RESUMEN
Environmental chemicals are increasingly incriminated in the pathogenesis of several disease states. The eosinophilia-myalgia syndrome is a recently described entity attributed to the ingestion of the normal dietary amino acid L-tryptophan. We describe a patient who fulfills criteria for the eosinophilia-myalgia syndrome and who was ingesting supplemental L-tryptophan. Exhaustive investigations failed to reveal other causes for her eosinophilia or her myalgic/neuropathic complaints, and she improved dramatically when she discontinued the L-tryptophan supplements. The mechanisms whereby this chemical may induce this syndrome are discussed.
Asunto(s)
Eosinofilia/inducido químicamente , Enfermedades Musculares/inducido químicamente , Triptófano/efectos adversos , Anciano , Fatiga/inducido químicamente , Femenino , Humanos , Enfermedades Musculares/fisiopatología , Dolor , Parestesia/inducido químicamente , SíndromeAsunto(s)
Autoanticuerpos/inmunología , Factores de Coagulación Sanguínea/inmunología , Coagulación Sanguínea , Trastornos de la Coagulación Sanguínea/etiología , Factores de Coagulación Sanguínea/antagonistas & inhibidores , Factor IX/antagonistas & inhibidores , Factor IX/inmunología , Factor V/antagonistas & inhibidores , Factor V/inmunología , Factor VIII/antagonistas & inhibidores , Factor VIII/inmunología , Humanos , Inmunoglobulina G/inmunología , Inmunoglobulina M/inmunología , Inhibidor de Coagulación del Lupus , Lupus Eritematoso Sistémico/complicaciones , Lupus Eritematoso Sistémico/inmunologíaRESUMEN
We employed four crossmatch techniques to select platelet donors for refractory patients. Forty-four donor-recipient pairs were studied in 32 patients. Analysis of effectiveness of platelet transfusions revealed that only 18 percent of transfusions gave a borderline response; the remainder were either effective or not effective at all. The corrected predictive values of three crossmatch tests were as follows: enzyme-linked immuno-specific assay, 81 percent; platelet immunofluorescence test, 73 percent; and lymphocytotoxicity, 70 percent (p greater than 0.05). The predictive value of these tests did not differ in HLA-matched versus unmatched platelet transfusions. Donor selection by lymphocytotoxicity compatibility did not appear to be useful if donors were selected by either of the other two methods. The fourth test, antiglobulin-modified lymphocytotoxicity, offered no advantage over lymphocytotoxicity. Our data suggest that platelet crossmatching assays are a useful adjunct to the selection process for the platelet donor in addition to ABO, Rh, and HLA matching.
Asunto(s)
Donantes de Sangre , Transfusión Sanguínea , Prueba de Histocompatibilidad/métodos , Transfusión de Plaquetas , Adulto , Anciano , Plaquetas/inmunología , Preescolar , Pruebas Inmunológicas de Citotoxicidad , Ensayo de Inmunoadsorción Enzimática , Femenino , Técnica del Anticuerpo Fluorescente , Humanos , Isoanticuerpos/análisis , Leucemia/sangre , Leucemia/terapia , Masculino , Persona de Mediana Edad , Recuento de Plaquetas , Reacción a la TransfusiónRESUMEN
Circulating anticoagulant activity that had at least two distinct mechanisms--one directed against factor XII and one directed against blood thromboplastin (prothrombin activator complex)--developed in a patient with clinical and laboratory evidence of procainamide hydrochloride-induced systemic lupus erythematosus. The anticoagulant activity behaved as a gamma-globulin in chromatographic and electrophoretic analyses, with the majority of activity behaving as an IgM immunoglobulin. Despite markedly abnormal coagulation study results, no clinical bleeding occurred. Anticoagulant activity paralleled clinical and laboratory evidence of the inflammatory disease and improved on discontinuance of procainamide therapy.
Asunto(s)
Coagulación Sanguínea , Inmunoglobulinas/análisis , Lupus Eritematoso Sistémico/inducido químicamente , Procainamida/efectos adversos , Anciano , Pruebas de Coagulación Sanguínea , Humanos , Inmunoglobulina M , Inmunoglobulinas/farmacología , Lupus Eritematoso Sistémico/sangre , Masculino , gammaglobulinasRESUMEN
Seven of eight patients with thrombotic thrombocytopenic purpura who were treated with both exchange plasmapheresis and antiplatelet agents (aspirin and dipyridamole) achieved complete remission. The eighth patient appeared to fail on this regimen but responded to corticosteroids and splenectomy. A ninth patient attained full remission after therapy with only aspirin and dipyridamole. The antiplatelet agents appeared to play an important role in the response of four patients. Eight patients received maintenance aspirin and dipyridamole. This maintenance therapy may have prevented relapses of thrombotic thrombocytopenic purpura in some patients as evidence of active, subclinical disease persisted for many weeks in most patients. Treatment with maintenance antiplatelet agents was discontinued in five patients after 7 to 18 months and no patient has relapsed. An effective therapeutic regimen for thrombotic throbocytopenic purpura would include initial therapy with exchange plasmapheresis, aspirin, and dipyridamole and maintenance therapy with antiplatelet agents.
Asunto(s)
Aspirina/uso terapéutico , Dipiridamol/uso terapéutico , Plasmaféresis , Púrpura Trombocitopénica Trombótica/terapia , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prednisona/uso terapéutico , EsplenectomíaRESUMEN
A patient with acute lymphocytic leukemia is described who developed meningeal leukemia 14 months after the initial diagnosis was made. As part of his antileukemic therapy, at that time, he received prednisone and vincristine, given prophylactically to maintain a bone marrow remission. He inadvertently received 15 mg of vincristine instead of 1.5 mg. Following this overdosage he developed pancytopaenia, mild neurotoxicity and subsequently a grand mal seizure associated with the delayed onset of hyponatremia. This was presumed to be due to the inappropriate secretion of antidiuretic hormone (ADH) secondary to vincristine toxicity. This responded to fluid restriction and anti-epileptiform therapy.