[Blood lead in a population of children with iron deficiency]. / Estudio de la plumbemia en la población infantil con ferropenia.

BACKGROUND: Analysis of blood lead levels in relation to the state of iron metabolism was carried out in children. METHODS: A transversal study of blood lead levels was designed in 89 iron deficient children (serum ferritin < 15 micrograms/l) (group F). Fifty seven of the children did not have anemia (sub-group FS) and 32 had anemia (sub-group AF) with ages ranging between 6 months and 14 years, and 41 children of the same age with normal iron metabolism (group C). A longitudinal study was also carried out by the determination of blood lead levels prior and after iron therapy in 18 of the iron deficient children. RESULTS: A significant difference was seen between the mean of blood lead levels in iron deficient children (group F), 9.41 micrograms/dl and normal children (group C), 6.88 micrograms/dl (p < 0.01). The mean of blood lead levels of the sub-group FS was 7.79 micrograms/dl and the sub-group AF, 12.30 micrograms/dl (p < 0.01). The prevalence of lead poisoning (blood lead levels > 20 micrograms/dl) was 8% in group F (2% in sub-group FS, 19% in sub-group AF) and 0 in group C (p < 0.01). A significant decrease was found in the longitudinal study in the mean of blood lead levels following iron therapy from 14.12 micrograms/dl to 7.51 micrograms/dl (p < 0.05). CONCLUSIONS: The iron deficient state may constitute a predisposing factor of lead poisoning in childhood.

[Cerebral sinovenous thrombosis in a girl with acute lymphoblastic leukaemia carrying the prothrombin G20210A variant]. / Trombosis de senos venosos cerebrales en una niña con leucemia linfoblástica, portadora de la variante de la protrombina G20210A.

Although cerebral venous thrombosis is rare, it is more commonly associated with children suffering from acute lymphoblastic leukaemia. We report the case of a 7-year-old girl who developed massive cerebral sinovenous thrombosis on day 22 of induction therapy for high-risk acute lymphoblastic leukaemia. Clinical symptoms were gradual onset of headache, decreasing consciousness, and ensuing left hemiplegia. A subsequent prothrombotic study revealed a heterozygous prothrombin G20210A variant in the child and mother. We analysed the prothrombotic factors found in the case before and after thrombosis. We confirm the importance of early exploration of patients for clinical predisposing risk factors of thrombosis and primary prothrombotic states in children with acute lymphoblastic leukaemia. This might help identify patients at particular risk from thrombosis and so administer thromboprophylaxis.

[Platelet immunoglobulins and complement in idiopathic thrombocytopenic purpura. Specificity to the IIb/IIIa membrane complex]. / Inmunoglobulinas y complemento plaquetarios en la PTI. Especificidad frente al complejo IIb/IIIa.

Platelet-associated IgG, IgM and C3c was studied by an enzyme-linked immunosorbent assay (ELISA) procedure using polystyrene microter plates and solubilize platelets. At the time of investigation patients fell into the following disease categories: 24 chronic ITP, 10 acute ITP and 11 ITP in remission (normal platelet counts). A significant elevation of platelet IgG was found in acute and chronic ITP. The C3c was increased in acute categories and normal in the others. There was not significant difference in the immunoglobulins and complement values between ITP in remission and normal donors. The platelet specificity of IgG and IgM antibodies to IIb/IIIa membrane complex was positive in 20% from chronic ITP and in none from acute. It is concluded that an elevated platelet immunoglobulins or complement is usefull for ITP diagnosis but the difference between acute and chronic categories only is possible in some cases by the antibodies specificity.

[Polymorphism of platelet glycoprotein Ib in the Spanish population ]. / Polimorfismo de la glicoproteína Ib plaquetaria en la población española.

PURPOSE: To assess the polymorphism of the platelet membrane glycoprotein in castilians and gypsy people and to confirm the genetic transmission of such glycoprotein by means of family studies. MATERIAL AND METHODS: Two-hundred castilians and 87 gypsy subjects were studied. Glycoprotein Ib was analysed by means of SDS polyacrylamide gel electrophoresis followed by Western-Blotting and labelling with glycoprotein-specific monoclonal antibodies and lectins. The different populations were compared by using the chi-square method (Fisher's test). RESULTS: Only three groups of glycoprotein Ib, namely, B, C and D, were found in both population groups, no differences being observed in the expression of the different phenotypic variants. Lesser polymorphism was present in the gypsy group. The family studies showed that glycoprotein Ib is genetically determined, the two alleles being co-dominantly expressed in each individual. CONCLUSIONS: The polymorphism of glycoprotein Ib is similar to that of caucasians, type A being not found. No differences seem to exist between castilians and gypsy people. The heredity pattern is autosomal co-dominant.

[Glycohemoglobins in diabetic children]. / Estudio de las glicohemoglobinas en niños diabéticos.

The percentages of glycohaemoglobins in sixteen diabetic children are studied in different metabolic situations (hypoglycemia, hyperglycemia, coma, hemolytic anaemia) by two different methods; chromatographic method (stable and unstable glycohemoglobin), and colourimetric method (unstable glicohaemoglobin). The glycohaemoglobins appear as a useful parameter to assess the hydrocarbonate metabolism in infant diabetes; provided that alterations in the average life the red blood cells, do not exist. The chromatographic method is a quick, reliable technique in determining glycohemoglobins, although it is necessary to bear in mind that one may detect hyperglycemias changes dose to their realization, furnishing greater amounts than those which correspond to the stable form. Administration of slow insulin divided in two dose throughout the day appears more useful than administration of one dose in metabolic control of the diabetic.

