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Hemoglobinometry: A comparison between the hemiglobincyanide method and the Coulter S counter.

The relative accuracy and precision of the Coulter S Counter have been evaluated in comparison with manual hemiglobincyanide determination according to the recommendations of the International Committee for Standardization in Hematology. Some improvements in the manual procedure, such as centrifugation of hemiglobincyanide solutions and the use of the detergent Triton X-100, were also tested. The Coulter S Counter generally gives higher precision in comparison with the manual method. Nevertheles, Coulter S determinations are systematically lower due to both constant and proportional errors. The available data ranged between hemoglobin values of 11.5 and 18.5%, giving differences of 0-8% between hemoglobin values determined by the Coulter S Counter and the hemiglobincyanide method.

Detergents

The calibration of automated instruments for accuracy in hemoglobinometry.

The surveys of the College of American Pathologists indicate a consistent bias between the manual "reference" method for hemoglobin determinations and the Coulter S measurements. The Coulter S hemoglobin values are invariably lower; the difference averages 0.3 g/dl. The commonly used calibration methods for the Coulter appear to be subobtimal. The hemoglobin calibration and quality assurance method proposed by Bull and colleagues is advocated as the presently most acceptable method. Commercial hemoglobin control materials should not be used for hemoglobin calibration.

Automation

Less symptomatic hypotension using blood volume controlled ultrafiltration.

Symptomatic hypotension due to ultrafiltration (UF) is one of the most frequent unwanted side effects of dialysis therapy. Using hemoglobinometry for continuous monitoring of blood volume (BV), ultrafiltration rate (UFR) can be adapted to actual changes in BV. A control system is shown in which UFR is set according to a predefined profile of BV. The conditions of control are: relative BV shall decrease steadily; BV shall decrease rapidly during the first 60 min of dialysis, thereafter decrease in BV should be less; UFR shall be as high as possible; and dry weight should be obtained within a given time. Application of this controlled UF method in 10 dialysis patients shows significantly fewer hypotensive periods and muscle cramps compared to conventionally constant UFR. It is concluded that BV controlled UF is an important step toward optimizing dialysis therapy.

Blood Flow Velocity

[Envenomation by Echis Carinatus in Africa: clinical study and evolution. Indications for antivenins].

In North Cameroon, venom inoculations by Echis Carinatus are frequent and severe and thus pose a serious problem at Public Health Services. 48 bites without antivenomous serum injection have been considered in Garoua, Benoue valley North Cameroon. Without antivenomous serum light inoculations heal spontaneous by in a couple of days about 20% of the average clinical forms are evoluting insidiously to severe globulolysis. The great majority of severe inoculations lead to dreadful hemorrhagic threatening the life of patients. New borns and infants are particularly exposed, it is not advisable to inject systematically antivenomous serum. But it has to be considered as compulsory in the three following clinical situations before 11 years of age, venom inoculation often brings about fast aggravation, mainly in new borns, after 11 years and at adult age, when clinical signs are of great concern, when hemoglobinometry indicates less than 9 gr/100 ml after 48 hours of evolution in youngs and adults, but without any symptom of severity.

Adolescent

The conjunctival sickling sign, hemoglobin S, and irreversibly sickled erythrocytes.

Sixty-five patients with hemoglobins AS, SC, and SS were investigated in a masked fashion. We observed a statistically significant positive correlation between the severity of conjunctival sickling signs and the counts of irreversibly sickled cells in each hemoglobinopathy group. We also observed a statistically significant positive correlation between the severity of the conjunctival vasculopathy and the percentage of sickle hemoglobin in the total group of patients with hemoglobins AS, SC, and SS.

Adolescent

Cardiovascular disease risk factor variables during the first year of life.

