OBJECTIVE: Primary brain tumours may be associated with coagulation disorders which can pose intraoperative and postoperative management difficulties. The aim was to evaluate the coagulation profile of patients with brain tumours undergoing surgery using thromboelastography (TEG) in combination with simple laboratory tests. METHODS: Fifty adult patients with primary brain tumours larger than 4 cm in maximum diameter and no history of coagulation disorders were studied in a prospective, observational manner over a one year period. Preoperative, intraoperative, and postoperative measurements included haemoglobin concentration, platelet count, prothrombin and partial thromboplastin times, fibrin(ogen) degradation product concentration, D-dimer concentration, and TEG. RESULTS: Eleven patients (22%) had abnormal intraoperative TEGs, of whom six (12%) subsequently developed haematomas requiring surgical evacuation. The coagulopathy seemed to be hyperfibrinolysis in two cases (4%) and disseminated intravascular coagulation in four (8%). There was no preoperative difference in reaction time (R time) for clot formation between the non-haematoma and haematoma groups(mean 11.44 (SD 3.42) v 12.33 (2.50) min, P=0.46). However, when other preoperative indices were compared, in the non-haematoma group, K time (time to reach a clot amplitude of 20 mm) was shorter (6.72 (2.15) v 10.56 (3.50) min, P=0.001), rate of clot growth (å) was faster (43.67 degrees (7.53) v 27.11 degrees (5.42), P<0.0001) and maximum amplitude of clot strength (MA) was greater (52.64 (7.85) v 40.33 (6.59) mm, P<0.001). Intraoperatively, R time was significantly shortened in the non-haematoma group, (7.67 (1.78) min, P<0.0001) unlike the haematoma group (10.67 (1.58) minutes, P=0.11). CONCLUSIONS: Although these results indicate a general hypercoagulability during brain tumour surgery, in certain cases, a predisposition towards hypocoagulability may exist even before surgery, detectable only when the physical characteristics of clot formation are studied by TEG. Judicious replacement of clotting factors, platelets, and antifibrinolytic agents should be considered intraoperatively if the TEG is abnormal, without waiting for laboratory test results.

Adolescent↗

PubMed1997

Hemophagocytosis by rhabdomyosarcoma cells in bone marrow.

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Adolescent↗

PubMed1996

Splenic hematopoiesis after granulocyte-colony stimulating factor therapy in a lupus patient.

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Combined Modality Therapy↗

PubMed1996

Plasma cells with iron inclusions in two non-alcoholic Chinese women.

Plasma cells with iron granules are rare, especially among non-alcoholic individuals. We report two teetotaller Chinese women with nasopharyngeal carcinoma and non-Hodgkin's lymphoma, whose bone marrow studies revealed plasma cells with inclusions morphologically compatible with iron granules. The iron nature of the granules was confirmed by elemental analysis. The clinical significance and the exact mechanism of formation of these iron inclusions in plasma cells remain unknown.

Adult↗

PubMed1994

Evaluation of laboratory tests for lupus anticoagulant in a group of Chinese lupus patients.

The sera of 69 Chinese patients with systemic lupus erythematosus were tested for the presence of lupus anticoagulant (LA) by a panel of laboratory tests: Kaolin clotting time (KCT), dilute Russell viper venom time (DRVVT) and platelet neutralization procedure (PNP). The prevalence of LA varied among the 3 tests (10-19%), and was 10% when LA was considered present if either KCT or DRVVT and the PNP were positive. Concordance was fair between KCT and PNP, but was poor for DRVVT with either of the other 2 tests. Only 2 of our lupus patients had a history of thrombo-embolic disease, and neither were serologically positive for LA. The incidence of thrombo-embolic diseases and that of LA were both too low in this group of Chinese lupus patients for their association to be evaluated.

Adolescent↗

PubMed1994

A morphologic variant of May-Hegglin anomaly in a Chinese girl.

An 8 yr old Chinese girl was investigated for easy bruising and mild thrombocytopenia. Platelet aggregation studies and coagulation tests were found to be normal. The giant platelets and Döhle-like cytoplasmic inclusions in granulocytes confirmed the diagnosis of May-Hegglin anomaly. The father's granulocytes also had Döhle-like inclusions and one paternal aunt had a history of bleeding tendency. Review of literature showed that such Döhle-like inclusions had always been described morphologically as crescentic or spindle-shaped. In this case, however, the shape was roundish, oval or poorly defined. Ultrastructurally, the classic description was electron-dense long rods and needles orientating along the long axis of the "spindle". In this case, the only electron-dense particles were dot-like with a haphazard arrangement.

Asian People↗

PubMed1994

Erythrocyte creatine levels in hyperthyroidism.

The mechanism by which erythrocyte mean corpuscular volume (MCV) is decreased in hyperthyroidism is not known. One possible mechanism is premature aging of erythrocytes in the circulation. Since erythrocyte creatine has been shown to be a good marker of cell senescence, we determined this in hyperthyroid patients and control subjects to examine whether the decrease in MCV is related to senescence. Erythrocyte creatine levels were similar in both hyperthyroid patients and controls, suggesting that premature senescence of erythrocytes does not account for the lower MCV in hyperthyroidism.

Adult↗

PubMed1993

Prevalence of pyruvate kinase deficiency among the Chinese: determination by the quantitative assay.

