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Biomedical subjects

H Pflieger

Publications and source records attributed to H Pflieger.

At least 37 records · Page 2Linked to original sources

Lymphocytotoxic antibodies in patients receiving granulocyte transfusions.

The presence of lymphocytotoxic antibodies was studied in 22 patients receiving granulocyte transfusions. Due to previous blood transfusions 7 out of 22 patients had lymphocytotoxic antibodies before granulocyte transfusions were started. 6 out of 15 unsensitized patients developed antibodies during granulocyte transfusion therapy, and 9 out of 15 patients had no detectable antibodies at any time. Transfusion reactions occurred in the presence of lymphocytotoxic antibodies not directed against donor cells.

Adolescent↗

Collection of large quantities of granulocyte/macrophage progenitor cells (CFUc) in man by means of continuous-flow leukapheresis.

Continuous-flow leukapheresis using the AMINCO Celltrifuge was performed in 35 adult volunteers for the procurement of large quantities of granulocyte/macrophage progenitor cells (CFUc) as part of the mononuclear leucocytes. The donor blood volume processed was 12 1 at a flow rate of 50 ml per min. The centrifuge speed was 800 rpm. The mean yield of mononuclear cells (MNC) per run was 12.0 x 10(9) and that of CFUc, 8.7 x 10(5). The leukapheresis did not much affect the donor blood cell concentration except the platelet concentration; this must be considered as a limiting factor for leukapheresis. The mean granulocyte contamination of the leukapheresis-derived leucocytes was only about 10%. Successive leukaphereses (with short-term intervals) in 7 donors led to significant increases in CFUc yield. The possible therapeutic application of blood stem cells in the treatment of haemopoietic failure in man is discussed.

Adult↗

Micromegakaryocytes in Human Bone Marrow.

Micromegakaryocytes (MMK) were defined morphologically by the cell area, nucleus form and cytoplasmic structure. Bone marrow smears of 7,156 patients were retrospectively analyzed. MMK were found most frequently and abundantly in acute non-lymphatic leukaemia, chronic myeloid leukaemia and pre-leukaemia. The presence of more than 10% MMK in the megakaryocyte population suggest a pre-leukaemic condition or non-lymphatic leukaemia. The platelet production of MMK is probably quantitatively normal although a functional defect is suspected.

Acute Disease↗

Collection, storage and transfusion of blood stem cells for the treatment of hemopoietic failure.

Migration of hemopoietic stem cells via the blood to sites of stem cell need is a principle that becomes established during the embryonic development of hemopoiesis and can be observed in the adult whenever bone marrow transplantations are being performed. The regular presence of stem cells in the peripheral blood lends itself to the study of their collection, storage, and use for transfusion purposes in cases of bone marrow failure. Both in dog and in man, granulocyte-macrophage progenitor cells (CFU-C) can be collected by leukapheresis from the blood in large quantities, particularly if the yield is increased by the administration of mobilizing agents such as dextran sulfate, and appear to be an indicator for the presence of stem cells. For collection and storage, a closed plastic bag system has been developed that allows the safe handling of the cells. The loss of CFU-C from freezing and thawing with DMSO as a cryoprotective agent is only 10%-20%. If frozen and thawed mononuclear leukocytes are transfused into 1200 rad whole-body X-irradiated autologous or allogeneic recipient dogs, a hemopoietic take is observed when 0.2 X 10(5) CFU-C are present among the mononuclear leukocytes (MNC). Graft-versus-host disease can be avoided in the allogeneic situation when a purified CFU-C rich cell fraction is being transfused. In man collection and storage of MNC including CFU-C is feasible and may eventually become a therapeutic tool.

Animals↗

Beneficial effect of granulocyte transfusions in patients with defects in granulocyte function and severe infections.

A 3-year-old boy (patient A) with a congenital and a 24-year-old man (patient B) with an acquired granulocyte function defect received supportive granulocyte transfusions for the management of severe infections. The boy had suffered from recurrent infections since bith. His granulocytes showed in vitro almost no chemotactic responsiveness, an impaired phagocytosis and reduced intracellular killing of Candida albicans. Family studies suggested that it was an inherited autosomal recessive defect. The child developed a Pseudomonas pneumonia at the age of 3 years, which did not respond to antibiotic therapy. Granulocyte transfusions were then started and soon after the fever and pneumonia disappeared. Patient B showed the haematological signs of a preleukaemic state. He had 3 recurrent episodes of furunculosis which led each time to cellulitis and septic temperatures accompanied by symptoms of an enterocolitis. Tests of granulocyte function in vitro showed reduced intracellular killing of Staphylococcus aureus. Granulocyte transfusions were started, since no clinical improvement could be attained by antibiotics. With transfusion therapy, fever, cellulitis and enterocolitis disappeared each time.

Adult↗

Differential blood counts from cell concentrates. A comparison with routine differential blood counts.

Two methods have been compared through performing differential blood counts: the routine blood count (routine count = RC) and blood counts from films after concentrating white blood cells (cell concentrate = CC). Normal persons were examined and patients with leukocytes less than 1,000/microliter of peripheral blood. The correlation coefficient between RC and CC is higher for more frequent cell types and lower for less frequent cell types. It is concluded that the preparation of CC is simple and reproducible, and that the time-saving CC method for performing differential blood counts from patients with severe leukopenia may be a worthwhile addition to routine laboratory methods.

