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P0333 THE EFFECT OF RESTRAINT STRESS IN PREGNANT RATS ON BLOOD PARAMETERS OF THEIR OFFSPRING
Abstracts from 8th Congress of the European Federation of Internal Medicine / European Journal of Internal Medicine 20S (2009), S1–S283 Discussion and conclusion: The presence of the Arab-Indian haplotype as the predominant haplotypes might be suggestive of a gene flow from Saudi Arabia or India to this area and presence of Benin, Bantue A2 and Senegal haplotypes in this area must have occurred during the Arab slave and trade with Arabian countries. Keywords: Sickle cell disease-Haplotype-Iran
P0331 CAUSES OF HYPOCHROMIC MICROCYTIC ANAEMIA IN SENIOR PATIENTS
Stefanos Patiakas 1 , Kiriaki Akritopoulou 2 , Ioannis Hoursalas 3 , Dimitra Kipeni 4 . 1 General Hospital of Kastoria; 2 General Hospital of Goumenissa; 3 “onasio” Heartsurgery Center; 4 General Hospital of Corfu, Greece Introduction and objectives: Documentation of situations that cause Hypochromic Microspherocytic Anaemia (HMA) in senior patients, demonstration of the criticality of Hypoferric Anaemia (HA) and scrutiny of its causes. Materials and methods: The material for our study was 126 patients > 65 years of age, 52 male and 74 female with age average 76,8 years of age who presented HMA, that is MCV< 80 fl, MCH<27pg and MCHC<30g/dl. 96 out of them suffered from one or more diseases connected to chronic anaemia. All of them where subjected to iron, ferritine and Mayer stool test, while in some cases other complementary tests were performed (e.g. colon endoscopy, CT scan etc.). Hematologic analyzer Sysmex and biochemical analyzer (chromatometric method). Results: Out of 126 patients, 84 (percentage 66,7%) presented HA according to WHO criteria, having ferritine levels < 15ng/dl, and/or positive stool hemoglobin, 4 patients (percentage 3,2%) had hemoglobin disease, while in 38 (percentage 30,1%) the cause was attributed to anaemia of chronic disease (ferritine> 15ng/dl), negative stool hemoglobin, chronic disease in advanced stage). Out of the 84 patients with HA, further study revealed: a) 72 senior patients (85,7%) who presented blood loss (12 with chronic ulcer, 10 with stomach neoplasm, 8 with hemorroidopathy, 8 with large intestine neoplasm, etc.), b) 4 seniors with malabsorption (2 due to gastrectomy), and c) 8 seniors in whom we were unable to find the cause despite the tests that were performed. Conclusions: 1) The search for HMA causes especially in senior patients is crucial and should always be performed since in most cases HA is revealed due to blood loss from the intestinal tract, often due to the presence of a neoplasm. 2) Differential diagnosis from anaemia of chronic disease, which at an advanced stage can also be hypocromic microspherocytic, is very important yet sometimes difficult, considering the fact that serum ferritine can be normal in both HA and anaemia of chronic disease. 3) Therefore, potential diagnosis of anaemia of chronic disease should only be put after having excluded all other possible causes.
