Pappenheimer bodies. An additional cause for a spurious platelet count

A 67-year-old woman who had sideroblastic anemia had a spuriously elevated platelet count due primarily to Pappenheimer bodies. The platelet count on an electrooptical instrument was falsely elevated. The true platelet count was determined by phase microscopy using lysed whole blood and by the peripheral blood smear. There appear to have been no previous reports of falsely elevated platelet counts due to Pappenheimer bodies. Other causes of spuriously elevated platelet counts are reviewed. The reasons for the spurious counts are discussed.

A role for radiation in the treatment of hairy cell leukemia complicated by massive lymphadenopathy: a case report

A patient with leukemic reticuloendotheliosis is described who two years following splenectomy developed massive retroperitoneal, abdominal, and mediastinal lymphadenopathy. Therapeutic intervention was necessary because the bulky tumor masses produced disabling pain in the back and chest regions. Low-dose radiation to the involved fields produced prompt regression of the adenopathy along with dramatic pain relief. This case suggests that hairy cells may be quite sensitive to radiation, and this therapeutic modality should be considered, especially when local problems are present.

Hairy cell leukemia with acquired dyserythropoiesis

Dyserythropoiesis, a qualitative abnormality of erythrocyte production, is described in a patient with hairy cell leukemia (leukemic reticuloendotheliosis). The development of a second population of circulating RBCs with a mean corpuscular volume of 154 cu mu suggests the emergence of an abnormal clone of marrow erythrocyte precursors.

Quinine protects pyruvate-kinase deficient red cells from dehydration

Pyruvate kinase deficient red blood cells have an abnormal tendency to lose ATP when exposed to low pO2 or cyanide, whereas normal red cells do not. Once energy is depleted, all red cells take up calcium and subsequently lose intracellular potassium and water. It has been shown previously that quinine will inhibit the potassium and water flux seen in energy depleted normal cells. The present study indicates that quinine protects cyanide treated pyruvate kinase deficient erythrocytes from water and potassium loss. Quinine does not prevent ATP depletion or calcium uptake. By six hours, cyanide treated pyruvate kinase deficient cells have lost an average of 486 gm of water per kilogram cell solids and 140 mmoles of potassium per kilogram of cell solids, while cells treated with both quinine and cyanide have lost only 106 gm of water per kilogram of cell solids and 77 mmoles of potassium per kilogram of cell solids. These data support the concept that the membrane lesion in pyruvate kinase deficiency is secondary to ATP depletion and is a manifestation of the Gardos effect. Quinine may have therapeutic potential in the treatment of pyruvate kinase deficiency hemolytic anemia.

Adriamycin inhibits Ca permeability and Ca-dependent K movements in red blood cells

Normal human red blood cells show a prompt, large increase in K permeability when their cytoplasmic Ca concentration is increased by various in vitro manipulations. Adriamycin, in concentrations greater than 0.02 mM, inhibits this response. Although the mechanism of adriamycin's action is not clear, experiments with dog red blood cells suggest that the drug inhibits passive Ca permeability. The importance of Ca-gated K movements in red blood cells is obscure, but in excitable tissues such ion currents play an important role in membrane repolarization. The influence of adriamycin on this ion conductance pathway may be related to the acute cardiotoxic and neurotoxic effects of the drug.

A new treatment strategy for hemophilia B: incorporation of factor IX into red cell ghosts

