Willy Goossens

Blood neutrophil function in primary myelodysplastic syndromes

Ten different tests of blood neutrophil function were studied in 20 patients with primary myelodysplastic syndromes (PMDS). The patients were selected according to the new diagnostic criteria for PMDS of the FAB‐cooperation group. Impairments of granulocyte functions were found in all patients. Moreover, several steps in the mobilization of granulocytes at the site of injury seemed to be affected: decreased adhesion (P < 0–05), deficient chemotaxis (P < 0.05), decreased enzyme content (P < 0.001), ‘slower’chemiluminescence (P < 0005), decreased phagocytosis (P < 0.05) and impaired microbicidal capacity (P < 0.025). No significant correlation between disease category and severity of granulocyte dysfunction was discerned, though an increasing number of blasts was associated with more severe granulocytic disability. Results in seven patients with abnormal karotypes were not significantly different from 13 others with normal karyotypes. Our results indicate that defects in blood neutrophil function are a common feature in PMDS and might account for the increased frequency of infection in these patients.

Cobalamin absorption and serum homocysteine and methylmalonic acid in elderly subjects with low serum cobalamin

Abstract: We prospectively studied 41 consecutive elderly patients with serum cobalamin (vitamin B12) levels lower than 125 pmol/l. The protein‐bound cobalamin absorption test (PBAT) was performed in 34 of them and in 27 selected elderly control patients. The lower decision limit was 0.18% and an abnormal test was detected in only 9 (26%) of the 34 patients with low serum cobalamin level. When the PBAT was compared to the Schilling (Dicopac method) test, a concordant result was found in 80 %. Serum methylmalonic acid and/or total homocysteine concentrations were elevated in 75% (26/35) of the patients with low serum cobalamin levels but also in 30% (5/17) of the control patients. Of the 12 and 9 cobalamin‐deficient patients with elevated serum levels of methylmalonic acid and homocysteine, normalization after cobalamin therapy was obtained in 11 and 5 respectively. In conclusion, determination of serum metabolites and their response to cobalamin therapy are a sensitive index of significant cobalamin deficiency and a useful means of distinguishing between cobalamin and folate deficiency. The PBAT offers little advantage over the Schilling test in diagnosing cobalamin malabsorption in elderly patients.

Serum Erythropoietin Levels in Elderly Inpatients with Anemia of Chronic Disorders and Iron Deficiency Anemia

Objective: To analyze the relationship between serum erythropoietin levels and hemoglobin levels in elderly patients with anemia of chronic disorders related to cancer or acute infection when compared with anemic patients with iron deficiency.

Complement activation and adult respiratory distress syndrome during intermittent flow apheresis procedures

We observed complement (C) activation during intermittent flow apheresis procedures (Haemonetics model 30) in four subjects, two of whom developed adult respiratory distress syndrome (ARDS). Actual C3 conversion during apheresis was illustrated by the finding of significantly elevated C3d levels (p < 0.05) and of significantly increased alpha‐1‐antitrypsin/C3 ratios (p < 0.05) in postapheresis serums. Similarly, marked granulocyte aggregating activity was found in these serums, indicative of the generation of significant amounts of the C‐derived anaphylatoxin, C5a or C5a desarginine. A mean decrease of 59.75 percent in neutrophil count during the four procedures suggested sequestration of aggregated granulocytes in the pulmonary vasculature. Moreover, granulocytes activated by apheresis serums induced significant 51Cr leak from cultured human endothelial cells in vitro (p < 0.001). We conclude that inflammatory C components produced during apheresis procedures may provoke granulocyte aggregation and embolization, leading to plugging of the pulmonary vasculature, and that apheresis‐activated granulocytes may induce endothelial cytotoxicity, leading to the capillary leakage syndrome, characteristic of ARDS. Individual variability in C5a generation capacity or alterations in normal C5a clearing mechanisms may account for the low incidence of clinical C activation and true ARDS during apheresis. In these instances, high‐dose steroids, which interfere with granulocyte‐C interactions, may be beneficial.

THE EFFECT OF BLOOD TRANSFUSION ON CEREBRAL BLOOD‐FLOW IN PRETERM INFANTS: A DOPPLER STUDY

Stable infants with anaemia needing a transfusion with adult red blood‐cells were studied to elucidate changes in brain blood‐flow velocity. Within 24 hours and at five to six days following transfusion a substantial mean flow velocity reduction was observed. Haemodynamic factors contributing to the reduction were an increase in cerebrovascular resistance and an increase in whole blood viscosity, as reflected by a raised pulsatility index. Transfusion with adult red blood‐cells causes an elevation in haemoglobin concentration, thereby increasing the total oxygen‐carrying capacity of arterial blood; however, this lowers the concentration of fetal haemoglobin which possesses a higher affinity for oxygen. Since cerebral oxygen transport is equal to the product of cerebral blood‐flow and arterial oxygen content, this finding suggests the existence of a homeostatic mechanism for cerebral oxygen transport. The actual amount of cerebral oxygen transport was found to increase progressively as the percentage of fetal haemoglobin rose above 30 per cent. At higher fetal haemoglobin levels, appropriate elevations in cerebral blood‐flow occurred, causing an increase in the supply of oxygen to the brain.