Humans↗

[Effectiveness of gnotobiotic measures in the treatment of acute leukemia: the results of a prospective randomized clinical study].

60 adult patients with acute leukemia (AL) previously untreated or in relapse received induction chemotherapy with different types of supportive care. Group A was decontaminated by nonabsorbable antibiotics in strict reverse isolation, group B was isolated only and group C was treated under routine hospital conditions. There were less infections in group A and B compared with group C. 76% of patients in group A achieved remission, in contrast to 57% in group B and 59% in group C. Late evaluation three years after termination of the study showed that all patients were dead except four patients being in first remission after discontinuation of maintenance treatment. Three patients were treated in group A, one patient in group C. However, the differences of survival and remission rates were not significant. Failure to demonstrate significant advantage of isolation and decontamination in treatment of AL was caused by insufficient suppression of microbes by the applied antimicrobial measures. Thus, it is suggested to investigate better antimicrobial treatment before gnotobiotic care is accepted as routine supportive treatment in AL.

Acute Disease↗

Collection and cryopreservation of mononuclear blood leukocytes and of CFU-C in man.

For bone marrow reconstitution after hemopoietic failure as a consequence of the action of a variety of etiological factors, hemopoietic stem cells are needed. These have been derived in the past mainly from bone marrow. This report describes studies and their results that indicate that granulocytic progenitor cells, measured in cell culture systems as "colony forming units in culture - CFU-C", can be collected in large quantities from the peripheral blood of human blood donors by continuous flow leukapheresis. They can be stored at ultra-low temperatures. Their recovery rate after thawing and washing is better than 85%. In a canine model, evidence was obtained that the presence of CFU-C in a suspension of mononuclear blood leukocytes is also indicative for the presence of pluripotent hemopoietic stem-cells. Therefore it is suggested that stem cells can also be collected from human blood as an alternative source for bone marrow reconstitution.

Blood Preservation↗

High granulocyte yield with a simple method of filtration leukapheresis.

A simple continuous filtration leukapheresis has been devised whereby two Leuko-Pak filters can be charged and eluted within 5 h with approximately 121 of blood in a closed system of tubes. Blood flows by means of gravity without the use of pumps. Without premedication with prednisolone the average yield from 10 donors was 3.66 x 10(10) granulocytes per leukapheresis and after premedication with 150 mg prednisolone orally it was 6.44 x 10(10) granulocytes per leukapheresis. The in vitro function of filter granulocytes was not reduced even after premedication with prednisolone. In comparison with leukapheresis by blood cell separators this modified method of filtration leukapheresis offers the following advantages: 1) the granulocyte yield per litre of whole blood processes is higher, 2) technical assistants in a blood-bank can carry out the method on several donors simultaneously, 3) the method is more economical than leukapheresis by blood cell separators.

Cell Survival↗

[Acute drug-induced agranulocytosis: comparison between openward treatment and antimicrobial decontamination in a plastic isolation bed system (retrospective study of 30 cases) (author's transl)].

Thirty patients with severe drug-induced agranulocytosis were admitted to the Ulm University Hospital between January, 1968 and October, 1976. All of 13 already infected patients treated with antimicrobial decontamination in a plastic isolation bed system survived. But nine of 17 patients treated in the open ward died. The cases were not randomised and there was a difference in age between the two groups, but nevertheless the results suggest that antimicrobial decontamination and isolation is superior to treatment in an open ward.

Adolescent↗

The clinical efficacy of granulocyte transfusions: studies on the oral cavity.

Patients with severe granulocytopenia of different origin received granulocyte transfusions. The migration and phagocytic ability of the transfused granulocytes in the oral cavity ("orogranulocytes") served as a parameter for measuring the viability of the granulocytes in vivo. There was no difference between granulocytes collected by continuous flow centrifugation and those collected by filtration leukapheresis. Under the influence of the transfusion treatment mucous membrane ulcers (MMU) subsided and healed. Where ulcers were present the number of orogranulocytes (OG) increased after granulocyte transfusion. In addition there was a significant correlation between the number of granulocytes in the peripheral blood and the number of orogranulocytes. As a control, orogranulocytes were studied in a group of healthy persons with intact teeth, toothless persons with normal blood counts and one patient with an acute agranulocytosis.

Adult↗

High dose granulocyte substitution after bone marrow transplantation in a case of aplastic anaemia in childhood.

A bone marrow transplantation (BMT) was successfully carried out in a seven-year-old boy with aplastic anaemia. An HLA and MLC-identical brother served as donor. During the first 16 days after BMT between 0.55 and 7.11X10(10) granulocytes were transfused 14 times (an average of 4.03X10(10) per transfusion). The maximum increment in the peripheral blood after transfusion was over 4000 granulocytes per microliter. The course of local infections was taken as parameter for determining the clinical effectiveness of the granulocyte transfusion. Under the substitution therapy the necrotic ulcer of a fingertip and the mucous membrane ulcers in the oral cavity subsided. The presence of transfused granulocytes in the oral cavity ("orogranulocytes") could be established. There was a statistically significant relationship between the number of granulocytes in the peripheral blood and the number of orogranulocytes. It could be demonstrated that in children a temporary normalisation of the number of granulocytes in the peripheral blood can be attained by means of granulocyte substitution and that the transfused granulocytes are clinically effective.

Anemia, Aplastic↗