血液透析对慢性肾衰血清红细胞生成素浓度无影响

用酶联免疫吸附分析测定了１５列慢性肾功能衰竭（ＣＲＦ）患者血透前、后血清促红细胞生成素（ＥＰＯ）浓度的变化。结果发现血透前慢性肾衰竭患者血清ＥＰＯ浓度在“正常范围”，透析后尽管贫血有所改善，但血清ＥＰＯ浓度无明显变化，与贫血改善无关。血透不影响ＣＲＦ血清ＥＰＯ浓度，血透对ＣＲＦ贫血的改善可能与透析清除某种红细胞生成抑制物质有关。     

尿毒症患者急性缺氧状态下血清红细胞生成素浓度的变化

７例尿毒症贫血患者在自发急性缺氧状态下，其血清红细胞生成素（ＥＰＯ）浓度显著提高（平均７倍），且与ＰＯ２呈负相关。缺氧状态纠正后血清ＥＰＯ浓度下降。提示尿毒症贫血患者的ＥＰＯ氧依赖调控系统功能尚存在，但处于不敏感的低调状态。进一步了解其机遇，则可能通过促进内源性ＥＰＯ的生成，有助于悄毒症贫血的治疗。     

肝硬化和肝癌患者血清中T3、T4变化探讨

近年来，文献报道，一些非甲状腺疾病可引起血清T3浓度降低，少数危重患者可伴有血清T4浓度降低，但临床上无甲状腺功能低下表现，称之为“正常甲功病态综合征”，或“低T3综合征”。肝硬化、肝癌是当今威胁人类健康的严重疾病，为了解其非甲状腺疾病与功能间的关系，本文收集85例肝硬化和肝癌患者进行血清T8，R放射免疫测定含量变化，现将结果报告如下。     

新生儿HIE血清SOD活性和MDA浓度变化及临床意义

目的：探讨缺氧缺血性脑病（ＨＩＥ）新生儿血清超氧化物歧化酶（ＳＯＤ）活性和丙二醛（ＭＤＡ）浓度的变化及临床意义。方法：采用化学比色法分别测定２０例ＨＩＥ新生儿和２０例正常新生儿血清ＳＯＤ活性和ＭＤＡ浓度。结果：新生儿ＨＩＥ急性期血清ＳＯＤ活性明显低于恢复期及对照组（Ｐ均〈０．０１）,有非常显著差异,ＨＩＥ急性期血清ＭＤＡ浓度明显高于恢复期及对照组（Ｐ均〈０．０１）,有非常显著差异。ＨＩＥ急性期血清     

脑梗塞患者血清VEGF、NO和NOS测定及其意义

血管内皮生长因子(ｖａｓｃｕｌａｒｅｎｄｏｔｈｅｌｉａｌｇｒｏｗｔｈｆａｃｔｏｒ,ＶＥＧＦ),也称血管通透性因子(ＶＰＦ),由平滑肌细胞等产生和分泌,特异性地作用于血管内皮细胞,是一种强有力的多功能细胞生长因子,可促使血管内皮细胞分裂增生、转移,增加血管通透性并促使新血管形成[1]。为探讨ＶＥＧＦ与缺血性脑血管疾病的关系,本文检测38例脑梗塞患者血清ＶＥＧＦ浓度,同时测定一氧化氮(ＮＯ)、一氧化氮合酶(ＮＯＳ)的水平。1　方法和结果以脑梗塞患者为研究对象,健康献血者为对照组。ＶＥＧＦ采用双抗体夹心ＥＬＩＳＡ法;ＮＯ采用…     

慢性阻塞性肺病患者血浆内皮素水平与肺血流动力学的关系

本文报告采用放射免疫方法测定慢性阻塞性病２４例（ＣＯＰＤ）患者体静脉，肺动脉，体动脉血的血浆ＥＴ－１水平，并与１６例正常对照组作了比较，ＣＯＰＤ患者尚进行了肺动脉压力直接测定，结果表明，ＣＯＰＤ患者ＥＴ－１水平显著高于正常组（Ｐ〈０．００１），肺动脉高压（ＰＡＨ）组ＥＴ－１水平显著高于ＰＡＨ组（Ｐ〈０．０５）。本文还分参与ＣＯＰＤ患者血浆ＥＴ－１水平的升高在ＰＡＨ形成可能是参与发病的因素之定。血浆     

