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Biomedical subjects

W L Marsh

Publications and source records attributed to W L Marsh.

At least 73 records · Page 4Linked to original sources
PubMed1983

Primary leptomeningeal presentation of T-cell lymphoma. Report of a patient and review of the literature.

Although secondary leptomeningeal lymphoma is relatively common, primary leptomeningeal lymphoma is rare. We report a patient with the extremely unusual clinical and pathologic presentation of a primary T-cell lymphoma of the leptomeninges. Diagnosis was established by morphologic and immunologic studies of cerebrospinal fluid (CSF) and brain biopsy. The leptomeningeal lymphoma responded well to intrathecal chemotherapy and irradiation but the patient has severe residual motor paralysis. The clinical and pathological features of primary and secondary central nervous system (CNS) lymphoma are reviewed in reference to this most unusual patient.

Adult↗
PubMed1983

Free erythrocyte protoporphyrin (FEP) I. Normal values for adults and evaluation of the hematofluorometer.

Since the early 1970s, measurement of free erythrocyte protoporphyrin (FEP) (by microextraction or by hematofluorometer) has been widely used to screen for lead poisoning and to evaluate microcytic red blood cell (RBC) disorders in children. However, published information on normal values for FEP, performance of the hematofluorometer, and usefulness of FEP in classifying microcytic RBC disorders in adults is scant. In an adult population with normal hematocrit and MCV and normal values for serum ferritin, blood lead level, and serum bilirubin, we obtained normal hematofluorometer FEP levels of less than 30 micrograms/dL for men, and less than 40 micrograms/dL levels for women. We have evaluated a hematofluorometer against a standard microextraction procedure and feel that the hematofluorometer is superior for clinical laboratories if elevated FEPs are confirmed by retesting with washed RBC. In the second part of this paper we demonstrate the usefulness of the FEP in classifying microcytic RBC disorders in adults.

Adult↗
PubMed1983

Free erythrocyte protoporphyrin (FEP) II. The FEP test is clinically useful in classifying microcytic RBC disorders in adults.

Microcytic red blood cells (RBC) are commonly encountered in clinical medicine and are caused by disorders of heme synthesis [usually iron deficiency anemia (IDA) or anemia of chronic disease (ACD)] or disorders of globin synthesis (usually thalassemia syndromes or HbE). Using the clinical history and standard laboratory tests (hematocrit, per cent saturation of transferrin (% sat), serum ferritin, Hb electrophoresis, HBA2, and HbF) we classified 198 adults with microcytic RBC as follows: 48 IDA, 11 probable IDA, 11 iron-deficient erythropoiesis without anemia, 13 ACD, 42 alpha-thalassemia trait, 35 probable alpha-thalassemia trait, 20 beta-thalassemia trait, and 15 unclassified. In addition, we demonstrated that the FEP test reliably (83-90% of the time, depending on FEP methodology) classifies microcytic RBC states into disorders of heme synthesis vs. disorders of globin synthesis. Because of reliability and ease of measurement, we recommend the hematofluorometer FEP as the first step in the clinical laboratory evaluation of microcytic RBC disorders in both adults and children.

Adolescent↗
PubMed1983

The Sdx antigen and antibody: biochemical studies on the inhibitory property of human urine.

Anti-Sdx is an IgM complement-binding autoantibody that defines a red cell antigen which is independent of I, i, Sp1 (Pr) and Gd. Hemagglutination by the antibody is unusually sensitive to variation in pH, salt, or other charged molecular species. The antibody is inhibited by urine from Sd(a+) persons, but inhibition is a nonspecific effect caused by charged molecules. No specific Sdx substance could be demonstrated, and Sdx antigen does not appear to be directly associated with the Sid blood group. In view of these findings we propose that this antibody should be renamed anti-Rx.

Animals↗
PubMed1983

Autoimmunity and the Kell blood groups: auto-anti-Kpb in a Kp(a+b-) patient.

An example of auto-anti-Kpb in a Kp(a+b-) patient is described. The antibody present in the patient's serum and in eluates from her red cells was IgG. It did not bind complement, and did not cause in vivo hemolysis. 9 months after recognition of the autoimmune state the direct antiglobulin test had become negative and anti-Kpb was no longer detectable. It is postulated that autoimmunity involving the Kell blood group may be precipitated by antigens or enzymes of microbial origin.

