Serum Lactate Dehydrogenase Isoenzyme Pattern in non-Hodgkin's lymphomas

Serum lactate dehydrogenase (S-LDH) and its isoenzyme pattern were assayed in 63 non-Hodgkin's lymphoma (NHL) patients, 37 at diagnosis, 15 at relapse and 11 in complete remission (CR). S-LDH in NHL patients with active disease was higher than in normal subjects and CR patients (p<0.001). Among the isoenzymes, LDH-2 and LDH-5 showed no remarked differences; LDH-1 was reduced and LDH-3 and LDH-4 raised in comparison to the normal group (p<0.001). S-LDH levels and isoenzymes 1 and 4 were influenced by the stage, the histological subgroup and by the presence of general symptoms. In fact, cases in stage IV, with “high-grade malignancy” and with general symptoms, had higher S-LDH levels and more evident LDH-1 and LDH-4 changes than the other stages, the other histopathological subgroups and the cases classified as “A”. S-LDH was the same as in normal subjects in the “low-grade” and “intermediate-grade” malignancies as was LDH-1 in stage II and LDH-4 in stages II and III, in “low-grade” malignancy and in the A cases. In contrast, LDH-3 was always high, with no significant difference in relation to the variables considered.

Thus, in NHL, LDH-3 seems to be a reliable marker of the presence of the disease in any case, whereas S-LDH is more related to the spread of the lymphoma.

Analysis of leucocyte populations with the Coulter S-Plus STKR as a screening tool for haematological abnormalities

In two institutions at Rome and Florence we evaluated the clinical sensitivity of two Coulter STKR systems using the NCCLS standard H20-T for leucocyte differential count in a patient population with high prevalence of haematologic abnormalities. Reference ranges of normal leucocytes were obtained on 278 adult subjects. On a population of 455 patient specimens, 200 specimens (44%) were flagged by the STKR because of a distributional abnormality, and 122 (27%) because of a morphological abnormality. Percentage of subtotal agreements between the STKR and the reference manual differential count was 85.4%, with 67.5% full and 20.9% partial agreements. Eight specimens that showed a morphological abnormality with the reference manual differential count were classified as normal by the STKR, with a false normal rate of 6.6%. Analysis of the STKR performance for morphological abnormalities showed acceptable sensitivity (82.0%) and rather low specificity (71.5%), low predictive value of positive results (51.3), high predictive value of negative results (91.5%) and efficiency of 74.3%. The main problems of the STKR differential count were a high rate of false monocyte count, and the misidentification of eosinophilias and low-concentration abnormal cells.

Automated measurement of red blood cell microcytosis and hypochromia in iron deficiency and beta-thalassemia trait

Some routine red blood cell (RBC) measurements and indexes (count, mean volume, volume dispersion, and mean hemoglobin [HGB] concentration) can be used to differentiate iron deficiency from heterozygous beta-thalassemia. A number of formulas that incorporate two or more of these measurements have been described to amplify such differences. The H*1 hematology analyzer directly measures volume and HGB concentration of individual RBCs. We have assessed the diagnostic usefulness of conventional and new RBC measurements provided by the H*1 on a learning data set that comprised 119 patients with iron deficiency and 172 patients with beta-thalassemia trait, both untreated and uncomplicated. The most striking finding was the inverse behavior of percentages of microcytes (volume, less than 60 fL) and hypochromic RBCs (HGB concentration, less than 280 g/L) in the two conditions. In 162 of 172 patients with beta-thalassemia trait, the percentage of microcytes (mean, 33.1%; central 95th percentile range, 9.2% to 54.5%) was higher than the percentage of hypochromic RBCs (mean, 13.9%; central 95th percentile range, 1.7% to 24.7%). In 105 of 119 patients with iron deficiency, on the contrary, the percentage of hypochromic cells (mean, 34.6%; central 95th percentile range, 9.7% to 73.1%) was higher than the percentage of microcytes (mean, 12.8%; central 95th percentile range, 1.7% to 29.6%). The ratio between the percentage of microcytes and the percentage of hypochromic cells provided by the H*1 (microcytic-hypochromic ratio) was useful in differentiating the two types of microcytic anemia: with the use of a discriminant value of 0.9, the discriminant efficiency of the microcytic-hypochromic ratio was 92.4% (95% confidence interval, 88.8% to 95.2%), higher than that of the five previously described discriminant formulas and simple RBC measurements. When assessed on a test data set that comprised 149 unselected cases of microcytic anemia, a microcytic-hypochromic ratio lower than 0.9 demonstrated high sensitivity (94.0%), specificity (92.3%), and predictive value (94.0%) for the presence of iron-deficient erythropoiesis in patients with isolated iron deficiency, polycythemia vera treated by phlebotomy, and iron deficiency complicating heterozygous thalassemia. In conclusion, our results showed that iron-deficient erythropoiesis is characterized by the production of RBCs with a severely decreased HGB concentration, while microcytes of beta-thalassemia trait are generally smaller, with a more preserved HGB concentration. Such properties, as assessed by the H*1 hematology analyzer, are very useful in distinguishing these two common types of microcytic anemia.