P0332 ANEMIA IN A PATIENT WITH FAMILIAL MEDITERRANEAN FEVER (FMF)
Mehmet Yildiz 4 , Neyran Kertmen 4 , Hacer Salman 4 , Nevzat Iliman 4 . 1 Ministry of Health Diskapi Yildirim Beyazit Education and Research Hospital Second Department of Internal Medicine, Turkey FMF is an inherited disorder characterized by recurrent self – limiting attacks of joints, chest and abdominal pain associated with fever. Cytokines have been shown to participate in the pathogenesis of FMF. Case: An 18-year-old male patient was diagnosed with FMF 6 years ago and started on colchine 2x1/day treatment. The patient has not complied with the treatment regularly in the last 8-9 months. He presented with abdominal pain. It was attributed to acute FMF attack and a symptomatic treatment was started. Urgent abdominal ultrasonography showed dilated intestinal ans and edematous walls and minimal amount of free fluid accumulation in the pelvis. Based on the prediagnosis of amyliodiosis, endoscopic duodenal biopsy evaluation revealed normal results. The routine examinations indicated anemia and the etiology was determined to be chronic disease anemia and vitamin B 12 deficiency anemia. Discussion: Anemia of chronic disease is a condition brought about by chronic infections and inflammatory diseases where anemia develops without bleeding or hemolysis and in the face of normal iron states with low serum iron measurement, especially in patients with high disease activity. Although inflammation is known to occur in FMF to date, no studies have been conducted to determine there is no study whether chronic disease anemia develops
S115
in these patients. In our patients, chronic disease anemiae and vitamin B 12 deficiency were determined. The patient had a prolonged history of colchine. Colchine displays its effects by fixating the intracellular tubuli and arresting their polimerization into microtubules. The most affected organs are those that have a high rate of cell turnover, such as gastrointestinal tract and bone narrow. Colchine was effective not only on the frequency of attacks but also on the occurence of anemia.In some studies, no relationships were determined between the duration of colchine and the dose of colchine and hemoglobin levels. In other studies, colchine was found to distrupt the absorption of vitamin B12. In our patient, who did not have any amyloidiosis development and/or gastrointestinal involvement, anemia associated with vitamin B12 deficiency was attributed to colchine use. Chronic disease anemia is an expected complication of FMF.
P0333 THE EFFECT OF RESTRAINT STRESS IN PREGNANT RATS ON BLOOD PARAMETERS OF THEIR OFFSPRING
Fereshte Ebrahimian 1 , Ashraf Amirzargar 1 , Dr Kheirolah 2 . 1 Department of Biochemistry, Ahvaz Jundishapour University of Medical Sciences, Ahvaz, Iran; 2 Department of Physiology, Ahvaz Jundishapour University of Medical Sciences, Ahvaz, Iran Introduction: Stress has many effects on the development of systems and organs in the fetal period, and these effects appear after birth. Since hemopoietic system is susceptible to stress, effects of restraint stress from 8 to 21, 8 to 17, and 17 to 21 days of gestation, respectively. At the age of 60 days, the blood samples were taken from the male offspring rats. Results: The results in the offspring were as follows: a) Restraint stress markedly decreased the total number of white blood cells in offspring 1 and 3. The percentage of granulocytes decreased and lymphocytes increased significantly in these group. b) The number of red blood cells increased significantly in groups 1 and 2 compared with the control group. c) As for the index of RBC, the prenatal stress had an effect on MCV, MCH and MCHC in all groups. Conclution: our results showed that prenatal restraint causes long lasting changes in the blood parameters after birth. These data prove that restraint stress alters the function of immune and hemopoietic systems.
P0334 PERSISTENT EOSINOPHILIA IN ASYMPTOMATIC PATIENT
Sérgio Janeiro 1 , Ana Natário 2 , Ana Margarida Fernandes 1 , Bárbara Lobão 1 , Susana Marques 1 , Ermelinda Pedroso 1 . 1 Centro Hospitalar De Setúbal, E.p.e. - Internal Medicine; 2 Centro Hospitalar De Setúbal, E.p.e. Nephrology The authors present the case of a 54 year old black male, from Cabo Verde (Africa), sent in 2008 to Hematology consultation because of persistently elevated eosinophil count (2,0-3,2×103 /uL). He had Arterial Hypertension, Late Autoimmune Diabetes of the Adult (LADA), with advanced target organ lesion, under hemodialisys program since 2005 for Terminal-stage of Chronic Renal Insufficiency (TCRI), proposed to kidney transplant. There’s reference to asthma in his childhood, but without exacerbations ever since. No known allergies. In 2004, in admittance to the Internal Medicine ward, some investigation was initiated: stool examination for eggs, cysts and parasites; autoimmunity markers; upper endoscopy with duodenal biopsy; myelogram. No explanation for the eosinophilia was found. The patient presented without any symptoms. Observation revealed an aortic systolic murmur and symmetric trophy alterations in the lower limbs. No lymph nodes were found. We’ve decided to repeat some of the tests, including stool examination, added with the serologic tests for parasites. The ELISA test was positive for IgG against Strongyloides stercoralis. Curiously, stool examination came negative once again. Infected humans can become chronic carriers, usually with none to mild symptoms. The major complication of strongyloidiasis is the hyper infection syndrome, with massive dissemination of filariform larvae to the lungs, liver, heart, central nervous system and endocrine glands. Immune compromised hosts, such as our patient, are in higher risk. Therefore, our patient initiated treatment with Ivermectin. In contrast to other helminthic parasites, S. stercoralis have an unusually long life cycle (5 days),
