RESUMO
UNLABELLED: Extramedullary hematopoiesis (EMH) is defined as the formation and development of erythrocytic, granulocytic and megakaryocytic cell lines outside the bone marrow; it is a rare occurrence, which is limited to case reports. OBJECTIVE: To describe a case of renal EMH secondary to chronic hypoxia. CASE REPORT: The patient is a 16 year old teenager who developed chronic hypoxia, central cyanosis, clubbing and lives more than 2,500 m above sea level. Chronic hypoxia is probably secondary to pulmonary hypertension, neither detected nor previously treated. The Consultation was due to a mass in the left upper quadrant for the last three months. An Echocardiogram showed pulmonary hypertension that could not be assessed by hemodynamic parameters. A computed tomography showed bilateral left renal pelvic masses. The hemogram showed polycythemia, so bone marrow aspiration was performed, which rule out malignant pathology. A biopsy of the renal mass reported EMH with three hematopoietic cell lines. CONCLUSION: This EMH case is a response to chronic hypoxia rather than to a bone marrow lesion as it has usually been described.
Assuntos
Hematopoese Extramedular/fisiologia , Hipertensão Pulmonar/complicações , Hipóxia/complicações , Adolescente , Biópsia , Doença Crônica , Humanos , Hipóxia/etiologia , Masculino , Tomografia Computadorizada por Raios XRESUMO
A hematopoiese extramedular (HE) é um mecanismo compensatório raro que surge em pacientes com distúrbios medulares graves para a correção do déficit de células sanguíneas no organismo, sendo uma de suas causas as anemais arregenerativas decorrentes de hemangiossarcoma. O objetivo dos pesquisadores é descrever um caos clínico de HE hepática decorrente de hemangiossarcoma em cão. Foi atendida no Hospital Veterinário da Universidade Federal Rural da Amazônia (HOVET/UFRA) uma cadela SRD, com oito anos de idade e peso vivo de 10 kg com histórico de êmese, anorexia, letargia, oligúria e presença de uma massa irregular de consistência firme no fígado. Dois meses antes, o animal já havia sido submetido à esplenectomia total devido a presença de hemangiossarcoma com peso de aproximadamente 3kg. A ultrassonografia evidenciou aumento das dimensões hepáticas, dilatação de vasos e dutos hepáticos, paredes espessadas, presença de duas áreas nodulares soltas na cavidade abdominal com aproximadamente quatro centímetros cranial a bexiga e ascite. O hemograma constatou anemia arregenerativa e leucocitose. Foi indicado tratamento sintomático, paracentese para drenagem do líquido cavitário sanguinolento, e laparotomia exploratória com transfusão sanguínea total. Foram administrados metoclopramida (1mg/kg IV), antibioticoterapia com metronidazol (25mg/kg BID) e ampicilina (25mg/kg BID) por via oral e fluido com solução de ringer com lactato acrescidos de vitaminas C e do complexo B. Durante a cirurgia foi identificada metástase em todos os órgãos abdominais e peritônio e optou-se pela realização da eutanásia. Durante a necropsia foi colhido material para exame histopatológico, tendo como resultado hemangiossarcoma e um achado relevante foi a presença de metaplasia mielóide hepática...
The extramedullary hematopoiesis (EH) is a compensatory mechanism that often arises in patients with severe marroudisorders for the correction of the deficit of blood cells in the body, one of the causes is nonregenerative anemia due to hemangiosarcoma. The researchers' objective is to describe a clinical case of EH in a dog's liver due to hemangiosarcoma. It was admitted at the Veterinary Hospital of the Federal Rural University of Amazonia (HOVET/UFRA) a 8 years old female, and weight 10kg, with history of vomit, anorexia, lethargy, oliguria, and presence of an irregular mass of firm consistency in the liver. Two months earlier, the animal had already been submitted to total splenectomy due the presence of hemangiosarcoma weighing about 3kg. Ultrasonography showed an increase in liver size, dilatation of vessels and hepatic ducts, thickened walls, presence of two nodular areas loose in the abdominal cavity with about four centimeters cranial to the bladder and ascites. The CBC noted not regenerative anemia and leukocytosis. It was indicated symptomatic treatment, paracentesis to drain the fluid cavity that was bloody, and exploratory laparotomy with total blood transfusion. Were administered metoclopramide (1 mg / kg BID) oral antibiotic therapy with metronidazole (25 mg/kg BID) and ampicillin (25 mg/kg BID) and fluid IV therapy with lactated ringer's solution plus vitamins C and B complex. During the surgery, it was detected metastasis in all abdominal organs and peritoneum and it was chosen to perform euthanasia. During the necropsy material was sampled for histopathological examination, resulting in hemangiosarcoma and one finding was the presence of hepatic myeloid metaplasia. The history of the patient with hemangiosarcoma, chronic bleeding and blood loss kidnapping and nutrition of the tumor led to severe and persistent anemia, which triggered a compensatory behavior forming sites of EH in liver...
