scholarly journals PRIMARY MYELOFIBROSIS

Author(s):  
Muhammad Irhamsyah ◽  
Darwati Muhadi ◽  
Mansyur Arif

 A 55-year-old male was admitted to hospital with chief complaint of abdominal distention since one year before admission, and it became more prominent than before. The physical examination showed splenomegaly with schuffner line S5, and it was confirmed with ultrasonography. The routine blood test showed a hemoglobin level of 9.2 g/L, leukocyte count of 14.690/µL and thrombocyte count of 115 x 103/µL. From the peripheral blood smear results, the suspected diagnosis of chronic myeloid leukemia with differential diagnosis of a leukemoid reaction was made. However, bone marrow aspiration revealed hypoplastic marrow of primary myelofibrosis. The patients with primary myelofibrosis need early diagnosis and treatment to manage the symptoms of splenomegaly, stop fibrosis process and extramedullary hematopoiesis. Early treatment, in this case, can decrease poor prognosis and mortality rate.

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 482-482
Author(s):  
Koki Ueda ◽  
Kazuhiko Ikeda ◽  
Kazuei Ogawa ◽  
Akiko Shichishima-Nakamura ◽  
Kotaro Shide ◽  
...  

Abstract Myeloproliferative neoplasms (MPN) are characterized by chronic proliferation of myeloid cells, extramedullary hematopoiesis and occasional leukemic transformation. Mutations in JAK2, CALR and MPL have been established as drivers of myeloproliferative phenotype, but their roles in disease progression with clonal expansion remain unclear. In addition, studies have shown mutations in epigenetic modifiers including TET2, DNMT3A, ASXL1 and EZH2, and aberrant expressions of microRNAs in MPN, but downstream of these changes is also largely unknown. Recently, we showed high expression of HMGA2 mRNA partly correlated with reduced microRNA let-7 in granulocytes of patients with MPN, including 100% patients with primary myelofibrosis (MF) and 20% polycythemia vera and essential thrombocythemia (Harada-Shirado et al, Brit J Haematol, 2015). In mice, loss of epigenetic modifiers such as BMI1 and EZH2, along with the Arf/Ink4a knockout (Oguro et al, J Exp Med, 2012) or the JAK2 V617F (Sashida et al, ASH, 2013), leads to overexpression of HMGA2 with accelerating MPN. We have generated transgenic (Tg) mice of Hmga2 cDNA with truncated 3'UTR (ΔHmga2) lacking binding sites of let-7 thatrepresses expression of HMGA2 (Ikeda et al, Blood, 2011). Δ Hmga2 mice overexpress HMGA2 and develop MPN-like disease, and represent a clonal advantage in competitive repopulations with serial bone marrow (BM) transplants (BMT). Here, to clarify if HMGA2 affect JAK2 V617F+ hematopoiesis, we crossed Δ Hmga2+/- mice with JAK2 V617F+/- Tg mice (Shide et al, Leukemia, 2008). Δ Hmga2-/-JAK2 V617F-/- wild type (WT), Δ Hmga2+/-JAK2 V617F-/- (Δ Hmga2 -Tg), Δ Hmga2-/-JAK2 V617F+/- (JAK2 V617F-Tg) and Δ Hmga2+/-JAK2 V617F+/- (double-Tg) mice were born at expected Mendelian ratios and we could analyze 5 - 6 of each. At 3 months old, leukocytosis, thrombocytosis, anemia and splenomegaly were most severe in double-Tg compared with JAK2 V617F-Tg or Δ Hmga2 -Tg mice. Relative to WT, peripheral leukocyte and platelet counts were nearly 16- and 4-fold higher in double-Tg, while 3- and 2-fold higher in JAK2 V617F-Tg mice, respectively. Mean spleen weights were 0.067, 0.10, 0.83 and 2.8 g in WT, Δ Hmga2 -Tg, JAK2 V617F-Tg and double-Tg mice, while BM cell counts were 2.4, 2.8, 0.4 and 1.2 x 107/femur, respectively. However, JAK2 V617F-Tg and double-Tg equally showed MF whereas no MF was detected in WT and DHmga2-Tg, suggesting that HMGA2 partly recovers cellularity in fibrotic BM. In the absence and presence of JAK2 V617F, HMGA2 augments lineage- Sca1+ Kit+ cells (WT: Δ Hmga2-Tg: JAK2 V617F-Tg: double-Tg= 0.17%: 0.19%: 0.17%: 0.27% in BM cells), endogenous erythroid colonies (1: 11: 13: 21 CFU-E/104 BM cells) and CD71+ Ter119+ erythroblasts (23%: 29%: 5.7%: 10% in BM and 2.0%: 4.4%: 7.9%: 16% in spleen cells), indicating HMGA2 contributes to expansion of hematopoietic stem/progenitor cells (HSPC) and erythroid commitment in JAK2 V617F+ hematopoiesis. Most Δ Hmga2-Tg and JAK2 V617F-Tg survived for over one year, but all double-Tg mice died within 4 months after birth due to severe splenomegaly and MF with no acute leukemia. To study the effect of HMGA2 on JAK2 V617F+ HSPC activity, we performed BMT with 0.25 x 106 Ly5.2+Δ Hmga2-Tg, JAK2 V617F-Tg or double-Tg cells with 0.75 x 106 Ly5.1+ competitor WT cells to lethally irradiated Ly5.1+ WT mice. Proportions of Ly5.2+ cells were higher in recipients of Δ Hmga2 -Tg than double-Tg cells, while JAK2 V617F-Tg cells were almost rejected at 8 weeks after BMT. To confirm role of HMGA2 without let-7 repression in JAK2 V617F+ hematopoiesis, we performed another BMT with 1 x 104 KIT+ cells of JAK2 V617F-Tg mice transduced with retroviral vector of Hmga2 with each let-7 -site-mutated full-length 3'UTR (Hmga2-m7) to sublethally irradiated WT mice. Recipients of JAK2 V617F-Tg cells with Hmga2-m7 developed MPN-like disease, whereas donor cells were rejected in recipients of JAK2 V617F cells with empty vector. In conclusion, HMGA2 may play a crucial role in hematopoiesis harboring JAK2 V617F by expanding HSPC, leading to disease progression. Disclosures No relevant conflicts of interest to declare.


