ALBERT

Description: Red cells labeled with radioactive phosphorus have been used by us to measure the extent and the rate of the replacement of blood in exchange transfusions. The experimental results confirmed the theoretic formulations developed in the preceding paper. On the basis of the above data, it seems reasonable to introduce these curves and formulae whenever exchange transfusions are to be performed.

Description: 1. Theoretic effectiveness of different types of exchange transfusions has been determined. 2. Homogeneous and nonhomogeneous solutions used as the exchanging medium differ in final results obtained. 3. The final concentration of original eryrthrocytes (in per cent of total red cells in the circulation) diminishes as the ratio of donor to patient’s initial hematocrit increases for the same volume exchange. 4. Final hematocrit values may be obtained from the calculated data. 5. Optimum considerations for exchange transfusions are discussed.

Description: 4-Amino-N10-methyl-pteroylglutamic acid in the usual treatment dosage caused a slight leukopenia, but no change in the differential count of normal mice. However, in animals with the Ak 4 strain of transplanted leukemia, such dosage caused prolongation of survival time, held the total leukocyte count at approximately normal levels, decreased the percentage of abnormal cells, and caused a marked delay in the appearance of leukemic infiltrations in liver, spleen, lymph nodes, kidney and bone marrow. Less than twenty hours after administration, a single massive dose of this drug caused a fall in the total leukocyte count of mice with advanced Ak 4 leukemia.

Description: Frommeyer, Epstein and Taylor: Refractoriness in hemophilia to coagulation-promoting agents: Whole blood and plasma derivatives. Blood 5: 401-420 (May), 1950. The authors wish to note that the following changes should have appeared in the article: Page 402, first line: "Lawrence and Johnson, 1941,8 reported" (instead of "Lawrence and Johnston, in 1946,8 reported"). Page 402, second sentence of same paragraph: "In this instance the patient had received whole blood and plasma in therapeutic management prior to the appearance of resistance to therapy." (instead of ". . . had received chemically prepared plasma fractions in the form of Fraction I of Cohn in addition to whole blood and plasma in therapeutic management prior to . . . "). Page 420, reference 8. To this reference should be added: "(Presented before the American Clinical and Climatological Society, October 1941.)".

Description: 1. Dependable results with supravital staining can be obtained only with apochromatic objectives, compensating oculars, an achromatic condenser, controlled illumination and a transparent daylight filter on the light source. 2. Proper technic is of the utmost importance in making supravital slides. 3. Pinacyanol is preferable to Janus green as a mitochondrial stain. 4. Supravital preparations should be studied in a darkened room to increase the apparent brilliance of the staining. 5. More accurate counts of the number of lobes in the nucleus of neutrophils can be made with the supravital method than from dried stained smears. 6. Myelocytes C in supravital preparations correspond to the myelocytes seen on dried smears, while myelocytes B are the promyelocytes. 7. Myelocyte A has been redefined. The neutrophil granules of these cells do not as a rule stain on dried smears, and these cells are therefore classed as myeloblasts or leukoblasts in the latter type of preparation. They are peroxidase-negative. 8. Myeloblasts may or may not contain neutral red vacuoles, and may or may not contain a rosette. 9. Supravital staining is a good technic for the identification of monocytes from human blood and marrow, and is the method of choice for the study of macrophages. 10. Supravital preparations of the peripheral blood of severe cases of erythroblastosis foetalis show all transition stages between monocytes and macrophages, and there is no reason for regarding these cells as separate types. 11. Lymphocytes contain many more neutral red vacuoles than have been previously described. 12. The lymphocyte of infectious mononucleosis has a characteristic appearance, and can be used as a means of diagnosis. 13. Qualitative changes do not always occur in the lymphocytes of acute lymphatic leukemia. 14. Myeloma cells have a characteristic appearance in supravital preparations. 15. Sarcoma cells in the peripheral blood are more variable in appearance than had been supposed. 16. The precipitation of neutral red in the cytoplasm is a quantitative staining reaction and is not specific for the earliest stages in red cell formation. 17. The appearance of the developing red cells in supravital preparations is described. 18. The megaloblastic line of developing red cells which is present in pernicious anemia cannot be distinguished in supravital preparations from the normoblastic line found in normal marrow or in marrow after hemorrhage or hemolysis. 19. The supravital method therefore cannot be used for diagnostic work involving erythropoiesis. 20. There is no evidence of any kind indicating that a maturation arrest occurs in pernicious anemia. 21. Cells intermediate between pronormoblasts and myeloblasts are occasionally seen in supravital preparations. 22. Differential counts can be made from supravital slides just as accurately as from dried stained smears, and if many fragile cells are present, more accurately. 23. The cytology of the developing blood cells as seen in supravital preparations would support a monophyletic view of hematopoiesis just as well as the polyphyletic theory.

Description: 1. A series of 1337 obstetric cases, of which 170 were instances of sensitized Rh negative women, were studied with regard to (a) the incidence of the ABO blood groups, and (b) the incidence of ABO compatibility between the mother and child. 2. The incidence of ABO compatibility between the mother and child was found to vary with the blood group of the mother. 3. ABO compatibility between the mother and child was found to be present in 80 per cent of an unselected obstetric population in contrast to 95 per cent in a group of sensitized Rh negative women who bore infants afflicted with hemolytic disease of the newborn. 4. ABO compatibility appears to be related to the occurrence of hemolytic disease of the newborn. 5. In 120 sensitized Rh negative women who bore afflicted infants, the incidence of group A mothers was greater than expected.

