1/40. bacillus cereus causing fulminant sepsis and hemolysis in two patients with acute leukemia.PURPOSE: hemolysis is so rarely associated with bacillus cereus sepsis that only two very well documented cases have been reported. This article reports two unusual cases of bacillus cereus sepsis with massive intravascular hemolysis in patients who had acute lymphoblastic leukemia (ALL). patients AND methods: A 20-year-old woman who was 9 weeks pregnant experienced a relapse of ALL. A therapeutic abortion was performed. During week 4 of reinduction the patient had abdominal pain, nausea, and vomiting, with severe neutropenia but no fever. Her condition deteriorated rapidly with cardiovascular collapse, acute massive intravascular hemolysis, and death within hours of the onset of symptoms. Blood cultures were positive for bacillus cereus. Postmortem histologic examination and cultures revealed bacillus cereus and candida albicans in multiple organs. The second patient, a 10-year-old girl, presented with relapsed T-cell ALL. In the second week of reinduction, she had abdominal pain followed by hypotension. Again, no fever was noted. Laboratory studies showed intravascular hemolysis 12 hours after admission. Aggressive support was promptly initiated. Despite disseminated intravascular coagulation; cardiovascular, hepatic, and renal failure; and multiple intracerebral hypodense lesions believed to be infarcts, the patient recovered fully and resumed reinduction therapy. CONCLUSIONS: bacillus cereus infection can have a fulminant clinical course that may be complicated by massive intravascular hemolysis. This pathogen should be suspected in immunosuppressed patients who experience gastrointestinal symptoms and should not be precluded by the absence of fever, especially if steroids such as dexamethasone are being given. Exchange transfusion may be lifesaving in bacillus cereus septicemia associated with massive hemolysis.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
2/40. First clinical experience with the DeBakey VAD continuous-axial-flow pump for bridge to transplantation.BACKGROUND: A shortage of donor organs and increased numbers of deaths of patients on the waiting list for cardiac transplantation make mechanical circulatory support for a bridge to transplantation a standard clinical procedure. Continuous-flow rotary blood pumps offer exciting new perspectives. methods AND RESULTS: Two male patients (ages 44 and 65 years) suffering from end-stage left heart failure were implanted with a DeBakey VAD axial-flow pump for use as a bridge to transplant. In the initial postoperative period, the mean pump flow was 3.9 /-0.5 L/min, which equals a mean cardiac index (CI) of 2.3 /-0.2 L. min(-1). m(-2). In both patients, the early postoperative phase was characterized by a completely nonpulsatile flow profile. However, with the recovery of heart function 8 to 12 days after implantation, increasing pulse pressures became evident, and net flow rose to 4.5 /-0.6 L/min, causing an increase of mean CI up to 2.7 /-0.2 L. min(-1). m(-2). patients were mobilized and put through regular physical training. hemolysis stayed in the physiological range and increased only slightly from 2. 1 /-0.8 mg/dL before surgery to 3.3 /-1.8 mg/dL 6 weeks after implantation. CONCLUSIONS:The first clinical implants of the DeBakey VAD axial-flow pump have demonstrated the device to be a promising measure of bridge-to-transplant mechanical support.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
3/40. Severe haemolysis after an ABO unmatched kidney transplant - a nonsecretor transplanted from a donor with high anti-A titre.A case of severe haemolysis following an ABO unmatched renal transplant is reported in a group A nonsecretor who received a kidney from a group O living related donor. Following the haemolytic episode, group A donor units were incompatible and the patient was transfused with group O blood. Serological investigation of the recipient revealed anti-A present in the serum and on the red cells. Investigation of the donor revealed the presence of high-titre anti-A. The association of such high-titre donor antibody with haemolysis in ABO unmatched grafts has not been reported before. We discuss the risk factors for developing haemolysis in an ABO unmatched organ transplant and explore the possible relevance of such high donor antibody titre to recipients who are nonsecretors.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
4/40. lead poisoning. A comprehensive review and report of a case.Lead, a ubiquitous heavy metal which has realized increased use, can cause poisoning by environmental contamination in either its organic or its inorganic form. lead poisoning can be either acute or chronic, with the latter being the more common. The clinical signs and symptoms of lead poisoning are nonspecific, resulting in a difficult diagnostic problem, especially when it is not industrially related. On occasions, the dentist or oral surgeon may be the first to see an afflicted patient because of oral manifestations.- - - - - - - - - - ranking = 2keywords = organ (Clic here for more details about this article) |
5/40. Unusual presentation of congenital syphilis.Congenital syphilis (CS) usually presents in the neonatal period and may involve any organ system. The signs are diverse and a high index of suspicion must be maintained to make the diagnosis. Early congenital syphilis can present at any time before 2 years of age, but a review of the literature over the last 30 years indicates that it usually presents in the neonatal period and seldom later than 3-4 months of life. We report an 8-month-old boy who presented an unusual combination of signs of congenital syphilis, which led to delay in establishing the diagnosis. This case emphasises the importance of maintaining a high index of suspicion for CS throughout early childhood.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
