Subject(s)
Embolization, Therapeutic , Spleen , Thalassemia/therapy , Adolescent , Adult , Blood Cell Count , Blood Transfusion , Child , Ferritins/blood , Humans , Iron/metabolism , Iron/urineABSTRACT
Patients with thalassemia who receive multiple blood transfusions are at risk for the acquired immunodeficiency syndrome. Peripheral blood lymphocyte subpopulations were studied in 22 multitransfused thalassemic patients; 10 patients were without splenectomy and 12 were studied after splenectomy. Both groups were negative for anti-HIV. Four additional patients who were found positive for anti-HIV and ten healthy controls were also included in this study. Patients without splenectomy compared to controls and to patients after splenectomy showed a significant decrease of both percentage (p less than 0.001) and absolute numbers (p less than 0.001) of Leu-7+ cells without significant abnormalities of T4/T8 ratio (1.56 +/- 0.4). Patients after splenectomy compared to controls and to patients without splenectomy showed a significant increase of the absolute numbers of lymphocytes and lymphocytes subsets T11+, T3+, T4+, T8+ and SmIg+ cells. In the seropositive patients for HIV only a significant increase of the absolute number of T8+ cells was observed while the T4/T8 ratio was 1.24 +/- 0.73. The decrease in the percentage of Leu-7+ cells in patients without splenectomy correlated inversely to the total amount of blood transfused. In conclusion patients with thalassemia had normal T4/T8 ratio and did not show the abnormal immunologic profile that has been reported in haemophiliacs.
Subject(s)
Antibodies, Viral/analysis , Thalassemia/immunology , Adolescent , Adult , Antigens, Differentiation, T-Lymphocyte , Antigens, Surface/immunology , Blood Transfusion , Child , Female , Greece , HIV Antibodies , Hemophilia A/immunology , Humans , Immunoglobulin G/analysis , Killer Cells, Natural/immunology , Male , Monocytes/immunology , T-Lymphocytes/classificationABSTRACT
Six patients with thalassaemia major were treated by partial splenic embolisation as an alternative to splenectomy and followed up for five years. Results were compared with those in a matched control group of seven patients treated by splenectomy. All patients treated by partial splenic embolisation showed a reduction in blood transfusion requirements comparable with those in the controls and which remained unchanged over the five years. Serious infections that commonly occur in patients splenectomised for thalassaemia did not occur after embolisation, presumably owing to preservation of some immune function by the splenic remnant. By contrast with the change in platelet counts seen after splenectomy, platelet counts remained normal after partial splenic embolisation, so reducing the risk of thromboses. On the other hand, pre-existing leucopenia and thrombocytopenia were corrected after embolisation. It is concluded that partial splenic embolisation provides an alternative to splenectomy for thalassaemia major and is equally effective and much safer.
Subject(s)
Embolization, Therapeutic , Hypersplenism/therapy , Thalassemia/therapy , Adolescent , Adult , Child , Female , Ferritins/blood , Follow-Up Studies , Humans , Hypersplenism/etiology , Immunoglobulin A/analysis , Immunoglobulin G/analysis , Leukocyte Count , Male , Platelet Count , Thalassemia/blood , Thalassemia/complicationsABSTRACT
The glycemic and insulin response to an oral glucose load was studied in 17 children with acute lymphoblastic leukemia (ALL) and 13 normal controls. The patients were randomly assigned to either group A, receiving prednisone and vincristine, or group B, receiving these agents and, in addition, L-asparaginase from days 9-19 of the study. The glucose load was performed prior to (phase I), and on days 8 (phase II), and 19 (phase III) of chemotherapy. The mean glycemic response in both groups of patients was significantly higher than in controls at diagnosis and prior to any treatment, while mean insulin levels were not significantly different from controls. One week after initiation of treatment, the mean glycemic response improved, and was associated with hyperinsulinism. After the second week of treatment, the mean glucose and insulin response curves in group A were similar to controls. In group B, while insulin values returned to normal, blood glucose levels remained higher than in controls, but not significantly so. These findings suggest that: 1) The leukemic process itself, through mechanisms as yet undetermined, causes impairment of glucose tolerance, and 2) the diabetogenic effect of L-asparaginase is not manifested in all patients.
Subject(s)
Asparaginase/adverse effects , Hyperglycemia/chemically induced , Leukemia, Lymphoid/drug therapy , Adolescent , Asparaginase/administration & dosage , Blood Glucose/metabolism , Child , Child, Preschool , Drug Therapy, Combination , Female , Glucose Tolerance Test , Humans , Insulin/metabolism , Leukemia, Lymphoid/metabolism , Male , Prednisone/administration & dosage , Random Allocation , Vincristine/administration & dosageABSTRACT
Six patients with beta-thalassemia major underwent partial splenic embolization as an alternative to splenectomy. One patient required 2 embolizations. All 6 patients showed a marked reduction in transfusion requirements. Transfusion requirements fell to a level within that reported by other authors following total splenectomy, although significantly above that of a group of patients from the same institution who underwent total splenectomy. It is felt that this procedure provides an acceptable alternative to splenectomy in these patients with the possible preservation of some splenic immune function.
