The Controversy Around Contentious BAY 57-1293-Techniques

AIHA is the most common complication, at about 7%. An additional 7�C14% of patients have a positive direct antiglobulin test (DAT) without clinical evidence of haemolysis (Dearden et?al, 2008). ITP http://www.selleckchem.com/products/Roscovitine.html occurs at a frequency of between 2% and 5% (Visco et?al, 2008; Moreno et?al, 2010) although it may be underestimated unless a bone marrow examination is performed on all patients with thrombocytopenia (Zent et?al, 2009). The incidence of autoimmune granulocytopenia and PRCA is much lower ( http://en.wikipedia.org/wiki/Methisazone failure (stage C ��infiltrative��), though their survival was inferior to patients with uncomplicated stage A (Moreno et?al, 2010). This may be related to the association observed in these series between AIHA and poor prognostic factors, such as unmutated IGHV gene, high ZAP70 expression, and increased serum ��2 microglobulin levels. Visco et?al (2008) reported that acute ITP was associated with an inferior outcome, which could be explained by the association found by the same group of investigators between ITP and unmutated IGHV genes (Visco et?al, 2007). Dearden et?al (2008) assessed the prognostic effect of a positive DAT in patients with CLL requiring treatment for the first time. A positive DAT predicted a poorer response to treatment and together with AIHA was associated with a lower overall survival. It is important to note, however, that this study was performed in a subset of patients with CLL that required treatment, which is a different group of patients from those who are diagnosed with a clinically apparent AIHA. Given the multiple possible causes of cytopenia in CLL (e.g. bone marrow failure, http://www.selleckchem.com/products/bay-57-1293.html hypersplenism, chemotherapy, sepsis, autoimmunity), a high degree of suspicion is required to diagnose these patients. Autoimmune cytopenia will most commonly present before CLL requires therapy (Zent et?al, 2008; Moreno et?al, 2010). However, the highest risk is in those patients with advanced stage disease. It is thus imperative to exclude autoimmune cytopenia in the work-up of any patient with CLL and cytopenia (Hallek et?al, 2008). For this, it is important to undertake a bone marrow biopsy, as an aspirate alone can give equivocal results.