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Simmonds WM, Awuku Y, Barrett C, Brand M, Davidson K, Epstein D, Fredericks E, Gabriel S, Grobler S, Gounden C, Katsidzira L, Louw VJ, Naidoo V, Noel C, Ogutu E, Ramonate N, Seabi N, Setshedi M, Van Zyl J, Watermeyer G, Kassianides C. Guidance for the gastrointestinal evaluation and management of iron deficiency in Sub-Saharan Africa. S Afr Med J 2024; 114:e711. [PMID: 38525666 DOI: 10.7196/samj.2024.v114i1b.711] [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] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Over 30% of the world's population is anaemic, with a significant proportion of these being iron deficient. As iron deficiency (ID) anaemia in men and post-menopausal women is mostly caused by gastrointestinal blood loss or malabsorption, the initial evaluation of a patient with ID anaemia involves referral to a gastroenterologist. The current drive towards patient blood management in sub-Saharan Africa (SSA)prescribes that we regulate not only the use of blood transfusion but also the management of patients in whom the cause of iron loss or inadequate iron absorption is sought. Recommendations have been developed to: (i) aid clinicians in the evaluation of suspected gastrointestinal iron loss and iron malabsorption, and often a combination of these; (ii) improve clinical outcomes for patients with gastrointestinal causes of ID; (iii) provide current, evidence-based, context-specific recommendations for use in the management of ID; and (iv) conserve resources by ensuring rational utilisation of blood and blood products. METHOD Development of the guidance document was facilitated by the Gastroenterology Foundation of Sub-Saharan Africa and the South African Gastroenterology Society. The consensus recommendations are based on a rigorous process involving 21 experts in gastroenterology and haematology in SSA. Following discussion of the scope and purpose of the guidance document among the experts, an initial review of the literature and existing guidelines was undertaken. Thereafter, draft recommendation statements were produced to fulfil the outlined purpose of the guidance document. These were reviewed in a round-table discussion and were subjected to two rounds of anonymised consensus voting by the full committee in an electronic Delphi exercise during 2022 using the online platform, Research Electronic Data Capture. Recommendations were modified by considering feedback from the previous round, and those reaching a consensus of over 80% were incorporated into the final document. Finally, 44 statements in the document were read and approved by all members of the working group. CONCLUSION The recommendations incorporate six areas, namely: general recommendations and practice, Helicobacter pylori, coeliac disease, suspected small bowel bleeding, inflammatory bowel disease, and preoperative care. Implementation of the recommendations is aimed at various levels from individual practitioners to healthcare institutions, departments and regional, district, provincial and national platforms. It is intended that the recommendations spur the development of centre-specific guidelines and that they are integrated with the relevant patient blood management protocols. Integration of the recommendations is intended to promote optimal evaluation and management of patients with ID, regardless of the presence of anaemia.
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Affiliation(s)
- W M Simmonds
- Gastroenterology Division, Department of Internal Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa.
| | - Y Awuku
- Department of Medicine, University of Health and Allied Sciences, Ho, Ghana.
| | - C Barrett
- School of Clinical Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa.
| | - M Brand
- Department of General Surgery, School of Medicine, University of Pretoria, South Africa.
| | - K Davidson
- Private practice, IBD nurse specialist, Cape Town, South Africa.
| | - D Epstein
- Division of Gastroenterology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa.
| | - E Fredericks
- Department of Medicine, Stellenbosch University, South Africa.
| | - S Gabriel
- Gastroenterology Unit, Tygerberg Hospital and Stellenbosch University, South Africa.
| | - S Grobler
- niversitas Netcare Private Hospital, Bloemfontein, South Africa.
| | - C Gounden
- Department of Gastroenterology, School of Clinical Medicine, University of KwaZulu-Natal and Inkosi Albert Luthuli Central Hospital, Durban, South Africa.
| | - L Katsidzira
- Internal Medicine Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe.
| | - V J Louw
- Division of Clinical Haematology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa.
| | - V Naidoo
- Department of Gastroenterology, School of Clinical Medicine, University of KwaZulu-Natal and Inkosi Albert Luthuli Central Hospital, Durban, South Africa.
| | - C Noel
- Division of Gastrointestinal Surgery, Department of Surgery, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa.