分泌性中耳炎中耳积液和血清中sIL－2R水平的初步研究

应用酶联免疫吸附法（ＥＬＩＳＡ）对３０例正常人血清（对照组）和６０例分泌性中耳炎患者（ＳＯＭ组）中耳积液和血清中可溶性白细胞介素２受体（ｓＩＬ－２Ｒ）进行了检测。结果示ＳＯＭ组血清ｓＩＬ－２Ｒ水平明显高于对照组，ＭＥＦ中其含量明显高于血清；鼻咽癌组血清及ＭＥＦ中ｓＩＬ－２Ｒ水平明显高于─般ＳＯＭ组；粘液组高浆液组；慢性组高于急性组（均Ｐ＜０．０１）。提示：血清及ＭＥＦ中ｓＩＬ－２Ｒ水平的测定有助于对ＳＯＭ患者免疫状态的评估；ＭＥＦ中ｓＩＬ－２Ｒ可能主要由局部中耳粘膜产生；ＭＥＰ中高浓度的ｓＩＬ－２Ｒ存在可能是ＳＯＭ迁延不愈的─个原因。     

37℃凝血温度下正常人和哮喘患者血清ECP水平的测定

室温（２０℃）是广泛接受的血清ＥＣＰ测定凝血温度，但存在一些问题。设想体温３７℃可能是血清ＥＣＰ测定的有效凝血温度。为此，对６８例急性发作的哮喘患者在３７℃凝血温度下血清ＥＣＰ水平进行分析，比较凝血温度分别为２０℃和３７℃时同一患者血样本的ＥＣＰ水平变化，结果发现３７℃下哮喘患者血清ＥＣＰ水平（５０．９±３．１８μｇ／Ｌ）显著高于正常对照（１７．２７±１．３６μｇ／Ｌ，Ｐ＜０．０１）。在６８例病人中，３７℃凝血下有２８人血清ＥＣＰ水平高于正常值，而２０℃凝血下只有１７人血清ＥＣＰ水平高于正常值，两者间存在显著差异（Ｐ＜０．０５）。３７℃凝血温度下血清ＥＣＰ水平与哮喘症状计分显著相关（ｒ＝０．７７，Ｐ＜０．０１）。此外，尚测定了３７℃凝血温度下１０１位１０～５０岁的健康人血清ＥＣＰ水平，结果显示３７℃下正常人血清ＥＣＰ水平的几何均数是１７．８１μｇ／Ｌ，血清ＥＣＰ水平的正常值为７０μｇ／Ｌ以下（９５％的可信限）。本研究表明，在血清ＥＣＰ的测定中设凝血温度为３７℃不仅是有效、简化的方法，而且还可减少哮喘患者血清ＥＣＰ水平的假阴性。     

恶性肿瘤患者NO、TNF-α测定及其临床意义

利用硝酸还原酶法对１３０例实体瘤患者进行血清一氧化氮（ＮＯ）测定,其中部分患者作了肿瘤坏死因子（ＴＮＦ α）测定。结果,肿瘤患者血清ＮＯ浓度显著高于正常对照组（Ｐ＜０００１）,并随病情进展而升高;血清ＴＮＦ浓度亦显著高于正常对照组（Ｐ＜００５）,且与ＮＯ浓度呈显著正相关（ｒ＝０５４,Ｐ＜００５）。提示ＮＯ参与抗肿瘤免疫,且与病情密切相关,并可能由ＴＮＦ α所诱导。     

大剂量口服1,25（OH）2D3冲击治疗腹透患者血清甲状旁腺素（1 …

测定了２０例持续不卧床腹膜透析（ＣＡＰＤ）患者治疗前，后的血清甲状旁腺素（１～８４）的含量，并观察了１，２５（ＯＨ）２Ｄ３大剂量冲击和常规剂量每日口服对ＣＡＰＤ患者血清ＰＴＨ（１－８４）的浓度的影响，结果显示，１，２５（ＯＨ）２Ｄ３口服能降低ＣＡＰＤ患者血清ＰＴＨ（１～８４）纠正低钙血症，口服冲击疗法优于常规剂量口服疗法。     

Erythropoietin level in patients with acute leukaemia.

