A 13-year-old, spayed, female Chihuahua dog was referred for evaluation of fever, lethargy, and dyspnea. Hematologic evaluation revealed severe neutropenia, thrombocytopenia, and mild anemia. The dog had been undergoing phenobarbital therapy for the past 7 weeks because of generalized seizures due to meningoencephalomyelitis of unknown etiology. After ruling out other possible causes of cytopenias, a tentative diagnosis was made of drug-induced blood cell dyscrasia. The neutropenia and thrombocytopenia resolved after discontinuation of phenobarbital (8 days and 15 days after discontinuation, respectively). This is the first case report in Korea to demonstrate blood dyscrasia associated with idiosyncratic adverse effects of phenobarbital.
Adolescent ; Anemia ; Animals ; Blood Cells* ; Diagnosis ; Dogs* ; Dyspnea ; Female ; Fever ; Humans ; Korea ; Lethargy ; Leukopenia ; Neutropenia ; Phenobarbital* ; Seizures ; Thrombocytopenia

BACKGROUND: In the Republic of Korea, there had been no reports about indigenous malaria cases since 1984 until a vivax malaria case was detected in 1993. Thereafter vivax malaria has been a reemerging disease in Korea, the number of cases of malaria increasing recently and the prevalent area being more wider. We suggested that we should take malaria into consideration as the differential diagnosis whenever we meet the febrile patients. We analyzed the cases of malaria who were treated in Myoungji hospital located in Goyang-Si during 4years. METHODS: We retrospectively analyzed data of 79 confirmed cases of malaria treated in the Myoungji hospital from January 1, 1998 to December 31, 2001. All of the patients had no histories of traveling abroad, drug abuse or blood transfusion. The clinical manifestation, hematologic abnormalities and prognosis of patients were reviewed. RESULTS: Seventy-nine cases of malaria were diagnosed as vivax malaria by blood smears. Vivax malaria was developed in Goyang-Si from May through November. Common symptoms were fever (100%), chilling (84.8%), headache (64.6%) and myalgia (55.7%). Splenomegaly was detected in 77.2% of cases by sonography. In 1998, Tertian fever pattern was most frequent. Since 1999, irregular and atypical fever patterns, such as almost-daily high fever or the every fourth or fifth-day fever, were increased in numbers. Laboratory findings included thrombocytopenia (92.4%), anemia (29.1%), leukopenia (25.3%) and leukocytosys (5.1%). CONCLUSION: ICases of indigenous malaria have been progressively increasing in the Republic of Korea. Therefore early diagnosis, treatment and prevention of malaria are very important. Fortunately, patients were well responsed to treatment.
Anemia ; Blood Transfusion ; Diagnosis, Differential ; Early Diagnosis ; Fever ; Headache ; Humans ; Korea ; Leukopenia ; Malaria* ; Malaria, Vivax ; Myalgia ; Plasmodium vivax ; Prognosis ; Republic of Korea ; Retrospective Studies ; Splenomegaly ; Substance-Related Disorders ; Thrombocytopenia

Histiocytic necrotizing lymphadenitis that causes unusual lymphadenopathy is a newly recognized disease of unknown etiology and may be mistaken for other conditions such as malignant lymphoma and tuberculosis, in which specific treatment will be required. Local lymph node enlargement especially in neck is the only characteristic feature, sometimes accompanied by pain, tenderness, fever and chill like a cold, nausea, vomiting. Laboratory investigations are usually noncontributory with an occasional case showing leukopenia or an elevated erythrocyte sedimentation rate. For further understanding of this disease and helping make diagnosis, clinical features were reviewed in 15 patients (29 lymph node enlargement), who were diagnosed as histiocytic necrotizing lymphadenitis on clinical evaluation (9 patients) or excisional biopsy (6 patients). The results are as follows; Disease was more common in female(1:2) and young patient. It involved left sided neck nodes frequently (67%) and the most common site was suboccipit-al triangle (62%). 47% of patient showed multiple enlargement of lymph nodes and the size of nodes were varied from 8 to 23 mm (mean: 12.4 mm). Most nodes were movable and showed oval in shape. Fever (47%), pain (33%), tenderness (53%), recent history of upper respiratory infection (33%), leukopenia (47%) and increased erythrocyte sedimentation rate (67%) were showed in many cases. Ultrasonogrphic and CT scan showed well defined oval to round lymph nodes enlargement with inhomogenous enhancement. All affected nodes are resolved spontaneously within 3-10 weeks (mean 5.1 weeks) without specific treatment. After reviewing all of above results, it is concluded that histiocytic necrotizing lymphadenitis is self-limiting disease without characteristic clinical features, but some factors like fever, pain, tendrness, leukopenia and increased erythrocyte sedimentation rate with cervical lymphadenopathy in young female patient are thought to be very helpful in diagnosis and in these circumstances, lymph node biopsy must be delayed for 2-3 months.
Biopsy ; Blood Sedimentation ; Diagnosis ; Female ; Fever ; Histiocytic Necrotizing Lymphadenitis* ; Humans ; Leukopenia ; Lymph Nodes ; Lymphatic Diseases ; Lymphoma ; Nausea ; Neck ; Tomography, X-Ray Computed ; Tuberculosis ; Vomiting