An assessment of the operating characteristics of Coulter Counter Model S-Plus STKR

BACKGROUND AND METHODS

The operating performance of the Coulter Counter S Plus STKR was evaluated in two hospital laboratories in Rome and in Florence. Experimental design conformed to both the ICSH and NCCLS Standards for the evaluation of hematologic analyzers, and to the ECCLS guidelines for the multicenter evaluation of analyzers in clinical chemistry.

RESULTS AND CONCLUSIONS

Cell counts in K3 EDTA were unchanged over 6 hours at room temperature and 72 hours at 4 degrees C, while MCV, MPV and leukocyte differentials were far less stable. Carry over, precision and linearity met the manufacturer's specifications, while a satisfactory relative accuracy was demonstrated by determining reference values on an adult reference group and by comparing the instrument with the previous model S Plus IV D. The accuracy of the leukocyte differentials was evaluated by the microscope reference method, and our results seemed to validate the hypotheses that the STKR model counts: i) eosinophils, basophils and banded neutrophils among GR; ii) variant lymphocytes among LY, and iii) various abnormal cells among mononuclear cells. However, in spite of this statistical significance, some difficulties in correctly classifying the mononuclear population were demonstrated.

Rationale for large scale bone marrow hemopoietic stem cell manipulation

Many years have passed since the first attempt in marrow grafting was performed (1939). During this period several techniques have been developed in marrow processing and manipulation to overcome bone marrow transplant complications: the ABO barrier in case of major incompatibility between donor and recipient, the graft-versus-host disease due to the presence of allogeneic mature T-lymphocytes in cellular suspension and the neoplastic cell residue in autografts. At the end, the final volume of autologous mononuclear cell suspension must be frozen and an optimized cryopreservation allows a cell viability and subsequently an adequate medullar repopulating capacity.

Plasmapheresis in the therapy of hyperthyroidism associated with leukopenia

Surgery, the treatment of choice for hyperthyroidism due to nodular goiter, requires an euthyroid state, which is generally achieved with thionamides. Leukopenia is the most serious toxic effect of thionamides, and it causes controindication. We report a 50-year old woman with severe hyperthyroidism and leukopenia, in whom an euthyroid state before thyroidectomy was obtained with the use of therapeutic plasmapheresis. This procedure was carried out immediately before surgery using an intermittent flow separator; three sessions removed a total of 6,300 cc of plasma. Plasmapheresis caused a rapid reduction of both total and free thyroid hormone levels. Thyroidectomy was performed without any complications. Plasmapheresis can be considered a valid and safe method to prepare hyperthyroid patients for thyroidectomy when other therapies are ineffective or counterindicated.

Semiautomated autologous bone marrow processing for transplantation

This paper describes the development of a semiautomated procedure for autologous bone marrow processing, prior to ex vivo manipulation and/or cryopreservation. This procedure was employed with a pediatric bowl (125 ml Latham bowl) and the automated DuPont Stericell processor. We have obtained a mononuclear cell recovery of 85% and a hemopoietic progenitor cell recovery of 81% (CFU-GM; BFU-E), with a red cell removal of 84%. We believe that a reliable and standardized bone marrow processing procedure is the basic necessity for a bone marrow transplantation program.

