losartan-potassium and Remission--Spontaneous

Treatment of aplastic anemia may raise considerable problems in some patients. This report concerns a boy whose illness started at 11 years of age. At first admission laboratory data were: hemoglobin 7.5 g/l, and counts of leucocytes, neutrophils and platelets were 2.3, 0.6, and 8 x 10(9)/l, respectively. His bone marrow was hypoplastic with sparse erythropoiesis. The patient did not respond to traditional medical treatment. Serum contained a high concentration of erythropoietin but no antibodies against erythropoietin. The patient's serum did neither alone, nor supported with recombinant erythropoietin, stimulate erythropoiesis in a bioassay, suggesting that some factor(s) inhibiting erythropoietic activity was present. Based on this hypothesis, plasma exchange was performed. After 26 weeks of plasmapheresis the hematological parameters were normalized. We conclude that plasmapheresis might be an alternative in treatment of resistant aplastic anemia. Further diagnostic tools to identify patients who might benefit from such a treatment are required.

Topics: Anabolic Agents; Anemia, Aplastic; Antilymphocyte Serum; Blood Cell Count; Child; Cyclosporins; Erythropoietin; Hemoglobins; Humans; Immunotherapy; Male; Plasmapheresis; Prednisone; Remission, Spontaneous

Pure red cell aplasia is a selective aplasia of the marrow erythroid cells. Unlike aplastic anemia, the marrow has a normal cellularity and the patients generally have normal leukocyte and platelet blood counts. The congenital form of the disease occurs in the firlst 1 1/2 years of life and is often responsive to corticosteroids. The acquired form may be secondary to infections, drugs, chemicals, or hemolytic anemia (aplastic crisis). In these cases it is often acute and self-limited with cessation of the infection or drug ingestion. It may also be secondary to systemic lupus erythematosus, rheumatoid arthritis, acute severe renal failure, severe nutritional deficiency, or diverse neoplasms, and may remit with treatment of the primary condition. When a thymoma is present, it should be resected since a remission is produced in 29 per cent of these patients. The remaining patients have an acquired primary form of the disease that tends to be chronic and in some cases may have an immune pathogenesis. A cytotoxic immunoglobulin inhibitor of the marrow erythroid cells or erythropoietin has been described and these patients may respond to prednisone and/or to cytotoxic immunosuppressive drugs such as cyclophosphamide and 6-mercaptopurine. Pure red cell aplasia appears to be more common than the literature has revealed and has stimulated much investigation into an immune pathogenesis for marrow failure.

Topics: Acute Kidney Injury; Anemia, Aplastic; Antilymphocyte Serum; Arthritis, Rheumatoid; Blood Cell Count; Blood Transfusion; Cyclophosphamide; Deficiency Diseases; Erythropoietin; Humans; Immune System Diseases; Infections; Lupus Erythematosus, Systemic; Mercaptopurine; Prednisone; Remission, Spontaneous; Splenectomy; Thymoma; Thymus Neoplasms

Topics: Age Factors; Aged; Androgens; Anemia, Aplastic; DNA; Erythropoietin; Female; Hematopoiesis; Humans; Male; Methenolone; Oxymetholone; Prognosis; Remission, Spontaneous; RNA; Testosterone

Topics: Animals; Cell Division; Cortisone; Culture Techniques; Endocrine Glands; Erythropoietin; Glycoproteins; Gonadal Steroid Hormones; Growth Hormone; Growth Inhibitors; Hematopoiesis; Hematopoietic Stem Cells; Hormones; Humans; Leukemia; Leukemia, Erythroblastic, Acute; Leukemia, Experimental; Mice; Neurotransmitter Agents; Radiation Chimera; Remission, Spontaneous; Thrombopoietin; Thymus Gland

In a prospective, controlled trial 26 anaemic, neutropenic children with newly diagnosed acute lymphocytic leukaemia were randomised in pairs to receive either transfusion to a haemoglobin of 10--12 g/dl where clinically indicated (group A) or hypertransfusion to a haemoglobin of 16--18 g/dl (group B). Compared with group A (11 of 13 transfused), group B (all transfused) had a significantly more rapid rise in neutrophils at 7 and 10 days post-transfusion, a lower incidence of infection, and less interruption to chemotherapy. Hypertransfusion restored the myeloid/erythroid ratio to normal in bone-marrow of 5 of 6 children and the proportion of early myeloid precursors was greater than in controls.

