Current opinion in hematology
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This review provides an overview of the clinical management of sickle-cell disease (SCD) with recently published findings. ⋯ SCD treatment relies on concomitant preventive and curative measures to control its acute and chronic manifestations. Pathophysiologic advances have enabled better management, with new therapeutics highly likely in the near future.
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Curr. Opin. Hematol. · Jan 2012
ReviewAgranulocytosis and other consequences due to use of illicit cocaine contaminated with levamisole.
Most of the illicit cocaine consumed in the United States and elsewhere is contaminated with levamisole, a veterinary medication. Agranulocytosis caused by levamisole exposure through cocaine abuse was first described in 2009. Since then, levamisole has also been shown and is known to cause vascular and neurologic complications. In this review, we provide an overview of the medical consequences of exposure to levamisole from adulterated cocaine. ⋯ More than three fourths of cocaine users in the United States are exposed to levamisole; a significant minority of these individuals will develop autoimmune-mediated neutropenia, cutaneous vascular complications, and/or leukoencephalopathy. Levamisole exposure should be considered in the differential diagnosis of patients who present with these conditions in the setting of cocaine abuse. Neutropenia appears to resolve rapidly with cessation of exposure, so that GCSF therapy and a work-up for other causes may not be needed in all patients.
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Curr. Opin. Hematol. · Nov 2011
ReviewNew thoughts on the correct dosing of prophylactic platelet transfusions to prevent bleeding.
Recent studies have evaluated the effects of platelet dose on hemostasis. ⋯ Platelet doses in ranges between half to twice the usual dose of 2.2 × 10(11) platelets/transfusion/BSA have no affect on WHO bleeding grades.
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Curr. Opin. Hematol. · Jul 2011
ReviewRoles for MSI2 and PROX1 in hematopoietic stem cell activity.
The MSI2 and PROX1 proteins are increasingly recognized for their critical roles in the biology of primitive hematopoietic cells and for their potential contributions to leukemic pathogenesis. Here we summarize the studies that have shed light on the hematopoietic-specific roles of MSI2 and PROX1 and give an overview of the molecular mechanisms underlying their function. ⋯ Deciphering the molecular mechanisms through which MSI2 and PROX1 affect primitive hematopoietic cell fate will provide insight into the regulation of normal hematopoiesis and facilitate better understanding of the leukemic transformation process. This will be directly applicable to the development of effective regenerative therapies and targeted leukemia treatments.
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Curr. Opin. Hematol. · May 2011
ReviewEndothelial activation and dysregulation in malaria: a potential target for novel therapeutics.
Despite parenteral artesunate therapy, the fatality rate of cerebral malaria remains high. Adjunctive therapy targeting the underlying pathophysiology of cerebral malaria may further improve the clinical outcome. Endothelial activation and dysfunction is a central process in the pathogenesis of cerebral malaria. An improved understanding of how endothelium is perturbed in cerebral malaria may yield novel strategies to diagnose and intervene. Here, we discuss recent findings on the key molecular mediators of endothelial activation/dysregulation in cerebral malaria, and innovative endothelial-based experimental approaches to improve detection and treatment. ⋯ Interventions targeting the Ang-Tie-2 axis to promote endothelial quiescence, including agents to improve endothelial nitric oxide, represent potential adjunctive therapies for cerebral malaria.