RESUMEN
BACKGROUND: An acute hemolytic transfusion reaction (AHTR) caused by intravascular hemolysis features a decrease in hemoglobin/hematocrit, reduced haptoglobin, and increases in creatinine, and bilirubin. Acute intravascular hemolysis carries its own morbidity and mortality, especially in the setting of a patient liver disease related pre-existing alterations in hemostasis. Additionally, AHTR significantly impacts the laboratory values used in calculating the Model for End Stage Liver Disease (MELD) score and thus liver transplant status. CASE REPORT: Herein, we present a case of a patient with hepatorenal syndrome due to ESLD on the transplant list who developed an AHTR due to an evolving anti-Jka that initially presented as non-specific reactivity in solid phase adherence testing. This evolving antibody caused intravascular hemolysis and a significant increase in bilirubin from 4.7 to 17.1 mg/dl, thus, raising the MELD score, increasing the predicted short-term mortality risk, and affecting the patient's transplant status. RESULTS: Acute hemolysis caused significant elevation of bilirubin raising the MELD score which increased both the predicted mortality to 70 percent and the perceived urgency of transplant. The MELD score improved after resolution of the AHTR and clearing of the offending Jka-positive RBCs. CONCLUSION: This case highlights the effect of AHTR on parameters used in the determination of MELD score which significantly increases the perceived short-term mortality and urgency of liver transplant. Therefore, any nonspecific reactivity in initial workup could be due to developing antibodies, and put the patient at higher risk for an acute hemolytic transfusion reaction.
Asunto(s)
Enfermedad Hepática en Estado Terminal , Reacción a la Transfusión , Humanos , Enfermedad Hepática en Estado Terminal/cirugía , Hemólisis , Índice de Severidad de la Enfermedad , Bilirrubina , AnticuerposRESUMEN
Laryngeal chondrosarcoma is a rare tumor requiring clinical, histologic, and radiographic correlation for definitive diagnosis. Although it typically presents with low-grade histology, even high-grade histology has a fairly indolent progression in this location, with a relatively low-likelihood for metastatic potential or recurrence. Because of this, conservative surgical excision with negative margins is recommended. We present a case of a laryngeal chondrosarcoma arising from the cricoid cartilage in a patient who presented with hoarseness, dysphagia, and odynophagia with subsequent head and neck computed tomography scan suggestive of the diagnosis. The patient was treated with hemicricoidectomy.
Asunto(s)
Condrosarcoma/patología , Neoplasias Laríngeas/patología , Condrosarcoma/cirugía , Humanos , Neoplasias Laríngeas/cirugía , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos XRESUMEN
Focal osseous dysplasia (FOD) is one of the benign fibro-osseous lesions of the jaw bones and the most commonly occuring benign fibro-osseous lesion. This entity occurs more commonly in females and has a predilection for African Americans. Radiographically, the lesion has a variable appearance depending on the duration but may appear as a radiolucent to radiopaque lesion that can be well to poorly defined. Hisotologically, when biopsied, there are fragments of bony trabeculae intermixed with fibrous stroma with incomplete stromal vasculature. The main differential diagnosis is with ossifying fibroma, which is neoplastic while FOD is considered a reactive process. Most patients with FOD may be followed clinically without surgical intervention.