| | - E Ogutu
- Department of Internal Medicine, University of Nairobi and Kenyatta National Hospital, Kenya.
| | - N Ramonate
- Gastroenterology Division, Department of Internal Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa.
| | - N Seabi
- Gastroenterology Division, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa.
| | - M Setshedi
- Division of Gastroenterology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa.
| | - J Van Zyl
- Department of Internal Medicine, Faculty of Health Sciences, University of the Free State and Netcare Universitas Private Hospital, Bloemfontein, South Africa.
| | - G Watermeyer
- Division of Gastroenterology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa.
| | - C Kassianides
- Department of Medicine, Faculty of Health Sciences, University of Cape Town and Morningside Mediclinic, Johannesburg, South Africa.
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Van den Berg K, Vermeulen M, Glatt TN, Wasserman S, Barrett CL, Peter J, Brittain D, Louw VJ. COVID-19: Convalescent plasma as a potential therapy. S Afr Med J 2020; 110:562-563. [PMID: 32880317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/04/2020] [Indexed: 06/11/2023] Open
Affiliation(s)
- K Van den Berg
- Translational Research, Medical Division, South African National Blood Service, Roodepoort, South Africa; Division of Clinical Haematology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
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Thomson J, Hofmann A, Barrett CA, Beeton A, Bellairs GRM, Boretti L, Coetzee MJ, Farmer S, Gibbs MW, H Gombotz H, Hilton C, Kassianides C, Louw VJ, Lundgren C, Mahlangu JN, Noel CB, Rambiritch V, Schneider F, Verburgh E, Wessels PL, Wessels P, Wise R, Shander On Behalf Of The South African Patient Blood Management Group A. Patient blood management: A solution for South Africa. S Afr Med J 2019; 109:471-476. [PMID: 31266571 PMCID: PMC10414180 DOI: 10.7196/samj.2019.v109i7.13859] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Indexed: 11/08/2022] Open
Abstract
For more than 70 years the default therapy for anaemia and blood loss was mostly transfusion. Accumulating evidence demonstrates a significant dose-dependent relationship between transfusion and adverse outcomes. This and other transfusion-related challenges led the way to a new paradigm. Patient blood management (PBM) is the application of evidence-based practices to optimise patient outcomes by managing and preserving the patient's own blood. 'Real-world' studies have shown that PBM improves patient outcomes and saves money. The prevalence of anaemia in adult South Africans is 31% in females and 17% in males. Improving the management of anaemia will firstly improve public health, secondly relieve the pressure on the blood supply, and thirdly improve the productivity of the nation's workforce. While high-income countries are increasingly implementing PBM, many middle- and low-income countries are still trying to upscale their transfusion services. The implementation of PBM will improve South Africa's health status while saving costs.
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Affiliation(s)
- J Thomson
- South African National Blood Service, Johannesburg, South Africa.
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Sonnekus PH, Louw VJ, Ackermann AM, Barrett CL, Joubert G, Webb MJ. An audit of the use of platelet transfusions at Universitas Academic Hospital, Bloemfontein, South Africa. Transfus Apher Sci 2014; 51:44-52. [PMID: 25457007 DOI: 10.1016/j.transci.2014.10.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [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: 10/24/2022]
Abstract
An audit was performed at a tertiary hospital in Bloemfontein, South Africa, to establish whether clinicians adhered to local platelet transfusion guidelines. The audit showed poor compliance with local guidelines, with 34% of platelet transfusions not aligned with guidelines and 29.9% of transfusions administered to patients with platelet counts of ≥ 150 × 10(9)/L. When compared to medical disciplines, surgical disciplines tended significantly more to transfuse platelets inappropriately (17.1% and 53.7%, respectively; p < 0.0001). Documentation was poor and in 48.4% of orders for platelets, the indication for the platelet transfusion was not clearly stated. Considerable cost could be avoided with improved adherence to guidelines. This study emphasises the need for improving education in transfusion medicine amongst medical doctors. It is hoped that the information gleaned from this study would assist in the design of educational programmes in transfusion medicine as we attempt to close the existing gaps in knowledge and skills in the field, while ensuring that blood is transfused in a cost-effective and appropriate manner.
