Bilten za hematologiju i transfuziju最新文献

In the group of blood donors submitted to the long term plasmapheresis with the weekly withdrawal of 370--670 ml of plasma, the concentrations of total bilirubin, alkaline phosphatase, aspartate (GOT) and alanine (GPT) transaminases, total lipids, triglycerides and cholesterol were not significantly changed (P greater than 0,05). The mean concentration of total lipids in plasma donors were close to the upper normal limit, while the concentrations of triglycerides slightly increased simultaneously with the increase of the number of plasmapheresis. The mean concentrations of indirect bilirubin significantly decreased (P less than 0,05) and the concentrations of indirect bilirubin increased (P less than 0,05), but because they do not differ significantly from the concentrations of the control group, these changes are of no clinical importance.

Glycolipid compounds causing agglutination of erythrocytes in vitro and the appearance of the anti-P-antibodies in vivo have been named P antigens. The P denotes blood group factor P, being the antigen belonging to multiple allelomorphs in the P system. Their structure has been shown to be of glycosphingolipid nature differing in number and character from carbohydrate components. It has been established that at infestations by parasites the titre of the anti-P-antibodies increases, and hydatid fluid from the cysts of Echinococcus granulosus, as well as certain tissue extracts of some helminths inhibit agglutination of the P1-erythrocytes by anti-P1--antisera. We have isolated the very polar glycolipid complex from hydatid fluid of the cysts of Echinococcus granulosus and from the tissue homogenates of some parasite helminths. We have named it as cytolipin P, designating by P its parasitic origin. The complex is immunologically active and induces cellular and humoral immune response. Having taken into account the nature of cytolipin P we investigated its biological relation to blood group P-factor. Equine, sheep and human p1-erythrocytes agglutinate the cytolipin P when the concentration of it reaches 75--100 mg%. The inhibition of agglutination was achieved by four sequential doses inducing haemagglutination with anti-P-sera when used as standards, and with human anti-P1-sera of the patients exhibiting echinococcal and ascardial positive human and animal sera. Inhibition was reached two times quicker with anticytolipin-P-sera. It would appear that in the organisms invaded by parasites the cytolipin P represents that antigenic structure which provokes the organism to produce the polyclonal anti-P-antibodies.

The group of 31 patients with acute leukemia was analysed: 24 ALL and 5 ANLL. The complete remission was achieved in 84% of children. Mortality in induction was high and reached 16%. All recidives occurred with in 24 months from the diagnosis. 15% of patients achieve complete continuous remission (CCR) lasting 2 and more years, the result beeing better in patients treated with more intensive regimen. 53% patients will ALL achieved CCR for 5 and more years. In a small group of patients with ANLL the rate of CR is 60%. Only one girl, with a M 3 form lives more than 20 months.

An infant at the age of one month was admitted to hospital due to anaemia and icterus. Premature delivery was induced because of Rh immunisation. Newborn's grave condition permitted only one "blood volume" exchange transfusion and as a consequence prolonged haemolytic anaemia occurred. At the age of one month anti Rh-D antibody persisted in the infant circulation with the titre 1:16 in an indirect antiglobulin method.

Blood donors who were tested twice at interval from 6 to 8 months, were HBs-Ag positive both times. The biochemical parameters for the evaluation of liver function were within normal limits. The significantly decreased values of total haemolytic activity of complement-CH50 (0,001) and Clq (0,005) and increased level of Cl Inh (0,005) point ot the activation of the complement system (Table 2, 3). The level of Cl Inh statistically significantly and positively correlates with the values of C4, C5 and with C3A, what means that it participates in the process of activation regulation (Table 5). Using the method of precipitation by means of 0,3 g/l PEG we have registered in 92% of HBs-Ag positive blood donors elevated concentrations of immune complexes and in all PEG precipitates HBs-Ag (Table 6). These findings point to the need of clinical investigation and treatment of those persons.

Case reports dealing with preleukemic syndromes are rare. During the last years preleukemia has been ill defined. Nowadays, most authors agree that a marrow stem disorder with clinically recognisable haematological abnormalities, which proceed the development of overt leukemia, is to be regarded as preleukemia syndrome. Clinical and haematological features are different in preleukemic syndromes terminating with acute lymphoblastic (ALL) and acute non-lymphoblastic leukemia (ANLL). We describe two cases of preleukemia--the first evolving into ALL and the second into ANLL. Our first patient had developed pancytopenia and hypocellular bone marrow five months before overt ALL. In the moment the diagnosis was made clinical examination revealed enlarged lymph glands, liver and spleen. Laboratory tests showed pancytopenia and bone marrow infiltrated with blasts L1 morphology (F. A. B. classification). Preleukemic phase terminating with ANLL featured pancytopenia and hypercellular bone marrow infiltrated with histiocytes, some showing signs of erythrocyte-, leukocyte- and platelet-ingestion. Diagnosis of acute monoblastic leukemia M5 (F. A. B.) was made three months after the illness onset, according to bone marrow infiltration with monoblasts. Clinical and haematological features helpful in the recognition of preleukemic syndromes are discussed.

Based on clinical findings of patients with some proliferative tumors and experimental data, a hypothesis of positive feedback mechanism by which tumor stimulates its own growth has been formulated. In some patients with Hodgkin's disease and non-Hodgkin's lymphomas, i.e. leukemias, the high levels of substances immunologically cross reactive with insulin (SICRI), low glycemic values and increased values of growth hormone were found in the blood. These findings were in correlation with the status and stages of the disease. In a more advanced stage of the disease, the concentration of insulin-like substances was higher and glucose levels were lower in patients in remission. The high correlation was found between the increased SICRI levels of insulin-like substances showed faster growth. It is certain that some tumor cells excrete these substances. In mice with melanomas, high concentrations of these substances, growth hormone and low glucose levels were found in the blood. On the basis of these findings a hypothesis was formulated about positive feedback mechanism by which tumors stimulates their own growth. Tumor excretes SICRI which decreases glucose concentration in the blood. Hypoglycemia is a stimulation for the pituitary to release growth hormone into the blood. This hormone probably stimulates protein synthesis and replication of tumor cells contributing to increased SICRI excretion, etc. The final results of this positive feedback mechanism is faster growth of tumor and death of host.

Clinical and morphologic characteristics of hairy cell leukemia at 11 patients have been analyzed. The frequency of this disorder is 2.5% from all leukemias. This disorder is often retrospectively diagnosed--at 7 cases from our study. the disorder is often retrospectively diagnosed--older age (78%). Splenomegaly is the main clinical manifestation, at all 11 patients. Pancytopenia is frequent finding but at 4 patients the leucocyte count was over 10 X 10(9)/1 in the beginning. Hairy cells, although not always with typical appearance, in 90% of the cases are found in peripheral blood over 10%. Bone marrow biopsy cytological and hystological findings at 9 patients were typical for diagnosis. Fibrosis was present in 6 specimens. At 7 patients diagnosis was confirmed with histological examinations of lymphocyte concentrates from peripheral blood on thin and ultrathin sections, as well as with electron microscopy characteristic appearance of hairy cells. Pneumonia as complication was registered in 24 occasions, gastro-intestinal infections at 9, haemorrhagic syndrome at 4 and skin carcinoma at 2 cases. Treatment was variable--2 patients were observed for more than 50 months, 2 were splenectomised, of which one with complete remission longer than a year, while from 8 treated with COP protocol, complete remission was obtained in 5 (62%) patients, and two treated with CHOP protocol entered complete remission for longer than 12 months. Average survival is 51 months (2--144). Three (28%) patients died.