No abstract

SUMMARY The presence of a subdural haemorrhage was observed in a fetus during antenatal ultrasound examination. The infant was found to be a homozygote for factor X deficiency. Prompt recognition permitted replacement treatment from an early stage. Inherited coagulation disorders should be suspected when intracranial haemorrhage is detected antenatally.Congenital factor X deficiency is a rare coagulation disorder with considerable heterogeneity in its clinical manifestations. Intracranial haemorrhage in early infancy has been observed in a small number of these patients, and this is often associated with a poor outcome.' Although antenatal intracranial haemorrhage (including subdural haemorrhage) occurs as an unusual complication of other coagulation defects,2 it has never been found in association with this disorder. We report a girl with a subdural haemorrhage, diagnosed on ultrasound scans before birth, who was subsequently shown to have factor X deficiency. Case reportThe girl was born by caesarean section at 37 weeks' gestation. Her parents were first cousins and belonged to a family in which there had been a number of intermarriages. A male sibling had died at another hospital five years previously at 2 days of age from a hypoplastic left heart and had been noted to have an unidentified coagulopathy. The mother, who had a history of easy bruising, was investigated at that time and found to have a prolonged prothrombin time (British comparative ratio [1][2][3][4][5] and concentrations of factor V of 86%, factor VII of 60%, and factor X oi 41%. There was no other family history of a bleeding disorder.In this pregnancy the mother had booked at 22weeks' gestation. Details of her previous confinement and investigations were not known. An ultrasound scan had shown an appropriately grown fetus with no detectable abnormalities. The pregnancy proceeded uneventfully except for a minor fall down some stairs at 33 weeks. At 35 weeks, however, an ultrasound scan had shown a fluid collection with a straight medial border underlying the left parietal bone and a shift of the midline to the right. This appearance, which was thought to be due to a subdural haemorrhage, was seen on further ultrasound scans up to 37 weeks (fig 1). It did not appear to be enlarging. A caesarean section was performed in order to minimise trauma to the fetal head.

Our observations suggest that use of products enriched with BKV-specific T cells generated using this system is safe and efficient in HLA-haploidentical HCT where BKV cystitis can be a serious complication.

Two sulphated polysaccharides, fucoidan (a derivative of seaweed) and the newly synthesised dextrin sulphate, were tested for their ability to inhibit human immunodeficiency virus (HIV) infection in vitro in comparison to dextran sulphate and azidothymidine. They were found to be potent inhibitors of diverse strains of HIV-1 in a variety of human cell lines and in peripheral blood lymphocytes (PBL) using a range of assays, including cell-free and cell-to-cell spread of infection. The drugs did not adversely affect cell proliferation or protein metabolism of PBL. As dextrin sulphate is less potent than dextran sulphate in prolonging thrombin-induced fibrin clotting time, it merits further development as an antiviral agent.

There are now simple and suitable devices available for measuring haemoglobin at point-of-care, away from a laboratory. This provides a useful screening test in general practice as a full blood count would, as a rule, be required only in the small proportion of cases where anaemia is detected or the patient's history and/or clinical signs specifically indicate the need for this further investigation. This approach should contribute to more efficient, convenient and economical practice without compromising clinical management.