Turkish Journal of Hematology Volume: 33 - Issue: 4

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Turk J Hematol 2016;33:355-370 LETTERS TO EDITOR for pH alteration are not known, Ackerman [2] suggested that cytoplasmic pH alteration occurred in specific leukemia cells, which allowed the granules to unite into crystal-like rods [3]. Additionally, a titration rate of 1/200 or higher in O antigen should be considered positive for acute infection diagnosis. Salmonella Typhi isolation in culture is the gold standard for diagnosis [4]. Keywords: Auer rods, Non-neoplastic cells Anahtar Sözcükler: Auer cismi, Neoplastik olmayan hücreler Conflict of Interest: The authors of this paper have no conflicts of interest, including specific financial interests, relationships, and/or affiliations relevant to the subject matter or materials included. References 1. Chandra H, Chandra S, Gupta V, Mahajan D. Auer rod in a neutrophil in a nonmalignant condition. Turk J Hematol 2016;33:167. 2. Ackerman GA. Microscopic and histochemical studies on the Auer bodies in leukemic cells. Blood 1950;5:847-863. 3. Yoshida Y, Oguma S, Ohno H. John Auer and Auer rods; controversies revisited. Leuk Res 2009;33:614-616. 4. Mogasale V, Ramani E, Mogasale VV, Park J. What proportion of Salmonella Typhi cases are detected by blood culture? A systematic literature review. Ann Clin Microbiol Antimicrob 2016;15:32. Reply Dear Sir, The authors are thankful for considering their manuscript entitled “Auer Rod in a Neutrophil in a Nonmalignant Condition” interesting enough for critical analysis. However, the authors would like to clarify few points: 1. The authors have clearly stated in the manuscript the presence of Auer rod-like inclusions on peripheral examination. 2. In view of the presence of Auer rods bone marrow examination was done and which showed only unremarkable features of normoblastic maturation. There was presence of no leukemia cells. This clearly excluded the possibility of malignant condition and nonmalignant diagnosis was considered. Moreover the patient also responded well to an antibiotic course after diagnosis of typhoid. 3. Genetic studies were however not done as firstly it was not considered necessary in view of absolutely normal bone marrow and secondly also due to financial constraints. 4. The Salmonella Typhi O antigen titre of 1: 160 dilution was considered positive and patient responded very well to course of antibiotics. Her clinical follow up was unremarkable and thus chance of any leukemic process was completely eliminated. 5. The authors agree with the various hypotheses that have been enlisted by Yavaşoğlu and Bolaman for genesis of Auer rod in infectious conditions. In the background of these theories and findings, the presence of clear rod-like structure due to condensation of azurophilic granules in neutrophil in typhoid infection led to the consideration of Auer rod in nonmalignant condition. Thanking you, Harish Chandra, Smita Chandra, Vibha Gupta, Divyaa Mahajan Address for Correspondence/Yazışma Adresi: İrfan YAVAŞOĞLU, M.D., Adnan Menderes University Faculty of Medicine, Division of Hematology, Aydın, Turkey Phone : +90 256 212 00 20 E-mail : dr_yavas@yahoo.com Received/Geliş tarihi: May 19, 2016 Accepted/Kabul tarihi: May 24, 2016 DOI: 10.4274/tjh.2016.0179 369
LETTERS TO EDITOR Turk J Hematol 2016;33:355-370 Iron and Zinc Treatment in Iron Deficiency Demir Eksikliğinde Demir ve Çinko Tedavisi Beuy Joob 1 , Viroj Wiwanitkit 2 1Sanitation 1 Medical Academic Center, Bangkok, Thailand 2Hainan Medical University, Hainan, China To the Editor, The recent report by Özhan et al. was very interesting [1]. Özhan et al. concluded that “iron and zinc treatment instead of only iron replacement may be considered in cases of iron deficiency” [1]. The results from their study might support this suggestion. Nevertheless, we would like to add some comments. First, there was no complete nutritional evaluation in the patient and control groups, and there might have been some effects due to differences of intake among the subjects. In addition, it is not doubted that the patients had iron deficiency, but there is still the chance of the coexistence of other hemoglobin disorders. In Southeast Asia, concurrent iron deficiency and hemoglobinopathy are very common and can be misdiagnosed and incorrectly managed [2]. Iron supplementation in the case of combined iron deficiency and hemoglobinopathy has to be carefully considered [2,3]. Focusing on the serum zinc level, there is still no pathogenesis to explain the problem in the case of iron deficiency, but there is already a report confirming that hemoglobinopathy can result in low serum zinc levels [4]. Hence, to apply the recommendation of Özhan et al., further studies are required for validation, and attention to possible concomitant hemoglobinopathy is necessary [1]. Keywords: Iron, Zinc, Treatment, Deficiency Anahtar Sözcükler: Demir, Çinko, Tedavi, Eksiklik Authorship Contributions Concept: Beuy Joob, Viroj Wiwanitkit; Design: Beuy Joob, Viroj Wiwanitkit; Data Collection or Processing: Beuy Joob, Viroj Wiwanitkit; Analysis or Interpretation: Beuy Joob, Viroj Wiwanitkit; Literature Search: Beuy Joob, Viroj Wiwanitkit; Writing: Beuy Joob, Viroj Wiwanitkit. Conflict of Interest: The authors of this paper have no conflicts of interest, including specific financial interests, relationships, and/ or affiliations relevant to the subject matter or materials included. References 1. Özhan O, Erdem N, Aydoğdu İ, Erkurt A, Kuku İ. Serum zinc levels in iron deficient women: a case-control study. Turk J Hematol 2016;33:156-158. 2. Pansuwan A, Fucharoen G, Fucharoen S, Himakhun B, Dangwiboon S. Anemia, iron deficiency and thalassemia among adolescents in Northeast Thailand: results from two independent surveys. Acta Haematol 2011;125:186-192. 3. Burdick C. Combined iron deficiency and thalassemia minor. Am J Clin Pathol 2013;139:260. 4. Fung EB, Gildengorin G, Talwar S, Hagar L, Lal A. Zinc status affects glucose homeostasis and insulin secretion in patients with thalassemia. Nutrients 2015;7:4296-4307. Reply Dear Dr Joob, Thank you for your comments and recommendations. We had evaluated the zinc deficiency in iron deficiency anemia, not in all anemia types. Serum iron, ferritin, and transferrin saturation levels were used in diagnosis and whether or not hemoglobinopathy exists, these patients were diagnosed iron deficiency anemia. And for possible mechanisms, there are some theories mentioned in the article. One of them is increase in production of Zn-protoporphyrin and usage of zinc instead of iron in the protoporphyrin structure [1], which can explain zinc deficiency in iron deficiency. And in another study, histopathological changes causing iron and zinc deficiency in intestinal mucosa were reversed with zinc treatment and the absorption of zinc and iron was improved [2]. But still as you mentioned and as we mentioned in our article, further studies are needed. References 1. Hastka J, Lassere JJ, Schwarzbeck, Hehlmann R. Central role of zinc protoporphyrin in staging iron deficiency. Clin Chem 1994;40:768-773. 2. Arcasoy A. İnsan sağlığında çinkonun önemi. TÜBİTAK Bilim ve Teknik Dergisi 1996;12:56 (in Turkish). Address for Correspondence/Yazışma Adresi: Beuy JOOB, M.D., Sanitation 1 Medical Academic Center, Bangkok, Thailand E-mail : beuyjoob@hotmail.com Received/Geliş tarihi: June 27, 2016 Accepted/Kabul tarihi: June 27, 2016 DOI: 10.4274/tjh.2016.0249 370
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