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Moreno-Castaño AB, Ramos A, Pino M, Parra R, Altisent C, Vidal F, Corrales I, Borràs N, Torramadé-Moix S, Palomo M, Escolar G, Diaz-Ricart M. Diagnostic challenges in von Willebrand disease. Report of two cases with emphasis on multimeric and molecular analysis. Platelets 2020; 32:697-700. [PMID: 32664776 DOI: 10.1080/09537104.2020.1784403] [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: 10/23/2022]
Abstract
Identification of qualitative variants of von Willebrand disease (VWD) can be a diagnostic challenge because of discrepant results obtained in the multiple laboratory tests available for its appropriate classification. We report two cases of infrequent inherited variants of VWD with unclear preliminary results with the test panel available at the time of first consultation and that were finally diagnosed as a VWD type 2A/IID with a c.8318 G > C, p.Cys2773Ser mutation and a VWD type 2M with c.4225 T > G, p.Val1409Phe mutation, respectively. The description of these two cases highlights that despite the limited diagnostic panel for the evaluation of von Willebrand Factor (VWF) functionality, the multimeric analysis and genetic family studies were fundamental tools to achieve the final diagnosis.
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Affiliation(s)
- A B Moreno-Castaño
- Hemostasis and Eritropathology Unit, Hematopathology, Department of Pathology, CDB, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain.,Barcelona Endothelium Team, Barcelona
| | - A Ramos
- Hemostasis and Eritropathology Unit, Hematopathology, Department of Pathology, CDB, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain.,Barcelona Endothelium Team, Barcelona
| | - M Pino
- Hemostasis and Eritropathology Unit, Hematopathology, Department of Pathology, CDB, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain.,Barcelona Endothelium Team, Barcelona
| | - R Parra
- Congenital Coagulopathies Department, Banc de Sang i Teixits, Barcelona
| | - C Altisent
- Medicina Transfusional, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona (VHIR-UAB), Barcelona
| | - F Vidal
- Congenital Coagulopathies Department, Banc de Sang i Teixits, Barcelona.,Medicina Transfusional, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona (VHIR-UAB), Barcelona.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - I Corrales
- Congenital Coagulopathies Department, Banc de Sang i Teixits, Barcelona.,Medicina Transfusional, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona (VHIR-UAB), Barcelona
| | - N Borràs
- Congenital Coagulopathies Department, Banc de Sang i Teixits, Barcelona.,Medicina Transfusional, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona (VHIR-UAB), Barcelona
| | - S Torramadé-Moix
- Hemostasis and Eritropathology Unit, Hematopathology, Department of Pathology, CDB, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain.,Barcelona Endothelium Team, Barcelona
| | - M Palomo
- Hemostasis and Eritropathology Unit, Hematopathology, Department of Pathology, CDB, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain.,Barcelona Endothelium Team, Barcelona.,Josep Carreras Leukaemia Research Institute (IJC), Barcelona
| | - G Escolar
- Hemostasis and Eritropathology Unit, Hematopathology, Department of Pathology, CDB, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain.,Barcelona Endothelium Team, Barcelona
| | - M Diaz-Ricart
- Hemostasis and Eritropathology Unit, Hematopathology, Department of Pathology, CDB, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain.,Barcelona Endothelium Team, Barcelona
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Diarra B, Cissé AB, Kodio O, Sanogo M, Baya B, Togo ACG, Somboro A, Tolofoudié M, Degoga B, Keita ML, Diallo F, Nguiakam N, Coulibaly G, Bane S, Sarro YDS, Doumbia S, Murphy RL, Diallo S, Dejong BC. Screening new tuberculosis patients in Mali for rifampicin resistance at 2months. Int J Mycobacteriol 2016; 5 Suppl 1:S42-S43. [PMID: 28043602 DOI: 10.1016/j.ijmyco.2016.09.