Guy Neild

HAEMATOLOGICAL AND BIOCHEMICAL MONITORING OF EBOLA INFECTION IN RHESUS MONKEYS: IMPLICATIONS FOR PATIENT MANAGEMENT

Patients with severe viral infections such as Lassa or Ebola may be denied adequate laboratory investigations because of justifiable fears among laboratory staff. This study in monkeys was designed to provide comprehensive haematological and biochemical monitoring in a contained environment during all stages of Ebola infection. Marked neutrophilia, depletion of lymphocytes, and early failure of platelet aggregation preceded a consumption coagulopathy with a microangiopathic haemolytic anaemia, thrombocytopenia, and failure of prostacyclin production by vascular endothelium. Liver dysfunction was moderate but in conjunction with the dehydration and hypoalbuminaemia could be expected to precipitate renal failure and shock. It seems reasonable to anticipate successful patient support with a patient management isolator and treatment with platelet transfusions, fresh frozen plasma, and possibly prostacyclin when haemostasis is defective during this otherwise self-limiting illness.

DIFFERENTIATION BETWEEN ALLOGRAFT REJECTION AND CYCLOSPORIN NEPHROTOXICITY IN RENAL-TRANSPLANT RECIPIENTS

In a retrospective study of 60 renal-transplant patients immunosuppressed with cyclosporin no specific clinical features differentiated allograft dysfunction responsive to anti-rejection therapy from dysfunction responsive to reduction in cyclosporin dosage. Histologically, allograft dysfunction responsive to anti-rejection therapy was strongly associated with diffuse interstitial infiltration by mononuclear cells, oedema, and haemorrhage, vascular endothelial-cell proliferation, and infiltration of arterial walls by mononuclear cells. Arteriolar medial hypertrophy and hyalinosis were more commonly found in biopsy specimens from allografts with dysfunction responsive to reduction in cyclosporin dose than in those with dysfunction responsive to anti-rejection therapy and those with stable or improving function. Whole-blood cyclosporin concentrations were significantly lower in patients with dysfunction reversed by anti-rejection therapy than in those with dysfunction reversed by reduction in cyclosporin dose or in those with stable function. There was, however, considerable overlap between these groups, so that individual cyclosporin measurements were of little diagnostic value.