Haematological values during normal reproduction of the maternal and the fetal rabbit

1. Haematological values of non-pregnant/non-lactating, pregnant as well as lactating rabbits and 28-day-old fetuses were measured. 2. The haemoglobin content in does decreased during the observed periods from 122 +/- 8 g/l to 100 +/- 11 g/l. In 28-day-old fetuses it was 85 +/- 0 g/l. 3. The erythrocyte count in 28-day-old fetuses was 2.4 X 10(12)/l. In the does, the erythrocyte count was 5.2 X 10(12)/l in week 4 of gestation. The erythrocyte volume in fetuses was about 45% higher than that of the doe. 4. In fetuses the leucocyte count was approximately one ninth that of the mother in week 4 of gestation (0.41 +/- 0.08 X 10(9)/l vs 3.8 +/- 0.4 X 10(9)/l).     

Treatment of autoimmune thrombocytopenic purpura with rhesus antibodies (anti-Rh0(D)]

There is evidence that blockade of the reticuloendothelial system (RES) by sequestration of autologous red blood cells (RBC) leads to an elevation of platelet counts in immune thrombocytopenia. To substantiate this hypothesis, 10 Rh0(D)-positive adult patients (9 female, 1 male) with chronic autoimmune thrombocytopenic purpura (ITP) (1 to 21 years duration) were treated with low doses of intravenous IgG-anti-Rh0(D) (200 to 1,000 micrograms per dose; 300 to 3,600 micrograms per course; administration within 1 to 5 days). All patients improved clinically as indicated by cessation of bleeding. In eight out of ten patients there was a rise in platelet count. Platelet increments were excellent (greater than 100 X 10(9)/l) in one, good (50-100 X 10(9)/l) in three, fair (20-50 X 10(9)/1) in two and low (10-20 X 10(9)/1) in two patients. Splenectomized patients (N = 4) had a poorer response than non-splenectomized patients (N = 6) with mean increments of 16 X 10(9)/l (range 5-43 X 10(9)/l) versus 60 X 10(9)/l (range 10-110 X 10(9)/l). The increase in platelet counts persisted for seven to over 150 days. Transient and slight signs of haemolysis developed in seven out of ten patients (haemoglobin remained stable; increase of lactate dehydrogenase (greater than 250 IU/l) in four, decrease of haptoglobin (less than 60 mg/dl) in five patients). The direct antiglobulin test became positive in all cases due to IgG1 without complement fixation. We conclude that the interaction of antibody-coated RBC with macrophages (and, probably, other means of RBC alteration) is a feasible therapeutic approach in selected cases of ITP and related conditions.     

Effect of obesity on erythrocyte count and hemoglobin levels in Libyan diabetic patients

Fasting blood glucose, erythrocyte count and hemoglobin levels of obese and nonobese Libyan diabetic women were determined. The mean values of fasting blood glucose, erythrocyte count and hemoglobin of obese diabetic women were 209.55 +/- 8.85 mg/dl, 4.986 +/- 0.04 X 10(6)/mm3 and 14.51 +/- 0.18 g/dl. The respective values for nonobese diabetic women were 243.47 +/- 12.56 mg/dl, 4.865 +/- 0.06 X 10(6)/mm3 and 14.31 +/- 0.19 g/dl. The mean values of the three variables of obese patients were significantly different from those of the nonobese patients. Statistically significant correlations were found between fasting blood glucose levels and erythrocyte count, and hemoglobin levels in both obese and nonobese patients. The levels of erythrocyte count and hemoglobin of obese patients were higher than those of their nonobese counterparts. This elevation was attributed to the effect of obesity. It is suggested that regulation of body weight should be considered an essential step in the management of diabetes.     

