Severe immune-mediated hemolytic anemia secondary to treatment with cefotetan

Severe acute hemolytic anemia developed in a woman following treatment with multiple antibiotics for possible postpartum uterine infection. On admission, the hemoglobin was 5 g per dL (50 g/L), the reticulocytes were 35 percent (0.350), the direct antiglobulin test was strongly positive for IgG and C3d (mixed fields), and the indirect antiglobulin test was negative. Serologic studies revealed antibody to cefotetan that reacted by both the immune complex and the drug adsorption mechanisms. Before the diagnosis of cefotetan-related immune hemolysis was made, all medications had been discontinued, and the patient received 4 units of red cells and a short course of adrenocorticosteroids. Recovery was prompt and complete.

Chronic idiopathic thrombocytopenic purpura followed by chronic myelocytic leukemia

An 8-year old girl was diagnosed as having idiopathic thrombocytopenic purpura which later became refractory to steroids, splenectomy, and immunosuppressive therapy. While she was being treated for pneumococcal meningitis, 7 1/2 years later, she was found to have Philadelphia-chromosome-positive chronic myelocytic leukemia. She died 2 1/2 years after the diagnosis of leukemia. The association of autoimmune disorders and hematologic malignancies has been well-recognized. To our knowledge, there has been no previous report of chronic idiopathic thrombocytopenic purpura preceding the development of chronic myelocytic leukemia in the literature.

Lymphocytopenia in acute experimental renal failure

Lymphocytopenia is a common accompaniment of renal failure. To study this phenomenon, guinea pigs were made uremic by ureteral ligation. In one day, peripheral lymphocytes had decreased by 44%. The phenomenon is not species-specific since both rats and rabbits exhibited early peripheral blood lymphocytopenia after bilateral nephrectomy or ureteral ligation. Lymphocytopenia due to the markedly elevated blood cortisol levels following ureteral ligation is unlikely for two reasons. Normal guinea pigs injected with large amounts of corticosteroids showed no lymphocytopenia. Adrenalectomized rats underwent bilateral nephrectomy with resultant increase in plasma creatinine and marked fall in peripheral lymphocytes. The rapid development of the lymphocytopenia associated with uremia would favor increased destruction rather than decreased production.

Dissociation of circulating renin and erythropoietin in rats

Renin and erythropoietin activities were measured in the plasma of 110 rats exposed to various conditions designed to dissociate the two renal "hormones." In acute experiments, intraperitoneal injection of polythiazide increased renin activity but did not change erythropoietin activity; exposure to low oxygen tension increased erythropoietin activity and caused an insignificant decrease in renin activity. In chronic experiments, salt restriction or the combination of salt loading and desoxycorticosterone for 2 weeks increased or decreased renin activity, respectively, without changing erythropoietin activity. The combination of chronic salt loading and acute hypoxia reduced renin activity and increased erythropoietin activity. In the final experiment, intraperitoneally injected cobaltous chloride acutely increased erythropoietin activity without markedly altering renin activity. Without contributing to the solution of the problem of the cell origin of erythropoietin, the present study clearly indicates that the secretion of renin and erythropoietin can be dissociated.