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Affiliation(s)
- P H Sonnekus
- Department of Internal Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa.
| | - V J Louw
- Division of Clinical Haematology, Department of Internal Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - A M Ackermann
- Department of Anaesthesiology, School of Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - C L Barrett
- Department of Internal Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - G Joubert
- Department of Biostatistics, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - M J Webb
- Division of Clinical Haematology, Department of Internal Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
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Du Toit M, Claassen D, Le Roux A, Nel E, Van Biljon W, Joubert G, Louw VJ. Percutaneous injuries in doctors in the School of Medicine, University of the Free State: incidence, reporting and adherence to precautionary and management procedures. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786204.2009.10873827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Joubert S, Bosman M, Joubert G, Louw VJ. The utilization of red cell concentrates at Kimberley Hospital Complex, Northern Cape Province, South Africa. Transfus Apher Sci 2013; 49:522-7. [PMID: 23764250 DOI: 10.1016/j.transci.2013.04.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 03/03/2013] [Accepted: 04/25/2013] [Indexed: 11/30/2022]
Abstract
This prospective clinical audit of the utilization of red cell concentrates assesses 55 consecutive transfusion episodes in chronically anaemic adult patients. It examines the appropriateness and outcome of the transfusion episodes; over-transfusion and wastage rates, assessment of anaemia, the informed consent process, and if teaching influenced these parameters when compared to an earlier retrospective audit. The audit revealed several strengths and weaknesses relating to our institution's transfusion practices. Training sessions led to clinically and economically important improvements in transfusion decisions, the investigation of anaemia and the obtainment of informed consent prior to transfusions.
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Affiliation(s)
- S Joubert
- Department Internal Medicine, Kimberley Hospital Complex, Kimberley, South Africa.
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Louw VJ, Bassa F, Chan SW, Dreosti L, Du Toit M, Ferreira M, Gartrell K, Gunther K, Jogessar V, Littleton N, Mahlangu J, McDonald A, Patel M, Pool R, Ruff P, Schmidt A, Sissolak G, Swart A, Verburgh E, Webb MJ. Guidelines for the treatment of myelodysplastic syndromes (MDS) in South Africa. S Afr Med J 2011; 101:900-906. [PMID: 22273034] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Accepted: 09/12/2011] [Indexed: 05/31/2023] Open
Abstract
INTRODUCTION Myelodysplastic syndromes (MDS) encompass a heterogeneous group of clonal haematopoietic disorders characterised by chronic and progressive cytopenias resulting from ineffective haematopoiesis. Treatment is complicated by differences in disease mechanisms in different subgroups, variable clinical phenotypes and risk of progression to acute myeloid leukaemia. RATIONALE Changes in disease classification, prognostic scoring systems, the availability of novel treatment options and the absence of South African guidelines for the diagnosis and management of these complex disorders underpinned the need for the development of these recommendations. METHODS These recommendations are based on the opinion of a number of experts in the field from the laboratory as well as clinical settings and came from both the private and institutional academic environments. The most recent literature as well as available guidelines from other countries were discussed and debated at a number of different meetings held over a 2-year period. RESULTS A comprehensive set of recommendations was developed focusing on risk stratification, supportive management and specific treatment. Novel agents and their indications are discussed and recommendations are made based on best available evidence and taking into account the availability of treatments in South Africa. CONCLUSION Correct diagnosis, risk stratification and appropriate therapeutic choices are the cornerstones of success in the management of patients with myelodysplastic syndromes.
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Affiliation(s)
- V J Louw
- Department of Internal Medicine, University of the Free State, Bloemfontein, South Africa.