Basic haematological values in carnivores--II. The Felidae

1. Basic haematological values in 34 animals of eight carnivorous species are reported. 2. In four Northern lynxs (Lynx lynx lynx), two male and two female animals, the mean values are given: erythrocyte counts 8.51 X 10(12)/l, haematocrit 0.392/l, haemoglobin content 148.0 g/l and leukocyte count 7.92 X 10(9)/l. 3. In six male pumas (Puma concolor missolensis) the mean values estimated are: erythrocyte count 9.35 X 10(12)/l, haematocrit 0.43/l, haemoglobin content 163.9 g/l and leukocyte count 7.73 X 10(9)/l. Individual values in one female puma are also given. 4. In six jaguars (Panthera onca), three male and three female animals, the mean values are given: erythrocyte count 8.27 X 10(12)/l, haematocrit 0.37/l, haemoglobin content 137.1 g/l and leukocyte count 15.15 X 10(9)/l. 5. Only individual values are reported in one clouded leopard (Neofelis nebulosa), in one leopard (Panthera pardus saxicolor), in one Corbett's tiger (Panthera tigris Corbetti) and in one Altaic tiger (Panthera tigris Altaica). 6. In four lions (Panthera leo leo), two male and two female animals, the mean estimated values are: erythrocyte count 10.14 X 10(12)/l, haematocrit 0.462/l, haemoglobin content 159.0 g/l and leukocyte count 11.05 X 10(9)/l. In six female cheetahs (Acinonox jubatus jubatus) the mean values estimated are: erythrocyte count 7.86 X 10(12)/l, haematocrit 0.373/l, haemoglobin content 142.8 g/l and leukocyte count 8.65 X 10(9)/l. For three male cheetahs only individual values are reported. 8. All results achieved are compared with those abstracted from the literature and discussed.     

Basic haematological values in carnivores--I. The Canidae, the Hyaenidae and the Ursidae

Basic haematological values for 32 animals of four carnivore species are reported. In six adult wolves (Canis lupus) the mean values estimated for the erythrocyte count 7.48 X 10(12)/l, haematocrit 0.465/l, haemoglobin 172.0 g/l and leukocyte counts 7.33 X 10(9)/l are given. For five young wolves, these parameters were markedly decreased, only the white cell count was raised. In 14 hunting dogs (Lycaon pictus) the mean values estimated are: erythrocyte count 9.15 x 10(12)/l haematocrit 0.435/l, haemoglobin 179.2 g/l and leukocytes 12.95 X 10(9)/l. In six striped hyaenas (Hyaena hyaena) the mean estimated values are: erythrocyte count 8.11 X 10(12)/l, haemoatocrit 0.445/l, haemoglobin 178.0 g/l and leukocytes 13.95 X 10(9)/l. Only individual values for the reported parameters are given in the Asiatic black bear (Selenarctos thibetanus). All results are compared with values derived from the literature for animals under investigation and for the domestic dog (Canis familiaris).     

Cytoreductive effect of recombinant alpha interferon in patients with myelofibrosis with myeloid metaplasia

In an attempt to reduce myeloproliferation, we administered recombinant alpha-2b interferon (r-alpha INF) to ten patients with myelofibrosis with myeloid metaplasia (MMM) in a hypercellular phase, as part of a phase II trial. Two patients experienced severe side effects and stopped treatment before completion of the first week. In the eight evaluable patients, r-alpha INF was given for 16 weeks at an initial dosage of 3 X 10(6) U/day, with monthly increments in the case of response failure, i.e. a decrease in WBC or platelet count of less than 25% of the initial value. Two cases responded at the starting dosage, while the effective dosage was 5 X 10(6) U/day in the others. At the end of the 16th week, Hb showed minor changes: from an initial value of 12.08 g/dl, range 8.3-17.3, to 11.6 g/dl, range 7.7-18 (P = 0.12); WBC were reduced from 54 X 10(9)/l, range 6.4-69.4, to 17.5 X 10(9)/l, range 5-39 (P = 0.09, 4/8 responses); platelets decreased from 775 X 10(9)/l, range 215-1748, to 403 X 10(9)/l, range 118-730 (P = 0.008, 8/8 responses). Minor changes in spleen size were also noted, while no significant changes in bone marrow fibrosis occurred. Influenza-like symptoms and fatigue were common side effects. In conclusion, r-alpha INF has a role as a non-leukemogenic cytoreductive agent in the therapy of MMM, especially for cases with thrombocytosis.     

Comparison of whole-blood eosinophil counts in extrinsic asthmatics with acute and chronic asthma.

