Diana Helena de Benedetto Pozzi

Metabolism of chylomicron-like emulsions in patients with Hodgkin's and with non-Hodgkin's lymphoma.

BACKGROUND Chylomicrons carry in the bloodstream dietary fats absorbed the intestine for storage in the body tissues such as adipose and muscle. The two-step chylomicron metabolism consists in lipolysis by lipoprotein lipase on vessel walls and hepatic uptake of triglyceride-depleted remnants. Chylomicron metabolism is understudied in cancer, despite its direct involvement in the patient nutritional status. We investigated this metabolism in Hodgkin and non-Hodgkin lymphoma patients, using the method of triglyceride-rich emulsions that mimic chylomicrons. PATIENTS AND METHODS The chylomicron-like emulsion, labeled with [9,10-3H]glycerol-trioleate and [1-14C] cholesteryl-oleate was intravenously injected into 11 Hodgkins, 19 non-Hodgkins patients and 12 healthy subjects. Triglyceride kinetics evaluate lipolysis whereas cholesteryl ester kinetics evaluate remnant removal. RESULTS Plasma total, LDL, HDL cholesterol, apo B, apo A1 and Lp(a) values were similar between the three groups, but VLDL cholesterol and triglycerides were higher in the lymphoma groups. The fractional catabolic rate (FCR, in min(-1)) of the emulsion triglycerides was roughly three-fold smaller in non-Hodgkins (0.043+/-0.007, mean+/-S.E.M., P<0.001) and Hodgkins (0.045+/-0.009, P<0.0001) lymphoma patients compared with the control values (0.151+/-0.032). FCR of the emulsion cholesteryl esters, was four-fold smaller in non-Hodgkins (0.016+/-0.002, P<0.0001), and three-fold in Hodgkins lymphoma patients (0.024+/-0.006, P<0.001) compared with the control group (0.069+/-0.013). The lipolysis index, calculated from the decay curves of both isotopes was also markedly smaller in both groups of lymphoma patients compared with the controls. CONCLUSIONS In both lymphoma groups, marked alterations in chylomicron lipolysis and remnant removal occurs.

Estudo da refratariedade plaquetária do dia 0 ao 50, em pacientes submetidos a transplante de medula óssea

From October 1997 to July 1999, platelet refractoriness was studied in 15 patients, aged from 1 to 66 years old, in the early stage of allogeneic and autologous BMT, carried out at the Sao Camilo Hospital. The following parameters were used for this analysis: daily clinical progress, 1- and 24 hour-post-transfusion platelet corrected count increment (CCI),complement-dependent microlymphocytotoxicity test (CDC) sensitized by human antiglobulin (AGH) and solid phase red blood cell adherence (SPRCA) platelet analysis. Platelet concentrated products were obtained from automated cell separator machines, filtered through retention filters of pre-storage leukocyte reduction and, subsequently, stored at room temperature for a maximum of 96 hours. Each platelet unit featured on average 0.51 x 104 leukocytes, with platelet cell counts of 3.58 x 1011. The mean pH of each thrombocytapherese concentrate was 6.34 and was storage for 32 hours and 21 minutes. Platelets concentrates were transfused on a prophylactic basis, when the platelet counts were below 20 x 109 /L or above these values in cases of therapeutic intervention or bleeding. The platelet refractory potential was defined as the lack of response to a transfusion of two compatible ABO platelet concentrate products confirmed by the reduction in platelet CCI 1 hour after transfusion was less than 7.5 or 24 hours after transfusion was less than 4.5. Only the 24-hour CCI analysis showed statistically significance with the platelets refractoriness occurring in 80.0% of the cases, as a consequence of non-immune factors, such as, amphotericin 66.66%, veno-occlusive disease 53.33 %, undetermined fever 40.0%, splenomegaly, slight nose bleeds, fever, severe melene, severe hematemesis and bacterial infection, 20.0%. Slight melene, severe enterorrhagia and moderate and severe nose bleeds 13.33%, whereas CIVD, moderate and severe enterorrhagia were 6.66%. The presence of immune factors was detected by GVHD and CMV infections that were identified in 33.33% and 13.33% of the cases, respectively, although the detection of autoantibodies was negative. The conclusion is that the 24-hour post-transfusion CCI analysis has proven to be a predictor of platelet refractoriness and a useful test in refractory thrombocytopenic patients, mainly those undergoing BMT.