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Biomedical subjects

J R Krause

Publications and source records attributed to J R Krause.

At least 73 records · Page 4Linked to original sources
PubMed1982

The effect of hemoglobin F upon glycosylated hemoglobin determinations.

Glycosylated hemoglobin (Hgb A1) determinations have been advocated for monitoring the control of diabetes mellitus. The prevalent method today for measuring Hgb A1 for most clinical laboratories has been a "mini-column" utilizing ion exchange chromatography. It has been stated that hemoglobin F (Hgb F) will elute with Hgb A1 and interfere with Hb A1 determinations. This study was designed to determine the quantitative effects of Hgb F upon Hgb A1 determinations. Thirty per cent of the study group had elevated Hgb A1 levels at 2% Hgb F concentration, 66% at 3% Hgb F concentration, and all individuals had elevated Hgb A1 levels at Hgb F concentrations of 4% or greater. The relationship of Hgb F to Hgb A1 concentration was not a simple identity, but could be represented by the equation y = 6.03 + 1.24x. If the ion exchange chromatography methodology is used, Hgb F levels should be determined whenever Hgb A1 levels are elevated, particularly in populations where increased Hgb F levels also might be encountered. The authors determined Hgb F levels whenever the concentration of Hgb A1 was 10% or greater. In their population, they found that approximately 1.5% of samples with elevated Hgb A1 concentrations had increased (greater than 2%) Hgb F levels.

Chromatography↗
PubMed1982

Bone marrow findings in infectious mononucleosis and mononucleosis-like diseases in the older adult.

The bone marrow findings in 5 older adults with infectious mononucleosis or mononucleosis-like illnesses are presented. These individuals were initially considered to have lympho-proliferative disorders which often have similar constitutional signs and symptoms. All had atypical lymphocytosis of the peripheral blood. In addition, there were also abnormalities in the bone marrow. The most common findings included focal collection of lymphocytes and the presence of granulomas. The granulomas were small without caseous necrosis and giant cells were infrequent. This is in contrast to the idea that the bone marrow is normal in infectious mononucleosis and gives support to performing core biopsies as the aspirate smears in these individuals did not demonstrate the focal lymphocytosis or granulomas. Whereas, infectious mononucleosis and mononucleosis-like illness may be uncommon in the older individual, they certainly are not rare and it is important to differentiate these benign disorders from the more serious lymphoproliferative diseases. Heterophil test and/or Epstein Barr titers are important confirmatory tests.

Age Factors↗
PubMed1980

Induced acute non-lymphocytic leukemia following long-term chemotherapy: a study of 20 cases.

Twenty individuals developed acute non-lymphocytic leukemia (ANLL) following long-term chemotherapy for other disorders. The primary disorders included non-Hodgkin's lymphoma (five), Hodgkin's disease (five), carcinoma (four), multiple myeloma (three), chronic leukemia (two), and rheumatoid arthritis. Leukemia developed from 11-132 months (mean approximately 60 months) following institution of chemotherapy and all cases have occurred since 1974. Pre-leukemic cytopenias were present in 15 individuals. Fifteen of the 20 patients had chromosome analyses and 14 were abnormal. The leukemia was invariably refractory to chemotherapy with a median survival of only two months. Of the patients autopsied, only one individual had any evidence of the primary malignancy. This study illustrates the need for surveillance for secondary ANLL following long-term chemotherapy with/without radiotherapy. Duration of optimal chemotherapy for the primary disease must be determined by control trials and weighed against the risk of developing a secondary leukemia.

Adult↗
PubMed1980

Serum ferritin and bone marrow biopsy iron stores. II. Correlation with low serum iron and Fe/TIBC ratio less than 15%.