2016 ◽  
Vol 15 (1) ◽  
pp. 142
Author(s):  
N S Neki ◽  
Ankur Jain

<p>Priapism is rarely seen in leukemia. We report a 30-year-old man presented with persistent painful erection of penis for 30 hours. Treatment of the priapism was initially performed by cavernosa aspiration and epinephrine irrigation at emergency department under the impression of low flow-type priapism by urologist. This approach resulted in a flaccid penis later. The patient was diagnosed as a case of Chronic myeloid Leukemia (CML) on the basis of peripheral blood smear and bone marrow aspiration. Neither impotency nor other sequelae was noted after his discharge from the hospital. This case highlights regarding the awareness of all physicians in the diagnosis and management of patients with priapism occurring as a rare manifestation of chronic myeloid leukemia. To the best of our knowledge, probably this is the first case report from this part of the country, hence the case report.</p><p id="tinymce" class="mceContentBody " dir="ltr">Bangladesh Journal of Medical Science Vol.15(1) 2016 p.142-144</p>


2019 ◽  
Vol 6 (6) ◽  
pp. 1937
Author(s):  
Avtar Singh Dhanju ◽  
Princy Tyagi ◽  
Sumitoj Singh Dhaliwal ◽  
Surender Paul ◽  
Rajbinder Singh ◽  
...  

Priapism is a rare presenting feature of Chronic Myeloid Leukemia (CML). It is an urological emergency which requires urgent treatment to prevent long term complications, in particular erectile dysfunction. Author report a case of 18 year old male presenting with persistent painful erection of penis for around 14 hours. The patient underwent immediate irrigation and decompression of priapism in emergency and was started on cytoreductive therapy. During hospitalization, peripheral blood smear and bone marrow aspiration confirmed the diagnosis of CML.