Venous whole-blood eosinophil counts were performed on 50 occasions in 42 patients with varying patterns of asthma. None of the patients studied had received systemic corticosteroids during the previous year. Patients with acute severe asthma, as defined by symptomatic airways obstruction with a tachycardia of at least 120 beats/min, showed eosinopenia (21 x 10(9)/l +/- SD 57 x 10(9)/l). Patients with chronic asthma, as defined by symptomatic airways obstruction with a heart rate of less than 100 beats/min, showed appreciable eosinophilia (1048 x 10(9)/l +/- SD 708 x 10(9)/l). Finally, asymptomatic patients had a variable total eosinophil count but with values lower than those of patients with chronic asthma (345 x 10(9)/l +/- SD 431 x 10(9)/l). Eosinophilia may contain chronic asthma, thereby mediating bronchial damage, whereas absence of eosinophils in acute asthma enables vasoactive mediators to enter the systemic circulation, possibly causing circulatory disturbances.     

Intravenous immunoglobulin (i.v. IgG) for previously treated acute or for chronic idiopathic thrombocytopenic purpura (ITP) in childhood: a prospective multicenter study

In a prospective multicenter study 42 thrombocytopenic (less than 30 X 10(9) platelets/l) children with chronic idiopathic thrombocytopenic purpura (ITP) or with acute ITP, dependent on or refractory to corticosteroids, were given 0.4 g i.v. IgG/kg body weight/day on 5 consecutive days and thereafter once a week if the platelet count fell to less than 20 X 10(9)/l or if the patient bled. After the initial 5 days of i.v. IgG the platelets rose within a mean of 7-8 days to greater than 30 X 10(9)/l in all and to greater than 150 X 10(9)/l in 33 of 42 patients (79%). After a mean observation time of 26.6 months 26 of 42 patients (62%) showed a satisfactory long-term effect, i.e. no need for treatment for at least 6 months without bleeding and with no platelet counts below 20 X 10(9)/l. No difference in response rate was found between children with chronic and those with previously treated acute ITP. These results indicate that i.v. IgG could be used to control emergency situations, e.g. to stop bleeding or to prepare a patient for surgery. I.v. IgG also represents a good alternative to treatment modalities, such as splenectomy and/or the administration of cytostatic immunosuppressants with potentially serious side effects. In addition to the expected transient rise in serum IgG levels, i.v. IgG induced a more prolonged elevation of serum IgM. Platelet associated IgG, elevated before therapy, was correlated with the clinical long-term outcome.     

Acute lymphoblastic leukaemia: cyclical chemotherapy with three combinations of four drugs (COAP-POMP-CART regimen).

Forty-two adults and children with previously untreated acute lymphoblastic leukaemia (ALL) were entered into a programme of chemotherapy in which three combinations, each of four drugs were administered in a predetermined cyclical rotation together with cranial irradiation and intrathecal injections of methotrexate. Forty-one patients (98%) entered remission and no patient developed neuroleukaemia. Relapse of ALL occurred in 10 patients, and three patients died during remission, while eight patients stopped treatment after two and a half years and have remained in remission for two to 26 months. Comparison of remission and survival experience in this mixed group of children and adults with the experience of children treated at Memphis and in the Medical Research Council''s UKALL-I trial showed no significant differences. On the other hand, analysis by prognostic factors showed that neither age nor blast cell count at presentation had any adverse effect in patients treated in this study. No relapses occurred in nine patients with blast cell counts greater than 20 x 109/1 at presentation. This regimen is effective treatment for ALL and may be of special value in patients with poor prognoses. The regiment has not as yet proved superior for the treatment of children with ALL who do not have adverse prognostic features.     

Survival of coliform bacteria in sewage sludge applied to a forest clearcut and potential movement into groundwater.

