Browsing by Department "Division of Haematology"

Now showing 1 - 9 of 9
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    A study of iron kinetics in normal and abnormal human subjects
    (1973) French, Terence John
    The work to be presented in this thesis took pl ace while I was working as a registrar in the department of radio-isotope diagnosis at Groote Schuur Hospital. During this period, I became interested in the ferrokinetic technique for attempting to quantitate normal and abnormal erythropoietis, and the possible development of these techniques so as to allow more accurate quantitation of the data. At the time the study started, the department was offering standard ferrokinetic investigations to aid in the diagnosis of abnormal haematological states. These studies did not, I felt, provide adequate information for the referring clinician, particularly in regard to ineffective erythropoietic activity.
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    Burkitt and Burkitt-like lymphoma/leukaemia at Groote Schuur Hospital from 2005 to 2014: a retrospective review
    (2018) Koller, Anna J; Opie, Jessica
    Introduction: South Africa has the highest global burden of human immunodeficiency virus (HIV). The HIV seropositive population is at increased risk of developing non-Hodgkin lymphoma, particularly high grade aggressive subtypes such as Burkitt- and Burkittlike lymphoma (also known as B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma). Methods: Ten year retrospective review of clinico-pathological features and survival of adults with newly diagnosed Burkitt- and Burkitt-like lymphoma at a tertiary hospital in South Africa. Results: Burkitt lymphoma (BL) (n=109) was more frequent than Burkitt-like lymphoma (BLL) (n=41) and at presentation there were no significant differences in HIV prevalence (86% vs 78%); median CD4 count (213 vs 207 cells/μL); bone marrow involvement (49% vs 34%), leukaemic dissemination (37% vs 27%) and most frequent site of diagnosis (abdomen/pelvis; 26% vs 29%), respectively. There were significant differences in median age (34 vs 41 years, p=0.0319), median lactate dehydrogenase levels (2052 vs 869 U/l, p=0.0011) and cerebrospinal fluid involvement (12% vs 0%, p=0.046). 43% of patients with an available HIV viral load result showed virological supression defined as lower than detectable limit (LDL) with the median value also being LDL. The patients that received high dose chemotherapy including high dose methotrexate (112/150; 75%) showed a one-year survival of 62% with no significant difference between Burkitt and Burkitt-like lymphoma (66 months versus 51 months, respectively; p=0.267). Patients with leukaemic presentation showed a significantly lower mean survival of 24 months compared to those without (72 months; p< 0.001). The 2 year survival for the whole group, regardless of type of treatment received, was 40% (95% CI, 32-48%) with a median survival of 7.5 months. Conclusion: This is the largest cohort of Burkitt- and Burkitt-like lymphoma patients described in South Africa. There was a high HIV prevalence. The majority received intensive chemotherapy and survival was comparable to certain well-resourced countries. Leukaemic presentation was frequent and associated with less favourable survival.
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    Cancer/Testis Antigen Expression Panel Incorporating MAGEC1 and BAGE2 Predicts Multiple Myeloma Disease Stage and Severity
    (OMICS publishing group, 2016-04-07) Shires, Karen; Teuchert, Andrea; Wienand, Kirsty; Shankland, Iva; Novitzky, Nicolas
    To provide a single molecular assay that could be used to easily stage Multiple Myeloma patients at diagnosis, we investigated the association between the simultaneous expression of 7 Multiple Myeloma-associated Cancer/Testis Antigens and biochemical parameters that are currently used for disease staging. We analysed the mRNA expression of MAGEC1, MAGEA3/A6, BAGE2, PRAME, NYESO1, SSX2 and PAGE by qualitative reverse transcription PCR using RNA extracted from diagnostic bone marrow samples from 39 patients covering the Multiple Myeloma disease continuum and compared this to levels of key biochemical parameters at diagnosis. We found that the Cancer/Testis Antigen panel was expressed in a specific order that was specifically associated with the severity of disease. This allowed the Cancer/Testis Antigens expression profile to successfully place the patient clearly into either stage I or stage III of the disease, with further sub-stratification in the stage III grouping. In addition, we putatively identified MAGEC1 expression as a confirmatory diagnostic marker for symptomatic Multiple Myeloma and clearly associated BAGE2 expression exclusively with stage III disease. We also demonstrated the novel finding of PAGE expression in Multiple Myeloma, with an association with more advanced disease. We suggest that this particular molecular Cancer/Testis Antigen panel can be used at diagnosis as a single test to clearly stage patients
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    Correction to: Diagnostic accuracy of the Xpert MTB/Rif Ultra for tuberculosis adenitis
    (2020-03-02) Antel, Katherine; Oosthuizen, Jenna; Malherbe, Francois; Louw, Vernon J; Nicol, Mark P; Maartens, Gary; Verburgh, Estelle
    After publication of the original article [1], we were notified that there is a mistake in the article note.
