Flow-cytometric analysis of erythrocytes and reticulocytes in congenital dyserythropoietic anaemia type II (CDA II): value in differential diagnosis with hereditary spherocytosis.

Congenital dyserythropoietic anaemia type II (CDA II) is the most common congenital dyserythropoietic anaemia. CDA II is frequently misdiagnosed as Hereditary Spherocytosis (HS) due to the presence of mild chronic haemolytic anaemia with splenomegaly, increased osmotic fragility, and presence of microspherocytes. Accurate diagnosis of CDA II is important to prevent severe iron overload. Erythrocyte and reticulocyte indices were assessed in 10 patients from six families with CDA II, 18 patients from eight families with HS, and 50 normal controls. Characteristic increases in distribution width were present in CDA II for cell volume (RDW, anisocytosis) and in HS for cell haemoglobin concentration (HDW, anisochromia), resulting in an RDW/HDW ratio which was significantly greater in CDA than HS (P < 0.0002). A cut-off value for RDW/HDW of 5.34 resulted in 89% sensitivity and 70% specificity in distinguishing CDA II from HS. Distribution width for cell haemoglobin content of reticulocytes (CHDWr) was characteristically increased in CDA II, resulting in a CHDW/CHDWr ratio significantly lower in CDA II than HS (P < 0.0002). A cut-off value of 0.98 provided 89% sensitivity and 80% specificity in distinguishing CDA II from HS. These differences in distribution widths of flow-cytometric parameters of reticulocytes and mature erythrocytes reflect the different pathogeneses of the two diseases and are helpful for the differential diagnosis of these two conditions.     

Pregnancy following nonsurgical donor ovum transfer to a functionally agonadal woman

We report this country's first nonsurgical donor ovum transfer pregnancy in a functionally agonadal woman who had received chemotherapy and radiation for Hodgkin's lymphoma. For women with ovarian failure, nonsurgical uterine lavage and ovum transfer may provide an opportunity for motherhood that was not possible previously.     

Value of strain-ratio on thyroid real-time sonoelastography

Purpose

The aim of this study was to determine the accuracy of elastosonography in the differential diagnosis of thyroid nodules using a qualitative [evaluation of the stiffness score (SS)] and quantitative assessment [evaluation of the strain ratio (SR)].

Materials and methods

In our single-centre retrospective study, 368 patients were enroled between December 2010 and March 2012 (134 men, 234 women, mean age 56.1 ± 14.2) with a diagnosis of thyroid nodules, who underwent conventional ultrasonographic and elastosonographic evaluation. The SS and SR were assessed and the results were expressed in terms of sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). The nodules were subjected to needle aspiration.

Results

Forty-four nodules were malignant (TIR ≥ 3) and 324 benign on cytological analysis. Considering a cut-off of SS > 2, we had 91 % sensitivity, 68 % specificity, 27 % PPV and 98 % NPV. Considering a cut-off of SR ≥ 3.28, we had 81.8 % sensitivity, 82.7 % specificity, 39.1 % PPV and 97.1 % NPV.

Conclusions

The SR calculation did not provide additional data to the SS, which remains the elastosonography benchmark. It will be necessary to validate these preliminary data by larger prospective randomised trials.     

Bilateral optic neuritis after COVID vaccination

Neurological Sciences -