2018 ◽  
Vol 3 (2) ◽  
pp. 13-26
Author(s):  
Rahmat Aryandi ◽  
Subakhir Salnus

During pregnancy, there will be a marked change in anatomy, physiology and biochemistry since the onset of pregnancy and often lackof nutrient intake. Hematologic disorder is often found in pregnant women because it causes pregnant women more susceptible to disturbances in blood circulation, The purpose of this study to determine the description of blood smear results in pregnant women in the laboratory RSUD H.A.Sulthan Daeng Radja District. This research is descriptive with laboratory observation approach. The sample used in this study were 30 samples of pregnant women who checked themselves in the Laboratory of RSUDH.A.Sulthan Daeng Radka Bulukumba District. The result of this research showed the result of peripheral blood smear on the morphology of erythrocytes using 30 samples of pregnant women showed 14 samples (46,66%) normocytic normochrom and the remaining 16 samples were morphological variation (53,33%), on morphological examination and platelet count with using 30 samples of pregnant women showed each 29 samples had morphology and normal platelet counts with respectively 96.66% percentage and platelet aggregation and decreased platelet count (thrombocytopenia) with each persentase 3.33%. At leukocyte morphology examination using 30 samples of pregnant women showed 29 samples had normal morphology with 96,66% percentage and one sample with hypersegmentation with percentage 3,33%. normal leukocyte count at 9 samples with percentage 30% and leukocyte count increased at 21 samples with percentage 70%.


Author(s):  
Mea Asou ◽  
Tomohiko Asakawa ◽  
Makoto Araki ◽  
Takashi Ehara ◽  
Tsunekazu Hishima ◽  
...  

Extramedullary hematopoiesis is widely known to occur in patients with primary myelofibrosis (PMF). Autopsy studies on individuals with PMF revealed that extramedullary hematopoiesis occurred in the kidneys in 35% of the cases, but there is little awareness regarding such lesions. A 63-year-old man was diagnosed with PMF based on a detailed examination of persistent high white blood cells. An examination of the patient’s medical records revealed an increased white blood cell count, deterioration of kidney function, and urinary protein excretion developed simultaneously. Thus, a kidney biopsy was performed. Advanced lymphocyte invasion was recognized in the interstitial tissue, and the tubular structure was highly disrupted. Based on these findings, he was diagnosed with interstitial nephritis. However, because of the large number of cells with nuclear atypia in the stroma, additional immunohistochemical staining was also performed, such as glycophorin A, naphthol AS-D, myeloperoxidase, and CD42b. As a result, invasion of three lineages of immature cells, erythroblasts, megakaryocytes, and granulocytes, was identified. Renal dysfunction resulting from interstitial cellular infiltration due to extramedullary hematopoiesis was therefore diagnosed. Treatment with ruxolitinib was initiated after a renal biopsy and the rate of decline in renal function was slightly reduced. Although, in myeloproliferative disorders, proliferative glomerular lesions are widely considered to be renal disorders, there is little awareness regarding interstitial lesions. Extramedullary hematopoiesis of the kidney in PMF is not uncommon, but 40% of cases are reportedly misdiagnosed as interstitial nephritis. Because extramedullary hematopoiesis can be controlled by ruxolitinib, early detection is important.


2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Lugyanti Sukrisman

Abstract Background Myeloid cells express microparticles that could increase the expression of adhesion molecules including P-selectin. We aimed to evaluate the level of soluble P-selectin (sP-selectin) and prothrombin fragment 1 + 2 (F1 + 2), and to determine correlation of sP-selectin with leukocyte count and F1 + 2 levels in acute myeloid leukemia (AML) and chronic myeloid leukemia (CML) patients. Methods Patients with newly diagnosed AML (n = 25), CML (n = 13), and controls (n = 17) were recruited in this study. The diagnosis of AML and CML is based on 2001 WHO and/or FAB criteria. Levels of sP-selectin and F1 + 2 were determined using enzyme-linked immunosorbent assay kits (Behring ELISA Processor-III® and Behring Enzygnost F1 + 2). Results sP-selectin was significantly elevated in CML patients compared to AML patients (p = 0.001). Levels of F1 + 2 in AML and CML patients were significantly increased in comparison to controls (p < 0.001 and p = 0.043). Levels of sP-selectin were significantly correlated to leukocyte count (r = 0.437; p = 0.029) and F1 + 2 (r = 0.436; p = 0.029) in AML patients. Conclusions AML and CML patients had an increased tendency to thrombosis. While CML patients had higher platelet and/or endothelial activation, hypercoagulable state are more pronounced in AML patients.