Assuntos
Animais , Cães , Cães , Hemangiossarcoma/veterinária , Hematopoese Extramedular/fisiologia , Mielofibrose Primária/veterináriaRESUMO
A hematopoiese extramedular (HE) é um mecanismo compensatório raro que surge em pacientes com distúrbios medulares graves para a correção do déficit de células sanguíneas no organismo, sendo uma de suas causas as anemais arregenerativas decorrentes de hemangiossarcoma. O objetivo dos pesquisadores é descrever um caos clínico de HE hepática decorrente de hemangiossarcoma em cão. Foi atendida no Hospital Veterinário da Universidade Federal Rural da Amazônia (HOVET/UFRA) uma cadela SRD, com oito anos de idade e peso vivo de 10 kg com histórico de êmese, anorexia, letargia, oligúria e presença de uma massa irregular de consistência firme no fígado. Dois meses antes, o animal já havia sido submetido à esplenectomia total devido a presença de hemangiossarcoma com peso de aproximadamente 3kg. A ultrassonografia evidenciou aumento das dimensões hepáticas, dilatação de vasos e dutos hepáticos, paredes espessadas, presença de duas áreas nodulares soltas na cavidade abdominal com aproximadamente quatro centímetros cranial a bexiga e ascite. O hemograma constatou anemia arregenerativa e leucocitose. Foi indicado tratamento sintomático, paracentese para drenagem do líquido cavitário sanguinolento, e laparotomia exploratória com transfusão sanguínea total. Foram administrados metoclopramida (1mg/kg IV), antibioticoterapia com metronidazol (25mg/kg BID) e ampicilina (25mg/kg BID) por via oral e fluido com solução de ringer com lactato acrescidos de vitaminas C e do complexo B. Durante a cirurgia foi identificada metástase em todos os órgãos abdominais e peritônio e optou-se pela realização da eutanásia. Durante a necropsia foi colhido material para exame histopatológico, tendo como resultado hemangiossarcoma e um achado relevante foi a presença de metaplasia mielóide hepática... (AU)
The extramedullary hematopoiesis (EH) is a compensatory mechanism that often arises in patients with severe marroudisorders for the correction of the deficit of blood cells in the body, one of the causes is nonregenerative anemia due to hemangiosarcoma. The researchers' objective is to describe a clinical case of EH in a dog's liver due to hemangiosarcoma. It was admitted at the Veterinary Hospital of the Federal Rural University of Amazonia (HOVET/UFRA) a 8 years old female, and weight 10kg, with history of vomit, anorexia, lethargy, oliguria, and presence of an irregular mass of firm consistency in the liver. Two months earlier, the animal had already been submitted to total splenectomy due the presence of hemangiosarcoma weighing about 3kg. Ultrasonography showed an increase in liver size, dilatation of vessels and hepatic ducts, thickened walls, presence of two nodular areas loose in the abdominal cavity with about four centimeters cranial to the bladder and ascites. The CBC noted not regenerative anemia and leukocytosis. It was indicated symptomatic treatment, paracentesis to drain the fluid cavity that was bloody, and exploratory laparotomy with total blood transfusion. Were administered metoclopramide (1 mg / kg BID) oral antibiotic therapy with metronidazole (25 mg/kg BID) and ampicillin (25 mg/kg BID) and fluid IV therapy with lactated ringer's solution plus vitamins C and B complex. During the surgery, it was detected metastasis in all abdominal organs and peritoneum and it was chosen to perform euthanasia. During the necropsy material was sampled for histopathological examination, resulting in hemangiosarcoma and one finding was the presence of hepatic myeloid metaplasia. The history of the patient with hemangiosarcoma, chronic bleeding and blood loss kidnapping and nutrition of the tumor led to severe and persistent anemia, which triggered a compensatory behavior forming sites of EH in liver... (AU)
Assuntos
Animais , Cães , Hematopoese Extramedular/fisiologia , Mielofibrose Primária/veterinária , Hemangiossarcoma/veterinária , CãesRESUMO
OBJECTIVE: To present findings on computed tomography scans of the chest indicative of extramedullary hematopoiesis in six patients. METHODS: We retrospectively analyzed computed tomography scans of six adult patients - five males and one female - with a mean age of 36.5 years. Two radiologists independently reviewed the scans, and a consensus was reached in discrepant cases. RESULTS: The most common finding in the scans was lower paravertebral masses with heterogeneous content (four patients). The scans of two patients showed a solitary parietal and pleural mass. CONCLUSIONS: There are findings in computed tomography scans that are highly suggestive of extramedullary hematopoiesis, especially when those findings correlate with underlying blood diseases. Such findings, in most of the cases, allow physicians to dispense with histopathological confirmation.
