Medical Biology - Research Publications

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Author: Hogan, Christopher × Start date: 2008 ×

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    Appropriate clinical use of human leukocyte antigen typing for coeliac disease: an Australasian perspective
    Tye-Din, JA ; Cameron, DJS ; Daveson, AJ ; Day, AS ; Dellsperger, P ; Hogan, C ; Newnham, ED ; Shepherd, SJ ; Steele, RH ; Wienholt, L ; Varney, MD (WILEY, 2015-04)
    The past decade has seen human leukocyte antigen (HLA) typing emerge as a remarkably popular test for the diagnostic work-up of coeliac disease with high patient acceptance. Although limited in its positive predictive value for coeliac disease, the strong disease association with specific HLA genes imparts exceptional negative predictive value to HLA typing, enabling a negative result to exclude coeliac disease confidently. In response to mounting evidence that the clinical use and interpretation of HLA typing often deviates from best practice, this article outlines an evidence-based approach to guide clinically appropriate use of HLA typing, and establishes a reporting template for pathology providers to improve communication of results.
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    Thrombotic thrombocytopenic purpura is associated with a high relapse rate after plasma exchange: a single-centre experience
    Frawley, Natasha ; NG, ASHLEY ; NICHOLLS, KATHLEEN ; Hogan, Chris ; COHNEY, SOLOMON ; GRIGG, ANDREW (Blackwell Snergy, 2008)
    Background: Thrombotic thrombocytopenic purpura (TTP) is a rare condition characterized by microangiopathic haemolytic anaemia, thrombocytopenia, renal and/or neurological dysfunction secondary to microvascular or macrovascular thrombosis. Despite advances in treatment, TTP remains a serious condition with significant morbidity and mortality. Methods: We undertook an audit of patients with TTP over 14 years to assess remission, relapse, survival and factors predictive of outcome using current therapy based on plasma exchange with fresh-frozen plasma. Results: Forty patients were identified between January 1992 and December 2005. Thirty-one (82%) achieved complete response (CR) to therapy using plasma exchange with fresh-frozen plasma (median 11 exchanges) and steroids. Twelve (37%) relapsed a median of 14 days following cessation of therapy, with multiple relapses occurring in two patients. TTP-related death occurred in four patients during their initial presentation and in two during subsequent relapse. Four patients were only partially responsive to first-line therapy. The absence of neurological features at presentation was the only factor predicting a sustained CR to first-line therapy (P = 0.027, log–rank analysis). The mean duration of inpatient treatment was 18 days (range 4–38 days) with 30% of patients requiring intensive care admission. Thirty-four per cent of patients acquired central venous line infection, with a median of two episodes of line sepsis per patient. Conclusion: Our results indicate the need for better treatments to reduce the high early relapse rate and significant mortality associated with current therapy.