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    Efficiency of Buccal DNA sampling device in the mortuary
    (Avens Publishing Group, 2015-08-31) Tredoux, Simone; Mfolozi, Sipho; Shires, Karen
    Identification of forensic DNA samples by short tandem repeat (STR) profiling is currently an essential component of criminal investigations and can aid in linking perpetrators to crimes as well as identifying missing individuals or unidentified remains. In South Africa, recent amendments to legislation have allowed for the mandatory acquisition of reference DNA samples from certain offenders in order to populate the new National Forensic DNA Database. A novel method for the collection of buccal samples, the EasiCollect device, has been proposed to facilitate the collection of these DNA samples, replacing blood collecting devices as the standard method of DNA collection. Subsequently, this device has been introduced into South African state mortuaries to assist in the identification of deceased individuals. In order to ascertain if this device is suitable for use in the postmortem setting, an investigation was performed to compare the main methodology currently utilised within South African mortuaries, namely femoral blood transferred to ‘Fast Technology for Analysis of nucleic acids’ (FTA) cards, and buccal cells obtained using the EasiCollect device. DNA yields and STR genotyping results were compared between the two collection methods in thirty deceased individuals. Buccal samples provided a significantly greater DNA yield than blood samples, while no significant difference was observed between the qualities of the sample types as measured by the 260/280 nm ratio. Full STR profiles were obtained from all blood and buccal samples, with amplification efficiency showing limited DNA degradation and PCR inhibition in these samples, and only 3% of samples giving potentially disputable results. Numerous issues surrounding the collection of blood samples, however, indicated that this method is not optimal for use in the mortuary, with the EasiCollect device providing a more practical and robust method for the collection of DNA samples in the mortuary
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    Guideline for the treatment of myelodysplastic syndromes (MDS) in South Africa
    (2011) Louw, V; Bassa, F; Chan, S; Dreosti, L; Toit, M; Ferreira, M; Gartrell, K; Gunther, K; Jogessar, V; Littleton, N; Mahlangu, J; McDonald, A; Patel, M; Pool, R; Ruff, P; Schmidt, A; Sissolak, G; Swart, A; Verburgh, E; Webb, M
    ABSTRACT INTRODUCTION: Myelodysplastic syndromes (MDS) encompass a heterogeneous group of clonal haematopoietic disorders characterised by chronic and progressive cytopenias resulting from ineffective haematopoiesis. Treatment is complicated by differences in disease mechanisms in different subgroups, variable clinical phenotypes and risk of progression to acute myeloid leukaemia. RATIONALE: Changes in disease classification, prognostic scoring systems, the availability of novel treatment options and the absence of South African guidelines for the diagnosis and management of these complex disorders underpinned the need for the development of these recommendations. METHODS: These recommendations are based on the opinion of a number of experts in the field from the laboratory as well as clinical settings and came from both the private and institutional academic environments. The most recent literature as well as available guidelines from other countries were discussed and debated at a number of different meetings held over a 2-year period. RESULTS: A comprehensive set of recommendations was developed focusing on risk stratification, supportive management and specific treatment. Novel agents and their indications are discussed and recommendations are made based on best available evidence and taking into account the availability of treatments in South Africa. CONCLUSION: Correct diagnosis, risk stratification and appropriate therapeutic choices are the cornerstones of success in the management of patients with MDS.
