Does the platelet‑to‑lymphocyte ratio have a prognostic effect in patients with myelodysplastic syndrome?

INTRODUCTION

Myelodysplastic syndromes (MDS) include various hematologic abnormalities characterized by chronic cytopenia due to disruption in cellular differentiation. This study aims to evaluate the prognostic value of PLR in patients with MDS.

MATERIAL AND METHODS

Clinical-laboratory findings and the results of bone marrow biopsies of MDS patients before treatment were recorded. p value of <0.05 was considered statistically significant. SPSS version 20.0 was used for statistical analysis.

RESULTS

The study included 62 patients with median follow-up time of 62.8±4.5 months and median age of 68.5 years. In 13 patients, acute leukemia was transformed. In these subjects, a PLR cut-off level of 46 was established for mortality (p=0.015). We found a significant relationship between PLR and multilineage series with the presence of dysplasia (p=0.017). The survival analysis showed a decreased survival in cases with dysplasia in two and/or more series, transformation into acute leukemia, and thrombocytopenia.

CONCLUSION

Our study demonstrated that there was a relationship between PLR and MDS with multilineage dysplasia (mld-MDS). PLR is investigated as an inflammatory finding in various hematologic malignancies. Further studies investigating the value of PLR in MDS are needed to determine whether PLR may be a marker of bone marrow dysplasia grading (Tab. 2, Fig. 4, Ref. 32).

A forgotten screening test for iron deficiency anemia: oral iron absorption test

OBJECTIVE

In this study, we aimed to investigate the iron absorption defects using the oral iron absorption test (OIAT) in patients with iron deficiency anemia (IDA).

MATERIALS AND METHODS

Forty-six patients with IDA which nonresponder to oral iron treatment were included in the study. OIAT was started at 8 a.m. after an overnight fast; 52.8 mg of elemental iron were given orally as 160 mg of iron sulfate. Iron levels of all participants were analyzed at baseline and at the 3rd hour of the study.

RESULTS

Compared to baseline; serum iron levels whose serum iron levels exceed 91 mcg/ dl in 40(%87) patients. Further investigations in 6 patients revealed that 4 patients had chronic atrophic gastritis with helicobacter pylori infection; while the remaining 2 patients did not have any prominent.

CONCLUSIONS

This study demonstrated that OIAT is a good index for the evaluation of absorption defects and can be a screening clinical test of IDA.

Evaluation of serum levels of zinc, copper, and Helicobacter pylori IgG and IgA in iron deficiency anemia cases

OBJECTIVE

Iron deficiency anemia (IDA) is the most common form of anemia. Impaired intake absorption and blood loss are the main factors in the etiology. Impaired absorption can be caused by a decrease in trace elements such as copper and zinc, which are found in the structure of enzymes that coordinate iron metabolism or act as a catalyst for them, and the existence of Helicobacter pylori (H. pylori), which inhibits iron absorption in the stomach. Serum levels of zinc, copper, and H. pylori antibodies were measured in IDA cases, and correlations with IDA were evaluated.

PATIENTS AND METHODS

The study group was composed of 115 IDA cases who were followed at hematology outpatient clinics, and the control group was composed of 92 gender- and age-matched healthy individuals. Patients were diagnosed with iron deficiency anemia according to hemoglobin, serum ferritin, and iron levels and total iron-binding capacity. Serum zinc, copper, H. pylori immunoglobulin A (HpIgA) and immunoglobulin G (HpIgG), vitamin B12, and folic acid levels were examined in the blood specimens collected.

RESULTS

No statistically significant difference in zinc and copper serum levels between the study and control groups was observed (p > 0.05 for both groups). Although no difference was observed between the HpIgG levels of the two groups, patients with IDA had a statistically significant increase in HpIgA levels (p < 0.05). Pearson's correlation analysis showed that the zinc levels of the IDA group did not have a correlation with any parameters (p < 0.05 for all). Copper levels had a positive correlation with only the HpIgA level in the IDA group (r = 0.222, p = 0.017).

CONCLUSIONS

Trace elements and H. pylori infection did not have a correlation with IDA. Elevated levels of HpIgA and positive correlation of HpIgA with copper levels were observed. The literature review clearly suggests that several points require further explanation, and extensive research with larger samples is required.

The predictive value of epidemiological characteristics, clinical and laboratory findings in adult lymphadenopathy etiology

OBJECTIVE

Our aim was to determine the presence or absence of malignant etiology in the epidemiological, clinical and laboratory results of patients undergoing lymph node biopsies.

PATIENTS AND METHODS

This study was carried out between January 2013 and April 2014. We enrolled a total of 150 adult patients who had lymph node biopsies. 73 of these were females (48.7%) and 77 were males (51.3%). The epidemiological characteristics, clinical and laboratory findings were evaluated and compared with the pathological results.

RESULTS

Leukopenia (p=0.05) thrombocytopenia (p=0.03) and increased lactate dehydrogenase levels (p=0.01) were found to be associated with the malignancy. In the cervical, submandibular, axillary and inguinal areas lymphadenopathy was generally seem to be benign while the rate of malignancy was higher in the intra-abdominal and supraclavicular regions. In those cases who had a lymph node index of below 2 there was a higher rate of malignancy (p=0.04). In cases which lymphadenopathy accompanied by splenomegaly has been found associated with malignancy (p=0.009). No association with regards to malignancy was found with the erythrocyte sedimentation rate, C-reactive protein and hepatomegaly.