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Louw VJ, Dreosti L, Ruff P, Jogessar V, Moodley D, Novitzky N, Patel M, Schmidt A, Willem P. Recommendations for the management of adult chronic myeloid leukaemia in South Africa. S Afr Med J 2011; 101:840-846. [PMID: 22272968] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Accepted: 08/17/2011] [Indexed: 05/31/2023] Open
Abstract
INTRODUCTION Chronic myeloid leukaemia (CML) is a chronic myeloproliferative disorder characterised by a chromosomal translocation between the long arms of chromosomes 9 and 22 [corrected] resulting in the formation of the BCR-ABL fusion gene. The management of CML has undergone major changes over the past decade. Novel treatment approaches have had a dramatic impact on patient outcomes and survival. Nevertheless, these outcomes can only be achieved in the context of expert management, careful monitoring of disease response, appropriate management of adverse events and timeous adjustments to therapy when responses are not achieved within stated time-frames. AIM With the advent of novel treatments providing molecular responses, both the monitoring and management of CML have become more complicated. The aim of these recommendations was to provide a pragmatic yet comprehensive roadmap to negotiate these complexities. METHODS Recommendations were developed based on local expert opinion from both the academic and private medical care arenas after careful review of the relevant literature and taking into account the most widely used international guidelines. About five meetings were held at which these recommendations were discussed and debated in detail. RESULTS A comprehensive set of recommendations was compiled with an emphasis on diagnosis, investigation, treatment and monitoring of disease. Careful attention was given to circumstances unique to South Africa, funding constraints, availability and access to laboratory resources, as well as the effects of concurrent HIV infection. CONCLUSION Most patients with CML can live a reasonably normal life if their disease is appropriately managed. These recommendations should be of value to all specialists involved in the treatment of haematological disorders.
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MESH Headings
- Adult
- Benzamides
- Comorbidity
- Dasatinib
- Disease Management
- HIV Infections/epidemiology
- Humans
- Imatinib Mesylate
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/epidemiology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Piperazines/administration & dosage
- Piperazines/therapeutic use
- Protein Kinase Inhibitors/administration & dosage
- Protein Kinase Inhibitors/therapeutic use
- Protein-Tyrosine Kinases/antagonists & inhibitors
- Pyrimidines/administration & dosage
- Pyrimidines/therapeutic use
- South Africa
- Thiazoles/administration & dosage
- Thiazoles/therapeutic use
- Treatment Outcome
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Affiliation(s)
- V J Louw
- Division of Clinical Haematology, Department of Internal Medicine, University of the Free State, Bloemfontein.
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9
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Abstract
Thrombotic thrombocytopenic purpura (TTP) has been associated with human immunodeficiency virus (HIV) infection. With the high prevalence of HIV in sub-Saharan Africa, HIV-associated TTP is the most common form of this disease seen in the South African population. Several case reports describe myocardial infarction in HIV-negative TTP patients. The case of the first HIV-positive patient who presented with clinical signs and symptoms of TTP and myocardial injury is reported in this study. A patient with fragmentation haemolysis and thrombocytopenia presented with angina. Risk factors for ischaemic heart disease were absent. An electrocardiogram (EKG) revealed ST-segment elevation and a significantly raised Troponin T level. The patient's HIV test was positive and a diagnosis of myocardial injury with HIV-associated TTP was made. The patient was treated with plasma infusion and steroid therapy. Due to poor response, the therapy was changed to plasma exchange. The patient recovered fully and subsequent coronary angiography revealed normal coronary vessels. Treatment of myocardial infarction in TTP is controversial, but the treatment cornerstone should remain plasma infusion or plasma exchange. As patients are often young and do not have the classical risk factors of ischaemic heart disease, a high level of suspicion and routine exclusion of myocardial ischaemia in these patients are advised.
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Affiliation(s)
- G J Visagie
- Department of Internal Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein 9300, South Africa.
