Cryoglobulinemia in a patient with Sj?gren's syndrome, and factors of cryoprecipitation.

The IgGK cryoglobulin in a patient with Sj?gren's syndrome showed deviations from normal IgG involvine its amino acid composition as well as its carbohydrate components. The heavy chains showed abnormal numbers of arginine, threonine, valine and isoleucine residues, and there was an impressive reduction of fucose and hexose components. The carbohydrate deficits appear to be the reason for the incomplete solubility of the isolated IgGK(Ru) at 37 degrees C. with completion at 52 degrees C.     

Human melanoma metastasis culture supernatant contains chemotactic factors for phagocytes

Several findings point out that melanoma culture supernatants release soluble factors which modulate mononuclear cell chemotactic responsiveness. In this regard, either an enhancement or an impairment of chemotactic capacity has been found. Here, we provide evidence that supernatant recovered from human melanoma cell metastasis culture is able to trigger monocyte and polymorphonuclear cell chemotaxis. This activity is not affected by the presence of anti-IL-1 antibody during the assay. Further studies are in progress to isolate and characterize soluble factors involved in this activity.     

Clotting factor VIII in Sneddon syndrome

Hyperactivity of coagulation factor VIII (fVIII) marks hypercoagulation. FVIII enhances activity of factor IX and their combination activates factor X, which is of primary importance in prothrombin transformation into thrombin, on the phospholipid membrane. The activity of fVIII was studied in 28 patients (26 women, 2 men, mean age 49.6 +/- 7.8 years) with Sneddon's syndrome (SS). SS manifests clinically similarly to primary antiphospholipid syndrome (PAS). The leading of them are ischemic disorders of cerebral circulation (IDCC) and advanced livedo present in all the examinees. Hyperactivity of fVIII was registered in 21 (75%) of 28 patients. Most of thrombosis-related symptoms occurred more frequently in patients with high than normal activity of fVIII: ischemic strokes (91% vs 57%, p > 0.05), repeated strokes (71% vs 0%, p = 0.0014), transient IDCC (76% vs 57%, p > 0.05), vascular dementia (43% vs 0%, p > 0.05), ischemic heart disease (43% vs 0%, p > 0.05), thickening of heart valves according to echocardiography (91% vs 57%, p > 0.05), peripheral venous thromboses (24% vs 0%, p > 0.05). In high fVIII activity cardiolipin antibodies occurred more rarely (24% vs 43%, p > 0.05) but lupus anticoagulant was seen more often (47% vs 14%, p > 0.05). High fVIII activity was in 8 of 12 aPL-negative patients. It is demonstrated that elevated fVIII activity is an essential mechanism of thrombosis development in SS. The cause of this enhanced activity is suggested to be special aPL in interaction with which fVIII becomes insensitive to inactivation with protein C. The activity of protein C was normal in all the cases.     

两种设备虹吸法制备冷沉淀凝血因子的质量和方法比较

目的通过2种设备(虹吸法)制备冷沉淀凝血因子的质量和方法的比较,选择合适的制备冷沉淀的设备。方法用贝克曼ACL-7000的原厂配套试剂分别对冷沉淀进行凝血因子Ⅷ、纤维蛋白原的测定。结果血浆融化箱制备冷沉淀中凝血因子Ⅷ含量为80.8-317.9IU,平均值为152.08 IU;纤维蛋白原含量为190.5-759.6 mg,平均值为373.02 mg,全自动冷沉淀制备仪制备冷沉淀中凝血因子Ⅷ的含量为80.2-326.7 IU,平均值为181.3 IU;纤维蛋白原含量为209.1-880.2 mg,平均值为424.8 mg,凝血因子Ⅷ差异有统计学意义(P0.01)纤维蛋白原差异没有统计学意义(P0.05),均达到了国家标准。结论 2种方法都能制备出符合根据《全血及成分血质量要求》规定的冷沉淀,冷沉淀中凝血因子Ⅷ的含量不少于80 IU/袋,纤维蛋白原含量不少于150 mg/袋,但全自动冷沉淀制备仪制备的冷沉淀凝血因子质量及方法优于血浆融化箱法,适宜推广。     

Incidence of allergic reactions with fresh frozen plasma or cryo‐supernatant plasma in the treatment of thrombotic thrombocytopenic purpura

