Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0026986 (myelodysplastic syndrome)
 14,926 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Humoral regulation of erythropoiesis has been known for 100 years, while clinical utilization of recombinant human erythropoietin (rhEPO) only for two decades. It can be said that there is much experience in regard to indications, models and results of its clinical utilization. According to the standpoint of secretion of erythropoietin, anemias can be divided into those where secretion is increased and satisfactory, those where it is increased but not satisfactory and into those where it is not increased or it is even decreased. Anemias of the first group are not an indication for rhEPO utilization, the second group is relative and the third group absolute indication for its utilization. The best results are achieved with absolute indications and it is anemia in chronic renal insufficiency and nonphysiologic anemia of premature babies. Good results can be expected, but not predicted in relative indications, such as anemias in chronic infections, anemias in malignant diseases, myelodysplastic syndrome, aplastic anemia and other secondary anemias. Utilization of rhEPO is useful also in certain states without anemia, especially in transfusiology.
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PMID:[Clinical use of erythropoietin]. 899 93

The Sysmex R-3000 (TOA Medical Electronics, Kobe, Japan) evaluates maturation of reticulocytes by quantitating the fraction of reticulocytes within low-, middle-, and high-fluorescence intensity regions. We defined the immature reticulocyte fraction (IRF) as the sum of the fraction of high-fluorescence intensity regions plus the fraction of middle-fluorescence intensity regions. Then, we studied the clinical significance of IRF in the evaluation of anemia by comparing the IRF with the absolute reticulocyte count (ARC) and with the reticulocyte production index (RPI) and by reviewing pertinent clinical information about the patients. In the study, 132 specimens from 102 patients undergoing evaluation of anemia were analyzed. By using simple regression analysis, our results showed that the IRF has a weak but significantly positive correlation with ARC and with RPI, indicating that IRF is an additional useful parameter to evaluate the erythropoietic activity in anemia. Interpretation by integrating IRF and reticulocyte enumeration (ARC and RPI) provided useful information for further subclassification of anemia. Increased IRF (IRF > or = 0.23) and increased ARC generally indicated an adequate erythroid response to anemia. All but three specimens with an IRF less than 0.23 showed an RPI of 2 or less. These specimens were from patients with underlying diseases known to lead to decreased erythropoietic activity, predominantly chronic renal insufficiency. Specimens with a subnormal or normal ARC (with a corresponding RPI < or = 2) but with an IRF of more than 0.23 were from patients with various underlying conditions, including acute infection, iron deficiency anemia, human immunodeficiency virus infection, sickle disease with crisis, pregnancy, and myelodysplastic syndrome. Our results indicate that an IRF of 0.23 or less in patients with anemia reflects bone marrow that is nonresponsive or underresponsive to the anemia. Patients with an increased IRF (IRF > or = 0.23) may require further examination to clarify the cause of the anemia.
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PMID:Clinical significance of immature reticulocyte fraction determined by automated reticulocyte counting. 920 80

Effective management of early anaemia in the course of chronic renal insufficiency requires the following: (i) implementing an efficient diagnostic strategy to exclude common contributing factors; (ii) initiating epoetin therapy for the majority of patients; for and (iii) ensuring adequate iron supply erythropoiesis. Diagnostic inquiry is warranted whenever the haemoglobin concentration is below the normal range adjusted for age and gender. The most efficient diagnostic approach is to assume erythropoietin deficiency, exclude iron deficiency, and pursue further diagnostic tests only when red-cell indices are abnormal or when leukopenia or thrombocytopenia are also present. Macrocytosis should prompt an inquiry into alcoholism, B12 deficiency, or folate deficiency. Microcytosis suggests iron deficiency or thalassaemia. Associated cytopenias raise the possibility of alcohol toxicity, pernicious anaemia, malignancy, or myelodysplastic syndrome. Epoetin therapy is warranted whenever the haemoglobin concentration has fallen below 10.0 g/dl. To initiate therapy prior to dialysis, epoetin should be administered at an average dose of 100 IU/kg/week (80-120 IU/kg/week, 50-150 IU/kg/ week) by subcutaneous injection. Haemoglobin concentration should be monitored every 2 weeks and the epoetin dose adjusted by increments or decrements of 25% to maintain a rate of rise of haemoglobin concentration of 0.2-0.6 g/dl (0.3 0.6 g/dl/week, 0.2-0.5 g/dl/week). When the target range is achieved, the dose of epoetin should be continually adjusted to maintain a stable haemoglobin concentration. Transferrin saturation and ferritin concentration should be monitored monthly, and sufficient iron provided to maintain transferrin saturation above 20%. The lower the haemoglobin concentration, the greater the likelihood that future intravenous iron will be required. Oral iron supplements should be avoided, since they are costly, ineffective, and troublesome to patients. Finally, a blunted therapeutic response to epoetin therapy provides important diagnostic information and gnostic inquiry.
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PMID:Management of early renal anaemia: diagnostic work-up, iron therapy, epoetin therapy. 1103 56

Anaemia is a common medical problem in elderly patients and is associated with an increased mortality and morbidity risk and a reduced quality of life. It is not known at which exact haemoglobin level investigations should be initiated in order to optimize the diagnostic efficacy. Serum ferritin determination remains the most accurate laboratory test for the diagnosis of iron deficiency anaemia and its differential diagnosis with the anaemia of chronic disease. The introduction of the metabolites methylmalonic acid and homocysteine has made it possible to diagnose vitamin B(12) and folate deficiencies at an early subclinical stage, even without neurological and haematological symptoms, but the clinical importance of this 'biochemical' diagnosis is unclear. Other causes of anaemia, such as myelodysplastic syndromes and chronic renal insufficiency, will become more and more common in the elderly because of the ageing of the population. Although erythropoietin analysis has no clear diagnostic value at the moment, it has become more and more obvious that its therapeutic importance in elderly patients with chronic anaemia is increasing. A substantial number of patients have an unexplained anaemia. Whether this is disease related, or may be attributed to an age-related anaemia, is still a matter of debate, but it is advisable to perform an extensive laboratory, cytogenetic, and morphological investigation before one should assess the anaemia as unexplained.
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PMID:Strategies for the laboratory diagnosis of some common causes of anaemia in elderly patients. 1496 71

We retrospectively evaluated the safety and efficacy of high-dose chemotherapy consisting of cyclophosphamide, etoposide and ranimustine (CEM) with autologous peripheral blood stem cell transplant (PBSCT) in 55 adult patients with relapsed or high-risk de novo diffuse large B-cell lymphoma (DLBCL) or DLBCL associated with follicular lymphoma. This included 36 patients in the upfront setting in their first complete remission. The median follow-up of 42 patients surviving at the time of the analysis was 52 months (range 1-159). Relapse or disease progression after PBSCT was a frequent cause of death, but no therapy-related mortality associated with PBSCT was observed. The 5-year overall survival and progression-free survival were 70.6% (95% confidence interval [CI], 54.0-82.1) and 57.0% (95% CI, 39.5-71.2), respectively. Chronic renal impairment, therapy-related myelodysplastic syndrome and prostate cancer were the major late complications. The CEM regimen is a tolerable, effective conditioning regimen for autologous PBSCT for DLBCL, with no therapy-related mortality observed.
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PMID:Safety and efficacy of high-dose cyclophosphamide, etoposide and ranimustine regimen followed by autologous peripheral blood stem cell transplant for patients with diffuse large B-cell lymphoma. 2449 Oct 27