Anaerobically digested dewatered sludge (10 to 15 cm thick) was applied to a forest clearcut as a fertilizer source in northwest Washington on gravelly glacial outwash soil. This sludge is not microbiologically sterile and may contain pathogenic organisms. Fecal coliform bacterial counts in sludge applied in summer (July) fell from 1.08 X 10(5) to 358/g in 204 days and to 0/g in 267 days. Dieoff appeared more rapid in winter (January)-applied sludge, when colnts fell from 1.2 X 10(5) to 20/g in 162 days. Initial death rates were related to sludge temperature, moisture, pH, physical composition, and microbial competition. Aftergrowth of fecal coliforms occurred in warm summer and fall months, but counts were of similar magnitude to background levels in forest soils, where a maximum count of 54/g was recorded. Total coliform counts in fresh sludge ranged from 1.4 X 10(4) to 1.9 X 10(6)/g. Numbers stabilized at 10(3) to 10(4)/g in spring, fall, and summer, with lower numbers in winter. Both total and fecal bacteria moved from the sludge to the soil beneath, but few penetrated past the first 5 cm. The soil acts as an effective biological filter. Few fecal coliform bacteria were recorded in the groundwater, generally being less than 5/100 ml and mostly 0/100 ml. A maximum count of 52/100 ml was recorded. Groundwater contamination from vertical movement of potential pathogens appears unlikely, but hazards from surface runoff and direct handling in the first year may arise.     

Survival of coliform bacteria in sewage sludge applied to a forest clearcut and potential movement into groundwater.

Anaerobically digested dewatered sludge (10 to 15 cm thick) was applied to a forest clearcut as a fertilizer source in northwest Washington on gravelly glacial outwash soil. This sludge is not microbiologically sterile and may contain pathogenic organisms. Fecal coliform bacterial counts in sludge applied in summer (July) fell from 1.08 X 10(5) to 358/g in 204 days and to 0/g in 267 days. Dieoff appeared more rapid in winter (January)-applied sludge, when colnts fell from 1.2 X 10(5) to 20/g in 162 days. Initial death rates were related to sludge temperature, moisture, pH, physical composition, and microbial competition. Aftergrowth of fecal coliforms occurred in warm summer and fall months, but counts were of similar magnitude to background levels in forest soils, where a maximum count of 54/g was recorded. Total coliform counts in fresh sludge ranged from 1.4 X 10(4) to 1.9 X 10(6)/g. Numbers stabilized at 10(3) to 10(4)/g in spring, fall, and summer, with lower numbers in winter. Both total and fecal bacteria moved from the sludge to the soil beneath, but few penetrated past the first 5 cm. The soil acts as an effective biological filter. Few fecal coliform bacteria were recorded in the groundwater, generally being less than 5/100 ml and mostly 0/100 ml. A maximum count of 52/100 ml was recorded. Groundwater contamination from vertical movement of potential pathogens appears unlikely, but hazards from surface runoff and direct handling in the first year may arise.     

Limited usefulness of lymphocytopenia in screening for AIDS in hospital patients.

Lymphocytopenia is often present in patients with acquired immune deficiency syndrome (AIDS) and has been suggested as a useful screening test for AIDS. Of 625 patients consecutively admitted to an acute care university teaching hospital 91 (15%) were found to have a lymphocyte count of less than 1 X 10(9)/L, and 25 (4%) had a count of less than 0.5 X 10(9)/L. The corresponding figures for 32 patients at the hospital in whom AIDS had been diagnosed were 13 (41%) and 4 (13%). Absolute lymphocyte counts in hospitalized patients should not be used as the sole means of identifying patients at high risk for AIDS.     

Bedside haematology: new facility in general practice.

A technique has been developed for performing rapid white cell counts and differential white cell counts at the bedside which uses a pocket McArthur microscope and a development of Field''s staining technique. A fixed volume thick film technique is used for the total white cell count that uses the minimum of equipment, all of which is disposable. In a study of samples from 88 patients using the thick film technique and standard laboratory techniques the thick film counts fell within 1.1 X 10(9)/1 (mean) of the standard laboratory count. This compares with a value of 1.0 X 10(9)/1 (mean) for within laboratory variability, using different electronic counters on the same specimen.     

Serum cortisol concentrations during low dose dexamethasone suppression test to screen for Cushing's syndrome.

