Elevation of serum transcobalamin II in patients with scrub typhus.

Serum transcobalamin II levels were measured in scrub typhus patients. Eighteen out of fifty-two patients admitted to Maharat Nakhon Ratchasima Hospital were diagnosed with scrub typhus infection. The serum unsaturated vitamin B12 binding protein (UBBC) and total vitamin B12 binding protein (TBBC) levels in these patients were significantly higher than in normal subjects (p < 0.001). The mean serum transcobalamin II level in the typhus patients was also significantly higher than in the normal subjects (p=0.004). There was a significant correlation between serum TCII levels and typhus IgM or IgG titers (p < 0.05), but not to total IgM levels. These findings indicate that patients with scrub typhus had stimulation of the recticuloendothelial system as a result of a considerable increase in transcobalamin II levels.

Effect of chloroquine on serum vitamin B12 and its binding proteins in patients with plasmodium vivax.

Chloroquine (CQ) is widely used as an antimalarial agent. It is accumulated in the lysosomes of various types of cells and inhibits the intralysosomal degradation of a wide range of proteins. CQ is found to interfere with vitamin B12 transportation in vitro and in the experimental animal. The present study was performed in order to determine such interference in humans receiving CQ. Serum vitamin B12 and vitamin B12 binding proteins were determined in 13 patients with P.vivax, both before and after receiving six tablets and 10 tablets of CQ. There were no significant differences between serum vitamin B12, UBBC, TBBC and TC values in patients before and after taking 6 tablets of CQ. A slight but not significant decrease in serum vitamin B12 and a significant increase in serum TCII were found after taking 10 tablets of CQ. The low serum vitamin B12 could be due to the effect of CQ on prevention of lysosomal degradation of intrinsic factor, leading to the accumulation of IF-B12 in the intestinal mucosa. As CQ also inhibits the intracellular degradation of TCII, therefore, more TCII levels are synthesized and secreted from various organs by the feedback mechanism. All these findings indicated the CQ had some effects on vitamin B12 absorption and transportation. However, these effects were relatively unsevere for the required dose of CQ in the treatment of P.vivax malaria.

Increased circulating levels of transcobalamin II in typhoid fever.

Many previous studies have shown that serum transcobalamin II (TCII) is usually elevated in patients with a stimulated and proliferative reticuloendothelial system resulting from such diseases as multiple myeloma, systemic lupus erythrematosus, dermatomyositis, rheumatoid arthritis and Gaucher’s disease. As reactive macrophage hyperplasia with monocytosis also occurs in patients with typhoid fever, we therefore studied TCII in these patients. The mean value of serum TCII was significantly higher in the typhoid patients’ group, and 15 out of 35 patients had serum TCII values over 2,000 pg/ml. There was no relationship between serum TCII and white blood count, haemoglobin or haematocrit values. The increased serum TCII level in typhoid patients was possibly due to increased synthesis by the proliferative mononuclear cells derived from reticuloendothelial tissue in various organs such as the spleen, liver and mesenteric lymph nodes. This supposition is supported by a previous report that TCII is synthesized in part by mouse peritoneal macrophages, as well as by human monocytes and macrophages which produced and secreted considerable amounts of TCII into the medium. Findings of increased serum TCII in typhoid patients therefore add a new area of information which has never been studied before.

Elevated serum transcobalamin II levels in patients with prolonged fever.

Serum transcobalamin II levels were determined in 70 patients with prolonged fever. Twelve patients were found to have elevated serum TCII levels, i.e., 8 patients with salmonellosis, 3 patients with scrub typhus and 1 patient with pyrexia of unknown origin. There were no relationships between serum TCII levels and white blood cells, lymphocytes or monocytes. The possible mechanism producing increased serum TCIII levels in patients with salmonellosis and scrub typhus is the increased synthesis and release of TCII by the proliferative mononuclear phagocytic cells of the reticuloendothlial tissues such as spleen, liver, bone marrow and lymph nodes. This study gives the additional data that elevated serum TCII may occur not only in inflammatory disorders, autoimmune diseases, lymphoproliferative disorders, malignant histiocytosis and neoplasms, but also in infection with salmonellosis and scrub typhus.

A case with acute myelofibrosis and acute promyelocytic leukemia.

