[Randomized multi-center trial of the administration of erythropoietin in anemia of prematurity]. / Estudio multicéntrico aleatorizado de administración de eritropoyetina en la anemia de la prematuridad.

OBJECTIVES: The purpose of this study was to test the therapeutic effect of human recombinant erythropoietin (rH-EPO) on anemia of prematurity. MATERIAL AND METHODS: Fifty-eight preterm infants less than 34 weeks of gestational age from three different hospitals were studied. Transfusional policies were similar in all three centers. Infants with ABO or Rh incompatibility were excluded. At 28 days after birth, 28 infants (48.3%) had hemoglobin levels under 10.5 g/dL and were randomized to receive rH-EPO or standard care. Those infants ascribed to the treatment group received 200 U/kg of body weight of rH-EPO subcutaneously once a day, three days a week for 4 weeks together with oral supplements of ferrous sulfate at a dosage of 4 mg/kg/day. Both groups received daily doses of 50 micrograms of folic acid and 5U of vitamin E per os. Erythropoietin and ferritin were determined at randomization and at 60 days of age. Hemoglobin, reticulocytes, leucocytes, granulocytes and platelets were measured once a week, from the beginning of the treatment until 60 days of age. RESULTS: At randomization into treatments, there were no significant differences between the groups with respect to weight, gestational age, hemoglobin (9.42 +/- 0.73 vs 9.26 +/- 0.68 g/dL), reticulocytes (61.7 +/- 32.2 vs 68.0 +/- 61.0 x 10(9)/L), ferritin, EPO1 leucocytes or platelets. At 60 days of age, the treatment group showed higher hemoglobin values (10.5 +/- 1.73 vs 9.1 +/- 1.0 g/dL, p < 0.05). There were no significant differences between reticulocyte counts (176.4 +/- 91.1 vs 112.6 +/- 85.0 x 10(9)/L), granulocytes (2,351 +/- 868 vs 2,075 +/- 856 x 10(9)/L), platelets (400 +/- 138 vs 316 +/- 164 x 10(9)/L) or ferritin (209 +/- 177 vs 393 +/- 328 micrograms/mL). Of the infants in the nontreated group, 13.3% received blood transfusions between 30 and 60 days of age, while only 6.7% of the treatment group did (p = 0.31). DISCUSSION: We have been able to find 11 controlled studies in the medical literature which deal with the clinical usage of rH-EPO in newborns. Six use the hormone in an early phase and 5 in a posterior one. Our study should be included in the later and, as happens in most of them, demonstrates the efficacy of rH-EPO in the treatment of late anemia of the preterm newborn as shown by an increment in the hemoglobin levels and a trend towards the diminution in the use of blood transfusions. We have not observed substantial adverse effects.

[Evaluation of a method for the determination of serum ferritin by chemiluminescence]. / Evaluación de un método para la determinación de la ferritina sérica por quimioluminiscencia.

The aim of this study was to assess a technique for serum ferritin determination by means of chemoluminiscence (Magic Lite, Ciba Corning) in a series of unselected patients. A group of 100 healthy blood donors (50 men and 50 women), in whom iron deficiency had been previously excluded, was used as control. The results were validate according to the Societé Francaise de Biologie Clinique guidances. The characteristics of the method and its comparison with IRMA and ELISA techniques are described here. Its major advantages are related with simplicity and sensitivity; the main disadvantage is the necessity to repeat every step in samples with ferritin levels over 1,500 ng/dl.

[Hematometric values in delta-beta thalassemia minor. Special importance of the erythrocyte distribution in comparison with beta thalassemia and iron deficiency]. / Valores hematimétricos en la delta beta talasemia minor. Especial importancia de la amplitud de distribución eritrocitaria en comparación con la beta talasemia y la ferropenia.

The haematological parameters of 97 cases of beta thalassaemia trait and 40 cases of delta beta thalassaemia trait have been compared. No differences in haemoglobin, haematocrit, MCV, MCH, ferritin, % saturation or free erythrocyte protoporphyrin have been found. The RDW, however, is significantly increased in delta beta thalassaemia trait, its mean value (+/- SD) being 20 (2.05), even higher than that found in iron deficiency anaemia. The discrimination function described by England and Fraser may be of help in distinguishing these entities.

[Osteolytic lesions in chronic myeloid leukemia. Report of three cases (author's transl)]. / Lesiones osteolíticas en la leucemia mieloide crónica. Presentación de tres casos.

Contrarily to what happens in acute leukemia, the incidence of osteolytic lesions in chronic leukemia is exceedingly low. Three patients with chronic myeloid leukemia (CML) who developed such lesions during the chronic phase of their disease form the basis of this report. Osteolytic lesions appearing during the chronic phase of CML are different from those appearing during acute leukemia or during the acute terminal phase of CML, and the differences between both types of osteolysis are briefly reviewed. In the present cases the appearance of osteolytic lesions during the chronic phase of CML preceded for a variable period the terminal acute blastic phase. Therefore this complication must be considered as a sign of poor prognosis as it relates to the subsequent course of the leukemia. Even though other authors advise local radiotherapy as the treatment of choice of osteolytic lesions, only cytostatic therapy was given to the present patients, with good results as it regards the lesions per se.

[Disseminated intravascular coagulation as the presenting feature of lymphoblastic leukemia. Study of a case]. / Coagulación intravascular diseminada como forma de presentación de leucosis linfoblástica. Estudio de un caso.

Disseminated intravascular coagulation is relatively common as initial clinical presentation of certain myeloblastic leukemias, particularly acute promyelocytic leukemia, occurring less frequently in association with acute non-myeloid leukemias. The occurrence of such coagulopathy as presenting feature of a lymphoblastic leukemia is exceptional as demonstrated by the scarcity of reports in the literature and by the authors experience, having encountered only one case out of 86 consecutive patients with acute lymphoblastic leukemia. The laboratory findings in this case are commented upon, and particular emphasis is made on the measurement of coagulation factors II, V, VII-X, and VIII, the study of fibrin formation and fibrinolysis, and the changes in these parameters brought about by therapy with heparin, coagulation factors (fibrinogen, platelets), and cytostatic drugs. The coagulation abnormalities were corrected once the blast population was destroyed by chemotherapy, with the exception of persisting fibrinopenia secondary to the corticosteroid treatment included in the chemotherapy protocol. Disseminated intravascular coagulation was manifested in this case by gingivorrhagia, ecchymosis and hematuria. The probable etiological role of lymphoblasts in the development of disseminated intravascular coagulation is discussed.