Journal of Blood & Lymph

Aortic mural thrombus is an uncommon source of peripheral embolization. We present a case of a patient with a symptomatic mobile mural thrombus in the proximal descending thoracic aorta who presented with left hand ischemia. The patient was treated with anticoagulation and radial artery thrombectomy followed by thoracic aortic stent graft placement.

Background: Thrombocytopenia is seen in various haematological and non haematological conditions and has been defined as platelet count less than 1.5 lakh/mm³. Dysplastic changes are well known in Myelodysplastic syndrome (MDS) but these can be seen in other haematological conditions.

Methods: This was a retrospective study done on 100 bone marrow aspirations in a tertiary care center in South India from Jan 2015 to Dec 2016. All bone marrow aspirations in this study period was retrieved and the slides were reviewed by two pathologists.

Results: Total of 100 cases were included in the study. Out of 100 cases of bone marrow aspiration, 78 cases were of thrombocytopenia, 6 cases were of thrombocytosis, and 16 cases were of normal platelet count. The most common cause for which bone marrow aspiration was sought was pancytopenia (30 %), followed by ITP (15%), PUO (12%), Anaemia (10%). Bicytopenia (8%), Hepatosplenomegaly (3%), Lymphoproliferative disorder (5%), GMCSF treatment (1%),MPN (3%), T.B , MM (4% each), MDS (2%), AL (2%), MGUS (1% ). Conclusion: Most common cause of thrombocytopenia in this study was pancytopenia followed by ITP. Dysplastic features were seen in MDS but also present in other conditions like megaloblastic anaemia and acute leukemia.

Immune thrombocytopenia (ITP) is an acquired autoimmune disorder characterized by immune-mediated destruction of otherwise normal platelets and can be either primary, without obvious initiating or underlying cause, or secondary ITP due to an underlying disease or drug exposure.

The goals of therapy for ITP include achieving an adequate platelet level for hemostasis and minimizing toxicities with current options including: corticosteroids, rituximab, splenectomy, intravenous gamma globulin (IVIG), Anti-D, and thrombopoietin receptor agonists (TPO) like romiplostim and eltrombopag.

TPO mimetics like romiplostim have emerged as viable and practical option in relapsed and refractory ITP. We present a 70-year-old Caucasian male patient with chronic lymphocytic leukemia/small cell lymphoma (CLL/SLL) related secondary ITP who had been maintained for nearly a decade on romiplostim after failing all other options of therapy. We report this case to demonstrate the efficacy and sustainability of romiplostim use in the relapse/ refractory ITP in such a patient who failed to respond to other therapeutic options.

Background: Amyloidosis is a metabolic disease of unknown cause and mainly presents with organ damage due to abnormal amyloid deposition. In the oral cavity, it is characterized by macroglossia with a nodule that frequently develops on the tongue. Moreover amyloidosis is often accompanied by multiple myeloma. Herein, we reported a case of multiple myeloma diagnosed from tongue amyloidosis.

Case presentation: The patient was a 66-year-old woman who presented to our department with a chief complaint of roughness on the tongue in July 2014. Her tongue was huge and had nodules. Biopsy of the nodule on the right tongue confirmed a definitive diagnosis of amyloidosis. She complained of paresis on the fingers, for which neuropathy due to amyloidosis was suspected. Blood test showed anemia, increased erythrocyte sedimentation rate, decreased serum albumin, and increased serum β2 microglobulin. Immunoelectrophoresis detected the presence of λ-type M protein in the urine and serum. Bone marrow aspiration from the iliac bone led to the definitive diagnosis of multiple myeloma (IgA λ-type, International Staging System stageⅠ) .Lenalidomide, bortezomib, and dexamethasone therapy and autologous peripheral blood stem cell transplantation were administered for multiple myeloma. The treatment effects were “very good partial response” before transplantation and “stringent complete response” after transplantation. As of July 2018, no new nodular formation was seen in the oral cavity, and the general condition was good.

Conclusion: When multiple nodules and macroglossia in the tongue are confirmed to be amyloidosis, a systemic search for the possibility of multiple myeloma is important.

Carotid artery disease is a significant contributor of diabetic patients’ morbidity and mortality driven by its strong association with ischemic stroke. The link between carotid atherosclerosis and cerebrovascular or coronary artery disease is otherwise well established pointing to a high risk patient. This link gets particularly important in diabetic patients who demonstrate high rates of silent cardiovascular events, as a means of early detection of underlying atherosclerotic disease. Carotid ultrasonography now allows clinicians to visualize the characteristics of the carotid wall and lumen surfaces, to quantify the severity of local and systemic atherosclerosis and better guide the intensity of primary and secondary prevention strategies. Carotid revascularization remains the standard of care for high grade stenosis and while higher perioperative events and restenosis rates may be anticipated the benefits derived from the procedure still outweigh the risks. Current guidelines recommend carotid endarterectomy as a gold standard procedure; however carotid artery stenting can be a valid alternative in high medical risk symptomatic diabetic patients. Optimal glycemic control and confounding risk factor management can ameliorate short and longer term adverse events.

Introduction: When molecular and cytogenetic studies are not available, the risk stratification of AML patients will be difficult. This study was conducted to evaluate the prognostic value of IL-8 among AML patients with its relation to outcome.

Methods: This is a cross sectional study; 42 newly diagnosed AML patients (<65 years) were investigated with determination of serum IL-8 by ELISA and followed up for 36 months. In addition, 20 sex and age matched normal volunteers were included as control.

Results: In AML patients, serum IL-8 was ranging from 5 to 200 pg/mL with a mean of 76.5 pg/mL. It was significantly higher among AML patients when compared to the control (76.5 vs 32.3 pg/mL). The mean did not show any significant relationship to patients’ sex or the FAB classification of AML (p>0.05). While significant higher mean was observed among poor cytogenetic risk group (110.4 pg/mL) as well as among died patients (108.8 pg/mL) and refractory patients (84.2 pg/mL). In regard to survival, among those with IL-8>40 pg/mL, the mean survival time was higher in comparison to AML patients with IL-8 ≤ 40 pg/mL (34.6 months vs 26.3 months).

Conclusion: This study concluded that serum IL-8 concentration at presentation of AML patients is high and it could be used as a marker for risk stratification for AML patients.