An acute form of T gamma lymphoproliferative disease presenting with massive splenomegaly--importance of immunophenotyping for diagnosis.

We describe a case of T gamma lymphoproliferative disease (T gamma LPD) which presented in an uncustomary acute onset in an adult with massive splenomegaly. Morphologically the cells represented monocytic leukemia. Karyotyping and equivocol special stain results suggested hairy cell leukemia. Gene rearrangement indicated a T lymphocytic malignancy. Immunocytochemistry stains were not definitive. Immunophenotyping by flow cytometry defined the cells as consistent with T gamma LPD (CD45+, CD56+, CD2+, CD3+, CD11b+, and CD38+; some cells CD8+; and CD57-). Although the cells did not have spontaneous activity, which is often the situation for most cases of T gamma LPD, the cells could be partially induced with exogenous interleukin 2 to exhibit in vitro cytotoxicity against a natural killer lymphocyte-susceptible target cell line (K562) but not a lymphocyte-activated killer target cell line (HEPG2). This report hopefully continues to increase the awareness of T gamma LPD as well as demonstrates an unusual acute form which could have been misdiagnosed unless a multidisciplinary approach, especially including flow cytometric immunophenotyping, was used to evaluate the patient.

MY4 expression on B-lymphocyte malignancies may be associated with a more adverse prognosis.

We have noted what other preliminary reports have also described as a new specificity of the MY4 monoclonal antibody from Coulter Immunology which previously was designated to only have myelogenous CD14 specificity. The MY4 marker appears to characterize a subpopulation of some B-lymphocytic malignancies that are CD19, CD20, surface immunoglobulin as well as MY4 positive. The results occurred when other myelogenous markers such as CD11b, CD13 and CD33 were unreactive. Another monoclonal antibody marker of CD14 specificity, MO2, did not demonstrate a similar reactivity. Various other monoclonal antibodies of the same IgGI subclass as MY4 were also not reactive and thereby excludes non-specific adsorption as an explanation of the results. The six patients described in this report represented five non-Hodgkin's lymphoma cases and one chronic lymphocytic leukemia case. Fifteen B-lymphocytic leukemias and 30 other B-lymphocytic non-Hodgkin's lymphomas analysed during the same period were not MY4 positive. In reviewing the clinical course of the six patients compared to the general behavior of these types of malignancies and making a speculative generalization from the small group of cases, the MY4 antigen appeared to be expressed by low to intermediate grade B-lymphocytic malignancies of a type that were more rapidly progressive and/or had a greater tendency to undergo a transformation of their malignancy. Two of the three transformed cases were proceeded by chronic lymphocytic leukemia.

Coumarin skin necrosis in a patient with heparin-induced thrombocytopenia--a case report.

A patient with evidence of both heparin-related thrombocytopenia and coumarin-induced skin necrosis is presented. Etiology, diagnostic evaluation, histopathology, and therapeutic options are discussed.

Heparin elimination following continuous infusion during intra-aortic balloon counterpulsation.

The decline of the activated partial thromboplastin time (APTT) following discontinuation of heparin infusion was measured in six intra-aortic balloon pump (IABP) patients. The heparin infusion requirement was determined for eight other IABP patients during stable therapeutic anticoagulation. Following discontinuation of infusion, APTT declined with a relatively constant half-life (t 1/2 of 2.4 +/- 0.08 hr, suggesting elimination by first-order kinetics. In comparison, the t 1/2 following single bolus doses has been shown to be markedly dose dependent, increasing from 30 min at low doses to 2 hr at very high doses. The heparin requirement for IABP patients was found to be 16 +/- 2.5 U/kg/hr, similar to that reported for other clinical situations. The t 1/2 of the APTT following discontinuation of heparin infusion can be used to time invasive procedures that would best be done with normal hemostasis.