospital Santa Maria, Lisbon Academic Medical Centre, Lisboa, Portugal
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11
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Gonçalves C, Oliveira ME, Palha AM, Ferrão A, Morais A, Lopes AI. Autoimmune gastritis presenting as iron deficiency anemia in childhood. World J Gastroenterol 2014; 20:15780-15786. [PMID: 25400463 PMCID: PMC4229544 DOI: 10.3748/wjg.v20.i42.15780] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Accepted: 04/29/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To characterize clinical, laboratorial, and histological profile of pediatric autoimmune gastritis in the setting of unexplained iron deficiency anemia investigation.
METHODS: A descriptive, observational study including pediatric patients with a diagnosis of autoimmune gastritis (positive parietal cell antibody and gastric corpus atrophy) established in a 6 year period (2006-2011) in the setting of refractory iron deficiency anemia (refractoriness to oral iron therapy for at least 6 mo and requirement for intravenous iron therapy) investigation, after exclusion of other potentially contributing causes of anemia. Helicobacter pylori (H. pylori) infection and anti-secretory therapy were also excluded. Data were retrospectively collected from clinical files, including: demographic data (age, gender, and ethnic background), past medical history, gastrointestinal symptoms, familial history, laboratorial evaluation (Hb, serum ferritin, serum gastrin, pepsinogen I/ pepsinogen II, B12 vitamin, intrinsic factor autoantibodies, thyroid autoantibodies, and anti-transglutaminase antibodies), and endoscopic and histological findings (HE, Periodic Acid-Schiff/Alcian blue, gastrin, chromogranin A and immunochemistry analysis for CD3, CD20 and CD68). Descriptive statistical analysis was performed (mean, median, and standard deviation).
RESULTS: We report a case-series concerning 3 girls and 2 boys with a mean age of 13.6 ± 2.8 years (3 Caucasian and 2 African). One girl had type I diabetes. Familial history was positive in 4/5 cases, respectively for autoimmune thyroiditis (2/5), sarcoidosis (1/5) and multiple myeloma (1/5). Laboratorial evaluation on admission included: Hb: 9.5 ± 0.7 g/dL; serum ferritin: 4.0 ± 0.9 ng/mL; serum gastrin: 393 ± 286 pg/mL; low pepsinogen I/ pepsinogen II ratio in 1/5 patients; normal vitamin B12 levels (analyzed in 3 patients). Endoscopy findings included: duodenal nodularity (2/5) and gastric fold softening (2/5), and histological evaluation showed corpus atrophic gastritis with lymphocytic infiltration (5/5), patchy oxyntic gland mononuclear cell infiltration (5/5), intestinal and/or pseudo-pyloric metaplasia in corpus mucosa (4/5), and enterochromaffin cell hyperplasia (4/5). Immunochemistry for gastrin on corpus biopsies was negative in all cases. Duodenal histology was normal. All biopsies were negative for H. pylori (Giemsa staining and cultural examination).
CONCLUSION: We highlight autoimmune gastritis as a diagnosis to be considered when investigating refractory iron deficiency anemia in children, particularly in the setting of a personal/familial history of autoimmune disease, as well as the diagnostic contribution of a careful immunohistological evaluation.
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Póvoas MI, Luís PP, Esteves I, Ferrão A. Severe Langerhans cell histiocytosis in an infant: haemophagocytic syndrome association. BMJ Case Rep 2014; 2014:bcr-2014-206983. [PMID: 25336558 DOI: 10.1136/bcr-2014-206983] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is a rare disease of unknown origin with a heterogeneous clinical presentation, varying from benign and self-limited to lethal. It is classified as single or multisystemic, according to the number of organs involved (one or at least two, respectively). Diagnosis can be challenging and is based on the histological and immunophenotypic examination of affected tissues. Secondary haemophagocytic lymphohistiocytosis is rarely reported in association with LCH and may impair its diagnosis. Some authors suggest that the coexistence of the two disorders is more than coincidental. We present a case of multisystem LCH in a 5-month-old infant, with all risk organs involved, in which severity and rapid progression reflect an association with haemophagocytic syndrome.
