Harold A. Wurzel

Isolation of Anticoagulant Fractions from Crude Fucoidin

Summary A method of preparation, some physical and chemical properties and anticoagulant activities of fucoidin fractions from Fucus vesiculosus have been described. Certain fractions prepared from crude fucoidin proved to have potent anticoagulant effects. The nature of the anticoagulant action and the chemical composition place fucoidin in the group of heparinoids. The most active preparations contained no demonstrable carbohydrate other than fucose and a component which migrated on paper chromatograms faster than fucose and rhamnose but slower than 2-0-methylfucose. This component gave all color reactions of the methyl-pentoses.

The Complications of Therapeutic Plasma Exchange

We reviewed a series of 181 patients who were treated with therapeutic plasma exchange (TPE) a total of 1,389 times. Complications were associated with 22 (1.6%) of the procedures and involved 20 (11%) of the patients. Six of the complications were of a technical nature and did not affect the medical conditions of the patients. 8 patients developed the following serious medical problems: unexplained death during the post‐TPE period, myocardial infarction, pulmonary embolus, loss of consciousness, myocardial ischemia, cerebral ischemia and chest pain. Although these problems were temporally associated with TPE, none of them could be attributed to the TPE with certainty. The remaining eight medical complications were of a less serious nature.

Characterization of lymphocyte subpopulations in chronic lymphocytic leukemia

B cell and T cell characteristics of circulating lymphocytes were studied in 13 patients with chronic lymphocytic leukemia (C.L.L.). Immunofluorescence of surface immunoglobulins and rosette formation using sensitized sheep red blood cells were employed to detect B cells. Rosette formation with untreated sheep red blood cells and in vitro PHA stimulation and cytogenetics were used to study T cells. The findings generally confirm the conclusions of others that C.L.L. usually represents a proliferative disorder of B cells, probably clonal in nature. In 11 of 13 cases the predominant cell surface immunoglobulin was IgM; in 1 case it was IgG, and in 1 case there was only a slight elevation in the incidence of IgM positive cells. In general, EAC rosette studies confirmed the observations made using immunofluorescence, but in one case this correspondence was apparent only after the incidence of EAC rosettes was increased by pretreatment of the C.L.L. cells with 2‐mercaptoethanol. In another case, the incidence of EAC rosette‐forming cells significantly exceeded the incidence of immunofluorescent cells, perhaps suggesting a variable expression of different surface markers on neoplastic cells in C.L.L. E rosette studies and PHA cultures indicated a decreased proportion of T cells in the peripheral blood of these patients, but suggested that the absolute number of T cells was not reduced. Further, kinetic and cytogenetic studies in PHA cultures demonstrated no qualitative abnormality in the circulating T cells in this disease, supporting the view that they represent a normal population diluted in a large pool of neoplastic B cells.

Retroperitoneal Hemorrhage During Heparin Therapy

Abstract The records of all cases of retroperitoneal hemorrhage seen in the Hospital of the University of Pennsylvania since 1953 were reviewed. Most cases were postoperative or post-traumatic. In almost one third, however, the hemorrhage occurred in patients on heparin therapy. Heparin in all instances but one had been injected in the thigh or buttock. From these sites heparin and the resultant hematoma could have reached the retroperitoneal space by extending up from the site of injection. The fascia in this area is so arranged as to allow this. The cause of thrombocytopenia in 5 patients is discussed. We suggest that heparin, when injected subcutaneously, be given through a small bore needle (No. 27) into the abdominal fat pad.

Coagulation defects in rabbits after infusion of dispersed fluorochemicals.

Coagulation parameters were studied in rabbits during and after intravenous infusion of suspensions of dispersed fluorochemicals. Blood samples from rabbits given dispersed perfluorobutyltetrahydrofurane or perfluoro‐tributylamine showed thrombocytopenia, prolongation of activated partial thromboplastin time, and decreases in Factors X and XI. The possible presence of an inhibitor of coagulation was suggested by the prolongation of prothrombin time when measured with serial dilutions of thromboplastin reagent. These abnormalities were not found in whole blood or platelet‐rich plasma after incubation in vitro with dispersed fluorochemical.

Effects of Fenwal 4C2423 transfusion microfilter on microaggregates and other constituents of stored blood.