BACKGROUND AND OBJECTIVES: The origin and clinical characteristic of histiocytic necrotizing lymphadenitis (HNL), or Kikuchi's disease, are not well-known. This report was conducted to investigate clinical characteristics and treatment outcome in order to contribute to the diagnosis and treatment of HNL. MATERIALS AND METHODS: We reviewed 28 patients with HNL by open biopsy during the past 8 years beginning January 1990 to December 1997 for the analysis of clinical features. RESULTS: 1) It occurred more often in females (17 cases: 61%) than males (11 cases: 39%). 2) It was seen relatively more often in the second decades showing 14 cases (50%). 3) Cervical lymphadenopathy appeared most common initial manifestation (16 cases: 57%), followed by cervical adenopathy with fever (12 case: 43%). 4) Cervical lymphadenopathy were usually multiple (22 cases; 79%) and tender (26 cases: 93%) rather than solitary (6 cases: 21%) and non-tender (2 cases: 7%) and in addition to cervical lymphadenopathy, some cases showed axillary and inguinal lymphadenopathy (2 cases: 7%). 6) Leukopenia and elevated erythrocyte sedimentation rates appeared most frequently in the abnormal laboratory data (16 cases: 57%). 7) Most patients recovered with the conser-vative treament and there was no specific complicatons and recurrence. CONCLUSION: We should consider open biopsy or fine needle aspiration cytology of lymph node in patients who have cervical adenopathy with fever, chills, night sweats, especially young women under the 30 years.
Biopsy ; Biopsy, Fine-Needle ; Blood Sedimentation ; Chills ; Diagnosis ; Female ; Fever ; Histiocytic Necrotizing Lymphadenitis ; Humans ; Leukopenia ; Lymph Nodes ; Lymphatic Diseases ; Male ; Recurrence ; Sweat ; Treatment Outcome

Acute lymphocytic leukemia (ALL) is uncommon lymphoid malignancy in dogs, and its diagnosis is challenging. A 14-year-old spayed female mixed breed dog was transferred to a veterinary medical teaching hospital for an immediate blood transfusion. The dog showed lethargy, pale mucous membranes, and a weak femoral pulse. Complete blood count revealed non-regenerative anemia and severe leukopenia with thrombocytopenia. ALL was tentatively diagnosed based on the predominance of immature lymphoblasts on blood film examination. For confirmation of lymphoid malignancy, PCR for antigen receptor rearrangement (PARR) on a peripheral blood sample and flow cytometry analysis were performed after blood transfusion. Flow cytometry analysis revealed that lymphocyte subsets were of normal composition, but PARR detected a T-cell malignancy. The dog was diagnosed with ALL and survived 1 wk after diagnosis. In conclusion, after blood transfusion, flow cytometry was not a reliable diagnostic method for an ALL dog, whereas PARR could detect lymphoid malignancy. Our results suggest that PARR should be the first-line diagnostic tool to detect canine lymphoid malignancy after a blood transfusion.
Adolescent ; Anemia ; Animals ; Blood Cell Count ; Blood Transfusion* ; Diagnosis* ; Dogs* ; Female ; Flow Cytometry ; Hospitals, Teaching ; Humans ; Lethargy ; Leukopenia ; Lymphocyte Subsets ; Methods ; Mucous Membrane ; Polymerase Chain Reaction* ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Receptors, Antigen* ; T-Lymphocytes ; Thrombocytopenia

BACKGROUND: Hematology analyzers may ineffectively recognize abnormal cells, and manual differential counts may be imprecise for leukopenic samples. We evaluated the efficacy of the Hematoflow method for determining the leukocyte differential in leukopenic samples and compared this method with the manual differential method. METHODS: We selected 249 blood samples from 167 patients with leukopenia (WBC counts, 500-2,000/microL) for analysis in this study. The EDTA-anticoagulated blood samples were analyzed using an automatic blood cell counter (DxH800; Beckman Coulter, USA) and flow cytometry (FC 500; Beckman Coulter) by using Cytodiff reagent and analysis software (Beckman Coulter). Hematoflow results were selected or calculated from DxH800 and Cytodiff results. Two trained pathologists performed a manual differential count by counting 50-100 cells. RESULTS: The precision of the Hematoflow method was superior to that of the manual method in counting 5 leukocyte subpopulations, immature granulocytes (IGs), and blasts. Blasts were detected in all 45 cases (100%) by Hematoflow. The correlation of the Cytodiff blast count to the reference count was high (r = 0.8325). For all other cell populations, the correlation of the Hematoflow results with the reference count was stronger than that of the other manual counts with the reference count. CONCLUSIONS: The Hematoflow differential counting method is more reproducible and sensitive than manual counting, and is relatively easy to perform. In particular, this method detected leukemic blasts more sensitively than manual differential counts. The Hematoflow method is a very useful supplement to automated cell counting.
Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Female ; Flow Cytometry/*methods ; Granulocytes/cytology ; Humans ; Infant ; Leukocyte Count/*methods ; Leukocytes/*cytology ; Leukopenia/*blood/diagnosis ; Male ; Middle Aged ; Reagent Kits, Diagnostic ; Software

