Charles E. Rath

Acute coagulopathy following infusion of prothrombin complex concentrate

An acute coagulopathy developed in a 49 year old woman with severe liver disease after she received an infusion of prothrombin complex concentrate. The concentrate used in the infusion was subsequently studied by observing the effect of the concentrate on the partial thromboplastin times of various plasmas. The evidence suggests that activated coagulation factors, including activated factor X, were present in the concentrate, and probably played a role in initiating the acute change in the patients coagulation status. Mechanisms whereby liver disease predisposes toward the development of such a coagulopathy are discussed. It would appear that prothrombin complex concentrates should be used in patients with liver disease only with utmost caution.

Idiopathic thrombocytopenic purpura in the elderly.

Idiopathic thrombocytopenic purpura (ITP) was diagnosed in 22 patients above the age of 50 during a seven-year period. There was no female preponderance. Steroid therapy was effective, particularly in preventing hemorrhage and is considered to be the treatment of choice. Splenectomy may be less beneficial than in younger patients with ITP. Complications of the disease and its treatment are minimal.

Malignant histiocytosis in a patient presenting with leukocytosis, eosinophilia, and lymph node granuloma

A patient with malignant histiocytosis presented with a number of unusual features including fever, leukemoid reaction, and eosinophilia. Other confusing findings included lymph node biopsies which showed reactive changes, noncaseating granuloma, and atypical Reed‐Sternberg cells. These features are compared with cases appearing in the literature. The course was rapidly progressive despite combination chemotherapy.

“B” cell origin of malignant cells in a case of american burkitt's lymphoma characterization of cells from a pleural effusion

Ninety‐eight percent of the cells isolated from a malignant pleural effusion in a case of American Burkitts lymphoma showed membrane fluorescence to antihuman IgM antisera, while only 2% of the cells formed spontaneous rosettes with sheep red blood cells. It is concluded that the Burkitt cells in the malignant effusion are derived from bursal equivalent lymphocytes. Epstein‐Barr (E‐B) viral titers to both viral capsule antigen and early antigen were not elevated. The significance of these findings is discussed.