The occurrence of an auto-immune hemolytic anemia with anti-U specificity in a patient with myelodysplastic syndrome.

A 73-year-old man with myelodysplastic syndrome developed during the course of his illness auto-immune hemolytic anemia. The association between auto-immune hemolysis and myeloproliferative disease is extremely rare. An even more unique finding is the nature of the antibody which demonstrated single specificity against the U antigen.

Malignant histiocytosis simulating granulomatous disease.

In its clinical presentation, malignant histiocytosis may mimic infections or hematologic neoplasms, and pathologically it may be mistaken for Hodgkin's disease, histiocytic lymphoma, or viral lymphadenitis. The case histories of three patients in whom malignant histiocytosis clinically and pathologically simulated granulomatous diseases are reported. Erythrophagocytosis was not present in the initial bone marrow aspirates from two of the patients. One patient was considered to hve sarcoidosis or Wegener's granulomatosis; the second patient, Weber-Christian disease, and the third patient, a granulomatous disease of infectious origin. Granulomas have been found in tissues of patients who have Hodgkin's disease, but have been found only rarely in association with malignant histocytosis. An explanation for the presence of granulomas in association with malignant histiocytosis is offered: they may represent a phase in the evolution of the disease.

T and B lymphocytes in pregnant women.

The peripheral blood of 27 women in their third trimester of pregnancy and of 16 control subjects was studied for total WBC counts and total numbers and percentages of T and B lymphocytes, including quantitation of the major immunoglobulin subtypes of the B lymphocytes. Although significant differences were found for percentages of total lymphocytes, T Lymphocytes, and B lymphocytes, the absolute numbers varied only slightly between the 2 study groups. A higher percentage and a higher absolute number of IgG-bearing B lymphocytes were found among pregnant women than among controls. It is concluded that significant quantitative alterations in circulating T and B lymphocytes do not occur in the third trimester of pregnancy; therefore, the concept of impaired cellular immunity, which has often been suggested to occur in this setting, is not supported. A review of the literature on T and B lymphocytes in human pregnancy is presented.

Idiopathic thrombocytopenic purpura in the elderly.

Idiopathic thrombocytopenic purpura (ITP) was diagnosed in 22 patients above the age of 50 during a seven-year period. There was no female preponderance. Steroid therapy was effective, particularly in preventing hemorrhage and is considered to be the treatment of choice. Splenectomy may be less beneficial than in younger patients with ITP. Complications of the disease and its treatment are minimal.

Association of breast cancer with myeloproliferative disorders.

Three cases of myeloproliferative disorders in patients with breast cancer are described. The first patient developed acute myeloblastic leukemia 26 years after her initial breast cancer; the second patient developed chronic myelogenous leukemia three years after the diagnosis of breast cancer; the third patient had polycythemia vera for nine years before cancer of the breast was noted. The literature dealing with the association of cancer and myeloproliferative disorders is reviewed. Possible explanations for this association are considered.

Autoimmune hemolytic anemia associated with ulcerative colitis.

Three patients are reported in whom autoimmune hemolytic anemia developed during the course of ulcerative colitis. A review of the literature yielded 11 additional cases, and the clinical, immunologic, and therapeutic characteristics are summarized. The results of steroid therapy and splenectomy are similar to those for idiopathic autoimmune hemolytic anemia. The cause and effect relationship between these two diseases is not clear, but colectomy appears to produce remission in hemolysis when the latter is refractory to both steroids and splenectomy.

Acute coagulopathy following infusion of prothrombin complex concentrate.

An acute coagulopathy developed in a 49 year old woman with severe liver disease after she received an infusion of prothrombin complex concentrate. The concentrate used in the infusion was subsequently studied by observing the effect of the concentrate on the partial thromboplastin times of various plasmas. The evidence suggests that activated coagulation factors, including activated factor X, were present in the concentrate, and probably played a role in initiating the acute change in the patient's coagulation status. Mechanisms whereby liver disease predisposes toward the development of such a coagulopathy are discussed. It would appear that prothrombin complex concentrates should be used in patients with liver disease only with utmost caution.

"B" cell origin of malignant cells in a case of American Burkitt's lymphoma. Characterization of cells from a pleural effusion.

Ninety-eight percent of the cells isolated from a malignant pleural effusion in a case of American Burkitt's lymphoma showed membrane fluorescence to antihuman IgM antisera, while only 2% of the cells formed spontaneous rosettes with sheep red blood cells. It is concluded that the Burkitt cells in the malignant effusion are derived from bursal equivalent lymphocytes. Epstein-Barr (E-B) viral titers to both viral capsule antigen and early antigen were not elevated. The significance of these findings is discussed.

Malignant histiocytosis in a patient presenting with leukocytosis, eosinophilia, and lymph node granuloma.

A patient with malignant histiocytosis presented with a number of unusual features including fever, leukemoid reaction, and eosinophilia. Other confusing findings included lymph node biopsies which showed reactive changes, noncaseating granuloma, and atypical Reed-Sternberg cells. These features are compared with cases appearing in the literature. The course was rapidly progressive despite combination chemotherapy.

Nitroblue tetrazolium reduction test in pregnancy.

The use of the nitroblue tetrozolium (NRT) dye reduction test as a screening method for bacterial and fungal infections is now widely recognized. Levels have been reported to be falsely elevated in the pregnant state. This report includes a prospective study which showed that the results of this test in 124 pregnant women were indistinguishable from those of a normal control population. Seven of 8 elevated levels were attributable to infection or allergy. With this data, it is concluded that the NBT test can be used to screen for bacterial and fungal illnesses in a febrile pregnant patient as well as in the general population.