Erythropoietin level in the serum and urine of adult patients with acute leukaemia (AML, ALL, MML) was estimated by polycythaemic mouse bioassay in order to obtain more information about the associated anaemia. In AML and ALL patients the serum erythropoietin level as found to be increased and in a negative correlation with the blood haemoglobin concentration. In ALL patients erythropoietin in urine was increased regularly while in AML patients it was not. No correlation between the serum level and the urinary excretion of ESF, or between the blood Hb and the serum ESF, was found in MML patients. The results show that anaemia in leukaemia is not due to the low ESF level.     

Assessment of erythropoietin levels and some iron indices in chronic renal failure and liver cirrhosis patients

This study was constructed to investigate the relationship between renal anaemia and erythropoietin (EPO) concentrations in chronic renal failure (CRF) patients and to evaluate the possible role of the liver. Serum EPO levels were measured in blood samples from 20 CRF patients on hemodialysis (HD), 20 liver cirrhosis (LC) patients, 20 patients having both CRF and LC and undergoing HD, and 20 normal control subjects. Blood cell counts, iron indices (iron, total iron-binding capacity (TIBC) and ferritin), renal function (blood urea nitrogen (BUN) and creatinine), hepatic function (ALT, AST, ALP and bilirubin) investigations were carried out for all the subjects enrolled in this study. CRF patients without LC had serum EPO concentration of 6.21 +/- 0.53 mU/ml (mean +/- SE), which was significantly higher than that in patients having both CRF and LC (4.32 +/- 0.52) (p < 0.01). Both groups showed significantly lower values than the controls (12.75 +/- 0.70) (p < 0.001). LC patients with intact kidneys had significantly higher EPO level (22.70 +/- 1.70) (p < 0.001). No correlation was found between EPO level and any of the hematologic or iron indices.     

Acute erythremic myelosis (true erythroleukaemia): a variant of AML FAB-M6

AIMS: Classic erythroleukaemia (acute myeloid leukaemia M6, or M6 AML) is defined as an excess of myeloblasts in an erythroid predominant background. Leukaemia variants in which the primitive blast cells are demonstrably erythroid are extremely rare and poorly characterised. Variably referred to as "true erythroleukaemia" or "acute erythremic myelosis", they are often included within the M6 AML category even though they do not meet strict criteria for this type of AML. METHODS: Two cases of acute erythroid neoplasia are presented with clinical, morphological, immunophenotypic, and cytogenetic analysis. RESULTS: Both patients presented with profound anaemia, one in a setting of long standing myelodysplasia. Bone marrow examination revealed a predominant population of highly dysplastic erythroid cells in both cases. In one case, the liver was infiltrated by neoplastic erythroid cells. Both patients died within four months of diagnosis. CONCLUSIONS: This report illustrates that cases of acute leukaemia occur in which the dominant neoplastic cell is a primitive erythroid cell without an accompanying increase in myeloblasts. This does not preclude the neoplastic clone originating in a multipotent haemopoietic stem cell, as suggested by cases arising in patients with myelodysplasia. Acute erythremic myelosis should be recognised as a distinct variant of M6 AML.     

Value of serum C-reactive protein measurement in the management of bone marrow transplant recipients. Part II: Late post-transplant period.

