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P0341 FOCAL HEPATIC LESIONS - A RARE PRESENTATION OF A POTENTIALLY FATAL DISEASE
Abstracts from 8th Congress of the European Federation of Internal Medicine / European Journal of Internal Medicine 20S (2009), S1–S283 with hyperthyroidism there was a significant negative correlation of SC to T4 (p=0.023) and a positive one of EMCC to TSH (p=0.031). Discussion and conclusions: Hyperthyroidism seems to decrease both SC and EMCC in a degree related to its severity. However the decrease of EMCC is much greater, thus resulting in a considerable depletion of erythrocyte membrane from its structural component. The possible consequences of this depletion to cell physiology have to be investigated. Keywords: hyperthyroidism, erythrocyte membrane cholesterol concentration.
S117
All cases were sent to laboratory to detect abnormal haemoglobin, because of shown erythrocytosis and striking history of familial polycythemia. In the majority of them, the diagnosis was done during an analysis of routine or for being relatives of the first ones. Some carriers of hemoglobin Malmö exhibit more relevant hematologic abnormalities and had thrombotic complications.
P0341 FOCAL HEPATIC LESIONS - A RARE PRESENTATION OF A POTENTIALLY FATAL DISEASE
P0339 RELATIONSHIP BETWEEN IRON DEFICIENCY ANEMIA AND SERUM HEMOGLOBIN A1C LEVELS
Ömer Önder Sava¸s, Gülden Bayrak, Özlem Barak Serkant, Tevfik Tanju Yılmazer, O˘guzhan Deniz Aydın, Murat Suher. Ankara Atatürk Training and Research Hospital Internal Diseases Clinic Objective: The purpose of this study is to find out if there is any relationship between iron deficiency anemia and HbA1c levels. Furthermore, we planned to detect if there would be any change in HbA1c levels after treatment of iron deficiency anemia. Materials and methods: Between January 2004 and September 2007 sixty five patients with iron defiency anemia and fourty patients who were not iron deficient (control group) were included in this study. CBC levels, serum iron, iron binding level, transferrin saturation, ferritin, HbA1c levels, fastening glucose levels were recorded. The anemic patients who were treated were evaluated with control hemogram, serum iron, iron binding level, transferrin saturation, ferritin, HbA1c levels after six months. The relationship between iron deficiency anemia and HbA1c levels were studied by SPSS 11.5 program. Results: Before iron therapy given to case group; Hb, Hct, MCV, MCH, MCHC, RBC, serum Fe, transferrin saturation ve ferritin average values were lower and statistically significant compared to control group (p<0,001). Before iron therapy, RDW, transferrin saturation average values of case group were found to be statistically significantly higher (p<0,001). Among the case group, when Hb, Hct, MCV, MCH, MCHC, RBC, serum Fe, transferrin saturation ferritin average values were evaluated, there were also statistically significant increase between the case group before and after iron therapy (p<0,001). After the therapy there was statistically significant decrease in RDW, average platellet and iron binding capacity (p<0,05, p<0,001). In the case group before the therapy the average HbA1c levels were found higher compared to control group (p<0,001). After the therapy the control group and case group average HbA1c levels were similar (p=0,641). In the case group HbA1c levels were significantly lower after iron treatment compared to pretreatment (p<0,001). Conclusion: In iron deficiency anemia there is an increase at HbA1c levels and after the iron therapy HbA1c levels decrease significantly. This HbA1c level alteration is important while evaluating the answer to iron therapy and might be used along with other parameters in follow up of patients. Our data provide evidence that HbA1c levels might be misleading while evaluating the iron therapy and pursuing glycemic control at diabetic iron defiency cases. Key words: iron deficiency anemia, diabetes mellitus, HbA1c,