BACKGROUND: Hematology analyzers may ineffectively recognize abnormal cells, and manual differential counts may be imprecise for leukopenic samples. We evaluated the efficacy of the Hematoflow method for determining the leukocyte differential in leukopenic samples and compared this method with the manual differential method. METHODS: We selected 249 blood samples from 167 patients with leukopenia (WBC counts, 500-2,000/microL) for analysis in this study. The EDTA-anticoagulated blood samples were analyzed using an automatic blood cell counter (DxH800; Beckman Coulter, USA) and flow cytometry (FC 500; Beckman Coulter) by using Cytodiff reagent and analysis software (Beckman Coulter). Hematoflow results were selected or calculated from DxH800 and Cytodiff results. Two trained pathologists performed a manual differential count by counting 50-100 cells. RESULTS: The precision of the Hematoflow method was superior to that of the manual method in counting 5 leukocyte subpopulations, immature granulocytes (IGs), and blasts. Blasts were detected in all 45 cases (100%) by Hematoflow. The correlation of the Cytodiff blast count to the reference count was high (r = 0.8325). For all other cell populations, the correlation of the Hematoflow results with the reference count was stronger than that of the other manual counts with the reference count. CONCLUSIONS: The Hematoflow differential counting method is more reproducible and sensitive than manual counting, and is relatively easy to perform. In particular, this method detected leukemic blasts more sensitively than manual differential counts. The Hematoflow method is a very useful supplement to automated cell counting.
Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Female ; Flow Cytometry/*methods ; Granulocytes/cytology ; Humans ; Infant ; Leukocyte Count/*methods ; Leukocytes/*cytology ; Leukopenia/*blood/diagnosis ; Male ; Middle Aged ; Reagent Kits, Diagnostic ; Software

BACKGROUND: High risk myelodysplastic syndrome has various clinical courses and refractoriness to various therapies. It is important to analyze clinical characteristics and therapeutic responses in high risk myelodysplastic syndrome. METHODS: Sixty nine cases of primary high risk myelodysplastic syndrome at diagnosis were enrolled in this study at Kyungpook National University Hospital and Taegu Hyosung- Catholic University Hospital from January 1987 to June 1996. We have investigated the clinical characteristics and therapeutic outcomes after low dose cytarabine chemotherapy. RESULTS: 1) The median age of the patients was 48 years. Male to female ratio was 2.1:1. The each numbers of RAEB, CMML and RAEB-T patients were 38, 11 and 20, respectively. 2) The most common chief complaint was dyspnea on exertion. General weakness, fever and dizziness were also observed. The most common physical finding was pallor. 3) The peripheral blood findings showed anemia in 65 cases (94.2%), thrombocytopenia in 64 cases (92.8%), leukopenia in 32 cases (46.4%) and pancytopenia in 26 cases (37.7%). 4) Twenty two cases transformed to acute myelogenous leukemia during the follow-up periods. Chemotherapy was done in 18 cases among 22 cases of transformed acute myelogenous leukemia. Complete remission was achieved in 3 cases (16.7%), partial remission in 4 cases (22.2%) and no response in 11 cases (61.1%). 5) Forty seven cases were treated by low dose cytarabine chemotherapy. Complete response was achieved in 11 cases (23.4%), partial response in 13 cases (27.7%) and no response in 23 cases (48.9%). Median duration of complete response was 12 weeks. 6) We made score system, which based on Sanz score and Gattermann score, according to age, hemoglobin, platelet and bone marrow blast. Overall survival was higher in group A (score< or = 5) than group B (score> or = 6). Complete response of low dose cytarabine chemotherapy was higher in group A than group B but overall survival according to low dose cytarabine chemotherapy was not different in group A and group B. CONCLUSION: Low dose cytarabine chemotherapy was not effective in survival benefit. Score system according to prognostic factors was important to predict therapeutic response and prognosis. In the future, more intensive therapeutic plan and analysis of prognostic factors should be considered.
Anemia ; Anemia, Refractory, with Excess of Blasts ; Blood Platelets ; Bone Marrow ; Cytarabine* ; Daegu ; Diagnosis ; Dizziness ; Drug Therapy ; Dyspnea ; Female ; Fever ; Follow-Up Studies ; Gyeongsangbuk-do ; Humans ; Leukemia, Myeloid, Acute ; Leukopenia ; Male ; Myelodysplastic Syndromes* ; Pallor ; Pancytopenia ; Prognosis ; Thrombocytopenia

