摘要:

SummaryWe have found a high incidence of ocular haemorrhage in patients with acute promyelocytic leukaemia (APL). We describe a series of seven consecutive cases of APL, five of which developed ocular haemorrhage. There were no consistent detectable abnormalities in coagulation predictive of ocular damage. Ocular haemorrhage occurred despite the use of aggressive blood product support and its incidence was not altered by the use of the anti fibrinolytic agent tranexamic acid or by the use of heparin. Complete spontaneous resolution of the ocular pathology occurred in three of the five cases of ocular haemorrhage and partial recovery occurred in one. The fifth patient required surgical intervention. The mechanisms underlying the coagulopathy associated with APL are poorly understood. We discuss the evidence in support of primary disseminated intravascular coagulation and primary fibrinolysis. A logical approach to the management of the bleeding complications in APL can only follow greater understanding of the underlying pathophysiology.

ISSN:0141-9854    

DOI:10.1111/j.1365-2257.1992.tb00362.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

SummaryReview of splenectomies carried out for haematological disease over a ten‐year period, at a district hospital, shows that the indications for splenectomy have changed substantially over this time. Fewer patients with idiopathic thrombocytopenic purpura now require splenectomy, however its role in the management of lymphoproliferative disorders has expanded. Splenectomy remains an important therapeutic option for a range of haematological disorders: this series shows it to be a safe and effective operation in selected patients, although it is not without both short and long‐term seque

ISSN:0141-9854    

DOI:10.1111/j.1365-2257.1992.tb00363.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

SummaryFrom 1981 to 1989, 12 patients of the University Hospital, Kuala Lumpur, were diagnosed to have Evans syndrome based on direct antiglobulin test (DAT) positive haemolytic anaemia and immune thrombocytopenia occurring either simultaneously (7 patients) or consecutively (5 patients). Their mean age at presentation was 24.8 years with a marked female preponderance. All 12 patients were given high dose steroid after diagnosis. Subsequently, other modalities including intravenous immunoglobulin (1 patient) and high dose methylprednisolone (1 patient) were given. Three patients died of intracranial haemorrhage during the first admission while 1 patient died of pulmonary embolism six months after diagnosis. Three patients had splenectomy because of thrombocytopenia. Six patients tested positive for antinuclear factor and antibodies to double stranded DNA and four of them died. Positive serology appeared to be associated with a poorer prognosis. Follow up observations indicate that patients who survive the acute attacks fare reasonably well.

ISSN:0141-9854    

DOI:10.1111/j.1365-2257.1992.tb00364.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

SummaryHigh oxygen affinity haemoglobins result in polycythaemia and cardiovascular adaptation to maintain tissue oxygenation. The polycythaemia can cause symptoms of hyperviscosity and vaso‐occlusive disease. We report a kindred with a high affinity haemoglobin (Haemoblobin Yakima) one of whose members gave birth to two infants with intra‐uterine growth retardation and who suffered with symptoms of hyperviscosity which settled on reduction of the PCV by venesect

ISSN:0141-9854    

DOI:10.1111/j.1365-2257.1992.tb00365.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

SummaryThe haemodynamic effects of the venesection of one unit (450 ml) of blood over 9 min were measured using non‐invasive techniques, in 14 healthy controls and 18 patients with coronary heart disease or hypertension. Venesection was associated with significant reductions in supine and standing systolic and diastolic blood pressure, stroke volume index and cardiac index, and increases in standing heart rate, in both patient groups. No significant differences were observed between the responses of subjects with and without cardiovascular disease. The authors conclude that, in contrast to established teaching, blood loss can be detected in its early stages by careful haemodynamic monitoring and that venesection can be performed safely without volume replacement in patients with stable cardiovascular diseas

ISSN:0141-9854    

DOI:10.1111/j.1365-2257.1992.tb00366.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

SummaryHydroxyethyl starch (HES) (Hespan, DPont) is a widely used synthetic volume expander which in standard doses of up to 1.51 in 24 h has no significant effect on coagulation (Munschet al.1988). However, the data sheet states that in large volumes HES may alter the coagulation mechanism. We now report a case of HES induced acquired von Willebrand's disease (vWD) in which severe bleeding occurred.