A comparison between two different procedures for bone marrow processing: a semiautomated procedure vs manual starch sedimentation

After high-dose chemotherapy, autologous cryopreserved bone marrow infusion is employed to restore rapidly the compromised hematopoietic function. An efficient bone marrow processing reduces the infusion toxicity produced by hemolized red cells, granulocytes and platelets clumping and DMSO amount; moreover it increases freezing efficacy, a critical step in autologous bone marrow grafting techniques. Gravity sedimentation technique with 6% hydroxyethyl-starch (HES) or a semiautomated procedure using a blood cell processor were used in our center to manipulate ex-vivo the collected bone marrow. In our experience we compared these two different procedure and we evaluated their efficiency.

Comparison of the side effects of therapeutic cytapheresis and those of other types of hemapheresis

The side effects of a series of 2418 hemapheresis procedures performed in a total of 570 subjects (patients and donors) are described. Patients with various diseases were subjected to plasmapheresis (926 procedures in 181 patients) or cytapheresis (305 procedures in 89 patients). One hundred twelve plasmapheresis procedures and 1075 of cytaphereses were also performed in 300 blood donors. A total of 225 complications involving 107 patients (39.6%) occurred during 196 (15.9%) therapeutic procedures. Among the blood donors only 45 complications, involving 35 patients (11.6%) occurred during 45 procedures (4.2%). The complications seen with therapeutic plasmaphereses were circulatory disturbances (38% of all those observed), citrate reactions (27%), technical problems (20%), allergic reactions (9%) and miscellaneous complications (6%). Therapeutic cytaphereses were complicated by citrate reactions (44%), technical problems (25%), circulatory disturbances (14%), allergic reactions (11%) and miscellaneous complications (6%). Complications in the blood donor group included circulatory disturbances (51%), technical problems (36%) and various other problems (13%). No infectious complications or deaths were observed. The probability that adverse reactions will occur depends on the condition of the patient, the frequency of the sessions and the volume of fluid exchanged. Evaluation of the main risk factors, use of less intensive protocols and interruption of the session at the first sign of disturbances will help improve patient tolerance of these procedures.

Chronic myelogenous leukemia in the course of chronic lymphocytic leukemia: evidence for an independent clonal origin

We report on a 69-year-old man who developed Ph-positive CML 6 years after the onset of B-cell CLL. When CML was diagnosed, both malignant cell populations were detected in bone marrow and peripheral blood. Peripheral leukocytes were fractionated by Ficoll-Hypaque density gradient, and cytogenetic and molecular studies were performed on mononuclear cell and granulocyte-enriched populations. Mononuclear cells were stimulated with either PHA or PWM. In PHA-treated cultures 76% of the metaphases were Ph-negative, while after PWM stimulation 87% were Ph-positive. A bcr rearrangement was observed in DNA from the granulocyte-enriched fraction, but not in mononuclear cells. On the contrary the IgH locus resulted in monoclonally rearranged DNA, only in peripheral blood mononuclear cells. These results indicate that the two neoplastic populations originated independently.

Indicative morphological myelodysplastic alterations of bone marrow in overt AIDS

In HIV infection, numerous alterations of the hematopoietic system, with frequent cytopenias in peripheral blood and dysplasia of the bone marrow, have been observed. In order to assess the incidence of the myelodysplastic anomalies, 69 bone marrow aspirate smears from 47 patients with group IV HIV infection, as classified by CDC, have been studied. Various degrees of myelodysplastic alterations were found in all cases; however, dysgranulopoiesis was more frequent and more accentuated than other kinds of dyshematopoiesis. Intense vacuolization, especially in the granuloblastic series, was very frequent. It is felt that a bone marrow configuration that is highly indicative of overt AIDS can be sketched. The human immune deficiency virus may be either directly or indirectly responsible for myelodysplastic alterations.

Respiratory syncytial virus infection in bone marrow transplantation: a case report (syncytial virus infection)

The authors describe the case of a patient receiving a second bone marrow transplantation for acute lymphoblastic leukemia who developed, in the early post transplant period, an interstitial pneumonia caused by respiratory syncytial virus. The patient promptly recovered, but radiological findings of interstitial pneumonia lasted for three months.

