Rinsho Ketsueki
Online ISSN : 1882-0824
Print ISSN : 0485-1439
ISSN-L : 0485-1439
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Volume 53, Issue 8
Displaying 1-12 of 12 articles from this issue
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The 73rd Annual Meeting of the Japanese Society of Hematology
Symposium11
Symposium12
Clinical Study
  • Immunophenotypic analysis of hematogones in patients with hematological malignancies
    Shoichi KOBAYASHI, Risa KUMAGAI, Akiko OMIYA, Hideki TANNO, Yoshimi IS ...
    2012 Volume 53 Issue 8 Pages 753-759
    Published: 2012
    Released on J-STAGE: September 04, 2012
    DOIhttps://doi.org/10.11406/rinketsu.53.753
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    We studied immunophenotypic analysis of hematogones by flow cytometry. A total of 102 specimens from 93 patients with acute leukemia (52 specimens), myelodysplastic syndromes (4), or malignant lymphoma (46) were analyzed between April and August, 2011. Hematogones were detected in 55 specimens and highly identified in patients with acute myeloid leukemia in remission and B cell lymphoma. Stage 1 (CD34+CD20-) and stage 2/3 (CD34-CD20+) were detected in 9.9% and 52.7%, respectively. In addition, the intermediate type (CD34+CD20+) was identified in 37.4%. All specimens of stage 3 in bright CD45 expression were positive for CD5 and included CD5+CD23-CD11c-, 11.1%, CD5+CD23+CD11c-, 85.2%, and CD5+CD23+CD11c+, 3.7%. These findings suggest that hematogones with unreported immunophenotypes may exist and the appearance of hematogones in hematologic malignancies may be relatively frequent.
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Case Reports
  • Early onset of paralytic ileus caused by simultaneous administration of bortezomib and azole antifungals in multiple myeloma patients
    Yuya KODA, Takehiko MORI, Takayuki SHIMIZU, Jun KATO, Akiko YAMANE, Ke ...
    2012 Volume 53 Issue 8 Pages 760-764
    Published: 2012
    Released on J-STAGE: September 04, 2012
    DOIhttps://doi.org/10.11406/rinketsu.53.760
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    We herein report two patients (70- and 45-year-old men) with refractory multiple myeloma who developed paralytic ileus shortly after starting bortezomib therapy. Bortezomib (1.3 mg/m2) was given on days 1, 4, 8, and 11 with daily oral solution itraconazole or voriconazole. Twelve and 15 days after beginning the therapy, each patient developed paralytic ileus. Interestingly, no other signs of peripheral neuropathy such as fingertip numbness were observed at the onset of ileus. Sporadic cases of paralytic ileus after bortezomib therapy have been reported, most of which developed ileus after several courses of bortezomib therapy. Our cases developed paralytic ileus shortly after initiating bortezomib, strongly suggesting that autonomic neuropathy due to bortezomib was induced by the concomitant use of itraconazole or voriconazole.
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  • A diagnosis of mild hemophilia A made by massive intraabdominal bleeding in a 13-year-old boy
    Yoko TERAO, Masaharu AKIYAMA, Kentaro YOKOI, Masayoshi YAMAOKA, Mika S ...
    2012 Volume 53 Issue 8 Pages 765-769
    Published: 2012
    Released on J-STAGE: September 04, 2012
    DOIhttps://doi.org/10.11406/rinketsu.53.765
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    We report a 13-year-old boy who had massive intra-abdominal bleeding without a history of bleeding episodes or traumatic cause of bleeding. The patient underwent surgical treatment because bleeding was not controlled after treatment with tranexamic acid and transfusions including fresh-frozen plasma. Bleeding was traced to the lower left lobe of the liver. The mother's side of the family had a history of bleeding episodes in the boy's grandfather, great uncle, and son of a great aunt. A low level of plasma factor VIII coagulant activity (22%) led to a diagnosis of mild hemophilia A. Compared with severe hemophilia, mild hemophilia is more difficult to diagnose because bleeding episodes are less frequent. Most cases are found after incidental trauma or uncontrolled surgery-related bleeding, there is rarely a family history of hemophilia and activated partial thromboplastin time is normal or slightly prolonged. However, bleeding episodes in mild hemophilia may result in excessive, sometimes life-threatening hemorrhage and require early diagnosis and replacement treatment with adequate amounts of factor VIII, as in severe hemophilia.
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  • Successful delivery following treatment with plasma exchange in a female patient with thrombotic thrombocytopenic purpura
    Yusuke TAKAGI, Yoshiya ADACHI, Akane TSUJIMURA, Keitaro TSUSHITA
    2012 Volume 53 Issue 8 Pages 770-773
    Published: 2012
    Released on J-STAGE: September 04, 2012
    DOIhttps://doi.org/10.11406/rinketsu.53.770
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    We report here on a case of a 27-year-old woman in her first pregnancy. She was diagnosed with idiopathic thrombocytopenic purpura (ITP) at the age of 14 years. At 36 weeks of gestation, she was admitted to our hospital due to thrombocytopenia. We initially suspected ITP exacerbated by pregnancy. Laboratory results revealed mild anemia, thrombocytopenia (5.0×109/l), and slightly elevated liver enzymes and lactate dehydrogenase. The next day, hemoglobin fell to 6.6 g/dl. Thrombotic thrombocytopenic purpura (TTP) was suspected on the basis of hemolytic anemia with schistocytes and a negative Coombs' test. Plasma exchange and methylprednisolone were initiated immediately. ADAMTS13 analysis showed a severe deficiency in ADAMTS13 activity but no inhibitors. At Day 6, the platelet count rose to 223×109/l and she delivered a live baby by cesarean section. Currently, the patient receives fresh frozen plasma infusions every 2 weeks due to suspected Upshaw-Schulman syndrome.
