Abnormal Hepatic Function and Splenomegaly on the Newly Diagnosed Acute Leukemia Patients

Poudel, Bishal; Karki, Lochan

doi:10.31729/jnma.258

Cited by 8 publications

(6 citation statements)

References 15 publications

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“…Unlike patient blood volume, however, the physiologic underpinning of this association is not known, but it is plausible that this finding also has a biologic basis. While information regarding spleen size or function was not directly captured in our study, splenomegaly occurs frequently in patients with acute myeloid leukemia (60% of our study population) and in those with leukemia evolved from myelodysplastic syndrome (another significant portion of our study population) and may correlate with disease severity . Previous studies have further demonstrated that patients with enlarged spleens also have reduced responses to transfusion .…”

Section: Discussionmentioning

confidence: 82%

“…While information regarding spleen size or function was not directly captured in our study, splenomegaly occurs frequently in patients with acute myeloid leukemia (60% of our study population) and in those with leukemia evolved from myelodysplastic syndrome (another significant portion of our study population) and may correlate with disease severity. 21,22 Previous studies have further demonstrated that patients with enlarged spleens also have reduced responses to transfusion. [23][24][25] While speculative, these observations logically suggest that patients in this cohort presenting with a lower starting pretransfusion Hgb may also have had more severe disease with potentially larger spleen sizes and had reduced responses to transfusion as a result.…”

Section: Discussionmentioning

confidence: 99%

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The impact of recipient factors on the lower‐than‐expected hemoglobin increment in transfused outpatients with hematologic diseases

et al. 2019

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BACKGROUND Patients with cancer or chronic hematologic disorders frequently receive red blood cell (RBC) transfusions. Based on long‐standing assumptions, each RBC unit is thought to increase recipient hemoglobin by 1 g/dL, but smaller increments can occur. A better understanding of recipient factors affecting hemoglobin increments could help providers manage these patients. METHODS Data were collected as a part of the observational Red Cells in Outpatients Transfusion Outcomes (RETRO) study of outpatients with hematologic or cancer‐related diagnoses. Hemoglobin was measured before transfusion and 30 minutes after transfusion. A classification and regression tree (CART) analysis was performed to identify statistically significant associations with clinical variables. A corresponding prediction equation was developed and validated using linear regression. RESULTS A total of 195 participants had both pre‐ and posttransfusion hemoglobin values for analysis. The median age was 66 years, and patients received one (73%) or two (27%) RBC units during the transfusion episode. The overall median change in hemoglobin was 0.6 g/dL per RBC unit. Both CART analysis and linear regression identified the following significant predictors of hemoglobin increment: number of units received (positive correlation), patient estimated circulating blood volume (negative correlation), pretransfusion hemoglobin (negative correlation), and patient age (negative correlation). CONCLUSION In this study of outpatients with hematologic disease, most patients had a hemoglobin increment of less than 1 g/dL/unit. Recipient‐specific factors influenced the hemoglobin increment at 30 minutes, and providers should consider circulating blood volume, pretransfusion hemoglobin, and recipient age, when developing patient‐specific RBC transfusion plans for this unique cohort.

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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

The impact of recipient factors on the lower‐than‐expected hemoglobin increment in transfused outpatients with hematologic diseases

et al. 2019

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“…Healthy volunteers (HV) and acute myelogenous leukemia (AML) were taken as control groups with no liver disease. Liver dysfunction is a rare complication of AML (43) and in one study of AML and acute lymphoblastic leukemia in Nepal (44), abnormal liver function tests (LFTs) were recorded in a subset of the patients. LFTs were within normal ranges for the 22 AML patients described in this study.…”