P0331 CAUSES OF HYPOCHROMIC MICROCYTIC ANAEMIA IN SENIOR PATIENTS
Stefanos Patiakas 1 , Kiriaki Akritopoulou 2 , Ioannis Hoursalas 3 , Dimitra Kipeni 4 . 1 General Hospital of Kastoria; 2 General Hospital of Goumenissa; 3 “onasio” Heartsurgery Center; 4 General Hospital of Corfu, Greece Introduction and objectives: Documentation of situations that cause Hypochromic Microspherocytic Anaemia (HMA) in senior patients, demonstration of the criticality of Hypoferric Anaemia (HA) and scrutiny of its causes. Materials and methods: The material for our study was 126 patients > 65 years of age, 52 male and 74 female with age average 76,8 years of age who presented HMA, that is MCV< 80 fl, MCH<27pg and MCHC<30g/dl. 96 out of them suffered from one or more diseases connected to chronic anaemia. All of them where subjected to iron, ferritine and Mayer stool test, while in some cases other complementary tests were performed (e.g. colon endoscopy, CT scan etc.). Hematologic analyzer Sysmex and biochemical analyzer (chromatometric method). Results: Out of 126 patients, 84 (percentage 66,7%) presented HA according to WHO criteria, having ferritine levels < 15ng/dl, and/or positive stool hemoglobin, 4 patients (percentage 3,2%) had hemoglobin disease, while in 38 (percentage 30,1%) the cause was attributed to anaemia of chronic disease (ferritine> 15ng/dl), negative stool hemoglobin, chronic disease in advanced stage). Out of the 84 patients with HA, further study revealed: a) 72 senior patients (85,7%) who presented blood loss (12 with chronic ulcer, 10 with stomach neoplasm, 8 with hemorroidopathy, 8 with large intestine neoplasm, etc.), b) 4 seniors with malabsorption (2 due to gastrectomy), and c) 8 seniors in whom we were unable to find the cause despite the tests that were performed. Conclusions: 1) The search for HMA causes especially in senior patients is crucial and should always be performed since in most cases HA is revealed due to blood loss from the intestinal tract, often due to the presence of a neoplasm. 2) Differential diagnosis from anaemia of chronic disease, which at an advanced stage can also be hypocromic microspherocytic, is very important yet sometimes difficult, considering the fact that serum ferritine can be normal in both HA and anaemia of chronic disease. 3) Therefore, potential diagnosis of anaemia of chronic disease should only be put after having excluded all other possible causes.
P0332 ANEMIA IN A PATIENT WITH FAMILIAL MEDITERRANEAN FEVER (FMF)
Mehmet Yildiz 4 , Neyran Kertmen 4 , Hacer Salman 4 , Nevzat Iliman 4 . 1 Ministry of Health Diskapi Yildirim Beyazit Education and Research Hospital Second Department of Internal Medicine, Turkey FMF is an inherited disorder characterized by recurrent self – limiting attacks of joints, chest and abdominal pain associated with fever. Cytokines have been shown to participate in the pathogenesis of FMF. Case: An 18-year-old male patient was diagnosed with FMF 6 years ago and started on colchine 2x1/day treatment. The patient has not complied with the treatment regularly in the last 8-9 months. He presented with abdominal pain. It was attributed to acute FMF attack and a symptomatic treatment was started. Urgent abdominal ultrasonography showed dilated intestinal ans and edematous walls and minimal amount of free fluid accumulation in the pelvis. Based on the prediagnosis of amyliodiosis, endoscopic duodenal biopsy evaluation revealed normal results. The routine examinations indicated anemia and the etiology was determined to be chronic disease anemia and vitamin B 12 deficiency anemia. Discussion: Anemia of chronic disease is a condition brought about by chronic infections and inflammatory diseases where anemia develops without bleeding or hemolysis and in the face of normal iron states with low serum iron measurement, especially in patients with high disease activity. Although inflammation is known to occur in FMF to date, no studies have been conducted to determine there is no study whether chronic disease anemia develops
S115
in these patients. In our patients, chronic disease anemiae and vitamin B 12 deficiency were determined. The patient had a prolonged history of colchine. Colchine displays its effects by fixating the intracellular tubuli and arresting their polimerization into microtubules. The most affected organs are those that have a high rate of cell turnover, such as gastrointestinal tract and bone narrow. Colchine was effective not only on the frequency of attacks but also on the occurence of anemia.In some studies, no relationships were determined between the duration of colchine and the dose of colchine and hemoglobin levels. In other studies, colchine was found to distrupt the absorption of vitamin B12. In our patient, who did not have any amyloidiosis development and/or gastrointestinal involvement, anemia associated with vitamin B12 deficiency was attributed to colchine use. Chronic disease anemia is an expected complication of FMF.
