leucopenie: caso clinico uod ematologia, usl2 (lucca e garfagnana) dott.alessandro melosi...
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leucopenie: caso
clinicoUOD Ematologia, USL2 (Lucca e Garfagnana)
dott.Alessandro Melosi
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B.L.Sesso f emminileAnno di nascita 1971Allergie: nessunaAF: ndnAPR:
• asportato melanoma della coscia sinistra, 2 cm sopra alginocchio, nel 2005, stadio I a
• due fi bromi utero• un fi broadenoma mammella destra
APP:gb 2500 di cui N tra 500 e 1000, plt 100.000 già dal 2009milza 125 mm, nel 2007 normaletrattata con B12, per carenza, senza esitoTerapie in atto: nessuna
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Harrison’s 17 edition
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da farmaci malattie ematologichemieloftisi, mielofibrosideficit nutritivoinfezione
Ac antineutrofilisplenomegaliamalattie autoimmuni
batteriemiaemodialisi
sequestro periferico
distruzione periferica
diminuita produzione
cause di neutropeniacause di neutropenia
Harrison’s 17 edition
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Peter A. Kouides, MD John M. Bennett, MD Published by the Myelodysplastic Syndromes Foundation, Second Edition, revised, 2001
1.200 casi di MDS: distribuzione per età
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http://info.cancerresearchuk.org/cancerstats/types/leukaemia/incidence/#age
Average Number of New Cases Per Year and
Age-Specific Incidence Rates per 100,000
Population, UK
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J Clin Oncol 17:3835-3849
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• incidenza: 3.2-3.3/milione/anno
• età media alla diagnosi: 58 anni
• M/F 4:1
• età media alla diagnosi: 57 anni uomini, 63 anni donne
• rischio cumulativo di un secondo tumore a 10, 20 e 25 anni dopo la diagnosi: 13.2%, 24.5% e 31.9% (SEER, su 3104 pz)
• linfociti B maturi della zona marginale, producono TNFa e IL2R (CD25), sovraproducono ciclina D1 e fibronectine, rispondono alle citochine prodotte dalle cellule T; esprimono integrine (CD103, CD11c) che interagiscono con VCAM-1 presente nell’endotelio di milza fegato midollo
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Grever MR. Blood. 2010 Jan 7;115(1):21-8.
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Grever MR. Blood. 2010 Jan 7;115(1):21-8.
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Fig 1. Fifteen-year survival curves comparing localized melanoma (stages II and I), regional metastases (stage III), and distant metastases (stage IV). The numbers in parentheses are patients from the AJCC melanoma staging database used to calculate the survival rates. The differences between the curves are significant (P < .0001).
JCO August 15, 2001 vol. 19 no. 16 3635-3648
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ematossilina eosina
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giemsa
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Leukemia & Lymphoma, June 2011; 52(S2): 57–61
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Leukemia & Lymphoma, June 2011; 52(S2): 57–61
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J Natl Cancer Inst 2007;99: 215 – 22
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Leukemia & Lymphoma, June 2011; 52(S2): 57–61
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26/01/09 18/06/10 15/12/10 07/06/11 24/10/11
hb 13,5 11,4 11,3 11,1 10,7
leucociti 3,14 2,46 2,31 2,19 1,73
neutrofili 1,15 0,81 0,58 0,45 0,28
piastrine 157 100 73 71 63
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Grever MR. Blood. 2010 Jan 7;115(1):21-8.
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Grever MR. Blood. 2010 Jan 7;115(1):21-8.