Collection of peripheral blood stem cells using an automated discontinuous flow blood cell separator

Twenty collections of peripheral blood stem cells were performed in 3 patients (2 NHL, 1 AML) using the Haemonetics V50S discontinuous flow blood cell separator. A modified lymphocyte collection protocol (Nebraska Surge) was used in all instances. Leukapheresis were performed after 1 or 2 courses of chemotherapy and started when peripheral blood leukocytes count reached 1 x 10e9/l and platelets count 80 x 10e9/l. A mean blood volume of 5.9 +/- 0.6 litres was processed per procedure and the mean yields for mononuclear cells, nucleated cells and CFU-GM were respectively 5.4 +/- 1.4 x 10e9, 4.9 +/- 1.6 x 10e9 and 128.5 +/- 182.3 x 10e4 per procedure. Haemonetics V50S had showed a mean collection efficiency for mononuclear cells of 67.5 +/- 5.0% per procedure. Results obtained are not significantly different from the ones obtained with an automated continuous flow separator even if extracorporeal circulation is consistently high in patients with a low hematocrit when the 250 ml Latham Bowl is used.

Chronic. Myeloid Leukemia with Monoclonal Gammopathy Terminating in Myeloid Crisis and Immunoblastic Lymphoma

A patient, with chronic myeloid leukemia and IgA monoclonal gammopathy, who contemporaneously developed myeloid blast crisis and immunoblastic lymphoma is reported. Cytogenetic studies showed complex chromosome abnormalities concerning chromosomes 8, 14 and 22, other than the Ph chromosome. A possible relationship between the emergence of immunoblasts from slow proliferating lymphoplasmacytoid cells, myeloid blasts crisis and chromosomal changes is discussed.

Lymphocyte subset counting by immunoperoxidase using an automated routine hematologic analyzer

Using monoclonal antibodies against CD2, CD4, CD8 and CD19 antigens and an automated biotin-avidin immunoperoxidase technique on whole blood samples, we evaluated the technical performance and clinical usefulness of lymphocyte subset counting by the routine hematology analyzer Technicon H*1. Statistical evaluation demonstrated excellent precision and very good correlation with the immunofluorimetric flow cytometer Ortho Spectrum III. Correlation between manual immunofluorescence at the microscope and the H*1 method was much poorer, owing to the high intrinsic imprecision of the manual method. Reference ranges obtained with the H*1 immunoperoxidase method in 44 healthy subjects closely matched those obtained with the Spectrum III. In 46 subjects with or at risk for HIV infection, we found with the H*1 method a significant decrease in CD4+ cells and in the CD4+/CD8+ cell ratio, which was progressively more marked in HIV- negative patients with lymphadenopathic syndrome, AIDS-related complex, and in patients with full-blown AIDS.

Long-term cytogenetic effects of antineoplastic treatment in relation to secondary leukemia

Chromosome translocations are consistently present in leukemias and lymphomas and are likely to represent primary events in the development of these neoplasias. A study of conditions that predispose to leukemia could shed some light on the origin of these translocations and therefore help in clarifying their exact role in the process of neoplastic transformation. Based on this assumption, we studied a group of individuals treated with radiochemotherapy for previous lymphoma and who were at increased risk of developing a secondary leukemia. The group comprised 14 Hodgkin's disease patients, 11 non-Hodgkin's lymphoma patients, and 13 controls. The patients were in remission and had been off therapy for at least 6 months. Chromosomes were studied from phytohemagglutinin (PHA)-stimulated peripheral lymphocytes and from bone marrow cells by the direct method and after short-term cultures (72 hours). The latter were also exposed to 5-bromodeoxyuridine (BrdU). Metaphases were scored for chromosome breaks, gaps, and other rearrangements. The percentage of gaps and breaks was significantly higher in patients than in controls. The difference was induced by BrdU and was apparent in bone marrow cells, but not in peripheral lymphocytes. We conclude that individuals exposed to the action of mutagenic agents (radiochemotherapy) have an increased chromosome instability that could be related to their increased risk of developing a secondary leukemia.

