Summary. The French‐American‐British (FAB) classification of acute lymphocytic leukaemia (ALL) has recently been modified to improve its reproducibility. We therefore thought it beneficial to test the utility of this modified classification in the prognosis of children with ALL. Eighty‐eight patients of less than 18 years of age with ALL were subtyped according to the modified FAB classification by two independent observers. The initial concordance was 86%. Seventy per cent of the patients were subtyped as LI, 27% as L2 and 3% as L3. Patients with L3 subtype were not analysed further. No significant differences were observed between Ll and L2 subtypes when the distribution of other prognostic factors were examined. No differences were observed between L1 and L2 subtypes in the achievement of complete remission. Patients with L1 morphology demonstrated no significant increased duration of first remission or survival when compared to patients with L2 morphology. We conclude that the morphology oflymphoblasts may not be an independent prognostic variable in patients with ALL.
An autoantibody was found on the red cells of a patient who had never been transfused previously, but was ill with metastatic adenocarcinoma. The patient's blood group was A1. In addition, the patient's serum and the eluate from the patient's red cells agglutinated A1 but not A2, B, and O red cells. This auto-A1 antibody was reactive at a wide thermal range and was inactivated by dithiothreitol, suggesting the presence of an IgM immunoglobulin. Moreover, the antibody was not associated with a hemolytic anemia.
Context.—Febrile nonhemolytic transfusion reactions (FNHTRs) cause unwelcome interruptions during the course of blood product transfusions and necessitate measures to verify the nature of the reaction and to exclude certain dangerous reactions, such as hemolytic and septic phenomena. Objective.—To examine transfusion medicine data to determine the clinical implications of the routine administration of antipyretic medication to adult patients before transfusion for the prevention of FNHTRs. Design.—A retrospective review was conducted of FNHTR data during 5 years (1998–2002), and a determination was made of the cost of a transfusion complicated by an FNHTR. In addition, a comparative cost analysis was performed using our data and published data on the incidence of FNHTRs. The clinical implications of medication with respect to possible drug-induced adverse effects were assessed, as well as the potential interference with diagnosing other forms of transfusion reactions and the mitigation of the clinical effect of an FNHTR. Results.—For nearly 120 000 U of transfused blood components, approximately 80% of which were preceded by antipyretic medication during the study period, the overall incidence of FNHTR was found to be 0.09%. Furthermore, there was no evidence of antipyretic-associated complications, nor any evidence that antipyretics prevented the recognition of other more dangerous complications of transfusions. Conclusion.—Our findings indicate that this practice provides significant advantages to the recipient of a transfusion, but does not appear to yield significant cost benefits for the health care provider.
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