Although patients with severe hemophilia B have lifelong spontaneous hemorrhage and crippling hemarthroses, patients with 0.01--0.03 U/ml Factor IX activity have a milder disease state. The clinical condition of severely affected individuals could potentially be improved by prolonging the half-life of transfused Factor IX. The feasibility of incorporating Factor IX into red cell ghosts was suggested by resealing experiments with similar sized molecules such as albumin. We have prepared resealed red cell ghosts containing human Factor IX and X. Human red cells were subjected to hypotonic lysis at 0 degrees C, pH 6.0. Commercial prothrombin complex concentrate was dissolved in the lysing medium immediately prior to the addition of the red cells. After being returned to isotonicity, the red cell ghosts were annealed at 37 degrees C for 30 minutes and then washed extensively. When intact red cell ghosts were tested, no Factor IX or X activity could be demonstrated. After disruption of the red cell ghost membranes with 3M urea or 2% Triton X-100, the procoagulants could be quantitatively recovered. Similar recovery of the clotting factors could be demonstrated from the lysate and the early wash samples. Red cells from Factor IX and X deficient patients served equally well as those from normal subjects. Red cell ghosts prepared in similar fashion but not exposed to the procoagulants had negligible clotting activity. We have demonstrated that human clotting factors can be incorporated into red cell ghosts. The ability of this system to prolong the biological half-life of Factor IX is under investigation.

An ascorbate-mediated transmembrane-reducing system of the human erythrocyte

Actively metabolizing human erythrocytes catalyze the extracellular reduction of ferricyanide to ferrocyanide. Because neither of these anions can enter the cell, reducing equivalents generated in the course of glycolysis must in some manner be transferred across the cell membrane, thereby resulting in ferricyanide reduction. Work described in this paper suggests that the transmembrane reduction is effected by ascorbic acid. This compound in its oxidized form (dehydroascorbate) rapidly enters the cell. Here it obtains reducing equivalents which appear to come from NADH made available at the level of glyceraldehyde 3-phosphate dehydrogenase. Once reduced, it leaves the cell as ascorbic acid and accomplishes the non-enzymatic reduction of ferricyanide.

Hb Nottingham (alpha2beta2 (FG5) 98 val leads to gly) in a Caucasian male: clinical and biosynthetic studies

A second instance of the unstable mutant Hb Nottingham (alpha2beta2 (FG5) 98 Val leads to Gly) is reported in a 7-year-old boy. Because of splenomegaly, cholelithiasis, and frequent episodes of abdominal pain, he underwent a splenectomy and cholecystectomy at age 6. The surgery resulted in both an amelioration of his RBC destruction and an acceleration of his rate of growth.

Selective increase of potassium permeability in red blood cells exposed to acetylphenylhydrazine

Normal human red blood cells, when exposed briefly to acetylphenylhydrazine (APH), acquire Heinz bodies and a propensity for net ion and water loss upon subsequent incubation in an APH-free medium of physiologic sodium and potassium (K) content. The cells can be protected from APH damage by previous deoxygenation. The ion and water loss depend on the presence of a K gradient from cell to medium. In contradistinction to some other types of membrane perturbation in which K permeability is increased, the APH effect is not dependent on calcium. The meaning of these observations is discussed in relation to the vulnerability of the K permeability barrier.

Parenteral nutrition at home for 5 years via arteriovenous fistulae. Supplemental intravenous feedings for a patient with severe short bowel syndrome

On March 26, 1970, a 33-year-old male suffered intestinal infarction which required total enterectomy and duodeno-transverse colostomy. Nutrition was maintained in the hospital by daily parenteral feeding for 2 months postoperatively, after which parenteral feedings were decreased and stopped for long periods. Various oral dietary regimens failed to provide adequate nutrition, and the patient lost 40 kg and became severely malnourished during the next 13 months. In June 1971, supplemental home parenteral nutrition (PN) via an arteriovenous fistula was instituted on a 3 or 4 nights per week basis. The patient's weight and strength increased markedly after institution of the home supplemental PN program. The first fistula became occluded after 9.5 months of home PN use and subsequent successive fistulae have remained patent for 31.3, 8.8, and 5.5 months of use. The patient prepares his own PN fluids at home, using a commercial device for filling plastic intravenous fluid bags. Although several different types of fluid have been used, the current mixture of 25% glucose and 2.75% amino acids with added vitamins, potassium, calcium, magnesium, and insulin plus simultaneously administered lipid emulsion has proven most effective. Only when the patient's low fat, low oxalate diet is supplemented with this parenteral mixture 4 nights each week is he in positive nitrogen, phosphorus, and magnesium balance. However, his negative calcium balance is only partially corrected. There has been no sepsis, embolism, or fistula infection during 5 years of home PN.