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 09/18/2016] [Accepted: 09/20/2016] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE/BACKGROUND The recent call for universal drug susceptibility testing (DST) for all tuberculosis (TB) patients will be difficult to meet in settings where Xpert rollout is limited, such as low prevalence of HIV and Multi-drug Resistant Tuberculosis (MDR) settings. As recommended by World Health Organization (WHO) guidelines, the success of TB treatment is measured by Ziehl-Neelsen (ZN) microscopy or auramine-rhodamine fluorescent microscopy (FM) on sputum, in which conversion to negative smear at 2months (M) is an important predictor of treatment success, defined as a negative smear at 5M. The sputum smear that fails to convert to negative at 5M are screened for rifampicin resistance. We tested in a prospective study whether an early screen for rifampicin resistance, based on FM results at 2M, could detect MDR patients early, rather than screening all patients with GeneXpert MTB/Rif at baseline. METHODS Between February 2015 and August 2016, we enrolled new TB patients in an IRB-approved prospective cohort study at four health centers in Bamako district. Fresh sputum samples were collected at 2M and 5M to measure FM smear conversion. Patients who failed to show a decline in FM positivity at 2M (moderate or many Acid Fast Bacilli (AFB)) had their sputum tested in GeneXpert to detect rifampicin resistance. Patients who had any AFB seen at 5M were also tested using GeneXpert. RESULTS Of the 570 patients who were enrolled in the study, 22 (3.8%) died and 27 (4.7%) were lost to follow-up. The prevalence of HIV and TB coinfection was 12.4%, and 65.6% of the patients were male. At 2M, 32 out of 429 patients still had moderate or many AFBs in FM, and were screened by Xpert, of whom 5 (15.6%) tested rifampicin-resistant and were referred for MDR treatment. Of the 310 patients who completed 5M of treatment, 35 (11.3%) met the definition of failure (few or moderate AFB in FM) and had their sputum tested in Xpert; moreover, four (11.4%) demonstrated rifampicin resistance. In total, 67 (21.6% of 310) patients were screened by Xpert, of whom nine were detected to have MDR (or 13.4% of those screened). CONCLUSION Although we cannot exclude additional MDR patients having been missed by our screening strategy, our screening algorithm at 2M detected five out of nine MDR patients. Detecting patients at 2M allowed for earlier referral, and potentially less acquired drug resistance and lower mortality. This strategy may be advantageous while awaiting further rollout of Xpert machines that will permit universal DST.
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Affiliation(s)
- Bassirou Diarra
- SEREFO/UCRC, University Clinical Research Center, Techniques and Technologies of Bamako, Bamako, Mali.
| | - Aissata B Cissé
- Tuberculosis National Reference Laboratory, Institut National de Référence en Santé Publique, Bamako, Mali
| | - Ousmane Kodio
- SEREFO/UCRC, University Clinical Research Center, Techniques and Technologies of Bamako, Bamako, Mali
| | - Moumine Sanogo
- SEREFO/UCRC, University Clinical Research Center, Techniques and Technologies of Bamako, Bamako, Mali
| | - Bocar Baya
- SEREFO/UCRC, University Clinical Research Center, Techniques and Technologies of Bamako, Bamako, Mali
| | - Antieme C G Togo
- SEREFO/UCRC, University Clinical Research Center, Techniques and Technologies of Bamako, Bamako, Mali
| | - Amadou Somboro
- SEREFO/UCRC, University Clinical Research Center, Techniques and Technologies of Bamako, Bamako, Mali
| | - Mohamed Tolofoudié
- SEREFO/UCRC, University Clinical Research Center, Techniques and Technologies of Bamako, Bamako, Mali
| | - Boureima Degoga
- SEREFO/UCRC, University Clinical Research Center, Techniques and Technologies of Bamako, Bamako, Mali
| | - Marie Laure Keita
- SEREFO/UCRC, University Clinical Research Center, Techniques and Technologies of Bamako, Bamako, Mali
| | - Fatimata Diallo
- SEREFO/UCRC, University Clinical Research Center, Techniques and Technologies of Bamako, Bamako, Mali
| | - Natacha Nguiakam
- SEREFO/UCRC, University Clinical Research Center, Techniques and Technologies of Bamako, Bamako, Mali
| | - Gagni Coulibaly
- SEREFO/UCRC, University Clinical Research Center, Techniques and Technologies of Bamako, Bamako, Mali
| | - Sidy Bane
- SEREFO/UCRC, University Clinical Research Center, Techniques and Technologies of Bamako, Bamako, Mali
| | - Yeya Dit Sadio Sarro
- SEREFO/UCRC, University Clinical Research Center, Techniques and Technologies of Bamako, Bamako, Mali
| | - Seydou Doumbia
- SEREFO/UCRC, University Clinical Research Center, Techniques and Technologies of Bamako, Bamako, Mali
| | | | - Souleymane Diallo
- SEREFO/UCRC, University Clinical Research Center, Techniques and Technologies of Bamako, Bamako, Mali
| | - Bouke C Dejong
- Mycobacteriology Unit, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
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