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L Corash

Publications and source records attributed to L Corash.

At least 55 records · Page 3Linked to original sources

Multiple in vivo effects of interleukin-3 and interleukin-6 on murine megakaryocytopoiesis.

The in vivo effects of interleukin-3 (IL-3), interleukin-6 (IL-6), and a combination of IL-3 plus IL-6 on murine megakaryocytopoiesis and thrombopoiesis were examined. Human recombinant IL-6 was administered subcutaneously as 14 equal injections of 5,000 units each during a 102-hour period. Murine recombinant IL-3 was given as 8 injections of 80,000 units each during the first 54 hours. Megakaryopoiesis and thrombopoiesis were evaluated 120 hours after initial administration of the cytokines. Platelet levels increased by 20% following IL-3 alone, 35% following IL-6 alone and 61% after administration of both IL-3 and IL-6. Platelet production, as measured by 75Se-selenomethionine incorporation, increased by approximately 120% in animals that had received IL-6 or IL-3 plus IL-6. Megakaryocyte ploidy analysis by two-color flow cytometry showed a shift in the modal ploidy class from 16N to 32N and a significant increase in the frequency of 64N cells only in IL-6 treated animals. Both bone marrow and splenic megakaryocyte colony-forming cells were significantly increased following either IL-3 or IL-6. Bone marrow megakaryocyte size increased 18%, 43%, and 38%, respectively, after administration of IL-3, IL-6, or the combination of IL-3 plus IL-6. Leukocyte counts and hematocrits were unaffected by either cytokine. Additional groups of mice received the same injection schedule as above and the serial effects on peripheral blood cell levels were assessed for 30 days. Platelet levels, which had been elevated by IL-3 or IL-6, fell to control values within 4 days following the last injection. Animals given IL-6 or IL-3 plus IL-6 were subsequently thrombocytopenic relative to controls on days 7 through 9 following cessation of treatment. Temporary 'cycling' of platelet levels was observed for 3 weeks following treatment with IL-6 or the combination of IL-3 plus IL-6. We conclude that IL-6 and to a lesser extent IL-3 stimulate platelet production in vivo and that their combined effects on platelet levels are approximately additive. Following discontinuation of IL-3 or IL-6, the effects are rapidly reversed, presumably by negative feedback mechanisms, resulting in a period of 'rebound thrombocytopenia' in mice that had received IL-6.

Animals↗

Stimulation of megakaryocytopoiesis in mice by human recombinant interleukin-6.

The in vivo effects of purified human recombinant interleukin-6 (IL-6) on murine megakaryocytopoiesis were examined. IL-6 was administered subcutaneously to Swiss Webster mice, followed by evaluation of bone marrow megakaryocyte ploidy, size and frequency, and median platelet volume 24, 48, and 72 hours after the initiation of IL-6 administration. In addition, bone marrow megakaryocyte morphology was examined using electron microscopy at 72 hours. IL-6 (10,000 U per subcutaneous injection) was administered three times during the first 24 hours, three times during the second 24 hours, and twice during the last 24-hour period. IL-6 bioactivity (10 U/ng) was determined using the IL-6-dependent murine hybridoma cell line B9. Megakaryocyte ploidy distribution, measured by two-color flow cytometry, demonstrated a shift in the modal ploidy class from 16N to 32N and a significant increase in the relative frequency of 64N megakaryocytes 48 and 72 hours (but not 24 hours) after initiation of IL-6 administration (cumulative doses of 60,000 and 80,000 U at 48 and 72 hours, respectively). In addition, ploidy levels were increased in animals that received a cumulative IL-6 dose of only 40,000 U (evaluated after 72 hours). The size of recognizable bone marrow megakaryocytes, determined by the cross-sectional areas of plastic embedded bone marrow megakaryocytes, was increased at the 48-hour (60,000 U IL-6) and 72-hour (80,000 U IL-6) time points. Megakaryocyte frequency, measured by flow cytometry, was unaffected at all time points and doses of IL-6. Median platelet volume, measured by electrical impedance, was not consistently altered by administration of IL-6. Electron microscopic examination of bone marrow megakaryocytes showed an increase in the proportion of megakaryocytes with a wide, peripheral, organelle-deficient zone from 20% +/- 9% (SD) in control animals to 50% +/- 7% (SD) (P less than .02) in animals that received IL-6. No changes were observed in the distribution of the demarcation membranes. IL-6 is a potent stimulator of murine megakaryocytopoiesis, in vivo, and appears to act early in megakaryocyte differentiation.