Forty four subjects (23 obese controls, 11 patients with possible Cushing''s syndrome, and 10 patients with definite Cushing''s syndrome) underwent low dose (0 X 5 mg every six hours for two days) dexamethasone suppression tests during which serum cortisol concentration at 0800 and excretion of urinary free cortisol over 24 hours were measured. Serum cortisol concentration fell to below 60 nmol/1 (2 X 2 micrograms/100 ml) in 31 subjects and remained above 250 nmol/1 (9 X 1 micrograms/100 ml) in the 13 others. Excretion of urinary free cortisol showed a similar response, falling to below 110 nmol (40 micrograms)/24 h in 31 and remaining above 180 nmol (65 micrograms)/24 h in the 13 others. There was complete concordance between the two variables in terms of the pattern of response. Serum cortisol concentration fell to below 60 nmol/1 (2 X 2 micrograms/100 ml) in at least 97% (31 of a possible 32) of subjects without Cushing''s syndrome. On the other hand, a serum cortisol concentration of above 250 nmol/1 (9 X 1 micrograms/100 ml) after low dose dexamethasone gave a false positive diagnosis of Cushing''s syndrome in at most only one of 13 patients (7 X 7%). Measurement of serum cortisol concentration during the low dose dexamethasone test is simpler than, and as accurate and reliable as, measurements of urinary steroids.     

Recombinant interferon-alpha, but not interferon-gamma is effective therapy for essential thrombocythemia

Recombinant interferon-gamma with a starting dose of 0.5 mg 3x/week subcutaneously, was administered to 6 patients with essential thrombocythemia (median platelet count 1172 X 10(9)/l, range 602-1564). Four of the patients had received alkylating agents previously. Hematological remission, defined as a decrease in platelet counts to less than or equal to 350 X 10(9)/l, was observed in none of these patients. Subsequently 4 of these 6 patients, supplemented by 2 others were treated with interferon-alpha 2c at a dose of 5 X 10(6) U daily subcutaneously. Five patients showed hematological remission. In case of hematological remission the interferon-alpha doses was reduced to 5 X an thereafter to 3 X weekly 5 X 10(6) U. During an observation period ranging from 12-41 weeks platelet counts remained normal in all patients. Side-effects were mild and consisted of fever, myalgias, malaise and itching occurring mainly during the first month of treatment. No dose adaptation was required. The patients treated previously with interferon-gamma experienced the side effects from this drug less tolerably than those from the alpha-compound. These observations suggest that recombinant interferon-alpha may be an effective drug in treating essential thrombocythemia resulting in a sustained response.     

Relationship between sperm count, serum gonadotropins and testosterone levels in normo-, oligo- and azoospermia

In 92 men with normozoospermia (greater than 40 X 10(6)/ml), 105 with slight oligozoospermia (greater than 10 X 10(6)/ml), 100 with severe oligozoospermia (less than 10 X 10(6)/ml) and 56 with azoospermia, serum testosterone, LH and FSH were measured radioimmunologically. With an increasing degree of reduction of spermatozoa, a decreasing testosterone level and increasing LH and FSH levels could be demonstrated. In normozoospermia, between 40 and 140 X 10(6)/ml, a direct correlation was found between FSH and sperm count, and, in the group between 40 and 100 X 10(6)/ml, a direct correlation between T and sperm count. A disturbed LH:T balance is often observed which beside decreased serum T levels demonstrates a testicular deficiency in androgen production.     

Oxymetholone treatment in myelofibrosis

In order to study the effect of oxymetholone therapy in advanced myelofibrosis, 11 patients (4 females, 7 males) were given, 3--5 mg per kg body weight, long-term oxymetholone treatment in a prospective multicenter study. Five cases had previously had a diagnosis of polycythemia vera. All patients had anemia initially, 4 leukocytopenia and 10 thrombocytopenia in addition. Hepato-splenomegaly was present in all cases but in varying degree. Five patients required regular blood transfusions before treatment. In 9 of the 15 courses given, there was normalization of the peripheral blood or substantial improvement (better than 3 g hemoglobin/dl or 50 X 10(9) platelets/1) after androgens. Significant effects were noted both on hemoglobin values and platelet counts. The need for blood transfusions ceased completely in all 5 cases. When oxymetholone treatment was reduced or interrupted 4 patients relapsed; 2 of them responded to a renewed course. The red cell counts returned to previous polycythemic values in one patient and another died from acute leukemia. The results of this study suggest that androgens might be of value in advanced cases of myelofibrosis with transfusion-requiring anemia or severe thrombocytopenia.     

