Cohen E

Effect of platelet transfusion on hemorrhage in patients with acute leukemia: An autopsy study

The effect of platelet transfusion therapy in acute leukemia was studied in 27 cases, whose autopsy findings were compared to 30 similar cases treated prior to availability of such therapy. Major hemorrhage which was considered to be the proximate cause of death was present in 63% of the controls, but occurred in only 15% of the platelet‐treated group. This difference was highly significant (p <.001). Of the 30 patients who did not receive intensive platelet therapy, 15 (50%) had gross intracranial hemorrhage and 27 (90%) had gross pulmonary hemorrhage. In contrast, of the 27 patients in the study group who had received platelet therapy, 5 (19%) had gross intracranial hemorrhage and 14 (52%) had gross pulmonary hemorrhage. The platelet‐treated patients had a significantly decreased incidence of intracranial hemorrhage (p < .05) and of pulmonary hemorrhage (p <.005) compared to the control group of patients. The incidence of gastrointestinal hemorrhage was slightly lower in the study group; there were no differences in the amount of hemorrhage in the heart and kidney. The transfusion of large numbers of platelets significantly reduced the incidence and severity of hemorrhagic complications in these patients with acute leukemia and may have slightly prolonged their survival.

Hydroxyethyl Starch and Dexamethasone as an Adjunct to Leukocyte Separation with the IBM Blood Cell Separator

A total of 67 leukaphereses were performed with the IBM blood cell separator (BCS) on 50 healthy donors for the purpose of obtaining a clinically useful number of granulocytes for infusion into patients with acute leukemia and granulocytopenia accompanied by severe infection. The pretreatment of donors with dexamethasone and the addition of hydroxyethyl starch (HES) to the input line of the BCS significantly increased the total number of granulocytes collected, as compared to the total number of granulocytes harvested either by dexamethasone pretreatment only or by the absence of dexamethasone and HES. A mean of 2.03 × 1010, 1.58 × 1010, and 1.07 × 1010 total granulocytes was collected by the HES plus dexamethasone, by dexamethasone alone and with neither HES or dexamethasone, respectively. The efficiency of cell collection, as evidenced by the total number of granulocytes harvested per liter of blood processed, was also significantly improved by the combined use of HES and dexamethasone. The results of the present study demonstrates that a clinically useful number of granulocytes can be harvested and made available for supportive therapy to patients experiencing granulocytopenia caused by malignant disease or its treatment.

Granulocyte transfusions in children using filter-collected cells.

Twenty‐three children with various stages and morphologic types of leukemia were treated with multiple granulocyte transfusions obtained by filtration leukapheresis when neutropenia‐associated infection appeared unresponsive to antibiotics. All children meeting the above qualifications were given granulocyte transfusions during this time period. Twenty‐one of 23 became afebrile during or shortly after the transfusions; one died with disseminated Herpes simplex; and one became well enough to be discharged, although he was never free of fever. Frequent mild to moderate fever and chills were noted. One child developed a severe pulmonary reaction followed by resolution of pneumonia. Filtration leukapheresis is a useful adjunct in controlling severe infections in neutropenic children.

Increased Elevation of Peripheral Leukocyte Counts by Infusion of Histocompatible Granulocytes

Abstract. The results of 38 HL‐A and other antigen matching studies revealed an inverse relationship between the percent of donor‐recipient serologic discordance and increases in recipient granulocyte levels 1 h after infusion of donor cells. Selected unrelated, parent, and sibling donors possessing mean percent serologic discordances of 33, 22, and 16, respectively, increased postinfusion granulocyte counts by 10, 46, and 117%, respectively. A mean of 1.58 × 1010 total granulocytes collected from sibling donors was associated with a significant elevation of recipient levels, as compared to unfavorable results with the infusion of 2.05 × 1010 and 2.31 × 1010 total granulocytes harvested from less compatible parent and selected unrelated donors, respectively.

Histocompatibility testing in intrafamilial renal transplantation.

The results of 25 intrafamilial renal allografts were compared with tissue typing and compatibility testing by the standard histocompatibility techniques of Amos, et al.1 The degree of consanguinity did not appear to matter in relation to rejection, since one half of sibling donors or parental-child donors did not elicit rejection. No correlation was noted with direction of parent-child allografts. Grade B allografts were more successful than C-D allografts. The one instance of hyperacute rejection occurred in a C-match, with disparate HL-A8 antigen. Patient survival was 76 per cent (19 of 25 allografts) with allogrqft survival of 83.6 per cent (16 of 19 allografts) for one year posttransplantation. The data underscore tissue typing as a necessity for intrafamilial renal allografting. Further evaluation is suggested of prognostic value of per cent serologic incompatibility of donorrecipient antigenic profiles for predicting success of allograft.