Molecular markers of the endothelium, the coagulation and the fibrinolytic systems in healthy newborns.

Endothelium derived substances may play a role in the physiological adaptation processes at the time of birth. The aim of this study was to investigate plasma concentrations of activation markers of the endothelium (endothelin-1, thrombomodulin, von Willebrand factor), of the coagulation and the fibrinolytic systems (thrombin-antithrombin III complex, D-dimer, plasmin-alpha2-antiplasmin complex) during the first days of life. Venous blood from peripheral veins was collected from 79 healthy newborns and for comparison from 38 healthy infants and schoolchildren, as well as from 17 healthy adults. Except for endothelin and von Willebrand factor, the concentrations of activation markers were significantly higher in the newborn group. During the first 12 days of life thrombomodulin, thrombin-antithrombin III complex, and plasmin-alpha2-antiplasmin complexes showed a continuous decline whereas the concentrations of endothelin, von Willebrand factor and D-dimer did not change. The highest D-dimer concentrations were found at low umbilical arterial pH and after birth by vaginal operation suggesting an influence of birth stress. Thrombomodulin was correlated with endothelin (r=+0.471) and with von Willebrand factor (r=-0.415). In conclusion, endothelial, coagulation, and fibrinolytic systems are activated in newborns which might occur during birth by the mechanical stress, the adaptation of circulation, and the short-term hypoxic state. An additional intrauterine activation should also be considered.

[Acute leukemia after aplastic anemia in childhood]. / Akute Leukämien nach aplastischen Anämien im Kindesalter.

Only few reports about ALL after aplastic anaemias in childhood exist. It remains still unclear which immunophenotypes of the leukaemias must be expected thereafter. Here it is reported about two children with quite different immunophenotypes of the leukaemic cells. In the first one the most common type was found, the constellation of a c-ALL, whereas in the other the precise classification was impossible at all. Myeloic and T-cell markers were present at the same time. This form of leukaemia was not influenced therapeutically in a sufficient manner. The patient died after recovery phases of only short duration. After aplastic anaemias with fast recovery by prednisolone ALL of different constellation has to be expected. Therefore the antileukaemic treatment immediately after recovery of the aplastic anaemia should be taken into consideration.