T cell acute lymphocytic leukemia terminating as malignant histiocytosis

flow plateletpheresis

thrombocythemia

Gastrointestinal

Thrombo-occlusive

disease

bleedlng arterial

immune complexes

Erythropoietin Hypoxemla

leukemia reticulosls

Malignant

histiocytosis

Continuedon page A96

Less than 200 cases of malignant histiocytosis (histiocytic medullary reticulosis) have been reported in the literature. Five previously reported cases and the case reported in this article have been preceded by acute lymphocytic leukemia. All of these cases have had similar cous~s characterized by prompt response of the leukemia to chemotherapy followed in three to six months by the onset of rapidly fatal malignant histiocytosis. The leukemic lymphoblasts in the two cases studied for lymphocyte surface markers had T cell markers. No residual leukemia was identified at autopsy in four of the SIX cases

medullary

Raji cell radioimmunoassay and Clq solid phase radioimmunoassay were used to determine serially circulating immune complexes in a patient with rapidly progressive glomerulonephritis receiving hemodialysis therapy Initiation of hemodialysis was associated with a significant decrease in detectable immune complexes which, in turn, was associated with improvement and stabilizationof renal function We suggest that hemodlalysis may remove immune complexes from the circulation and could be of therapeutic benefit in selected patients with presumed immune complex-mediated glomerulonephritis

Histiocytlc

T cell acute lymphocytic

The presence of cyanotic congenital heart disease (tetralogy of Fallot) in a child with a moderately severe beta thalassemia syndrome provided the opportunity to determine the effect of severe hypoxernia on red cell production in this disorder. Erythropoietin was markedly increased. and erythropoiesis was markedly stimulated but ineffective. Oxygen delivery was accomplished by a hiih cardiac output and marked venous desaturation. Surgical correction of the right to left shunt and hypoxemla resulted in the development of anemia but was associated with marked improvement In the effectiveness of erythropoiesis. Oxygen delivery was accomplished at a lower cardiac output and higher venous saturation despite anemia. The degree of imbalance In the synthesis of alpha and beta globin increased after surgery, and there was also an increase in hemoglobin F

Skoog DP, Feagler JR: T cell acute lymphocytic leukemia terminating as malignant histiocytosis. Am J Med 64: 678-682, 1976.

Hemodialysis

Clq solid phase radioimmunoassay

Glomerulonephrttls

Hemoglobins heart disease

Peterson DT, Winslow RM, Adamson JW, Morrow AG, Nienhuls AW: Tetralogy of Fallot with hypoxemia in a patient with beta thalassemia intermedia. Am J Med 64: 662671, 1976

of Fallot

Beta thalassemia Tetralogy

Ahlin TD, Tung KSK, Walker LC, Leonard CD, Williams RC Jr : Decrease tn circulating immune complexes during hemodialysis. Am J Med 64. 672-677, 1976

Raji cell radioimmunoassay

Circulating

Dramatic reduction of platelet count by discontinuous flow plateletpheresis was achieved safely and swiftly n a patient with essential hemorrhagic thrombocythemia. The patient had a history of thrombo-occluslve arterial disease and on admission had gastrointestinal bleeding. This technic is recommended as an effective means of rapidly controlling marked increases in the platelet count, and its consequences in the interval before chemotherapy becomes effective.

Younger J. Umlas J. Rapid reduction of platelet count In essential hemorrhagtc thrombocythemia by discontinuous flow plateletpheresls. Am J Med 64: 659-661, 1978

Hemorrhagic

Discontinuous