Case 3: Cyclic Neutropenia
Laurel J. Gershwin in Case Studies in Veterinary Immunology, 2017
Neutrophils are an important first line of defense against bacterial pathogens. Formed in the bone marrow from myeloid precursors, mature neutrophils are released into the blood on a regular basis. The neutrophil is responsive to several chemotactic factors that are released from epithelial and other cells after contact with damage-associated molecular patterns (DAMPs) and/or pathogen-associated molecular patterns (PAMPs). This chapter examines neutrophils that are incapable of leaving the blood vascular space in response to chemotactic stimuli, and explores neutrophils that are unable to ingest and kill. Cyclic episodes of neutropenia occur in a regular pattern in dogs affected with this condition, leading to episodes of infection when peripheral neutrophil counts fall to less than 1000/μL. The history of recurrent infection and the breed and coat color of the dog strongly suggested cyclic neutropenia. The cycle occurs at approximately 10- to 12-day intervals, with periods of neutropenia often followed by a brief neutrophilia.
Emerging Oral Treatments: Oral JAK Inhibitors for Alopecia Areata
Rubina Alves in Techniques in the Evaluation and Management of Hair Diseases, 2021
Alopecia areata (AA) is a chronic autoimmune disease of hair loss that can lead to significant disfigurement and cause a detrimental impact on patient well-being that may be independent of objective severity. Prompt treatment is therefore vital in stopping disease progression and reversing hair loss. Two decades of experimental research, using animal models of AA and genome-wide association studies in both mice and humans, have elucidated key mechanisms in AA pathogenesis. The most commonly reported adverse events (AEs) were upper respiratory tract infections. Additional AEs include other infections such as urinary tract infections, herpes zoster, and herpes simplex, as well as mild symptoms such gastrointestinal complaints, headache, acne, fatigue, weight gain, hyper-seborrhoea, anaemia, neutropaenia, and thrombocytopaenia. Patients should be advised about the increased risk of overall infections, especially those of the upper respiratory tract, opportunistic infections, and reactivation of latent infections such as tuberculosis.
Hairy Cell Leukemia
Dongyou Liu in Tumors and Cancers, 2017
This chapter presents a state of the art summary of hairy cell leukemia (HCL) to its definition, biology, epidemiology, disease mechanisms, clinical signs, diagnosis, treatment and prognosis. HCL is a mature B-cell lymphoproliferative disorder included as a distinct entity in the World Health Organization classification of hemopoietic and lymphoid tumors. A major advance in the understanding the molecular pathogenesis of HCL was the discovery of a mutation on the BRAFV600E gene as detected by whole exome sequencing in virtually all patients with HCL. The blood counts show variable degrees of anemia, thrombocytopenia, and neutropenia. Macrocytosis is frequent, and monocytopenia is characteristic in active HCL. The differential diagnosis arises with other primary splenomegalic disorders such as splenic marginal zone lymphoma, unclassifiable splenic B-cell leukemias/lymphomas, HCL-variant, and—rarely—with primary myelofibrosis and aplastic anemia. Since the introduction of effective treatments three decades ago, the prognosis for HCL is good overall.
Lack of Efficacy of the Neutropenic Diet in Decreasing Infections among Cancer Patients: A Systematic Review
Published in Nutrition and Cancer, 2020
Venkataraghavan Ramamoorthy, Muni Rubens, Sandeep Appunni, Anshul Saxena, Peter McGranaghan, Emir Veledar, Ana Viamonte-Ros, Nancy Shehadeh, Adeel Kaiser, Rupesh Kotecha
The objective of this systematic review is to evaluate the existing evidence supporting the effectiveness of the neutropenic diet in decreasing infection and mortality among cancer patients. We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Scopus for relevant articles published from database inception until March 2019. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed for this review. Individual studies were evaluated using the Oxford Center for Evidence-Based Medicine guidelines. A total of 473 articles were identified and 11 articles were selected after assessing eligibility. Our review showed that the neutropenic diet does not decrease infection rates or mortality among cancer patients. Currently, there is no uniform definition for the neutropenic diet across different institutions. For example, some institutions follow general food safety practices while others avoid foods that increase exposure to microbes and bacteria, and some follow both. Given these differences in practice regarding what constitutes a neutropenic diet, it is advisable that safe food handling and preparation practices recommended by the Food and Drug Administration be uniformly followed for neutropenic patients.
Neutropenia and leukemia development: genetic risk factors and prognosis
Published in Leukemia & Lymphoma, 2019
Saeid Shahrabi, Mohsen Maleknia, Yousef Tavakolifar, Zeinab D. Zayeri, Najmaldin Saki
Neutropenia is known as a clinical consequence in various genetic disorders and other neutropenia-inducing mutations (NIM) nonmalignant diseases. Leukemia development is now a major concern about the mortality of patients with congenital neutropenia. We searched the PubMed database and Google Scholar engine using English-language article (1980–2019) using the terms ‘Neutropenia,’ ‘Leukemia,’ ‘Mutation,’ and ‘Polymorphism.’ Patients with neutropenia have leukemia-related genetic abnormalities which are noticeable as mutations and chromosome abnormalities. The presence of mutations in patients with neutropenia can affect the biological function of neutrophils and increase the likelihood of leukemia progression, which can be important in the diagnosis and prognosis of patients. NIM can play an important role in leukemia development via enhancing intracellular signaling, apoptosis inhibition, and effects on transcription factors in patients with neutropenia. Therefore, the detection of genetic risk factors can be useful in prognosis, early diagnosis, and prevention of leukemia development.
The association of UGT1A1*6 and UGT1A1*28 with irinotecan-induced neutropenia in Asians: a meta-analysis
Published in Biomarkers, 2014
Yi-Jing Chen, Fei Hu, Chun-Yan Li, Jue-Min Fang, Li Chu, Xi Zhang, Qing Xu
Background: The UGT1A1*28 polymorphism is known as a biomarker of irinotecan-induced neutropenia in Caucasians. However, in Asians, the UGT1A1*28 mutation is much less frequent. Methods: A meta-analysis was performed to assess the association of the UGT1A1*6 and UGT1A1*28 with neutropenia in Asians. Results: In a combination test of the two variations, patients with severe neutropenia displayed a 155% higher mutational load than those that were not neutropenic (ORG = 2.55; 95% CI: 1.82–3.58). Conclusions: In Asians, a combination test of UGT1A1*6 and UGT1A1*28 might be a potential biomarker of irinotecan-induced neutropenia, an observation that will need additional trials for confirmation.
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