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Affiliation(s)
| | - Pedro Pereira Luís
- Department of Anatomic Pathology, Hospital de Santa Maria, Lisbon, Portugal
| | - Isabel Esteves
- Department of Pediatrics, Hospital de Santa Maria, Lisboa, Portugal
| | - Anabela Ferrão
- Department of Pediatrics, Hospital de Santa Maria, Lisboa, Portugal
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Silva IV, Reis AF, Palaré MJ, Ferrão A, Rodrigues T, Morais A. Sickle cell disease in children: chronic complications and search of predictive factors for adverse outcomes. Eur J Haematol 2014; 94:157-61. [PMID: 25039473 DOI: 10.1111/ejh.12411] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Sickle cell disease (SCD) has extremely variable phenotypes, and several factors have been associated with the severity of the disease. OBJECTIVES To analyze the chronic complications of SCD and look for predictive risk factors for increased severity and number of complications. METHODS Retrospective study including all children followed for SCD in the Paediatric Haematology Unit of a tertiary hospital in Portugal, who completed 17 yr old between the years 2004 and 2013. RESULTS We identified 44 patients, 55% female and 98% black. Chronic complications occurred in 80% of cases. Slight dilatation of the left ventricle was the most frequent complication (47.7%), followed by respiratory function disturbs (43.2%), microlithiasis or cholelithiasis (40.9%), increased flow velocity of cerebral arteries (31.8%), enuresis, delayed puberty and bone abnormalities (6.8% each), sickle cell retinopathy and leg ulcer (4.6% each) and recurrent priapism (2.3%). We identified a statistically significant association between leukocytes >15 000/μL and a higher number of hospitalizations (P < 0.001) and chronic complications of the disease (P = 0.035). The occurrence of dactylitis in first year of life was also significantly associated with a higher number of hospitalizations (P = 0.004) and chronic complications (P = 0.018). The presence of α-thalassemia was associated with a lower number of chronic complications (P = 0.036). CONCLUSIONS Leucocytosis and dactylitis in the first year of life can be predictors of SCD severity, while the presence of α-thalassemia can be protective. The determination of early predictors of chronic complications of SCD may improve the comprehensive care of these patients.
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Affiliation(s)
- Inês Vaz Silva
- Department of Paediatrics, Hospital Vila Franca de Xira, Vila Franca de Xira, Portugal
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Abstract
A 14-year-old adolescent presented with a prolonged fever, abnormal liver function, anaemia, thrombocytopaenia, but a good general status. Diagnosis of hemophagocytic lymphohistiocytosis (HLH) was suspected, in spite of the initial indolent course. Secondary causes were excluded, but no specific mutation indicative of primary HLH was found. The patient started with specific therapy, but progressed with reactivations and later with persistently active disease. Haematopoietic stem cell transplantation was not successful and the adolescent died 7 months after diagnosis.
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Abstract
A 13-year-old boy presented with spontaneous skin and mucosal bleeds 3 weeks after acute hepatitis of unknown aetiology. Laboratory analyses revealed pancytopenia and bone marrow biopsy that confirmed the diagnosis of aplastic anaemia. Other causes of congenital and acquired aplastic anaemia were excluded. He was diagnosed with hepatitis-associated aplastic anaemia. He developed a critical clinical condition, becoming totally dependent on erythrocyte and platelet transfusions, and severe neutropenia, which led to invasive bacterial infection. He died due to sepsis with multiple organ failure 3 months after admission.
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Affiliation(s)
- Vivian Gonçalves
- Department of Pediatrics, Hospital São Francisco Xavier, Lisboa, Portugal.