BACKGROUND: Although multiple myeloma is known to be a hematologic malignancy which cannot be cured, MP (melphaln, prednisone) based combination chemotherapy can prolong survival and improve quality of life for myeloma patients. The purpose of this report is to analyse chemotherapeutic effect and prognostic factors in myeloma patients. METHODS: Between March, 1983 and March, 1995 at Yeungnam University Hospital 45 patients were diagnosed as multiple myeloma by SWOG criteria. Thirty-four of 45 patients were treated with MP chemotherapy. RESULTS: 1) The peak incidence was in 6th decade (20%) and male to female ratio was 2.2:1. The most common presenting symptom at first diagnosis was bone pain (55%). 2) Seventy one percent of the patients were clinical stage III. Performance status (ECOG scale) was grade 3 in 64%, grade 2 in 12%, grade 1 in 9% of the patients. 3) Hematologic findings showed anemia (Hb<8.5g/dL) in 40%, leukopenia in 27%, thrombocytopenia in 27% and increased ESR in 72% of the patients. Hypercalcemia was noted in 11% and renal failure in 29%. Serum immune electrophoresis revealed myeloma protein as IgG in 67%, light chain only in 24%, IgA in 9%, and kappa to lambda ratio was 1:2.6. 4) The median survival of chemotherapy group was 84 weeks and that of non-treatment group was 7 weeks. Response rate to MP chemotherapy was 35%, median response duration was 78 weeks. There was statistically significant survival difference between responder and non-responder (187 weeks to 27 weeks) (P<0.001). 5) Patients with ECOG grade>3, hypercalcemia, renal insufficiency, beta-2 microglobulin >4microgram/mL, non-treatment group, non-responder had lower survival time. CONCLUSION: These results suggest that there is no prospect of cure with MP-based chemotherapy, but the survival benefit is meaningful for patients with chemotherapy responder. More intensive treatment, especially myeloablative treatment with bone marrow or peripheral blood stem cell transplantation should be investigated, considering curability.
Anemia ; Bone Marrow ; Diagnosis ; Drug Therapy ; Drug Therapy, Combination ; Electrophoresis ; Female ; Hematologic Neoplasms ; Humans ; Hypercalcemia ; Immunoglobulin A ; Immunoglobulin G ; Incidence ; Leukopenia ; Male ; Multiple Myeloma* ; Peripheral Blood Stem Cell Transplantation ; Quality of Life ; Renal Insufficiency ; Staphylococcal Protein A ; Thrombocytopenia

OBJECTIVETo analyze experimental results of Graft-versus-host disease (GVHD) after liver transplantation.

METHODS13 cases of GVHD out of the 1013 liver transplantation between 2002-2008 were analysed. Routine blood test, liver function and microorganisms test were done in all of the 13 cases, bone marrow test was done in 5 cases, liver pathological test was done in 5 cases, cytokines were analyzed in 4 cases, chimerism test was done in 6 cases.

RESULTSLeukocytes were reduced to various degree in all 13 cases, and were extremely low in 8 cases. Hematopoiesis was repressed in 4 cases. Normal liver function was found in 9 cases. Bacterium were found in blood, bile, wound secrete juice, excrement, phlegm of 10 cases. The pathological characteristics was in accordance with GVHD in 5 cases. The levels of IL-1 alpha, IL-1 beta, IL-2, IL-4 were low or undetectable. IL-10 was decreased in 4 cases but increased in 1 case. MCP-1, VEGF, IL-6, EGF, IL-8 were increasing or remained at high level during GVHD. TNF alpha was slightly increased. IFN gamma was only slightly changed before GVHD.

CONCLUSIONChimerism is a reliable but not unique evidence of GVHD.

Acute Disease ; Adult ; Aged ; Bacterial Infections ; etiology ; Bone Marrow Diseases ; blood ; etiology ; Bone Marrow Examination ; Cause of Death ; Chimerism ; Cytokines ; blood ; Female ; Graft vs Host Disease ; blood ; diagnosis ; etiology ; mortality ; Humans ; Interleukins ; blood ; metabolism ; Leukopenia ; blood ; etiology ; Liver Transplantation ; adverse effects ; Male ; Middle Aged ; Retrospective Studies ; Transplantation, Autologous ; Tumor Necrosis Factor-alpha ; metabolism