The use of hydroxocobalamin in the Schilling test

Hydroxocobalamin and cyanocobalamin have been compared as the 'flushing dose' in the Schilling test. In healthy, haematologically normal subjects excretion of the test dose was greater following a hydroxocobalamin flushing dose than following a cyanocobalamin flushing dose, and to a lesser extent this was also true in patients requiring investigation. There were occasional discrepant results, but in general it appears that, although reference values differ, hydroxocobalamin is a suitable replacement for cyanocobalamin in the Schilling test.

Platelet count and platelet size in healthy Africans and West Indians

Healthy subjects of African origin were found to have lower platelet counts than simultaneously studied healthy Caucasians. A similar reduction was found in a large group of West Indian females, though not in a small group of West Indian males. It is suggested that the lower platelet counts observed in Africans and West Indians may be partly environmental and partly genetic in origin. The mean platelet volume and platelet distribution width in the Africans and West Indians showed the same relationship with the platelet count as was found in Caucasians, so that the same nomograms can be used in all ethnic groups to assess whether there is deviation from normality.

A comparison of the white cell counts of cord blood from babies of different ethnic origins

Cord blood samples were collected from 242 babies of five different ethnic groups. All had a birth weight of at least 2.5 kg, but they were otherwise unselected. No ethnic differences were found in the total white cell count, neutrophil, lymphocyte, monocyte or eosinophil counts. Thus the lower total white cell and neutrophil count which has been observed in adults of African and Afro-Caribbean origin is not present in neonates. Similarly eosinophil counts did not differ between the different ethnic groups suggesting that high eosinophil counts previously reported in Indian and African subjects have an environmental cause.

Platelet count and platelet size in males and females

The platelet count of healthy males was compared to that of healthy females. A higher platelet count in women was confirmed. A similar inverse non-linear relationship between the platelet count and the mean platelet volume (MPV) was found in the two sexes. The slightly higher MPV in men was insufficient to compensate for the lower platelet count so that the plateletcrit, which measures total volume of platelets in a given volume of blood, was also significantly higher in women.

Assessment of the value of a competitive protein binding radioassay of folic acid in the detection of folic acid deficiency

The diagnostic value of the Becton Dickinson Radioassay Kit (125I) for the the assay of red cell folate has been investigated. The assay was acceptable with regards to precision but was non-linear with changing packed cell volume. Sensitivity of the assay was satisfactory, with 24 of 25 folate deficient patients giving red cell folate values which fell below the reference range. Specificity of the assay in the detection of folate deficiency was less satisfactory. As with microbiological assays, a considerable proportion of vitamin B12 deficient patients had low red cell folate values. In addition, low concentrations were found in 12% of patients who were unlikely to be deficient in either vitamin B12 or folic acid.

Hepatic sinusoidal ectasia in association with Hodgkin's disease

A patient developed abnormal liver function tests in association with hepatic sinusoidal ectasia concurrently with relapse of Hodgkin's disease. Tests returned to normal following successful chemotherapy for the Hodgkin's disease. Sinusoidal ectasia and the related condition, peliosis hepatis, should be recognized as rare non-infiltrative manifestations of Hodgkin's disease.

Megakaryoblastic leukemia presenting as acute myelofibrosis -- a study of four cases with the platelet-peroxidase reaction

Acute myelofibrosis (AM) or malignant myelosclerosis is a myeloprofilerative syndrome in which bone marrow fibrosis is associated with a proliferation of immature myeloid cells. In four patients with typical AM, investigated by the platelet-peroxidase reaction at ultrastructural level, the blast cells were found to be megakaryoblasts. One patient, treated with the drug combination DAT, achieved a complete remission of 5 mo duration. This study supports the view that megakaryoblastic leukemia is the most frequent underlying cause of AM and proposes that it should be classified as a form of acute myeloid leukemia.

Sideroblastic anaemia in association with malignant histiocytosis

A 69-year-old women died of malignant histiocytosis in association with sideroblastic anaemia. Respiratory insufficiency was a prominent clinical feature and was found to be due to obstruction of pulmonary capillaries by malignant histiocytes. It is possible that the same abnormal myeloid clone gave rise to malignant histiocytosis and sideroblastic anaemia.

Automated differential leucocyte counters: an evaluation of the Hemalog D and A comparison with the Hematrak. II. Evaluation of performance on routine blood samples from hospital patients

The performance of the Hemalog D on routine blood samples from patients was assessed over a 6 wk period, 500 samples being studied in detail. The performance of the Hematrak was assessed on 85 routine blood samples. It was found that in our hospital population at least 58% of blood samples counted by the Hemalog D would require a blood film to be examined. Occasional patients with haematological diseases had abnormalities on the blood film but had normal Hemalog 8 and Hemalog D printouts. The Hemalog D was unable to perform an accurate differential count on the blood from a large proportion of patients with uraemia, including dialysis patients. The Hematrak was imprecise because of the small number of cells counted; it was also found to be inaccurate if blood films were not made rapidly after the blood was taken.

