Biomedical subjects
Publications and source records attributed to D Abbott.
A number of patients demonstrate thrombocytopenia in the peripartum period. One hundred four patients with unexplained transient periparturient thrombocytopenia were found over a nine-month period. Sixty-one of them received epidural anesthesia without neurologic sequelae. Epidural anesthesia is safe if the platelet count exceeds 100 x 10(9)/L in otherwise healthy women.
This report describes events and findings in a pregnant patient with factor XI deficiency who suffered at least one episode of hemarthrosis. The incidence and rarity of this complication are discussed and views on management expressed.
Since the advent of routine automated platelet counting we have observed unexplained periparturient thrombocytopenia (PPT) in an unexpected number of periparturient women, ie, during labor or within 24 hr postpartum. Mean +/- SD platelet count in 686 random blood donors was 236 +/- 50 X 10(9)/L and 1.02% had a platelet count less than 136 X 10(9)/L; in 2,204 random prenatal and postpartum women mean count was significantly higher (275 +/- 86 X 10(9)/L; p less than 0.001). Of 1,621 periparturient women, 74 (4.6%) had unexplained PPT (mean +/- SD platelet count 122 +/- 24 X 10(9)/L, range 21-135 X 10(9)/L, N = 74). Platelet count in PPT usually rose to normal within 1 week of delivery; in 10% thrombocytopenia persisted greater than 6 months. PPT occurred in successive pregnancies with normal intervening platelet counts. Nine of 34 newborns of mothers with PPT were thrombocytopenic; there was no correlation between mother's and baby's platelet counts. In no case of PPT was there excessive bleeding in mother or infant. Positive indirect platelet radioactive antiglobulin tests (PRAT) were seen in 11% of normal postpartum women and in 90% of 22 women with PPT; 65% of the positive tests in PPT were due to reactions with anti-C3 only. In contrast, pregnant women with autoimmune thrombocytopenic purpura (AITP) had positive PRAT primarily because of anti-IgG (+/- anti-C3); only 10% were positive only with anti-C3. Results were concordant in all of eight women with PPT tested by both indirect and direct PRAT. Amount of C3 bound per platelet in direct or indirect PRAT was not predictive of degree of thrombocytopenia, but there was correlation of fg C3 per platelet detected by the two assays in individual patients (r = 0.8). Mean levels of serum C3, C4, and factor B in women with PPT did not differ from normal; individual patients had abnormal serum complements but no characteristic pattern was observed. Increased immune complexes were observed in 6% of normal subjects and 33% of women with PPT. Etiology and mechanism of PPT is unclear. Despite lack of clinical evidence in women with PPT of syndromes associated with increased platelet destruction, the presence of preeclampsia cannot be absolutely excluded. Similarly, although the pattern of antiglobulin sensitization in PPT differed markedly from that seen in AITP, autoimmune disorder cannot be excluded. Alloantibodies did not appear to be responsible for PPT. While PPT is usually benign, some patients had a markedly reduced platelet count. Recognition of the phenomenon may be important in obstetrics.
A neoplastic lesion in the liver of a king snake, Lampropeltis getulus, was identified as a hepatocellular carcinoma. There were metastases in the spleen.
Sixteen mothers, fathers, and their 4- to 7-year-old children were observed interacting in their homes during three family groupings: (a) mother and child, (b) father and child, and (c) mother, father, and child. Half the children had Down syndrome and half were nonhandicapped. Parents of children with Down syndrome structured their interactions with their offspring by assuming manager and teacher roles more often than did parents of nonhandicapped children. Children with Down syndrome were less contingently responsive to both parents than were nonhandicapped children. Mothers of Down syndrome children assumed the teacher role more often than fathers did. Fathers of both groups of children interacted less with their offspring in the triadic family grouping, whereas mothers were more consistent, assuming a parenting role across family contexts.
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Eleven children with documented growth hormone deficiency were studied to assess their cognitive and emotional functioning and their academic achievement before and after 1 year of human growth hormone replacement therapy. Standardized personality and intelligence measures were used, and records of school achievement, as well as developmental and family history from parents, were obtained. Although some subjects in this group were coping with problems other than their short stature (e.g., other medical and psychosocial problems), their intelligence and academic achievement were found to be positively correlated with socioeconomic status and independent of the condition of hypopituitarism. This study supports others that have found these children vulnerable to problems of emotional adjustment in middle and late childhood. Because of the heterogeneity of the group, findings must be interpreted cautiously. However, the consistent finding of disturbance in visual-motor integration is thought to be significant and demonstrates the need for further research that will examine possible neurological sequelae of long-term growth hormone deficiency.
A case of primigravida in whom anti-C, anti-D, and anti-Kpb developed during the third trimester is described. Her first-born infant, delivered at 40 weeks' gestation, was mildly affected with hemolytic disease of the newborn and responded well to phototherapy. Her second-born infant, delivered at 36 weeks' gestation, had a positive direct antiglobulin test, but required no treatment. Clinical and laboratory aspects of both pregnancies are discussed.
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Current methods of assessment of heparinization are either inconvenient as bedside procedures or lack correlation with the Lee-White whole blood clotting time over the therapeutic range. A new thromboplastin time (CAT time) has been developed to overcome these disadvantages by offering uniform contact activation. The test makes use of a partial thromboplastin activated by celite-adsorbed "contact factor", thus eliminating the activation phase of the activated partial thromboplastin time. Preliminary experiments suggest that this modification will be helpful in the study of "contact factor" deficiencies.
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Two hundred and thirty-eight ;megaloblastic' pregnancies are reviewed. Bone-marrow aspiration was performed in every case. Serum folate estimations were strongly suggestive of folic acid deficiency in only 34% of cases. If, however, the red cell folate was determined as well, there was an almost complete agreement with the changes in the erythroblasts. It is suggested that hyper-segmentation of the neutrophils in association with a diminished red cell folate level is indicative of significant folic acid deficiency. This series possibly shows a slight but statistically insignificant increase of accidental haemorrhage. No effect on birth weight or incidence of stillbirth was demonstrable.