Plasma replacement for thrombotic thrombocytopenic purpura (TTP) is accomplished with various plasma products. This study sought to determine the incidence of allergic reactions with FFP or CPP as replacement in therapeutic plasma exchange (TPE). Forty‐one TTP patients were identified retrospectively who received TPE replacement with either FFP (n=21) or CPP (n=20). Anti‐histamine was administered prophylactically following the initial occurrence of an allergic reaction (urticaria, respiratory distress, or anaphylaxis with hypotension). Fifty‐one allergic reactions occurred in 65.8% of patients. Urticaria comprised 49 of 51 (96%) of reactions and respiratory distress the remaining 4%. No anaphylaxis occurred. Nineteen urticarial reactions occurred in 50% of CPP recipients compared to 71% of FFP recipients (P=0.28). Anti‐histamine breakthrough occurred in 36.3% of patients who experienced a previous allergic reaction with CPP and 37.5% with FFP (P=1.0). The overall risk of allergy per unit of plasma was 1.37% (1.23 % CPP, 1.48% FFP), comparable to estimates in non‐TTP recipients. The median number of donor exposures preceding the first allergic reaction was 35 and 32, CPP and FFP, respectively (P=0.63). The mean volume of plasma transfused prior to reaction was 9,883 mL for CPP and 9,348 mL for FFP (P=0.85). Neither product was advantageous in preventing allergic complications. Because of the large volume, the number of donor exposures, and prolonged duration of therapy, allergic reactions to plasma are common (65.8%) in the treatment of TTP. J. Clin. Apheresis. 16:134–138, 2001. © 2001 Wiley‐Liss, Inc.     

Clotting Factor Levels in Patients with Coronary Atherosclerosis

The clotting system was studied in a number of patients with coronary atherosclerotic disease, with special regard to antihemophilic A factor (AHA) and antihemophilic C factor (AHC).

The levels of a number of clotting factors were determined in plasma samples from 14 patients with atherosclerotic coronary disease before the start of anticoagulant treatment. A similar study was made in 80 patients with the same disease under long-term anticoagulant treatment with phenylindanedione or dicoumarol for more than 3 months.

AHA was found on the average higher in both groups of patients than in a group of 30 normal healthy persons. The AHA values did not seem to be definitely correlated with age, judged from the variations within the group of normal persons and within the group of treated patients. The high AHA values were not found to he correlated in any definite way with the duration of the anticoagulant treatment.

The investigations confirmed the findings of other workers that average fibrinogen levels in these patients are high. The fibrinogen values, like those for AHA, seemed neither to be markedly correlated with age, judged from the variations within the group of treated patients, nor with the duration of treatment. The study showed a positive correlation between high AHA and high fibrinogen values in the treated patients.

Average AHC was found near the normal level for both investigated groups of patients, supporting the assumption that AHC it not specially affected by the anticoagulant treatment.

Average AHB, proaccelerin, proconvertin and prothrombin + Stuart-Prower factor were near the normal level in the untreated patients. Assays in the treated patients showed markedly decreased AHB, and roughly normal average for proaccelerin, in accordance with the findings of other workers.     

病毒灭活冷沉淀在肝硬化大鼠模型中的研究应用

目的探究病毒灭活冷沉淀在肝硬化大鼠中的临床疗效。方法选取20只健康大鼠为健康对照组,20只肝硬化大鼠为实验组,两组均输入10ml病毒灭活冷沉淀,24h后剪各组存活大鼠尾尖取血2ml,测定血清中Fg和PT、TT、APTT含量。结果与健康对照组比较,实验组Fg显著降低,PT、TT、APTT显著升高(P0.05);对照组输入前后未见明显差异(P0.05),实验组输入后凝血结果较输入前得到明显改善,差异具有统计学意义(P0.05)。结论病毒灭活冷沉淀对肝硬化大鼠有良好的纠正凝血功能效果,为病毒灭活冷沉淀的临床推广应用提供理论基础和实验室依据。     

Prevention of cryoprecipitation during cardiopulmonary bypass in a patient with HIV-HCV co-infections