Partial duplication of chromosome 1q preceding the development of an L3 lymphoblastic leukemia with t(8;14), secondary to treatment for Hodgkin's disease

We report on a case of secondary lymphoblastic leukemia L3 in a patient treated with chemo- radiotherapy for a previous Hodgkin's disease. The typical chromosome translocation t(8;14) was found in association with a translocation t(9;19) and a marker chromosome 1, dup(1q). The same marker chromosome had been detected in a few cells of peripheral blood 2 years before the onset of the acute leukemia and may represent a proliferation-associated change, responsible for the initiation of the process of leukemogenesis.

Ph1-chromosome-positive chronic myelogenous leukemia following a 1-year 'off-therapy' acute lymphoblastic leukemia

In this paper we describe a patient with acute lymphoblastic leukemia followed after 4 years by a Ph1-positive chronic myelogenous leukemia. The possible relationship between these two diseases is discussed.

Identification of blast cells in peripheral blood through automatic assessment of nuclear density: a new tool for monitoring patients with acute leukaemia

The Technicon H*1 haematology system is provided with a new method for basophil count, neutrophil lobularity assessment and detection of blasts in peripheral blood through automated measurement of nuclear density. We compared the results of the H*1 blast flag with those of the microscope examination in 131 peripheral blood samples from 43 patients with acute leukaemia in different phases of their disease, to determine the degree of sensitivity and specificity of the system in this setting. In six patients at diagnosis or in overt relapse, all having large percentages of blasts at the manual differential count, a typical deformation of the profile of the mononuclear cell population on the display was consistently observed, regardless of the morphological subtype of leukaemic cell which was involved. Amongst 34 samples with 4-95% morphologically recognizable blasts on the peripheral blood film, the sensitivity of the system was 100% with no false negatives at all. In 43 samples, on the other hand, the H*1 blast flag was positive in the absence of any morphological evidence of blasts on the smear. These 'false positives', however, were always obtained from leucopenic patients who had more than 12% blast infiltration in the bone marrow, compared to the 0-6% value that was found in patients with a negative H*1 blast flag. These results suggest that the H*1 system is a highly sensitive tool for the detection in peripheral blood of even small concentration of leukaemic cells, which escape morphological identification.

Combination of 6-mercaptopurine, vincristine, methotrexate, and prednisone in resistant or relapsed acute nonlymphoid leukemia

Twenty-six adults with acute nonlymphoid leukemia (ANLL) relapsed or resistant after first-choice chemotherapy including cytarabine and/or anthracyclines were treated with a modified POMP (6-mercaptopurine, vincristine, methotrexate, and prednisone) combination. Complete remission (CR) was achieved in five of eight resistant patients (62%) and in nine of 18 relapsed patients (50%). Intermittent cycles of chemotherapy including daunorubicin, cytarabine, 6-thioguanine, and etoposide were then administered. In the resistant group CR lasted from 11 to 126 weeks (median, 86), with two patients remaining in CR 126 and 108 weeks after remission induction; in relapsed patients, CR lasted from 9 to 50 weeks (median, 31).

Giant neutrophils with increased peroxidase activity. Another evidence of dysgranulopoiesis in AIDS

Using the automated hematologic analyzer Technicon H6000, which classifies leukocytes by their size and peroxidase activity, the authors have observed in nine patients with full-blown acquired immune deficiency syndrome (AIDS) a consistent increase in peroxidase content of circulating neutrophils. The increase in peroxidase activity was homogeneous in three patients (P less than 0.05). The most striking finding, however, was the occurrence of single abnormal neutrophils with peroxidase activity higher than the major neutrophil population (i.e., HPX [high peroxidase] cells). The importance of this phenomenon was correlated with the clinical status, higher HPX values being found in patients with more advanced disease. These instrumental observations were associated with the morphologic finding of atypical neutrophils, much larger than normal, with irregular nuclei and abundant cytoplasm filled with peroxidase-positive granulations. Such cells represent, in the authors' experience, the most common expression of dysgranulopoiesis in AIDS.