Animals↗

Neuraminidase-induced thrombocytopenia in mice: effects on thrombopoiesis.

Previous studies to examine the effects of thrombocytopenia on thrombopoiesis have generally utilized immune-mediated platelet depletion. We have developed a nonimmune model to exclude the possibility that adverse immune-mediated effects have been misinterpreted as the physiological response to stimulation of thrombopoiesis. Thrombopoiesis was examined in mice after induction of thrombocytopenia with a single injection of the nonimmunologic agent neuraminidase (Ndase). Utilizing electron microscopy, we examined platelets and megakaryocytes (MK) obtained 8, 12, 24, 48, 72, 96, and 120 hr after administration of Ndase. Eight to 48 hr after induction of acute, severe thrombocytopenia (mean platelet count less than 50,000/microliters), the medians of the platelet sectional area distributions, as measured morphometrically, were significantly greater than the median platelet sectional area of pooled controls. The maximum median value for platelet sectional area was observed at 24 hr. The largest platelets in these samples contained more profiles of endoplasmic reticulum and Golgi cisternae, and a lower concentration of surface-connected canalicular system, as compared with normal platelets. By 72 hr post-injection of Ndase, virtually all platelets exhibited normal size and organelle complement. Mean platelet volumes, determined by electrical impedance analysis, paralleled the serial changes in platelet sectional areas. MK frequency and ploidy, measured by two-color fluorescence activated flow cytometry, were unchanged 12 and 24 hr following Ndase. At 48 hr, total MK frequency increased significantly (P less than 0.01) from 0.11% to 0.17%, and MK ploidy distribution shifted with a reduction in 16N MK (P less than 0.005) and an increase in 32N MK (P less than 0.01). MK ploidy was maximally altered from normal at 72 hr with increased 32N MK frequency (32.0%, P less than 0.001) and increased 64N MK frequency (2.4%, P less than 0.005). Morphologic and morphometric examination of MK at all time points did not reveal detectable changes from normal in cytoplasmic appearance or size, respectively. Therefore, we have demonstrated marked alterations of morphology and size of platelets, and of MK ploidy, using this nonimmunologic model. These studies further support our previous observations that megakaryocyte ploidy and platelet volume are independently regulated in response to depletion of the circulating platelet mass, and they show that these changes are not dependent upon the mechanism of thrombocytopenia.

Animals↗

The effect of a salmon diet on blood clotting, platelet aggregation and fatty acids in normal adult men.