A 65-year-old man was admitted to a provincial hospital repeatedly over a period of years with a history of weakness, tiredness and progressive anemia. One occasion a bone marrow aspiration was found to contain normal marrow elements. On admission four months later, the patient was pale with pitting edema on both legs. His liver was barely palpable and the spleen was palpable 2 cm below the costal margin. He was anemic and peripheral blood showed anisopoikilocytosis, burr cells, ovalocytes and macrocytosis. The platelet level was very low, with some giant cells. The white blood cell count was normal, with some immature granulocytes. Bone marrow biopsy confirmed the diagnosis of acute myelofibrosis. The patient had very high levels of serum vitamin B12 and vitamin B12 binding proteins, especially transcobalamin I. After treatment with blood transfusion and prednisolone, his white cell count increased considerably. He died nine days after admission because of bronchopneumonia. This patient is an example of the simultaneous occurrence of acute myelofibrosis and acute promyelocytic leukemia that can terminate as acute myeloblastic or other stem – cell leukemia.

Excessively high serum vitamin B12 level in patients with a provisional diagnosis of megaloblastic anemia.

High serum vitamin B12 level has been reported in patients with liver diseases ad some hematological disorders. It has been observed that some patients diagnosed as megaloblastic anemia have high serum vitamin B12 with low serum unsaturated vitamin B12 binding capacity (UBBC). The objective of the present study was to investigate in these patients. A retrospective study in 9 patients with a provisional diagnosis of megaloblastic anemia showed extraordinarily high serum vitamin B12 with very low UBBC. Their past history showed that these patients were treated with 1,000 g vitamin B12 intramuscularly 10-24 hours before serum samples were taken for vitamin B12 determination. Study in another 3 patients showed that within 12 hours after a single injection of 1,000 g cyanocobalamin, their serum vitamin B12 raised considerably with an extremely low UBBC level. These findings indicated that the injected vitamin B12 saturated all transcobalamins and then exceeded to bind to other serum proteins such as albumin and gamma globulin. Serum vitamin B12 was maintained at a very high level with a very low unsaturated vitamin B12 binding capacity. Therefore the past history of receiving vitamin B12 must be exactly known in any patients who were taken blood sample for vitamin B12 determination.

Malabsorption syndrome and tropical sprue in a patient with capillaria infection.

A 52-year-old male complained of a four-year history of diarrhea. He had severe diarrhea and lost 10 kg of weight during the previous eight months. Physical examination revealed moderate wasting with mild eodema on both legs. His serum cholesterol, calcium, total protein, albumin, glodium and potassium levels were depressed. Both serum folate and vitamin B12 levels were within the normal limits. A G-I follow through study revealed irregularity of distal jejunum and mid-ileum. Intestinal biopsy showed shortening and widening of ileal villi, and that the submucosa was infiltrated with lymphocytes, eosinophils and plasma cells. Because of these findings coupled with the fact that no ova and parasites were detected in the stool, this patient was diagnosed as a case of tropical sprue. Tetracycline, flagyl and folic acid were given, but there was no clinical improvement. A segmental biopsy of the ileum showed C. philippinensis larvae in the crypts and surface mucosa. Mebendazole was given and the patient improved. Intestinal capillariasis is different from tropical sprue in that its pathology is usually in the jejunum while tropical sprue is in both the jejunum and ileum. Therefore, the serum vitamin B12 level is usually normal in the former while both serum folate and vitamin B12 levels are low in the latter.

Vitamin B12 deficiency in a patient with total gastrectomy.

A 31-year-old female was admitted to the hospital with a history of weight loss, weakness and exertional dyspnoea lasting for three months. Four years prior to admission, she had consumed half a glass of cleaning solution and had been admitted to hospital for a total gastrectomy. Physical examination showed markedly pale, cachexia and generalized muscle wasting. Oedema of both legs and hepatomegaly about 2 FB were noted. No abnormal neurologica,l findings were detected. Her blood picture and bone marrow showed megaloblastic changes. Serum vitamin B12 was low but serum and red-cell folate levels were within normal limits. Vitamin B12 (1 mg) was given intramuscularly and it produced a remarkable improvement in the clinical and haematological findings. The patient was discharged nine days after admission and attended the out-patient clinic where she received 1 mg of vitamin B12 intramuscularly once a month. The patient is now healthy with normal haematological findings, but she still receives vitamin B12 therapy monthly.

Amniotic fluid folate level in normal pregnancy.

