RESUMEN
BACKGROUND: Gamma heavy chain disease with underlying thyroid pathology is rare. There are 5 reported cases in the English literature, including the present case of an elderly female with γ heavy chain disease with underlying lymphoplasmacytic lymphoma of the thyroid who initially presented with long-standing goiter and chronic thyroiditis. METHODS: The protein studies and histopathologic findings in her thyroid are described. Her case is compared with reported cases of γ heavy chain disease with thyroid involvement. RESULTS: Initial impression on most cases was chronic thyroiditis; however pathology showed 3 cases with plasmacytoma and 2 with lymphoplasmacytic infiltrate. All were diagnosed and followed up using serum and urine electrophoresis. CONCLUSION: Gamma heavy chain disease has a protean manifestation; however there appears to be a more uniform pattern of the disease when it is associated with the thyroid. The inclusion of protein studies in cases diagnosed with chronic thyroiditis by FNA may aid in establishing γ heavy chain disease with underlying thyroid involvement. In this case serum and urine electrophoresis, and immunofixation studies which are simple and affordable tests facilitated the hematologic workup and follow up.
Asunto(s)
Enfermedad de las Cadenas Pesadas/diagnóstico , Glándula Tiroides/inmunología , Neoplasias de la Tiroides/diagnóstico , Tiroiditis/diagnóstico , Macroglobulinemia de Waldenström/diagnóstico , Anciano , Anciano de 80 o más Años , Biopsia con Aguja Fina , Electroforesis de las Proteínas Sanguíneas , Enfermedad Crónica , Femenino , Enfermedad de las Cadenas Pesadas/complicaciones , Enfermedad de las Cadenas Pesadas/inmunología , Humanos , Cadenas gamma de Inmunoglobulina/inmunología , Inmunohistoquímica , Masculino , Persona de Mediana Edad , Plasmacitoma/diagnóstico , Plasmacitoma/inmunología , Glándula Tiroides/patología , Neoplasias de la Tiroides/complicaciones , Neoplasias de la Tiroides/inmunología , Tiroiditis/complicaciones , Tiroiditis/inmunología , Macroglobulinemia de Waldenström/complicaciones , Macroglobulinemia de Waldenström/inmunologíaRESUMEN
We implemented a protocol incorporating a higher fresh frozen plasma (FFP)/RBC ratio for the management of trauma patients requiring massive transfusion in 2007. This study aims to identify issues that affected the effective deployment of the massive transfusion protocol (MTP) and compare outcome variables with a historic cohort. Data from 49 trauma patients who received at least 10 units of packed RBCs within 24 hours were analyzed and compared with a historic massively transfused cohort who had received recombinant activated factor VII (rFVIIa). Of the patients, 28 received an FFP/RBC ratio of 1:1 to 1:2; 12 received a lower ratio of 1:2 to 1:4; 3 received more than 1:1 and 6 had less than 1:4. Compared with the historic cohort, the 1:1-1:2 group received significantly fewer blood components and did not require rescue rFVIIa. An MTP incorporating a higher FFP/RBC ratio of 1:1 to 1:2 is associated with decreased use of blood components and may obviate the need for rFVII.