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CHROMOSOMES IN GIANT HÆMANGIOMA WITH THROMBOCYTOPENIA
1170
during the first trimester and as altered by the nutritional status during the critical periods of embryogenesis. (vi) Karyotypic variants: subject to the above considerations, a general proportionality is to be found between excess or deficiency of chromosomal material and the resultant phenoHowever, in the apparently completely trisomic type. syndromes (such as Ei-trisomy) phenotypic variability can but rarely be assigned to undetected mosaicisms, deletions and/or translocations too small to be recognised by the microscope,
as
suggested by others.2
Human Cytogenetics Research Laboratory, Los Angeles County Hospital, Los Angeles, California.
RUSSELL A. ROHDE NATALINE BERMAN.
CHROMOSOMES IN GIANT HÆMANGIOMA WITH THROMBOCYTOPENIA
finding by Becak and others1 an of extra acrocentric chromosome in a case of giant cavernous haemangioma with thrombocytopenia, a case of this condition previously described2 has been studied for chromosome complement. Now aged 4 years, the boy is entirely well. No trace remains of the hsemangioma, though there is some atrophy of subcutaneous tissues at the site of the haemangioma and the irradiation therapy. A peripheral-blood leucocyte culture showed a normal male karyotype, SIR,-After
we
read the
44+XY. Departments of Microscopic Anatomy and Pædiatrics,
University of Western Ontario, London, Canada.
D. H. CARR G. H. VALENTINE.
MODIFIED DIRECT ANTI-GLOBULIN TEST FOR DIAGNOSIS OF HÆMOLYTIC DISEASE OF THE NEWBORN DUE TO ABO INCOMPATIBILITY
SIR,-The Coombs test is usually negative in newborns with haemolytic disease due to ABO incompatibility, except when a sensitive method such as Rosenfield’s is used. Some anti-globulin reagents produce very weak agglutination of A globules in newborns sensitised by hyperimmune anti-A antibodies, but the same reagents give a stronger reaction when adult A globules are used in the same circumstances. We noted a similar reaction, in vivo, after an exchangetransfusion with adult Al Rh-negative blood, in an Al Rhpositive newborn with icterus, whose mother had both an anti-D antibody and a hyperimmune anti-A antibody. The direct anti-globulin test became strongly positive after the exchange-transfusion, while icterus increased. We have been able to eluate an anti-A antibody from adult red blood-cells circulating in the child.3 This reveals different behaviour between adult and newborn red blood-cells, which also appears when anti-H antibodies are mixed with adult 0 red blood-cells which are agglutinated or newborn 0 red bloodcells which are not. Likewise, anti-AI antibody agglutinates adult Al red blood-cells, but not those of Al newborn. If newborn red blood-cells are treated with papain, they may be agglutinated either by anti-H if they are 0, or by anti-AI if
they
AI, prompted
are
us to treat newborn A red blood-cells with and confront them with immune anti-A antibodies: papain we obtained no agglutination, but a mere coating giving a positive Coombs test. These results were no different when a different order was used: first confronting anti-A antibody and newborn A red blood-cells, then treating with papain, and lastly the Coombs test.4 Thus, coating of newborn red blood-cells by anti-A anti-
This
Beçak, W., Beçak, M. L., Andrade, J. D., Manissadjian, A. Lancet, Aug. 31, 1963, p. 468. Valentine, G. H. Canad. med. Ass.J. 1961, 84, 791. Bierme, R., Ducos, J., Vergnes, H. Nouv. Rév. franç. Hemat. (in the press). 4. Ducos, J., Ruffie, J., Marty, Y. ibid. (in the press). 1.
2. 3.
bodies is detectable by papain and selected anti-globulin reagents. We checked it by applying our technique to all cordblood samples sent by the obstetric department of the medical school and Maternity Hospital of Toulouse. 1. Mothers and children, compatible for ABO.-The direct Coombs test was always negative, either by the usual technique, or by ours (more than 300 samples examined). 2. Group-A children born from 0 mothers not immunised against A.-The Coombs test was either normal or (with papain) always negative (more than 100 samples). 3. Group-A children born from 0 mothers immunised against A. -We regard a mother as immunised against A when her rate of anti-A exceeds 1/256, and is higher in albuminous medium than in saline medium, and when heating of the serum for 20 minutes at 70°C does not entirely suppress anti-A activity
(13 samples). In all
cases
in group 3 the usual Coombs
test
made with
anti-globulin reagents was weakly positive. But in 6 cases, the Coombs test, after treatment with papain, became strongly positive, whereas in 7 others it remained unaltered. The 6 some
children of the first group had icterus, their indirect bilirubin 11 mg. per 100 ml. to 29 mg. per 100 ml. 2, examined rather late, had to be treated by exchange-transfusion ; the others were given extracts of lyophilised liver and corticoids in time, which enabled us to avoid exchangetransfusion. The serum-bilirubin in the 7 children of the second group was less than 2 mg. per 100 ml.; and they had no icterus, despite the absence of preventive treatment.
varying from
The Coombs test on A red blood-cells of the newborn, previously treated with papain, permits early diagnosis of haemolytic disease of the newborn due to ABO incompatibility before the appearance of any icterus. Prophylactic medical treatment avoids the need for exchange transfusion. Centre de Transfusion
Sanguine, Hôpital Purpan,
Toulouse, France.
REPORTS
FROM
HOSPITAL
J. DUCOS. CONSULTANTS
SiR,—I wonder whether other general practitioner have come across a device used by a few local consultant in their hospital reports. During the past few years I havl " received reports which end " dictated but not signed and others do not bear a signature but only a stampe( name.
In either case, there are mistakes which one coul( hardly expect a secretary to correct. Surely a few minute for the signature is not asking much, particularly when th reports come sometimes four or six weeks after tb patient’s discharge from hospital. SIGNET.
VENTRICULAR DEFIBRILLATION AND CARDIAC MASSAGE
SIR,-After ventricular defibrillation a series of weak contractions may occur. These do not empty the left ventricle, and it gradually dilates and fibrillation again occurs. One has been hesitant to apply manual massage immediately the weak beat occurs for fear of producing fibrillation. I recently had occasion to test the effect of bimanual massage on the weakly contracting heart. Three shocks were applied to the heart within a few seconds. A weak beat appeared and bimanual massage was immediately commenced. This was continued for fifteen minutes and the spontaneous beat was felt between the hands, whether the hands were in a position of pressure or relaxation. At the end of this time the beat was strong and the ventricle was small in systole. 5.
Bierme, R., Ducos, J., Bourbon, P., Poey, J. Sem. Hôp. Paris, 1960, 36, 431.
during the first trimester and as altered by the nutritional status during the critical periods of embryogenesis. (vi) Karyotypic variants: subject to the above considerations, a general proportionality is to be found between excess or deficiency of chromosomal material and the resultant phenoHowever, in the apparently completely trisomic type. syndromes (such as Ei-trisomy) phenotypic variability can but rarely be assigned to undetected mosaicisms, deletions and/or translocations too small to be recognised by the microscope,
as
suggested by others.2
Human Cytogenetics Research Laboratory, Los Angeles County Hospital, Los Angeles, California.
RUSSELL A. ROHDE NATALINE BERMAN.
CHROMOSOMES IN GIANT HÆMANGIOMA WITH THROMBOCYTOPENIA
finding by Becak and others1 an of extra acrocentric chromosome in a case of giant cavernous haemangioma with thrombocytopenia, a case of this condition previously described2 has been studied for chromosome complement. Now aged 4 years, the boy is entirely well. No trace remains of the hsemangioma, though there is some atrophy of subcutaneous tissues at the site of the haemangioma and the irradiation therapy. A peripheral-blood leucocyte culture showed a normal male karyotype, SIR,-After
we
read the
44+XY. Departments of Microscopic Anatomy and Pædiatrics,
University of Western Ontario, London, Canada.
D. H. CARR G. H. VALENTINE.
MODIFIED DIRECT ANTI-GLOBULIN TEST FOR DIAGNOSIS OF HÆMOLYTIC DISEASE OF THE NEWBORN DUE TO ABO INCOMPATIBILITY
SIR,-The Coombs test is usually negative in newborns with haemolytic disease due to ABO incompatibility, except when a sensitive method such as Rosenfield’s is used. Some anti-globulin reagents produce very weak agglutination of A globules in newborns sensitised by hyperimmune anti-A antibodies, but the same reagents give a stronger reaction when adult A globules are used in the same circumstances. We noted a similar reaction, in vivo, after an exchangetransfusion with adult Al Rh-negative blood, in an Al Rhpositive newborn with icterus, whose mother had both an anti-D antibody and a hyperimmune anti-A antibody. The direct anti-globulin test became strongly positive after the exchange-transfusion, while icterus increased. We have been able to eluate an anti-A antibody from adult red blood-cells circulating in the child.3 This reveals different behaviour between adult and newborn red blood-cells, which also appears when anti-H antibodies are mixed with adult 0 red blood-cells which are agglutinated or newborn 0 red bloodcells which are not. Likewise, anti-AI antibody agglutinates adult Al red blood-cells, but not those of Al newborn. If newborn red blood-cells are treated with papain, they may be agglutinated either by anti-H if they are 0, or by anti-AI if
they
AI, prompted
are
us to treat newborn A red blood-cells with and confront them with immune anti-A antibodies: papain we obtained no agglutination, but a mere coating giving a positive Coombs test. These results were no different when a different order was used: first confronting anti-A antibody and newborn A red blood-cells, then treating with papain, and lastly the Coombs test.4 Thus, coating of newborn red blood-cells by anti-A anti-
This
Beçak, W., Beçak, M. L., Andrade, J. D., Manissadjian, A. Lancet, Aug. 31, 1963, p. 468. Valentine, G. H. Canad. med. Ass.J. 1961, 84, 791. Bierme, R., Ducos, J., Vergnes, H. Nouv. Rév. franç. Hemat. (in the press). 4. Ducos, J., Ruffie, J., Marty, Y. ibid. (in the press). 1.
2. 3.
bodies is detectable by papain and selected anti-globulin reagents. We checked it by applying our technique to all cordblood samples sent by the obstetric department of the medical school and Maternity Hospital of Toulouse. 1. Mothers and children, compatible for ABO.-The direct Coombs test was always negative, either by the usual technique, or by ours (more than 300 samples examined). 2. Group-A children born from 0 mothers not immunised against A.-The Coombs test was either normal or (with papain) always negative (more than 100 samples). 3. Group-A children born from 0 mothers immunised against A. -We regard a mother as immunised against A when her rate of anti-A exceeds 1/256, and is higher in albuminous medium than in saline medium, and when heating of the serum for 20 minutes at 70°C does not entirely suppress anti-A activity
(13 samples). In all
cases
in group 3 the usual Coombs
test
made with
anti-globulin reagents was weakly positive. But in 6 cases, the Coombs test, after treatment with papain, became strongly positive, whereas in 7 others it remained unaltered. The 6 some
children of the first group had icterus, their indirect bilirubin 11 mg. per 100 ml. to 29 mg. per 100 ml. 2, examined rather late, had to be treated by exchange-transfusion ; the others were given extracts of lyophilised liver and corticoids in time, which enabled us to avoid exchangetransfusion. The serum-bilirubin in the 7 children of the second group was less than 2 mg. per 100 ml.; and they had no icterus, despite the absence of preventive treatment.
varying from
The Coombs test on A red blood-cells of the newborn, previously treated with papain, permits early diagnosis of haemolytic disease of the newborn due to ABO incompatibility before the appearance of any icterus. Prophylactic medical treatment avoids the need for exchange transfusion. Centre de Transfusion
Sanguine, Hôpital Purpan,
Toulouse, France.
REPORTS
FROM
HOSPITAL
J. DUCOS. CONSULTANTS
SiR,—I wonder whether other general practitioner have come across a device used by a few local consultant in their hospital reports. During the past few years I havl " received reports which end " dictated but not signed and others do not bear a signature but only a stampe( name.
In either case, there are mistakes which one coul( hardly expect a secretary to correct. Surely a few minute for the signature is not asking much, particularly when th reports come sometimes four or six weeks after tb patient’s discharge from hospital. SIGNET.
VENTRICULAR DEFIBRILLATION AND CARDIAC MASSAGE
SIR,-After ventricular defibrillation a series of weak contractions may occur. These do not empty the left ventricle, and it gradually dilates and fibrillation again occurs. One has been hesitant to apply manual massage immediately the weak beat occurs for fear of producing fibrillation. I recently had occasion to test the effect of bimanual massage on the weakly contracting heart. Three shocks were applied to the heart within a few seconds. A weak beat appeared and bimanual massage was immediately commenced. This was continued for fifteen minutes and the spontaneous beat was felt between the hands, whether the hands were in a position of pressure or relaxation. At the end of this time the beat was strong and the ventricle was small in systole. 5.
Bierme, R., Ducos, J., Bourbon, P., Poey, J. Sem. Hôp. Paris, 1960, 36, 431.