A clinicopathological analysis of 26 patients with infection-associated haemophagocytic lymphohistiocytosis and the importance of bone marrow phagocytosis for the early initiation of immunomodulatory treatment.

Abstract:

OBJECTIVE:To analyse the clinicopathological presentation, outcome and importance of bone marrow haemophagocytosis in patients with infection-associated haemophagocytic lymphohistiocytosis (IA-HLH) in a tertiary care hospital in Northern India. STUDY DESIGN:Between January 2007 and December 2009, 26 consecutive patients meeting the diagnostic criteria for IA-HLH, based on the HLH2004 protocol of the Histiocyte Society, were followed up for between 12 and 34 months (median 20 months). RESULTS:IA-HLH was diagnosed in three of the five patients who died 5-6 weeks after the onset of the illness, whereas diagnosis in the remaining group was made a median of 2 weeks after the onset of the illness. The predominant presenting features were fever (100%), hepatomegaly (69%), splenomegaly (58%) and anaemia (96%). All patients showed >3% haemophagocytosis on bone marrow studies-in four cases after serial aspiration/biopsies. Twenty-one (80.8%) cases were non-fatal and five (19.2%) patients died. The non-fatal cases included eight (38.1%) cases of viral infection, seven (33.3%) bacterial infections, two (9.6%) fungal and four (19.0%) protozoal infections; whereas four (80%) bacterial infections and one (20%) viral infection were associated with the fatal cases. The mean of the nadir blood counts of white blood cells, absolute neutrophil counts and platelets; the mean of all the peak biochemical parameters of liver function tests, lactate dehydrogenase and ferritin and the lowest fibrinogen values before treatment, differed significantly (p<0.05) between the non-fatal and the fatal group, being worse in the latter. CONCLUSIONS:IA-HLH is important because it can obscure the typical clinical features of the underlying primary disease, thus delaying the diagnosis and having a negative effect on the outcome. Although bone marrow haemophagocytosis is not a mandatory diagnostic criterion, we found it to be a useful tool together with biochemical parameters for early recognition of HLH, especially in developing countries lacking molecular and flow laboratories. The severity of pancytopenia and derangement in biochemical markers were significantly higher in the patients who died.

journal_name

Postgrad Med J

authors

Nair V,Das S,Sharma A,Sharma S,Sharma P,Ray S,Bhattacharya S

doi

10.1136/postgradmedj-2012-130955

subject

Has Abstract

pub_date

2013-04-01 00:00:00

pages

185-92

issue

1050

eissn

0032-5473

issn

1469-0756

pii

postgradmedj-2012-130955

journal_volume

89

pub_type

杂志文章
  • Prognostic value of long non-coding RNA 01296 expression in human solid malignant tumours: a meta-analysis.

    abstract::Long intergenic non-coding RNA 01296 (LINC01296) has been reported to play an important role in many human malignancies, but a consistent perspective has not been established now. To explore the prognostic value of LINC01296 in different types of human solid malignant tumours, we performed this meta-analysis.An electr...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章,meta分析,评审

    doi:10.1136/postgradmedj-2019-136684

    authors: Dai C,Dai C,Ni H,Xu Z

    更新日期:2020-01-01 00:00:00

  • Muscarinic receptors in lung.

    abstract::Muscarinic receptors are present on several different cells in lung and are predominantly involved in bronchoconstriction and mucus secretion. Muscarinic receptor activation leads to breakdown of phosphoinositides in airway smooth muscle cell membranes, which leads to intracellular calcium release and contraction. Mus...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章,评审

    doi:

    authors: Barnes PJ

    更新日期:1987-01-01 00:00:00

  • Unravelling the helix--a physician's guide to spiral computed tomography.

    abstract::The introduction of spiral technology to computed tomography (CT) scanners in the late 1980s has revolutionised the field of CT. Spiral CT offers definite practical benefits over conventional scanners and has expanded the role of CT through the development of new scanning techniques. CT scanning now rivals magnetic re...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章,评审

    doi:10.1136/pgmj.74.868.96

    authors: Kearney SE,Garvey CJ

    更新日期:1998-02-01 00:00:00

  • The normal range: it is not normal and it is not a range.

    abstract::The NHS 'Choose Wisely' campaign places greater emphasis on the clinician-patient dialogue. Patients are often in receipt of their laboratory data and want to know whether they are normal. But what is meant by normal? Comparator data, to a measured value, are colloquially known as the 'normal range'. It is often assum...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章

    doi:10.1136/postgradmedj-2018-135983

    authors: Whyte MB,Kelly P

    更新日期:2018-11-01 00:00:00

  • Venepuncture: the medicolegal hazards.