Adult↗
PubMed1983

Congenital self-healing histiocytosis-X.

Histiocytosis-X (H-X) is heterogeneous clinically, varying from localized benign forms to disseminated fatal forms, but has a relatively uniform and specific pathologic appearance, both by light and electron microscopy. H-X localized to bone or lung has long been recognized. Much less frequent are patients with H-X localized to skin. We report two infants with congenital self-healing H-X, clinically confined to the skin. Prediction of the clinical course from the histology of a H-X lesion is unreliable, especially for cutaneous lesions. We feel that patients with localized forms of H-X should be followed closely for progression of disease but should not be treated aggressively until time is allowed for spontaneous resolution.

Biopsy↗
PubMed1982

Inactivation of Kell blood group antigens by 2-aminoethylisothiouronium bromide.

Human red cells incubated with a solution containing 6% 2-aminoethylisothiouronium bromide (AET) lose activity of antigens that are part of, or related to, the Kell blood group system. However, Kx antigen is not inactivated. Studies on a wide range of other blood-group antigens show no other evidence of changes and AET appears to react specifically with red-cell membrane structures that have Kell activity. The AET procedure produces an artificial K0 red cell that can be used in blood group serology, and allows easy recognition of antibodies that are associated with the Kell system. AET has been used by other workers to produce a red cell that has many serological and biochemical characteristics of a PNH cell. Our studies on red cells from PNH patients have not shown any changes in Kell blood-group antigens.

Blood Group Antigens↗
PubMed1982

The laboratory evaluation of microcytic red blood cells.

Microcytic red blood cell states are common clinical problems in both adult and pediatric age groups. The recent widespread availability of electronic blood cell counters for performing routine blood counts has increased the detection of microcytic red blood cells. Physicians must workup both symptomatic and asymptomatic patients with microcytic red blood cells before they can initiate proper therapy and/or counseling. The purpose of this review is threefold: (1) to discuss the causes of microcytic red blood cells in terms of disorders of decreased heme production vs. disorders of decreased globin production, (2) to review the clinical laboratory tests useful in differentiating microcytic red blood cell states, and (3) to present a practical approach for the laboratory workup of microcytic red blood cells.

Adolescent↗
PubMed1982

Chido and Rogers antigenic determinant on the fourth component of human complement.

The blood group substances Chido (Cha) and Rogers (Rga) represent two electrophoretic variants of human C4. Based on the observation that anti-Cha and anti-Rga antisera agglutinated human red blood cells prepared in sucrose-activated autologous serum (LIS cells) at 37 degrees C, it has been assumed that the Cha and Rga antigenic determinants reside in the C4d fragment of C4. Here, we present evidence indicating that C4d is not present on those cells. In order to identify structurally the C4 fragments deposited, LIS cells were prepared at 37 degrees C and 4 degrees C in autologous serum to which 125I-C4 was added. Membranes of LIS cells were solubilized and analyzed by SDS-PAGE in 5 to 15% gradient gels followed by autoradiography. C4d was not deposited on LIS cells prepared at 37 degrees C, whereas C4c (beta, gamma, alpha 3 alpha 4) was. Cells prepared at 4 degrees C carried C4d (alpha 2) and C4c. Anti-Cha and anti-Rga antisera agglutinated both cell types, although C4d was not present on the cells prepared at 37 degrees C. Purified C4, C4c, C4d, and alpha-, beta- and gamma-chains of C4, as well as alpha 3 and alpha 4, were used to neutralize these antisera. C4 and the alpha-chain C4d and alpha 4 fragment of C4c, but neither the alpha 3 fragment nor the beta- or gamma-chains, were capable of neutralizing anti-Cha and anti-Rga antisera. These results strongly suggest that C4d and alpha 4 share an antigenic determinant, both of which are recognized by anti-Cha and anti-Rga antisera.

Blood Group Antigens↗
PubMed1981

Biochemical studies on McLeod phenotype erythrocytes.