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Louw VJ, Nel TJ, Leipoldt EJ, Badenhorst PN, Hay JF, Nel MM. Challenges in transfusion medicine recruitment and trainingâa solution. Transfus Med 2010; 20:70-1. [DOI: 10.1111/j.1365-3148.2009.00965.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Affiliation(s)
- F. J. Bosch
- Department of Internal Medicine, University of the Free State, Bloemfontein, South Africa
| | - L. Badenhorst
- Department of Medical Microbiology, University of the Free State, Bloemfontein, South Africa
| | - J. A. Le Roux
- Department of Medical Microbiology, University of the Free State, Bloemfontein, South Africa
| | - V. J. Louw
- Division of Clinical Haematology, Department of Internal Medicine, University of the Free State, Bloemfontein, South Africa
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Smedema JP, Abrahams S, Louw VJ. Partial reversal of hemolysis-associated pulmonary arterial hypertension in response to oral administration of L-arginine in a patient with hereditary spherocytosis. Acta Haematol 2007; 118:167-8. [PMID: 17890851 DOI: 10.1159/000108767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2007] [Accepted: 07/18/2007] [Indexed: 11/19/2022]
MESH Headings
- Administration, Oral
- Anti-Inflammatory Agents, Non-Steroidal/administration & dosage
- Anticoagulants/administration & dosage
- Arginine/administration & dosage
- Aspirin/administration & dosage
- Hemolysis
- Humans
- Hypertension, Pulmonary/blood
- Hypertension, Pulmonary/complications
- Hypertension, Pulmonary/drug therapy
- Hypertension, Pulmonary/physiopathology
- Male
- Middle Aged
- Spherocytosis, Hereditary/blood
- Spherocytosis, Hereditary/complications
- Spherocytosis, Hereditary/drug therapy
- Spherocytosis, Hereditary/physiopathology
- Vasodilator Agents/administration & dosage
- Warfarin/administration & dosage
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Louw VJ, du Preez P, Malan A, van Deventer L, van Wyk D, Joubert G. Pica and food craving in adult patients with iron deficiency in Bloemfontein, South Africa. S Afr Med J 2007; 97:1069-1071. [PMID: 18250914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
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Smedema JP, Louw VJ. Pulmonary arterial hypertension after splenectomy for hereditary spherocytosis. Cardiovasc J Afr 2007; 18:84-9. [PMID: 17497044] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023] Open
Abstract
Hereditary spherocytosis consists of a group of haemolytic anaemias caused by defects in the proteins involved in the vertical interactions between the membrane skeleton and the lipid bilayer of the red blood cell. Inheritance is most commonly autosomal dominant with variable expression. Splenectomy may be indicated because of anaemia or for the prevention of gall-stones. We describe a patient who presented with symptoms of pulmonary hypertension 32 years after splenectomy. Idiopathic pulmonary arterial hypertension (IPAH) and chronic thromboembolic pulmonary hypertension (CTEPH) have been associated with splenectomy, while chronic haemolysis may result in haemolysis-associated pulmonary hypertension. We briefly discuss the current views on the pathophysiology, diagnosis and management of this rare condition.
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Affiliation(s)
- J P Smedema
- Lazaron Heart Clinic, N1 City Hospital, Goodwood, South Africa
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Verburgh E, Achten R, Louw VJ, Brusselmans C, Delforge M, Boogaerts M, Hagemeijer A, Vandenberghe P, Verhoef G. A new disease categorization of low-grade myelodysplastic syndromes based on the expression of cytopenia and dysplasia in one versus more than one lineage improves on the WHO classification. Leukemia 2007; 21:668-77. [PMID: 17301818 DOI: 10.1038/sj.leu.2404564] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [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: 11/09/2022]
Abstract
Multilineage dysplasia was advanced by the World Health Organization to increase prognostic accuracy in myelodysplastic syndromes (MDS) classification. We performed a structured cytomorphological examination of bone marrow (BM) in 221 low-grade MDS patients, this in conjunction with strict guidelines for cytopenias. A dysplasia scoring system was developed utilizing dysplastic changes, which were associated with worse outcome on univariate and multivariate analysis corrected for the International Prognostic Scoring System (IPSS). Dysplasia >or=10% in one BM lineage and one cytopenia constituted the low-risk category UCUD or Unilineage Cytopenia and Unilineage Dysplasia. The high-risk category comprised patients with cytopenia in >or=2 lineages and dysplasia in >or=2 BM lineages, namely MCMD or Multilineage Cytopenia and Multilineage Dysplasia. Intermediate-risk patients had one cytopenia and multilineage dysplasia, or cytopenia in >or=2 lineages and unilineage BM dysplasia, designated UCMD/MCUD or Unilineage Cytopenia and Multilineage Dysplasia/Multilineage Cytopenia and Unilineage Dysplasia. This system utilizing cytopenia-dysplasia scoring at diagnosis enabled comprehensive categorization of low-grade MDS cases that predicted for overall as well as leukemia-free survival. Cytopenia-dysplasia categorization added additional prognostic values to the lower risk IPSS categories. This suggests that a standardized dysplasia scoring system, used in conjunction with cytopenia, could improve diagnostic and prognostic sub-categorization of MDS patients.
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Affiliation(s)
- E Verburgh
- Department of Hematology, University Hospitals, University of Leuven, Leuven, Belgium.