Hairy cell leukemia: B-lymphocyte and phagocytic properties

The diagnosis of hairy cell leukemia was made in three patients by phase-contrast microscopy and histochemistry of the abnormal peripheral blood cells. Both IgM and IgD surface immunoglobulins were resynthesized after these cells were trypsinized and cultured. Aggregate or Fc receptors were demonstrated on hairy cells. The ability to phagocytose latex was also a property of hairy cells; however, these cells did not demonstrate nonspecific esterase activity. Stimulation by phytohemagglutinin resulted in very low incorporation of tritiated thymidine. Cytofluorographic analysis of the phytohemagglutinin-stimulated cell population revealed less than 9% of the cells in an interploid or tetraploid state. The abnormal mitogen response was largely restored when purified T lymphocytes obtained from the peripheral blood of the patients were cultured with phytohemagglutinin. Hairy cells cultured with normal allogeneic mononuclear cells did not undergo blast transformation. These data strongly suggest that the cells of at least some patients with hairy cell leukemia are B lymphocytes with phagocytic capabilities.

Hemolysis caused by factor VIII concentrates

Immune hemolytic anemia is a recognized complication of the use of factor VIII concentrates. Hemolysis is obscured often by the presence of active bleeding. Where hemolysis has been demonstrated, red blood cell (RBC) destruction has been attributed to anti-A antibodies found in the transfused material. We present two episodes of hemolysis associated with the use of factor VIII concentrate. In the first, a high titer of "immune" anti-A (1:256) was present in the factor VIII. In the second, the patient's RBCs were group B, and the hemolysis was caused by anti-B antibody in the factor VIII concentrate. In addition, the antibody titer in the material that was received was much lower than previously described. The RBC destruction presumably occurred because of the massive dosage of factor VIII concentrate administered on order to overcome a factor VIII inhibitor.

Formaldehyde-induced hemolysis during chronic hemodialysis

We investigated an outbreak of hemolytic anemia among patients on hemodialysis shortly after the installation of a new water-filtration system. Using in vitro technics, we demonstrated that a water-soluble inhibitor of red-cell metabolism could easily be extracted from the intact filters. Subsequent experiments showed this toxic substance to be formaldehyde, a potent reducing agent whose mechanism of action involves conversion of NAD to NADH. This alteration of the redox state of the erythrocyte leads to inhibition of glycolysis at the level of glyceraldehyde 3-phosphate dehydrogenase and rapid decline in cellular energy (ATP) stores. Because formaldehyde is widely used as a preservative for dialysis equipment, the toxicity of this agent for red blood cells is of clinical importance.

Azotaemic inhibition of organic anion transport in the kidney of the rat: mechanisms and characteristics

1. While azotaemic sera depressed the in-vitro Na-iodohippurate transport of rat kidney slices at any concentration, normal sera excited transport at low concentrations and depressed transport at high concentrations. The depression of transport by azotaemic sera was partially overcome by neomycin feeding in contrast to the depression by normal sera, which was not altered by neomycin feeding.

2. Plotting the reciprocal of sodium-iodohippurate accumulated by slices against the reciprocal of the media concentrations of sodium iodohippurate suggested that the depression of hippurate transport produced by normal and azotaemic sera was competitive in nature.

3. Normal sera slowed the efflux of Na-iodohippurate from kidney slices while azotaemic sera affected it very little.

4. The depression produced by normal and azotaemic sera and the stimulation produced by low concentrations of normal sera were seen with serum ultrafiltrates and dialysates, and after passage through cation exchange columns, but not anion exchange columns.

5. The effects on Na-iodohippurate accumulation by normal and azotaemic sera could be reproduced with metabolizable (lactate), and nonmetabolizable (hippurate) organic anions as well as combinations of these.

6. The implications of these observations on the altered renal transport of Na-iodohippurate produced by azotaemic and normal sera are discussed.