Andreia Gonçalves, Bruno Valente, André Lencastre, Isabel Baptista. Centro Hospitalar De Lisboa Central, E.p.e. - Hospital De S. José Introduction: About half of non-Hodgkin’s lymphomas behave in a clinically aggressive way (survival of the untreated disease measured in months). Diffuse large B cell lymphoma, with its histologic variants, is the most common subtype, representing approximately 30% of the total of non Hodgkin’s lymphomas. It originates essentially de novo and, less frequently, by Richter’s transformation from more indolent forms. Its incidence peaks between the sixth and seventh decades of life, being slightly more prevalent (55%) in males. Case report: 69-year-old hypertensive and diabetic male patient, with past history of pulmonary tuberculosis in adolescence and excision of a basalioma of the trunk at the age of 60, admitted by fever, fatigue and non-selective anorexia with a 7% weight loss, lasting for three weeks and having started three days after hemorroidectomy, which was undertaken without peri-operatory complications. Physical examination was unremarkable, except for discrete signs of dehydration and conjunctival paleness, with absence of palpable lymphadenopathy and a normal abdominal and proctologic examination. Laboratorial evaluation revealed microcitic hypocromic anemia with a chronic disease-type iron kinetics, slight thrombocytopenia and elevated C-reactive protein and lactate dehydrogenase. Transthoracic echocardiography was normal. Further imagiologic study documented exuberant nodular hepatic lesions suggestive of secondary deposits, in a normally dimensioned, bosselated liver, without any evidence of a thoracic, abdominal or pelvic primary tumour or deep lymphadenopathy. These aspects were corroborated by echographic evaluation of the thyroid, prostate, scrotum and breasts and bronchial as well as upper and lower digestive tract endoscopy. Ophthalmologic and otorhynolaringological examinations were also normal. The thorough microbiological and serological workup was negative. A slight elevation of beta2-microglobulin was documented. Tomography-guided biopsy of the hepatic lesions was performed, establishing the diagnosis of bcl2(+), bcl6(+), CD5(-) diffuse large B cell lymphoma, and a therapeutic regimen of R-CHOP (rituximab + cyclophosphamide, doxorubicin, vincristine and prednisolone) was subsequently implemented. Bone marrow involvement was excluded by biopsy. Conclusion: At the time of diagnosis, diffuse large B cell lymphoma presents with visceral involvement in 40% of patients. Nevertheless, exclusive extranodal involvement is a rarity – consideration of the diagnosis is therefore paramount for staging and timely institution of treatment. Keywords: hepatic lesions, non-Hodgkin’s lymphoma, diffuse large B cell lymphoma.
P0340 HEMOGLOBIN MALMO - A CAUSE OF POLYCYTHEMIA; EXPERIENCE OF A PORTUGUESE HOSPITAL
P0342 A RARE ETIOLOGIC FACTOR IN REFRACTORY IDIOPATHIC THROMBOCYTOPENIA: HYPOTHYROIDISM
S. Janeiro 1 , P. Lago 2 , B. Lobão 1 , S. Marques 1 , E. Pedroso 1 , I. Quintas 2 , A. Lourenço 1 . 1 Centro Hospitalar De Setúbal, E.p.e. - Internal Medicine; 2 Centro Hospitalar De Setúbal, E.p.e. - Imunohemotherapy
Mehmet Yildiz, Ozge Keskin, Ediz Tutuncu, Sanem Kayhan, Ceyhun Varim. Diskapi Yildirim Beyazit Education and Research Hospital
Haemoglobinopathies are the world’s most frequently found monogenic disorders. In the cases with high oxygen affinity, the decrease in the liberation of the oxygen determines a secondary erythrocytosis. In this work, we present 5 unrelated families of Caucasian race, with a variant of haemoglobin with high oxygen affinity which were followed in our district hospital consultation and diagnosed in our national laboratory. The manipulation of the conditions of electrophoresis and chromatographic methods permitted identification of hemoglobin Malmö in these families, in total of 15 cases. In Hb Malmö, the change of amino acid affects zones of the contact alpha(1)beta(2); In these cases, the change of amino acid, though of different form, facilitates that the quaternary structure of the haemoglobin becomes stable in its relaxed configuration so the transfer of oxygen and the P(50) value are decreased.