Assuntos
Anemia Falciforme/diagnóstico por imagem , Hematopoese Extramedular/fisiologia , Mediastino/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Mediastino/fisiologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Talassemia/diagnóstico por imagem , Adulto JovemRESUMO
OBJETIVO: Apresentar os achados na tomografia computadorizada do tórax indicativos de hematopoese extramedular de seis pacientes. MÉTODOS: Foram estudadas, retrospectivamente, as tomografias de seis pacientes adultos-cinco homens e uma mulher-com idade média de 36,5 anos. Os exames foram analisados por dois radiologistas, de forma independente, e as decisões finais foram obtidas por consenso. RESULTADOS: O achado mais freqüente nas tomografias foi o de massas paravertebrais inferiores, de conteúdo heterogêneo (quatro pacientes). As tomografias de dois pacientes mostravam uma massa solitária parietal e pleural. CONCLUSÕES: A hematopoese extramedular apresenta aspectos na tomografia computadorizada fortemente sugestivos do diagnóstico que, quando correlacionados com a presença de doença hematológica de base, permitem, na maior parte dos casos, dispensar a comprovação histopatológica.
OBJECTIVE: To present findings on computed tomography scans of the chest indicative of extramedullary hematopoiesis in six patients. METHODS: We retrospectively analyzed computed tomography scans of six adult patients - five males and one female - with a mean age of 36.5 years. Two radiologists independently reviewed the scans, and a consensus was reached in discrepant cases. RESULTS: The most common finding in the scans was lower paravertebral masses with heterogeneous content (four patients). The scans of two patients showed a solitary parietal and pleural mass. CONCLUSIONS: There are findings in computed tomography scans that are highly suggestive of extramedullary hematopoiesis, especially when those findings correlate with underlying blood diseases. Such findings, in most of the cases, allow physicians to dispense with histopathological confirmation.
Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Anemia Falciforme , Hematopoese Extramedular/fisiologia , Mediastino , Tomografia Computadorizada por Raios X/métodos , Diagnóstico Diferencial , Mediastino/fisiologia , Estudos Retrospectivos , Talassemia , Adulto JovemRESUMO
Intrathoracic extramedullary haematopoiesis is a rare entity encountered in patients with long standing anaemias such as thalassaemia and congenital spherocytosis. It is rare in patients with homozygous sickle cell disease; only 11 cases of intrathoracic and two cases of pelvic extramedullary haematopoiesis have been documented in the literature. We report the case of a 30-year old man with homozygous sickle cell disease with intrathoracic and pelvic extramedullary haematopoiesis, the first case to be documented from the Caribbean.
La hematopoyesis extramedular intratorácica es una entidad que raras veces se encuentra en pacientescon anemias de larga duración tales como la talasemia y la esferocitosis congénita. También es rara en pacientes que padecen la enfermedad de células falciformes homocigóticas. En la literatura se han documentado sólo 11 casos de hematopoyesis extramedular intratorácica y dos casos de hematopoyesis extramedular pélvica. Reportamos el caso de un hombre de 30 años de edad con la enfermedad decélulas falciformes homocigóticas con hematopoyesis extramedular intratorácica y pélvica el primercaso que se documenta en el Caribe.
