RESUMO
We report five episodes of severe aplastic anemia (AA) followed by spontaneous remission in three patients. They were classified as transient aplastic anemia (TAA). Two were females and one male of 32, 56 and 41 years of age, respectively; the man had two recurrences. They had been in contact with insecticides, solvents or drug ingestion. The three had fever, anemia and muco-cutaneous purpura. Supportive measures were used (transfusion of packed red blood cells and platelets, antibiotics, corticosteroids and danazol, the latter two given for ten days in three episodes). They showed spontaneous remission after 16 to 45 days of evolution. The patients did not suffer infection or myeloproliferative disorders which might explain the AA. Transient AA is infrequent and should be considered a variant of AA.
Assuntos
Anemia Aplástica/induzido quimicamente , Pirazolonas , Adulto , Anemia Aplástica/tratamento farmacológico , Anemia Aplástica/terapia , Antibacterianos/uso terapêutico , Anti-Inflamatórios não Esteroides/efeitos adversos , Danazol/uso terapêutico , Dexametasona/uso terapêutico , Feminino , Ácido Fólico/uso terapêutico , Humanos , Inseticidas/intoxicação , Masculino , Pessoa de Meia-Idade , Progestinas/uso terapêutico , Pirazóis/efeitos adversos , Pirimetamina/efeitos adversos , Recidiva , Remissão Espontânea , Solventes/intoxicação , Combinação Trimetoprima e Sulfametoxazol/efeitos adversos , Combinação Trimetoprima e Sulfametoxazol/uso terapêuticoAssuntos
Síndromes Mielodisplásicas , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Apoptose , Transfusão de Sangue , Medula Óssea/patologia , Ensaios Clínicos como Assunto , Células Clonais/patologia , Citocinas/fisiologia , Eritropoetina/uso terapêutico , Hematopoese , Fatores de Crescimento de Células Hematopoéticas/uso terapêutico , Transplante de Células-Tronco Hematopoéticas , Células-Tronco Hematopoéticas/patologia , Hormônios/uso terapêutico , Humanos , Síndromes Mielodisplásicas/classificação , Síndromes Mielodisplásicas/metabolismo , Síndromes Mielodisplásicas/patologia , Síndromes Mielodisplásicas/terapia , Retinoides/uso terapêuticoRESUMO
Acute adult nonlymphoblastic leukemia (ANLL) involves a large group of diseases which originate in an abnormal process of differentiation of the hematopoietic stem cell. This paper analyses the historical background of such a group of malignant hemopathies, current criteria to perform the diagnosis and also the most important therapies used in both the stage of remission induction and the period following this stage (post-remission status). In this context, the therapeutic achievements that have had place during the last two decades at the Hospital de Especialidades del Centro Medico Nacional Siglo XXI are analyzed.
Assuntos
Hematologia , Hospitais Especializados , Leucemia Mieloide Aguda/tratamento farmacológico , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Transplante de Medula Óssea , Terapia Combinada , Humanos , Leucemia Mieloide Aguda/classificação , Leucemia Mieloide Aguda/diagnóstico , Leucemia Mieloide Aguda/mortalidade , México/epidemiologia , Indução de Remissão , Falha de TratamentoRESUMO
The purpose of this paper is to describe the current advances in the pathogenesis, classification and treatment of acquired aplastic anemia (AA). The therapeutical experience obtained at the Servicio de Hematología, Centro Medico Nacional, Siglo XXI is described. Bone marrow transplantation is the first choice therapy for severe AA. This procedure succeeds in obtaining complete remission in nearly 80% of the cases. Nevertheless, few patients are eligible for such therapy, consequently other treatments should be considered. In this context some immunosuppressive therapies such as antilymphocyte globulin had shown to produce favorable responses in 60% of the patients. In addition, androgens and immunosuppressive drugs like methylprednisolone bolus and cyclosporin A do not have a definitive place in severe AA. Finally, it is important to describe the experience with lymphocytapheresis, a new procedure, that decreases the immunological response against the normal hematopoiesis by removing the population of T-lymphocytes inducing complete remission in a few patients.
Assuntos
Anemia Aplástica/terapia , Anemia Aplástica/fisiopatologia , Soro Antilinfocitário/uso terapêutico , Transplante de Medula Óssea , Terapia Combinada , Ciclosporina/uso terapêutico , Glucocorticoides/uso terapêutico , Hematopoese/efeitos dos fármacos , Humanos , Leucaférese , Linfócitos T/imunologia , Congêneres da Testosterona/uso terapêuticoRESUMO
This study was carried out to establish the level of concordance between two observers from two different health institutions in Mexico City, in the diagnosis of acute leukemias and their different varieties. We studied 73 consecutive cases of adults with these diseases. Each one of the two observers established their diagnosis on two occasions at least 15 days apart. They first made their diagnosis taking as a base the neoplastic cells morphology in bone marrow smears, and after that, with morphology plus specific cytochemistry. The outcomes of the two observers were also compared with the official diagnosis. Kappa test was performed to know interobserver and intraobserver concordance. The kappa values for the diagnosis myeloid/lymphoid were found among the highest (51 to 91). Weighted kappa was also applied to know the level of concordance in the diagnosis of the different varieties of acute leukemia, myeloid and lymphoid. In these cases the weighted kappa values were lower compared with the previous values (lymphoid, from 47 to 82; myeloid, from 30 to 66). Cytochemistry paradoxically was a confusing factor when it was used: in these cases the kappa values were lower (32 to 84) than morphology alone (39 to 91). The outcomes showed the subjective level in the diagnosis of the myeloid subtypes was more important in them than in the lymphoid subtypes.