Introduction: Idiopathic thrombocytopenic purpura (ITP) is an autoimmune disorder characterised by persistent thrombocytopenia (platelet count <150000/mm3 ) as a result of autoantibody binding to platelet antigens and causing their premature destruction by the reticuloendothelial system, in particular the spleen. Etiologies for ITP were often infections (viral or bacterial) and immunologic mechanisms (antibody cross reactivity). We present the case of a patient with acute ITP due to a bacterial infection and resistant to treatment because of hypothyroidi. Case description: A 32 year old woman was referred to the infection clinic because of an inguinal lesion. Her physical examination was totally normal except her inguinal purulent lesion. Her sedimentation rate, leucocyte count and CRP level were high confirming the infection. The serum biochemistry, thyroid function test, prothrombin time and partial thromboplastin time were normal. We started antimicrobial therapy according to the bacterial culture
S117
All cases were sent to laboratory to detect abnormal haemoglobin, because of shown erythrocytosis and striking history of familial polycythemia. In the majority of them, the diagnosis was done during an analysis of routine or for being relatives of the first ones. Some carriers of hemoglobin Malmö exhibit more relevant hematologic abnormalities and had thrombotic complications.
P0341 FOCAL HEPATIC LESIONS - A RARE PRESENTATION OF A POTENTIALLY FATAL DISEASE
P0339 RELATIONSHIP BETWEEN IRON DEFICIENCY ANEMIA AND SERUM HEMOGLOBIN A1C LEVELS
Ömer Önder Sava¸s, Gülden Bayrak, Özlem Barak Serkant, Tevfik Tanju Yılmazer, O˘guzhan Deniz Aydın, Murat Suher. Ankara Atatürk Training and Research Hospital Internal Diseases Clinic Objective: The purpose of this study is to find out if there is any relationship between iron deficiency anemia and HbA1c levels. Furthermore, we planned to detect if there would be any change in HbA1c levels after treatment of iron deficiency anemia. Materials and methods: Between January 2004 and September 2007 sixty five patients with iron defiency anemia and fourty patients who were not iron deficient (control group) were included in this study. CBC levels, serum iron, iron binding level, transferrin saturation, ferritin, HbA1c levels, fastening glucose levels were recorded. The anemic patients who were treated were evaluated with control hemogram, serum iron, iron binding level, transferrin saturation, ferritin, HbA1c levels after six months. The relationship between iron deficiency anemia and HbA1c levels were studied by SPSS 11.5 program. Results: Before iron therapy given to case group; Hb, Hct, MCV, MCH, MCHC, RBC, serum Fe, transferrin saturation ve ferritin average values were lower and statistically significant compared to control group (p<0,001). Before iron therapy, RDW, transferrin saturation average values of case group were found to be statistically significantly higher (p<0,001). Among the case group, when Hb, Hct, MCV, MCH, MCHC, RBC, serum Fe, transferrin saturation ferritin average values were evaluated, there were also statistically significant increase between the case group before and after iron therapy (p<0,001). After the therapy there was statistically significant decrease in RDW, average platellet and iron binding capacity (p<0,05, p<0,001). In the case group before the therapy the average HbA1c levels were found higher compared to control group (p<0,001). After the therapy the control group and case group average HbA1c levels were similar (p=0,641). In the case group HbA1c levels were significantly lower after iron treatment compared to pretreatment (p<0,001). Conclusion: In iron deficiency anemia there is an increase at HbA1c levels and after the iron therapy HbA1c levels decrease significantly. This HbA1c level alteration is important while evaluating the answer to iron therapy and might be used along with other parameters in follow up of patients. Our data provide evidence that HbA1c levels might be misleading while evaluating the iron therapy and pursuing glycemic control at diabetic iron defiency cases. Key words: iron deficiency anemia, diabetes mellitus, HbA1c,