[Modification of complement factors and their inhibitors during meningococcal sepsis (author's transl)]. / Modificaciones de los factores del complemento y de sus inhibidores en el curso de sepsis meningocócicas.

Various complement components (C'1s, C'3, C'4, C'5, C'8, C'9, C'3 act., C'1 inh., C'3b inact.) and seric immunocomplexes (by polyethylene glycol, PEG) were evaluated in 43 children with meningococcal sepsis. 28 patients had disseminated intravascular coagulation (DIC), group I, and 15 did not show it, group II; 14 patients died in group I and none of group II. In 21 cases studies were repeated 24 hours later. In group I all complement components were decreased, specially C'3 (x: 67 mg./100 ml., p < 0.01) and C'5 (x: 8 mg./100 ml., p < 0.01) and they were lower 24 h. later. Results of group II were normal, except a decrease of C'5. Catabolic products of C'3 were founded in 11/14 cases of group I and two/nine of group II and products of C'3 act. in four/14 and one/10. PEG precipitation was positive in 10/14 cases of group I and 10/12 of group II and IgG, IgM, C'3 and C'4 were found in precipitations. This complement components were more frequently present in sepsis without DIC and after 24 h. of evolution. C'1 and C'3b inhibitors decreased after evolution in group I and by contrast increased in group II. This fall enhances complement activation.

[The fibronectin deficiency in normal newborn infants corrects itself very quickly]. / La deficiencia de fibronectina en recién nacidos normales se corrige muy pronto.

Fibronectin (FN) is a protein which acts as an opsonin and participates in anti-infective mechanisms. We measured FN in cord blood from 39 normal newborns by Laurell's electroimmunoassay. The mean value of FN was 13.5 +/- 6.8 mg/dl, lesser then mean value of 26 normal children 1 mo. to 7 y. old, 27.3 +/- 8.7 mg/dl (p less than 0.001). FN continued being low, 14.1 +/- 8.1 mg/dl al 48 h. of age. Nevertheless it was normal at 15 days of age (24.6 +/- 9.7 mg/dl). FN levels were lower at 15 days of age in 19 newborns who received vitamin K (12.2 +/- 6.1 mg/dl) than in the group which was not treated (18.1 +/- 9.9 mg/dl) but the difference was not significant (p greater than 0.05). There was a close correlation between cord blood levels and levels at 48 h. (p = 0.001) and levels at 15 d. (p = 0.003). There was no relationship either with the gestational age and birth weight, no prothrombin and protein C levels. The FN decrease in the newborn can be one of the causes of the opsonization deficiency, nevertheless normalization occurred very soon, before the second week.

[Diagnostic evaluation of cervical adenopathies in childhood]. / Evaluación diagnóstica de las adenopatías cervicales en pediatría.

Between 1985 and 1990, 45 children were studied in an inpatient basis hospital because of cervical lymphadenopathy. This was the most important clinical sign in these patients. Forty-three had true adenitis. In the others, one was submaxillitis and one a sarcoma. The age range was from 2.1 to 13.3 years. Seven children (16%) had neoplastic adenitis (2 papillary carcinoma of the thyroid, 4 Hodgkin's lymphoma and one non-Hodgkin's lymphoma). Thirty-six patients had benign disorders (18 mononucleosis infections, 7 nonspecific adenitis, 5 infections of mycobacteria, 2 of toxoplasma and 2 of rickettsia, one cervical Whipple and one desmopathic adenitis). We did no find any differences related to age or morphological characteristics of the lymph nodes. The evolution time in patients with malignant tumors was 16.4 weeks and 9.6 weeks in the benign group. All of the cases with supraclavicular location had a lymphoma. The mean LDH in patients with malignant tumors was 214 U/L and 614 U/L in those with non-malignant tumors (p < 0.01).

[Lupus anticoagulant in children. Report of 4 cases]. / Anticoagulante lúpico en pediatría. Presentación de 4 casos.

OBJECTIVE: We present four cases of lupus anticoagulant (AL) in children. In addition, as a result of the lack of literature published on the subject in our country. We also evaluate the epidemiological, clinical and prognostic characteristics of AL in children. PATIENTS AND METHODS: The diagnostic criteria established by the "Subcommittee for the Standardization of Lupus Anticoagulant" were followed. RESULTS: Over a ten-year period (1988-1998), 46 cases of children with TTPA prolongation were documented. Nine children showed circulating anticoagulant, 4 of which were lupus type anticoagulants. The age of the patients ranged from 4 to 13 and there was a prevalence of males (3/4). Half of the children had a family history of bleeding dyscrasia and it was these who showed hemorrhage or thrombotic symptoms. The case that started with ecchymosis and hemorrhaging showed prothrombin prolongation due to factor II deficit. In 3 of the 4 children, AL was linked to acute respiratory infections and was transitory. The other coincided with two thrombotic episodes of the lower extremities in a healthy child. Positive anticardiolipin antibodies were detected in two patients, both showing repeated AL episodes, one with thrombosis and the other always asymptomatic. CONCLUSIONS: Diagnosis of AL in children is difficult and has probably been underestimated. Although it is usually transitory, it can appear in repeated episodes. Its early detection is important as it can be linked to both prothrombin deficit, as well as significant symptoms of hemorrhaging.