- Email: [email protected]
River blindness
1178
HEPARIN
DERMATAN SULPHATE
Fibrinogen, ATM, and D-dimer values during treatment with heparin Dotted
areas
indicate normal range, 0 basal values, and 1 day of
Fibrinogen, ATM, and D-dimer values are shown in the figure. Mean TT values fluctuated between 18-8and 27 8sin the dermatan group and between 47.6and 66 4 in the heparin group (normal range 17-26 s), and aPTT fluctuated between 262and 31 ’8 s and between 32-5 and 62-4 s, respectively (normal range 24-34 s) during anticoagulant treatment. Blood product support was higher in the heparin than in the dermatan group. The sole serious cutaneous bleeding complication during chemotherapy occurred in the heparin group. In line with Lane and colleagues’ findings, this pilot study confirms that it is possible to control intravascular thrombin production through the heparin cofactor II pathway of thrombin inhibition rather than through action on antithrombin III. The availability of glycosaminoglycans with reduced charge density, reduced effect upon TT and aPTT, and without interference with platelet function may represent a safer alternative to heparin in the management of consumption coagulopathy in acute leukaemia. Department of Infectious Diseases and Immunopathology, Institute of Internal Medicine, University of Milan, 20122 Milan, Italy
ELISABETTA COFRANCESCO CARLA BOSCHETTI PATRIZIA LEONARDI MICHELE CORTELLARO
KA, Rosenberg RD. Thrombin generation m acute promyelocytic leukemia. Blood 1984; 64: 791-96. 2. Cunningham I, Gee TS, Reich LM, Kempin SJ, Naval AN, Clarkson BD. Acute promyelocytic leukemia: treatment results during a decade at Memorial Hospital. Blood 1989; 73: 1116-22. 3. Rodeghiero F, Avvisati G, Castaman G, Barbui T, Mandelli F. Early deaths and anti-hemorrhagic treatments in acute promyelocytic leukemia: a GIMEMA retrospective study in 268 consecutive patients. Blood 1990; 75: 2112-17. 4. Cofrancesco E, Colombi M, Gianese F, Cortellaro M. The effect of dermatan sulfate on in vitro human plasma coagulation platelet aggregation and &bgr;TG and PF4 release. Thromb Res 1990; 57: 405-14. 5. Femandez FA, Van Ryn J, Ofosu FA, Hirsh J, Buchanan MR. The haemorrhagic and antithrombotic effects of dermatan sulphate. BrJ Haematol 1986; 64: 309-17. 6. Agnelli G, Cosmi B, Di Filippo P, et al. A randomized, double blind, placebocontrolled trial of dermatan sulfate for prevention of deep vein thrombosis in hip fracture. Thromb Haemost 1992; 67: 203-08. 1. Bauer
River blindness SIR,- Your note about river blindness (Mar 28, p 803) provides excellent summary of the outstanding achievements of the Onchocerciasis Control Programme in West Africa (OCP). Unfortunately, the title you have chosen is distinctly misleading. The OCP is starting its final attack on river blindness in most parts of the 11West African countries covered by its remit. Nevertheless, there are still more than 16 million persons infected with Onchocerca volvulus in the remaining 23 endemic countries an
or
dermatan
starting antiblastic
sulphate.
chemotherapy.
outside the OCP area, most ot which are m Atnca. At least /3U UUU of these dwellers in remote rural areas are blind as a result; and a
similar number have severe visual impairment. For them, the attack on river blindness has scarcely begun. Their only hope lies in regular annual dosing with ivermectin. The World Health Organisation, several non-governmental organisations (especially the recently-founded River Blindness Foundation), UN agencies, USAID, and the Mectizan (ivermectin) Expert Committee are now just beginning to assist the Ministries of Health in other affected countries that are untouched by OCP. The task of delivering ivermectin in a cost-effective manner is even greater than that which faced the OCP at its outset; and the struggle will take just as long. Success may well depend on the world bank and OCP donors being prepared to help fmance the scheme. The OCP’s final attack may signal the end of one campaign, but it is far from being the end of the war against river blindness. River Blindness Foundation, 1 Sugar Creek Place, Sugar Land, Texas 77478, USA
W. R. BALDWIN B.O.L. DUKE
Inadequate information on needlestick accidents SIR,- The article by Klein and colleagues1 reinforces the need for health-care workers to regard patients as potentially infected with a communicable blood-borne agent. The agents potentially transmissible by accidental needlestick inoculation and for which routine screening assays are available include hepatitis B virus (HBV), hepatitis C virus (HCV), human T-cell leukaemia virus (types I and II), and human immunodeficiency virus types 1 and 2. While analysing the risk of infection in two London hospitals to health-care personnel who had been exposed parenterally to blood via accidental inoculation, we reviewed data and serum samples received from donors in needlestick accidents from mid-1986 to the end of 1990. For 1990 we analysed the type of accident and looked at how often paired sera (donor and recipient) were available, at what proportion of accidents were reported to our division of virology, and at identification of donor and/or recipient. Sera were randomised and tested for antibodies to HIV-1, HTLV-I, and HCV.1All had previously been tested for HBV infection (HBsAg ELISA). Between mid-1986 and the end of 1990, sera from 528 donors in needlestick accidents (parenteral exposure to blood) were identified. 135 related to accidents in 1990. On 85 (63%) of donor request forms it was possible to identify the recipient. During the same year the division received 211 sera from the injured recipients; 84 (40%)