Topics: Adolescent; Agranulocytosis; Blood Transfusion; Cell Count; Child; Child, Preschool; Clinical Trials as Topic; Erythropoietin; Female; Hematopoietic Stem Cells; Hemoglobins; Humans; Infant; Infection Control; Leukemia, Lymphoid; Leukocyte Count; Male; Neutropenia; Neutrophils; Prospective Studies; Random Allocation; Remission, Spontaneous

In a patient with chronic renal failure due to diabetes mellitus pure red-cell aplasia developed during treatment with erythropoietin (epoetin alfa). The treatment with erythropoietin was stopped and immunosuppressive therapy resulted in normalisation of the bone marrow function and increase of the Hb level to normal values. Pure red cell aplasia which develops during treatment with erythropoietin has recently been reported in a few other patients with anaemia due to chronic renal failure. Hitherto our patient is the first case reported in Denmark.

Topics: Epoetin Alfa; Erythropoietin; Hematinics; Humans; Immunosuppressive Agents; Male; Middle Aged; Recombinant Proteins; Red-Cell Aplasia, Pure; Remission, Spontaneous

A 20-year-old woman presented with polycythemia vera and was treated with phlebotomy alone for eleven years, following which all clinical manifestations of the disease disappeared. The clinical remission with normal physical findings and normal peripheral blood counts has persisted for a further 11 years. Erythroid colony culture results have paralleled the clinical state. Initial bone marrow cultures revealed spontaneous growth of erythroid burst-forming units (BFU-E). Subsequent cultures of peripheral blood cells throughout most of the period of spontaneous clinical remission have revealed little or no spontaneous growth of BFU-E. This suggests a suppression of the abnormal stem cell clone during the period of remission.

Topics: Adult; Bloodletting; Cells, Cultured; Erythroid Precursor Cells; Erythropoietin; Female; Humans; Polycythemia Vera; Remission, Spontaneous

We report two girls with primary erythrocytosis in whom extensive diagnostic studies revealed no underlying cause. Normal growth of colonies derived from erythroid burst forming units (BFU-E) was observed, and serum erythropoietin concentrations were within or below the normal range. The absence of a rise in serum erythropoietin levels after isovolemic phlebotomy implicated the erythroid marrow as the site of the pathophysiologic abnormality in both patients. Spontaneous resolution of erythrocytosis occurred during the second decade of life. Our experience suggests that primary erythrocytosis may be self-limited in some children. In these cases, the proliferative abnormality may be sufficiently subtle as to not be detected by standard in vitro culture systems, which support the growth of colonies derived from erythroid progenitors.

Topics: Aging; Bloodletting; Bone Marrow; Child; Erythroid Precursor Cells; Erythropoietin; Female; Hemoglobins; Humans; Infant; Polycythemia; Remission, Spontaneous

Hydroxyurea (HU), given ip four times, each time at 500 mg/kg in 6-hour intervals, was used to treat DBA/2 mice with Friend murine leukemia virus-induced polycythemia (F-MuLV-P). In these mice a new cell type, found after virus infection, gave rise to erythropoietic colonies in vitro without addition of erythropoietin (Ep) and completely replaced Ep-dependent normal erythropoietic colonies in vitro. The colony-forming units in the spleen (CFUs), the colony-forming units in culture (CFUc), and the erythropoietic colony-forming units (CFUE) were studied. Two days after treatment, CFUs were reduced to about 20% in controls and F-MuLV-P-infected animals, and CFUc were reduced to 6-11% in controls and F-MuLV-P-infected animals. CFUE were not detectable. At day 4 after the first HU dose, when CFUs has regenerated to about normal levels, a sharp rise in Ep-dependent CFUE was seen in the marrow; this rise was not present before HU treatment. The subsequent fall at day 7 coincided with a regeneration of CFUE in the spleen, but in the spleen these CFUE were all Ep-independent. Possibly, the normal Ep-dependent CFUE during regeneration in the marrow might have derived from previously resting CFUs that were not killed by HU. The subsequent conversion to Ep independency could have been due to reinfection by F-MuLV-P persisting in the animal.

Topics: Animals; Cell Survival; Colony-Forming Units Assay; Erythropoiesis; Erythropoietin; Female; Friend murine leukemia virus; Hematopoietic Stem Cells; Hydroxyurea; Leukemia, Experimental; Mice; Mice, Inbred DBA; Recurrence; Remission, Spontaneous