Carbohydrate-Deficient Transferrin and Other Markers of High Alcohol Consumption: A Study of 502 Patients Admitted Consecutively to a Medical Department

An isoform of transferrin, carbohydrate-deficient transferrin (CDT) is increased in a high percentage of abusing alcoholics and has been found superior in its specificity compared with other biological markers. We used serum CDT as a screening parameter in 502 patients consecutively admitted to our medical department during a 4-week period. The intake of ethanol during the last 4 weeks was registrated by personal interviews and the mean daily consumption calculated. Serum CDT was measured at admission (CDTect) and compared with γ-glutamyltranspeptidase (GGT), AST, ALT, and mean corpuscular volume (MCV). Serum CDT detected 18 of 26 (69%) patients who consumed >50 g ethanol daily. The clinical sensitivity of CDT of detection ethanol consumption >50 g daily was 69%, compared with 73%, 50%, 35%, and 52% for increased values of GGT, AST, ALT, and MCV, respectively. Altogether, 38 of 476 patients (8%) with a daily ethanol consumption < 50 g also had increased serum CDT levels. The specificity of CDT was 92%, compared with 75%, 82%, 86%, and 85% for GGT, AST, ALT, and MCV, respectively. In the 60 patients who consumed >10 g ethanol daily, we found a significantly positive correlation between CDT and ethanol consumption ( r = 0.52, p < 0.001). A positive correlation was also found between serum transferrin and CDT ( r = 0.51, p < 0.001). In conclusion, the specificity of CDT is much higher compared with GGT in detecting alcohol abuse. Some acute and chronic illnesses may increase the serum level of CDT. False-positive CDT levels may be caused by changes in serum transferrin concentration.     

Dosage of salicylates for children with juvenile rheumatoid arthritis. A preliminary report.

The daily dosage of salicylates is traditionally very high for patients with juvenile rheumatoid arthritis. In order to achieve the optimal therapeutic effect, serum salicylate levels are kept at 30-35 mg/100 ml (2175-2540 mumol/l). The recommended daily dosage in the textbooks is about 100 mg/kg of body weight, and the reported dosage/m2 of body surface area has been 3.2 g/m2/day. These dosages are, however, too high in clinical routine. In the present investigation, 19 children were treated with salicylates for 15 days with daily check-ups of the serum salicylate levels. Seven of these children had symptoms of salicylate intoxication which corresponded closely to the serum salicylate levels. If the daily dosage of salicylates exceeds 3 g/m2 of body surface area, intoxication can be expected.     

Recurrent venous thrombosis during warfarin treatment related to acquired protein S deficiency

Failure of warfarin to prevent new thrombotic processes was observed in three patients with very low free protein S concentrations and high C4b-binding protein (C4bBP) concentrations, and in one patient with hereditary protein S deficiency. We suggest that an increase in C4bBP reduces the free Protein S level, and warfarin treatment causes an additional decrease of free protein S. The four patients presented indicate that such reductions are of clinical importance. Heparin seems preferable as an anticoagulant in this situation, as warfarin given alone is ineffective, or may even be harmful. In a group of pancreatic cancer patients with advanced disease, subnormal mean free protein S was found, whereas mean total protein S concentration, and mean C4bBP concentrations were significantly higher (p<0.01) than in healthy controls. These findings indicate that an increase in C4bBP may induce free protein S deficiency contributing to the increased thrombotic tendency in this group of patients. The correlation between free protein S and C4bBP was 0.11, (n.s.), between total protein S and C4bBP 0.73 (p<0.0001).     

Lineation of the Osmotic Fragility Curve of Erythrocytes

Lineation of the osmotic fragility curve by the method of Detraglia et al (1974) may be performed in most samples from a hospital population. Using the lineation procedure, the osmotic fragility may be tested by only 2 solutions of known osmolarity without any great loss of precision or accuracy. The osmotic fragility curve may be described by 2 values: C₅₀ = the concentration at which 50% of the erythrocytes are haemolyzed and C₅₀ - C₈₀ = the decrease in concentration raising the fraction of haemolysis from 0.50 to 0.80.     