This study was designed to measure the effect of dietary n-3 fatty acids (FA) on platelets and blood lipids. Healthy men (n = 9), ages 31 to 65, were fed diets in which salmon was the source of n-3 fatty acids. They were confined in a nutrition suite at this Center for 100 days. Food intake and exercise levels were rigidly controlled. Initially they were placed on a stabilization diet for 20 days, then six men were fed the salmon diet for 40 days. The others remained on the stabilization diet. The two groups switched diets for the last 40 days of the study. Both diets were isocaloric [16% protein, 54% carbohydrate, and 30% fat by energy-% (En%)]. The salmon diet contained 7.5% of calories from n-6 FA and 2% from n-3 FA, primarily eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in a 40:60 ratio, while the stabilization diet contained 7.5% of calories from n-6 FA and less than 0.3% n-3 FA, mainly 18:3n-3. The bleeding time was unaffected by the diets in this study. The prothrombin time was shortened (11.6 sec. vs. 12.6 sec., p less than 0.01) for the subjects consuming the salmon diet as compared to that measured after 20 days of the stabilization diet. Mean platelet volume increased significantly during the period in which the volunteers consumed the salmon diet compared to the baseline diet (p less than 0.01), while the mean platelet levels decreased. Platelet aggregation (PA) was measured in platelet rich plasma before, during, and after the salmon diet using collagen, ADP, arachidonic acid (AA), and thrombin agonists. The PA threshold for ADP was significantly increased for the subjects on the salmon diet (p less than 0.05). No change in the PA threshold was detected for collagen or thrombin. The PA threshold for AA was unchanged also, but the platelets in subjects consuming the salmon diet had a prolonged time to maximum aggregation (p less than 0.01) with this reagent compared to platelets from men on the stabilization diet. Plasma, red cell, and platelet total FA composition was determined by capillary GLC. While the men consumed the salmon diets, there were marked increases (3 to 10-fold) in the EPA and DHA levels in all blood components with concomitant decreases in linoleic acid and AA levels.(ABSTRACT TRUNCATED AT 400 WORDS)

Adenosine Diphosphate↗

The automated modified Russell viper venom time test for the lupus anticoagulant.

Antiphospholipid antibodies, both anticardiolipin antibody and lupus anticoagulant, are associated with a hypercoagulable state, manifested as thrombotic events and pregnancy losses. Multiple coagulation tests are available for the lupus anticoagulant, but few are in wide use. The modified Russell viper venom test (RVVT) is one of several excellent tests for the lupus anticoagulant, with high sensitivity and specificity. We present an automated method for measuring the RVVT and demonstrate its reproducibility.

Automation↗

Measurement of platelet activation by fluorescence-activated flow cytometry.

Platelet activation is postulated to play a critical role in the pathogenesis of thrombotic and hemorrhagic disorders. Previous assays for detection of activated platelets were cumbersome and provided only nonspecific information with limited sensitivity. The recent introduction of fluorescence-activated flow cytometric techniques for platelet analysis used in combination with monoclonal antibodies for detection of specific platelet-activation antigens has introduced the possibility of improved assays to detect activated platelets. The monoclonal antibody S12, directed against the unique platelet-activation antigen GMP-140, has been used to develop a fluorescence-activated flow cytometric assay. Patient samples for this assay can be easily prepared and maintained until analyzed in batch mode. Peripheral blood obtained from normal subjects exhibited low levels of activated platelets, and the assay had sufficient sensitivity to detect as few as 2% to 3% activated platelets among normal platelets. Patients undergoing cardiopulmonary bypass had transiently increased numbers of circulating activated platelets. Evaluation of standard blood bank platelet concentrates has shown the presence of significant numbers of activated platelets. Other studies have suggested that the degree of platelet activation correlated with poor posttransfusion increments and survival. Thus, this assay may also be useful for quality control of platelet concentrates. Future development of the GMP-140 and other platelet-activation antigen assays should improve detection of disorders characterized by inappropriate platelet activation.

Flow Cytometry↗

Splenic thrombopoiesis after bone marrow ablation with radiostrontium: a murine model.

