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Multiple myeloma is the most common form of plasma cell cancer. It is a disease of elderly people, with a mean age at diagnosis of 65–70, and represents 10–15% of all blood cancers. It is a heterogeneous disease associated with intrinsic factors and disease characteristics such as genetics, which dictate the clinical course of the disease. Multiple myeloma involves several abnormalities in the IgH variable region. The first oncogenic events in this cancer occur in the germinal centre, apparently during isotype switching and somatic hypermutation of B cells. While these primary mutations have been found in myeloma cells, these events alone are not enough to cause pathogenesis. However, few genes have been identified in this type of disease. The expression of cancer/testis antigens (CTAs) is limited to testis tissue and various types of cancer, in which they are considered as a tumour marker as they are associated with the prognosis and monitoring of the disease, and are involved with overall survival and event-free disease. In view of the above, the objective of this study was to analyse the expression of CTAs (MAGE-A3 and -C1, NY-ESO and SSX1) by RT-PCR in patients diagnosed with de novo multiple myeloma admitted to the Haematology Department of Hospital General de México. Our results proved that there is presence of these genes and that they may be involved in resistance, progression and survival. Resumen: El mieloma múltiple es la forma más común de las neoplasias malignas de células plasmáticas. Es una enfermedad de los adultos mayores, la media al diagnóstico es de 65 a 70 años y representa del 10 al 15% de todas las neoplasias hematológicas. Es una enfermedad heterogénea donde existe una asociación con factores y características intrínsecas de la enfermedad, tales como las genéticas, las cuales dictan el curso clínico del padecimiento. El mieloma múltiple involucra diversas anormalidades en la región variable de la IgH. Los primeros eventos oncogénicos en esta neoplasia ocurren en el centro germinal, al parecer durante el proceso de cambio de clase de isotipo y de hipermutación somática de las células B. Si bien estas mutaciones primarias han sido encontradas en células mielomatosas, estos eventos por sí solos no son suficientes para provocar la patogénesis. Sin embargo, son escasos los genes identificados en este tipo de padecimiento. La expresión de los antígenos testiculares de cáncer (ATC) se limita a tejido testicular y a varios tipos de cánceres, en donde ha sido considerada como marcador tumoral, pues están implicados en el pronóstico y seguimiento de la enfermedad, impactando en la supervivencia global y en la enfermedad libre de eventos. Por lo tanto, el objetivo de este trabajo fue analizar la expresión de los ATC (MAGEA3, C1, NY-ESO y SSX1) en pacientes diagnosticados con mieloma múltiple de novo que ingresaron al Servicio de Hematología del Hospital General de México por medio de RT-PCR. Nuestros resultados comprobaron que existe presencia de dichos genes, por lo que podrían estar participando en la resistencia, progresión y supervivencia. Keywords: Cancer/testis antigens, Multiple myeloma, RT-PCR, Palabras clave: Antígenos testiculares de cáncer, Mieloma múltiple, RT-PCR

Acute leukaemias are characterised by uncontrolled proliferation of immature blood cells with lymphoid or myeloid lineage. Morphological classification is based on the identification of the leukaemia cell line and its stage of differentiation. The first microscopic descriptions dating from the 1930s pointed to 2 different types of leukaemia cells: lymphoid and myeloid. In 1976, the consensus that led to the French-American-British (FAB) classification was achieved. This includes criteria for identifying myeloid and lymphoid leukaemias, and gives a list of morphological subtypes, describing how these affect the patient's prognosis. Today, despite new classifications based on sophisticated studies, FAB classification is widely used by experts due to its technical simplicity, good diagnostic reliability and cost-effectiveness.

Iron deficiency anaemia is a public health problem that affects all age groups. In Mexico, it is a common cause of morbidity, and accounts for 50% of cases of anaemia worldwide. It is more prevalent during the first 2 years of life, during adolescence and pregnancy. It is characterised by fatigue, weakness, pallor and koilonychia. Treatment is based on dietary recommendations and oral and intravenous iron supplements. In this review article, we summarise the characteristics of iron efficiency anaemia, its metabolism, epidemiology, symptoms and diagnosis, and explore different therapeutic approaches.