Description: Twenty-two patients with classic hemophilia were studied from the point of view of refractoriness to the usual coagulation-promoting effect of whole blood, and of chemically prepared plasma fractions. Of these, 5 patients showed clinical and laboratory evidence of refractoriness to therapy. All had previously received by intravenous injection for therapeutic purposes during bleeding episodes large amounts of plasma fractions in addition to whole blood and plasma. Subsequently, each refractory patient exhibited a poor clinical response to therapy during hemorrhagic episodes. Thus, despite the administration of whole blood, plasma, or plasma derivatives in amounts which were usually effective, bleeding continued unabated and the blood coagulation time was not significantly reduced. An anticoagulant distinct from antithrombin, antithromboplastin, antiprothrombin and heparin was demonstrated in the plasma of each patient. Each had adequate amounts of fibrinogen and prothrombin in the circulating plasma. However, antibodies were demonstrated in the plasma of each patient by means of precipitin reactions with antigens possessing antihemophilic activity, including various plasma derivatives and Fraction I of Cohn. No such antibodies were demonstrable in a normal individual, in 2 anemic patients who had received many transfusions of whole blood, or in a patient with afibrinogenemia who had received large amounts of antihemophilic globulin because of its fibrinogen content. Prompt reduction in plasma anticoagulant activity, in precipitin titer, and coagulation time were effected only by the administration of large quantities of fresh whole blood. A secondary rise of antibodies always followed such a procedure within several days. When therapy was withheld, the anticoagulant effect and precipitin titer decreased in one patient over a period of six months and in another, had essentially disappeared by the end of a year. From these studies the following conclusions may be drawn: 1. A refractory state in hemophilia may develop following the therapeutic use of whole blood, plasma or chemically prepared plasma fractions. 2. This state is characterized by defective clinical and laboratory responses to therapy with whole blood, plasma or plasma fractions. An anticoagulant is demonstrable in the plasma as well as precipitins to various plasma derivatives possessing antihemophilic activity. 3. The formation of antibodies is apparently an immunologic response to a substance closely associated with antihemophilic activity in normal blood and in plasma derivatives previously employed in therapy. 4. The refractory state can be promptly and temporarily abolished and good clinical and laboratory responses can be effected by transfusions of very large amounts of fresh whole blood. 5. Because of their demonstrated ability to act as antigens in certain hemophilic patients, whole blood, plasma and chemically prepared plasma fractions should be withheld unless their employment as an emergency therapeutic measure is necessary.

Description: A case has been presented in which thrombocytopenic purpura was a complication of infectious mononucleosis. A review of the literature revealed 6 other cases in which there was an association between these conditions. Serial platelet counts were made in 7 consecutive cases of infectious mononucleosis. There was a slight depression of the platelets early in the illness, followed by a thrombocytosis and a subsequent return to normal. Hypersplenism is considered as a possible cause for the thrombocytopenia in infectious mononucleosis.

Description: By Baker’s method for the staining of lipids, various types of cytoplasmic rods and granules in leukocytes give a positive acid hematein test but are negative after the pyridine-extraction test. According to Baker,8 this combination of results indicates the presence of phospholipids. Some of the rods and granules which are stained appear to be mitochondria, judging from their shape, size and distribution. as well as from the fact that they coincide in all respects with mitochondria demonstrable by supravital staining. Baker8 pointed out that in a great variety of cells his method stained mitochondria, although he did not report having examined leukocytes. In addition to mitochondria, Baker’s method stains the specific granules of the three varieties of granular leukocytes. In the neutrophilic leukocytes, the granules appear gray or black; in some of the eosinophilic leukocytes, they are intensely black, while in others they are unstained although surrounded by stained ground substance; and in the basophilic leukocytes, some of the granules of individual cells are stained while others are not. Provided the method is chemically specific, it follows that the specific granules of these leukocytes contain phospholipids. The appearance of the eosinophils indicates that many of them possess granules composed of protein surrounded by phospholipid, although some of them contain granules with lipid in their interiors. These differences in the eosinophils suggest possible functional stages, related perhaps to the age of the cells or some other metabolic factors. In the monocytes, besides a general stippling of the cytoplasm corresponding to mitochondria, the region of the attraction sphere often contains numerous deeply stained granules. Sudan black B stains both the mitochondria and the specific leukocytic granules in a manner similar to Baker’s method. However, certain slight differences were noticed. Platelets were brought out moderately distinctly by the acid hematein procedure, whereas in sudan black preparations they were barely visible. A variability was noted in the staining of the granules of the eosinophilic leukocytes in Baker’s method, in contrast to the uniformity of their staining with sudan black. This difference should perhaps be interpreted as indicating that the eosinophilic granules contain other lipid substances besides phospholipids. Mitochondnia, in whatsoever type of leukocyte they are observed, appear to stain more deeply and distinctly by Baker’s method than with sudan black, a circumstance suggesting that mitochondria are very rich in phospholipids.