Murine platelet production is normally supported by high-ploidy bone marrow megakaryocytes without significant contribution from splenic megakaryocytes with predominantly low-ploidy levels. We produced sustained bone marrow ablation using radiostrontium, and examined the processes by which splenic platelet production is initiated and maintained in the absence of bone marrow function. Bone marrow hematopoiesis, measured by total nucleated cell number and viability, megakaryocyte colony-forming cells, and granulocyte-macrophage colony-forming cells, was rapidly ablated in mice by using yttrium 90-free strontium 90. Platelet count declined from normal (1224 x 10(3)/microliters) to a nadir (98 x 10(3)/microliters) 11 days after 90Sr, and then rose to a stable level (705 x 10(3)/microliters) on days 20 through 115. Peripheral leukocyte concentration decreased rapidly and remained below 25% of normal in contrast to hemoglobin levels, which were minimally lowered. Mean spleen weight rose rapidly after 90Sr to 66% above normal. Splenic megakaryocyte frequency, measured by two-color fluorescence-activated flow cytometry, rose from basal levels (0.09% +/- 0.06%) to 0.15% +/- 0.07% (p less than 0.001), total spleen nucleated cells fell to 71% of normal, and the absolute number of spleen megakaryocytes was unchanged. Total spleen megakaryocyte colony-forming cells were not significantly increased above normal whereas total spleen granulocyte-macrophage colony-forming cells increased abruptly after day 13 to 10 times normal levels. Splenectomy after hematopoietic recovery from 90Sr bone marrow ablation resulted in a rapid decline of platelet levels, followed by death. Although the spleen became the sole site of platelet production, the splenic megakaryocyte ploidy distribution was only minimally changed from normal, and the modal ploidy class remained 2N. In contrast to experimental thrombocytopenia in mice with intact bone marrow, in which megakaryocyte ploidy is increased, thrombocytopenia associated with sustained bone marrow ablation does not result in upward regulation of splenic megakaryocyte ploidy as a compensatory mechanism.

Animals↗

Sustained thrombocytopenia in mice: serial studies of megakaryocytes and platelets.

We studied thrombopoiesis in mice after the experimental induction of sustained, immune thrombocytopenia with platelet antiserum (PAS). Utilizing light and electron microscopy and a digital image analyzer to determine platelet sectional areas, we examined platelets and megakaryocytes (MK) after 120 h of sustained, severe thrombocytopenia (120CT) and during recovery from thrombocytopenia at 48 h (48R), 72 h (72R), and 120 h (120R) after cessation of administration of PAS. Mean platelet volume (MPV), determined by electrical impedance, also was measured at each time point. Platelets at 120CT (platelet count less than 50,000/microliter), 48R (platelet count 100-200,000/microliter), and 72R (platelet count approximately 1 x 10(6)/microliter) were significantly larger in sectional area than control platelets and contained increased profiles of endoplasmic reticulum and Golgi cisternae, a lower concentration of surface-connected canalicular system, and occasional membrane complexes. The largest median platelet sectional area was detected at 48R and was the largest median value observed in response to either chronic or acute thrombocytopenia. At 120R, most platelets were normal in size and cytoplasmic appearance, although some large cells remained present in the circulation. MPV paralleled the morphometric changes in platelet sectional area. MK were increased in number at 120CT, 48R, 72R, and 120R. In addition, at least half of the MK examined at 48R contained small areas of cytoplasm, devoid of organelles, that were interspersed between larger areas of organelle-filled, undemarcated cytoplasm. The modal bone marrow megakaryocyte ploidy class, determined using two-color fluorescence-activated flow cytometry, shifted from 16N to 32N in response to sustained thrombocytopenia. In contrast, during recovery and development of rebound thrombocytosis, the relative frequency of 8N megakaryocytes was significantly increased. Because there was no consistent correlation between megakaryocyte cytoplasmic characteristics and platelet morphology, these data support the hypothesis that platelet formation is not determined by compartmentalization of MK cytoplasm into platelet areas as MK mature in the bone marrow, but involves a rearrangement of MK cytoplasm immediately prior to platelet release.

Animals↗

Regulation of platelet heterogeneity: effects of thrombocytopenia on platelet volume and density.