Background Cancer testis antigens (CTA) are expressed in several types of cancer but not in normal adult tissue, with the exception of testicular germ cells, and for this reason are considered targets for immunotherapy. Objective The aim of this study was to determine the frequency and clinical significance of CTA expression in cells from patients with chronic myeloid leukaemia (CML). Materials and methods We analysed 8 genes of the CTA family (MAGE-A3, MAGE-A4, MAGE-B2 MAGE-C1, BAGE-1, GAGE-2, LAGE-1 and NY-ESO-1) in 10 peripheral blood samples from healthy donors and 65 bone marrow samples from CML patients using reverse transcriptase polymerase chain reaction (RT-PCR). Eleven samples from hematopoietic progenitor stem cells from patients receiving conventional treatment (hydroxyurea and INFα) and 21 samples from patients receiving tyrosine kinase inhibitors (Imatinib, Nilotinib, Dasatinib) were analysed. Results Frequency of CTA genes in CML patients was 32.3%, 63.0%, 1.5%, 3.0%, 6.1%, 20.0%, 13.8% and 36.9% for MAGE-A3, MAGE-A4, MAGE-B2, MAGE C1, BAGE, GAGE, LAGE and NY-ESO, respectively. The correlation between expression and clinical parameters showed statistical significance in the MAGE-A3 genes in sex ( p = 0.018), MAGE-C1 in leukocytes ( p = 0.014) in platelets ( p = 0.002), and finally LAGE-1, which was associated with platelets ( p = 0.001). The hematopoietic progenitor stem cells from patients in treatment showed a higher frequency of expression than de novo patients. In patients receiving conventional drugs (CD), frequency of MAGE-A3 expression was 50%, and 69.2% with TKI, MAGE-A4 frequency was 20% with CD and 53.8% with TKI. Finally, frequency of NY-ESO-1 was 20% with CD and 0% with TKI. The frequency of MAGE-A4 expression was highest, followed by MAGE-A3, NY-ESO-1, GAGE-2, LAGE-1, BAGE-1, MAGE-B2 and MAGE-C1. Conclusion Detection of CTA genes by molecular biology techniques is important due to their use as biomarkers in LMC, in the monitoring of disease progression and in patients who are resistant to chemotherapy. The frequency of CTA expression in treated and de novo differs significantly.

Even though blood transfusion saves thousands of lives worldwide, it causes complications in some patients, and must therefore be correctly administered. As there is no universally accepted consensus on blood transfusion in surgical patients, we have reviewed the latest studies and gathered the best available evidence on blood management strategies. In this study, we discuss indicators for transfusion of erythrocytes and other blood products, haemostatic agents for cardiothoracic and orthopaedic interventions where it is imperative to regulate blood loss, and alternatives in specific situations such as Jehovah's Witnesses patients. Finally, we put forward an algorithm for the preoperative management of surgery patients with low haemoglobin levels.

Background CIWA-Ar score is the gold standard for stratifying severity of alcohol withdrawal syndrome (AWS). Aim To identify the correlation between the different scales used in patients with AWS, and with the biochemical–haematological profile. Material and methods Prospective, analytical observational study in 49 patients with AWS diagnosed between February 2011 and July 2012. Maddrey, Glasgow, MELD, CIWA-Ar scores and laboratory values were obtained at diagnosis. Results There was no correlation between CIWA-Ar and other scales (R2 = 0.001, p = 0.823, 95%CI); however, a linear relationship (p = 0.000, 95%CI) was found. On the correlation matrix, CIWA-Ar was not associated with any of the study parameters. There were no significant differences in length of stay when analyzed by type of treatment. Conclusion CIWA-Ar is a good predictor of severity, albeit with no biochemical or hematic correlation.

Bone marrow aspiration and bone marrow biopsy are invasive procedures in which good technical skill is crucial to obtain samples suitable for processing and diagnostic interpretation. The type and calibre of the needle is one of the main variables of the technique, and is selected on the basis of the age, gender and body mass of the patient. This article provides a practical, step-by-step guide to the technique for both procedures. It also discusses existing techniques for reducing the pain associated with the procedure, an essential aspect for the patient that if poorly handled, can force cancellation of the procedure.

Intrathecal chemoprophylaxis prevents central nervous system relapses in patients with acute lymphoblastic leukaemia (ALL) but few studies have addressed the predictive markers of relapse. Among these, traumatic lumbar puncture (TLP) has been associated with lower disease-free survival (DFS). To investigate the risk posed by TLP on relapse and DFS, we assembled a retrospective cohort including 79 patients with ALL who received intrathecal chemoprophylaxis during 2009 to 2013. One TLP per patient was recorded in 49 cases, and more than one TLP in 3. Mean follow-up was 283 (22–1118) days with an overall DFS of 68%. DFS was significantly lower in the group that had experienced TLP (58% vs 100% [ P = .070]). Multiple TLP posed a greater risk of relapse than single TLP ( P = .001). In conclusion, TLP in adults constitutes a major risk factor, greater than that reported in the large paediatric series.

Background The minor BCR-ABL ( e1;a2 ) transcript oncogene is the most common genetic alteration in adults with acute lymphoblastic leukaemia (ALL). It is associated with a poor prognosis. Aim To determine the frequency of minor BCR-ABL ( e1;a2 ) transcript oncogene expression in ALL patients in Mexico. Material and methods A cohort of 411 patients with de novo ALL were tested for the oncogene using reverse transcription polymerase chain reaction (RT-PCR). Results The oncogene was found in 14% ( n = 57) of the study population. Mean age was 29 years, and 53% were male. Median leucocyte count was 53 × 10 3 μl. Conclusion Prevalence of BCR-ABL expression by RT-PCR has not previously been reported in Mexico. Our laboratory found a higher prevalence than that reported in Latin-American series, but lower than that reported for the European population.