Diseases associated with defective reticuloendothelial release of iron may be difficult to distinguish from the iron-deficient state, since serum iron parameters (serum iron, percentage saturation of transferrin less then 15%) may overlap. Assessment of the bone marrow biopsy iron stores was often necessary to resolve the diagnosis. Serum ferritin levels have proved very useful in distinguishing the uncomplicated iron-deficient state from other disorders associated with low serum iron and low percentage saturation of transferrin. However, a small percentage of iron-deficient persons may have normal ferritin values, particularly if these persons have liver disease or hematopoietic or lymphoreticular neoplasms. In these cases, assessment of the bone marrow biopsy iron would still be necessary to evaluate the body iron stores.

Bone Marrow↗
PubMed1979

Granulocytic sarcoma preceding acute leukemia: a report of six cases.

An unusual case of granulocytic sarcoma presenting in a pericardial effusion following trauma and preceding acute myelogenous leukemia (AML) by 8 months is presented. Five additional cases of granulocytic sarcoma preceding leukemia collected by the author are also tabulated. Granulocytic sarcoma in a nonautopsy population of myelogenous leukemic patients was found to be 2.9%. When presenting in an extramedullary site, especially preceding peripheral blood and bone marrow manifestations of leukemia, a misdiagnosis of histiocytic lymphoma may result. In questionable cases, other techniques including the naphthol-ASD-chloroacetate stain, touch imprints, immunoperoxidase stain for lysozyme, and electron microscopy should be utilized. Although only a small series, the most recent cases have shown induction/remission and survival characteristics of AML patients without granulocytic sarcoma.

Adolescent↗
PubMed1979

Comparison of stainable iron in aspirated and needle-biopsy specimens of bone marrow.

A comparison of stainable iron in simultaneously obtained aspirated smears and needle-biopsy specimens from 1,000 patients was undertaken. Significant differences occurred when iron was assessed as absent in the aspirated smear. In only 35% of the corresponding needle-biopsy specimens was iron absent. When only the aspirated smear was used, there was a significant overdiagnosis of iron deficiency. In general, iron tended to be less in the aspirated smear; however, correlations were better when iron stores were assessed as being present or increased in the aspirated smears, for stainable iron in the needle-biopsy specimen was always present in equal or greater amounts. Hemosiderotic smears (increased stainable iron) and needle-biopsy specimens (3+ -4+) correlated well. The aspirated smear and needle-biopsy are complementary procedures, and each has advantages. In the authors' experience, the needle-biopsy was preferable to the aspirated smear for evaluation of iron stores, particularly when iron stores were low or absent.

Biopsy, Needle↗
PubMed1979

Serum ferritin and bone marrow iron stores. I. Correlation with absence of iron in biopsy specimens.

Serum iron, total iron-binding capacity, and percentage saturation of transferrin have classically been used to demonstrate a hypoferremic state; however, these tests may not discriminate between depleted iron stores and conditions associated with defective reticuloendothelial release of iron. Estimation of stainable iron in the bone marrow biopsy specimen is then the most practical way to assess body iron stores. With the availability of a radioimmunoassay procedure for serum ferritin, we undertook a prospective study to determine whether serum ferritin concentrations might replace assessment of the marrow biopsy iron stores as an indicator of hypoferremia. Iron stores were absent from bone marrow biopsy specimens from 104 patients. A good correlation between low serum ferritin levels and absence of iron stores in biopsy specimens was found for 91 patients (87.5%). Thirteen (12.5%) had normal serum ferritin concentrations with absence of biopsy iron. These individuals had hematopoietic malignancies or active hepatic disease, or were receiving iron therapy. In this group, a bone marrow biopsy would still be necessary for evaluation of a hypoferremic state, even though the serum ferritin concentration might be normal.

Adult↗
PubMed1979

Identification of cytomegalovirus in bone marrow biopsy.