We have examined the effects of variable degrees of acute thrombocytopenia on platelet levels, mean platelet volume (MPV), and buoyant density after induction of thrombocytopenia by platelet antiserum (PAS) in mice with or without spleens. Mice were studied serially 10-16, 36, 48, 60-64, 84, 108, 144, 180, 228, 276, 348-360, 372, and 516 h after PAS treatment. MPV and platelet count (PC) x 10(6)/microliters for normal intact mice (n = 136) were 4.7 +/- 0.3 fl (SD) and 1.69 +/- 0.52 (SD), respectively. Twelve hours after PAS-induced severe thrombocytopenia (PC less than 0.05 x 10(6)/microliters), MPV increased significantly (p less than 0.01) to 6.4 fl, was maximal at 36 h (8.2 fl), remained elevated until 144 h following PAS treatment, and then returned to normal. Platelet density decreased significantly (p less than 0.05) 64 h after PAS treatment and returned to normal at 144 h. Hematocrits of repeatedly bled intact control mice decreased from 45% to 30%, accompanied by thrombocytosis (maximal PC 2.24 x 10(6)/microliters) without significant changes in either MPV or platelet density. Moderate thrombocytopenia (PC 0.1-0.2 x 10(6)/microliters) in intact mice produced significantly (p less than 0.05) increased MPV, at 5.7 fl 12 h after PAS treatment, with a peak MPV of 7.6 fl (p less than 0.001) at 36 h; MPV returned to normal at 84 h. Platelet density decreased (p less than 0.001) 12 h after PAS treatment and returned to baseline at 228 h. Control splenectomized mice (n = 185) had an MPV of 5.0 fl +/- 0.7 fl and a PC of 2.14 +/- 0.6 x 10(6)/microliters. Comparably severe and moderate thrombocytopenia in splenectomized mice produced alterations in platelet count, MPV, and density similar to those in intact mice, although maximal MPV and the degree of rebound thrombocytosis after severe thrombocytopenia were more marked in splenectomized mice. In response to reduction of the platelet mass in both intact and splenectomized mice, MPV increased in proportion to the severity of thrombocytopenia, occurred as early as 4 h after induction, and persisted during early rebound thrombocytosis. Previous observations that megakaryocyte ploidy did not shift until 48 h after onset of thrombocytopenia confirm that both initial and maximal changes in MPV in response to this stimulus are regulated by processes other than alterations of megakaryocyte DNA levels.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗

The relationship between megakaryocyte ploidy and platelet volume in normal and thrombocytopenic C3H mice.

Previous studies have suggested that platelet volume may be primarily regulated by the ploidy distribution of mature bone marrow megakaryocytes. However, earlier investigations from this laboratory using C57/BL mice have shown that in response to acute, severe, or moderate thrombocytopenia, platelet volume is regulated independently of megakaryocyte ploidy. Murine strains, including C57/BL, usually have a modal bone marrow megakaryocyte ploidy class of 16N. In contrast, the C3H mouse has a 32N modal bone marrow megakaryocyte ploidy class. We have examined the platelet count, platelet volume distribution, and bone marrow megakaryocyte ploidy distribution of C3H mice during steady-state thrombopoiesis and after depletion of platelets by antiplatelet serum. The platelet count and volume of normal C3H mice were not substantially different from those of C57/BL mice, but megakaryocyte frequency was marginally greater (p less than 0.05), and the ploidy distribution exhibited a a marked reduction in the proportion of 16N cells (p less than 0.001) and increased relative frequencies of 32N (p less than 0.001) and 64N (p less than 0.01) megakaryocytes. In response to acute severe thrombocytopenia, C3H mice demonstrated an increase in platelet volume equivalent to that previously reported for C57/BL mice, without a subsequent shift in the modal megakaryocyte ploidy class. The relative frequencies of 64N and 128N megakaryocytes increased significantly (p less than 0.005) compared to normal C3H mice, without a change in the frequency of 32N megakaryocytes. These studies indicate that during steady-state thrombopoiesis, a greater proportion of higher ploidy megakaryocytes (32N plus 64N) does not necessarily alter peripheral platelet count or platelet volume. Therefore, it appears that neither platelet volume nor count are primarily regulated by bone marrow megakaryocyte ploidy and that the magnitude of upward regulation of megakaryocyte ploidy is limited.

Animals↗

Measurement of megakaryocyte frequency and ploidy distribution in unfractionated murine bone marrow.