P0333 THE EFFECT OF RESTRAINT STRESS IN PREGNANT RATS ON BLOOD PARAMETERS OF THEIR OFFSPRING
Fereshte Ebrahimian 1 , Ashraf Amirzargar 1 , Dr Kheirolah 2 . 1 Department of Biochemistry, Ahvaz Jundishapour University of Medical Sciences, Ahvaz, Iran; 2 Department of Physiology, Ahvaz Jundishapour University of Medical Sciences, Ahvaz, Iran Introduction: Stress has many effects on the development of systems and organs in the fetal period, and these effects appear after birth. Since hemopoietic system is susceptible to stress, effects of restraint stress from 8 to 21, 8 to 17, and 17 to 21 days of gestation, respectively. At the age of 60 days, the blood samples were taken from the male offspring rats. Results: The results in the offspring were as follows: a) Restraint stress markedly decreased the total number of white blood cells in offspring 1 and 3. The percentage of granulocytes decreased and lymphocytes increased significantly in these group. b) The number of red blood cells increased significantly in groups 1 and 2 compared with the control group. c) As for the index of RBC, the prenatal stress had an effect on MCV, MCH and MCHC in all groups. Conclution: our results showed that prenatal restraint causes long lasting changes in the blood parameters after birth. These data prove that restraint stress alters the function of immune and hemopoietic systems.
P0334 PERSISTENT EOSINOPHILIA IN ASYMPTOMATIC PATIENT
Sérgio Janeiro 1 , Ana Natário 2 , Ana Margarida Fernandes 1 , Bárbara Lobão 1 , Susana Marques 1 , Ermelinda Pedroso 1 . 1 Centro Hospitalar De Setúbal, E.p.e. - Internal Medicine; 2 Centro Hospitalar De Setúbal, E.p.e. Nephrology The authors present the case of a 54 year old black male, from Cabo Verde (Africa), sent in 2008 to Hematology consultation because of persistently elevated eosinophil count (2,0-3,2×103 /uL). He had Arterial Hypertension, Late Autoimmune Diabetes of the Adult (LADA), with advanced target organ lesion, under hemodialisys program since 2005 for Terminal-stage of Chronic Renal Insufficiency (TCRI), proposed to kidney transplant. There’s reference to asthma in his childhood, but without exacerbations ever since. No known allergies. In 2004, in admittance to the Internal Medicine ward, some investigation was initiated: stool examination for eggs, cysts and parasites; autoimmunity markers; upper endoscopy with duodenal biopsy; myelogram. No explanation for the eosinophilia was found. The patient presented without any symptoms. Observation revealed an aortic systolic murmur and symmetric trophy alterations in the lower limbs. No lymph nodes were found. We’ve decided to repeat some of the tests, including stool examination, added with the serologic tests for parasites. The ELISA test was positive for IgG against Strongyloides stercoralis. Curiously, stool examination came negative once again. Infected humans can become chronic carriers, usually with none to mild symptoms. The major complication of strongyloidiasis is the hyper infection syndrome, with massive dissemination of filariform larvae to the lungs, liver, heart, central nervous system and endocrine glands. Immune compromised hosts, such as our patient, are in higher risk. Therefore, our patient initiated treatment with Ivermectin. In contrast to other helminthic parasites, S. stercoralis have an unusually long life cycle (5 days),