Treatment-related leukemia in Hodgkin's disease: a multi-institution study on 75 cases

Hematological and cytogenetic characteristics of 75 cases of therapy-related acute non lymphoid leukemia (t-ANLL) occurring in Hodgkin's disease (HD) are analysed in this multi-institution study. Combined radio and chemotherapy had been given in 88 per cent of patients, either as adjuvant (44 per cent) or as salvage modality (44 per cent). Radiotherapy alone and chemotherapy alone had been given in 3 per cent and 9 per cent respectively. Eighty per cent of patients were in remission of HD and 71 per cent off-therapy while developing leukemia. The median latent time from remission of HD to leukemia was 34 months. The myeloblastic variety of leukemia accounted for 43 per cent of total cases; the myelomonocytic and monocytic for 17 per cent and 4 per cent, the promyelocytic and erythroblastic variants for 5 per cent and 7 per cent of t-ANLL. Twenty four per cent of cases were unclassifiable; one of these was TdT-positive. Dysplastic features of erythrocytic line were invariably present with circulating erythroblasts; defects of granulocytes, circulating megathrombocytes and micromegakaryocytes were also present. Bone marrow hypoplasia and marked fibrosis were documented in 47 per cent and 30 per cent of cases. Preleukemia heralded overt leukemia in 73 per cent of cases; 37 per cent had refractory anemia with no excess of blasts; 16 per cent of preleukemias were unclassifiable. Cytogenetics revealed chromosome abnormalities in 83 per cent of cases; 72 per cent presented chromosome 5 and/or 7 monosomy or partial deletion (5q- or 7q-) of the long arm (94 per cent in the combined modality therapy group). In 3 cases, a pure monosomy 7 was observed; in none 5q-alone. Response rate to conventional therapy was 14 per cent; low and high-dose cytarabine were of little benefit. Long-term CR (28 + and 16 + months) was achieved in 2 cases with allogeneic bone marrow transplantation (BMT) as first-line therapy. A better knowledge of t-ANLL in HD and new therapies, including BMT, may improve the prognosis of this late complication of intensive HD treatment.

Depletion lymphocytapheresis in chronic lymphocytic leukemias: criteria for predicting which patients will respond to treatment

Depletion lymphocytapheresis therapy using the continuous-flow separator was used in twenty-two cases of chronic lymphocytic leukemia. Applying the Montserrat scoring system, a prediction can be made, to a good approximation, whether the patient will be a "responder" or a "non-responder" to leukapheresis. Criteria have been formulated for decisions on when depletion lymphocytapheresis is absolutely or only relatively indicated, on the basis of total scores from 2 through 6 using the Montserrat criterion.

Human eosinophils and parasitic diseases--III. Beta-interferon increases eosinophil IgG-Fc receptor expression and capacity

Eosinophilic granulocytes from the blood of patients with parasitic diseases were preincubated in the presence or absence of beta-interferon (beta-IFN). The number of cells bearing IgG-Fc receptors was determined by rosette formation with chicken erythrocytes coated with IgG antibodies. beta-IFN augmented the expression of IgG-Fc receptors on the cells within 1 h incubation. Treatment of beta-IFN with heat or acid did not abolish the activity. The doses of beta-IFN needed to induce the modulations of IgG-Fc receptors could also augment the eosinophil-mediated antibody-dependent cytotoxicity (ADCC) against chicken red blood cells which resulted most pronounced when the IgG antibodies were present in suboptimal amount. These data suggest the role of beta-IFN in the host resistance to parasitic diseases, mainly in the initial phases of parasitic infestation when the specific IgG antibody levels are very low.

Sequential Therapy with Lithium in Chemotherapy-induced Vomiting

Having noticed psychotic traits in some patients showing incoercible vomiting due to antineoplastic drugs we have thought of establishing a therapy with lithium in the days preceding the therapeutic cycle in order to reduce the emetic events. The effectiveness of lithium carbonate (600 mg/mq p.o./day for one week) in the prevention or reduction of vomiting induced by antiblastic therapy has been checked in comparison with metoclopramide and domperidone in 40 patients. In the group pretreated with lithium, 80 % of the cases showed favorable results. In the control groups, on the contrary, the efficacy of the antiemetic therapy has shown to be of lesser importance (55 %). The undesirable side-effects of lithium appear to be irrelevant. We therefore think that pretreatment with lithium may become, in selected cases not affected by traditional antiemetics, of great importance in the control of emetic symptomatology.

