Comparison of the efficacy of D-dimer, fibrin degradation products and prothrombin fragment 1+2 in clinically suspected deep venous thrombosis.

The diagnostic efficacy of D-dimer, fibrin degradation products (FbDP) and prothrombin fragment 1+2 (F1+2) in patients with clinically suspected deep venous thrombosis (DVT) was investigated. 161 patients suspected of DVT were investigated. The diagnosis DVT was made in 58 patients using isotope leg scanning and ultrasonic duplex scanning. In all patients D-dimer, FbDP and F1+2 levels were determined using a latex method for D-dimer and enzyme-linked immunosorbent assays (EIA) for FbDP and F1+2. For the D-dimer latex assay sensitivity was 69% and specificity 92% (cut-off level 500 ng/ml). For the FbDP assay sensitivity was 100% and specificity 8% (cut-off level 250 ng/ml). For the F1+2 assay sensitivity was 100% and specificity 17% (cut-off level 0.3 nM). Specificity could not be improved by the combination of FbDP and F1+2. We conclude that in our population the use of the latex D-dimer assay, FbDP and F1+2 EIA's have no value as screening tests to rule out the diagnosis DVT in clinically suspected patients.

Erythrocyte apheresis as a method for autologous blood transfusion--a case study in a patient with Vel-antibodies.

A 60-year old man was suffering from angina and a percutaneous transluminal coronary angioplasty (PTCA) had to be done. In the preoperative screening procedure antibodies anti-Vel were identified. The patients blood group is 0, rr. The prevalence of the blood group 0, rr, Vel(-) is 1:60,000. Compatible blood groups were not found in the patients family. The only alternative method to give this patient his necessary units of blood was an autologous transfusion procedure, however, because of the patients clinical condition it was necessary to use an erythrocyte apheresis procedure without changing his blood volume. We performed erythrocyte apheresis, using the Fenwal CS-3000. 920 ml blood was collected, Ht 0.67 l/l, enough for three units packed cells compared with random donor blood. The erythrocyte apheresis procedure was performed without any problem. The PTCA was done without complications and transfusions. The units of blood are stored in liquid nitrogen in the central laboratory of blood transfusion, Amsterdam.

Five-year survival in Hodgkin's disease. The prospective value of immune status at diagnosis.

Immune status was measured in 47 previously untreated patients with Hodgkin's disease. For all patients, a 5-year follow-up was established. Immunologic capacity was measured by delayed-type hypersensitivity tests to common recall-antigens; enumeration of T- and B-lymphocytes in the peripheral blood; in vitro lymphocyte responsiveness to mitogens, antigens, and allogeneic lymphocytes; and serum levels of immunoglobulins. Compared with healthy controls, skin reactivity was decreased in the patients (P less than 0.05), but was not a prognostic marker with regard to survival. Total lymphocyte counts and the numbers of T- and B-cells did not differ between surviving and deceased patients. Decreased in vitro lymphocyte responsiveness to phytohemagglutinin and impaired responding capacity of patients lymphocytes in the mixed lymphocyte culture (MLC), used as markers, were a poor prognostic sign (P less than 0.001). The relevant clinical parameters with regard to 5-year survival were age, stage, and B symptomatology (P less than 0.005). The prognostic information supplied by age plus responding capacity in the MLC exceeded the predictive value of any combination of clinical parameters. Lymphocyte stimulation to pokeweed mitogen and antigens, stimulatory capacity of patients' lymphocytes in mixed lymphocyte cultures, the spontaneous DNA-synthesis, and immunoglobulin levels, did not provide prognostic information. The use of mixed lymphocyte cultures in staging patients with Hodgkin's disease may refine the prognostic information supplied by age, stage, and symptomatology.

A prospective study of the changes in immune status following radiotherapy for Hodgkin's disease.

In a prospective study, immune status was measured in 23 previously untreated patients with Hodgkin's disease Stage I-IIIA. Assessments of immunologic capacity were performed at diagnosis and repeated after staging laparotomy and after radiotherapy. The immune status was measured using delayed-type hypersensitivity tests to common recall antigens, the number of T- and B-lymphocytes in the peripheral blood, in vitro lymphocyte responsiveness to mitogens, antigens, and allogeneic lymphocytes, and serum levels of immunoglobulins. Skin reactivity was not significantly affected by either the staging laparotomy with splenectomy or the radiotherapy. Absolute T-lymphocyte count increased after splenectomy (P less than 0.025) and decreased after radiotherapy (P less than 0.005 compared to postsplenectomy values). In vitro lymphocyte responsiveness after splenectomy was comparable to the initial presenting level and diminished after radiotherapy (P less than 0.005). Serum levels of IgM were lowered after radiotherapy (P less than 0.05) while the fall was not significant after splenectomy. Three months after radiotherapy, lowest mean T-cells percentages were noted, but the responses to mitogens were significantly higher than those obtained immediately after treatment (P less than 0.01). While the reduction in the proportion of the T-lymphocytes persisted for 18 months, the mean lymphocyte responsiveness to mitogens, antigens, and allogeneic lymphocytes increased on follow-up. Apart from a severe impairment of the immune status following radiotherapy, this study also shows the existence of significant repair mechanisms during the follow-up period.

A prospective study of the changes in the immune status before, during, and after multiple-agent chemotherapy for Hodgkin's disease.

In a prospective study, immune status was measured in 20 previously untreated patients with Stage III and IV Hodgkin's disease. Assessments of immunologic capacity were performed at diagnosis and repeated after eventual staging laparotomy and after multiple-agent chemotherapy. The immune status was measured using delayed-type hypersensitivity tests to common recall-antigens and in vitro lymphocyte responsiveness to mitogens, antigens, and allogeneic lymphocytes. Immunoglobulin levels were determined on each point of assessment. In untreated patients, the disturbances in the cell-mediated immunity had no predictive value with respect to the chance to achieve a complete remission. During chemotherapy the mean value of the unstimulated culture in responders increased, whereas it decreased in nonresponders (P less than 0.05 between both groups). After treatment, the proliferative capacity of lymphocytes in vitro was severely affected, while the reactivity to skin tests improved. Chemotherapy also reduced the IgM level, irrespective of the performance of splenectomy. Thirteen patients achieved a complete remission after chemotherapy. In this group, measurements of immunologic capacity were continued. The patients showing a relapse did so despite gradual improvement of delayed-type hypersensitivity and the lymphocyte responsiveness to phytohemagglutinin in vitro.