A capillary whole blood method for measuring the INR.

This study describes a method of measuring the INR on native whole blood capillary samples using Innovin recombinant thromboplastin. Modification of the reagent was necessary to compensate for the nonoptimal level of calcium in the sample/reagent mixture. Ninety-five percent of results obtained by the capillary blood method were no more than 0.42 INR higher or 0.38 INR lower than the venous blood method. The effect of changes in haematocrit was minimal. Significant differences in results were found between the Innovin and Thrombotest capillary blood methods. Provided the reagent was properly stored, there was no reagent drift and satisfactory results were obtained on samples supplied by UKNEQAS (coagulation) from previous trials. The method described is a convenient, simple and accurate method of measuring the INR using native capillary whole blood and Innovin recombinant thromboplastin.

Transmission of human parvovirus B19 by coagulation factor concentrates.

The prevalence of antibody to human parvovirus B19 was determined in 86 children with congenital bleeding disorders. Forty-seven of 53 boys (89%) receiving non-heat-treated factor VIII or prothrombin complex concentrates were anti-B19 IgG positive compared with 38% of their age-matched controls and 48% of children treated with cryoprecipitate. Acute B19 virus infection occurred in 2 boys 3-4 weeks after they had received the same batch of commercial factor VIII concentrate. Of 11 susceptible children who had only received heat-treated National Health Service factor VIII concentrate (8Y), 1 acquired anti-B19 IgG. This suggests that 8Y heat-treated concentrate has a much reduced risk of transmitting B19 virus and, by implication, other less heat-stable viruses such as human immunodeficiency virus.

Distribution of leukemia, lymphoma, and allied disease in parts of Great Britain: analysis by administrative districts and simulations of adjacencies. Leukaemia Research Fund 1984 Data Collection Group.

An analysis is presented of the distribution of cases of leukemia and allied disorders occurring in 151 administrative districts from England, Wales, and Scotland during 1984. The age-adjusted rates for certain conditions present an unusual pattern highlighting excessively high and low rates in parts of the country, some of which share contiguous boundaries. In particular, high rates for non-Hodgkin's lymphoma are found in rural Yorkshire districts, whereas leukemias and primary polycythemias are much more common in the Midland districts.

Unusually high incidence of tuberculosis among boys with haemophilia during an outbreak of the disease in hospital.

Of 30 children with bleeding disorders exposed to an index tuberculosis case, six developed primary pulmonary tuberculosis and two others became positive skin reactors. There was a significant correlation between the amount of replacement treatment received and the development of evidence of tuberculous infection. Only two of those who developed evidence of tuberculosis had antibodies to the human T cell lymphotropic virus. These two boys showed much later Mantoux positive conversion than the six others.

Lymphocyte subset ratios and factor VIII usage in haemophilia.

Type and quantity of replacement treatment, together with haematological and immunological parameters were determined in 37 boys with severe haemophilia A and 41 children with other bleeding disorders. The quantity of factor VIII concentrate given to boys with severe haemophilia A (mean U/year) showed a significant inverse correlation with total white cell counts, lymphocyte counts, platelet counts, and the ratio of monoclonal antibody defined T lymphocyte subsets, T4 and T8 (T4:T8). Of the boys with severe haemophilia A, 49% had inversed T4:T8 ratios and 24% had thrombocytopenia. Treatment with high dose factor VIII concentrate (more than 25 000 U/year) was associated with low platelet counts, low lymphocyte counts, low T4:T8 ratios, and hypergammaglobulinaemia. In addition, six patients with severe haemophilia A and factor VIII inhibitors had inversed T4:T8 ratios. Patients treated exclusively with cryoprecipitate or prothrombin complex concentrates had normal T4:T8 ratios and platelet counts. The severity of the haematological and immunological abnormalities observed seems to be associated with high usage of factor VIII concentrates. Similar abnormalities have been described in patients with the acquired immune deficiency syndrome (AIDS). Prospective study of haemophiliacs is required to assess long term sequelae of factor concentrate usage, including the possible development of AIDS.

Simultaneous inheritance and expression of classical haemophilia A and type IIA von Willebrand's disease.

A family is described in which the mother is a haemophilia carrier, the father has asymptomatic type IIA von Willebrand's disease, and their second son has simultaneously inherited both severe haemophilia and type IIA von Willebrand's disease. This is the first report of both diseases occurring simultaneously. The inheritance patterns and laboratory data on the family are presented and discussed.

Quantitative cytochemistry of the toxic granulation blood neutrophil.

A quantitative cytochemical study has been made, using scanning-integrating microdensitometry, of 1000 toxic granulation blood neutrophils from 20 infected patients, in comparison with 1250 normal blood neutrophils. Myeloid precursor cells in 10 normal marrows were also studied. Normal bone marrow granulocyte maturation was associated with a progressive decrease in azurophilic granule enzymes (myeloperoxidase, beta-glucuronidase, acid phosphatase, chloroacetate esterase), and also Alcian blue staining from acid mucosubstance, but an increase in the specific granule marker lactoferrin. Toxic granulation blood neutrophils showed minor changes in the enzyme content of their azurophilic and specific granules, consistent with cell immaturity, and an increase in acid mucosubstance in azurophilic granules. Abnormal maturation of azurophilic granules, with persistence of acid mucosubstance, is the likely explanation for the intense Romanowsky dye staining of the toxic granulation neutrophil.