6/40. Alloimmune hemolysis after renal transplantation.A 35-year-old patient with blood group AB developed hemolysis 1 week after receiving a blood group B cadaveric kidney transplant. The patient's serum was shown to contain anti-A antibody, which was likely to have been derived from passenger lymphocytes transplanted concurrently with the graft. The alloimmune hemolysis subsided spontaneously without treatment. The present case underscores the potential complication of ABO blood group-compatible but nonidentical organ transplantation. Clinical vigilance is important to differentiate from other more sinister causes of posttransplant hemolysis.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
7/40. Severe hemolysis with a fabric-worn cloth-covered aortic valve prosthesis.A patient developed severe hemolytic anemia one year after insertion of a cloth-covered aortic valve prosthesis (Starr-Edwards No. 2320). The cloth over the three struts was disrupted but showed coverage with mostly organized collagen. hemolysis stopped after replacement with a porcine heterograft. Fabric wear seems to augment the hemolysis in patients with cloth-covered artificial valves.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
8/40. Donor-derived alloantibodies and passenger lymphocyte syndrome in two of four patients who received different organs from the same donor.BACKGROUND: Reported here is the occurrence of RBC alloimmunization in two of four patients who received different organs from an immunized donor. STUDY DESIGN AND methods: The donor, a 58-year-old woman, was group O D , K-, and Fy(a-). Initially, her serum contained only a K antibody. After blood transfusion, a second antibody (anti-Fy(a)) could also be identified. The liver was given to a group O D , K-, Fy(a ) patient; the pancreas and one kidney to a group O D , K-, Fy(a ) patient; the heart to a group A D , K-, Fy(a-) patient; and the other kidney to a group B D , K-, Fy(a ) patient. RBC grouping and antibody screening were performed by standard techniques. Lymphoid microchimerism in the peripheral blood of the recipients was analyzed by flow cytometry and nested PCR. RESULTS: None of the recipients had irregular RBC alloantibodies at the time of transplantation. After the transplant, anti-K became detectable in the serum of the liver recipient, and anti-Fy(a) could be eluted from the RBCs of the liver recipient and the pancreas-kidney recipient. The latter patient also developed mild hemolysis, and his Hb dropped to 8 g per dL on posttransplant Day 9. Donor-derived lymphocytes were detectable by flow cytometry in the peripheral blood of the liver recipient and the pancreas-kidney recipient until Days 8 and 63, respectively, whereas no lymphoid chimerism could be demonstrated in the heart recipient. PCR chimerism analyses were positive in all three recipients over the whole observation period of 97 postoperative days. CONCLUSION: The amount of cotransplanted lymphoid tissue may correlate with the extent of peripheral lymphoid microchimerism and the antibody-formation capacity in solid organ transplantation.- - - - - - - - - - ranking = 6keywords = organ (Clic here for more details about this article) |
9/40. Donor anti-Jk(a) causing hemolysis in a liver transplant recipient.BACKGROUND: Hemolytic transfusion reactions have been observed in recipients of ABO- and/or D-mismatched marrow, peripheral blood, and solid organs. Passenger lymphocyte syndrome occurs when immunocompetent donor lymphocytes transferred during transplantation produce alloantibodies against host antigens. CASE REPORT: The first case of a delayed, anti-Jk(a)-mediated hemolytic reaction in a liver transplant recipient, caused by passenger donor lymphocytes, is reported here. A 43-year-old man underwent liver transplantation. Six weeks later, the patient underwent a second liver transplant. On Day 10 of the second transplant, clinical hemolysis ensued; anti-Jk(a) was detected. The patient's DAT became positive, and anti-Jk(a) was eluted from his RBCs. On Day 35 of the patient's second transplant, 3 weeks after the last blood transfusion, the patients' DAT was still weakly positive with anti-Jk(a) in the eluate. Six months later, serum antibody screening was negative, but the DAT was still weakly positive. The patient's RBCs tested Jk(a ), whereas the second donor's RBCs were Jk(a-). CONCLUSION: This is the first documentation of clinically significant hemolysis caused by anti-Jk(a), produced by passenger lymphocytes transferred from the donor's liver to the transplant recipient.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
10/40. Phenotypic variation of staphylococcus epidermidis isolated from a patient with native valve endocarditis.Two colonial variants of staphylococcus epidermidis were isolated from the valvular tissue of a patient with native valve endocarditis. In addition to differing in colonial morphology, the two variants differed in hemolysis on blood-containing media, in adherence capacity, and in the expression of certain enzymes. Under suitable conditions, both variants were themselves capable of phenotypic variation, although they differed in the rate at which variants were generated. The variants yielded identical profiles on restriction endonuclease analysis of plasmid dna and pulsed-field gel electrophoresis of whole-cell dna. This report suggests a possible role for phenotypic variation in coagulase-negative staphylococcal virulence. congo red agar would be an excellent medium for studying the contribution of variation to the virulence of these organisms.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
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