BACKGROUND: There are no guidelines for the management of patients with cryoglobulins during cardiopulmonary bypass (CPB) necessitating core hypothermia. OBJECTIVE: To evaluate a simple, pragmatic protocol of in vitro temperature-dependent cryoprecipitation of serum in patients with cryoglobulinemia before elective cardiac surgery with CPB. METHODS: A 44-year-old female patient was known for chronic hepatitis C and type III cryoglobulinemia. Elective surgery was planned for an aortic arch aneurysm. A differential serum cryoprecipitation profile was established in vitro prior to surgery. RESULTS: Whereas, at temperatures < or = 15 degrees C, cryoglobulin levels were > or = 0.112 g/L (normal value < 0.05 g/L), at 20 degrees C and above, the precipitate was < or = 0.016 g/L. Accordingly, surgery was performed without any cryoglobulin-related complications at an extracorporeal circulation temperature of 22-24 degrees C, to minimise the risk of cryoprecipitation. CONCLUSION: In elective cases of surgery with CPB and hypothermia, temperature-dependent differential serum cryoprecipitation profile may be an easy and efficient way to assess a safe peroperative level of temperature to avoid complications due to cryoglobulins, without enhancing the patient's tissue ischemia risks.     

The results of 5 years' use of a method for heparin cryoprecipitation of plasma proteins (selective plasmapheresis) in patients with an immune-complex pathology

The paper treats the results of the 5-year use of plasma protein heparin cryoprecipitation (selective plasmapheresis) (SPA) in patients with immune complex pathology. The method consists in the removal of fibronectin and bound complement components, cryoglobulins, cryofibrinogen, circulating immune complexes (CIC), and other gross-dispersed proteins in the presence of heparin in the cold. The SPA was applied to 122 patients with immune complex diseases and syndromes. Altogether 1279 procedures were carried out. The method turned out effective in 80% of patients with hemorrhagic vasculitis, systemic lupus erythematosus, rheumatoid arthritis, and other types of vasculitis. The changes in the blood serum concentration of immune complexes correlated with the time-course of changes in the clinical and laboratory parameters. The SPA efficacy was in agreement with the reduction in the level of immune complexes. Provided 2-3 procedures were carried out a week, the lowering of the level of immune complexes and other laboratory parameters marking the degree of inflammation could be seen by procedures 4-6. Therefore, to attain a stable clinical effect, its is necessary to perform not less than 6 SPA procedures. It has been demonstrated that SPA can be used an unlimited number of times, for the use of the method does not entail the development of plasma protein deficiency. This circumstance is of paramount importance for the treatment of chronic relapsing immune complex diseases.     

Rhesus alloimmunization following intensive plasma exchange

A 17-year-old woman was admitted to the hospital for the treatment of rapidly progressive systemic lupus erythematosus. She failed to improve when treatment with cyclophosphamide and prednisone and, therefore, was treated with intensive plasma exchange. A total of 24 liters of plasma was exchanged during six separate procedures over an 8-day period. The patient, who was blood group B Rh negative (Cde/cde), was found to have an IgG anti-D antibody reacting at a titer of 16 by the indirect antiglobulin technique 6 weeks after the first plasma exchange procedure. The titer of this antibody subsequently rose to 512. This patient, who had neither been pregnant nor received any blood products other than the plasma used during the plasma exchange, was presumably immunized by Rh positive red cells or stroma present in the transfused plasma. It is estimated that the patient received approximately 10(10) Rh positive cells, or approximately one ml of packed red cells–a quantity sufficient to cause Rhesus alloimmunization.     