Measurement of megakaryocyte frequency, ploidy distribution, and maturation stage have been complicated by the low frequency of megakaryocytes in either bone marrow or spleen. Due to harsh labeling conditions, previous studies utilizing flow cytometry have not quantified cell recovery or megakaryocyte frequency. We have modified our two-color fluorescence-activated cytometric technique in order to identify megakaryocytes in unfractionated murine bone marrow with a fluoresceinated cell surface immunologic probe (heterologous polyclonal platelet antiserum) and to selectively measure megakaryocyte DNA content with propidium iodide using isosmolar conditions. Under these conditions, total nucleated cell recovery from unfractionated normal murine bone marrow, after all preparative procedures, averaged 68.0% +/- 5.0% (SD) with 93.5% +/- 2.0% DNA staining efficiency. Mean megakaryocyte frequency (n = 30) was 0.14% +/- 0.04%. Using both our previously described gating technique with single parameter analysis and our modified dual parameter technique, the modal megakaryocyte ploidy class was 16N. Low ploidy megakaryocytes, 2N and 4N, constituted 9.8% and 10.8%, respectively, of the total megakaryocyte population. Analysis of the megakaryocyte population with respect to cell surface fluorescence intensity demonstrated that the dimly fluorescent population contained an increased proportion of lower ploidy class cells (2N + 4N + 8N) compared with brightly fluorescent cells, which contained an increased proportion of higher ploidy cells (16N + 32N). Our modifications of the two-color technique yielded improved recovery of total nucleated bone marrow cells from unfractionated bone marrow and provided more precise measurements of megakaryocyte frequency and ploidy than previously available.

Animals↗

The relationship between megakaryocyte ploidy and platelet volume.

The origins and biologic significance of platelet heterogeneity in general, and platelet volume heterogeneity in particular, have been controversial scientific issues during the past decade. Although it has generally been held that specific megakaryocyte properties, especially ploidy level, are important determinants of platelet volume, the precise relationship between megakaryocyte properties and platelet properties is not well defined. The physiologic processes that specifically determine the relationship between megakaryocyte ploidy and platelet volume are unclear, and understanding of these processes has been further complicated due to the multiplicity of experimental and clinical models used to study the problem. Although it is generally true that increases in megakaryocyte ploidy are associated with increases in megakaryocyte volume, it is not well established that platelet volume is also increased during normal or abnormal thrombopoiesis as a direct result of a change in the ploidy level. Reexamination of earlier studies and some recent investigations suggest that changes in platelet volume and megakaryocyte ploidy are in fact dissociated in response to experimental thrombocytopenia. Critical review of the literature concerning the relationship between megakaryocyte ploidy and platelet volume reveals a limited number of conclusions that are well substantiated and emphasizes the relative lack of understanding about the events governing the complex process of platelet production and platelet heterogeneity.

Animals↗

Use of 8-methoxypsoralen and long-wavelength ultraviolet radiation for decontamination of platelet concentrates.

Transmission of viral diseases through blood products remains an unsolved problem in transfusion medicine. We have developed a psoralen photochemical system for decontamination of platelet concentrates in which platelets are treated with long wavelength ultraviolet radiation (UVA, 320-400 nm) in the presence of 8-methoxypsoralen (8-MOP). Bacteria, RNA viruses, and DNA viruses ranging in genome size from 1.2 x 10(6) daltons, encompassing the size range of human pathogens, were inoculated into platelet concentrates and subjected to treatment. This system inactivated 25 to 30 logs/h of bacteria Escherichia coli or Staphylococcus aureus, 6 logs/h of bacteriophage fd, 0.9 log/h of bacteriophage R17 and 1.1 logs/h of feline leukemia virus (FeLV) in platelet concentrates maintained in standard storage bags. Platelet integrity and in vitro function before, immediately following photochemical treatment, and during prolonged storage after treatment, were evaluated by measuring: (1) extracellular pH; (2) platelet yields; (3) extracellular lactate dehydrogenase (LDH) levels; (4) platelet morphology; (5) platelet aggregation responsiveness; (6) thromboxane beta-2 (TXB-2) production; (7) dense body secretion; and (8) alpha granule secretion. These assays demonstrated that this photochemical inactivation system inactivated bacteria and viruses in platelet concentrates with minimal adverse effects on the in vitro function of platelets in comparison to untreated control concentrates maintained under current, standard blood bank conditions.