Red cells of the McLeod phenotype in the Kell blood group system have an acanthocytic morphology. The membrane protein composition analyzed on sodium dodecyl-sulfate-polyacrylamide gel electrophoresis, the ATP level and the activities of a large number of intracellular enzymes appear to be normal. Membranes prepared from McLeod red cells incubated with gamma AT[32P] and MgCl2 incorporated twice as much radioactivity into spectrin and also showed a slight elevation of phosphorylation in band 3 protein when compared to membranes from normal cells. Intact normal red cells incubated with carrier-free [32P] incorporated radioactivity into several proteins, with most incorporation in spectrin and band 3 protein. In comparison, McLeod cells incorporated three times more radioactivity into spectrin and band 3 protein but increased phosphorylation also occurred in other, but not all, membrane proteins. Intact McLeod red cells also showed increased phosphorylation of membrane phospholipids, but they incorporated [32P] into intracellular nucleotide phosphates in a normal manner.

Adenosine Triphosphate↗
PubMed1981

Elevated serum creatine phosphokinase in subjects with McLeod syndrome.

McLeod phenotype red cells of the Kell blood group system have acanthocytic morphology and reduced in vivo survival. The phenotype has an X-linked mode of inheritance and is found in some males who have no abnormality of leukocyte function and in some who have X-linked chronic granulomatous disease (CGD). We now describe an association between the McLeod phenotype and an abnormal elevation of serum creatine phosphokinase (CPK). The increase is of the MM isoenzyme type, derived from skeletal muscle or cardiac muscle, and muscle biopsy shows evidence of muscle cell changes. All of 11 males who have McLeod syndrome but do not have CGD have high levels of serum CPK. Males with McLeod syndrome and CGD may have normal or high levels of the enzyme. Individuals with other variant phenotypes in the Kell system have normal levels of serum CPK. Studies on a large kindred, which includes 5 people of McLeod phenotype, show high CPK levels only in the members of McLeod type. We conclude that the high level of CPK in the serum of these people is a reflection of a muscle cell anomaly and that in these individuals it is a pleiotropic effect of the X-linked gene that produces the McLeod red cell phenotype.

Anemia, Hemolytic, Congenital↗
PubMed1981

Kx: its relationship to chronic granulomatous disease and genetic linkage with Xg.

The relationship between neutrophil function and the neutrophil antigen, Kx, as well as the linkage of the gene, Xk, with Xg was examined in a kindred with X-linked chronic granulomatous disease. Four of the eight male siblings had chronic granulomatous disease by clinical history and tests of neutrophil function, and all four had Kx-negative neutrophils. The remaining four were in good health and had normal nitroblue tetrazolium reduction tests. However, one of these latter four had Kx-negative neutrophils that functioned normally. These data suggest that closely linked but distinct genes on the X chromosome code for chronic granulomatous disease and Kx. In addition, close linkage was demonstrated between Xk and Xg, a gene coding for an erythrocyte surface antigen.

Adult↗
PubMed1980

Mosaicism of red cell ABO type without recognizable cause.

A 19-year old woman has been found whose red cells are a mixture of groups A1B (60%) and A1 (40%). Tests for many other genetic markers show no other evidence of mosaicism. She is not a twin and her parents and a sib are of normal ABO type. The cause of her dual population of red cells cannot be established, but may be an effect of somatic crossing over or mutation.

ABO Blood-Group System↗
PubMed1980

Anti-Km in a transfused man with McLeod syndrome.

An 18 year old man has red cells of the McLeod phenotype in the Kell system but does not have chronic granulomatous disease. His red cells show acanthocytic morphology and there is evidence of a compensated hemolytic state. Following an accident he was transfused with blood of common Kell type and made anti-K and anti-Km. Leukocytes from the patient are deficient in Kx antigen but the cells appear to have normal function. The mother is a carrier of the variant Xk allele and has a double red-cell populatio of McLeod cells and cells of common Kell type. The family may be informative with respect to linkage between the Xk and Xg loci. One of the mother's 5 brothers and one of her maternal uncles are possible Xk:Xg recombinants.

Acanthocytes↗