Bone Marrow Aspirate Can Be Avoided in Low-Risk MGUS Patients

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 3997-3997
Author(s):  
Silvia Mangiacavalli ◽  
Federica Cocito ◽  
Lara Pochintesta ◽  
Cristiana Pascutto ◽  
Alessandra Pompa ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Aspirate ◽  
Conflicts Of Interest ◽  
Univariate Analysis ◽  
Low Risk ◽  
Invasive Procedures ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up ◽  
Monoclonal Component

Abstract Abstract 3997 Monoclonal gammopathy of undetermined significance (MGUS) is a premalignant plasmacell dyscrasia with a high prevalence. Diagnostic criteria include: presence of serum monoclonal component (MC) <30 g/l, <10% clonal plasma cells in the bone marrow (BMPC) and absence of end-organ damage according to CRAB criteria. Define the minimal diagnostic work up of patients with small amount of MC (<1.5 g/dl) at low risk for progression to multiple myeloma (MM) according to Mayo clinic stratification is still a matter of debate. This study assess the risk of missing a MM diagnosis not performing invasive procedures (bone marrow aspirate or biopsy) in presence of small amount MC. After approval by our local ethical committee, we retrospectively reviewed medical records of 2304 patients addressed to our single Hematology department for definition MC of IgG or IgA isotype. Diagnostic work-up included: bone marrow aspirate, skeletal bone survey and laboratory tests (i.e. complete blood count, chemistry screening including calcium and creatinine, serum protein electrophoresis and immunofixation, 24-hour urine electrophoresis for quantification of urinary monoclonal component). Patients were defined as having low-risk MC entity according to IMWG criteria (i.e. <1.5 mg/dl). There were 940 out of 2304 patients (41%) presenting with low-risk MC, among them a not negligible percentage (10%, 93 pts) encountered the criteria for MM after completing the scheduled diagnostic work-up. In detail 36% of them were asymptomatic, the remaining 64% presented at least one of CRAB criteria for active disease (60% had lytic lesions at skeletal survey). When adopting lower cut-off value of MC the criteria for MM were encountered in smaller amount of pts. In detail: 6% (30 out of 499 pts) and 4% (8 out of 206 pts) respectively for cut-off value at 1 or 0.5 g/dl respectively. Univariate analysis found a significant correlation between MC amount and BMPC either in MGUS (p<0.001) and MM patients (p<0.001). The probability of missing a MM diagnosis due to a set of value below a specified cut-off was assessed by means of a ROC curve analysis. The probability of finding a clonal BMPC infiltration ≥10% was of 15.4% keeping the serum MC cut-off value at 1.5 g/dl. The risk of missed MM diagnosis was significantly lower choosing low MC cut-off, with 7.5% and 2.8% risk of missed diagnosis for MC cut-off value of 1 g/dl and 0.5 g/dl respectively. Similar specificity value were found either when selecting patients with none of the CRAB criteria for symptomatic disease or with a IgA isotype. In conclusion our study showed a strict correlation between the amount of serum MC and BMPC infiltration. Excluding cases presenting with any of CRAB symptoms, the risk of missed MM diagnosis is very low (7.5%) in patients with a MC <1 g/dl, confirming the chance to avoid invasive procedures during diagnostic work-up of opportunely selected patients. Disclosures: No relevant conflicts of interest to declare.

Flow Cytometric Findings Indicative of Myelodysplasia Differ Depending on the Karyotype

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 3652-3652
Author(s):  
Wolfgang Kern ◽  
Torsten Haferlach ◽  
Susanne Schnittger ◽  
Claudia Haferlach
Keyword(s):  
Bone Marrow ◽  
Chromosome Abnormality ◽  
Median Number ◽  
Monosomy 7 ◽  
Consistent Finding ◽  
Blast Count ◽  
Normal Cytogenetics ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