Immunologic findings,thrombocytopenia and disease activity in lupus nephritis.

Twenty patients with nephritis due to systemic lupus erythematosus were followed up for a mean of 34 months after renal biopsy with serial determinations of total serum complement and C3 and C4 concentrations, binding of deoxyribonucleic acid (DNA), antinuclear antibody pattern and platelet count. There were 25 episodes of nonhematologic observed disease activity in 16 of the 20 patients; elevated DNA binding and thrombocytopenia correlated well with these episodes. The mean platelet count during episodes of observed disease activity was 96 +/- 42 X 10(9)/L, which was significantly different from the mean count of 248 +/- 90 X 10(9)/L during disease quiescence. The proportion of false-positive results with the immunologic tests varied from 25% to 67% and with platelet counts it was 11%. It is suggested that thrombocytopenia may be a simple and accurate index of disease activity in lupus nephritis.     

Clinical significance of fibrinopeptide A in acute lymphocytic and non-lymphocytic leukaemia

Fibrinopeptide A (FPA) was systematically investigated in 74 patients with acute leukaemia at different stages of the disease (50 with non-lymphocytic leukaemia, ANLL; 24 with lymphocytic leukaemia, ALL). At diagnosis, 75% of the cases had high FPA levels (86% in ANLL and 54% in ALL) with significantly higher levels in ANLL than in ALL (13.4 vs 4.4 ng/ml; p less than 0.001). Patients with DIC (20 cases in ANLL and 1 case in ALL) had significantly higher levels (p less than 0.001). FPA levels were neither correlated with fibrinogen or FDP levels nor with blast cell count. During chemotherapy, median FPA did not show significant changes whereas, at the end of therapy, a return toward normality was generally observed both in ALL and ANLL apart from the group of patients with acute promyelocytic leukaemia. Among the 24 patients who entered post-remission follow-up (13 ANLL and 11 ALL), 10 cases out of the 11 relapsing (6/6 with ANLL and 4/5 with ALL) had increased FPA 1 to 2 months before the ascertainment of the relapse. However, 16% and 9% of the samples obtained on different occasions, respectively from ANLL and ALL cases in maintained first remission, showed FPA above the normal limit. This study demonstrates that subclinical activation of blood coagulation, as indicated by high FPA level, is common both in lymphocytic and non-lymphocytic leukemia and suggests that this phenomenon is related to disease activity.     

Hyperventilation-induced changes of the blood picture

In a controlled study of 11 male volunteers the following changes (means +/- SD) were observed in venous blood during (D) and 75 min after (A) a period of 20 min of voluntary hyperventilation in comparison with before (B) hyperventilation (P values referring to the difference between D and B) erythrocyte count 5.18 +/- 0.17 X 10(6) (B), 5.70 +/- 0.21 X 10(6) (D) (P less than 0.001), and 5.18 +/- 0.16 X 10(6)/microliter (A); hemoglobin 15.7 +/- 0.6 (B), 17.2 +/- 0.7 (D) (P less than 0.001), and 15.8 +/- 0.6 g/dl (A); centrifuged hematocrit 46.6 +/- 1.0 (B), 50.4 +/- 1.7 (D) (P less than 0.001), and 47.0 +/- 1.8% (A). The platelets increased from 159 +/- 30 X 10(3) (B) to 205 +/- 40 X 10(3) (D) (P less than 0.001) and returned to 157 +/- 26 X 10(3)/microliter (A). The leukocytes (WBC) were 4,210 +/- 630 (B), 6,220 +/- 1,660 (D) (P less than 0.001), and 6,190 +/- 1,870/microliter (A) (P less than 0.002, as compared with B). The rise of WBC during hyperventilation was mainly due to a 83% increase of lymphocytes, whereas a 93% increase of neutrophil leukocytes accounted for the increased WBC 75 min posthyperventilation. The increase of the ratio of band forms to segmented neutrophils from 9 (B) to 19% (A) (P less than 0.01) indicates that band forms were released from the bone marrow. The results show that WBC and platelets can be mobilized by hyperventilation by as yet unidentified mechanisms.