Assuntos
Humanos , Masculino , Adulto , Anemia Falciforme/fisiopatologia , Hematopoese Extramedular/fisiologia , Medula Óssea/fisiologia , Evolução Fatal , Ossos Pélvicos , Vértebras TorácicasRESUMO
PURPOSE: To research the hyperbaric oxygen therapy effects on rats' livers and spleens. METHODS: 30 adult male Hotzman rats were used, being randomly distributed, by raffle, into 2 groups of 15 animals each: group 1 - control; group 2 - hyperbaric oxygen therapy. Group-2 animals underwent hyperbaric oxygen therapy for 120 minutes daily, 90 minutes of which were under pressure of 2.5 atmospheres. The first and last 15 minutes were used for gradual compression and decompression, respectively, for 20 days in a row. The livers and spleens of the animals from the two groups were taken out for histologic examination, on the day after the end of hyperbaric oxygen therapy in group 2 animals. Liver and spleen histologic changes of the animals from the two groups were compared by using Fisher exact test. P < 0.05 was regarded as a significant difference. RESULTS: The only change in liver and spleen histology was the significant reduction in hepatic extramedullary erythropoiesis in the animals that underwent hyperbaric oxygen therapy (p < 0.05). CONCLUSION: Hyperbaric oxygen therapy reduces hepatic extramedullary erythropoiesis in rats and doesn't jeopardize the other liver and spleen structures.
OBJETIVO: Pesquisar os efeitos da oxigenoterapia hiperbárica sobre o fígado e baço de ratos. MÉTODOS: Foram utilizados 30 animais machos adultos da espécie Holtzman, distribuídos aleatoriamente e por sorteio em dois grupos de 15 animais cada, assim designados: grupo 1 - controle; grupo 2 - oxigenoterapia hiperbárica. Os animais do grupo 2 foram submetidos à oxigenoterapia hiperbárica por 120 minutos ao dia, sendo 90 minutos sob pressão de 2,5 atmosferas e 15 minutos iniciais e finais para a compressão e descompressão gradativa, respectivamente, em 20 dias consecutivos. Os fígados e baços dos animais dos dois grupos foram retirados para exame histológico, no dia seguinte após o término da oxigenoterapia hiperbárica nos animais do grupo 2. Compararam-se as alterações na histologia do fígado e baço entre os animais dos dois grupos empregando-se o teste exato de Fisher, considerando diferença significante o valor de p<0,05. RESULTADOS: A única alteração na histologia dos fígados e baços foi a redução significativa da eritropoiese extramedular hepática nos animais submetidos a oxigenoterapia hiperbárica. (p < 0,05) CONCLUSÃO: A oxigenoterapia hiperbárica reduz a eritropoiese extramedular hepática em ratos e não compromete as demais estruturas do fígado e do baço.
Assuntos
Animais , Masculino , Ratos , Eritropoese/fisiologia , Oxigenoterapia Hiperbárica , Hematopoese Extramedular/fisiologia , Fígado/citologia , Baço/citologia , Distribuição AleatóriaRESUMO
PURPOSE: To research the hyperbaric oxygen therapy effects on rats' livers and spleens. METHODS: 30 adult male Hotzman rats were used, being randomly distributed, by raffle, into 2 groups of 15 animals each: group 1 - control; group 2 - hyperbaric oxygen therapy. Group-2 animals underwent hyperbaric oxygen therapy for 120 minutes daily, 90 minutes of which were under pressure of 2.5 atmospheres. The first and last 15 minutes were used for gradual compression and decompression, respectively, for 20 days in a row. The livers and spleens of the animals from the two groups were taken out for histologic examination, on the day after the end of hyperbaric oxygen therapy in group 2 animals. Liver and spleen histologic changes of the animals from the two groups were compared by using Fisher exact test. P < 0.05 was regarded as a significant difference. RESULTS: The only change in liver and spleen histology was the significant reduction in hepatic extramedullary erythropoiesis in the animals that underwent hyperbaric oxygen therapy (p < 0.05). CONCLUSION: Hyperbaric oxygen therapy reduces hepatic extramedullary erythropoiesis in rats and doesn't jeopardize the other liver and spleen structures.
Assuntos
Eritropoese/fisiologia , Hematopoese Extramedular/fisiologia , Oxigenoterapia Hiperbárica , Fígado/citologia , Baço/citologia , Animais , Masculino , Distribuição Aleatória , RatosRESUMO
Intrathoracic extramedullary haematopoiesis is a rare entity encountered in patients with long standing anaemias such as thalassaemia and congenital spherocytosis. It is rare in patients with homozygous sickle cell disease; only 11 cases of intrathoracic and two cases of pelvic extramedullary haematopoiesis have been documented in the literature. We report the case of a 30-year old man with homozygous sickle cell disease with intrathoracic and pelvic extramedullary haematopoiesis, the first case to be documented from the Caribbean.