Takayuki Takubo

Platelet recovery after eradication of Helicobacter pylori in patients with idiopathic thrombocytopenic purpura

Abstract. The association between Helicobacter pylori (H. pylori) infection and idiopathic thrombocytopenic purpura (ITP) has been reported by several groups. We investigated the prevalence of H. pylori infection and the effectiveness of its eradication in Japanese patients with ITP. H. pylori infection was found in 21 of 30 patients (70.0%) by 13C urea breath test and presence of serum antibodies to H. pylori. H. pylori was eradicated in 18 of the 21 infected patients (85.7%) by administration of a proton pump inhibitor and two kinds of antibiotics. In only one patient was medication discontinued due to skin rash on the 4th day of treatment. Platelet recovery was obtained in ten patients (55.6%). In two patients with treatment failure, platelet recovery was obtained after successful re-eradication. In three patients without H. pylori infection, platelet counts did not significantly increase with the same treatment. On the other hand, eradication therapy did not affect platelet counts in patients with gastric ulcer. In conclusion, H. pylori eradication can be used for initial treatment with tolerable adverse effects in some ITP patients.

DNA extraction from human urinary sediment

DNA was extracted from urinary sediments and was sufficient for polymerase chain reaction (PCR) and enzymatic analysis, even if DNA from microorganisms coexisted. From urine samples, the yield of DNA ranged from trace levels to 20 μg per 10 mL urine. When urinary sediment was stored in ethanol, DNA remained stable for 2 weeks or more. Individual identification and sex determination could easily be performed using either fresh or ethanol‐fixed urine. In conclusion, urine can be used as a source for PCR‐based investigations and genetic studies. J. Clin. Lab. Anal. 12:88–91, 1998.

Pathophysiological significance of simultaneous measurement of reticulated platelets, large platelets and serum thrombopoietin in non‐neoplastic thrombocytopenic disorders

Abstract: An automated reticulocyte counter using flowcytometric analysis, the R‐3000 (Sysmex Inc. Kobe, Japan), has recently been modified to determine reticulated platelets (RPs) and large platelets (LPs). We measured frequencies of RPs, LPs in total platelet count and serum thrombopoietin concentration comprehensively in non‐neoplastic thrombocytopenic patients with immune thrombocytopenic purpura (ITP, n = 23), aplastic anemia (AA, n = 21), liver cirrhosis (LC, n = 17), and hematologically normal subjects (control, n = 151). ITP was characterized as high frequencies of both RP and LP, AA as high RP frequency and elevated thrombopoietin concentration, and LC as no difference compared with control. Interestingly, the frequency of RP appeared to depend on total platelet count rather than the cause of thrombocytopenia, while the frequency of LP appeared to depend much less on total platelet count. Furthermore, significant positive correlations were observed between frequencies of RP and LP in control, ITP and LC subjects, in whom bone marrow stem cells are intrinsically normal. However, there was no such correlation in AA patients with stem cell deficiency, suggesting that this correlation might be a useful new parameter for detecting qualitatively abnormal platelets. Measurement of RP and LP is thus useful for elucidating the pathophysiology of thrombocytopenic disorders.

Effectiveness of washed platelet concentrate and red cell transfusions for a patient with anhaptoglobinemia with antihaptoglobin antibody

Summary A 71‐year‐old Japanese male with myelodysplastic syndrome progressing to overt leukaemia and hepatocellular carcinoma developed dyspnea and urticaria immediately after infusion of platelet concentrate (PC). He exhibited an identical reaction following blood transfusion. Serum haptoglobin was undetectable. The patient was determined to be homozygous for Hpdel by polymerase chain reaction (PCR). Antibody to haptoglobin was detected by enzyme‐linked immunosorbent assay (ELISA) and Western blot analysis. No antibodies against human leucocyte antigen (HLA) or platelet‐specific antigens were detected. Washed PC and washed red blood cells were effective in preventing the transfusion‐related anaphylactoid reactions.

Blastic NK-cell lymphoma/leukemia with T-cell receptor γ rearrangement

Abstract. A 79-year-oldese man was admitted to our hospital with dyspnea in June 1999. Physical examination revealed general exanthema, hepatosplenomegaly, and lymphadenopathy. Increased numbers of abnormal cells were observed in peripheral blood; these cells were of lymphoblastic morphology with high nuclear/cytoplasm ratios and few azurophilic granules. Immunophenotypic analysis revealed positivity for CD2, CD4, CD56, and HLA-DR, and negativity for CD3, CD13, CD16, CD33, CD34, and T cell receptor (TCR). On genotypic analysis, TCRγ chain was rearranged, but neither the TCRβ chain nor TCRδ chain. Despite an initial good response to chemotherapy the disease relapsed in the early stage, and the patient died 6xa0months after diagnosis.