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Vasconcelos A, Prior AR, Ferrão A, Morais A. An adolescent with sickle cell anaemia experiencing disease-related complications: priapism and leg ulcer--a management challenge. BMJ Case Rep 2012; 2012:bcr.11.2011.5146. [PMID: 22605005 DOI: 10.1136/bcr.11.2011.5146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Sickle-cell anaemia (SCA) is a multi-system disease, associated with episodes of acute illness and progressive organ damage. Disease severity shows substantial variation and it is often a burden for adolescents. Complications such as leg ulcer and priapism have a significant impact on quality of life. There are still no definitive treatment guidelines available. Considering the embarrassing nature of priapism and the dire consequences for erectile dysfunction, it is important to inform patients, parents and providers about the relationship of SCA to prolonged painful erections. This article will review the pathophysiology and treatment options of SCA focusing the complications of leg ulcers, priapism, cholelithiasis and retinopathy. The case study of a 14-year-old boy is used to present a management challenge of multiple SCA-related complications.
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Affiliation(s)
- Alexandra Vasconcelos
- Paediatrics Department, Hospital Professor Doutor Fernando Fonseca, Lisboa, Portugal.
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Nunes P, Aguilar S, Prado SN, Palaré MJ, Ferrão A, Morais A. Severe congenital thrombocytopaenia--first clinical manifestation of Noonan syndrome. BMJ Case Rep 2012; 2012:bcr.10.2011.4940. [PMID: 22605701 DOI: 10.1136/bcr.10.2011.4940] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
This report focuses on a male infant, the first born of non-consanguineous parents diagnosed with polyhydramnios at 26 weeks of gestation. The newborn was admitted during the neonatal period with bleeding diathesis associated with a low platelet count at birth (5×10(9)/l).The authors registered a persistent low platelet count (9000-129 000/l) during the infants 1st year of life. Physical examination revealed a petechial rash, a dysmorphic face and bilateral cryptorchidism, in the absence of organomegaly. Additionally, cardiologic evaluation revealed an aortic valve dysplasia and an atrial septal defect, while bone marrow biopsy and aspiration were found normal. Throughout the investigation, the authors excluded congenital infection, alloimmune and familiar thrombocytopaenia, Fanconi anaemia and thrombocytopaenia absent radius syndrome. The cytogenetic analysis revealed a mutation in the PTPN11 gene associated with Noonan syndrome. Here the author highlights that severe neonatal thrombocytopaenia is a manifestation that should be considered in the diagnosis and clinical management of Noonan's syndrome.
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Affiliation(s)
- Paula Nunes
- Pediatria, Hospital S Francisco Xavier, Lisboa, Portugal.
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Pereira FJC, do Céu Silva M, Picanço I, Seixas MT, Ferrão A, Faustino P, Romão L. Human alpha2-globin nonsense-mediated mRNA decay induced by a novel alpha-thalassaemia frameshift mutation at codon 22. Br J Haematol 2006; 133:98-102. [PMID: 16512835 DOI: 10.1111/j.1365-2141.2006.05971.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
We describe a novel alpha-thalassaemia determinant in a 3-year-old girl presenting a mild microcytic and hypochromic anaemia, and normal haemoglobin A2 level. Molecular studies revealed heterozygosity for a novel microdeletion (-C) at codon 22 of the alpha2-globin gene. As the frameshift mutation generates a premature translation termination codon at position 48/49, we investigated the effect of the nonsense codon on the alpha2-globin gene expression. Although it does not affect RNA splicing, the premature nonsense codon induces accelerated mRNA degradation. To our knowledge, this is the first time the nonsense-mediated mRNA decay has been reported to occur in human alpha-globin mRNA.
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Affiliation(s)
- Francisco J C Pereira
- Centro de Genética Humana, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisbon, Portugal
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Faustino P, Picanço I, Miranda A, Seixas T, Ferrão A, Morais A, Lavinha J, Romão L. Compound heterozygosity for Hb Spanish town [alpha27(B8)Glu-->Val], Hb S [beta6(A3)Glu-->Val] and the -alpha(3.7kb) thalassemia deletion. Hemoglobin 2002; 26:185-9. [PMID: 12144063 DOI: 10.1081/hem-120005458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Paula Faustino
- Centro de Genética Humana, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisboa, Portugal.
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