The effects of a new micropore transfusion filter (Fenwal 4C2423) on stored whole blood have been examined. Five filters were preloaded by passage of two units of outdated type specific bank blood, and the effects of filtration on a third unit, consisting of 21‐day‐old blood, flowing under 150 mmHg pressure, were measured. Filtration did not significantly alter red blood cell count, total hemoglobin, red blood cell fragility, plasma sodium, potassium, albumin, or globulin. Some platelets and white blood cells were removed and a small amount of hemolysis of erythrocytes (<0.1%) was observed. Removal of microaggregates, assessed by Coulter counting, screen filtration pressure, total screen proteins, wet and dry weights of material retained, and scanning electron microscopy, was shown to be excellent over the entire range of particle size. Comparison of the Bentley PFS‐127, Fenwal 4C2417, Johnson & Johnson Intersept®, Pall Ultipore®, and Swank IL200 filters led to the conclusion that the Fenwal 4C2423 was both a significant improvement over the previous Fenwal design and comparable to the most efficient of these filters for both the removal of microaggregates during massive blood transfusion and for the blood flow rates obtained.

Effects of Intersept® Micropore Filtration of Blood on Microaggregates and Other Constituents

Micropore filtration (Intersept) of whole, stored blood was examined in two studies. In Study A, 1 unit of 14-day-old blood flowed by gravity across the filter. In Study B, the filter was preloaded by passage of 2 units of blood, and the effects on a third, consisting of 21-day-old blood, flowing under 150 mm Hg pressure, were examined. Filtration did not significantly alter erythrocyte count, total hemoglobin, plasma hemoglobin, erythrocyte fragility, plasma sodium, potassium, albumin, or globulin in either study, although some platelets and leukocytes were removed. Microaggregates, assessed by Coulter counting, screen filtration pressure, total screen proteins, wet and dry weights of material retained, and scanning electron microscopy, were satisfactorily removed over the whole range of particle sizes. Comparison with the Bentley PFS-127, Fenwal 4C2417, Pall Ultipore, and Swank IL200 filters led to the conclusion that the Intersept is the most efficient filter available at the present time for removing microaggregates during massive blood transfusion.

Evaluation of the Swank IL-201 transfusion filter.

The effects of a new transfusion filter (Swank IL-201) on stored, whole blood have been examined. Six filters were preloaded by passage of two units of outdated, type-specific bank blood, and the effects of filtration on a third unit of 81-day-old blood flowing under 150 mm Hg pressure were measured. Filtration did not significantly alter erythrocyte or leukocyte count, total or plasma hemoglobin, red-cell fragility, and plasma sodium, potassium, albumin, or globulin. Platelet counts were reduced by 33%. Removal of micro aggregates, assessed by Coulter counting, screen filtration pressure, total screen protein, net and dry weight of material retained, and scanning electron microscopy, was shown to be effective over the entire range of particle size.In comparison with other transfusion filters previously examined in this laboratory, the Swank IL-201 filter combines the features of efficient micro aggregate removal with moderate blood-flow rate. Compared to its predecessor, the Swank IL-200, this new filter design has improved flow characteristics without loss of microaggregate removal efficiency. In view of the similarity of performance demonstrated for several of the available filters, it seems lividly that relative cost will constitute an important determinant of filter selection.

Another example of anti-Ytb.

I n 1956 EATON et al. [l] reported an antibody whose corresponding antigen, Yta, was present in over 99% of Caucasian red blood cells and segregated from other known blood groups. Eight years later, GILES and METAXAS, [Z] reported the predicted antibody anti-Ytb, and IKIN et al. [4] subsequently reported a second example. The multitransfused patients in both of these reports had additional antibodies in their sera. GILES et al. [3] reported the following incidence of the Y t genotypes in a British population:

Coagulation defects in open heart procedures

Abstract Coagulation studies were done pre- and post-operatively on 335 patients undergoing open heart surgery utilizing extracorporeal circulation. The patients who had a marked deficiency of factor v or prolongation of the “k” time on thrombelastograms or both postoperatively were the ones more likely to lose the most blood. Possible etiologic factors in a group of patients who had persistent thrombocytopenia are discussed.