Sysmex XE-2100五分类全自动血细胞分析仪使用评价

目的:对SYSMEXXE-2100全自动血细胞分析仪的主要性能进行评价。方法:以体检者的标本和门诊患者标本分别对SYSMEXXE-2100的精密度、线性范围、相关性和交叉污染率进行测定,并和SysmexNE-1500血细胞分析仪进行比较。结果:SysmexXE-2100全自动血细胞分析仪精密度、准确度表现优异,重复性、稳定性好,线性范围宽,交叉污染率低。结论:SysmexXE-2100全自动血细胞分析仪是一种较理想的血细胞分析仪,适合在门诊检验中使用。     

Increased factor VIII/von Willebrand factor antigen and von Willebrand factor activity in renal failure.

Factor VIII/von Willebrand factor antigen and von Willebrand factor activity (ristocetin assay) were studied in 12 patients in renal failure. A dramatic increase in both activities was observed (antigen 315 +/- 30 per cent in patients verus 104 +/- 9 per cent in control subjects; activity 402 +/- 48 per cent in patients versus 111 +/- 5 per cent in control subjects; p less than 0.001 for both). Since von Willebrand factor is thought to play at least a facilitative role in the development of arteriosclerosis, these increased activities may contribute to the premature arteriosclerosis reported in patients with chronic renal failure undergoing dialysis.     

36例SARS患者外周血象检查结果分析

目的　通过对 3 6例严重急性呼吸综合征 (SARS)患者外周血细胞数据的研究 ,动态监测SARS患者的血象变化 ,探讨血象在发生、发展转归中的临床意义。　方法　收集江门市医院 3 6例确诊SARS患者的外周血检查数据 ,进行动态分析。　结果　入院时 3 6例患者外周血白细胞计数 (WBC)均值为 ( 5 2± 3 0 )× 10 9/L随后WBC升高 ,至第4周有 91 6%病例WBC计数恢复正常 ,入院时淋巴细胞值低于 1 5× 10 9/L者占 88 9% ( 3 2 / 3 6) ,均值为 ( 1 0± 0 5 )×10 9/L ,入院 4周后有 86 1%患者淋巴细胞绝对数恢复正常。 1例血小板降低 ,占 2 8%。其他细胞分类及血红蛋白无明显异常。　结论　白细胞降低或正常及淋巴细胞降低可作为SARS的早期诊断指标 ,淋巴细胞降低可作为SARS早期诊断的标准之一 ;淋巴细胞的降低显示SARS病毒严重侵犯患者免疫功能 ,淋巴细胞是否回升可作为监测患者免疫功能是否重建的指标     

Further studies on the mechanism of suppression of human lymphocyte transformation by human alpha fetoprotein

We investigated the possibility that noncovalent binding of negatively charged molecules such as prostaglandins (PGs) might be partly responsible for human alpha fetoprotein (HAFP) heterogeneity with respect to charge and the suppression of human lymphocyte responses, since PGs are potent suppressors of lymphocyte transformation. Indomethacin, an inhibitor of PG synthesis, had no effect upon the transformation of adherent-cell-depleted human lymphocytes, nor did it interfere with the capacity of HAFP to inhibit lymphocyte transformation. When a partially suppressive dose of HAFP was added to mitogen-stimulated lymphocytes together with varying doses of prostaglandin E₁ or E₂ (PGE₁ or PGE₂), no evidence of inhibitory synergy was demonstrable; their combined suppressive action was either less than or approximately equal to the sum of their respective inhibitory effects. Addition of PGE₂ to a nonsuppressive dose of an impotent HAFP preparation resulted in no greater lymphocyte suppression than that achieved by PGE₂ alone. Analysis of the kinetics of suppression of lymphocyte transformation by PG and HAFP yielded unequivocal evidence for their disparate mechanisms of action. Suppression of lymphocyte transformation by PGE₂ is evident by 24 to 40 hr of culture, persists throughout the entire culture period (including peak deoxyribonucleic acid [DNA] synthesis at 72 to 88 hr and beyond), and does not vary in profundity at any time. By contrast, HAFP-induced suppression of lymphocyte DNA synthesis is lacking at 24 to 40 hr, reaches a peak at 72 to 88 hr, and is waning by 96 to 112 hr. Cultures containing HAFP synthesize more DNA than control cultures during the 120 to 136 hr culture period. These observations, together with our earlier demonstration of a subpopulation of human lymphocytes resistant to HAFP inhibition, suggest that, after the first 24 to 40 hr of culture, HAFP may enhance the proliferation of a suppressor population which gradually dampens the proliferative response. HAFP is capable of suppressing the proliferative response of periodate-treated lymphocytes; this confirms that it does not act via competition with the cell membrane for a mitogen-binding site. Immunofluorescence studies indicate that human peripheral blood lymphocytes lack membrane-associated HAFP or HAFP receptors of high affinity. Our results indicate that PG, either present as a putative contaminant in HAFP isolates or endogenously synthesized by lymphocytes (or monocytes), plays no role in lymphocyte suppression by HAFP.     

Alterations of hemostasis associated with cardiopulmonary bypass.