Seventeen bone marrow recipients transplanted for acute leukaemia (8), chronic leukaemia (1), severe aplastic anaemia (3), and various inborn errors of metabolism (5) had 22 episodes of documented infection in the late (greater than 3 months) post-transplant period. Serum C-reactive protein concentrations were considerably increased in patients with bacterial infections, but not in those with viral or fungal infections. Serum C-reactive protein values were normal in 20 patients transplanted for acute leukaemia (12), chronic leukaemia (1), severe aplastic anaemia (2), and various inborn errors of metabolism (5) who had active chronic graft versus host disease but no evidence of infection. These findings indicate that serum C-reactive protein concentrations are useful in the diagnosis and monitoring of bacterial infections even in the presence of chronic graft versus host disease.     

Myelodysplastic Syndromes

Myelodysplastic syndromes (MDS) are clonal disorders of haemopoietic stem cells which are characterised by peripheral cytopenia and, usually, by an increased bone marrow cellularity. Transfusions of red blood cells and platelets comprise the basis of supportive care for anaemia and thrombocytopenia. In patients who progress to acute myeloid leukaemia, cytotoxic chemotherapy is used. In MDS, haemopoietic growth factors can enhance: proliferation and differentiation of normal and myelodysplastic haemopoietic progenitor cells, and prevent premature apoptosisacceleration of haemopoietic recovery after intensive chemotherapy and amelioration of mature cell function; and sensitisation of malignant cells for the cytotoxic action of chemotherapeutic agents. There is widespread clinical experience with the use of epoetin (EPO), granulocyte-macrophage colony-stimulating factor (GM-CSF) and granulocyte colony-stimulating factor (G-CSF). A meta-analysis of 17 trials with EPO showed a stimulation of erythropoiesis, resulting in a discontinuation of the need for transfusions or an increase in haemoglobin levels of at least 15 g/L in 16% of 205 patients. Favourable factors for the response were an initial absence of a need for transfusion and a serum EPO level <200 U/L. In clinical phase I/II studies of GM-CSF administration, a dose-dependent increase in the absolute neutrophil count was seen in >80% of patients, as well as a decrease in the infection rate. The effect on survival could not be assessed. Lower platelet counts, with a risk of bleeding, bone pain, local erythema at the subcutaneous injection site and phlebitis during intravenous infusion, were observed. The combined administration of GM-CSF and EPO to a small number of patients resulted in an increase in haemoglobin levels or a decrease in the need for transfusion, with an overall response rate of 46%, but is not a proven treatment. The use of G-CSF increased the absolute neutrophil count in about 90% of patients with MDS, and was accompanied by an improvement of neutrophil function, which is frequently impaired in these patients. However, contradictory data exist on the influence of prophylactic G-CSF treatment on the infection rate. Bone pain and thrombocytopenia were the most important adverse effects of G-CSF treatment. Synergism of G-CSF and EPO has not yet been proven in randomised phase III trials, although selected patients showing no response to EPO alone may achieve normal haemoglobin levels after receiving additional G-CSF. Treatment in vivo with EPO, GM-CSF or G-CSF has not been shown to change the percentage of bone marrow cells carrying cytogenetic aberrations. However, individual patients have shown a reversal from a monoclonal to a polyclonal pattern with GM-CSF therapy.     

Acute leukemia in sickle cell disease patients in a tertiary health facility in Nigeria: a case series

Background and objectivesSickle cell disease(SCD) is a disorder of red cells resulting from the co-inheritance of haemoglobin S (HbS) with another abnormal haemoglobin. The diagnosis of acute leukaemia is uncommon in our patients with sickle cell disease more so the patients have high morbidity and mortality due to the sickling process. Acute leukemia is a malignant clonal disorder of haemopoietic precursor cells resulting in accumulation of immature blood cells in the bone marrow and blood. The objective of the case series was to highlight the challenges of diagnosis and management of SCD patients with acute leukaemia, the importance of peripheral blood film review and propound a possible risk factor.MethodsRecords of 58 patients diagnosed and managed for acute leukaemia over a 7 year period at the University College Hospital, Ibadan were reviewed. The diagnosis of acute leukaemia was based on clinical features in addition to peripheral and bone marrow smears findings. Microsoft excel version 2013 was used for statistical analysis.ResultsFive (8.6%) of the patients with acute leukaemia also had sickle cell disease: 3 males and 2 females were described. Recurrent fever and anaemia were the most consistent presenting features in the patients. All the patients were not on any routine medications meant for SCD patients and had poor history of clinic attendance prior to the diagnosis of acute leukaemia. The diagnosis of acute leukaemia was not made until the patients were seen by a haematologist. The principal tool of diagnosis in all the patients was peripheral blood film review. Two patients were discharged against medical advice. The treatment period ranged between one month and one year in the remaining three patients.ConclusionSCD patients are not exempted from developing acute leukaemias and the diagnoses of the two conditions overwhelms the social and economic support of patients and care givers. The study also underscores the relevance of high level of suspicion and prompt review of peripheral blood film of SCD patients particularly when patients present with unremitting symptoms associated with anaemia and fever.     