Cardiovascular risk factor variables were measured in a cohort of 440 infants at birth 6 months, and 1 year of age. Blood pressures at 6 months of age were 93/47 mm Hg (systolic/diastolic pressure, fourth phase) and 97/51 mm Hg at 1 year of age. Serum total cholesterol, beta-lipoprotein, and alpha-lipoprotein levels rose dramatically from birth to 1 year of age. Serum triglycerides also showed an increase from birth to 6 months of age, but a decrease from 6 months to 1 years of age. At 6 months of age, the infants were consuming 949 kcal and at 1 year, 1,356 kcal. A statistically significant correlation between serum cholesterol level and protein, fat, cholesterol, and carbohydrate intake was noted at 1 year of age. These observations provide a background for tracing the evolution of risk factor variables as part of the early natural history of arteriosclerosis.

Anthropometry

Splenectomy for hematologic depression in lymphocytic lymphoma and leukemia.

Fifty patients with lymphocytic lymphoma and chronic lymphocytic leukemia underwent splenectomy for various combinations of anemia, thrombocytopenia, and leukopenia. All of these patients had advanced lymphoproliferative disease, and most had infiltration of bone marrow by neoplastic cells. Good response in all hematologic parameters was obtained in 27 of 48 evaluable patients. An additional 13 patients responded in one or two parameters; there were only 8 complete failures. The over-all surgical mortality was 8%. The median duration of response was 4 months, and the mean, 7 months. Increased tolerance to further antitumor therapy and a decreased transfusion requirement were seen among responding patients. Those patients with anemia who had evidence of shortened erythrocyte survival and splenic sequestration of 51Cr-labelled erythrocytes uniformly responded with rises in hemoglobin. However, half of the patients with negative splenic sequestration also showed improvement of anemia. Preoperative diagnostic studies failed to predict favorable responses of patients with thrombocytopenia or leukopenia. The classical criteria for the diagnosis of hypersplenism are not applicable in many cases of neoplastic lymphoproliferative disease; splenectomy could have been considered "contraindicated" in most of the patients in this series. We conclude that splenectomy is worth undertaking in patients with lymphoproliferative disease complicated by hematologic depression regardless of marrow findings or the results of other diagnostic studies.

Adult

The haematological hazards of autotransfusion.

Fourteen heparinized dogs were autotransfused from 1-5 to 6 times calculated blood volume. Five animals retransfused 12 litres from an intraperitoneal bleed had marked decreases in all cellular elements, haematuria and a large (82 percent) drop in fibrinogen. All these animals died within 12 hours and post-mortem examination revealed evidence of disseminated intravascular coagulopathy. The dogs in which a smaller volume (3-6 litres) was recycled showed similar, but less devastating, changes. Haematocrit and platelet count dropped by a half and fibrinogen by 20 per cent. A leucocytosis of about 30 000/mm3 occurred within 24 hours. Autotransfusion of salvaged blood which was not allowed extravascular tissue contact significantly lessened these adverse effects. We conclude that the risk of cellular destruction and defibrination in large volume intra-operative autotransfusion is significant and must be weighed against its potential benefits in each case, and that red cell and platelet damage results primarily from extravascular tissue contact and is therefore unavoidable.

Animals

Percutaneous transluminal coronary angioplasty in a patient with paroxysmal nocturnal hemoglobinuria.

Paroxysmal nocturnal hemoglobinuria (PHN) is an acquired chronic hemolytic anemia associated with an unusual susceptibility to hemolytic crisis, infection, and venous thrombosis which would be aggravated by a number of factors including surgery. We report a case of PHN undergoing percutaneous transluminal coronary angioplasty and discuss the corresponding perioperative management.

Adult

High-speed rotational angioplasty-induced echo contrast in vivo and in vitro optical analysis.