Section: Discussionmentioning

confidence: 99%

Aberrant Lipid Metabolism in Hepatocellular Carcinoma Revealed by Plasma Metabolomics and Lipid Profiling

et al. 2011

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There has been limited analysis of the effects of hepatocellular carcinoma (HCC) on liver metabolism and circulating endogenous metabolites. Here we report the findings of a plasma metabolomic investigation of HCC patients using ultraperformance liquid chromatography-electrospray ionization-quadrupole mass spectrometry (UPLC-ESI-QTOFMS), random forests machine learning algorithm and multivariate data analysis. Control subjects included healthy individuals as well as patients with liver cirrhosis or acute myeloid leukemia. We found that HCC was associated with increased plasma levels of glycodeoxycholate, deoxycholate 3-sulfate and bilirubin. Accurate mass measurement also indicated upregulation of biliverdin and the fetal bile acids 7α-hydroxy-3-oxochol-4-en-24-oic acid and 3-oxochol-4,6-dien-24-oic acid in HCC patients. A quantitative lipid profiling of patient plasma was also performed using ultra-performance liquid chromatography-electrospray ionization-triple quadrupole mass spectrometry (UPLC-ESI-TQMS). Using this method we found that that HCC was associated also with reduced levels of lysophosphocholines (LPC) and in 4/20 patients with increased levels of lysophosphatidic acid (LPA(16:0)), where it correlated with plasma α-fetoprotein levels. Interestingly, when fatty acids were quantitatively profiled by gas chromatography-mass spectrometry (GCMS), we found that lignoceric acid (24:0) and nervonic acid (24:1) were virtually absent from HCC plasma. Overall, this investigation illustrates the power of the new discovery technologies represented in the UPLC-ESI-QTOFMS platform combined with the targeted, quantitative platforms of UPLC-ESI-TQMS and GCMS for conducting metabolomic investigations that can engender new insights into cancer pathobiology.

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“…In ALL, most commonly affected extra lymphoreticular sites are nervous system and testes. [6,11] Our patient had multiple retroperitoneal organs and liver/duodenal involvement at the onset and CNS involvement during treatment, indicating the more aggressive biologic behavior of tumor cells. Despite good therapeutic response achieved at initial phase, the prognosis was still poor.…”

Section: Discussionmentioning

confidence: 85%

Acute lymphoblastic leukemia with pancreas involvement in an adult patient mimicking pancreatic tumor

Wang¹,

Zhang

Dong³

et al. 2019

Medicine

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Rationale: Acute lymphoblastic leukemia (ALL) is a malignant disease originating from abnormal proliferation of B or T lymphocytes in bone marrow (BM). Invasion of the pancreas is extremely rare in adults. Patient concerns: In this article, we report a case presenting that ALL invades the pancreas, as well as liver, kidney, and duodenum detected by magnetic resonance image. The patient was misdiagnosed as pancreatic tumor at initial since hemogram was unremarkable. Diagnoses: The diagnosis of ALL was established based on the endoscopic ultrasonography-guided fine-needle aspiration and bone marrow examination, showing BCR / ABL gene positive. Interventions: The patient was actively treated with chemotherapy. Hematological remission was obtained and the lesions in the pancreas disappeared. Outcomes: The patient finally died of complication from fungal pneumonia and central nervous system involvement 12 months after diagnosis. Lessons: Under the context of infection, persistent or intermittent fever and complete blood count are not significant prognoses of pancreatic involvement for adult with ALL. We hope that this case will help hepatobiliary and pancreatic surgeon to be aware of this kind of disease as pancreatic carcinoma and pancreas involvement by ALL have totally different treatment strategy.

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Abnormal Hepatic Function and Splenomegaly on the Newly Diagnosed Acute Leukemia Patients

Abstract: Abstract

Cited by 8 publications

References 15 publications

The impact of recipient factors on the lower‐than‐expected hemoglobin increment in transfused outpatients with hematologic diseases

The impact of recipient factors on the lower‐than‐expected hemoglobin increment in transfused outpatients with hematologic diseases

Aberrant Lipid Metabolism in Hepatocellular Carcinoma Revealed by Plasma Metabolomics and Lipid Profiling

Acute lymphoblastic leukemia with pancreas involvement in an adult patient mimicking pancreatic tumor

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