1/14. Artefactually-normal automated platelet counts due to malaria-infected RBC.Protein aggregates, red cell or white cell fragments are known to interfere with platelet counts in automated blood analysers, both by aperture impedance and optical technologies. When a falsely high value is suspected, interference by pseudo-platelet particles can be confirmed by systematic examination of stained blood films. The method that best avoids these sources of interference is the reference, immunological platelet count. We describe a case of treated malaria with a false normal platelet count. The blood smear revealed small red cells, infected by trophozoites of plasmodium falciparum, that interfered with the platelet count. The Cell Dyn 4000 shows different patterns of interference by infected red cells in its impedance and optical counts, and thrombocytopenia was suspected immediately. This was confirmed by a phase-contrast microscopic platelet count.- - - - - - - - - - ranking = 1keywords = white (Clic here for more details about this article) |
2/14. Apheresis for severe malaria complicated by cerebral malaria, acute respiratory distress syndrome, acute renal failure, and disseminated intravascular coagulation.Malaria has become a very uncommon disease in italy. Recently a variety of circumstances, such as travel to tropical countries as well as immigration from asia and africa, have combined to increase the number of malaria cases recorded annually. In this report we describe the use of red cell exchange transfusion and plasma exchange in the treatment of a patient with hyperparasitemic malaria (51% erythrocytes or more parasitized). When first observed the patient was in shock and had signs of cerebral malaria, disseminated intravascular coagulation, and acute respiratory distress syndrome, which in the following 2 days were complicated by acute renal failure. After mefloquine therapy combined with 3 red blood cell exchanges, 2 plasma exchanges, and 10 dialysis sessions over 14 days, the patient recovered completely. This case of severe malaria with multiple complications, treated with mefloquine in conjunction with both exchange transfusion and plasmapheresis, had a successful outcome and lends further support to the possible beneficial role of exchange transfusion in complicated malaria.- - - - - - - - - - ranking = 87.154935087835keywords = blood cell (Clic here for more details about this article) |
3/14. Use of immunoglobulin gene rearrangements to show clonal lymphoproliferation in hyper-reactive malarial splenomegaly.In africa, hyper-reactive malarial splenomegaly (HMS), which is also known as tropical splenomegaly syndrome, can be associated with a prominent lymphocytosis in blood and bone marrow that is difficult to distinguish clinically from chronic lymphocytic leukaemia (CLL). The observation that some patients with HMS become resistant to treatment with anti-malarial drugs has led to the suggestion that HMS may evolve into a malignant lymphoproliferative disorder. To test this hypothesis, 22 Ghanaian patients with HMS and/or lymphocytosis were categorised by degree of response to proguanil according to standard clinical criteria, and dna was extracted from peripheral blood cells and screened for rearrangements of the Jh region of the immunoglobulin gene with a dna probe. Clonal rearrangements of the Jh region were found in all 3 patients with no response, in none of 13 patients with sustained response, and in 2 of 6 patients with moderate response or relapse on proguanil therapy. The detection of such rearrangements, and hence clonal lymphoproliferation in individuals with clinical features intermediate between HMS and CLL, supports the hypothesis that HMS may evolve into a malignant lymphoproliferative disorder.- - - - - - - - - - ranking = 87.154935087835keywords = blood cell (Clic here for more details about this article) |
4/14. Brugada-type electrocardiographic changes in a febrile patient of african descent.brugada syndrome is an arrhythmic syndrome characterized by a pattern of right bundle branch block and an ST-segment elevation in the right precordial leads on the electrocardiogram. This type of electrocardiographic change is predominantly documented in Asian and white persons and almost never present in persons of African ancestry. Despite the well-known risk of sudden death in patients with brugada syndrome, controversy exists concerning the management of asymptomatic patients with Brugada-type electrocardiographic patterns. The present report describes the case of a patient with a Brugada-type electrocardiographic pattern induced by his febrile condition. A favorable outcome was achieved with a conservative approach.- - - - - - - - - - ranking = 1keywords = white (Clic here for more details about this article) |
5/14. amodiaquine-induced immune agranulocytosis.This report describes two patients who developed agranulocytosis while receiving prophylactic amodiaquine treatment. The neutrophil counts returned to normal in one after stopping the drug while the other died of sepsis. amodiaquine-dependent circulating neutrophil IgG antibodies were demonstrated in both patients using the indirect granulocyte immunofluorescence test. The antineutrophil antibody activity was enhanced with the use of the major amodiaquine metabolite, mono-desethyl amodiaquine. Additional studies showed the activity of the sera to be nondialysable, heat stable, active against autologous as well as allogenic cells, and absent from the convalescent sera. There was no growth inhibition of allogenic myeloid committed progenitor cells (CFU-GM) following incubation with the patients' sera, complement and amodiaquine. These results indicate that agranulocytosis can be mediated by a drug-dependent antibody which affects mature blood cells.- - - - - - - - - - ranking = 87.154935087835keywords = blood cell (Clic here for more details about this article) |
