The determination of plasma transferrin receptor as good index of erythropoietic activity in renal anemia and after renal transplantation.

Both the plasma determinations of erythropoietic (EPO) and transferrin receptor (TfR) would provide a good characterization of anemia especially when mixed erythron disorders underlie, such as in renal failure. Immunologic assays of EPO and TfR, as well as standard hematologic determinations (hematocrit, reticulocyte count, serum iron, transferrin, ferritin) were performed in patients with chronic renal failure (CRF), in regular dialysis treatment (RDT) and in transplanted (TX) patients. In nonanemic TX patients both EPO and TfR ranged normally, whereas in anemic TX ones (Hct < 40%) both values were increased suggesting the physiologic response both of the kidney and of the erythron to decreased red cell mass. In transitory posttransplant erythrocytosis the increased values of TfR, with normal EPO values, would hypothesize a defective feedback to EPO release. Both EPO and TfR values were found increased in TX patients with adult polycystic kidney disease with persistent erythrocytosis (Hct > 50%), thus confirming previous observations. In CRF and RDT patients, all anemic, both EPO and TfR were normal, even though significantly low with respect to the degree of anemia. In RDT seriously anemic patients, the administration of recombinant human EPO induced different patterns of bone marrow response. We conclude that the determination of TfR would provide further information on renal anemia since the receptor increase mostly preceded the rise of Hct, evidencing those patients who will not have an effective bone marrow response to the therapy.

Haematological profile in cancer patients: analysis of circadian pattern.

This study was intended to evaluate whether unusual circadian patterns in blood cells exist in cancer patients. Ten patients (five men and five women) suffering from advanced malignancy were compared with a control group of apparently healthy volunteers, of comparable age and sex. After synchronization of daily activities, meals and rest of the two groups, blood samples were taken four times (at 8.00 a.m., 12.00 a.m., 4.00 p.m. and 8.00 p.m.) in a single day. The total red and white cell counts, haemoglobin, platelet count, and neutrophil, lymphocyte, eosinophil, monocyte and basophil differential white cell counts were analysed by both conventional (Student's t-test; multifactorial analysis of variance) and inferential statistics (single and mean cosinor). The average values for platelets (P = 0.04), white blood cells (P = 0.004) and lymphocytes (P << 0.001) showed significant changes with time, independently of disease state. Cosinor analysis indicated a circadian rhythmicity for haemoglobin (P = 0.02), eosinophils (P = 0.014), and lymphocytes (P = 0.001) in healthy subjects, and for eosinophils only (P = 0.024) in cancer patients.