[Congenital immune deficiency agranulocytosis (reticular dysgenesia)].
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Biomedical subjects
Publications and source records attributed to E Kleihauer.
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Bone marrow transplantation is an experimental therapy, which has been used with success in patients with aplastic anemia, severe combined immunodeficiency and leukemia. We report here on the procedure of transplantation and the possible difficulties which can be encountered.
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The report describes the clinical syndroms of a 14-year-old boy which suffered from recurrent infections since early infancy. The clinical and general laboratory findings were similar to "the granulomatous disease of childhood" as described by Bridges et al. (8). The following serum factors were determined: Immunoglobulins, complement factors, isoagglutinins. The following assays with normal or patient's granulocytes were done: Chemotactic activity, nitroblue-tetrazolium test, bactericidal assay, fungicidal assay, myeloperoxidase, monocytes fungicidal assay. Immunological studies include kinetics of phytohaemagglutinin response, effect of serum of the patient on lymphocytic reactivity in vitro and skin tests. The following results were obtained: 1) Assays with normal or patient's granulocytes showed an impaired chemotatic activity, when serum of the patient was added. There was strong indication by treatment of the patient with plasma infusions, that the chemotactic defect is a serum dependent factor. 2) It could be demonstrated that the patient's serum also inhibited the response of lymphocytes to tuberculin and phytohaemagglutinin. Therefore the patient report focuses attention upon the possibility of serum related abnormalities that may influence granulocytic as well as lymphocytic functions leading to recurrent bacterial, fungal and viral infections.
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The neutrophil granulocytes of a 1-year-old boy with severe recurrent infections were found to have almost no chemotactic responsiveness, impaired phagocytosis and reduced intracellular killing of Candida albicans "in vitro". During the course of a febrile illness of unknown etiology which was accompanied by a leukemoid reaction, phagocytic activity became normal; the chemotactic response was also increased but still remained slightly subnormal. Family studies suggested that the defect was an inherited autosomal recessive one.
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Three cases of congenital selective malabsorption of vitamin B12 (Imerslund-Grasbeck syndrome) are presented. Pathophysiological aspected and clinical symptoms of this disease are discussed together with other megaloblastic anaemias in childhood caused by vitamin B12 deficiency.
Eight children with various diseases, who has frequent infections were examined for abnormalities of serum proteins and leucocyte function. Inborn or secondary defects could be recognized by the tests for chemotaxis, the intracellular killing of bacteria as well as yeast and the oxydative metabolism of the granulocytes. The defects were serum- or cell-dependent and they could be detected alone or in combination with other dysfunctions. Three children showed a reduced stimulation of the lymphocytes in addition to the impairment of chemotactic activity or fungicidal cavity.
Granulocyte function of 10 diabetic children has been investigated. At the time of testing the diabetes was in poor control. Five children were retested one week later after adjustment of diet and insulin dose. In contrast to some reports we did not find a phagocytic defect in the ingestion of particles, but the capacity of intracellular killing of Staphylococcus aureus was impaired. Chemotaxis was also reduced whereas the NBT-index and intracellular killing of Candida albicans were normal. Better control of the diabetes led to an improvement of bactericidal killing capacity.
In the first part we reviewed both the molecular basis of granulocyte function and the inborn defects. The present chapter summarizes our knowledge of the secondary defects of chemotaxis, opsonisation, phagocytosis and intracellular microbicidal activity.
The insight in the function and dysfunction of granulocytes lately arouses more and more interest. This report summarises our present knowledge. In the first of two chapters the authors review the molecular basis of granulocyte function and the inborn defects of chemotaxis, opsonisation, phagocytosis and intracellular killing of bacteria and fungi.
Report on a further hemoglobin M variant, discovered in a boy with congenital cyanosis. Chemical analysis of hemoglobin structure revealed indentity with HbM Saskatoon (= beta63 His leads to Tyr). The abnormal hemoglobin is characterized by normal oxygen transport function. The observed slight constant hemolysis is thought to be due to increased instability of the abnormal hemoglobin molecule. In addition to the hemoglobin anomaly, the activity of NADH-methemoglobin reductase was reduced by approximately 40% of normal. None of the parents presented with an abnormal hemoglobin, indicating that the occurrence of hemoglobin M Erlangen is most likely the result of a new mutation.
The concentrations of haemoglobin A1, A2, and F were determined quantitatively by column chromatography in 11 newborns with G-trisomy (Down's Syndrome)) and correlated to haematocrit values. In 3 infants the haemoglobin pattern was followed throughout the first six months of life. In connection to the well know polycythaemia, newborns with G-trisomy were found to have significantly higher haemoglobin A1 attaining 35.5 plus or minus 6.6% and A2 equal to 0.79 plus or minus 0.32% as compared to normal infants (HbA1 equal 17.74 plus or minus 4.56%, HbA2 equal to 0.25 plus or minus 0.2%). In G-trisomy the switch-over from synthesis of haemoglobin F to haemoglobin A appears to be initiated earlier than in normal individuals, and it seems even to proceed more rapidly during the first weeks after birth. The amount of adult haemoglobin being synthesized in G-trisomy during the perinatal period may possibly be a response to the increased erythropoiesis, while the influence of chromosomal abnormality seems not to be a specific phenomenon.