2021 ◽  
pp. 72-74
Author(s):  
Sarat Das ◽  
Prasanta Kr. Baruah ◽  
Sandeep Khakhlari ◽  
Gautam Boro

Introduction: Leukemias are neoplastic proliferations of haematopoietic stem cells and form a major proportion of haematopoietic neoplasms that are diagnosed worldwide. Typing of leukemia is essential for effective therapy because prognosis and survival rate are different for each type and sub-type Aims: this study was carried out to determine the frequency of acute and chronic leukemias and to evaluate their clinicopathological features. Methods: It was a hospital based cross sectional study of 60 patients carried out in the department of Pathology, JMCH, Assam over a period of one year between February 2018 and January 2019. Diagnosis was based on peripheral blood count, peripheral blood smear and bone marrow examination (as on when available marrow sample) for morphology along with cytochemical study whenever possible. Results: In the present study, commonest leukemia was Acute myeloid leukemia (AML, 50%) followed by Acute lymphoblastic leukemia (ALL 26.6%), chronic myeloid leukemia (CML, 16.7%) and chronic lymphocytic leukemia (CLL, 6.7%). Out of total 60 cases, 36 were male and 24 were female with Male:Female ratio of 1.5:1. Acute lymphoblastic leukemia was the most common type of leukemia in the children and adolescents. Acute Myeloid leukemia was more prevalent in adults. Peripheral blood smear and bone Conclusion: marrow aspiration study still remains the important tool along with cytochemistry, immunophenotyping and cytogenetic study in the diagnosis and management of leukemia.


2015 ◽  
Author(s):  
Hagop M. Kantarjian ◽  
Srdan Verstovsek

This review details two major clonal stem cell disorders: essential thrombocythemia (ET) and myelofibrosis (MF). ET is distinguished by a sustained proliferation of megakaryocytes that results in peripheral blood thrombocytosis. Primary myelofibrosis (PMF) is associated with extramedullary hematopoiesis, splenomegaly, a leukoerythroblastic blood picture, and varying degrees of marrow fibrosis with marked megakaryocyte hyperplasia and atypia. The epidemiology, etiology/genetics, pathogenesis, diagnosis (including clinical manifestations and laboratory tests), differentials, management, and prognosis of each disorder are examined. Also included is the evaluation of treatment options for MF, including interferon alfa, JAK inhibitors, and allogeneic stem cell transplantation, the latter of which is still the only curative treatment for MF. Figures show treatment algorithms for ET and MF. Tables list the current criteria for the diagnosis of ET and PMF via the World Health Organization (WHO), the guidelines for diagnosis of post-ET MF via the International Working Group for Myelofibrosis Research and Treatment (IWG-MRT), prognostic factors in the International Prognostic Score for ET (IPSET) and IPSET-thrombosis, prognostic scoring systems for MF, and the clinical activity of JAK2 inhibitors. This review contains ­2 highly rendered figures, 6 tables, and 60 references. 


2018 ◽  
Vol 08 (01) ◽  
pp. 48-51
Author(s):  
Sajna H. R. ◽  
Biju Thomas ◽  
Amitha Ramesh ◽  
Rahul Bhandary ◽  
Madhurya N. Kedlaya

AbstractMelanotic macule is the most common benign pigmented lesion of the oral cavity characterised by a focal increase in the melanin deposition. A 34 year old female patient reported with a chief complaint of black pigmentation with respect to maxillary gingiva between the central incisors since one year. An excisional biopsy was done for histo pathological examination, which revealed the lesion as melanotic macule.


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