Electromyography for the investigation and early diagnosis of scoliosis

A clinically normal 5 year old child with a family history of scoliosis was studied. Electromyography of the thoracic and lumbar erector spinae muscles and roentgenography of the spine were both done on two separate occasions, six months apart. On the first electromyographic investigation, moderate predominance of activity was found over the left thoracic erector spinae muscles. At that time, spinal roentgenography showed normal results, whereas six months later left thoracolumbar scoliosis was evident. It was concluded that electromyographic investigation is useful for the early diagnosis of scoliosis in school-age children.

Association of ankylosing spondylitis with hairy cell leukemia: a previously once reported case

We report a case of ankylosing spondylitis associated with hairy cell leukemia. This is the second observed case (I3) of ankylosing spondylitis with a B-type lymphoproliferative disorder which allows us to make some observations about the pathogenesis of these rare diseases.

Automated cytochemistry in acute leukemias. A new approach to the FAB classification based on cell distribution pattern

Automated cytochemistry by the Hemalog D carries out leukocyte differential counts in a continuous flow mode on whole blood EDTA-collected samples, through the optical measurement of enzyme activity and cell size. This operative principle thus parallels the basis of the FAB classification of acute leukemias. Although the cell classification logic system can be misled by the heterogeneity of most leukemic populations, valuable qualitative information may be obtained from the x-y oscilloscope display. This provides a true morphological representation of the leukemic cell distribution. According to such a preliminary assumption, each FAB subtype of acute leukemias is shown to reproduce a peculiar image of cellular distribution when analyzed by the Hemalog D.

[Gaucher's disease: hemorrhagic diathesis and term pregnancy with the birth of a malformed fetus]

A patient suffering from Gaucher's disease observed for the first time five years age while in pregnancy and observed again during a second pregnancy ended with the delivery of a malformed female infant is presented. Laboratory findings of this case and their correlation with the clinical manifestations of this disease are underlined. Occurrence of foetal malformations in this disease is also discussed.

Megathrombocytes, platelet regeneration time and platelet associated IgG in idiopathic thrombocytopenic purpura and in thrombocytopenia associated with chronic liver disease

Percentage of megathrombocytes, platelet regeneration time (PRT) and platelet-Associated IgG (Pl-A-IgG) were investigated in 12 patients with clinical features consistent with idiopathic thrombocytopenic purpura and in 11 patients with thrombocytopenia associated with chronic liver disease. Bone marrow smears were also examined and megakaryocytes classified into stages I-III according to the current principle. Of 12 patients with idiopathic thrombocytopenic purpura the percentage of megathrombocytes was increased in 9, PRT reduced in 10, and Pl-A-IgG increased in 8 patients. A statistically significant correlation was found between the percentage of megathrombocytes and the level of Pl-A-IgG. A slight correlation was also found between PRT and the percentage of megathrombocytes, while a significant correlation was found between megakaryocytes in stage I and the percentage of megathrombocytes, suggesting that growth of megakaryocytes probably contributes to platelet heterogeneity. In patients with thrombocytopenia and chronic liver disease, the percentage of megathrombocytes was in the normal range. A moderately increased level of Pl-A-IgG was found only in patients with active chronic hepatitis, PRT was reduced only in a few patients, while most of them also showed an increase of Pl-A-IgG.

[Value of CT and lymphography in the staging of lymphomas (author's transl)]

The contribution of CT is evaluated in association with conventional diagnostic investigations in the staging of lymphomas. The data obtained by means of CT are an integration of those obtained by means of lymphography. On the other hand CT offers elements which cannot be obtained by others methods, especially concerning the retroperitoneal region. This diminishes the average of patients who must undergo laparoscopy and laparotomy. Moreover CT allows to follow the evolution of the disease and to control the results of the treatment.

Disseminated intravascular coagulation in acute promyelocytic leukemia. Possibility of treatment with glucocorticoids at high doses

Seven patients affected by acute promyelocytic leukemia and presenting a hemorrhagic syndrome with hypofibrinogenemia have been treated with Daunorubicin and high doses of Glucocorticoids. In three out of the seven patients we also added an antiprotease agent (Trasylol, Bayer). Hemorrhagic diathesis has been controlled in all patients but one without massive platelet transfusions. A complete hematologic remission with prolonged survival was achieved in five patients.