High-speed rotational angioplasty is being evaluated as an alternative interventional device for the endovascular treatment of chronic coronary occlusions. It has been postulated that this type of angioplasty device may produce particulate debris or cavitations that induce myocardial ischemia. To determine the clinical presence of myocardial ischemia during rotational angioplasty, echocardiographic monitoring for wall motion abnormalities was performed in 9 patients undergoing rotational atheroablation using the Auth Rotablator for 10-sec intervals at 150,000 and 170,000 rpm. No wall motion abnormalities were detected in 5 patients evaluated with transesophageal echocardiography or in 4 patients monitored transthoracically, although AV block developed in one patient. Video intensitometry of the myocardial contrast effect for rotation times ranging from 3 to 20 sec found transient contrast enhancement of the myocardium supplied by the treated vessel. Intensity varied over time with half-time decay between 5.6 and 40 sec, indicating the likelihood of microcavitation. An in vitro model was constructed to measure the cavitation potential of the Auth Rotablator. A burr of 1.25 mm diameter rotating at 160,000 rpm achieves a velocity in excess of the 14.7 m/sec critical cavitation velocity. Testing the device in fresh human blood and distilled water produced microcavitations responsible for the enhanced echo effect, with the intensity and longevity of cavitation more pronounced in blood and proportional to the rotation time and speed. The mean size of the microcavitation bubbles in water was 90 +/- 33 (52-145) microns measured from photographs taken with a copper vapour laser emitting light pulses of 50 nsec duration as light source. The mean velocity of bubbles was found to be 0.62 +/- 0.30 ranging from 0.23 to 1.04 m/sec. It was measured via the motion of the bubbles during 5 laser pulses within 800 nsec. Clearly, microcavitations are associated with enhanced myocardial echo contrast effect.

Angioplasty, Balloon, Coronary

Hemolytic potential of methocarbamol.

Methocarbamol, a compound related to mephenesin, has in vitro hemolytic potential. A study was performed to determine whether any hemolysis was detectable after intravenous injection. Methocarbamol and its vehicle (50% polyethylene glycol-300) was compared with vehicle alone and with normal saline controls in high- and low-dose regimens in normal volunteers. Significant increases in plasma hemoglobin were detected 30 min after intravenous injection of methocarbamol or its vehicle alone. Maximum initial plasma hemoglobin levels were approximately 10 mg/dl with vehicle alone, but only 4 mg/dl with the methocarbamol added. Serum haptoglobin levels fell after both high-dose methocarbamol and vehicle during the 3-day period of treatment. Hemolysis, though detectable, did not exceed levels found under physiologic circumstances such as exercise, and represents only a small fraction of the normal daily hemolysis of aged erythrocytes.

Adult

Use of anemic piglet to assess bioavailability of iron from oral iron preparations.

Except for methods using long-lived iron isotopes, there are no reliable means for assessing the bioavilability of iron from oral preparations in human subjects. Use of the anemic piglet as an alternative means was studied. When piglets were made anemic on a commercial milk diet and then dosed with solutions of 1, 2, and 5 mg/kg of ferrous sulfate/day, a dose-related recovery of hematocrit and hemoglobin levels resulted. The most sensitive dose range for use in a bioavailability study of iron was between 1 and 2 mg of iron/kg/day when using these parameters. A study carried out using this method indicated that the iron from a delayed-release capsule and from a ferrous sulfate solution was equally bioavailable. Hemoglobin and hematocrit recovery rates of the anemic piglet were shown to be reliable and sensitive indicators of the bioavailability of iron from various iron dosage forms.

Anemia, Hypochromic

Simultaneous prevention of blood abnormalities and hereditary congenital amputations in a brachydactylous rabbit stock.

Hematological and histological studies of the rabbit brachydactyly mutant were made to clarify the question of the blood abnormality that had previously been implicated in the teratogenic process leading to congenital amputation. The hemoglobin of fetal and adult br/br rabbits, studied by electrophoresis and cyanmethemoglobin assay, exhibited no differences from that of controls. The br/br fetuses were polycythemic and severely macrocytic. Fetal limb vessels showed thrombosis leading to hemorrhages in the extremities. The hepatic tissue was abnormal, being particularly poor in hematopoietic cells; blood cell macrocytosis was attributed to impaired erthropoiesis. Treatment of pregnant rabbits with folic acid plus vitamin B12 or with folinic acid was able simultaneously to prevent the fetal blood cell macrocytosis and the congenital abnormalities.

Abnormalities, Multiple