Thrombocytopenia in solid tumors

Thrombocytopenia in patients with solid malignancy can be caused by bone marrow involvement or toxicity from anticancer therapy; however, it could rarely be the first presentation of a tumor such as breast cancer or lymphoma. Hematological paraneoplastic syndromes such as paraneoplastic thrombocytopenia and/or immune thrombocytopenic purpura (ITP) are well described as secondary findings simultaneously with malignancies such as breast cancer and lymphoma. Other hematological conditions such as severe amegakaryocytic thrombocytopenia, thrombotic thrombocytopenic purpura (TTP), and myelodysplastic syndromes (MDS) have also rarely been described as a possible paraneoplastic process complicating solid tumors. On the one hand, occult disseminated malignancy may mimic ITP and TTP, leading to diagnostic and therapeutic problems. On the other hand, thrombocytopenia could be the first manifestation of cancer

Prediction of Bone Marrow Cellularity from Aspiration as compared to Trephine Biopsy

Background: Bone marrow cellularity is an essential and integral part of the bone marrow examination report. Cellularity could be obtained from both bone marrow aspirations and biopsies. Predicting marrow cellularity from aspiration as opposed to biopsy would give the clinician the convenience of an early diagnosis and timely management. In this study, we aimed at knowing the degree of correlation between the bone marrow aspiration cellularity that could be ready within a short period of time to that of bone marrow biopsy cellularity that could take days to have a positive impact on the management, especially for acute blood disorders. Materials and Methods: We collected 200 consecutive bone marrow aspirations from the Nanakaly Teaching Hospital. All the bone marrow biopsy slides belonging to the same group of patients were also collected from the main histology center at Rizgary Teaching Hospital. Five expert hematopathologists were given the chance to report on the cellularity for both the aspirations and the biopsies. The study was performed in sessions, limiting each session to 20 aspirations and 20 biopsies. Cellularity was rated in percentage points of 5 giving the observer the chance to rate the cellularity from 0% to 100%. Results: Microsoft Excel spreadsheet was used to record all the data obtained from the observers. Mean values from all the five observers for each aspiration and biopsy was used for statistical analysis. We found a strong direct positive correlation between the bone marrow biopsy cellularity and bone marrow aspiration cellularity. Conclusion: A simple practical equation could be created to measure bone marrow biopsy cellularity from the usually available aspiration cellularity. Marrow biopsy cellularity was found to be 0.96 of the aspiration cellularity

Prevalence of Antibody to Hepatitis C Virus in Saudi Blood Donors

The prevalence of antibodies to hepatitis C virus (anti-HCV) was retrospectively determined using a second generation enzyme immunoassay in 3868 blood donors from the southern part of Saudi Arabia in an area with high prevalence of hepatitis B virus (HBV) infection. Of 3354 Saudis, 48 (1.43%) were seropositive for anti-HCV. A high prevalence (43 of 204, 21.08%) of anti-HCV was observed among Egyptian donors compared with Saudis (1.43%) and other nationalities (eight of 310, 2.58%). Furthermore, the prevalence of anti-HCV antibodies was observed to increase with age, peaking in the 25 to 34 year age group. From this and other studies conducted in different regions of Saudi Arabia, the prevalence of anti-HCV among Egyptian donors appears to range from 19.2 to 24.5%, and among Saudi donors appears to range from 1.00 to 1.7%, a rate similar to that reported from western countries; this latter rate does not seem to be influenced by the high prevalence of HBV infection in this region

Cost‐effectiveness analysis of a randomized clinical trial of early versus deferred endovenous ablation of superficial venous reflux in patients with venous ulceration

Background Treatment of superficial venous reflux in addition to compression therapy accelerates venous leg ulcer healing and reduces ulcer recurrence. The aim of this study was to evaluate the costs and cost‐effectiveness of early versus delayed endovenous treatment of patients with venous leg ulcers. Methods This was a within‐trial cost‐utility analysis with a 1‐year time horizon using data from the EVRA (Early Venous Reflux Ablation) trial. The study compared early versus deferred endovenous ablation for superficial venous truncal reflux in patients with a venous leg ulcer. The outcome measure was the cost per quality‐adjusted life‐year (QALY) over 1 year. Sensitivity analyses were conducted with alternative methods of handling missing data, alternative preference weights for health‐related quality of life, and per protocol. Results After early intervention, the mean(s.e.m.) cost was higher (difference in cost per patient £163(318) (€184(358))) and early intervention was associated with more QALYs at 1 year (mean(s.e.m.) difference 0·041(0·017)). The incremental cost‐effectiveness ratio (ICER) was £3976 (€4482) per QALY. There was an 89 per cent probability that early venous intervention is cost‐effective at a threshold of £20 000 (€22 546)/QALY. Sensitivity analyses produced similar results, confirming that early treatment of superficial reflux is highly likely to be cost‐effective. Conclusion Early treatment of superficial reflux is highly likely to be cost‐effective in patients with venous leg ulcers over 1 year. Registration number: ISRCTN02335796 (http://www.isrctn.com)