The prevalence of pyruvate kinase (PK) deficiency among the Chinese population has not been established. Fung et al. (Arch Dis Child 44:373-376, 1969) and Wu et al. (Am J Hematol 20:139-144, 1985) indicate 3.4% and 2.1% PK deficiency prevalence rates, respectively, the higher figure based on Beutler's screening test [3] without confirmatory testing. Neither figure is consistent with the occurrence of hemolytic anemia from this cause in the experiences of hematologists in Hong Kong. Using the standard quantitative assay, we measured PK activity in blood samples from 1,100 local Chinese people. The assay was automated on a centrifugal analyser, and the results were expressed in IU per gram of hemoglobin (IU/g Hb). Blood samples from 497 healthy male adults were measured, and PK activity was found to have a range of 15.2 +/- 5.2 (mean +/- 2 SD). A total of 100 cord blood samples were also measured, and the reference interval for this subgroup was 17.7 +/- 4.8. Additionally, samples from 503 anaemic patients were measured, and all were found to have values above the lower limit of the reference interval. The prevalence of PK deficiency among the Hong Kong Chinese population determined by this study was < 0.1%.

Adolescent↗

PubMed1993

A modified screening procedure to detect pyruvate kinase deficiency.

Beutler's screening procedure was used to detect pyruvate kinase deficiency in the local population. In this test, hemolysate and the reagent mixture are incubated and then placed at a spot on filter paper to be examined for fluorescence. Complete nonfluorescence marks the reaction endpoint, and fluorescence beyond 30 minutes indicates pyruvate kinase deficiency. It was difficult to determine this endpoint due to uneven sedimentation of unhemolyzed red cells on the spot. In this modified technique, the leukocyte-depleted red cell suspension was frozen and thawed for complete red cell lysis before being used for the test. Using both techniques, 493 health individuals and 126 anemic patients were screened for pyruvate kinase deficiency. By the conventional technique, 3.7% remained fluorescent after 30 minutes, whereas by the modified technique, none were fluorescent after 30 minutes. Quantitative assay indicated that all samples had pyruvate kinase activity levels greater than the lower limit of the reference range. We also demonstrated that blood samples from individuals with thalassemia trait were primarily responsible for the aberrant results from the conventional screening procedure.

Fluorescence↗

PubMed1993

A variant of gelatinous transformation of marrow in leukemic patients post-chemotherapy.

A variant of gelatinous transformation of marrow was described in leukemic patients post-chemotherapy. This lesion was found in 8 out of 1833 post-chemotherapy bone marrows from 429 patients with leukemia. Histologically, this variant form was identical to the classical gelatinous transformation except for the absence of fat atrophy. In marrow smears, mucoid strands were seen between marrow particles and oriented along the direction of spread. In clot and trephine sections, an eosinophilic ground substance was widespread, filling out spaces around the fat cells, which occupied the normal proportion of marrow space. At high magnification, this ground substance appeared granular and fibrillary, a non-specific feature which could also be seen in fibrin clot commonly found in marrow sections. This eosinophilic ground substance, however, can be distinguished from fibrin clots by positive staining with Alcian Blue (pH 2.3) and inhibition of the staining after treatment with hyaluronidase. Clinically, in contrast to the classical form, this variant form of gelatinous transformation was acute in onset, transient, and associated with chemotherapy but not with cachexia.

Adolescent↗

PubMed1993

[Determination of plasma endothelin-1 in aged patients with chronic obstructive pulmonary disease in its clinical significance].

The levels of plasma endothelin-1 (ET-1) were determined by radioimmunoassay in 25 aged healty men and 88 aged patients with chronic obstructive pulmonary disease (COPD) at different stages. The results showed that plasma ET-1 levels of stable patients with COPD did not significantly change, but it were significantly higher during attacks than that in healthy subjects; The levels of plasma ET-1 in the patients with cor pulmonale were significantly higher than those in the healthy and COPD patients. Plasma ET-1 levels of patients with cor pulmonale at acute exacerbation stage were the highest in all groups. It was demonstrated that ET-1 correlated negatively to PaO2 and PH and correlated positively to PaCO2 and blood creatinine. This study suggested that the elevation of ET-1 level may contribute to the pathophysiological changes in patients with COPD and cor pulmonale.

Aged↗

PubMed1992

Long-term survival of a baby with homozygous alpha-thalassemia-1.

Triplets born to a Chinese woman consisted of 2 healthy boys and a girl with hemoglobin Bart's hydrops syndrome. The girl with hemoglobin Bart's hydrops syndrome, confirmed by gene analysis to be homozygous for alpha-thalassemia-1, survives for 27 months at the time of reporting. The dilemma in sustaining her life and the availability of other therapeutic options are briefly discussed. This is the third case report of homozygous alpha-thalassemia-1 with long-term survival.

Child, Preschool↗

PubMed1991

Gelatinous transformation of marrow in a case of acute myelogenous leukemia post-chemotherapy.

Gelatinous transformation of marrow in a patient with acute myelogenous leukemia was reported. This case was at variance with other reported cases of gelatinous transformation of marrow in that a) it was associated with a primary bone marrow disease and b) there was no fat atrophy and the patient was not cachectic. The fact that it occurred abruptly post-chemotherapy suggested that marrow hypoplasia induced by chemotherapy could be the cause of this lesion in this particular situation.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1991

An unusual case of hairy cell leukemia: death due to leukostasis and intracerebral hemorrhage.

Hairy cell leukemia (HCL) was diagnosed in a 71-year-old Chinese man. His clinical presentation and the characteristics of the hairy cells were typical of classic HCL. However, extreme leukocytosis (195 to 323 x 10(9) cells/L) in peripheral blood was in striking contrast. This leukocytosis, which was much more pronounced than any of the reported cases of HCL with leukocytosis, was associated with leukostasis in the cerebral vasculature and was causally related to a massive intracerebral hemorrhage and death. This mode of death in HCL has not been reported previously.

Aged↗