Paroxysmal cold haemoglobinuria is an autoimmune haemolytic anaemia characterized by a biphasic polyclonal IgG autoantibody, the Donath‐Landsteiner (D‐L) antibody. Although classically described in association with chronic syphilis, it is most commonly seen after acute viral infections in children. We describe a case of high‐grade B‐cell non‐Hodgkin's lymphoma which presented with paroxysmal cold haemoglobinuria. The lymphoma responded promptly to combination chemotherapy whilst, at the same time, the haemolytic process rapidly resolved. Subsequent investigations showed that the D‐L antibody originated from the lymphoma cells.

We reviewed retrospectively the medical records of all patients (n = 77, mean age 74.2) on oral anticoagulants with an International normalized ratio (INR) of eight or above in a 12-month period in the Leicestershire District Health Authority (DHA). From a total of 55,625 INRs, 131 (0.24%) were > or = 8. A major cause of over-anticoagulation was unsatisfactory dose loading during in-hospital commencement of oral anticoagulation. The incidence of major bleeding was 12.9% of total episodes of INR > or = 8 with two haemorrhage-related fatalities. Therapy of major haemorrhage with fresh frozen plasma (FFP) and intravenous (i.v) vitamin K proved effective but was not given in a majority of such cases. In conclusion, improvements in initial dose loading of oral anticoagulation and in the management of major haemorrhage are required. Severely over-anticoagulated patients without obvious bleeding should nevertheless receive small dose vitamin K therapy to reduce the risk of haemorrhage related morbidity and mortality without compromising subsequent oral anti-coagulant control.

In a previous study, culture of peripheral blood mononuclear cells (PBMC) from myeloma patients with interleukin(IL)-4 and tumour necrosis factor(TNF)-alpha resulted in the appearance of clonal plasma cells, thus suggesting the presence of circulating myeloma cell precursors in the peripheral blood. Using the same cytokine combination, we cultured PBMC and purified peripheral blood B-cells from myeloma patients. In nearly all cases, partial differentiation of B-cells occurred but, similarly to results for normal controls, both kappa and lambda light chain (L.C.) cytoplasmic positive lymphoid and lymphoplasmacytoid cells were detected rather than clonal plasma cells. These results suggest that IL-4 and TNF-alpha cause partial differentiation of residual normal polyclonal B-cells rather than of circulating myeloma cell precursors in the peripheral blood of myeloma patients.

A case of high grade B cell lymphoma presented with bone marrow necrosis, followed by development of extensive marrow fibrosis, the evolution of which was documented by serial magnetic resonance imaging and bone marrow trephine histology. A markedly raised anticardiolipin antibody titre at diagnosis suggests that lymphoma associated antiphospholipid syndrome may have contributed to the aetiology of the bone marrow necrosis.

Microangiopathic hemolytic anemia (MAHA) is a well recognized complication of cyclosporin A (CyA) immunosupressive therapy post bone marrow and solid organ transplant but has rarely been reported in association with FK506 (tacrolimus), we describe a unique patient in whom both CyA and FK506 appear to have caused microangiopathy following an allogeneic peripheral stem cell transplant.

Topical retinoic acid has proved to be of variable benefit in a number of dry eye disorders of disparate aetiology, in which squamous metaplasia with keratinization of ocular epithelium is present. Its exact role in patients with dry eye however remains in dispute. We describe a case of severe dry eye due to chronic graft-versus-host disease, which was refractory to conventional therapy but which responded remarkably to topical retinoic acid with reversal of conjunctival keratinization and marked resolution of symptoms.

Clinical & Laboratory HaematologyVolume 16, Issue 4 p. 407-407 The role of plasmapheresis in myeloma patients with renal failure P.T. Murphy, P.T. Murphy Department of Haematology Leicester Royal Infirmary Leicester LE1 5WW, UKSearch for more papers by this authorM.C. Casey, M.C. Casey Department of Haematology Leicester Royal Infirmary Leicester LE1 5WW, UKSearch for more papers by this authorF. Walker, F. Walker Department of Haematology Leicester Royal Infirmary Leicester LE1 5WW, UKSearch for more papers by this authorR.M. Hutchinson, R.M. Hutchinson Department of Haematology Leicester Royal Infirmary Leicester LE1 5WW, UKSearch for more papers by this author P.T. Murphy, P.T. Murphy Department of Haematology Leicester Royal Infirmary Leicester LE1 5WW, UKSearch for more papers by this authorM.C. Casey, M.C. Casey Department of Haematology Leicester Royal Infirmary Leicester LE1 5WW, UKSearch for more papers by this authorF. Walker, F. Walker Department of Haematology Leicester Royal Infirmary Leicester LE1 5WW, UKSearch for more papers by this authorR.M. Hutchinson, R.M. Hutchinson Department of Haematology Leicester Royal Infirmary Leicester LE1 5WW, UKSearch for more papers by this author First published: December 1994 https://doi.org/10.1111/j.1365-2257.1994.tb00452.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume16, Issue4December 1994Pages 407-407 RelatedInformation

Journal Article Non-fatal massive right atrial thrombus associated with Hickman catheter in an adult receiving chemotherapy for acute leukaemia Get access P T Murphy, P T Murphy Department of Haematology, Leicester Royal Infirmary, Leicester LE1 5 WW, UK Search for other works by this author on: Oxford Academic Google Scholar M Sivakumaran, M Sivakumaran Department of Haematology, Leicester Royal Infirmary, Leicester LE1 5 WW, UK Search for other works by this author on: Oxford Academic Google Scholar K Ghosh, K Ghosh Department of Haematology, Leicester Royal Infirmary, Leicester LE1 5 WW, UK Search for other works by this author on: Oxford Academic Google Scholar C S Chapman, C S Chapman Department of Haematology, Leicester Royal Infirmary, Leicester LE1 5 WW, UK Search for other works by this author on: Oxford Academic Google Scholar J K Wood J K Wood Department of Haematology, Leicester Royal Infirmary, Leicester LE1 5 WW, UK Search for other works by this author on: Oxford Academic Google Scholar Postgraduate Medical Journal, Volume 70, Issue 825, July 1994, Pages 520–521, https://doi.org/10.1136/pgmj.70.825.520-a Published: 01 July 1994

A common Great Barrier Reef sponge, previously attributed to the genus Spongia, is described as new and placed in a new genus Rhopaloeides. This genus includes Spongiidae otherwise identical to Spongia in which the cored primary fibres form simple fascicles. The genus is also characterized by its form (massive, thick broad-based lamellae or multiple fused thick clubs). The chemistry is distinctive, characterised by possession of a rare group of C 20 diterpene furanodiols, triols and their peracetates. Considerable variation in the total yield and composition of the diterpenes for different collections of R. odorabile was confusing and led to a suggestion that more than one species was represented. Field experiments in which fragments of one individual sponge were transplanted to different conditions of illumination and depth, demonstrate that the chemical variability reflects the range of environmental conditions under which R. odorabile lives rather than any genetic differences.

A novel method has been developed for isolation of hemicellulose from alkaline extracts of plants. The method combines dialysis and ion exchange and yi

A reaction betweenD-xylose and Amberlite resinIR-45 (OH−) was detected during an attempt to remove uronic acids from hemicellulose hydrolysates. Kinetic studies have shown that the reaction is reversible, with the forward reaction being endothermic. The forward reaction is 1st order with respect toD-xylose, and the rate also depends on the proportion of resin. The compound produced is most likely a Schiff's base or a glycosylamine, obtained by the elimination of a molecule of water. This study has shown that caution should be exercised in using a weak-base anion-exchange resin in the presence of reducing sugars.