European journal of haematology
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Complications concerning the blood coagulation have been observed repeatedly after administration of highly substituted, high molecular weight hydroxyethyl starch (HES), but it has not been examined as to how intravascular molecular weight and degree of substitution of HES influence platelet number and volume after repeated administration. Thirty patients with cerebrovascular diseases were treated for 10 days with hemodilution. 500 to 1500 ml of HES 200/0.62(n=10), HES 200/0.5(n=10) or HES 40/0.5(n=10) were infused daily. During the first days, the number of platelets was not lowered beyond the dilution effect, but at the end of the therapy the number of platelets had increased in all 3 groups beyond the initial value. ⋯ A possible explanation could be that HES macromolecules are attached to platelets or are phagocytized by them. The larger platelets are then broken down and, to compensate the loss, more thrombocytes are released. A correlation between the molecular weight of HES and the breakdown rate of the platelets can be suspected, because HES 200/0.62 has the highest intravascular mean molecular weight(121 kD) and the largest effect on platelet volume.
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Thrombocytopenia is one of the most common laboratory manifestations of disseminated intravascular coagulation (DIC). To investigate whether thrombocytopenia in DIC is indeed due to platelet consumption, we measured the plasma levels of glycocalicin, a proteolytic fragment of the platelet membrane glycoprotein (GP) Ib alpha, a component of the GPIb/IX complex, in patients with solid tumors either with DIC(n=18) or without DIC (n=18). ⋯ These findings suggest that, in patients with DIC, thrombocytopenia is not always due to increased platelet consumption, but it may be due to decreased production of platelets. Determination of plasma glycocalicin concentrations is an easy way to identify thrombocytopenia, due to bone marrow insufficiency in these patients.
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Glycosylated hemoglobin (GH), hemoglobin (Hb), hematocrit, LDH and serum bilirubin were measured pre-operatively, and 1-10 days and 11-42 d post-operatively in 42 patients undergoing cardiac surgery. Their mean age was 39.90 years, ranging from 4 to 68 yr. In the early post-operation days, Hb and hematocrit, but not GH percentage, were significantly decreased. ⋯ This indicates the presence of chronic hemolysis with bone marrow compensation. In our study, the incidence of chronic mild hemolysis after cardiac surgery was very high (68.8%). We conclude that GH determination is a simple, easy and sensitive method to detect chronic hemolysis and we suggest measuring it in every case with suspicion of hemolysis.
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We studied the clinical efficacy and safety of the antifibrinolytic drug tranexamic acid (TA) in patients undergoing chemotherapy for acute leukemia. 54 newley diagnosed AML patients were treated with 1 g of TA every 6 hours until the platelet count rose to above 20 x 10(9)/l. Platelet transfusions were given, irrespective of the count, only when oral, mucosal or significant skin bleeding manifestations were observed. During induction, the average number of days with thrombocytopenia below 20 x 10(9)/l was 14.4 +/- 7.4 and 4.6 +/- 4.1 transfusions were given in each course. ⋯ TA was tolerated very well and no side effects or thromboembolic complications were observed. Only in 6 of the 78 induction courses did a major bleeding event occur and there were none in any of the 53 consolidation courses. Thus it seems that TA therapy allowed a significant reduction in the use of platelet transfusions without submitting the patients to greater bleeding risks.
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Comparative Study
Comparison of bone marrow histology in early chronic granulocytic leukemia and in leukemoid reaction.
A retrospective study was performed on bone marrow biopsies of 50 untreated patients with leukemoid reactions (LR) and 50 untreated patients with early chronic granulocytic leukemia (CGL). A comparison was made between hematopoietic and adipose tissues, bone and its cells, as well as other stromal components in these two disorders. ⋯ No significant differences between LR and CGL were detected in the quantity of erythro- and granulocytopoiesis and of megakaryocytes, but these were smaller in CGL than in LR. This histologic and histomorphometric evaluation demonstrates that certain histologic features may serve as valuable aids in distinguishing LR from CGL.