Erythrocyte sedimentation rate in elderly blacks

This study invitigated the erythrocyte sedimentation rate (ESR) in an elderly population with the objective of establishing reference ranges and the diagnostic value of the ESR. Elderly blacks were randomly selected from conununities in the Orange Free State. ESR determinations were done according to the Westergren method. Totalprotein, albumin, immunoglobulin and C-reactive protein (CRP) levels were measured on serum. Results were analysed by means of nonparametric statistical methods. In the group with normal CRP' and inununoglobulin levels it was found that 99% of values were below 44 mm/h for men and 62 mm/h for women. The sensitivity and specificity for these cut-off values (CRP used as 'gold standard') were 33% and 91% respectively for men and 75% and 89% respectively for women

Haematological condition of the San (Bushmen) relocated from Namibia to South Africa

No Abstract

Antinuclear antibody testing in obstetric patients

Objectives. To assess possible associations between the presence of antinuclear antibodies (ANAs) and pregnancy outcome in order to determine the significance of this test in obstetric practice.Methods. A case-control study was performed on 408 patients admitted to an obstetric high care unit and on whom ANA testing was consecutively performed. The study group consisted of 46 patients who tested positive for ANAs and a control group of 92 patients who tested negative for ANAs. In addition to demographic data, indications for admission and pregnancy outcome were compared between the two groups.                                Results. Of the 46 patients with a positive ANA result, 28 had an antinuclear pattern, 13 an anticytoplasmic pattern and 5 an antinuclear and an anticytoplasmic pattern. No significant differences were observed between the two groups (ANApositive and negative) with regard to demographic data, indication for admission, clinical and laboratory data, and pregnancy outcome. The patients were also tested for anticardiolipin antibodies, and significantly more patients with severe pre-eclampsia tested positive (24% versus 4.7%, p = 0.01). No difference in HIV status and presence of autoantibodies was found between the two groups.Conclusion. The presence of ANAs was not associated with adverse pregnancy outcome. Therefore routine patient testing for ANAs in an obstetric high-care unit is not recommended

Transient Thrombasthenia in a Patient with Tuberculosis

A 20-year-old Black female presented with menorrhagia and epistaxis. Similar episodes, two years previously, had necessitated blood transfusion. No association with drug ingestion was found and the family history revealed no bleeding diathesis. The patient had a normal platelet count and a prolonged bleeding time. Platelet aggregation, clot retraction and platelet factor 3 release were grossly abnormal. She had axillary tuberculous lymphadenitis and chemotherapy was initiated. Three months later there was no clinical or laboratory evidence of a platelet abnormality. No reason for this transient thrombasthenia, which is unknown to us, was found. Glanzmann's disease is a hereditary thrombasthenia with a similar qualitative platelet defect

The pharmacology of recombinant hirudin, a new anticoagulant

A new anticoagulant, recombinant hirudin, was given to healthy volunteers (5 per test dose) in single .intravenous doses of 0,01, 0,02, 0,04, 0,07 and 0,1 mg/kg to study its anticoagulant effects, how it was tolerated and its pharmacokinetics. Hirudin proved to be a potent anticoagulant with important effects on thrombin (increase in thrombin time and partial thromboplastin time). The maximum pharmacodynamic effect was achieved with the 0,07 mg/kg dose, and upwards. All doses of the compound were tolerated without sideeffects. The mean elimination half-life is about 1 hour. Mean total clearance and volume of distribution are approximately 190 ml/min and 14 I, respectively. Hirudin obeys first-order pharmacokinetics

Patient satisfaction at haematology and oncology clinics in the Free State & Northern Cape

The Free State and Northern Cape make up some 40% of the land area of South Africa, while being home to only 10% of the total population. Haematology and Oncotherapy outreach clinics were established in Kimberley, Bethlehem and Welkom to provide a more accessible service to the thinly spread population. A previous study showed these clinics to be cost-effective, but we had no idea how the patients experience them. Our aim was to obtain information about the demographics of the patients, the logistical support of the clinics, the medical needs of the patients and how they experience the clinics. This can help us to improve the service. A questionnaire was tested in a pilot study. The demographic questions covered age, sex and ethnicity. The logistical questions dealt with distance travelled to the clinic, mode of transport, length of time as a patient and cost. The medical need questions dealt with type of disease, treatment received, type of doctor seen and origin of referral. The questions about experience covered satisfaction with the service, staff, waiting times and involvement of non-governmental organizations. Of the 95 patients interviewed 42% were from the haematology clinics. The mean age was 59.5 and the male: female ratio was 0.6:1. Forty-six percent of the patients spoke Afrikaans and 31 % spoke South Sotho. The black:white ratio was 1:1. Twenty-eight percent used the government ambulances (of whom 80% were satisfied) and 56% used their own cars. The median payment at a clinic was R20 (R0 to R200). Only 19% of patients were paying privately. Ninety-five percent of the patients were follow-ups, with the median length of follow-up being 24 months (1 to 468). The patients were mainly referred by local hospitals. Twentytwo percent of the patients had chronic haematological malignancies, while 68% had solid tumours. Thirty-seven percent of the patients received drugs to take home and only 6% got intravenous chemotherapy. Consultants saw 44% of the patients. The median waiting time to be seen was 1.5 hours (0 to 5). Consultation time averaged 10 minutes and most patients were satisfied with this. Despite the study’s small size the system of outreach clinics seems to be delivering a satisfactory service. Criticisms were few. However there were suggestions to create better clinic facilities and to shorten the waiting times at the clinic

The sensitivity of tests to detect in vivo platelet activation induced by the removal of arterial endothelium of the baboon (Papio ursinus)

The relative sensitivities for the various in vivo and in vitro tests for platelet activation are unknown. This was studied in a baboon model where limited and more substantial injury to the vascular endothelum was inflicted. The endothelium of a segment of the right carotid artery was removed with a balloon catheter on day 0(limited de-endothelialisation), and that of the left carotid artery, abdominal aorta and left femoral artery on day 7 (substantial de-endothelialisation). Eight baboons (Papio ursinus) were used. Baseline tests for platelet activation (platelet volume, platelet density, platelet aggregate ratio, and platelet and plasma levels of platelet factor 4 [PF4] and β-thromboglobuln [β-TG]) were performed 7 days before de-endothelialisation and repeated on days 1, 9 and 16. The kinetics of indium-111-labelled platelets were measured after substantial de-endothelalisatiori. Sham operations were done on 3 animals eXactly as in the test, except that the balloon injuries were not inflicted. No influence on the results of the platelet function tests was found. Tile only test capable of detecting limited injury to the endothelium was the measurement of plasma PF4: The mean platelet life-span (MPLS) shortened, mean platelet density decreased, the circulating platelet aggregate ratio decreased, and plasma levels of PF4 and β-TG increased (P < 0,05 in all instances) after the substantial endothelal injury. The mean platelet volume, intraplatelet PF4 and β-TG, and the in vivo distribution and sites of sequestration of labelled platelets were poor tests for in vivo platelet activation. Nine days after the substantial deendothelialisation, the only remaining evidence of platelet activation was an increase in the number of circulating platelet aggregates. It is concluded that the most sensitive tests for in vivo platelet activation are the measurement of the circulating platelet aggregate ratio (sensitivity 0,63) and plasma β-TG (sensitivity 0,63), and the estimate of the MPLS (sensitivity 0,50)