CONCLUSIONS

According to the results of the study five variables including cytopenia, lactate dehydrogenase levels, splenomegaly, lymph node index below 2, intra-abdominal and supraclavicular lymphadenopathy were concluded to be the most suitable means of predicting malignant etiology.

A new sickling variant 'Hb S-Wake β[(Glu6Val-Asn139 Ser)]' found in a compound heterozygote with Hb S β(Glu6Val) coinherited with homozygous α-thalassemia-2: phenotype and molecular characteristics

We report the case of a 14-year-old African-American boy who was diagnosed with sickle cell disease. Laboratory tests showed that the patient was a compound heterozygote for a novel Hb variant with a double mutation detected on β(S) allele, Hb S βGlu6Val, and βAsn139Ser substitution, i.e. a β-chain variant named 'Hb S-Wake'. The patient also carried a single Hb S mutation in trans allele, leading to Hb SS-Wake disease. He had coinherited homozygous α(+)-thalassemia (-α(3.7)/-α(3.7)) simultaneously which resulted in multiple globin gene abnormalities.

5-azacytidine treatment results in myelodysplastic syndrome

e18003

Background: Myelodysplastic syndrome (MDS) is a clonal disease of hematopoiesis characterized by dysplasia in one or more series. 5-azacytidine (5-AZA) which is one of the methyl transferase inhibitors, targets the epigenetic changes in MDS and has been used for the last few years. Phase III studies which compare 5-AZA with supportive therapies report response rates up to 60%. Methods: In this study the aim was to retrospectively analyze the response rates of 26 MDS patients who were treated with 5-AZA between years 2002–2008. The patients were; median age 58 (21–84); male/female = 16/10; RAEB-I (7 patients); RAEB-II (18 patients); ve CMML (1 patient); secondary MDS (2 patients). According to an international prognostic scoring system, 6 patients were intermediate-1; 9 patients were intermediate-2; and 11 patients were high risk. Nine patients received 5-AZA as first-line therapy. The median leukocyte counts, absolute neutrophil counts (ANC), hemoglobin values, and thrombocyte counts at the begining of the cycles were; 2.4 (0.5–23)x10e9/L, 0.7 (0.1–16.5)x10e9/L, 8.6(5.3–11.4) gr/dl, 41(4–35)x10e9/L, respectively. The karyotype analysis revealed del5q in 3 patients; -7/del7q in 6 patients; trisomy 8 in 7 patients, del20q, del11q and complex karyotype (del7q+del5q+delY) in 1 patient each. The median cycles completed were 2 (1–6). Results: Seven patient were not elligible for response evaluation. Nine patients (47%) did not respond to the therapy and 8 of them were lost. Ten patients (53%) responded to the therapy with complete remission (n=4), partial remission (n = 2) and hematological improvement (n = 4). The responders and non-responders were similar in terms of median age, sex and pretreatment leukocyte, ANC and hemoglobin levels. However, there was statistically significant difference in terms of initial thrombocyte counts, total number of cycles received and serum ferritin levels. The patients who received 5-AZA as first line therapy had beter response than others (71% versus 29%). Conclusions: The observed response to 5-AZA therapy was similar to the reported rates in the literature. The most important factors for response were initial thrombocyte counts, total number of cycles, other therapies received before 5-AZA and the serum ferritin levels.

No significant financial relationships to disclose.

The effect of granulocyte colony stimulating factor on the immune parameters in experimental obstructive jaundice

BACKGROUND/AIMS

Obstructive jaundice is an important clinical problem. It may cause complications such as renal insufficiency, cardiovascular sequels, coagulation defects, gastrointestinal bleeding, delayed wound healing, secondary biliary cirrhosis and sepsis. We investigated the effect of GM-CSF on immunological parameters in the experimental obstructive jaundice.

METHODOLOGY

In our experimental study we studied four groups that consisted of 28 rats. The 1st group consisted of sham rats, the 2nd group consisted of sham and GM-CSF applied rats and the 3rd and 4th groups consisted of rats that had obstructive jaundice. In the 4th group we applied 4 micrograms/kg GM-CSF subcutaneously to the rats for 7 days. We measured the levels of neutrophils, lymphocytes, leukocytes, interferon-alpha, CD32, CD34 and CD64 in all groups.

RESULTS

In the jaundice group neutrophil, lymphocyte and leukocyte counts were found to be significantly lower compared to the other groups (P < 0.005). interferon-alpha and CD levels were found to be lower in the jaundice group compared to the other groups. In the GM-CSF applied jaundice group neutrophils, lymphocytes, leukocytes and interferon-alpha levels were found to be higher. CD34- CD64 levels were insignificantly increased in the GM-CSF group whereas CD32 levels were significantly increased.

CONCLUSIONS

We believe that in the prevention of serious septic complications which have a high mortality risk, GM-CSF application to restore the macrophage-neutrophil functions should be supported by advanced clinical studies.