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In 26 acute promyelocytic leukaemia (APL) patients treated with all-trans retinoic acid (ATRA), 23% had platelet counts between 459 and 800 x 10(9)/I during treatment. These values, observed between days 28 and 45 of ATRA treatment, were transient and asymptomatic. We report two APL cases with platelet counts > 1000 x 10(9)/I during ATRA therapy who were treated with recombinant interferon alpha. In both cases ATRA doses were not modified, no complications secondary to thrombocytosis were seen, and they subsequently achieved complete remission. It is suggested that IL-6 may play an important role in the pathogenesis of the thrombocytosis induced by ATRA. To our knowledge, this is the first report of thrombocytosis occurring during ATRA treatment.

Cardiovascular autonomic function tests were performed in 24 patients with sickle cell anemia (SCA). Twenty-five healthy Afro-Caribbean black subjects and 38 healthy white subjects of Hispanic origin served as controls. Measurements based on heart rate variability (HRV) included the coefficient of variation (the standard deviation of the distribution of R-R intervals divided by the mean) and spectral analysis (low- and high-frequency bands) at rest, HRV during deep breathing (expiration-inspiration difference), Valsalva maneuver (Valsalva ratio) and lying-to-standing test (30:15 ratio). Fourteen patients (58.3%) were found to have cardiovascular autonomic dysfunction based on abnormal values for at least two cardiovascular autonomic function tests, whereas ten (41.7%) had preserved cardiovascular autonomic function. In contrast, all control subjects had normal cardiac autonomic function. SCA is known to be associated with sudden death. Involvement of autonomic nervous dysfunction in sudden death has been reported in various diseases and we suggest that this may be the case in SCA.

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