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Reuter H, Burgess LJ, Louw VJ, Doubell AF. The management of tuberculous pericardial effusion: experience in 233 consecutive patients. Cardiovasc J S Afr 2007; 18:20-5. [PMID: 17392991] [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] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
AIM We report on the 30-day and one-year outcome of consecutive effusive pericarditis patients, including those with tuberculous pericarditis, over a six-year-period. METHODS AND RESULTS Patients with large pericardial effusions requiring pericardiocentesis were included in the study after having given written informed consent. Clinical and radiological evaluations were followed by echo-guided pericardiocentesis, and extended daily intermittent drainage via an indwelling pigtail catheter. A standard short-course anti-tuberculous regimen was initiated. A total of 233 patients was included. One hundred and sixty-two patients had pericardial tuberculosis (TB), including 118 (73%) with microbiological and/ or histological evidence of TB and 44 (27%) diagnosed on clinical and supportive laboratory data. Over the six-year period, two patients developed fibrous constrictive pericarditis after receiving adjuvant corticosteroid therapy. The 30-day mortality (8.0%) was statistically higher for HIV-positive patients (corresponding mortality 9.9%) than for HIV-negative patients (6.2%; p = 0.04). The one year all-cause mortality was 17.3%. It was also higher for HIV-positive (22.2%) than for IV-negative patients (12.3%; p = 0.03). Cardiac mortality was equal for HIV-positive and -negative patients. CONCLUSION Tuberculous pericardial effusions responded well to closed pericardiocentesis and a six-month treatment of antituberculous chemotherapy. The former was effective and safe irrespective of HIV status.
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Affiliation(s)
- H Reuter
- TREAD Research/Cardiology Unit, Tygerberg Hospital and University of Stellenbosch, Parow, Western Cape, South Africa
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Louw VJ, Reuter H, Smedema JP, Katjitae I, Burgess LJ, Doubell AF. Clinical experience with pericardiocentesis and extended drainage in a population with a high prevalence of HIV. Neth Heart J 2002; 10:399-406. [PMID: 25696035 PMCID: PMC2499794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND The data presented were generated in a prospective study on the immunopathogenesis and management of tuberculous (TB) pericarditis at Tygerberg Hospital in Cape Town. We report our experience with 2D echocardiographically guided pericardiocentesis in 170 consecutive patients who presented to us with large pericardial effusions since 1995. METHODS All patients referred to our department with echocardiographically confirmed large pericardial effusions underwent a clinical assessment followed by pericardiocentesis and drainage by an indwelling pigtail catheter. The appearance and amount of drained effusion were noted and fluid was sent for diagnostic assessment. The pigtail catheter was kept in place and fluid was aspirated once daily until the aspirate was less than 100 ml, at which stage the catheter was removed. RESULTS A chest wall puncture site was chosen in 165 of the 170 patients (97%), while the subcostal approach was only used in five patients. Echocardiographic signs of tamponade were seen in 88% of cases. In the majority of patients (68.2%) a diagnosis of TB could be established and of these 46.6% were HIV positive. TB could not be proven in only three HIV-positive patients (1.8% of all patients). Neither hospital stay nor complications were increased in the HIV-positive group when compared with the HIV-negative group and no patient developed intrapericardial sepsis. No death could be attributed with certainty to the procedure. One patient developed non-fatal tamponade within 24 hours after the tap and in another patient a left ventricular thrombus was noted on echo after 16 days. Twenty-four patients underwent a pericardial window procedure according to protocol for diagnostic purposes. In another four patients a window was performed for therapeutic reasons. The most common minor complication was local pain at the site of catheter insertion. Repeat drainage was necessary in only six (3.5%) cases. CONCLUSIONS 2D echocardiographically directed pericardiocentesis with extended catheter drainage has an excellent profile in terms of simplicity, safety and efficacy, even in a population with a very high prevalence of HIV.
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Arts J, Louw VJ, Bolliger CT. Pushed, pulled or twisted? Respiration 2001; 68:405. [PMID: 11464089 DOI: 10.1159/000050535] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/19/2022] Open
Affiliation(s)
- J Arts
- Department of Internal Medicine, University of Stellenbosch, Cape Town, South Africa.
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Affiliation(s)
- V J Louw
- Lung Unit, Department of Internal Medicine, Tygerberg Hospital, Cape Town, South Africa.
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