Renal failure after anti-D globulin treatment of idiopathic thrombocytopenic purpura

Idiopathic thrombocytopenic purpura (ITP) is a disorder of rapid destruction of antibody-coated platelets. Anti-D immune globulin has been used for treatment of ITP in the United States since 1995. Initial studies identified no significant side effects of treatment. However, a recent report highlighted occasional episodes of intravascular hemolysis after anti-D immune globulin. We describe two children with ITP who developed acute renal failure (ARF) after treatment with anti-D immune globulin and also analyze ten additional cases of ARF reported to the manufacturer, Cangene Corporation, through postmarketing surveillance. All episodes of ARF were associated with intravascular hemolysis. Four patients required dialysis. Patient age ranged from 1 to 82 years, but those requiring dialysis were all under age 15 years. Several patients with ARF had preexisting creatinine elevation. Three of the patients with ARF had serologic evidence of acute Epstein-Barr virus (EBV) infection. Renal biopsy in one patient showed acute tubular necrosis, with findings consistent with pigment nephropathy. Anti-D immune globulin, used to treat ITP, may be associated with intravascular hemolysis and resultant ARF. Renal function should be monitored in patients with evidence of intravascular hemolysis. Children and adolescents may have increased risk of ARF requiring dialysis. Received: 30 March 2001 / Revised: 17 September 2001 / Accepted: 18 September 2001     

Ethical and professional issues in pathology: a survey of current issues and educational efforts

Professionalism, including ethics, has assumed greater importance in residency education, and the Accreditation Council for Graduate Medical Education now requires its incorporation into residency training. Insight into current ethics education, as well as those ethical issues important to pathology, would be efficacious. A mail survey was sent to all members of the Association of Pathology Chairs that asked for specific information related to pathology resident education in ethics and identification of important ethical issues in the current practice of pathology. A total of 148 surveys were mailed, and 53 (35.8%) were returned. Formal instruction in ethics is provided by approximately 62% of pathology residency training programs, and 94% provide informal ethics education. However, 84% of programs believed that ethical issues were underrecognized, and 38% believed that current ethics training was inadequate. Issues regarding the use of tissue for research, confidentiality and privacy, and professionalism were identified as the most important ethical issues currently encountered in pathology.     

Stimulatory effect of procaine on the growth of several microalgae and cyanobacteria

Procaine has been used to stimulate plant growth and it has been noted that it also promotes growth of microorganisms. The effect of procaine hydrochloride concentration on the growth rates of several species of microalgae and cyanobacteria was studied under both photoautotropic and heterotrophic growth conditions. Procaine hydrochloride was added to cultures at concentrations over the range 0.01-1000 mg L(-1). A stimulating effect of procaine hydrochloride on photoautotrophic growth was observed for the cyanobacteria Anabaena cylindrica and Anabaena variabilis, and for the salt-tolerant green algae Dunaliella primolecta and Dunaliella parva. During active growth in batch culture an increase in growth rate (compared with control culture without procaine hydrochloride) of about 25% was observed at 0.1 mgL(-1) of procaine hydrochloride for A. cylindrica. However, procaine hydrochloride was toxic at concentrations of > 10 mgL(-1). Simultaneous administration of hydrolysis products of procaine, p-aminobenzoic acid and diethyl aminoethanol, in lieu of procaine hydrochloride, was as effective as procaine in stimulating growth of A. cylindrica. Heterotrophic growth of Chlorella ellipsoidea and Prototheca zopfii was not stimulated by procaine hydrochloride over the concentration range studied (0.1-10 mg L(-1)). The combined effects of procaine hydrochloride concentration and four other environmental factors (temperature, light intensity, CO2 concentration in the flushing gas and NaCl concentration) on growth rate of D. primolecta was modelled using both a neural network approach and a response surface method. These results indicate that procaine hydrochloride exerts different effects on the growth of microalgal and cyanobacterial cells as functions of dosage, species and culture conditions.     

Comparison of single and combined tests for the evaluation of plasma growth hormone secretion in normal short children

Growth hormone (GH) response to provocative tests was compared in normal short children. Seven of 23 children failed to respond to insulin hypoglycemia. Using insulin hypoglycemia followed by L-dopa only 2 of 23 children did not respond and giving bromocriptine combined with insulin hypoglycemia only 1 of 8 children failed to respond. All children submitted to propranolol followed by exercise (n = 14) and to bromocriptine followed by exercise (n = 6) responded with a satisfactory increase in plasma GH levels. The increase elicited by propranolol and exercise was higher than that induced by insulin hypoglycemia alone (p less than 0.005), exercise alone (p less than 0.05) or L-dopa after insulin hypoglycemia (p less than 0.01). The rise of GH induced by bromocriptine and exercise was higher than that obtained with insulin hypoglycemia alone (p less than 0.05). This study suggests that both adrenergic and dopaminergic mechanisms are involved in exercise induced GH release and confirms that combined tests are more useful than a single test to evaluate GH secretion.     

Evaluation of gonadal function following long-term treatment for acute lymphoblastic leukemia in girls

Twenty-four girls were studied following long-term treatment (mean: 50 months) for acute lymphoblastic leukemia; 14 were prepubertal and 10 pubertal. Follow-up during endocrine studies ranged from 2 months to 6.7 years (mean: 2.3 years). Five of 14 prepubertal patients started clinical pubertal development at a normal age and were reevaluated during puberty, increasing the pubertal group to 15 patients. Thirteen of 15 pubertal patients had received cranial radiotherapy. Ten of 15 pubertal patients started menses during the endocrine study. Although age of menarche was normal, in nine patients it was below the normal mean. Except for the remaining patient, all had received cranial cobalt therapy. In 6 of 19 patients bone age was significantly accelerated. Serum gonadotrophin response to LH-RH was normal in 13 prepubertal patients and in 10 pubertal patients. In 3 of 10 pubertal patients follicle-stimulating hormone (FSH) values were temporarily elevated. Only one pubertal patient had oligoamenorrhea. Five patients were studied by measuring serum progesterone on days 19-22 of the cycle to determine corpus luteum function. Three of them showed progesterone levels compatible with adequate corpus luteum function (6, 19, and 12 ng/ml, respectively) and two presented low progesterone levels (2 ng/ml), probably because of their short gynecological age (0.24 and 0.3 years, respectively). This study suggests that neither the disease nor the long-term antileukemia therapy seems to injure gonadal function in girls. A tendency to early sexual development was observed, which may be related to cranial cobalt therapy.