Platelet and fibrinogen kinetics with ( 75 Se)-selenomethionine in patients with myeloproliferative disorders

Metabolism of fibrinogen in children with acute lymphoblastic leukaemia

The metabolism and in vivo kinetics of fibrinogen were studied using homologous 125I-labelled fibrinogen in 21 children with acute lymphoblastic leukaemia (ALL). Ten patients were undergoing induction therapy, 11 children were in complete remission on maintenance therapy. Results in the patients undergoing induction therapy were: plasma fibrinogen levels were normal in all except one patient, the plasma fibrinogen pool was elevated in six cases, seven patients had a shortened fibrinogen half-life and increased fractional catabolic rate for fibrinogen. The absolute catabolic rate for fibrinogen was elevated in six cases. This shortened fibrinogen half-life together with the correcting effect of heparinisation on the fibrinogen turnover indicated that fibrinogen was consumed by chronic disseminated intravascular coagulation. Inhibition of the fibrinolytic system with epsilon-aminocaproic acid in five patients had no influence on the fibrinogen half-life in three of them but resulted in its prolongation in two patients. All except two children in complete remission had normal fibrinogen levels. Six patients had elevated plasma fibrinogen pools and in all of the cases survival and fractional catabolic rate of fibrinogen were normal. The absolute catabolic rate for fibrinogen was normal in eight, elevated in three of the patients. This observation indicates that fibrinogen synthesis remains accelerated in some cases of ALL in complete remission, but the cause of this is not known.

Measurement of platelet life-span in normal subjects and patients with myeloproliferative disease with indium oxine labelled platelets

The use of 111Indium oxine as a platelet label for the performance of platelet life-span studies has been examined. Platelet life-span in normal subjects varied between 8 X 10 and 10 X 36 d. Patients with primary thrombocythaemia had clearly reduced platelet life-span whether or not they presented with vascular occlusion and this abnormality persisted after reduction of the platelet count to normal by busulphan therapy. Patients with similarly elevate platelet counts due to chronic granulocytic leukaemia or after splenectomy had platelet life-span values in the normal range. Plasma beta-TG levels could not be used to predict platelet life-span in these groups of patients. Measurement of platelet life-span using 111Indium labelled platelets is a useful technique in the examination of platelet function in occlusive vascular disease.

The relation of platelet kinetics to bone marrow megakaryocytes in chronic granulocytic leukaemia

The relation of thrombokinetics to quantitative determinations of megakaryocytes (mgkc) in bone marrow sections was studied in 11 consecutive cases of untreated Ph1-positive chronic granulocytic leukaemia (CGL). The results were compared with controls and with previously obtained data in polycythaemia vera (PV), primary thrombocythaemia (PT) and in idiopathic thrombocytopenic purpura (ITP). Platelet survival was significantly reduced in CGL. Platelet production was 5.8 x normal and the mgkc number and volume/microliter bone marrow were significantly increased as compared to controls. The increase in mgkc volume was not in proportion to that of number due to a significant decrease of mgkc size. Platelet production was strongly related to mgkc number/mm2 and to the mgkc volume/microliter bone marrow. The platelet production rate in relation to a unit of mgkc volume/microliter bone marrow was, however, greater in CGL than in controls, PV, PT and ITP. The chief reason for this is most probably the greater expansion of the total bone marrow mass in CGL.

Quantitation of RNA-dependent platelet DNA polymerase in patients with myeloproliferative disorders

Platelets from 28 patients with the myeloproliferative diseases (MPD) polycythaemia vera (9), essential thrombocythaemia (6), myelofibrosis with myeloid metaplasia (5) and chronic myelogenous leukaemia (8) were examined for an RNA-dependent DNA polymerase activity using standardized conditions permitting highly reproducible quantitation. Low levels of activity were detected in platelets of normal individuals, but platelets of nearly all MPD patients (25/28) possessed higher levels. The polymerase activity correlated with diagnosis (P = 0.001) and did not correlate with platelet counts (P greater than 0.2). Quantitation of this RNA-dependent DNA polymerase activity may be a useful parameter in the diagnosis of myeloproliferative disorders.

Fibrinogen kinetics in patients with neoplastic disease

Fibrinogen half-life was determined in 30 patients with active or inactive malignancies by monitoring survival of administered 125I-labeled autologous fibrinogen. Six patients had no evidence of active disease and served as controls having fibrinogen levels and half-lives within the normal range reported in the literature. Twenty-six studies were conducted on 24 patients with various active malignancies. Significantly shorter fibrinogen half-lives were found in patients with active malignancies. The fractional catabolic rates calculated from both the plasma data and the urinary isotope excretion were significantly increased in patients in this group. Although there is some evidence that exposure to intensive chemotherapy may further shorten fibrinogen survival, there is no significant difference between treated and untreated or responding and nonresponding groups. The major determinant of fibrinogen survival appears to be the presence of active malignant disease, in addition to the specific type of malignancy involved.

In vivo study of platelet kinetics by 75Se-methionine in different haematological disorders

Labeling of platelets in vivo by 75Se-methionine was performed in premalignant and malignant haematological disorders for evaluation of the kinetics of platelet maturation. The "normal" platelet maturation time (time between the injection of the isotope and maximum radioactivity of separated blood platelets) in eight non-haematological patients showing normal platelet counts was 9.1 days. A shortening of platelet maturation time of 5-7 days was observed in three of four cases with panmyelopathy (high bone marrow cellularity), in three of four cases with malignant lymphatic disorders (multiple myeloma, chronic lymphocytic leukaemia, lymphosarcoma), and in two of four cases with myeloproliferative syndromes. No correlation to the peripheral platelet counts was observed. For explanation of the premature platelet release from the bone marrow a disturbance of the megakaryocyte maturation is suggested.

Thrombocytosis in rheumatoid arthritis

Of 75 patients with rheumatoid arthritis, 39 had a thrombocytosis and 36 normal platelet count. A highly significant relationship existed between the platelet count and disease severity and an inverse correlation with level of haemoglobin. An association appeared to exist between thrombocytosis and extra-articular manifestations of rheumatoid disease. By 75Selenomethionine labelling platelet and fibrinogen survival and turnover were determined. In 3 rheumatoid patients with thrombocytosis platelet survival was decreased and turnover increased. In these and a further rheumatoid patient with a normal platelet count there was reduced fibrinogen survival and increased fibrinogen turnover, and in addition excess fibrin degradation products were detected. The results suggest that thrombocytosis accompanies the more severe cases of rheumatoid disease and is due to a compensatory increase in platelet production associated with active intravascular coagulation.