Assuntos
Células da Medula Óssea/patologia , Células da Medula Óssea/parasitologia , Doença de Chagas/patologia , Doença de Chagas/parasitologia , Trypanosoma cruzi , Doença Aguda , Doença de Chagas/etiologia , Doença de Chagas/terapia , Evolução Fatal , Feminino , Rejeição de Enxerto/etiologia , Rejeição de Enxerto/parasitologia , Rejeição de Enxerto/patologia , Rejeição de Enxerto/terapia , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/patologia , Falência Renal Crônica/cirurgia , Transplante de Rim , Pessoa de Meia-Idade , Nefroesclerose/complicações , Nefroesclerose/cirurgia , Doadores de TecidosRESUMO
The number of CD34(+) cells in peripheral blood (PB) is a guide to the optimal timing to harvest peripheral blood progenitor cells (PBPC). The objective was to determine the number of CD34(+) cells in PB that allows achieving a final apheresis product containing > or =1.5 x 10(6) CD34(+) cells/kg, performing up to three aphereses. Between March 1999 and August 2003, patients with hematological and solid malignancies who underwent leukapheresis for autologous bone marrow transplantation were prospectively evaluated. Seventy-two aphereses in 48 patients were performed (mean 1.45 per patient; range 1-3). PBPC were mobilized with cyclophosphamide plus recombinant human granulocyte-colony stimulating factor (G-CSF) (n = 40), other chemotherapy drugs plus G-CSF (n = 7), or G-CSF alone (n = 1). We found a strong correlation between the CD34(+) cells count in peripheral blood and the CD34(+) cells yielded (r = 0.903; P < 0.0001). Using receiver-operating characteristic (ROC) curves, the minimum number of CD34(+) cells in PB to obtain > or =1.5 x 10(6)/kg in the first apheresis was 16.48 cells/microL (sensitivity 100%; specificity 95%). The best cut-off point necessary to obtain the same target in the final harvest was 15.48 cells/microL, performing up to three aphereses (sensitivity 89%; specificity 100%). In our experience, > or =15 CD34(+) cells/microL is the best predictor to begin the apheresis procedure. Based on this threshold level, it is possible to achieve at least 1.5 x 10(6)/kg CD34(+) cells in the graft with < or =3 collections.
Assuntos
Antígenos CD34 , Células-Tronco Hematopoéticas/citologia , Leucaférese/normas , Transplante de Células-Tronco de Sangue Periférico/normas , Valor Preditivo dos Testes , Adolescente , Adulto , Idoso , Células Sanguíneas/citologia , Transplante de Medula Óssea/métodos , Criança , Pré-Escolar , Feminino , Mobilização de Células-Tronco Hematopoéticas , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/terapia , Estudos Prospectivos , Curva ROC , Transplante AutólogoRESUMO
The Sebastian syndrome (SS) is a MYH9-related disorders, which are an extremely infrequent group of four autosomal dominant illnesses. SS consist of giant platelets, leukocyte inclusions and thrombocytopenia. To our knowledge, there are no case reports of this syndrome in South America. The propositus was a 35-year-old Argentine woman with a history of purpuric lesions in her lower limbs and thrombocytopenia. Idiopathic thrombocytopenia purpura (ITP) was previously diagnosed, but she did not respond to treatment with steroids. Family history failed to provide any evidence of hearing loss, easy bruising, nephritis, renal failure or cataracts. The patient and 11 members of her family were evaluated. The diagnosis of SS was established by demonstrating giant platelets, thrombocytopenia and leukocyte inclusions in peripheral smear in two relatives and by peripheral smear and electronic microscopy in the propositus. MYH9-related disorders should be suspected whenever a patient has a low platelet count or a bleeding diathesis of unknown origin. In these cases, the history, carefully peripheral smear exam, immunocytochemistry and electronic microscopy will be of great help. Differentiation ITP with SS is important to avoid unnecessary diagnostic studies and treatments.