Detection of various platelet-associated immunoglobulins by flow cytometry in idiopathic thrombocytopenic purpura

In 1975, Dixson reported that anti‐platelet IgG on platelets from patients with idiopathic thrombocytopenic purpura (ITP) is greater than in normal people, by determining anti‐platelet antibodies directly on the platelet surface with a quantitative complement lysis–inhibition–assay. Since then, platelet‐associated IgG (PAIgG) has been thought of as evidence of ITP. Although platelets from ITP patients show significantly higher PAIgG values than from normal control individuals, PAIgG is not specific for autoantibody because it increases in other than immune ITP patients.

Successful treatment with reduced-intensity stem cell transplantation in a case of relapsed refractory central nervous system lymphoma

A 33-year-old male with refractory relapsed central nervous system lymphoma underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) from an HLA-identical sibling after reduced-intensity conditioning chemotherapy. The preparative regimen for allo-HSCT consisted of fludarabine and busulfan. Cyclosporine (CsA) and short-term methotrexate were used as prophylaxis for acute graft-versus-host disease (GVHD). Although CsA was quickly reduced to induce a graft-versus-lymphoma (GVL) effect, no symptoms of GVHD and GVL effect were evident. Donor lymphocyte infusion (DLI) was performed on day +40 following transplantation. The patient developed acute GVHD (grade III) after DLI, and lymphoma regression was observed after the occurrence of GVHD. Four months after transplantation, complete remission was achieved with extensive chronic GVHD, and the patient continues to be disease free at 15xa0months after transplantation.

Acute rhabdomyolysis following administration of high-dose cyclophosphamide: case report

Abstract. Rhabdomyolysis is an unusual complication of hematopoietic stem cell transplantation (HSCT). Cyclophosphamide has been one of the key drugs in the most common preparative regimen for HSCT. We present here a rare case of acute rhabdomyolysis following administration of high-dose cyclophosphamide. A 47-year-old woman with adult T-cell leukemia in remission was treated with high-dose cyclophosphamide as a preparative regimen for allogeneic bone marrow transplantation. Nineteen hours later, general convulsions and acidosis suddenly occurred. Levels of serum creatine kinase (skeletal muscle type), myoglobin, and aldolase were markedly elevated to 32870xa0IU/l, 640xa0ng/ml, and 240.3xa0IU/l, respectively. Rhabdomyolysis caused by high-dose cyclophosphamide was diagnosed, and the preparative chemotherapy was discontinued. Subsequently, her muscular signs and symptoms improved, and the results of laboratory examinations returned to normal after 2xa0weeks. She had previously been treated with conventional doses of cyclophosphamide, doxorubicin, vincristine, and prednisolone without evidence of rhabdomyolysis. Acute rhabdomyolysis may be an adverse effect specific to high-dose cyclophosphamide therapy.

Usefulness of determining reticulated and large platelets in idiopathic thrombocytopenic purpura

This article is also accessible online at: http://BioMedNet.com/karger In 1969, Ingram and Coopersmith [1] identified reticulated platelets (RP) as those displaying coarse, punctate condensations (reticulum) when stained supravitally with the new methylene blue dye. They suggested that RP may provide valuable clinical information regarding thrombocytopoiesis, as reticulocyte counts do for erythropoiesis. However, this method had not been applied routinely in the clinical laboratory. Watanabe et al. [2] have recently counted RP using an automated reticulocyte counter (R-3000, Toa Medical Electronics Co., Kobe, Japan) equipped with special software. This instrument performs flow cytometry of reticulocytes after rapid staining of RNA by a fluorescent dye, auramine O [3]. The software used by Watanabe et al. contains a computer algorithm to discriminate the platelet population by the intensity of forward light scatter (cell size) and fluorescence (RNA content). A typical fluorescence scattergram of platelets from a normal control obtained with this system is shown in figure 1. Line C is predefined in the R-3000. Cells in the region between lines A and D were determined using

Primary refractoriness to platelet transfusion caused by Naka antibody alone

Anti‐Naka, a platelet‐specific antibody, occasionally causes platelet‐transfusion refractoriness (PTR) together with human leucocyte antigen (HLA) antibodies. Anti‐Naka usually appears after frequent platelet transfusions or pregnancy. We report the first case of PTR caused by anti‐Naka alone.