Erythropoietin for chemotherapy patient refusing blood transfusion.
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Biomedical subjects
Publications and source records attributed to E Pittermann.
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The case report is presented of a 18-year old patient, who was admitted to the Haematology Department of the Hanusch Hospital with septic fever, an enlarged spleen and suspected bone marrow failure. Since the patient reported a stay in Sicily prior to the onset of his disease, an infection with Leishmania was suspected. The serological test was highly positive and Leishmania was also isolated from the spleen aspirate. Chemotherapy with Pentostam was successful and the patient made an uneventful recovery. This paper deals with the epidemiology of the disease and discusses the diagnostic approaches.
Plasma exchange (PE) is the treatment of choice in emergencies arising in patients suffering from the hyperviscosity syndrome, factor VIII antibody haemophilia, autoimmune haemolytic anaemia or post-transfusion purpura. Apart from these clear indications, the efficacy of PE in other hematological disorders such as thrombotic thrombocytopenic purpura, immune thrombocytopenia, cryoglobulinaemia, rhesus incompatibility, autoimmune cytopenia and AB0 incompatibility with bone-marrow transplantation is less well defined. In such disorders PE can be performed when conventional treatment has failed.
The present situation in thrombocyte and granulocyte substitution is presented. First, the different methods of producing thrombocyte and granulocyte concentrates are discussed. Differential centrifugation and cell separators with continuous or intermittent flow are used for gaining thrombocytes, whereas cell separators with continuous or intermittent flow as well as filtration and gravitation leucapheresis may be used for producing granulocyte concentrates. Then, the indications for substituting granulocytes and thrombocytes are discussed. For thrombocyte substitution, thrombocyte numbers below 20 X 10(9)/1 and haemorrhagic diathesis are considered as an absolute indication. Granulocyte concentrates should only be administered to patients with transitory marked granulocytopenia, with granulocytes being less than 0.2 X 10(9)/1 and ensured bacterial infection. Finally, future basic developments of thrombocyte and granulocyte substitution are discussed.
Intensive cytostatic treatment is associated with severe depression of bone-marrow function, which requires treatment with specific replacement of blood components. Erythrocyte concentrates should be given "pure", without leucocytes and platelets, to prevent rapid alloimmunisation. Different separation techniques (intermittent flow and continuous flow centrifugation, double-bag platelet pheresis) provide platelet concentrates containing 2.0 to 10.0 X 10(11) platelets from a single donor. Immunization against HLA and specific antigens can be minimised by careful donor selection. Effective granulocyte support in granulocytic patients requires large doses of granulocytes given daily to compensate the deficit.
Report on a 19-year-old patient with bilateral papilledema and suffering from chronic granulocytic leukemia. No signs of increased intracranial pressure could be demonstrated. Under repeated leukapheresis therapy the extreme leukemic leukocytosis regressed and, as a result, the condition of the optic disk returned to normal.
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Great quantities of granulocytes or platelets can be removed from a single donor by following methods: 1) Continuous flow cellseparation 2) Intermittent flow cellseparation 3) Filtration leukapheresis. Using one of the methods mentioned above 1.0 X 10(10)--5.0 X 10(10) granulocytes can be obtained during a four hours procedure. The yield of platelets is more than 5.0 X 10(11) cells. The procedure itself is well tolerated and no severe side effects were seen.
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Increasing evidence has accumulated that the direct assay of reverse transcriptase in human blood cells is of value in the diagnosis of leukaemia. The isolation and characterization of this enzyme has shown that it possesses remarkable similarities to the DNA-polymerase of the RNA-tumour virus of simian sarcoma. Hence, leukaemic cells in humans are thought to possess a virus-related gene, namely, reverse transcriptase. Various clinical reports have established the presence of this enzyme in blood cells, not only in the case of morphologically-proven malignant change, but also in cases classified as non-leukaemic from the morphological picture, such as acute leukaemia in remission and in the pre-leukaemic state. In confirmation and augmentation of earlier views we now report on the presence of reverse transcriptase in a patient with pancytopenia, who subsequently developed acute leukaemia i.e. isolation of the enzyme occurred in the pre-leukaemic state.
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In order to provide leukemic patients during the critical granulocytopenic stage with a sufficient amount of granulocytes a blood cell separator with a continuous extracorporeal circulation was developed. This permits to obtain up to 3.0-10(10) leukocytes during a 4---5 hours period from a single donor. According to our own experiences with 20 leukophereses performed in 13 healthy donors by the use of the AMINCO cell separator an average of 1.17-10(10) leukocytes with a granulocytic portion of 61% was collected per run. In two cases of agranulocytosis and septic fever (one case of pseudomonas septicaemia) the repeated administration of leukocyte concentrates, while specific antibiotic therapy was continued, led to a marked improvement over a longer period of time. Furthermore thrombocyte concentrates up to 7.0-10(10) platelets can be obtained by the cell separator. Applied as depletory method in the treatment of CML and CLL leukopheresis may rapidly diminish the peripheral leucocyte count while spleen and lymphomas decrease in size at the same time. A 20% reduction in cell count may be achieved by a serie of 3---4 leukophereses. Also the use of the cell separator in the treatment of makroglobulinemia by plasmapheresis is discussed.
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