Cyclophosphamide in Treatment of Disseminated Malignant Disease

Abstract

BmISH ~~~~~~~~~~~~~~~~~MmlC.#LJOu"M cord haemoglobin level suggests and early exchange transfusion is indicated.'There were, in addition to the 80 pairs of cases described, 50 infants with cord haemoglobin values over 11.5 g./100 ml.but who were treated within the first nine hours of life.Evidence has already been presented indicating that exchange transfusion was performed in the first nine hourg in some of these either because the cord haemoglobin value was relatively low or because early jaundice developed.In many, however, the time of exchange transfusion and whether or not the case was paired was determined by chance.The subsequent course in these cases did not differ from either of the paired groups.The same proportion developed severe jaundice, a similar number required additional transfusion, and only one infant died, not from haemolytic disease but from hyaline membrane disease.Six of the 50 infants were upset by the transfusion itself, a slightly higher proportion than in either of the other two groups.Even where haemolytic disease of the newborn has not been predicted.relatively severe disease should be diagnosed within 24 hours of birth, and if prompt exchange transfusion is carried out satisfactory results should be achieved.Summary During 1958, 1959, and 1960 we performed exchange transfusion between 9 and 24 hours in 80 infants in whom the cord haemoglobin values exceeded 11.5 g./ 100 ml.From the same period we selected 80 infants treated between one and nine hours but who were otherwise similar with regard to birth weight and cord haemoglobin and cord bilirubin levels.Although jaundice was more common in the group treated after nine hours, the frequency of severe jaundice or bilirubinaemia exceeding 15 mg./ 100 ml. was the same in the two groups, as was the need for subsequent exchange transfusion.There was a suggestion that the infants treated later tolerated the procedure better.No death' attributed to haemolytic disease of the newborn occurred in either group.We conclude that if the cord haemoglobin value exceeds 11.5 g./100 ml. in the absence of clinical or other evidence of severe haemolytic disease exchange transfusion may safely be delayed up to 16 hours of life.