Background Androgens have been used to treat bone marrow failure syndromes such as aplastic anaemia (AA) since the 1970s, and are currently used as adjuvants to other treatment regimens. Objective To determine the efficacy and response time of androgens in the treatment of AA. Materials and methods A retrospective, analytical-observational nested study in a cohort of patients with AA. The study was conducted from January 2006 to December 2013. Results A total of 63 patients with a mean age of 47 (18–83) years were included in the study. Out of 27 patients in full remission, 17 received some type of immunosuppressant combined with androgens. The use of more than 2 immunosuppressants did not significantly improve response times ( p = 0.311, 95% CI). Mean response time was 725 (331–1119) days; 4-year survival rate was 86%. Conclusions Improved immunosuppressant response rates with adjuvant androgens were mainly observed in patients with severe AA.

A diet deficient in iron, vitamin B9 (folic acid) and/or vitamin B12 (cobalamin) can affect erythropoiesis and cause anaemia. Treatment consists in the administration of supplements to compensate for dietary deficiencies and build up body reserves. Pharmacological treatment should be complemented by a diet designed to supply the micronutrients lacking in food. Patients should continue to follow the diet even after completing their therapy in order to prevent a recurrence of deficiency anaemia. Nutritionists should understand deficiency anaemia, and physicians, particularly general practitioners, should be aware of dietary requirements. In this article, therefore, both health care professionals have come together to briefly explain, with examples, the type of diet that should be recommended to patients with deficiency anaemia.

Folic acid and cobalamin are B-group vitamins that play an essential role in many cellular processes. Deficiency in one or both of these vitamins causes megaloblastic anaemia, a disease characterized by the presence of megaloblasts. Megaloblasts occur when inhibition of DNA synthesis causes asynchronous maturation between the nucleus and the cytoplasm. Clinical manifestations are similar to those of other types of anaemia, with the exception of cobalamin deficiency megaloblastic anaemia, which presents distinctive neurological symptoms. An understanding of the metabolism of these vitamins will enable clinicians to make the best use and interpretation of laboratory studies and monitor therapeutic strategies, which consist mainly of administering supplements to restore body reserves.

Background Few studies compare the therapeutic efficacy of different iron deficiency anaemia treatments. Aim Evaluate the therapeutic response of the most common iron preparations. Material and methods Retrospective, observational-analytical study based on medical records from the Haematology Department, conducted from March to October 2014, including 121 adults with ferropenic anaemia and 3-month follow-up. Patients with comorbidities or pregnancy were excluded. Results 85.8% were women ( n = 103) and 14% men ( n = 17), with a mean age of 42 (16–83) years. Seventy patients (58.3%) started with oral administration; the rest received intravenous iron. Efficacy was similar among all the iron preparations, with no significant differences ( p > 0.05). Iron sucrose was most effective in rapidly replenishing body iron stores. Conclusions Despite comparable efficacy among treatments, ferrous fumarate had the lowest treatment failure and was the therapy of choice.

Molecular markers in leukaemia are essential to diagnose, establish prognosis factors and determine the correct treatment of patients; therefore, it is imperative to include molecular biology studies, so that, combined with cytomorphology and immunophenotyping studies, they constitute the differential diagnosis of these neoplasias. It is extremely important to implement a panel of molecular markers that allows us to detect oncogenes derived from chromosomal translocations, genes derived from epigenetic alterations and drug-resistant genes. A panel of molecular markers that included 11 genes derived from chromosomal translocations BCR-ABL major and minor breakpoints, E2A-PBX1, MLL-AF4, TEL-AML1, PML-RARα, AML1-ETO was standardised; cancer testis antigens (CTA) derived from NY-ESO1 and MAGE-A3 epigenetic alterations and multi-drug-resistant genes ABCB1 and ABCG2. 30 patients diagnosed with leukaemia from Mexico's General Hospital (Hospital General de Mexico) were included. They suffered from acute lymphoblastic leukaemia (ALL) and acute myeloblastic leukaemia (AML); bone marrow mononuclear cells were used, from which RNA was extracted for the synthesis of cDNA and RT-PCR for each of the markers. In acute lymphoblastic leukaemia (ALL), BCR-ABL biomarkers expressed under 30% (3/10), E2A-PBX1 10% (1/10), ABC-B1 80% (8/10), and ABC-G2 60% (6/10). Patients with acute myeloblastic leukaemia (AML) expressed 30% PML-RARα (3/10), 40% ABC-B1 (4/10), and 10% ABC-G2 (1/10). Lastly, in patients with chronic myeloid leukaemia (CML), BCR-ABL was over 100% (10/10), ABC-B1 20% (2/10), and ABC-G2 50% (5/10). The presence of transcripts from chimeric genes minor BCR-ABL and E2A-PBX1 in ALL; PML-RARα in AML; and major BCR-ABL in CML, confirms the importance that the panel of molecular markers has in strengthening the diagnosis and prognosis of these conditions.