Automated differential leucocyte counters: an evaluation of the Hemalog D and A comparison with the Hematrak. I. Principles of operation; reproducibility and accuracy on normal blood samples

The precision and accuracy of the Hemalog D, which uses cytochemical identification of cells in suspension, and of the Hematrak, which uses image recognition of cells on a stained blood film, have been compared counting normal blood samples. The Hemalog D showed superior precision for all cell types, as would be expected since 10,000 cells are counted per sample; however, the precision for monocytes was worse than expected for the number of cells counted. The precision of the Hematrak was equivalent or superior to that of a manual count of the same number of cells but showed the poor precision inevitable when only 100 cells are counted. With respect to accuracy, both automated counters showed statistically significant differences from manual counts and from each other in counting neutrophils, lymphocytes and eosinophils, bu the differences were not sufficiently great to be of practical importance. The Hematrak counted monocytes accurately (though imprecisely) whereas the Hemalog D overestimated monocytes on average by 2.3%, or 40% of the mean monocyte percentage. This was consequent on the counting of esterase positive neutrophils as monocytes, and the difference from the manual count was sufficient to be of some practical importance. The Hemalog D counted basophils both accurately and precisely. The precision of manual and Hematrak basophil counts was poor; the accuracy of the Hematrak basophil count was dependent on the quality of the stain and that of the manual basophil count was dependent on the quality of the stain and the attentiveness of the technologist. For other cell types in blood samples from normal volunteers, the Hematrak was versatile and accuracy was not greatly affected by the use of May-Grünwald-Giemsa rather than Wright's stain, nor by the use of hand spread rather than machine spread films.

The peripheral blood in chronic granulocytic leukaemia. Study of 50 untreated Philadelphia-positive cases

The haematological findings in the peripheral blood of 50 patients in whom the diagnosis of chronic granulocytic leukaemia (CGL) had been made in the haematology laboratory, and who were subsequently shown to be Philadelphia-chromosome-positive, have been reviewed. The differential leucocyte counts were performed by 3 observers, examining a total of 1,500 cells in each patient. The degree of anaemia at diagnosis was unrelated to sex and correlated poorly with leucocyte count; thrombocytopenia seemed unrelated to leucocytosis. A differential luecocyte count which included a complete spectrum of granulocytic cells, with prominent peaks in the percentages of myelocytes and neutrophils, was an invariable finding. Absolute basophilia occurred in all patients and absolute eosinophilia in 92%. In 54% of the patients there was an absolute lymphocytosis. Unlike the finding in normal subjects, there was no linear relationship between the numbers of circulating neutrophils and monocytes. Application of these findings should improve the accuracy of the haematological diagnosis of CGL, while study of the rare cases which possess the above features but are Ph1-negative may throw further light on the role of the Philadelphia chromosome in the natural history of CGL.

Relationship between the concentration of neutrophils and monocytes in venous blood

A striking linear relationship was found between the logarithms of the medians of the circulating neutrophil (granulocyte plus metamyelocyte) counts and the monocyte counts in 5 groups of individuals studied. These groups consisted of (1) 100 normal adult males, (2) 100 normal, non-pregnant females, (3) 50 females in the last trimester of pregnancy, (4) 15 patients with a persistent neutrophil leucocytosis and (5) 20 patients with polycythaemia rubra vera, essential thrombocythaemia or myelofibrosis. A different relationship appeared to exist between the circulating neutrophil and monocyte counts in a group of 16 patients with chronic granulocytic leukaemia.

Variations in leucocyte count during menstrual cycle

The neutrophil counts of seven women, three tkaing oral contraceptives and four nottaking them, showed cyclical variations during the menstrual cycle, most consistentlya fall in the neutrophil count at menstuation. The neutrophil count in women not taking oral contraceptives rose to a peak twice during each cycle. One womennot taking oral contraceptives was studied in detail over eight consecutive menstrualcycles. She showed two neutrophil peaks per cycle and a similiar variation in themonocyte count. The eosinophil count showed a reciprocal relation with the neutrophil count and the basophil count fell in mid-cycle. The changes in her neutrophil count seemed to follow changes in oestrogen level with a delay of one to two days. Oestrogen probably promotes release of neutrophils from the bone marrow rather than from the marginated pool.

Normal haematological values: sex difference in neutrophil count

Blood counts were performed on 100 male and 100 female staff to establish normal ranges for our hospital. Neutrophil counts were found to be on average 0.66 times 10-9/1 (660/mm-3) higher in women than in men. Statistically this difference was highly significant and was not due to the fact that many of the women were taking oral contraceptives. The neutrophil counts of the men and women were also on average 0.50 times 10-9/1 (500/mm-3) greater in the afternoon than in the morning. A correlation was observed between the neutrpphil and the monocyte counts.