The bone marrow trephine biopsy has become a common procedure for evaluating hematopoietic abnormalities. Occasionally, the first clue to an infectious process is obtained from this source. A bone marrow biopsy, done to evaluate pancytopenia in a patient who had received a renal transplant, revealed large intranuclear inclusions diagnostic of cytomegalovirus. Antibody titers were initially negative but rose over the next few weeks to confirm the diagnosis. Even though the bone marrow biopsy may not be the best site for finding CMV inclusions, the careful examination of a random bone marrow biopsy, particularly in an immunosuppressed individual, may contribute to the diagnosis.

Adolescent↗
PubMed1979

Rhabdomyosarcoma presenting as carcinocythemia.

A case of rhabdomyosarcoma presenting with circulating tumour cells (carcinocythemia) is discussed. Tumor cells must be differentiated from leukemic cells or a leukemoid reaction. If the abnormal cells appear as syncytia, tumor should be strongly suspected. Cytochemical and/or histochemical stains should also be employed to differentiate tumor cells from hematopoietic cells.

Abdominal Neoplasms↗
PubMed1979

Acute leukaemia and Gaucher's disease.

As association between Gaucher's disease and haematopoietic neoplasias has been reported in only a few instances. The authors recently encountered 2 cases of adult Gaucher's disease that developed acute myelogenous/myelomonocytic leukaemia. Both individuals had a pre-leukaemic phase. These cases are reported.

Aged↗
PubMed1979

Chronic granulocytic leukemia occurring in blast crisis.

Cytogenetic studies of marrow using chromosomal banding techniques revealed the presence of the Philadelphia (PH1) chromosome in two patients with clinical and hematologic findings of acute myelogenous leukemia (AML). A review of the literature since the use of chromosomal banding techniques revealed about 15 patients with Ph1)-positive acute leukemia that we consider to be chronic granulocytic leukemia (CGL) occurring in blast crisis. We describe two additional patients, one of whom we believe is unique in that the initial blast crisis contained Auer's rod-positive cells.

Bone Marrow↗
PubMed1979

Carcinocythemia.

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Abdominal Neoplasms↗
PubMed1978

Granulocytic sarcoma of the uterus.

The presenting features of vaginal bleeding and abnormal cytologic smears in a elderly patient with simultaneously occurring acute myelogenous leukemia (AML), were due to massive infiltration of the uterine cervix and endometrium by immature myeloid elements or granulocytic sarcoma. The abnormal cytologic smears and uterine mass were initially believed to represent a poorly differentiated lymphocytic lymphoma. The diagnosis of granulocytic sarcoma was confirmed with the naphthol AS-D chloroacetate stain that demonstrated activity in the cytoplasm of the neoplastic cells.

Diagnosis, Differential↗
PubMed1978

Ovarian carcinoma terminating in acute nonlymphocytic leukemia following alkylating agent therapy.

Rapidly fatal acute myelogenous leukemia (AML) occurred in a woman with advanced (Stage III) ovarian carcinoma who was treated with thiotepa for 30 months. This patient was 1 of 10 long term survivors and represented less than 2% of patients with advanced ovarian carcinoma with regional metastases who received long term chemotherapy during the period 1947-1975. Acute leukemia developed 44 months after initial diagnosis and was preceded by a 10 month period of pancytopenia following cessation of thiotepa. The leukemia did not respond to treatment and the patient expired 3 weeks after its onset. At autopsy, leukemic infiltration of organs was seen, but there was no evidence of carcinoma. A review of the literature suggests that the development of AML reported in ovarian cancer patients is related to alkylating agent therapy.

Adult↗
PubMed1978

Cryocrystalglobulinemia in hairy cell leukemia.

A patient with hairy cell leukemia (leukemic reticuloendotheliosis) was noted to have a spurious leukocytosis caused by a spontaneously crystallizing cryoglobulin. The cryoprotein was identified as IgG lambda. An intracytoplasmic immunoglobulin demonstrable within the hairy cell was also IgG lambda. The cryoglobulin spontaneously disappeared over a four day period. A reliable automated count on the Coulter Model S could be obtained by prewarming the blood specimen to 37 C.

Aged↗