Abstract Multiparameter flow cytometry (MFC) is increasingly being used as an adjunct to the diagnostic work-up in myelodysplastic syndromes (MDS). While many antigens have been described to be aberrantly expressed in MDS the findings are generally heterogeneous and there is no consistent finding that would be present in all cases with MDS. The aim of the present study therefore has been to assess the immunophenotype in cases with MDS with clearly defined cytogenetic abnormalities as well as with normal karyotypes. Bone marrow samples of a total of 115 patients with MDS have been analyzed in parallel by MFC and chromosome analysis. They had a complex (≥3) aberrant karyotype (n=7), a normal karyotype (n=74), a deletion of the long arm of chromosome 5 (del(5q), n=19), a deletion of the long arm of chromosome 20 (del(20q), n=8), or a monosomy 7 (−7, n=7), the latter three groups carrying the abnormality as sole chromosome aberration, respectively. A standardized panel of five-color combinations of antibodies has been applied for MFC allowing the detection of previously described aberrantly expressed antigens or antigen expression patterns. As compared to cases with other cytogenetics, in cases with a complex aberrant karyotype a higher bone marrow blast count (median 9.8 vs. 4.1%, p<0.001) as well as a higher frequency of coexpression of CD56 in granulocytes (70.0 vs. 25.9%, p=0.007) were found. Furthermore, the median side-scatter (SSC) signal in granulocytes was significantly lower in these cases (368 vs. 591, p=0.029). When combining the findings in the different cell lineages, significant differences between cases with complex aberrant karyotypes and those with other cytogenetics were found: the presence of more than 4 aberrantly expressed antigens on blasts, granulocytes or monocytes or the presence of >5% blasts were found in 80.0 vs. 29.0% of the cases (p=0.032). Cases with del(5q) as the sole chromosome abnormality more often featured a reduced SSC signal (94.7 vs. 69.3%, p=0.023) while an aberrant coexpression of CD56 on monocytes (21.1 vs. 54.5%, p=0.011) as well as the median number of aberrantly expressed antigens on monocytes (0.32 vs. 0.85, p<0.001) was lower in this group. Accordingly, at least 3 aberrantly expressed antigens on blasts, granulocytes or monocytes or a blast count >5% were found less frequently in cases with del(5q) as the sole chromosome abnormality as compared to other cases (36.8 vs. 69.9%, p=0.009). In cases with del(20q) as sole chromosome abnormality findings hardly differed from other cases with only a lack of CD13 expression in monocytes occurring more often (25.0 vs. 3.8%, p=0.058). Interestingly, in cases with −7 as sole chromosome abnormality a stronger SSC signal in blasts was observed as compared to other cases (median: 147 vs. 129, p=0.041) while the median number of aberrantly expressed antigens in granulocytes was lower (1.33 vs. 1.93, p=0.035). In cases with normal cytogenetics, a stronger SSC signal was found in granulocytes (median: 602 vs. 528, p=0.037) while the ratio of the SSC signal monocytes:lymphocytes was found to be lower (median: 3.0 vs. 3.3, p=0.044). Also the percentage of blasts was lower in these cases (median: 3.9 vs. 5.7%, p=0.032). With regard to the number of aberrantly expressed antigens on granulocytes and monocytes, however, at least 3 aberrantly expressed antigens were present more often in cases with normal cytogenetics (56.8 vs. 31.6%, p=0.016). These findings indicate that aberrantly expressed antigens are present in all of the analyzed cytogenetic subgroups of MDS. Importantly, the frequencies of findings typical for MDS differ between these groups. As a consequence, MFC panels used for the diagnostic work-up of MDS should be designed comprehensively to assure the detection of these diverse findings and should be evaluated prospectively.

scholarly journals Vaccine-Induced Thrombotic Thrombocytopenia: Novelty Testing in the Diagnostic Work-up?

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 1061-1061
Author(s):  
Rossella Rosari Cacciola ◽  
Veronica Vecchio ◽  
Elio Gentilini Cacciola ◽  
Emma Cacciola
Keyword(s):  
Conflicts Of Interest ◽  
Clot Lysis ◽  
Clotting Time ◽  
Vein Thrombosis ◽  
History Of ◽  
Diagnostic Work ◽  
Deep Vein ◽  
Work Up ◽  
Diagnostic Work Up ◽  
Maximum Clot Firmness