Folic acid level was determined in 175 amniotic fluid samples obtained by diagnostic amniocentesis from normal Thai pregnant women aged from 18 to 37 years. The mean value + one standard deviation was found to be 3.01+1.88 ng/ml, ranged from 0.5 ng/ml to 7.9 ng/ml. There were no difference of folic acid in amniotic fluid samples in different groups of gestational ages from 33 to 40 weeks and 1 to 4 gravida. The amniotic fluid folic acid also showed no correlation with the birthweight of the fetus or the foam test. The mechanism of the transfer of folic acid from mother to fetus and the significance of folic acid in the amniotic fluid is discussed in this paper.

Serum cholinesterase and erythrocyte acetylcholinesterase activity in patients with neuroblastoma.

Serum cholinesterase (ChE), red cell acetylcholinesterase (AChE), were determined in 18 neuroblastoma patients ages ranged from 8 months to 4 years. Sixteen patients (89%) were anemic and 15 patients (83%) showed bone marrow invasion and/or liver involvement. Both mean values of serum ChE and red cell AChE activities were significantly lower than those of 80 normal subjects. There was no relationship between red cell AChE and Hb, Ht or white blood cell count. The cause and mechanism of reduced serum ChE and red cell AChE activities in patients with neuroblastoma were possibly due to the invasion of the liver and bone marrow by the tumor cells. Although neuroblastoma cells can synthesize AChE which is inversely regulated by the rate of cell division, determination of serum ChE and red cell AChE could not serve to distinguish neuroblastoma from the other types of human tumour cells.

Superoxide dismutase, catalase and acetylcholinesterase in the red cells of patients with multiple myeloma.

Serum cholinesterase (ChE), red cell acetylcholinesterase (AChE), superoxide dismutase (SOD) and catalase were determined in 12 patients with multiple myeloma. Serum ChE was significantly depressed and bore a derect relationship with serum albumin concentration or Hb level. Red cell AChE was significantly elevated and showed a tendency of a reverse relationship with Hb. There was increased serum uric acid and 25% of the patients had serum uric acid over 9 mg/dl. Both SOD and catalase activities were found to be within normal limits, and showed no relationship with serum uric acid. These finding indicated that hyperuricemia occurs quite commonly in multiple myeloma patients with increased extracellular oxidants released from the degradation of purines to uric acid. However, these toxic oxidants could not overcome the antioxidant capacity of the red cells as indicated by a finding of normal SOD and catalase activities.

Erythrocyte superoxide dismutase and catalase activities in red cell infected with plasmodium vivax.

It has been shown that erythrocytes infected with asexual forms of malarial parasites are more sensitive to oxidant strees than normal red cells. Many studies reported a great alterations of SOD and catalase levels in red cells of subjects infected with different species of plasmodium indication the significant role of oxidant stress in the host defence mechanism against the parasites. In order to study these effects in patients with P.vivax, SOD and catalase activites were determined in red cells of 40 patients in comparison to 40 normal human subjects. Both mean erythrocyte SOD and catalase values in the patient group showed no significant difference from those of the normal group. There was a direct relationship between parasitemia and SOD cativity. AII these findings indicated that P.vivax parasites did not nave any effect on these enzymes of the host erythrocytes. It was therefore possible that the increased susceptibility of P.vivax infected red cells to oxidant damage was not a result of reduced functioning of the SOD and catalase. These findings could also explain the reasons why the symptoms of patients with P.vivax were less severe than those of patients with P.falciparum.

Superoxide dismutase and catalase activities in red cells of patients with malignancy of haematological origin.

Superoxide dismutase (SOD) and catalase activities were determined in 55 patients with acute lymphoblastic leukaemia (ALL), acute megaloblastic leukaemia (AML) and non-Hodgkin lymphoma (NHL) in comparison to 40 healthy normal subjects. Their ages ranged from 2 to 10 years. The mean value of erythrocyte activity in these patients was not significantly different from up for 6 months also showed the tendency of decreased values to be lower than the lower limits of normal values. There was no relationship between SOD activity and Hb, Hct, red cell count in these patients. These findings did not confirm the previous report that erythrocyte SOD activity was significantly higher in patients with CLL, AML, Hodgkin’s disease and lymphosarcoma. No significant difference of erythrocyte catalase activity between the groups of patients and the normal group was demonstrated in the present study.