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    The burden of imported malaria in Cape Town, South Africa
    (2014) Opie, Jessica; Freeks, Roschelle; Du Pisani, Louis Almero
    BACKGROUND: The Western Cape Province of South Africa (SA) is not malaria endemic; however, a considerable number of patients present with malaria to our healthcare services. OBJECTIVES: To establish the frequency of patients presenting with malaria at Groote Schuur Hospital (GSH), Cape Town, SA, and to describe their demographics, clinical outcomes and laboratory findings. METHODS: An observational, retrospective, descriptive study was conducted, which included all patients presenting with smear-positive malaria to GSH over a 4-year period between 1 April 2008 and 31 March 2012. RESULTS: During the study period, 134 malaria patients presented to GSH for management; 85% (n=114) were male, median age was 27 years. Of the total smear-positive tests, 96% (n=128) were Plasmodium falciparum, 3% (n=4) P. ovale, and in 1% (n=2) the species was not identified. The number of malaria patients increased markedly, from 6 cases in 2008 to 50 cases in 2012. Of the patients, 48.3% (n=57) were from Somalia, 8.5% (n=10) from SA and 29% (n=30) from other African countries. One SA patient acquired transfusion-transmitted malaria from a pooled platelet product, and the other SA patients had travelled to malaria-endemic areas. The remaining cases were from countries outside of Africa, including 13% (n=15) from Bangladesh. Almost two-thirds (62%; n=72) were admitted to hospital with a median length of stay of 3 days (range 1 - 32). Clinical outcomes were good with only one death and the remaining patients being discharged. CONCLUSION: Imported malaria is imposing a significant burden on health resources. The costs of medical care for the emergency treatment of foreign nationals needs to be recognised, and adequately budgeted for.
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    The evolving management of Burkitt's lymphoma at Red CrossChildren's Hospital
    (2006) Davidson, Alan; Desai, Farieda; Hendricks, Marc; Hartley, Patricia; Millar, Alastair; Numanoglu, Alp; Rode, Heinz
    Background. Treatment for Burkitt’s lymphoma at Red Cross Children’s Hospital has evolved from the use of aggressive surgery and less intensive chemotherapy to a conservative surgical approach with more intensive chemotherapy. Methods. The study was a retrospective folder review of patients diagnosed with Burkitt’s lymphoma at RCCH between 1984 and 2004. Results. Ninety-two children were treated for Burkitt’s lymphoma at RCCH between 1984 and 2004. There were 10 patients with group A or fully resected disease, 52 with group B or extensive localised disease, and 30 with dissemination to the bone marrow and/or central nervous system or group C disease. Protocol 1 (less intensive chemotherapy based on the COMP regimen) was used from 1984, with protocol 2 (more intensive chemotherapy based on the LMB regimen) introduced in 1988 for group C disease, 1991 for group B disease and 1996 for group A disease. Overall 5-year survival increased from 20% with protocol 1 to 66% with protocol 2 for group C disease, and from 76.5% with protocol 1 to 88.2% with protocol 2 for group B disease. There were more admissions for neutropenic fever in patients on protocol 2 and more episodes of mucositis, and these patients required more red cell and platelet transfusions. With a more conservative surgical approach, biopsy largely replaced attempts to partially resect the tumour at primary surgery, and there was a consequent decline in surgical complications. Conclusions. Intensive chemotherapy with protocol 2 has resulted in improved survival for group C and group B patients, but with more morbidity. Protocol 1, which is less intensive with less morbidity, remains a viable strategy for group A and group B disease in resource-poor settings.
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    The Use of MAGE C1 and Flow Cytometry to Determine the Malignant Cell Type in Multiple Myelom
    (PLoS One, 2015-03-20) Wienand, Kirsty; Shires, Karen
    The malignant cell phenotype of Multiple Myeloma (MM) remains unclear with studies proposing it to be either clonotypic B or proliferating plasma cells. Cancer/testis antigen MAGE C1 is being extensively studied in MM and it has been suggested that it is involved in the pathogenesis of the cancer. Therefore, we report on the use of MAGE C1 to determine the malignant cell phenotype in MM using flow cytometry. Bone marrow aspirate (BM) and peripheral blood (PB) was collected from twelve MM patients at diagnosis, as well as three MM disease-free controls. Mononuclear cells were isolated using density-gradient centrifugation, and stabilized in 80% ethanol, before analysis via flow cytometry using relevant antibodies against B cell development cell-surface markers and nuclear MAGE C1. MAGE C1 expression was observed consistently in the early stem cells (CD34+) and early pro-B to pre-B cells (CD34+/−/CD19+), as well as the proliferating plasma cells in both the MM PB and BM, while no expression was observed in the corresponding control samples. Monoclonality indicated a common origin of these cell types suggesting that the CD34+/MAGE C1+ are the primary malignant cell phenotype that sustains the downstream B cell maturation processes. Furthermore, this malignant cell phenotype was not restricted to the BM but also found in the circulating PB cells. Introduction