PubMed · 10135198
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K M Buckbee. 1994. Implementing a pediatric phlebotomy protocol.. https://pubmed.ncbi.nlm.nih.gov/10135198/
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BACKGROUND: In spite of many reports, it remains unclear whether the presence of tumor cells in circulating blood flow predicts a poor prognosis. METHODS: Competitive seminested reverse transcriptase-polymerase chain reaction (RT-PCR), a technique for the quantitative detection of tumor cells, was applied to detect the presence of tumor cells in portal and peripheral blood samples from 121 patients with colorectal carcinoma and to clarify their clinical significance. This technique can detect one carcinoembryonic antigen (CEA) mRNA-expressing tumor cell in 1 x 10(5) normal lymphocytes. RESULTS: Six of 33 healthy volunteers (18%) demonstrated a positive reaction to this technique. CEA mRNA expression was detected in the portal blood in 51% of patients and in the peripheral blood in 42% of patients. The results from the two blood samples were consistent in 91% of patients. The positive expression rates for portal blood in patients with T1 tumors and those with TNM Stage I disease were 38% and 45%, respectively. The positive rate was significantly higher in patients with colon carcinoma and those with Stage III or IV disease. CEA mRNA expression, quantitatively measured (x 10(-8)/beta-actin), was 22.9 +/- 35.1 in the portal blood and 19.9 +/- 40.0 in the peripheral blood, with no statistically significant difference. A significant positive correlation was noted between portal and peripheral CEA mRNA expression levels according to Spearman correlation analysis (correlation coefficient = 0.78; P < 0.01). Multivariate analysis revealed that the positive rate and level of CEA mRNA expression in the portal and peripheral blood did not appear to be influenced by the established prognostic factors. CONCLUSIONS: The presence of circulating tumor cells might be of less value as a prognostic factor because they also can be detected in patients with early-stage colorectal carcinoma and appeared to be independent of the conventional prognostic factors.
Some fetuses whose mothers have idiopathic thrombocytopenic purpura (ITP) may themselves have low platelet count and are thought to be at risk of serious bleeding complications, especially intracranial bleeding, during vaginal delivery. The aim of the present study was to prospectively evaluate outcome for mothers with ITP and their neonates with or without the information provided by percutaneous umbilical blood sampling (PUBS). Our intention was to perform cordocentesis using PUBS to measure fetal platelet count in pregnant women with ITP, utilizing the information thus derived as an aid in planning for delivery. Thirty-five pregnancies in 34 women with ITP or low platelet count (< 105 x 10(9)/L) were monitored. PUBS was to be performed on 13 women only, five of whom were splenectomized. There were two complications related to the PUBS itself which led to cesarean sections on the same day. Twelve of the 13 fetuses with PUBS had platelet count greater than 50 x 10(9)/L in the 36th week of pregnancy, and vaginal deliveries were initially planned. After experiencing one serious complication with PUBS, we found it difficult for ethical reasons to perform PUBS on mothers with ITP. Therefore 22 pregnancies were monitored without PUBS. Nine of the 35 children (26%) were delivered by cesarean section. The frequencies of vaginal and cesarean deliveries in the groups with and without PUBS were the same. Six of 15 neonates (40%) born to splenectomized mothers had platelet counts less than 50 x 10(9)/L during the first days of life and four of these were treated with intravenous gamma globulin and/or cortisone. No intracranial bleeding was observed in any of the children. In our hands, PUBS in ITP is potentially harmful and must be questioned. The frequency of low platelet count and/or bleeding complications in neonates of mothers with ITP born vaginally is low. In our opinion, the mode of delivery should be chosen mainly on the basis of obstetric criteria.
A rapid test for the diagnosis of congenital CMV infection is still needed. This study evaluated the usefulness of dried blood and urine samples collected on filter paper for detecting cytomegalovirus (CMV) by the polymerase chain reaction (PCR) assay compared with the use of liquid urine. Samples were obtained from 332 infants aged 1-7 days. Liquid urine samples were collected into bags, cultured in human fibroblasts, and processed using a multiplex PCR technique. Dried urine samples were obtained by placing a piece of filter paper in contact with the infant's genitals. The heels of neonates were punctured and capillary blood was blotted onto filter paper and dried. Dried blood and urine specimens were analyzed by multiplex PCR and nested-PCR assays. A diagnosis of congenital CMV infection was established by isolating the virus, and by detecting viral DNA in the liquid urine. Of the 332 liquid urine samples collected from 332 neonates, seven (2.1%) were positive for CMV and 325 were negative, by both cell culture and PCR assay. In dried samples, CMV DNA was detectable only with a nested PCR assay. Compared with known CMV infection status, 5/7 (71.4%) neonates were positive for congenital CMV infection using dried blood samples. All 325 uninfected neonates were negative. In the dried urine samples, 4/4 CMV-infected infants gave positive tests, and all 262 uninfected infants were negative. Although further improvements in sample collection and/or processing are still needed, PCR testing on dried urine or blood collected on filter paper is a promising approach in the diagnosis of neonatal CMV infection.