Abstract COVID-19 vaccination campagnies with several vaccines types are currently undeway. Recently, the ASTRA ZENECA vaccine has raised public alarm with concerns regarding the development of thrombotic events known as vaccine-induced thrombotic thrombocytopenia (VITT). Early and limited studies have implicated an antibody-mediated platelet activation as the mechanism of the clotting events. Aim of this study was to investigate the platelet and coagulation activation using specialized tests. In this study we enrolled 60 patients (40 men, 20 women; mean age 55±10 years) without cardiovascular risk factors or a history of thrombosis who reported having poplitea deep vein thrombosis (35/60) and pulmonary embolism (25/60) revealed with lower-limb ultrasonography and computed tomography (CT) angiography, respectively, 7 days after vaccination with ASTRA ZENECA. All patients were evaluated for initial testing such as platelet count, prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (Fib) and D-dimer (DD). Platelets were measured by automated analyzer, PT and APTT by coagulometric test, Fib using Clauss method, and DD using ELISA. Complete blood hemostasis was studied by platelet function assay (PFA-100) on Collagen/ADP (CT-ADP) and Collagen/Epinephrine (CT-EPI) cartridges and Thromboelastometry method on Clotting Time (CT), Clotting Formation Time (CFT), Maximum Clot Firmness (MCF), and clot lysis at 30 minutes (LY-30). All patients had thrombocytopenia (60±5x109/L), longer PT (28±10 s) and PTT (50±10 s), lower Fib (80±20 mg/dl), higher DD ((550±100 mg/l). All patients had shorter C/ADP and C/EPI (C/ADP, n.v. 68-121 s (42±10 s) and C/EPI n.v. 84-160 s (38±5 s) and shorter CT (CT, unit: s. n.v. 100-240 s) (INTEM 30±20 s, EXTEM 18±10 s), shorter CFT (CFT, unit: s, n.v. 30-160 s (INTEM 11±10 s, EXTEM 19±10 s), longer MCF (MCF, unit: mm, n.v. 50-72 mm (INTEM 128±10 mm, EXTEM 110±10 mm), and lower LY-30 (LY-30, %: v.n. 15% (INTEM 0.8%, EXTEM 0.7%). These interesting findings may be the novelty in the diagnostic work-up of the VITT. If these tests may aid in the diagnosis of VITT deserve to be confirmed and need reproducing in other studies. Disclosures No relevant conflicts of interest to declare.

scholarly journals Bone Marrow Trephine Biopsies from Posterior Superior Iliac Crest in Living Neonates.

2020 ◽  
Author(s):  
Sandip Bartakke ◽  
Umesh Lukade ◽  
Shrividya Sethuratnam
Keyword(s):  
Bone Marrow ◽  
Intensive Care ◽  
Neonatal Intensive Care ◽  
Iliac Crest ◽  
Underlying Mechanism ◽  
Neonatal Intensive Care Units ◽  
Diagnostic Work ◽  
Work Up ◽  
First Time ◽  
Diagnostic Work Up

Cytopenias are common among neonates in neonatal intensive care units (NICU). Although, bone marrow aspirations (BMA) are often performed as part of diagnostic work up but trephine marrow biopsies (BMB) have not been reported from living neonates. BMB is indispensable to accurately assess the cellularity and architecture. There is paucity of literature regarding the technique of BMB in neonates. In this report, for the first time, we describe trephine BMB from Posterior superior iliac crest (PSIC) using 18 guage BMA needle in six living neonates admitted to NICU where bone marrow biopsy findings helped in understanding the underlying mechanism and diagnosis of cytopenias.

scholarly journals Stroke masquerading as cardiac arrest: the artery of Percheron

2021 ◽  
Vol 14 (1) ◽  
pp. e238681
Author(s):  
Megan Quetsch ◽  
Sureshkumar Nagiah ◽  
Stephen Hedger
Keyword(s):  
Cardiac Arrest ◽  
Clinical Assessment ◽  
Altered Consciousness ◽  
Cognitive Changes ◽  
Consciousness Level ◽  
Artery Of Percheron ◽  
Conscious Level ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

The artery of Percheron (AOP) is a rare arterial variant of the thalamic blood supply. Due to the densely packed collection of nuclei it supplies, an infarction of the AOP can be devastating. Here we highlight a patient who had an AOP stroke in the community, which was initially managed as cardiac arrest. AOP strokes most often present with vague symptoms such as reduced conscious level, cognitive changes and confusion without obvious focal neurology, and therefore are often missed at the initial clinical assessment. This case highlights the importance of recognising an AOP stroke as a cause of otherwise unexplained altered consciousness level and the use of MRI early in the diagnostic work-up.

scholarly journals Death of unknown cause? Post-mortem diagnosis of fulminant course of an EBV-associated secondary hemophagocytic lymphohistiocytosis

2021 ◽  
Author(s):  
Josia Fauser ◽  
Stefan Köck ◽  
Eberhard Gunsilius ◽  
Andreas Chott ◽  
Andreas Peer ◽  
...  
Keyword(s):  
Immune Response ◽  
Case Report ◽  
Macrophage Activation ◽  
Post Mortem ◽  
Life Threatening ◽  
Appropriate Therapy ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up ◽  
Secondary Hemophagocytic Lymphohistiocytosis

