Effects of storage of blood on stability of hematologic parameters

The hematologic parameters of blood stored at 4 degrees C and at room temperature were studied. In blood stored at 4 degrees C with intermittent mixing, leukocyte count, hemoglobin, erythrocyte count, mean corpuscular volume (MCV), hematocrit, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration (MCHC), and platelet count showed no statistically significant change for three days. Blood stored at room temperature showed a significant increase in MCV in 24 hours, and corresponding changes occurred in hematocrit and MCHC. It is concluded from these observations that blood from normal healthy donors can serve as an adequate control for the Coulter Counter for three days if kept at 4 degrees C and mixed intermittently.

Platelet function, ultrastructure, and survival in the May-Hegglin anomaly

The May-Hegglin anomaly is one of the rare forms of heriditary thrombocytopenia. Since fewer than 100 cases of May-Hegglin anomaly have been described to date, major controversies regarding the adequacy of hemostasis in vivo and abnormalities of platelet function in vitro continue to prevail. This report describes the results of coagulation, platelet function, platelet ultrastructure, and survival studies performed for a family with six previously unreported cases occurring in three generations. One member of this family also had frequent epistaxis and a prolonged bleeding time associated with cyanotic heart disease that required open heart surgery for correction. The laboratory assessment of hemostasis in such patients before major surgery is also discussed.

Acute lymphoblastic leukemia following Hodgkin's disease

Over 100 instances of acute leukemia have been reported in the course of Hodgkin's disease. The type of leukemia almost always is nonlymphoblastic. Only five well documented cases of acute lymphoblastic leukemia (ALL) have been found by us in the world literature. One case who developed ALL six years after intensive radiotherapy for Hodgkin's disease is herewith reported. The patient responded to treatment with Prednisone, Vincristine and intrathecal methotrexate and maintained a complete remission on 6-mercaptopurine for nine months. When last seen, the bone marrow revealed a mild increase in blasts indicative of an early relapse.

Fatal intra-peritoneal bladder rupture due to blocked catheter in a paraplegic

A female paraplegic developed intraperitoneal rupture of urinary bladder seven weeks after institution of indwelling urethral catheter drainage. Blockage of the catheter precipitated this fatal event. Oliguria after an initial encouraging urinary output despite adequate fluid replacement led us to suspect bladder rupture which was confirmed by urgent cystography. Although emergency laparotomy to repair the rent in the bladder was performed, she succumbed to gram-negative septicemia. Other hazards of indwelling urethral catheter drainage even for short periods are highlighted (though the above complication itself is admittedly rare) with an oft re-emphasised plea to consider earlier the alternative modality of intermittent catheterisation or pharmacotherapy in female patients.

Intravascular coagulation and fibrinolysis within primate extremities during tourniquet ischemia

A common although infrequently recognized complication associated with the use of a pneumatic tourniquet is profuse bleeding from the wound after deflation of the tourniquet. The purpose of this study was to determine whether intravascular coagulation and fibrinolysis could be induced in subhuman primates by tourniquet ischemia, and whether this phenomenon could be altered by pretreatment of the animal with heparin. It was shown that, after 2(1/2) hours of tourniquet ischemia, (400 mmHg) to one lower limb, fibrinogen levels were significantly lower (p < .005), antithrombin III levels were significantly lower (p < .05), plasminogen levels were significantly lower (p < .05), fibrin split products significantly higher (p < .025) and fibrinopeptide A levels were significantly higher (p < .02) than values measured simultaneously in the control limbs. After pre-treatment with sodium heparin, 30 units/kg, there was no change in antithrombin III levels or fibrinogen levels, but fibrin split products in the experimental limbs were significantly elevated (p < .05) when compared to control limbs. In both groups the abnormal levels returned to control levels 5-30 minutes after tourniquet deflation. We conclude that intravascular coagulation and fibrinolysis develop within ischemic subhuman primate limbs during tourniquet ischemia. Pretreatment with heparin prevents the consumption of fibrinogen and antithrombin III but does not prevent the increase in fibrin split products which was observed. It is possible that intravascular coagulation and fibrinolysis contribute to post tourniquet bleeding.