HEPARIN
DERMATAN SULPHATE
Fibrinogen, ATM, and D-dimer values during treatment with heparin Dotted
areas
indicate normal range, 0 basal values, and 1 day of
Fibrinogen, ATM, and D-dimer values are shown in the figure. Mean TT values fluctuated between 18-8and 27 8sin the dermatan group and between 47.6and 66 4 in the heparin group (normal range 17-26 s), and aPTT fluctuated between 262and 31 ’8 s and between 32-5 and 62-4 s, respectively (normal range 24-34 s) during anticoagulant treatment. Blood product support was higher in the heparin than in the dermatan group. The sole serious cutaneous bleeding complication during chemotherapy occurred in the heparin group. In line with Lane and colleagues’ findings, this pilot study confirms that it is possible to control intravascular thrombin production through the heparin cofactor II pathway of thrombin inhibition rather than through action on antithrombin III. The availability of glycosaminoglycans with reduced charge density, reduced effect upon TT and aPTT, and without interference with platelet function may represent a safer alternative to heparin in the management of consumption coagulopathy in acute leukaemia. Department of Infectious Diseases and Immunopathology, Institute of Internal Medicine, University of Milan, 20122 Milan, Italy
ELISABETTA COFRANCESCO CARLA BOSCHETTI PATRIZIA LEONARDI MICHELE CORTELLARO
KA, Rosenberg RD. Thrombin generation m acute promyelocytic leukemia. Blood 1984; 64: 791-96. 2. Cunningham I, Gee TS, Reich LM, Kempin SJ, Naval AN, Clarkson BD. Acute promyelocytic leukemia: treatment results during a decade at Memorial Hospital. Blood 1989; 73: 1116-22. 3. Rodeghiero F, Avvisati G, Castaman G, Barbui T, Mandelli F. Early deaths and anti-hemorrhagic treatments in acute promyelocytic leukemia: a GIMEMA retrospective study in 268 consecutive patients. Blood 1990; 75: 2112-17. 4. Cofrancesco E, Colombi M, Gianese F, Cortellaro M. The effect of dermatan sulfate on in vitro human plasma coagulation platelet aggregation and &bgr;TG and PF4 release. Thromb Res 1990; 57: 405-14. 5. Femandez FA, Van Ryn J, Ofosu FA, Hirsh J, Buchanan MR. The haemorrhagic and antithrombotic effects of dermatan sulphate. BrJ Haematol 1986; 64: 309-17. 6. Agnelli G, Cosmi B, Di Filippo P, et al. A randomized, double blind, placebocontrolled trial of dermatan sulfate for prevention of deep vein thrombosis in hip fracture. Thromb Haemost 1992; 67: 203-08. 1. Bauer
River blindness SIR,- Your note about river blindness (Mar 28, p 803) provides excellent summary of the outstanding achievements of the Onchocerciasis Control Programme in West Africa (OCP). Unfortunately, the title you have chosen is distinctly misleading. The OCP is starting its final attack on river blindness in most parts of the 11West African countries covered by its remit. Nevertheless, there are still more than 16 million persons infected with Onchocerca volvulus in the remaining 23 endemic countries an
or
dermatan
starting antiblastic
sulphate.
chemotherapy.
outside the OCP area, most ot which are m Atnca. At least /3U UUU of these dwellers in remote rural areas are blind as a result; and a
similar number have severe visual impairment. For them, the attack on river blindness has scarcely begun. Their only hope lies in regular annual dosing with ivermectin. The World Health Organisation, several non-governmental organisations (especially the recently-founded River Blindness Foundation), UN agencies, USAID, and the Mectizan (ivermectin) Expert Committee are now just beginning to assist the Ministries of Health in other affected countries that are untouched by OCP. The task of delivering ivermectin in a cost-effective manner is even greater than that which faced the OCP at its outset; and the struggle will take just as long. Success may well depend on the world bank and OCP donors being prepared to help fmance the scheme. The OCP’s final attack may signal the end of one campaign, but it is far from being the end of the war against river blindness. River Blindness Foundation, 1 Sugar Creek Place, Sugar Land, Texas 77478, USA
W. R. BALDWIN B.O.L. DUKE
Inadequate information on needlestick accidents SIR,- The article by Klein and colleagues1 reinforces the need for health-care workers to regard patients as potentially infected with a communicable blood-borne agent. The agents potentially transmissible by accidental needlestick inoculation and for which routine screening assays are available include hepatitis B virus (HBV), hepatitis C virus (HCV), human T-cell leukaemia virus (types I and II), and human immunodeficiency virus types 1 and 2. While analysing the risk of infection in two London hospitals to health-care personnel who had been exposed parenterally to blood via accidental inoculation, we reviewed data and serum samples received from donors in needlestick accidents from mid-1986 to the end of 1990. For 1990 we analysed the type of accident and looked at how often paired sera (donor and recipient) were available, at what proportion of accidents were reported to our division of virology, and at identification of donor and/or recipient. Sera were randomised and tested for antibodies to HIV-1, HTLV-I, and HCV.1All had previously been tested for HBV infection (HBsAg ELISA). Between mid-1986 and the end of 1990, sera from 528 donors in needlestick accidents (parenteral exposure to blood) were identified. 135 related to accidents in 1990. On 85 (63%) of donor request forms it was possible to identify the recipient. During the same year the division received 211 sera from the injured recipients; 84 (40%)