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  • Fatal disseminated toxoplasmosis after unrelated bone marrow transplantation for myelodysplastic syndrome
    Jun KATO, Takehiko MORI, Norisato HASHIMOTO, Akiko YAMANE, Masatoshi S ...
    2012 Volume 53 Issue 8 Pages 774-778
    Published: 2012
    Released on J-STAGE: September 04, 2012
    DOIhttps://doi.org/10.11406/rinketsu.53.774
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    A 44-year-old man with myelodysplastic syndrome (RAEB-2) underwent allogeneic bone marrow transplantation from an unrelated donor after being conditioned with myeloablative regimen. Tacrolimus and short-term methotrexate were given for prophylaxis against graft-versus-host disease (GVHD). Engraftment was achieved on Day 17. He developed Grade II acute GVHD involving the skin and gastrointestinal tract and methylprednisolone (2 mg/kg) was initiated. On Day 60, he developed fever and liver dysfunction followed by diffuse interstitial infiltration of the lungs. Respiratory and cardiac failure rapidly progressed and the patient died on Day 66 despite treatment with antimicrobial agents and intravenous immunoglobulin. Autopsy findings revealed disseminated toxoplasmosis involving the lungs, heart, liver, gastrointestinal tract, and kidneys. Toxoplasmosis after allogeneic hematopoietic stem cell transplantation (HSCT) generally manifests as encephalopathy or brain abscess; however, disseminated disease has been sporadically reported. It should be recognized as a possible cause of rapidly progressing interstitial pneumonitis and cardiac dysfunction after allogeneic HSCT.
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  • Alleviation of palmoplantar pustulosis associated with adult T cell leukemia/lymphoma after allogeneic hematopoietic stem cell transplantation
    Hiroshi AKASAKA, Kisako IMAIZUMI, Emiko SAKANE, Hiroko TSUNEMINE, Kimi ...
    2012 Volume 53 Issue 8 Pages 779-784
    Published: 2012
    Released on J-STAGE: September 04, 2012
    DOIhttps://doi.org/10.11406/rinketsu.53.779
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    A 68-year-old female with palmoplantar pustulosis was referred to our hospital in July, 2009 because of liver dysfunction, a positive test for HTLV-1, and circulating abnormal lymphocytes with irregularly shaped nuclei. A diagnosis of acute type adult T cell leukemia/lymphoma (ATLL) was made based on generalized lymph node swelling and high levels of serum LDH, in addition to the findings described above. The associated palmoplantar pustulosis responded to some extent to antibiotics, steroid ointment, and narrow band UBV light irradiation. For ATLL, she was serially treated with CHOP chemotherapy, an LSG 15 protocol, and CytaBOM protocol with consequent partial remission. These chemotherapies did not affect the palmoplantar pustulosis. For ATLL in partial remission, we performed allogeneic peripheral blood stem cell transplantation (allo-PBSCT) from a related donor (HTLV-1-negative) with a conditioning regimen consisting of fludarabine, melphalan, and total body irradiation with 3 Gy in February, 2010. After the engraftment of donor hematopoietic cells, ATLL cells disappeared and the patient currently (as of April, 2012) remains in complete remission (CR). The residual palmoplantar pustulosis was further improved soon after allo-PBSCT and disappeared on Day 84 after transplantation. This refractory skin disease has also been in CR to date.
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A Short Report
  • Diminished expression of CD5 and/or CD7 surface antigens as the first clue of diagnosis for monoclonal T lymphocytosis
    Hiroki KAWANO, Kentaro MINAGAWA, Kanako WAKAHASHI, Yuko KAWANO, Akiko ...
    2012 Volume 53 Issue 8 Pages 785-787
    Published: 2012
    Released on J-STAGE: September 04, 2012
    DOIhttps://doi.org/10.11406/rinketsu.53.785
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    The significance of precursor status for mature T-cell neoplasms has not been elucidated. Diagnosis of T-cell neoplasms is often challenging and sometimes overlooked when leukocytosis is not evident and neoplastic cell morphology is hardly distinguishable. Here, we report two cases of monoclonal T lymphocytosis (MTL) without evident lymphocytosis and lymphadenopathies that show slightly diminished CD5 and/or CD7 surface antigens as the first clue of diagnosis. Recently, some reports have demonstrated the possibility that monoclonal lymphocytosis precedes leukemia/lymphoma. Although its clinical significance is unknown, flow cytometric analysis of peripheral blood is useful for detection of occult MTL and careful follow-up is required.
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