Prednisone therapy of post-transfusion purpura.
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Biomedical subjects
Publications and source records attributed to C A Linker.
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Acute lymphoblastic leukemia (ALL) developed in a 53-year-old survivor of the Hiroshima bomb blast. Chromosomal analysis disclosed a single abnormality, deletion of chromosome 7. This deletion has been reported in patients with radiation exposure, but it is uncommon in adults with ALL. The karyotypic abnormality suggests that our patient's leukemia may be related to prior radiation exposure despite a 37-year hiatus. The findings raise further questions about the persistent risk of leukemia among atomic bomb survivors.
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We reviewed the records of 32 patients with acute leukemia and proved invasive fungal infections to determine the clinical and pathologic characteristics of systemic mycosis in patients undergoing intensive induction chemotherapy. The incidence of invasive fungal infections among our patients was at least 27 percent, and Candida and Aspergillus accounted for the majority of these infections. Patients with systemic candidiasis generally had prolonged severe neutropenia, fever refractory to antibiotics, and evidence of mucosal colonization by fungi. At autopsy, Candida was always widely disseminated. Patients with aspergillosis generally had neutropenia, fever, and pulmonary infiltrates at the time of admission to the hospital and, at autopsy, their infections were primarily confined to the lungs. Patients infected with both Candida and Aspergillus had clinical and pathologic findings that were a combination of the features of each type of infection. A diagnosis of invasive fungal infection was established before death in only nine of the patients, all of whom had systemic candidiasis. Four of these patients were successfully treated and survived their hospitalization. The reasons for frequently misdiagnosing and unsuccessfully treating systemic mycosis in patients with acute leukemia are examined, and suggestions are made for improved management of patients at high risk for these infections. These suggestions are based upon recognition of the clinical settings in which fungal infections occur, the aggressive use of invasive diagnostic procedures, and the early empiric use of amphotericin B.
We report a case of combined idiopathic immune neutropenia and immune thrombocytopenia (thromboneutropenia). Therapy with prednisone was ineffective. Treatment with vincristine raised the patient's platelet count but did not increase the neutrophil count. Splenectomy led to a prompt complete remission. Using radioimmunologic techniques, we have shown both antiplatelet and antineutrophil antibodies and have shown the disappearance of these antibodies after successful treatment.