[Rinshō ketsueki] The Japanese journal of clinical hematology
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A patient with chronic idiopathic thrombocytopenic purpura (ITP), who had a transient increase in platelet count during infectious episodes, and had a transient remission of thrombocytopenia with administration of high-dose intravenous gammaglobulin during intercurrent pneumonia was described. A 64-year-old Japanese woman with a 12-year history of chronic ITP was refractory to steroids and azathioprine, and the platelet count was constantly less than 10 x 10(9)/l. During both acute upper respiratory infections and chronic cystitis due to E. coli, the platelet count transiently increased to more than 40 x 10(9)/l. ⋯ The bleeding tendency disappeared and transient remission of ITP was obtained. In contrast, the clinical efficacy of high-dose intravenous gammaglobulin proved to be only transient and slight, when administered before the onset of pneumonia or after recovery from pneumonia. These phenomena may suggest that high-dose gammaglobulin may enhance some positive mechanisms related to platelet increment in infectious diseases accompanied with chronic ITP.
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A 46-year-old woman with acute promyelocytic leukemia (APL) was treated with all-trans retinoic acid (ATRA) and chemotherapy according to the AML-92, M3 regimen of the Japan Adult Leukemia Study Group (JALSG). Between days 7 and 18 of therapy, she suffered chest discomfort, fever, cough, dyspnea and general fatigue. A chest roentogenogram showed bilateral interstitial infiltrates. ⋯ Her symptoms promptly abated. Therapy with ATRA was continued and her leukocyte count reached 44,800/microliters on day 19 of therapy. She achieved complete remission on day 48.
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Clonality analysis, by means of polymorphisms of X-linked genes and their methylation patterns, was performed in 41 female patients with various types of refractory anemia. Bone marrow cells, peripheral blood cells, and granulocytic and lymphocytic fractions were analysed by Southern blotting with PGK, HPRT, and M27 beta probes. ⋯ For aplastic anemia, clonal hematopoiesis was demonstrated in higher frequency in the patients who had longer history after diagnosis. In refractory anemia, as a whole, no clear correlation was observed between existence of clonal hematopoiesis and morphological characteristics of hematological cells.
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Case Reports
[Two cases of acute promyelocytic leukemia in pregnancy and the effect of anthracyclines on fetal development].
Two patients with acute promyelocytic leukemia (APL) in 2nd and 3rd trimester of pregnancy are reported on. Case 1: 38-year-old female consulted our hospital because of bleeding tendency and pancytopenia in April, 1988. She was diagnosed as having APL with disseminated intravascular coagulopathy (DIC) and was found to be in the 14th week of gestation. ⋯ Both cases developed APL accompanied by DIC during pregnancy and were treated with a similar regimen including high dose of anthracyclines. Case 2 treated in the late period of gestation delivered a normal infant, while fetal death resulted in case 1, treated in the early period of gestation. We reviewed the literature regarding chemotherapy using anthracyclines during pregnancy.
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Case Reports
[Superior sagittal sinus thrombosis following L-asparaginase therapy of acute lymphoblastic leukemia].
A 48-year-old female received serial combination chemotherapy including L-asparaginase (L-ASP) for acute lymphoblastic leukemia. After administration of L-ASP, the prothrombin time and activated partial thromboplastin time were prolonged, while fibrinogen and antithrombin III levels markedly decreased, so she was given fresh frozen plasma (FFP). But subsequently, she developed cerebral infarction in the left parietal region and further hemorrhagic infarction in the right parietal region, and died. ⋯ Fibrin-fibrinogen degradation products (FDP) slightly increased. However there were no significant abnormalities in the platelet count, nor soluble fibrin monomer, which suggested no evidence of disseminated intravascular coagulation. Thus, these findings suggest that L-ASP might be associated with the pathogenesis of thrombosis in this case.