Assuntos
Epiglotite/etiologia , Infecções Oportunistas/etiologia , Doença Aguda , Clorambucila/efeitos adversos , Ciclofosfamida/efeitos adversos , Humanos , Hospedeiro Imunocomprometido , Leucemia Linfocítica Crônica de Células B/complicações , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/complicaçõesRESUMO
Conventional doses of intravenous immunoglobulin (i.v. Ig) (0.4 g/kg/day for 5 days) commonly produce a remission in immune thrombocytopenia (ITP) but have only rarely been successful in autoimmune haemolytic anaemia (AIHA). There are a few reports of higher doses of i.v. Ig being more effective in AIHA. We have treated two patients with AIHA with high-dose i.v. Ig (0.5 g/kg/day for 5 days). In one patient with an associated ITP a prompt rise in platelet count but no change in Hb concentration occurred. The second patient with AIHA associated with chronic lymphatic leukaemia showed a prompt response, with a rise in Hb concentration and fall in plasma bilirubin. The poor response to i.v. Ig seen in AIHA may be related to the expansion of the reticulo-endothelial system seen in AIHA but not ITP. Clearance of antibody-coated red cells and platelets may occur at different rates and/or sites in the reticulo-endothelial system and this may account for the differential response seen in case 1. Higher doses of i.v. Ig, in the range 0.5-1 g/kg/day for 5 days, are required in AIHA, particularly if significant splenomegaly is present, and may be effective in refractory cases.
Assuntos
Anemia Hemolítica Autoimune/terapia , Imunoglobulinas/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Relação Dose-Resposta Imunológica , Hemoglobinas/análise , Humanos , Imunização Passiva , Injeções Intravenosas , Leucemia Linfocítica Crônica de Células B/complicações , Masculino , Contagem de Plaquetas , Trombocitopenia/complicaçõesRESUMO
Surface receptors on peripheral blood lymphocytes have been studied in 43 cases with chronic lymphocytic leukaemia (CLL), and five cases with lymphoma and overspill. One quarter of the cases with CLL had lymphocytes with no detectable surface immunoglobulin (SIg) by direct fluorescent antibody staining. The remainder had SIgM, which was associated with SIgD in one third of the cases. 70% of the SIg negative group had extensive extramedullary involvement (EMI) compared with 35% of the SIg positive group at presentation; correspondingly more of the SIg negative group were treated. 46% of the SIg negative group were CLL patients of more than 3 years standing compared with 9% of the SIgM+D group and 32% of the SIgM group. Some explanations for this pattern are discussed.
Assuntos
Linfócitos B/imunologia , Leucemia Linfoide/imunologia , Receptores de Antígenos de Linfócitos B , Idoso , Sítios de Ligação de Anticorpos , Feminino , Humanos , Imunoglobulina D/análise , Imunoglobulina M/análise , Linfoma/imunologia , Masculino , Pessoa de Meia-Idade , Receptores de Antígenos de Linfócitos B/análiseRESUMO
Methods of quality control of some major haematological techniques are described. These methods have been applied in haematology laboratories serving a population of 2 million using existing facilities for preparation and transport of the necessary materials.