Quantity and quality of retrograde menstruation: a case control study

BackgroundThe purpose of this study was to test the hypothesis that menstruation is associated with a higher concentration of endometrial cells in peritoneal fluid(PF) and with increased white and red blood cell concentration in PF when compared to nonmenstrual phases of the cycle.MethodsPF was obtained at laparoscopy from 107 women with endometriosis (n = 59) and controls with a normal pelvis (n = 48) during the luteal (n = 46), follicular (n = 38) or menstrual (n = 23) phase of the cycle. Endometriosis was classified according to the classification of the American Society for Reproductive Medicine (rAFS into minimal (n = 25), mild(n = 20), moderate(n = 6) and severe(n = 8) disease. Cell counts (leucocytes, erythrocytes, thrombocytes) were determined on a cell counter. In a subset of 32 patients (13 controls and 19 women with endometriosis), PF was fixed, processed and thinlayers were prepared and stained with Papanicolaou method and with immunocytochemistry using monoclonal antibodies against cytokeratin 7(CK 7), CK 8/18, Ber-Ep4, vimentin, calretinin and CD68. Ber-Ep4 is a marker for cells with epithelial origin (in some cases for mesothelial cells as well). CD68 is specific for cells from monocyte/macrophage lineage; CK7 and CK8/18 are markers for both endometrial epithelial and mesothelial cells, whereas calretinin and vimentin are markers for both endometrial stromal and mesothelial cells.ResultsIn comparison with the nonmenstrual phase of the cycle, analysis of PF during menstruation showed an increased concentration of leucocytes (3.3 × 109/L vs 0.8 × 109/L, P = 0.03), erythrocytes (0.3 × 1012/L vs 0.02 × 1012/L, P = 0.006), hematocrit (0.03 L/L vs 0.003 L/L, P = 0.01) and hemoglobin (0.8 g/dL vs 0.1 g/dL, P = 0.01). Mesothelial cells stained positively with CK7, CK8/18, vimentin, and calretinin. Cells positive for Ber-Ep4 were not observed, except in 2 patients with endometriosis investigated during menses. In all patients 50-98% of single cells were strongly positive for both vimentin and CD68.ConclusionWhen compared to nonmenstrual phases of the cycle, menstruation is associated with an increased concentration of red and white blood cells in PF. However, the presence of EM cells that are detectable by immunohistochemistry in PF is low during all phases of the cycle, including menstruation.

Racial differences in intracellular concentration and transmembrane fluxes of sodium and potassium in erythrocytes of normal male subjects

Erythrocyte concentrations and fluxes of sodium and potassium were investigated in normal black and white male subjects. Erythrocyte sodium concentration was significantly elevated in blacks compared to whites. In single regression analysis erythrocyte sodium concentration was inversely related to the ouabain-sensitive 86Rb-uptake and to the frusemide-sensitive sodium efflux. After adjusting for race, only the relationship between the erythrocyte sodium concentration and the Na+, K+-ATpase pump activity persisted. The sodium-lithium countertransport system was also depressed in the black subjects. No significant difference was observed in erythrocyte potassium concentration between blacks and white. It is probable that, in blacks the decreased active influx of potassium through the sodium-potassium pump was to some extent counter balanced by a reduced efflux of this cationic mediated by the depressed cotransport system. There was no difference in cationic concentrations and fluxes of sodium and potassium between blacks bearing and not bearing haemoglobin S.

Quality of washed salvaged red blood cells during total hip replacement: a comparison between the use of heparin and citrate as anticoagulants

A randomized, prospective study comparing heparin with citrate (ACD) as anticoagulant during red blood cell saving was performed in 10 ASA grade 1-II patients undergoing primary total hip replacement. Blood samples were taken before and after surgery and at several steps during cell saving. In the heparin group, salvaged red cells showed normal values, with the exception of decreased filtrability and moderate hemolysis. More differences in red cell quality were found in the ACD group. Mean corpuscular volume was higher (110 vs 95 x 10−12 mL), red cell distribution was increased (17% vs 13%), osmotic resistance was lower (0.54 vs 0.43 g NaCl/L at 50% hemolysis), antioxidative reserve capacity was lower (1.9 vs 4.6 U glutathione reductase per gram of hemoglobin) and there was more hemolysis (15% vs 11%). Despite the small volume of autologous blood retransfused (388 ± 92 mL), the differences in vitro produced significantly higher free hemoglobin levels in the patients plasma at the end of the operation (58 vs 23 mg/dL). We conclude that heparin is preferable to citrate as an anticoagulant during autotransfusion with cell washing and immediate retransfusion.

Erythrocyte 2,3-disphosphoglycerate concentration before and after a marathon in men

SummaryErythrocyte 2,3-diphosphoglycerate (2,3-DPG) concentration was studied in 23 runners before and after a marathon race. Blood samples were drawn from an antecubital vein the morning before the race (baseline), at 3 p.m. 2 h before the start, on finishing, and 12 and 36 h later. Compared to the baseline values, erythrocyte 2,3-DPG concentration was increased (p<0.001) immediately after the marathon from 4.62±0.14 to 5.56±0.13 μmol·ml−1 RBC and remained elevated 12 h later (5.45±0.14 μmol·ml−1 RBC): it returned to prerace values 36 h after completion of the marathon.

Erythrocyte 2,3-diphosphoglycerate and serum enzyme concentrations in trained and sedentary men

The acute effect of exercise on the intraerythrocyte 2,3-diphosphoglycerate concentration and on various serum enzymes and some related variables was investigated in 14 male athletes before and after a 50-min cross-country run and compared at rest to 15 sedentary subjects. Compared to the sedentary subjects, the athletes had higher resting levels of serum creatine phosphokinase, plasma myoglobin, and renin substrate but had a lower plasma renin activity. The red blood cell 2,3-diphosphoglycerate concentration increased after exercise in the runners and was not different at rest between the athletes and the sedentary subjects. Our data therefore suggest that the resting plasma renin activity is reduced in athletes when compared to sedentary subjects. Training seems however not to alter the resting level of 2,3-diphosphoglycerate in the red blood cells.