    abstract::Venepuncture is commonly regarded as a trivial procedure allocated to the most junior medical staff. The result of this policy is that junior doctors are required to perform a minimally invasive procedure on consenting patients without any structured venepuncture training or assessment. Consequently, inexperienced doc...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章

    doi:10.1136/pgmj.72.843.23

    authors: McConnell AA,Mackay GM

    更新日期:1996-01-01 00:00:00

  • The value of 5-aminosalicylic acid in inflammatory bowel disease for patients intolerant or allergic to sulphasalazine.

    abstract::The use of sulphasalazine in inflammatory bowel disease is often limited by intolerance or allergy. In previous studies 5-aminosalicylic acid (5ASA), the active ingredient of sulphasalazine, coated with an acrylic resin, has been shown to be as effective as sulphasalazine in maintaining remission. In this study coated...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章

    doi:10.1136/pgmj.61.722.1047

    authors: Donald IP,Wilkinson SP

    更新日期:1985-12-01 00:00:00

  • Fulminant hyperpyrexia induced by bleomycin.

    abstract::Mild and self-limiting fever following bleomycin use is common, and a fatal hyperpyrexial response occurs rarely. In previously reported cases, such hyperpyrexia occurred either after the initial administration of the drug or during subsequent therapy following an initial pyrexial response. We describe a fatal hyperpy...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章

    doi:10.1136/pgmj.65.764.417

    authors: Leung WH,Lau JY,Chan TK,Kumana CR

    更新日期:1989-06-01 00:00:00

  • A review of amlodipine in myocardial ischaemia.

    abstract::Amlodipine is a dihydropyridine calcium antagonist with a unique pharmacokinetic profile providing advantages over other therapies of its kind. It has been shown to possess high oral absorption, long elimination half-life, smooth onset of action and long duration of pharmacodynamic activity. These properties result in...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章,评审

    doi:

    authors: Taylor SH

    更新日期:1991-01-01 00:00:00

  • Economic evaluation of gastric ulcer prophylaxis in patients with arthritis receiving non-steroidal anti-inflammatory drugs.

    abstract::This study assesses the economic benefits of misoprostol in the prophylaxis of gastric ulcers larger than 0.3 cm in patients with osteoarthritis receiving non-steroidal anti-inflammatory drugs. Independent epidemiological data were obtained for patients in Scotland and the West Midlands. Co-diagnosis of arthritis with...

    journal_title:Postgraduate medical journal

    pub_type: 临床试验,杂志文章

    doi:10.1136/pgmj.66.778.639

    authors: Knill-Jones R,Drummond M,Kohli H,Davies L

    更新日期:1990-08-01 00:00:00

  • COX-2 inhibitors and the heart: are all coxibs the same?

    abstract::The selective COX-2 inhibitors (coxibs) were originally developed to minimise the adverse effects of conventional non-steroidal anti-inflammatory drugs (NSAIDs) while maintaining the same analgesic and anti-inflammatory properties. Many large studies confirmed the improved gastric side effect profile of coxibs compare...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章,评审

    doi:10.1136/pgmj.2005.042234

    authors: Sooriakumaran P

    更新日期:2006-04-01 00:00:00

  • Late presentation of a congenital gastric diverticulum causing pyloric obstruction.

    abstract::We report a case of adult pyloric obstruction caused by the delayed presentation of a congenital gastric diverticulum. The derivation, classification and treatment of these abnormalities are discussed. ...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章

    doi:10.1136/pgmj.68.798.296

    authors: Hale PC,O'Flynn WR

    更新日期:1992-04-01 00:00:00

  • A gene-based risk score for lung cancer susceptibility in smokers and ex-smokers.

    abstract:BACKGROUND:Epidemiological and family studies suggest that lung cancer results from the combined effects of age, smoking and genetic factors. Chronic obstructive pulmonary disease (COPD) is also an independent risk factor for lung cancer and coexists in 40-60% of lung cancer cases. METHODS:In a two-stage case-control ...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章,多中心研究

    doi:10.1136/pgmj.2008.077107

    authors: Young RP,Hopkins RJ,Hay BA,Epton MJ,Mills GD,Black PN,Gardner HD,Sullivan R,Gamble GD

    更新日期:2009-10-01 00:00:00

  • Florid granulomatous reaction in a seminoma.