Aplastic anaemia and the hypocellular myelodysplastic syndrome: histomorphological, diagnostic, and prognostic features.

In a retrospective study of 111 patients with aplastic anaemia iliac crest biopsies were evaluated for the presence of morphological features statistically related to the evolution of the disease. Prognostic variables for a transition to acute non-lymphatic leukaemia were: cellular atypias of the three haemopoietic lineages, as observed in the myelodysplastic syndrome, and especially "micromegakaryocytes"; high numbers or irregular distribution of megakaryocytes, or both; and (slight) marrow fibrosis. Clinical variables did not influence these prognostic correlations. Prognosis in relation to death from bone marrow failure without leukaemia might well have been influenced by a strong plasma cell reaction, but this correlation was weakened by clinical factors. On the basis of this study aplastic anaemia can thus be subdivided morphologically into two disease entities--namely, hypocellular myelodysplastic syndrome with a 23-82% risk of acute non-lymphatic leukaemia developing within three years, depending on how many variables associated with acute non-lymphatic leukaemia are present, and non-dysplastic myelohypoplasia.     

Value of serum C-reactive protein measurement in the management of bone marrow transplant recipients. Part I: Early transplant period.

Serum C-reactive protein concentrations were measured serially during the early transplant period in 68 bone marrow recipients transplanted for leukaemia (34), chronic granulocytic leukaemia (2), severe aplastic anaemia (6), and various inborn errors of metabolism (26). There were 116 clearly documented episodes of infection or acute graft versus host disease or both. Serum C-reactive protein concentrations in patients with viral (11) or fungal infection (6) were normal or only slightly raised. In 32 patients with isolated acute graft versus host disease, only three (10%) showed serum C-reactive protein concentrations above 40 mg/l. Values greater than 40 mg/l were strongly suggestive of bacterial infections and values above 100 mg/l were seen only in patients (43) with bacterial infections with or without acute graft versus host disease. These findings suggest that serum C-reactive protein concentrations are valuable both for diagnosis and monitoring of such infections.     

Diagnostic value of the serum folate assay

The diagnostic value of the serum folate assay has been assessed in 90 patients, each of whom had a macrocytic anaemia and a low serum vitamin B(12) level. Twenty-nine (32%) patients were found to have anaemia due primarily to folate deficiency. The cause of the low serum vitamin B(12) levels is uncertain in the 22 (25%) patients with normal or borderline vitamin B(12) absorption. The effect of folic acid therapy was studied in four of these patients, and in each case the serum vitamin B(12) rose slowly to a normal level.The serum folate was low in only four (7.5%) of the 54 patients with pernicious anaemia, and the levels rose to normal on treatment with vitamin B(12) alone. A high serum folate occurred in eight (15%) pernicious anaemia patients. A normal serum folate indicated the diagnosis of pernicious anaemia or megaloblastic anaemia following partial gastrectomy. However, a normal serum folate and a very low vitamin B(12) level was found in two patients with idiopathic steatorrhoea.It is concluded that the serum folate assay is a valuable routine test in patients who have a macrocytic anaemia and low serum vitamin B(12). A low folate level makes the diagnosis of pernicious anaemia unlikely and is a strong indication for full investigation of small intestinal function.