To examine the effects of acute altitude-induced hypoxia on the hormonal and metabolic response to ingested glucose, 8 young, healthy subjects (5 men/3 women; 26±2 yrs; BMI, 23.1±1.0 kg/m2) performed two randomized trials in a hypobaric chamber where a 75 g glucose solution was ingested under simulated altitude (ALT, 4,300m), or ambient (AMB, 362m) conditions. Plasma glucose, insulin, c-peptide, epinephrine, leptin and lactate concentrations were measured at baseline and 30, 60, 90 and 120 min after glucose ingestion during both trials. Compared to AMB, the plasma glucose response to glucose ingestion was reduced during the ALT trial (P=0.04). There were no differences in the insulin and c-peptide responses between trials, or in insulin sensitivity based on HOMA-IR. Epinephrine and lactate were both elevated during the ALT trial (P<0.05), while the plasma leptin response was reduced compared to AMB (P<0.05). The data suggest that the plasma glucose response is suppressed at ALT, but this is not due to insulin per se, since insulin and c-peptide levels were similar for both trials. Elevated plasma epinephrine and lactate during ALT is indicative of increased glycogenolysis, which may have masked the magnitude of the reduced glucose response. We conclude that during acute altitude exposure there is a rapid metabolic response that is accompanied by a shift in the hormonal milieu that appears to favor increased glucose utilization.

The distinction between plasmablastic lymphoma from plasmablastic myeloma warrants detailed knowledge of clinical, radiological and laboratorial findings. New studies identifying distinctive phenotypical or genetic features are needed to improve the histopathological differentiation of plasmablastic neoplasms.

Eosinophilic angiocentric fibrosis is a rare indolent lesion of the head and neck region that has characteristic histologic findings of onionskin fibrosis and prominent eosinophils. Its pathogenesis has been poorly understood and has been most commonly attributed to hypersensitivity or previous trauma. Recently, the lesion has been included in the spectrum of immunoglobulin G4 (IgG4)–related disease. However, few of the existing cases of eosinophilic angiocentric fibrosis have been evaluated for IgG4+ and IgG+ plasma cells. Therefore, we provide an update on the clinical and histologic features of eosinophilic angiocentric fibrosis to increase awareness of the entity and encourage its further characterization as an IgG4-related disease.

Objectives Although hemoglobin thresholds for red blood cell (RBC) transfusion have decreased, double‐unit RBC transfusion practices persist. We studied the effects switching from predominantly double‐unit to single‐unit RBC transfusions had on utilization and clinical outcomes for malignant hematology patients. Methods Retrospective chart review compared malignant hematology patients before and after implementing single‐unit RBC transfusion policy. Hemoglobin threshold was 8.0 g/dL for both groups. RBC utilization metrics included number of RBC units transfused, RBC units transfused per admission, and number of transfusion episodes. Clinical outcomes included length of stay, 30‐day mortality, and outpatient RBC transfusion 30‐days post‐discharge. Results Baseline hemoglobin was similar in both groups. The single‐unit group was transfused with fewer RBC units per admission (5.1 vs 4.5, P = 0.01) than the double‐unit group, but had more transfusion episodes per admission (4.1 vs 2.7, P < 0.001). After implementing single‐unit policy, a 29% reduction in RBC utilization was observed. Mean hemoglobin at discharge was lower in the single‐unit group (8.9 vs 9.5 g/dL, P = 0.005). No significant differences in length of stay or 30‐day mortality were observed. Conclusion Transfusing malignant hematology patients with single RBC units is safe and efficacious. Electronic provider order systems facilitating RBC transfusion requests provide excellent adherence to transfusion policy.