6/14. The treatment of severe falciparum malaria.In severe falciparum malaria there is a pathophysiological cascade beginning with changes in the parasitized red blood cells which induce intermediate effects, in turn contributing to dysfunction of several organs. A low serum albumin is a common but often unrecognized finding which may contribute to oedema especially in the lung and brain. The only irreversible complication in falciparum malaria is the acute respiratory distress syndrome, manifested by cyanosis and rapid breathing, basically distinct from acute pulmonary oedema caused by therapeutic overhydration. The pathophysiology of falciparum malaria may be complex but the treatment is simple. Drugs, other than antimalarials, are rarely needed. Guidelines for cholorquine or quinine dosage in severe disease are proposed; each drug is given at a dose of 5 to 10 mg/kg in 10 ml/kg of fluid as an intravenous infusion in four hours at a frequency of dosing every 12 to 24 hours. When the disease has been brought under control the treatment should be changed from the intravenous to the oral route.- - - - - - - - - - ranking = 87.154935087835keywords = blood cell (Clic here for more details about this article) |
7/14. Blood parasites: problems in diagnosis using automated differential instrumentation.To examine potential problems inherent in using automated differential instruments, we have reviewed herein two cases where blood parasites, Plasmodium vivax and plasmodium falciparum, were completely missed by use of this method. diagnosis of these infections was made when blood was sent to the parasitology laboratory after having been missed prior to that time. The first problem involved the laboratory request slip; no indication was made concerning possible suspect organisms. Therefore, peripheral blood examinations were performed using automated equipment. The number of fields scanned by a technologist on these smears is quite low; thus failure to pick up a light parasitemia is almost guaranteed. In both cases, after diagnosis had been made on smears submitted to the parasitology division, all previous smears examined by the automated system were reviewed and found to be positive for parasites. Failure to make the diagnosis resulted in delayed therapy. Although these instruments are not designed to detect intracellular blood parasites, the inability of the automated systems to discriminate between uninfected red blood cells and those infected with parasites may pose serious diagnostic problems.- - - - - - - - - - ranking = 87.154935087835keywords = blood cell (Clic here for more details about this article) |
8/14. chloroquine-resistant falciparum malaria from East africa.Seven patients (one black African and six white Europeans) developed chloroquine-resistant falciparum malaria in East africa. in vitro studies confirmed chloroquine resistance in three patients, but the parasites failed to grow in the other four patients. Six patients were cured by sequential quinine and Fansidar, one by sequential quinine and mefloquine.- - - - - - - - - - ranking = 1keywords = white (Clic here for more details about this article) |
9/14. Cerebral malaria in the United Kingdom.Four fatal cases of cerebral plasmodium falciparum malaria in English travellers returning from africa have been seen in the last 13 years. The haemorrhages, accumulations of microglia, and destruction of cerebral white matter around small veins as a result of blockage of cortical capillaries by parasitised red blood corpuscles resemble the effect of fat embolism. microglia in the lesions is demonstrated by special neuropathological techniques. attention is drawn to the need for a prompt recognition of malaria since appropriate treatment can be successful.- - - - - - - - - - ranking = 1keywords = white (Clic here for more details about this article) |
10/14. Epidemiological aspects and clinical implications of malaria as seen in Jeddah, saudi arabia.A review is presented of 242 patients with acute malaria seen at two hospitals in Jeddah. Jeddah should be regarded as the malaria outpost of the South Western region of saudi arabia since nearly all of these patients contracted the disease while travelling within that area during the previous month. plasmodium falciparum was the predominant infection (77%). There was a marked seasonal incidence with a peak during December to April; 84% of the patients were male. In contrast to the common impression that the total white cell count is low or normal in malaria, one-third of a sample of 124 patients had a total count of at least 10 000 mm-3; approximately 40% of the patients did not have a palpable spleen. Evidence is presented to show the danger of treating patients with falciparum malaria on an out-patient basis. Ideally, all such patients should be hospitalized and observed in order to ensure effective treatment. The Kingdom of saudi arabia has many medical and paramedical personnel who have little practical experience in the diagnosis of malaria. We therefore recommend that training programmes in the laboratory diagnosis of malaria should be initiated in specialized centres in the Kingdom or abroad.- - - - - - - - - - ranking = 1keywords = white (Clic here for more details about this article) |
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