Kadriye Özdemir, Nida Dincel, Orhan Kara, Ebru Yılmaz, Gözde Gözüoğlu, Sevgi Mir

Effect of treatment choice on survival in a case with meningococcemia and multiorgan failure

We report in this paper a case had continuous veno-venous hemodiafiltration (CVVHDF) with the diagnosis of meningococcemia - multiple organ failure (MOF) and without permanent damage development although it took more than 4 weeks of loss of kidney function. Three-year-old female patient was hospitalized for unconsciousness, no spontaneous respiration, blood pressure 50/30 mmHg, and widely echimotic- purpuric rash. In her laboratory. there were 19.600 / mm3 white blood cells, 5.7 g / dL hemoglobin, 76,000 / mm3 platelets, prothrombin time was 23.9 seconds, aPTT was higher than measurable values, creatinine was 7.2 mg / dL, ALT / AST were 378/714 / L, and she was anuric. She underwent CVVHDF treatment with the diagnosis of meningococcemia and MOF. On the 48 hours of treatment, her vital signs were improved, on 55 hours MOF was revealed except for renal functions and CVVHDF treatment was discontinued. Because of the damage to the kidneys continue, she had 3 hours/ day dose of hemodialysis. At the end of hospitalization for 1 week, her hemodialysis need was declined to 3 days/ week, on 5th week to 2 days / week and on the beginning of 6 weeks, there was entirely no need for dialysis and she had been seen in services in one more week without dialysis need. On the last visit, she had normal blood pressure, creatinine clearance, urine osmolarity and protein excretion. She was followed up for 4.5 years with no abnormality.Key words: Meningococcemia, dialysis, renal failure

Anahtar Kelimeler:

Meningokoksemi, diyaliz, böbrek yetmezliği

Determination of P-Glycoprotein Expression by Flow Cytometry in Hematological Malignancies

Objective: Determination the expression of P-glycoprotein is especially problematic for normal tissues because immunological methods are limited in terms of sensitivity. We aimed to determine the expression of P-glycoprotein and CD34 by flow cytometry, and to evaluate the level of expression of P-glycoprotein and CD34 with unresponsive to treatment in patients diagnosed with hematologic malignancy.Methods: Our study included fifty patients diagnosed with acute myeloblastic leukemia and acute lymphoblastic leukemia, and twenty healthy controls who were admitted to Erciyes University Hematology-Oncology Hospital. The suspended cells from bone marrow samples of patients and the peripheral blood samples of healthy people were marked with P-glycoprotein phycoerythrin and CD34 FITC or PerCP Cy 5.5; and then surface expression was measured by means of flow cytometry.Results: In 6 of 30 acute myeloblastic leukemia patients P-glycoprotein and CD34 expression, in 6 of 20 acute lymphoblastic leukemia patients P-glycoprotein, in 5 of them CD34 expression were determined. A significant relation between P-glycoprotein and CD34 expressions in acute myeloblastic leukemia and acute lymphoblastic leukemia bone marrow samples was reported.Conclusion: Our data indicate that flow cytometry is more reliable, precise and faster than molecular methods for measuring P-glycoprotein expression and suggests the possibility of a significant relationship between P-glycoprotein and CD34 expressions in acute myeloblastic leukemia and acute lymphoblastic leukemia bone marrow samples. The blast cells expressing CD34 on their surface along with P-glycoprotein simultaneously show that multi drug resistance 1 gene is mostly active in immature cells.Key words: MDR-1 gene, AML, ALL, P-glycoprotein, flow cytometry

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