Cardiopulmonary bypass (CPB) has become common surgery, but remains associated with poorly understood derangements in hemostasis. These alterations may lead to significant hemorrhage and subsequent increased morbidity and mortality. To better define alterations of hemostasis associated with CPB, coagulation proteins, fibrinolysis, and platelets were evaluated in thirty consecutive patients undergoing this procedure. Results of these studies have revealed activation of the fibrinolytic system with the presence of circulating plasmin, elevated fibrin(ogen) degradation products, and depletion of plasminogen and fibrinogen. All patients were void of soluble fibrin monomers of disseminated intravascular coagulation (DIC) and demonstrated only minimal to moderate thrombocytopenia. All patients undergoing CPB developed a severe functional platelet defect as assessed by measuring platelet retention. At one hour post-CPB, this defect only partially corrects. Hyperheparinemia, heparin rebound, and protamine excess were not noted in any patient with doses of heparin and protamine used in this series. Thus, these studies have revealed a primary hyperfibrino(geno)lytic state to occur in the majority of patients undergoing CPB; in addition, a severe defect in platelet function occurs in all patients subjected to this procedure. These two alterations of hemostasis occurring during CPB account for most instances of non-technical hemorrhage associated with this procedure. A quick search for these defects should lead to rapid diagnosis, efficacious therapy, and a subsequent reduction in morbidity and mortality due to CPB hemorrhage.     

Venous thrombosis and splenic rupture in paroxysmal nocturnal hemoglobinuria

A patient with an 11 year history of paroxysmal nocturnal hemoglobinuria presented with severe abdominal pain. On admission, the hematocrit value was 30 per cent and unchanged from repeated measurements during the previous three years. Abdominal angiography identified extensive thromboses of the splenic and portal venous systems. After initial improvement on heparin therapy, the patient experienced additional abdominal crises. A ruptured and multifragmented spleen was removed at the time of exploratory laparotomy. Postoperatively, after a several days' interval of improvement, the patient experienced additional thrombotic episodes of the abdomen, upper extremities and cerebral cortex. The latter was associated with disabling nerve paralysis. With continuous intravenous heparin plus steroid therapy, the patient's condition improved progressively. Despite the numerous thrombotic episodes during the prolonged hospital course, no hemolytic episodes were observed. This is the first report of documented splenic rupture in a patient with paroxysmal nocturnal hemoglobinuria.     

Fate of therapy failures in adult idiopathic thrombocytopenic purpura

Of 38 adult patients with idiopathic thrombocytopenic purpura followed an average of more than 12 years, 15 suffered splenectomy failure or postsplenectomy recurrence of thrombocytopenia. Nine of the 15 also received immunosuppressive agents, and four of the nine failed such therapy. In eight of these 15 treatment failures normal or safe platelet counts were achieved in a subsequent three to 12 year period during which they received no therapy. The frequency of spontaneous recovery of satisfactory platelet levels in adults with idiopathic thrombocytopenic purpura in whom treatment failed may have negative implications for very vigorous or longstanding immunosuppressive therapeutic attempts in certain cases.     

Hepatic neoplasia: Selected clinical aspects

Benign liver tumors are relatively uncommon and, even when large enough to be symptomatic, they usually remain undiagnosed prior to exploratory laparotomy. Hemangiomas constitute the majority of benign hepatic neoplasms and are 9 times as frequent in females as in males. Most are asymptomatic but abdominal swelling, a mass, or symptoms due to compression of adjacent organs may occur and abdominal hemorrhage is reported in 4.5% of patients. Hepatic hemangioma may produce a large arteriovenous communication serious enough to cause heart failure. Recently an increased frequency of liver tumors, mostly adenomas, has been noted in women taking oral contraceptives (OCs); the cause has been attributed to estrogens. The exact incidence is unknown but believed to be low. It is most common in women in their late 20s who have been on OCs for 7 years or more. The tumor occasionally completely regresses on withdrawal of the OCs. The tumor may be discovered incidentally at laparotomy or may manifest inself by pain, a palpable mass, or catastrophic hemoperitoneum. Hepatic adenoma is usually a solitary lesion and infrequently degenerates into malignancy. Differential diagnosis includes chronic gall bladder disease and peptic ulcer. Focal nodular hyperplasia (FNH) is apparently much less frequently related to OC use and is less likely to bleed seriously than adenoma. Hepatic chemistry is usually normal in adenoma and FNH, but slight increases in serum bilirubin, serum alkaline phosphatase, and serum transaminase may occur. Primary liver cancer (hepatocellular carcinoma or hepatoma) is mostly a disease of males and in the US and Western Europe seldom develops before age 40. Fibrolamellar carcinoma, which characteristically develops in adolescents and young adults, occurs with equal sex incidence. Doubt has been expressed about its relationship to OCs. In the US about 75% of primary hepatocellular carcinomas are associated with cirrhosis, and about 5% of cirrhosis cases develop primary liver cancer. Clinical manifestations of hepatoma have been divided into 5 groups: frank cancer (62.7%), acute abdominal cancer (8%), febrile cancer (8%), occult cancer (16%), and metastatic cancer (5%). Detection of large amounts of alpha fetoprotein has proven useful in diagnosis of hepatocellular carcinoma, but values may be negative in OC users. It has been estimated that 1/3 to 1/2 of all malignant tumors eventually metastasize to the liver.