    abstract::A case of seminoma of the testis complicated by an extensive granulomatous reaction is reported. This reaction was so florid that a benign condition was initially considered until further material for histology was examined and the correct diagnosis made. ...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章

    doi:10.1136/pgmj.59.691.334

    authors: Pickard WR,Clark AH,Abel BJ

    更新日期:1983-05-01 00:00:00

  • Severe acute respiratory syndrome (SARS): epidemiology and clinical features.

    abstract::Severe acute respiratory syndrome (SARS) is a newly emerged infectious disease with a significant morbidity and mortality. The major clinical features include persistent fever, chills/rigor, myalgia, malaise, dry cough, headache, and dyspnoea. Older subjects may present without the typical febrile response. Common lab...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章,评审

    doi:10.1136/pgmj.2004.020263

    authors: Hui DS,Chan MC,Wu AK,Ng PC

    更新日期:2004-07-01 00:00:00

  • Consultation activities of clinical ethics committees in the United Kingdom: an empirical study and wake-up call.

    abstract:OBJECTIVE:To identify the consultation activities of clinical ethics committees (CECs) in the UK and the views of CEC chairpersons regarding such activities. METHODS:An anonymous, password-protected online questionnaire was sent by e-mail to 70 CEC chairpersons. The questionnaire contained 14 items. RESULTS:Of the 70...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章

    doi:10.1136/pgmj.2008.075879

    authors: Whitehead JM,Sokol DK,Bowman D,Sedgwick P

    更新日期:2009-09-01 00:00:00

  • Leprosy presenting as unilateral foot drop in an immigrant boy.

    abstract::This is a case report of a boy who presented with unilateral foot drop approximately 1 year after traumatic injury from skateboarding. Exploratory surgical operation was eventually performed, and histological examination of the surgical specimen revealed leprous peripheral neuropathy of the peroneal nerve. The patient...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章

    doi:10.1136/pgmj.70.820.111

    authors: Choe W

    更新日期:1994-02-01 00:00:00

  • Changes in the prevalence of HBV infection in pregnant women in Turkey between 1995 and 2015: a 20-year evaluation.

    abstract:OBJECTIVE:To determine changes in hepatitis B virus (HBV) prevalence across three different time periods in pregnant women. METHODS:This was a retrospective study of pregnant women attending four healthcare centres between January 1995 and May 2015. Data for serum hepatitis B surface antigen (HBsAg) and anti-HBs level...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章

    doi:10.1136/postgradmedj-2015-133876

    authors: Furuncuoglu Y,Bolukbas FF,Bolukbas C,Torun P,Ozturk R

    更新日期:2016-09-01 00:00:00

  • Serum lipoprotein abnormalities in ischaemic heart disease.

    abstract::Quantitative lipoprotein level data was obtained from healthy subjects and patients with ischaemic heart disease or peripheral vascular disease in four European communities. Hypertriglyceridaemia, due mainly to an increase in VLDL triglyceride, was commoner in London and Uppsala than in Naples and Geneva. In three com...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章

    doi:

    authors: Lewis B,Carlson LA,Mancini M,Micheli H

    更新日期:1975-01-01 00:00:00

  • Prostate cancer.

    abstract::It is a paradigm in cancer treatment that early detection and treatment improves survival. However, although screening measures lead to a higher rate of detection, for small bulk localised prostate cancer it remains unclear whether early detection and early treatment will lead to an overall decrease in mortality. The ...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章,评审

    doi:10.1136/pmj.78.924.590

    authors: Mazhar D,Waxman J

    更新日期:2002-10-01 00:00:00

  • Alcoholic liver disease.

    abstract::Alcohol is a major cause of liver cirrhosis in the Western world and accounts for the majority of cases of liver cirrhosis seen in district general hospitals in the UK. The three most widely recognised forms of alcoholic liver disease are alcoholic fatty liver (steatosis), acute alcoholic hepatitis, and alcoholic cirr...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章,评审

    doi:10.1136/pmj.76.895.280

    authors: Walsh K,Alexander G

    更新日期:2000-05-01 00:00:00

  • Clomiphene-induced pituitary apoplexy in a patient with acromegaly.

    abstract::We describe the case of an acromegalic woman with primary infertility who was treated with clomiphene, and subsequently developed pituitary apoplexy. ...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章

    doi:10.1136/pgmj.72.845.172

    authors: Walker AB,Eldridge PR,MacFarlane IA

    更新日期:1996-03-01 00:00:00

  • Chemotherapy-induced nausea and vomiting: an overview and comparison of three consensus guidelines.

