Immunoregulatory T cells in B cell chronic lymphocytic leukaemia: evidence of a unique phenotype a flow cytometric study.

CD4+ T cells of 57 patients with B cell chronic lymphocytic leukaemia (CLL) were analysed for expression of CD45RA and CD29. The majority of CLL patients (33 cases) showed a novel coexpression of these markers on a significant proportion of CD4+ T cells; however, analysis of a single blood sample revealed no apparent prognostic value associated with the markers. Expression of CD45RA and CD29 correlated with parameters of immune function consistent with the known attributes of these markers.

Phenotypic abnormality of T cells in B cell non-Hodgkin's lymphoma.

CD4+ T cells of patients with B cell non-Hodgkin's lymphoma (NHL) were analysed for expression of CD45RA and CD29. It was found that CD45RA expression was significantly lower, and CD29 expression significantly higher, in lymphoma patients compared to normal controls. Moreover absolute numbers of CD4+ T cells were significantly lower in NHL patients, due to selective depletion of CD4+ CD45RA+ cells.

The fibrinolytic enzyme system in hepatic cirrhosis and malignant metastases.

Components of the blood fibrinolytic system were measured in 18 patients with hepatic cirrhosis, in two patients with acute hepatic necrosis, and in 10 patients with hepatic metastases. The frequency of an elevation of plasminogen activator and a reduction in plasminogen in hepatic cirrhosis has been confirmed. Patients with compensated cirrhosis had low levels of the serum inhibitor of plasminogen activation while those with severe hepatic insufficiency or coma due to cirrhosis or hepatic necrosis had elevated levels. The presence of hepatic metastases was associated with reduced plasminogen activator levels and an increase in the fibrinogen concentration.

Studies on the fibrinolytic enzyme system in obesity.

Plasma fibrinolytic activity, inhibitors of fibrinolysis, and fibrinogen were estimated in 34 subjects of varying ratio of observed to standard weight. The inverse relationship between fibrinolytic activity and the ratio of observed to standard weight was confirmed. No significant correlation was found between anti-plasmin or anti-urokinase and the ratio of observed to standard weight. It was therefore concluded that the decreased plasma fibrinolytic activity in obese subjects is due to decreased production of plasminogen activator rather than to excessive inhibition.

Non-cytotoxic antibodies in chronic lymphocytic leukaemia.

Non-cytotoxic Fc receptor blocking antibodies against autologous B lymphocytes were sought in sera from patients with chronic lymphocytic leukaemia (CLL), using a rosette inhibition assay. They were found in 11 of 52 (21%) of patients with CLL, but were not associated with previous blood transfusion or pregnancy, suggesting that they were unlikely to have resulted from allogeneic stimulation. Fc receptor blockade was more commonly detected in sera from patients with stage B rather than stage A CLL (Binet classification), though this did not achieve significance beyond the 90% level, and it was noted in 62.5% of those with lymphocyte doubling times of less than one year, compared with 36.3% of those whose lymphocyte doubling time was more than one year. The results indicate that autologous Fc receptor blocking antibody activity occurs in sera from patients with CLL, is more likely to be generated by the tumour itself than by allogeneic stimulation, and is associated with increased tumour load. Such antibodies may permit tolerance of tumour by the host.

A Scottish Hebridean antithrombin III deficient family--twelve years on.

The members of this family with ATIII deficiency have been followed for at least 12 years (1976-1989). All those with previous venous thrombo-embolism have been free from recurrence when on warfarin. During the half century 1931-1981, all 11 full term pregnancies in four affected patients were associated with venous thromboembolism; one patient was enigmatic having one full term pregnancy, without thrombotic event; between 1982 and 1989 three pregnancies have been actively managed with no clinical thrombosis. Management involved use of monitored, self administered, subcutaneous heparin before or very soon after conception and throughout pregnancy (warfarin having been stopped), planned delivery under cover of intravenous antithrombin III, reduction of heparin dosage at delivery and reintroduction of warfarin in the puerperium. The recognised hazards of heparin therapy in pregnancy did not occur. The involvement of the arterial system is reviewed. Clinical evidence provides tentative suggestions on (a) possible additional risk of cigarette smoking (b) avoidance of venography (c) avoidance of varicose vein surgery. A probe is now available for the defective antithrombin III gene in this family, but there has been no occasion yet to apply this in antenatal diagnosis.

The effect of prolonged exercise on the components of the blood fibrinolytic enzyme system.

1. The levels of the blood components of the fibrinolytic enzyme system were measured before, during and after a 4 hr period of exercise in eight subjects.2. Mean plasminogen activator level rose progressively over the first 3 hr with little further change during the 4th hr of exercise. Following the period of exercise there was a rise in a circulating anti-activator which was still present 20 hr after completion of the exercise.3. There was no alteration in the mean blood level of plasminogen, fibrinogen, anti-plasmin or a serum inhibitor of plasminogen activation during or following the exercise.4. The significance of the findings in relation to the mechanism of interaction of the components of the fibrinolytic system is discussed.

Protease inhibitors in liver disease.

Measurements of the principal protease inhibitors were carried out in patients with two types of chronic liver disease: alcoholic cirrhosis and primary biliary cirrhosis. Measurement of the two major protease inhibitors operative in the haemostatic mechanism--that is, antithrombin III and alpha 2-antiplasmin--showed significantly reduced levels in the alcoholic cirrhosis group, who satisfied clinical and biochemical criteria of impaired hepatocellular function, but not in the primary biliary cirrhosis group, who had relatively good preservation of hepatocellular function. Significant correlation of levels of both these major protease inhibitors with the serum albumin concentration was also found. No evidence of disseminated intravascular coagulation was detected, and therefore failure of synthesis by the liver is the likely explanation of the low levels noted.

Systemic hypertension--an unusual presentation of T-cell lymphoma.

Systemic hypertension is not commonly associated with lymphoid malignancy. We present two patients who had renal involvement with non-Hodgkins lymphoma (NHL) in which systemic hypertension was a major problem on presentation and resolved soon after appropriate chemotherapy.