ISSN:0141-9854    

DOI:10.1111/j.1365-2257.1992.tb00367.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

SummaryThe ultrastructure of bone marrow cells was studied in nine patients infected with the human immunodeficiency virus (HIV). Two of these (cases 1 and 3) were thrombocytopenic, had never suffered from opportunistic infections and had not received any drugs prior to the time of study. A number of ultrastructural abnormalities were found in a variable proportion of the affected cell types in all nine patients. These were: (a) an increased prevalence of multivesicular bodies within several cell types and of abnormalities of the nuclear membrane in neutrophil granulocytes, (b) an increase in the size of the Golgi apparatus and in the quantity of endoplasmic reticulum in neutrophil granulocytes, (c) dysplastic features, including multiple long intranuclear clefts and large cytoplasmic vacuoles in some erythroblasts and (d) vacuolation of the plasma cells. Other abnormalities seen in a proportion of the patients were: (a) cylindrical confronting cisternae (CCC) in some of the lymphocytes, macrophages (phagocytic reticular cells), non‐phagocytic reticular cells (including adventitial cells) and endothelial cells of marrow sinusoids, (b) tubuloreticular structures (TRS) in some lymphocytes, plasma cells, monocytes and endothelial cells and (c) precipitates of protein within occasional erythroblasts and marrow reticulocytes. There was also a striking and hitherto undescribed abnormality of the structure of the nucleus in intersinusoidal and perisinusoidal non‐phagocytic reticular cells. This was seen in six patients, including case 3, and was characterized by the extensive detachment of masscs of abnormally electrondense heterochromatin from the nuclear membrane, the presence of a uniformly thin layer of electron‐dense material at the inner surface of the areas of nuclear membrane denuded of heterochromatin masses and an abnormal electron lucency of areas containing euchromatin. The CCC and TRS were found in the six patients with the lowest number of circulating CD4‐positive T cells. The precipitation of protein within erythroid cells may have been caused by the oxidant effect of dapsone or high doses of co‐trimoxazole. The abnormalities in the stromal cells and in particular the nuclear changes seen in the non‐phagocytic reticular cells support the possibility that one of the mechanisms underlying the cytopenia in patients infected with HIV may be a disturbance of the microenvironmental regulation of h

ISSN:0141-9854    

DOI:10.1111/j.1365-2257.1992.tb00368.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

SummaryZymosan‐induced luminol‐enhanced chemiluminescence of phagocytes was measured in whole blood using a microtitreplate format. A consistent reaction response curve could be obtained using a normal blood sample, with low intra‐assay variations in peak light index, cumulated response as well as time taken to reach the peak. Variations were common when tests were done on different days for the same individual, or when different persons were compared simultaneously. Reactions were hastened and enhanced if continuous shaking at 37°C was applied. The interval between time zero and peak was the most consistent variable, with a coefficient of variation of 12% in inter‐assay analysis. Because of its simplicity and ease of operation, the method is potentially useful in studying phagocyte functions in pathologica

ISSN:0141-9854    

DOI:10.1111/j.1365-2257.1992.tb00369.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

SummaryAutomated platelet counts in a patient with newly diagnosed AML M5 with extreme leukocytosis were reported as 129, 166 and 121 × 109/1. Routine blood films showed a corresponding number of platelet‐sized particles, judged to be platelets. The patient was treated for DIC with low‐dose heparin infusion. Platelet transfusions were not given initially. The patient died 14 h after admission from intracerebral haematoma. The origin of the platelet‐sized particles seen in routine stained blood films was examined by cytochemical and immunological staining for peroxidase, non‐specific esterase, CD 13 and CD 33. About 1/3 of the fragments had the same staining characteristics as the leukaemia cells, indicating leukaemia cell origin. Staining for platelet‐specific antigen GpIIIa was positive only in 4% of the platelet‐sized fragments, with a calculated true platelet count of 4 × 109/1. The presence of cell fragments masquerading as platelets should be suspected in leukaemia patients with bleeding symptoms and normal or near normal pl

ISSN:0141-9854    

DOI:10.1111/j.1365-2257.1992.tb00370.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

SummaryA unique computerized management system has been used to control the anticoagulation of over 400 patients at a large teaching hospital for the last eighteen months. The system is located on the main pathology computer which can be interfaced with the patient administration system (PAS). This enables files in the anticoagulant program to be linked with files in the PAS and files in the haematology database. This system has many advantages over a stand‐alone microcomputer system and will form the basis for the next generation of computerized anticoagulant management system

ISSN:0141-9854    

DOI:10.1111/j.1365-2257.1992.tb00371.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY