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Leukocyte larceny: a cause of spurious hypoxemia
L
Arterial catheters
in the therapy of serious infections,
Bacteremia
Continued
Mezlocillin, a new semisynthetic penicillin chemically related to ampicillin which is more active than carbenicillin against Ps. aeruginosa, 6. fragilis and Strep. faecalis and which inhibits many Klebsiella, was evaluated in the therapy of 34 episodes of infection in 26 patients. Seven patients had bacteremia. Clinical cures were achieved in 83 per cent and bacteria cures in 76 per cent of infections. Adverse effects of therapy were minimal, one rash and one episode of reversible neutropenia. Serum and body fluid levels were easily maintained above the inhibitory levels of susceptible organisms. Mezlocillin was a safe, well tolerated and effective antibiotic in the treatment of infections due to susceptible organisms.
Pancoast SJ, Jahre JA, Neu HC: Mezlocillin Am J Med 67: 747-752, 1979.
Mezlocillin therapy
Serious infections
We studied prospectively the risk of infection caused by arterial catheters used for hemodynamic monitoring in 95 patients. Of 130 catheters, 23 (18 per cent) produced local infection and five septicemia (4 per cent). Sixteen local infections and all five septicemias occurred with catheter placements exceeding four days (p < 0.001). Other factors significantly increasing the risk of infection included insertion by surgical cut-down (ninefold increase in bacteremia) and the presence of local inflammation (12-fold increase). Systemic antimicrobial therapy did not protect against catheter-related infection but may account for the predominance of enterococci, Candida and gram-negative bacilli in these infections. Twelve per cent of all nosocomial bacteremias in these patients originated from an arterial catheter. Indwelling arterial catheters pose a significant risk of bacteremic infection to critically ilt patients. Percutaneous insertion is preferred; when prolonged monitoring is required, the site should be rotated every four days.
used for hemodynamic
Catheter-related bacteremia Nosocomial infection
Band JD, Maki DG: Infections caused by arterial catheters monitoring. Am J Med 67: 735-741, 1979.
Septicemia
Infusion-related sepis
Hemodynamic monitoring
Leukemia Leukocytosis
Leukocytes
Neoplastic disease
Carcinoma
Coombs’ test positive
on page A41
=I
-. CD
v)
F s
-.
Four patients with Coombs’ positive hemolytic anemia associated with carcinoma are described and compared to 12 previously described patients. Presenting symptoms were commonly related to the anemia rather than to the tumor mass. Ten of the 16 patients were more than 60 years of age. Carcinomas of many different organ systems were associated with autoimmune hemolytic anemia. Treatment of the hemolytic anemia with corticosteroids was usually ineffective. Autoimmune hemolytic anemia may disappear in patients with localized carcinomas following tumor extirpation. Diminution in the anemia often occurred with control of the neoplastic process by radiotherapy or chemotherapy. The positive Coombs’ reaction commonly reverted to negative with regression of the neoplasm due to treatment.
Spira MA, Lynch EC: Autoimmune hemolytic anemia and carcinoma: an unusual association. Am J Med 67: 753-758, 1979.
Tumor
Autoimmune hemolytic anemia
Multiple blood specimens with different leukocyte counts from two patients with extreme leukocytosis secondary to leukemia and unexplained hypoxemia were tonometered with a gas of known oxygen concentration, and the decay of oxygen tension was measured over time. The decay in the first 2 minutes for blood with leukocyte counts between 55.2 X 103/mm3 and 490.0 X 103imm3 ranged from 13 to 72 torr. The degree of decay was blunted by placing the blood on ice and was obliterated by adding potassium cyanide. Thus, extreme leukocytosis secondary to leukemia can cause spurious hypoxemia and spurious lowering of the mixed venous oxygen tension due to oxygen consumption by leukocytes (“leukocyte larceny”).
Fox MJ, Brody JS, Weintraub LR, with technical assistance of Szymanski J, O’Donnell C: Leukocyte larceny: a cause of spurious hypoxemia. Am J Med 67: 742-746, 1979.
Hypoxemia
Arterial catheters
in the therapy of serious infections,
Bacteremia
Continued
Mezlocillin, a new semisynthetic penicillin chemically related to ampicillin which is more active than carbenicillin against Ps. aeruginosa, 6. fragilis and Strep. faecalis and which inhibits many Klebsiella, was evaluated in the therapy of 34 episodes of infection in 26 patients. Seven patients had bacteremia. Clinical cures were achieved in 83 per cent and bacteria cures in 76 per cent of infections. Adverse effects of therapy were minimal, one rash and one episode of reversible neutropenia. Serum and body fluid levels were easily maintained above the inhibitory levels of susceptible organisms. Mezlocillin was a safe, well tolerated and effective antibiotic in the treatment of infections due to susceptible organisms.
Pancoast SJ, Jahre JA, Neu HC: Mezlocillin Am J Med 67: 747-752, 1979.
Mezlocillin therapy
Serious infections
We studied prospectively the risk of infection caused by arterial catheters used for hemodynamic monitoring in 95 patients. Of 130 catheters, 23 (18 per cent) produced local infection and five septicemia (4 per cent). Sixteen local infections and all five septicemias occurred with catheter placements exceeding four days (p < 0.001). Other factors significantly increasing the risk of infection included insertion by surgical cut-down (ninefold increase in bacteremia) and the presence of local inflammation (12-fold increase). Systemic antimicrobial therapy did not protect against catheter-related infection but may account for the predominance of enterococci, Candida and gram-negative bacilli in these infections. Twelve per cent of all nosocomial bacteremias in these patients originated from an arterial catheter. Indwelling arterial catheters pose a significant risk of bacteremic infection to critically ilt patients. Percutaneous insertion is preferred; when prolonged monitoring is required, the site should be rotated every four days.
used for hemodynamic
Catheter-related bacteremia Nosocomial infection
Band JD, Maki DG: Infections caused by arterial catheters monitoring. Am J Med 67: 735-741, 1979.
Septicemia
Infusion-related sepis
Hemodynamic monitoring
Leukemia Leukocytosis
Leukocytes
Neoplastic disease
Carcinoma
Coombs’ test positive
on page A41
=I
-. CD
v)
F s
-.
Four patients with Coombs’ positive hemolytic anemia associated with carcinoma are described and compared to 12 previously described patients. Presenting symptoms were commonly related to the anemia rather than to the tumor mass. Ten of the 16 patients were more than 60 years of age. Carcinomas of many different organ systems were associated with autoimmune hemolytic anemia. Treatment of the hemolytic anemia with corticosteroids was usually ineffective. Autoimmune hemolytic anemia may disappear in patients with localized carcinomas following tumor extirpation. Diminution in the anemia often occurred with control of the neoplastic process by radiotherapy or chemotherapy. The positive Coombs’ reaction commonly reverted to negative with regression of the neoplasm due to treatment.
Spira MA, Lynch EC: Autoimmune hemolytic anemia and carcinoma: an unusual association. Am J Med 67: 753-758, 1979.
Tumor
Autoimmune hemolytic anemia
Multiple blood specimens with different leukocyte counts from two patients with extreme leukocytosis secondary to leukemia and unexplained hypoxemia were tonometered with a gas of known oxygen concentration, and the decay of oxygen tension was measured over time. The decay in the first 2 minutes for blood with leukocyte counts between 55.2 X 103/mm3 and 490.0 X 103imm3 ranged from 13 to 72 torr. The degree of decay was blunted by placing the blood on ice and was obliterated by adding potassium cyanide. Thus, extreme leukocytosis secondary to leukemia can cause spurious hypoxemia and spurious lowering of the mixed venous oxygen tension due to oxygen consumption by leukocytes (“leukocyte larceny”).
Fox MJ, Brody JS, Weintraub LR, with technical assistance of Szymanski J, O’Donnell C: Leukocyte larceny: a cause of spurious hypoxemia. Am J Med 67: 742-746, 1979.
Hypoxemia