    abstract::Chemotherapy-induced nausea and vomiting (CINV) remains one of the most debilitating toxicities associated with cancer treatment. In recent decades, significant strides have been made in our understanding of the pathophysiology of CINV, making way to more effective targeted pharmacotherapies, especially 5-hydroxytrypt...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章,评审

    doi:10.1136/postgradmedj-2014-132969

    authors: Tageja N,Groninger H

    更新日期:2016-01-01 00:00:00

  • Paget's disease of bone.

    abstract::Paget's disease of bone is a relatively common condition in the UK affecting up to 5% of the population over the age of 55 years with particularly high prevalence in the North West of England. The majority of those affected are asymptomatic. Its precise cause remains unknown, and until recently, choice of treatment of...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章,评审

    doi:10.1136/pgmj.73.856.69

    authors: Ooi CG,Fraser WD

    更新日期:1997-02-01 00:00:00

  • Analysis of the human growth curve.

    abstract::Mathematical techniques are well suited to analysis of growth data. In the past there has been much emphasis on the mathematical description of shape and changes of shape as exemplified by the allometric equation. More recently these methods have been less popular and shape analysis has been handled largely by modern ...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章

    doi:

    authors: Preece MA

    更新日期:1978-01-01 00:00:00

  • Exercise and hormonal secretion.

    abstract::The effect of graded exercise on the secretion of cortisol, testosterone, prolactin, growth hormone, thyroid stimulating hormone (TSH), luteinizing hormone and follicle stimulating hormone (FSH) is reported. While cortisol, prolactin, growth hormone and testosterone rise during the period of exercise, a rise in lutein...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章

    doi:10.1136/pgmj.55.644.373

    authors: Gawel MJ,Park DM,Alaghband-Zadeh J,Rose FC

    更新日期:1979-06-01 00:00:00

  • Oedema and vasodilatation in inflammation: the relevance of prostaglandins.

    abstract::The role of prostaglandins in inflammation is still disputed. Some workers have attempted to fit prostaglandins into a simple model, i.e. inflammatory leads to chemical mediator leads to vascular response. Recent work has shown that this approach may be misleading. An alternative model is proposed, involving the inter...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章

    doi:10.1136/pgmj.53.625.660

    authors: Williams TJ

    更新日期:1977-11-01 00:00:00

  • Therapy of Candida peritonitis: penetration of amphotericin B into peritoneal fluid.

    abstract::Candida albicans peritonitis developed in a 48-year-old man with a perforated gastric ulcer who subsequently was treated with intravenous amphotericin B. The drug penetrated well into the inflamed peritoneal cavity and eradicated the organism from the peritoneal fluid. Nevertheless, at post-mortem, Candida organisms w...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章

    doi:10.1136/pgmj.54.631.340

    authors: Peterson LR,Kelty RH,Hall WH,Votava HJ

    更新日期:1978-05-01 00:00:00

  • Maintenance pharmacological immunosuppressive strategies in renal transplantation.

    abstract::Current maintenance immunosuppressive regimens for transplantation are based on three classes of drugs: corticosteroids, immunophilin-binding agents (eg, cyclosporin and tacrolimus), and antimetabolites (eg, azathioprine and mycophenolate). Drugs from the various classes inhibit the immune system at different points a...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章

    doi:10.1136/pgmj.73.861.386

    authors: Vella JP,Sayegh MH

    更新日期:1997-07-01 00:00:00

  • Severe dothiepin intoxication--a report of two cases.

    abstract::Two patients with severe dothiepin intoxication are described. The management of these cases is discussed and we draw attention to the prolonged elimination half-life of dothiepin and its metabolites, and the implication for treatment. ...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章

    doi:10.1136/pgmj.60.704.442

    authors: Bloodworth L,Wilson A,Collins P,Rainford DJ

    更新日期:1984-06-01 00:00:00

  • Post-exposure prophylaxis for blood borne viral infections in healthcare workers.

    abstract::Healthcare workers have a high risk of occupational exposure, more so in developing countries, with high incidence of blood borne diseases and prevalence of unsafe practices. Among the various blood borne diseases, the most common and important ones are HIV infection, hepatitis B, and hepatitis C. Most of the occupati...

    journal_title:Postgraduate medical journal

    pub_type: 杂志文章,评审

    doi:10.1136/pmj.79.932.324

    authors: Varghese GM,Abraham OC,Mathai D

    更新日期:2003-06-01 00:00:00