Blood Platelets↗

Central nervous system involvement in a patient with chronic lymphocytic leukemia and non-Hodgkin's lymphoma (Richter's syndrome), with concordant cell surface immunoglobulin isotypic and immunophenotypic markers.

Central nervous system (CNS) involvement in Richter's syndrome has not been previously described. This report describes a 45-year-old man with the simultaneous occurrence of B-cell chronic lymphocytic leukemia (CLL), extramedullary large cell non-Hodgkin's lymphoma (NHL), and malignant lymphoid meningeal involvement. In this case, peripheral blood lymphocytes, cerebrospinal fluid (CSF) lymphoblasts, and malignant cells in surgical biopsy tissue obtained from a soft tissue mass all stained concordantly for immunoglobulin isotypes and for B-cell immunophenotypic markers, supporting the hypothesis of a clonal origin for the three malignant cell populations. These observations suggest that the different tumors in Richter's syndrome (CLL and NHL) may represent the clonal progression of a common neoplasm rather than independent neoplastic events. Richter's syndrome and other transformations of lymphoid malignancies (prolymphocytic transformation of CLL, blast crisis of CLL, and blastic transformation of NHL) may all represent possible routes of progression in the natural history of a single neoplasm. The present case also suggests that, in patients with B-cell CLL with CNS symptoms, the possibility of blastic transformation presenting as CNS lymphoma deserves consideration.

Antigens, Neoplasm↗

Development of antithrombin antibodies following surgery in patients with prosthetic cardiac valves.

Although antibody inhibitors directed against blood coagulation factors are well known, antibody inhibitors directed against thrombin are rare. We describe three postsurgical patients with prosthetic cardiac valves who developed serum autoantibodies reactive with human and bovine thrombin, as demonstrated by coagulation studies and immunoblotting. Despite marked prolongation of the thrombin time in these patients, the inhibitors were not associated with significant clinical bleeding. The mechanism of antithrombin autoantibody formation following surgery in patients with prosthetic cardiac valves remains to be determined.

Adult↗

Antinuclear antibody, lupus anticoagulant, and anticardiolipin antibody in women with idiopathic habitual abortion. A controlled, prospective study of forty-four women.

In a controlled, prospective study of 44 consecutive women with idiopathic habitual abortion, only 5% had symptoms of rheumatic disease. Patients did not differ from control subjects in the frequency of positive results on tests for antinuclear antibody or anti-double-stranded DNA. Levels of C3 and C4 were higher in the habitual aborters. No patients had anti-Ro. The antiphospholipid antibody results were analyzed using 2 methods: the frequency of antiphospholipid antibodies was 9% by lupus anticoagulant using the Russell viper venom time (95% confidence interval 22-2.5) and 11% by anticardiolipin antibody assay (95% confidence interval 25-3.7), which was not significantly different from that in control subjects. However, the mean levels in the aborters (although within the normal range) were significantly higher than those in control subjects for anti-double-stranded DNA (P = 0.004), lupus anticoagulant (by Russell viper venom time; P = 0.05), and anticardiolipin antibody (P = 0.0007), when examined by multiple linear regression analysis corrected for age and concurrent pregnancy. Of the 3 patients with antiphospholipid antibodies and subsequent successful pregnancies, only 1 was treated with prednisone and aspirin. We conclude that, in the majority of women, subclinical lupus, anti-Ro, the lupus anticoagulant, and anticardiolipin antibodies are not associated with idiopathic habitual abortion.

Abortion, Habitual↗