Urinary trypsin inhibitor levels in the urine of patients with haematological malignancies

The urinary trypsin inhibitor (UTI) levels in the urine of patients with various haematological malignancies were determined, using automated latex agglutination immunoturbidimetry. The mean UTI levels in urine in acute non-lymphocytic leukaemia, myelodysplastic syndrome, non-Hodgkin's lymphoma, and multiple myeloma groups were significantly elevated, compared with the normal control group. It was found that the UTI level in urine changed from an elevated value to a normal value with haematological improvement by chemotherapy in a patient with myelodysplastic syndrome included in a previous study. These results suggest tha

Analysis of IL-18 bioactivity and IL-18 mRNA in three patients with adult T-cell leukaemia, acute mixed lineage leukaemia, and acute lymphocytic leukaemia accompanied with high serum IL-18 levels

Interleukin-18 (IL-18) bioactivity in sera and IL-18 mRNA expression in leukaemia cells of three patients with adult T-cell leukaemia (ATL), acute mixed lineage leukaemia (AMLL) and acute lymphocytic leukaemia (ALL) accompanied with high serum IL-18 levels have been analysed. There was little serum IL-18 bioactivity in the three patients with ATL, AMLL and ALL, while IL-18 mRNA expression was detected in leukaemia cells of all three patients.

Effectiveness of washed platelet concentrate and red cell transfusions for a patient with anhaptoglobinemia with antihaptoglobin antibody

A 71-year-old Japanese male with myelodysplastic syndrome progressing to overt leukaemia and hepatocellular carcinoma developed dyspnea and urticaria immediately after infusion of platelet concentrate (PC). He exhibited an identical reaction following blood transfusion. Serum haptoglobin was undetectable. The patient was determined to be homozygous for Hp(del) by polymerase chain reaction (PCR). Antibody to haptoglobin was detected by enzyme-linked immunosorbent assay (ELISA) and Western blot analysis. No antibodies against human leucocyte antigen (HLA) or platelet-specific antigens were detected. Washed PC and washed red blood cells were effective in preventing the transfusion-related anaphylactoid reactions.

DX-9065a, a specific factor Xa inhibitor, as a universal anticoagulant for blood collection tubes

DX-9065a is a direct and selective factor Xa inhibitor. We evaluated the usefulness of DX-9065a in anticoagulating specimens for routine laboratory tests. Results using blood anticoagulated with DX9065a corresponded well with results with blood treated with ethylendiamine tetraacetic acid (EDTA) in the complete blood count (CBC), including white blood cell (WBC) differential count and morphology of blood cells. Clinical chemistry results from DX-9065a-treated samples were similar to results obtained with serum specimens except for leucine aminopeptidase (LAP) and cholinesterase (Ch-E). Thus, DX-9065a may be a useful universal anticoagulant for laboratory medicine.

Hirudin as an anticoagulant for both haematology and chemistry tests

Hirudin, an extract from the leech, has powerful antithrombin activity affecting the blood coagulation pathway. We evaluated the usefulness of hirudin in anticoagulating specimens for routine laboratory tests. Results using blood anticoagulated with hirudin corresponded well with results with blood treated with ethylenediamine tetraacetic acid (EDTA) in the complete blood count (CBC), including white blood cell (WBC) differential count and morphology of blood cells, when CBC was performed within 2 h of blood collection. Clinical chemistry results from hirudin-treated samples were similar to results obtained with serum specimens. Thus, hirudin may be a useful anticoagulant for emergency laboratory medicine.

Argatroban as an anticoagulant for both hematologic and chemical tests

Argatroban possesses strong antithrombin-like activity. We evaluated the usefulness of argatroban in anticoagulating specimens for routine laboratory tests. Results using blood anticoagulated with argatroban corresponded well with the results of blood treated with ethylendiamine tetra-acetic acid (EDTA) in the complete blood count (CBC), including the WBC differential count and morphology of blood cells, when the CBC was performed within 2 hr of blood collection. Clinical chemistry results from argatroban-treated samples were similar to results obtained with serum specimens. Thus, argatroban may be a useful anticoagulant for emergency laboratory medicine.

Successful treatment using peroral itraconazole in a patient with acute promyelocytic leukemia complicated with splenic candidiasis

A 57-year-old female with acute promyelocytic leukemia was admitted to our hospital. The PML-RAR alpha fusion transcript was reverse transcription polymerase chain reaction. Complete remission was achieved with intensive induction chemotherapy. Then a high fever unresponsive to antibiotics with increased C-reactive protein continued. Abdominal computed tomography revealed multiple low-density lesions in the spleen. Splenic candidiasis was suspected and peroral treatment with itraconazole (200 mg/day) was begun. After the fungal infection was confirmed to be inactive, splenectomy was performed. The splenic tissue showed multiple white or yellow nodules and methenamine silver stain revealed fungal hyphae characteristic to Candida. There was no evidence of relapse of Candida infection. She has been in complete remission for these two years and free of fungal infection. It is indicated from our case that splenic candidiasis in patients with acute myeloid leukemia can be successfully treated with oral administration of itraconazole and subsequent splenectomy, when it is confined in the spleen.

[Acute myelogenous leukemia with hyperkalemia induced by pentamidine administration]

A 27-year-old male with acute myelogenous leukemia received an allogeneic bone marrow transplantation (allo-BMT). Pneumocystis carinii pneumonia developed on day 65 after the allo-BMT. The patient was intravenously treated with pentamidine. This resulted in a prompt improvement of his dyspnea and fever, but hyperkalemia occurred during the pentamidine therapy. Treatment with pentamidine was stopped and emergent treatment was started. Nevertheless, the serum potassium level rose to 7.7 mEq/l. Urgent dialysis was performed and the serum potassium level fell to 5.0 mEq/l after treatment. Careful monitoring of the serum potassium level is recommended during intravenous therapy with pentamidine.