Andreia Gonçalves, Bruno Valente, André Lencastre, Isabel Baptista. Centro Hospitalar De Lisboa Central, E.p.e. - Hospital De S. José Introduction: About half of non-Hodgkin’s lymphomas behave in a clinically aggressive way (survival of the untreated disease measured in months). Diffuse large B cell lymphoma, with its histologic variants, is the most common subtype, representing approximately 30% of the total of non Hodgkin’s lymphomas. It originates essentially de novo and, less frequently, by Richter’s transformation from more indolent forms. Its incidence peaks between the sixth and seventh decades of life, being slightly more prevalent (55%) in males. Case report: 69-year-old hypertensive and diabetic male patient, with past history of pulmonary tuberculosis in adolescence and excision of a basalioma of the trunk at the age of 60, admitted by fever, fatigue and non-selective anorexia with a 7% weight loss, lasting for three weeks and having started three days after hemorroidectomy, which was undertaken without peri-operatory complications. Physical examination was unremarkable, except for discrete signs of dehydration and conjunctival paleness, with absence of palpable lymphadenopathy and a normal abdominal and proctologic examination. Laboratorial evaluation revealed microcitic hypocromic anemia with a chronic disease-type iron kinetics, slight thrombocytopenia and elevated C-reactive protein and lactate dehydrogenase. Transthoracic echocardiography was normal. Further imagiologic study documented exuberant nodular hepatic lesions suggestive of secondary deposits, in a normally dimensioned, bosselated liver, without any evidence of a thoracic, abdominal or pelvic primary tumour or deep lymphadenopathy. These aspects were corroborated by echographic evaluation of the thyroid, prostate, scrotum and breasts and bronchial as well as upper and lower digestive tract endoscopy. Ophthalmologic and otorhynolaringological examinations were also normal. The thorough microbiological and serological workup was negative. A slight elevation of beta2-microglobulin was documented. Tomography-guided biopsy of the hepatic lesions was performed, establishing the diagnosis of bcl2(+), bcl6(+), CD5(-) diffuse large B cell lymphoma, and a therapeutic regimen of R-CHOP (rituximab + cyclophosphamide, doxorubicin, vincristine and prednisolone) was subsequently implemented. Bone marrow involvement was excluded by biopsy. Conclusion: At the time of diagnosis, diffuse large B cell lymphoma presents with visceral involvement in 40% of patients. Nevertheless, exclusive extranodal involvement is a rarity – consideration of the diagnosis is therefore paramount for staging and timely institution of treatment. Keywords: hepatic lesions, non-Hodgkin’s lymphoma, diffuse large B cell lymphoma.
P0340 HEMOGLOBIN MALMO - A CAUSE OF POLYCYTHEMIA; EXPERIENCE OF A PORTUGUESE HOSPITAL
P0342 A RARE ETIOLOGIC FACTOR IN REFRACTORY IDIOPATHIC THROMBOCYTOPENIA: HYPOTHYROIDISM
S. Janeiro 1 , P. Lago 2 , B. Lobão 1 , S. Marques 1 , E. Pedroso 1 , I. Quintas 2 , A. Lourenço 1 . 1 Centro Hospitalar De Setúbal, E.p.e. - Internal Medicine; 2 Centro Hospitalar De Setúbal, E.p.e. - Imunohemotherapy
Mehmet Yildiz, Ozge Keskin, Ediz Tutuncu, Sanem Kayhan, Ceyhun Varim. Diskapi Yildirim Beyazit Education and Research Hospital
Haemoglobinopathies are the world’s most frequently found monogenic disorders. In the cases with high oxygen affinity, the decrease in the liberation of the oxygen determines a secondary erythrocytosis. In this work, we present 5 unrelated families of Caucasian race, with a variant of haemoglobin with high oxygen affinity which were followed in our district hospital consultation and diagnosed in our national laboratory. The manipulation of the conditions of electrophoresis and chromatographic methods permitted identification of hemoglobin Malmö in these families, in total of 15 cases. In Hb Malmö, the change of amino acid affects zones of the contact alpha(1)beta(2); In these cases, the change of amino acid, though of different form, facilitates that the quaternary structure of the haemoglobin becomes stable in its relaxed configuration so the transfer of oxygen and the P(50) value are decreased.
Introduction: Idiopathic thrombocytopenic purpura (ITP) is an autoimmune disorder characterised by persistent thrombocytopenia (platelet count <150000/mm3 ) as a result of autoantibody binding to platelet antigens and causing their premature destruction by the reticuloendothelial system, in particular the spleen. Etiologies for ITP were often infections (viral or bacterial) and immunologic mechanisms (antibody cross reactivity). We present the case of a patient with acute ITP due to a bacterial infection and resistant to treatment because of hypothyroidi. Case description: A 32 year old woman was referred to the infection clinic because of an inguinal lesion. Her physical examination was totally normal except her inguinal purulent lesion. Her sedimentation rate, leucocyte count and CRP level were high confirming the infection. The serum biochemistry, thyroid function test, prothrombin time and partial thromboplastin time were normal. We started antimicrobial therapy according to the bacterial culture