The Clinical Expression of Hemochromatosis in Oslo,Norway: Excessive Oral Iron Intake May Lead to Secondary Hemochromatosis Even in HFE C282Y Mutation Negative Subjects

Background: The prevalence of hereditary hemochromatosis in Norway is one of the highest reported in the world. However, the clinical presentation in patients with hemochromatosis in Norway seems to be different compared with recent studies elsewhere. The aim of this study was to investigate patients with hemochromatosis in one community hospital in Norway and to study the prevalence of the C282Y mutation. Methods: One hundred and twenty patients were consecutively admitted to one medical department in Oslo. Serum transferrin and ferritin concentrations were measured in all patients, and a percutaneous liver biopsy was obtained in 108 of 120 (90%) patients. Stainable iron (Perls stain) in hepatocytes was graded from 0 to 4⁺ and fibrosis from 1 to 4. Genotyping for the C282Y and H63D mutation in the HFE gene was performed by PCR-RFLP. Results: Forty-eight (40%) of the patients suffered from tiredness and astenia and 29 (24%) had typical arthropathy. Only 5 of 105 (4.5%) had biopsy confirmed cirrhosis and 5 had diabetes mellitus. Patients referred from a blood bank had significantly less symptoms and signs compared with other patients. Twenty-one of 120 (17.5%) patients were C282Y mutation negative. Seventeen (81%) of these patients (16 women and 1 man) had a history of extensive oral iron intake lasting from 5 to 50 years. When excluding those with extensive oral iron intake (n = 17), 92 of 103 (89%) were homozygous for the C282Y mutation, 7 (7%) were heterozygous including 3 compound heterozygous and 4 (4%) were mutation negative. Conclusions: Only a minority of our patients with hemochromatosis had a far advanced disease at the time of diagnosis (less than 5% had cirrhosis) and hemochromatosis in a majority of the C282Y mutation negative patients was associated with excessive oral iron intake for several years.     

Protein C: an automated activity assay

Protein C in citrated plasma is found to be specifically activated by the snake venom derivative Protac, and the activator is used in a simple, automated assay method. The activation is completed in less than 120 s and an isolation of protein C from its inhibitor before activation is not necessary. The activated protein C is determined with the chromogenic substrate S-2366. Therapeutic concentrations of heparin in the test sample do not influence the result. A strong positive correlation to immunoassay of protein C was found (r = 0.92). Three cases of probable hereditary protein C deficiency belonging to the same family were discovered during the study.     

Serum Carbohydrate-Deficient Transferrin as a Marker of Alcohol Consumption in Patients with Chronic Liver Diseases

We meesured serum levels of carbohydrate deficient transferrin (CDT) in 420 subjects: 100 healthy blood donors, 82 healthy employses, 70 abstaining patients with different chronic nonalcoholic liver disease, 16 abstaining patients with alcoholic fatty liver, 50 abstaining patients with alcohotic liver cirrhosls, 25 abusing patients with alcoholic fatty liver, 41 abusing patients with alcoholic liver cirrhosis, and 36 patients with alcohol dependence syndrome with a daily ethanol consumption of 173 ± 120 g the last 4 weeks before blood was drawn. In controls the serum level of CDT was significantly higher in females compared with males (17.7 ± 5.1 and 13.7 ± 3.8 units/liter, respectively), and the upper normal limit was defined as 27 and 20 units/liter. Sixty-two of 102 (60.8%) abusing patients with alcoholic liver disease had increased levels of CDT compared with 1 of 66 abstaining (1.5%) patients with alcoholic liver disease, and 10 of 70 (14.3%) abstaining patients with nonalcoholic liver disease among them 3 with primary biliary cirrhosis and 2 with chronic autoimmune hepatitis. No correlation was found between serum CDT and γ-glutamyltranspeptidase (GGT), AST, ALT, and mean red cell volume (MCV). The sensitivity and specificity for serum CDT was 61 and 92%, respectively, compared with 85 and 18% for GGT and 70 and 66% for MCV. No advantage was gained by using the CDT/transferrin ratio. Our study confirms that CDT is a specific marker for chronic alcohol abuse, except in few patients with other chronic liver diseases. Serum CDT seems to be a better indicator of abstention than GGT; AST and MCV in patients with alcoholic liver disease. However, in our hands CDT is not so sensitive for alcohol abuse in patients with liver disease as reported earlier in unselected alcoholics     

Reference values for fibrinogen concentration and inhibitors of fibrinolysis

?-Aminocaproic acid and tranexamic acid when added to whole blood will dissolve in the plasma and draw water from the cells in accordance with their concentration. When these compounds are added to whole blood in recommended amounts (10 mg/ml), the osmotic dilution of the plasma must be taken into consideration when concentrated solutions or dry substances are used.