冷沉淀联合其它血液成分应用于大量输血治疗的回顾性分析

目的了解大量输血患者输注冷沉淀及其它血液成分的剂量、输注方式、输血疗效和疾病转归及生存率的关系。方法回顾性分析83例大量输血患者的血液输注资料,按照患者出院时疾病转归情况(良、尚可、差、死亡)分为4组。分组分析血液成分输注情况,输血前后血液常规、凝血功能实验室检测指标,临床症状,输血不良反应发生情况,各血液成分在大量输血患者输血救治中的使用时机、用量、方式与出院转归的关系。结果 4个分析组的患者术中平均出血量(mL)(1 920±1 171、2 246±1 315、3 029±2 827、2 875±1 706、)和手术日尿量(mL)(1 458±1 292、1 821±1 366、890±1 421、526±579)与疾病严重程度相关(P<0.05),病情越严重的患者出血量越多,尿量越少。大量输血的24 h内患者输血量(U)与疾病严重程度呈正相关(P<0.05),红细胞输注组4(10.95±3.41)和组3(12.90±7.38)>组2(9.86±2.72)和组1(10.16±2.06),血浆输注组4(14.27±7.53)和组3(13.02±8.54)>组2(3.44±0.89)和组1(10.97±6.12),冷沉淀输注组4(11.77±14.07)和组3(16.43±18.14)>组2(8.83±12.37)和组1(5.55±8.16),血小板输注组4(0.60±1.00)和组3(1.30±1.72)>组2(0.20±0.56)和组1(0.30±0.70)。大量输血的24 h内,14例(16.87%)进行冷沉淀血小板联合输注,27例(32.53%)进行冷沉淀联合输注,1例(1.20%)进行血小板联合输注。冷沉淀开始输注的时间为手术开始后4.2 h,血小板为手术开始后3.4 h;组3和组4开始使用时间晚于组1和组2,且早期仅有冷沉淀使用,未输注血小板。输血前后血液实验室检测数据显示:输血后组1、组3、组4 RBC和Hb均显著提高(P<0.05),组3提升不明显;Plt组1和组2上升显著(P<0.05);组3和组4实验室检测指标改善不明显;输血后组3、组4 APTT显著延长,FIB含量组2、组3下降,组1上升,组4无明显变化(P<0.05)。输血后患者临床症状改善的程度不一致:组1和组2输血后临床症状改善明显,组3和组4改善不明显。仅组2、组3各报告发生1例过敏性输血不良反应。结论对出血量大、尿量明显减少、并发症多且复杂的病例,在保持体温、及时恢复血容量、积极控制出血、并辅以止血药物应用基础上,缩短各血液成分等比例联合输注的时限,有助于提高患者出院生存率和生存质量。     

Changes in plasma osteocalcin concentration following treatment with stanozolol

Treatment of healthy, adult, human volunteers with stanozolol, 5 mg twice daily, for six weeks caused a marked elevation in circulating levels of osteocalcin. Plasma osteocalcin concentrations did not fall to pretreatment values for a period in excess of four weeks after the cessation of treatment but remained similar to levels whilst on treatment. At the same time, as the rise in plasma osteocalcin was seen, plasma alkaline phosphatase activity fell; however, in this case, a return to pretreatment levels occurred within four weeks of treatment ending. These data demonstrate that stanozolol has a detectable effect on the plasma concentration of a protein thought to be a marker of osteoblast activity, and that this effect continues for a period after treatment has been discontinued.     

Decrease of plasma fibronectin concentration following infusion of a gelatin-based plasma substitute in man

Intravenous infusion of 500 ml of a gelatin-based plasma substitute, Haemaccel, given to healthy volunteers, resulted in a significant decrease of the immunoreactive plasma fibronectin concentration 48 h and 72 h after infusion. One hour after infusion, the ability of fibronectin to bind gelatin was inhibited with a gradual recovery within 48 h. A dextran based plasma substitute, Macrodex, did not have this effect on plasma fibronectin.     

Preanalytical factors in human plasma ascorbate assay.

Estimation of vitamin C (ascorbic acid) in various samples of fresh and frozen human plasma has shown that freezing in a regular freezer at -25 degrees C causes an approximately 14% loss of ascorbate in the sample. Freezing the same samples in a deep freezer at -75 degrees C causes less of an ascorbate loss amounting to about 9%. On the other hand, using the dry ice alcohol bath freezing, which shortens the freezing process to a fraction of seconds produced loss of ascorbate by 3.5% only. The storage time of previously frozen samples at -25 degrees C or -75 degrees C, from 2 to 14 days does not produce noticeable differences in the sample ascorbate concentration. Loss of ascorbate in samples frozen in the dry ice alcohol bath may be acceptable assuming analytical variability of ascorbate assay amounting to about 4% and broad biological variability of ascorbate concentration in various clinical conditions. Use of frozen plasma samples for ascorbate assays may essentially facilitate running this analysis in clinical laboratories.     

烧伤后血浆纤维连接蛋白的动态观察

目的研究烧伤患者创面修复过程中２４ｈ到３周血浆纤维连接蛋白（Ｆｎ）变化规律及创面烧伤程度与Ｆｎ的关系。方法采用酶标仪比浊法检测５０例正常人和３５例烧伤患者。结果１６例烧伤总面积＞５０％以上的患者伤后２４ｈ出现血浆Ｆｎ明显下降，在伤后１周仍出现第２次下降，至２周后渐渐恢复正常水平。１９例烧伤总面积＜５０％以下的患者血浆Ｆｎ一般都处在正常范围内。７例死亡患者血浆Ｆｎ含量始终偏低。结论提示Ｆｎ的含量与烧伤后病情变化关系密切，并起着十分重要的作用