Erwin Deutsch

Factor XII activity and antigen concentrations in patients suffering from recurrent thrombosis

Abstract A group of 107 patients with recurrent venous thrombosis was tested for factor XII coagulant activity and antigen. Among these patients eleven were identified with Hageman factor (FXII) levels below our normal mean value minus two standard deviations (SD). A control group of 55 individuals without thrombosic problems was studied simultaneously. The factor XII levels of these persons were all within the normal range (normal mean ± 2 SD). The I I patients with reduced levels of factor XII belonged to seven families, 5 with positive history of thrombosis. On average, they experienced their first thrombosis at a younger age than the other patients, which supports the theory of a hereditary defect. Thus, reduced levels of factor XII should be considered as a risk factor in the development of thrombosis.

Pyrogens as thrombolytic agents: Clinical and experimental studies☆

Abstract Four effects of intravenously injected purified bacterial pyrogens are discussed: 1. 1. The induction of a leukopenia within the first hour after injection of the pyrogen. This is followed by a leukocytosis lasting for many hours. 2. 2. The induction of fibrinolysis beginning about sixty minutes after the injection and lasting for about ninety minutes. It is caused by the appearance of a great amount of a stable type activator in addition to a small amount of a labile type activator. In vitro experiments and some clinical observations suggest that the leukocytes may be a source of the stable type activator which may be liberated from the leukocytes (and possibly other cells) at the time of development of leukopenia. The activator induces the formation of free plasmin. We found in only a few cases, that another mechanism was responsible for the activation of fibrinolysis, a lysokinase, which induces the formation of a labile type activator. 3. 3. Effects on blood coagulation are not caused by the pyrogen itself. The most obvious effect is the development of a hypercoagulability, which could be demonstrated to be a general side effect of the action of proteolytic enzymes in low concentrations. The same effect, but less marked, may be observed after administration of nicotinic acid, small amounts of streptokinase, and trypsin. When the proteolytic activity is fully developed, a digestion of factors v and viii and to a smaller degree of prothrombin and factor vii is observed. Splitting products of fibrinogen cause a distinct antithrombin activity. 4. 4. The body temperature is elevated. A period of about ninety minutes after the injection is necessary for the formation of the intrinsic pyrogen which finally causes the rise in temperature. Leukocytes are apparently involved in this transformation.

Systemic Candidiasis Complicating Bone Marrow Transplantation in Aplastic Anemia

A 17-year-old male patient with aplastic anemia underwent bone marrow transplantation and succumbed 4 days after marrow infusion from sudden myocardial failure. Fever of unknown origin (FUO) had accompanied the patients course from admission until death. The cause of death was fungus myocarditis, which had escaped detection in vivo, in spite of a daily culture program for bacteria and fungi, and a close monitoring of the patients circulation and ventricular performance. Commonly applied diagnostic criteria for systemic mycosis, such as topical colonization, malfunction of invaded organs and positive fungus cultures failed to provide a timely diagnosis. With regard to the problems in diagnosing systemic mycosis, the potential stem cell toxicity of antifungal drugs and the need for immunosuppressive therapy prior to marrow infusion, we strongly recommend not to start the transplantation procedure unless FUO has been treated successfully.

Neopterin Levels in Serum After Bone Marrow Transplantation are Possibly Helpful to Estimate the Activity of Graft-Versus-Host-Disease

Neopterin, (Npt,6-1’,2’,3’-D-erythrotrihydroxy)propy-pteridin) is formed from Guanosine-Triphosphate during the biosynthesis of Tetra-hydrobiopterine, a co-factor of aromatic hydroxylation. The biological function of Npt is not yet known.It has been shown, that stimulation of T-lymphocytes in viral infections and malignant disorders may cause elevation of Npt levels in serum and urine (1,2,3,4). The aim of this study was to evaluate the usefulness of regular radioimmunological determinations of serum-Npt levels in human bone marrow graft recipients suffering from GVH-D reactions.