SummaryHLH is a life-threatening disease, which is characterized by a dysregulated immune response with uncontrolled T cell and macrophage activation. The often fulminant course of the disease needs a fast diagnostic work-up to initiate as soon as possible the appropriate therapy. We present herein the case of a 71-year-old patient with rapidly progressive hyperinflammatory syndrome, which post mortem resulted in the diagnosis of EBV-associated HLH. With this case report, we intend to highlight the relevance of the HScore in the diagnosis of HLH, to create a greater awareness for EBV as a trigger of HLH, and to demonstrate the importance of treating EBV-associated HLH as early as possible.

scholarly journals COVID-19 lung injury as a primer for immune checkpoint inhibitors (ICIs)-related pneumonia in a patient affected by squamous head and neck carcinoma treated with PD-L1 blockade: a case report

2021 ◽  
Vol 9 (2) ◽  
pp. e001870
Author(s):  
Angelo Dipasquale ◽  
Pasquale Persico ◽  
Elena Lorenzi ◽  
Daoud Rahal ◽  
Armando Santoro ◽  
...  
Keyword(s):  
Lung Injury ◽  
Head And Neck ◽  
Checkpoint Inhibitors ◽  
Experimental Therapy ◽  
Common Mechanism ◽  
Nasopharyngeal Swab ◽  
Immune Mediated ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

By the beginning of the global pandemic, SARS-CoV-2 infection has dramatically impacted on oncology daily practice. In the current oncological landscape, where immunotherapy has revolutionized the treatment of several malignancies, distinguishing between COVID-19 and immune-mediated pneumonitis can be hard because of shared clinical, radiological and pathological features. Indeed, their common mechanism of aberrant inflammation could lead to a mutual and amplifying interaction.We describe the case of a 65–year-old patient affected by metastatic squamous head and neck cancer and candidate to an experimental therapy including an anti-PD-L1 agent. COVID-19 ground-glass opacities under resolution were an incidental finding during screening procedures and worsened after starting immunotherapy. The diagnostic work-up was consistent with ICIs-related pneumonia and it is conceivable that lung injury by SARS-CoV-2 has acted as an inflammatory primer for the development of the immune-related adverse event.Patients recovered from COVID-19 starting ICIs could be at greater risk of recall immune-mediated pneumonitis. Nasopharyngeal swab and chest CT scan are recommended before starting immunotherapy. The awareness of the phenomenon could allow an easier interpretation of radiological changes under treatment and a faster diagnostic work-up to resume ICIs. In the presence of clinical benefit, for asymptomatic ICIs-related pneumonia a watchful-waiting approach and immunotherapy prosecution are suggested.

scholarly journals Long-Term Follow-Up of Thyroid Incidentalomas Visualized with 18F-Fluorodeoxyglucose Positron Emission Tomography—Impact of Thyroid Scintigraphy in the Diagnostic Work-Up

Diagnostics ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 557
Author(s):  
Kirsten Korsholm ◽  
Michala Reichkendler ◽  
Louise Alslev ◽  
Åse Krogh Rasmussen ◽  
Peter Oturai
Keyword(s):  
Emission Tomography ◽  
Thyroid Scintigraphy ◽  
Fdg Uptake ◽  
Positron Emission ◽  
Pet Ct ◽  
18F Fdg ◽  
Diagnostic Work ◽  
Fdg Pet Ct ◽  
Work Up ◽  
Diagnostic Work Up

Our objective was to evaluate the frequency of malignancy in incidental thyroidal uptake on 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in a cohort of Danish patients, and furthermore to evaluate the impact of thyroid scinti-graphy in the diagnostic work-up. All whole-body PET/CT reports from 1 January 2010 to 31 December 2013 were retrospectively reviewed and further analyzed if visually increased thyroidal FDG uptake was reported. Patient electronic files were searched for further thyroid evaluation. Of 13,195 18F-FDG-PET/CT scans in 9114 patients, 312 PET/CT reports mentioned incidental thyroid FDG-uptake, and 279 patients were included in the study (3.1%). The thyroid was further investigated in 137 patients (49%), and 75 patients underwent thyroid scintigraphy. A total of 57 patients had a thyroid biopsy and 21 proceeded to surgery. Surgical specimens displayed malignancy in 10 cases, and one thyroid malignancy was found by autopsy. Hence, 11 patients were diagnosed with thyroid malignancies among 279 patients with incidental thyroid 18F-FDG uptake (3.9%). In 34 patients, a biopsy was avoided due to the results of the thyroid scintigraphy. We conclude that patients with thyroid incidentalomas can benefit from further diagnostic work-up including a thyroid scintigraphy.

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