We report the case of a 39-year-old woman with acute myeloid leukemia (AML) with monocytic differentiation showing hemophagocytosis by leukemic blasts. This phenomenon is known to be associated with certain chromosomal changes, including t(8;16), der(8), inv(8), and t(16;21); however, in this case, the patient had a normal female karyotype. To our knowledge, this is the first published case of normal karyotype AML with hemophagocytosis by leukemic blasts.
Background: Research in several professional fields has demonstrated that delays (time lapse) in taking certification examinations may result in poorer performance by examinees. Thirteen states and/or territories require licensure for laboratory personnel. A core component of licensure is passing a certification exam. Also, many facilities in states that do not require licensure require certification for employment or preferentially hire certified individuals. Objective: To analyze examinee performance on the American Society for Clinical Pathology (ASCP) Board of Certification (BOC) Medical Laboratory Scientist (MLS) and Medical Laboratory Technician (MLT) certification examinations to determine whether delays in taking the examination from the time of program completion are associated with poorer performance. Methods: We obtained examination data from April 2013 through December 2014 to look for changes in mean (SD) exam scaled scores and overall pass/fail rates. First-time examinees (MLS: n = 6037; MLT, n = 3920) were divided into 3-month categories based on the interval of time between date of program completion and taking the certification exam. Results: We observed significant decreases in mean (SD) scaled scores and pass rates after the first quarter in MLS and MLT examinations for applicants who delayed taking their examination until the second, third, and fourth quarter after completing their training programs. Conclusions: Those who take the ASCP BOC MLS and MLT examinations are encouraged to do so shortly after completion of their educational-training programs. Delays in taking an exam are generally not beneficial to the examinee and result in poorer performance on the exam. ABBREVIATIONS: ASCP - American Society for Clinical Pathology, BOC - Board of Certification, CMP - Credential Maintenance Program, ANSI - American National Standards Institute, MLS - Medical Laboratory Scientist, MLT - Medical Laboratory Technician, NAACLS - National Accrediting Agency for Clinical Laboratory Sciences, ANOVA - analysis of variance, NCSBN - National Council of State Boards of Nursing, NCLEX - National Council Licensure Examination, CPA - Certified Public Accountant, MRCP(UK) - Membership of the Royal Colleges of Physicians of the United Kingdom
Vitamin D toxicity also known as hypervitaminosis D was previously believed to be rare. But with an increase in vitamin D supplementation several cases have been reported in literature. Fat soluble vitamins like Vitamin D, due to their ability to accumulate in the body, have a higher potential for toxicity than water soluble vitamins. The main clinical consequence of vitamin D toxicity is hypercalcemia. In this report we describe an adult female patient who developed very high serum Vitamin D levels (746 ng/mL, RI: 20 to 50) as a result of medication error. Inspite of such high serum concentrations the patient was without any clinical symptoms and had normal serum calcium. We critically discuss the mechanism of toxicity and hypothesize the possible molecular/metabolic factors which might have been responsible for this nontoxic presentation. This case study highlights the fact that physicians need to consider the risk of medication errors while prescribing Vitamin D therapy. Clinical trials to study Vitamin D toxicity in humans is not possible ethically. Thus the evidence base regarding the safety profile of Vitamin D supplementation in humans has been build through case reports. This review of the paradoxical clinico-laboratory manifestation of hypervitaminosis D could possibly contribute to existing literature.
Objective: To examine the associations between inflammatory markers, coagulation and fibrinolysis parameters, and microvascular complications in 182 Chinese patients with type 2 diabetes mellitus (T2DM) who sought treatment at a large hospital in Zhejiang province, China.Methods: We investigated the relationships of blood inflammatory markers with hemostatic markers in 87 patients with T2DM who did not have complications and 95 patients with T2DM who had microvascular complications.Results: C-reactive protein (CRP) and interleukin-6 (IL-6) were significantly correlated with fibrinogen, thrombin antithrombin III complex (TAT HI), plasminogen activator inhibitor-1 (PAI-1), von Willebrand factor (vWF), and coagulation factors (F) VII in patients with T2DM who had microvascular complications (P < .05). Based on logistic regression analysis, the highest-tertile groups of fibrinogen, FVII, and FAIL corresponded to a greater risk of high CRP, whereas risk of high IL-6 was significantly greater in the groups with highest-tertile values for fibrinogen, FVII, TAT III, PAI-1, and activated protein C (APC).Conclusions: Elevated levels of CRP and IL-6 might be associated with increased coagulability and a tendency towards thrombus formation in patients with T2DM who have microvascular complications.
Kidd antibodies have a reputation for causing hemolytic transfusion reactions and hemolytic disease of the fetus and newborn. We present a case of an untransfused male patient who developed anti-Kidd(a) (Jk(a)) antibodies after receiving an allogenic renal transplant. The formation of this antibody was associated with exposure to the Kidd antigen expressed on the tubular epithelium of the transplanted kidney. The 59-year-old white male patient had received a cadaveric renal transplant at our clinic and returned 5 years later with proteinuria and elevated serum creatinine levels, consistent with nephrotic syndrome. We review the expression of Kidd antigens and the development and detection of Kidd antibodies, and discuss the case reports from the literature of Kidd antibodies associated with kidney-graft rejection that suggest Kidd antigens play a role as a minor histocompatibility antigen.