Acute promyelocytic leukemia. A review of literature

Acute promyelocytic leukemia is a form of acute myeloblastic leukemia characterized by hemorrhagic episodes, severe thrombocytopenia and infiltration of the marrow with "hypergranular" promyelocytes, often with multiple Auer bodies. Ultrastructurally. the promyelocytes show many splinter granules and Auer bodies with characteristic hexagonal arrangement of tubules with a periodicity of 250 A. Serum vitamin B12 and B12-binding proteins, in particular, transcobalamin I, are abnormally high. Karyotypic abnormalities include pseudodiploidy and partial deletion of the long arm of chromosome 17. Coagulation profile during bleeding episodes is usually consistent with disseminated intravascular coagulation. Greatly improved prognosis in recent years as a result of aggressive chemotherapy and anticoagulation emphasizes the need of early recognition of this clinical entity.

Comparison of zeta sedimentation ratio with Westergren sedimentation rate

Zeta sedimentation ratio (ZSR) is a simple, rapid and reproducible test which is not influenced by variables like sex and anemia. There is good correlation with Westergren erythrocyte sedimentation ratio (ESR) in normal and hospital population. Limitation of packing force affects the use of the procedure in polycythemia and in patients with ZSR greater than 80%.

An improved procedure for quantitation of platelet factor 4

Platelet factor 4 (heparin neutralizing) activity shortens the thrombin time of a heparinized plasma. In the proposed procedure (I) a heparin thrombin time curve is constructed by adding gradually increasing amounts of heparin to a commercial plasma substrate and determining thrombin times, (2) a suitable concentration of heparin that gives highest reproducible thrombin time is selected and added to the substrate, (3) thrombin times are determined for the heparinized substrate before and after addition of a test material containing platelet factor 4. The two thrombin times are converted to heparin concentration by reference to the heparin thrombin time curve. The difference in heparin concentrations represents platelet factor 4 activity. When lyophilized commercial plasma is used as substrate larger quantities of heparin can be employed in the system, resulting in improved sensitivity and precision.

Effect of aspirin on prostaglandin synthesis by human platelets

When platelet rich plasma is exposed to N-ethylmaleimide, a ten fold increase in measurable prostaglandin E synthesis occurs. This effect is almost completely abolished within 2 hours of ingestion of 600 mg of aspirin by human volunteers. Recovery of this platelet function is slow for the first two days, returning sharply to normal over the next six days and plateauing approximately 8 days following initial removal from aspirin. It is suggested from these studies that platelet prostaglandin E production following NEM may be a useful test of platelet function.

Comparison of three methods for plasma fibrinogen

Three plasma fibrinogen methods are presented based on (1) clottable protein assay by Biuret reagent, (2) measurement of clot absorbance and (3) thrombin time. These methods show good correlation and adequate precision on normal subjects as well as heparinized plasmas. The effects of interference owing to hemolysis, lipemia, bilirubin, heparin and fibrinogen degradation products are discussed briefly.

An improved method for plasma fibrinogen based on thrombin time measurement

Methods for plasma fibrinogen based on thrombin time are technically simple, rapid, and sensitive, although "false low" results may occur due to heparin interference. The present modification incorporates Polybrene into buffer to eliminate this heparin interference. The proposed method shown excellent agreement with a reference procedure based on clottable protein, and excellent day-to-day precision (C.V.3.5%). The present method is easily adaptable to semi-automated measurements.

Improved micromethod for plasma fibrinogen unaffected by heparin therapy

An improved micromethod for plasma fibrinogen, based on the Ellis-Stransky thrombin-clot density procedure, is presented. Modifications includes: (1) addition of Polybrene eliminates heparin interference; (2) measurement of absorbance at 340 nm provides improved sensitivity at low fibrinogen levels as well as with small volumes of plasma (40 mul.); (3) higher concentration of thrombin reduces the incubation time. Plasma fibrinogen by the proposed method compares well with a reference procedure based on total clottable protein (coefficient of correlation 0.99).

Platelet activity ratio. A new approach for quantitation of platelet factor 3

The ratio of kaolin recalcification time in platelet-poor plasma to kaolin recalcification time in platelet-rich plasma appears to provide a more accurate estimate of platelet factor 3 activity than measurement of kaolin recalcification time in platelet-rich plasma alone. This ratio is termed the "platelet activity ratio." Over a fairly wide range the platelet activity ratio appears to follow a linear log-log relationship to platelet count (platelet counts of 12,500 to 200,000). The use of diluted platelet substitute as artificial standard greatly simplifies preparation of (1) standard curves and (2) quality control plasmas. If platelet activity ratio is expressed as a percentage of normal platelet factor 3 activity, the normal range for "total" platelet factor 3 (PF3t) is 60 to 175% and normal range for "available" platelet factor 3 (PF3a) is 14 to 47%.