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Letters and Correspondence REFERENCES
Intravenous Gammaglobulin Treatment for Thrombocytopenia Associated With Infectious Diseases To the Ediror: In their very interesting paper Cyran et al. [ I ] demonstrate clearly the usefulness of intravenous gammaglobulin in the treatment of severe thrombocytopenia associated with infectious mononucleosis. We think that the scope of this case report is far greater and may cover the field of all infection-associated severe thrombocytopenia. Thrombocytopenia is frequent in many infectious diseases whether viral, protozoan, or bacterial. Mumps, chicken-pox, measles, hepatitis, human deficiency virus 1, or cytomegalovirus infection can cause a decrease in platelet count. Parasitic infections like malaria, toxoplasmosis, or leishmaniasis can be associated with thrombocytopenia, and it is also the case in severe bacterial sepsis in general. Leptospirosis [2] very often includes in its clinical setting a severe thrombocytopenia: in this case we have shown [3] the efficacy of intravenous gammaglobulin administered alone, with a spectacular rise in platelet count comparable to that of patient 5 in the Cyran et al. case-report [I]. The common mechanism suggested for infection-related thrombocytopenia [4] along with the proven efficacy in HIV, leptospirosis, or infectious mononucleosis suggests the use of intravenous gammaglobulin each time an infectious disease is associated with severe thrombocytopenia.
I . Cyran EM, Rowe JM, Bloom R E Intravenous gammaglobulin treatment for immune thrombocytopenid associated with infectious mononucleosis. Am J Hematol 38:124-129, 1991. 2. Worledge SM, Dacie JV: Hemolytic and other anemias in infectious mononucleosis. In Carter HG, Penman RL (eds): “Infectious Mononucleosis.” Blackwell Scientific Publications, Oxford, 1969. 3. Wilkinson LS. Petz LD, Garratty G: Reappraisal of the role of anti-i in hemolytic anemia in infectious mononucleosis. Br J Haematol 25:715-718, 1973.
Effects of Zinc Supplementation on Somatomedin-C Level, in Beta Thalassemia
To the Editor: Growth retardation is a common problem in beta thalassemia patients. There are many contributing factors, such as chronic anemia, iron overload, chronic zinc (Zn) deficiency, and growth hormone deficiency [I]. We have previously reported the positive effect of zinc supplementation on linear growth in beta thalassemia [I]. We proposed that zinc deficiency may affect the generation of somatomedin-C (SM-C), as decreased SM-C levels were reported 121. SM-C mediates growth by contributing to the effect of growth hormone and requires Zn to be synthesized in liver [ I ] . We conducted a study in order to evaluate the effect of Zn supplementation on SM-C levels in beta thalassemia major patients. R. COSTELLO Twelve beta thalassemia patients, five males and seven females ranging Unite lNSERM U 119, 27 13006 Marseille, France in age from 4 to 22 years (5.90 t 11.6), were included in this study. All F. DUFFAUDhad growth retardation (below 3rd percentile). Diagnosis of thalassemia Sce Reanimation Dr Garrigues, Centre Hospitalier was made by clinical, hematological, and genetic studies. Standard methD’Aix-en-Provence, 13600 Aix-en-Provence, France ods were used for routine hematological, hormonal, and biochemical tests. Zn levels were determined by an atomic absorption spectrophotometer (Perkin Elmer 103 and 2380) [3]. SM-C levels were determined by RIA at the Reference Laboratories, Nichols institute (Los Angeles, CA). REFERENCES All patients showed compliance with Zn supplementation. Zn was given as zinc sulphate (100 mg ZnSO, , 7H,O) containing 22.5 mg elemental Zn I . Cyran EM, Rowe JM, Bloom R E Intravenous gammaglobulin treatment for immune thrombocytopenia associated with infectious mononucleosis. Am J Hematol in gelatin capsules, twice daily at the dose of 2 mgikg124 hr for 12 months. 38:124-129, 1991. Twenty children were taken as normal controls within the same age range. 2. Waitkins SA: Update on leptospirosis. Br J Med 290:1502-1503, 1985. Student’s t test was used for statistical analysis 3. Routy JP, Blanc AP, Costello R, Eucalipto 1, Lee Poeyio W, Chardon H. Interet Plasma SM-C levels and Zn levels were found to be decreased prior to Zn forte i dose au cours d u n e thrombopenie des gammaglobulines intraveineuses ? supplementation. After 12 months of supplementation, there was no change dans un cas de leptospirose. Presse Med 17:37, 1988. in SM-C (0.36 t 0.19 uiml and 0.25 ? 0.14; D 0 . 0 5 ) levels, although an 4. Schwenk HU, Baenkler, HW: Effect of gammaglobulin injection on circulating increase in plasma Zn levels occurred (78.12 t 18.12 pgldl, 104.33 t immune complexes in various diseases. Eur J Ped 131:4348, 1979. 2 8 . 3 0 P
Letters and Correspondence REFERENCES
Intravenous Gammaglobulin Treatment for Thrombocytopenia Associated With Infectious Diseases To the Ediror: In their very interesting paper Cyran et al. [ I ] demonstrate clearly the usefulness of intravenous gammaglobulin in the treatment of severe thrombocytopenia associated with infectious mononucleosis. We think that the scope of this case report is far greater and may cover the field of all infection-associated severe thrombocytopenia. Thrombocytopenia is frequent in many infectious diseases whether viral, protozoan, or bacterial. Mumps, chicken-pox, measles, hepatitis, human deficiency virus 1, or cytomegalovirus infection can cause a decrease in platelet count. Parasitic infections like malaria, toxoplasmosis, or leishmaniasis can be associated with thrombocytopenia, and it is also the case in severe bacterial sepsis in general. Leptospirosis [2] very often includes in its clinical setting a severe thrombocytopenia: in this case we have shown [3] the efficacy of intravenous gammaglobulin administered alone, with a spectacular rise in platelet count comparable to that of patient 5 in the Cyran et al. case-report [I]. The common mechanism suggested for infection-related thrombocytopenia [4] along with the proven efficacy in HIV, leptospirosis, or infectious mononucleosis suggests the use of intravenous gammaglobulin each time an infectious disease is associated with severe thrombocytopenia.
I . Cyran EM, Rowe JM, Bloom R E Intravenous gammaglobulin treatment for immune thrombocytopenid associated with infectious mononucleosis. Am J Hematol 38:124-129, 1991. 2. Worledge SM, Dacie JV: Hemolytic and other anemias in infectious mononucleosis. In Carter HG, Penman RL (eds): “Infectious Mononucleosis.” Blackwell Scientific Publications, Oxford, 1969. 3. Wilkinson LS. Petz LD, Garratty G: Reappraisal of the role of anti-i in hemolytic anemia in infectious mononucleosis. Br J Haematol 25:715-718, 1973.
Effects of Zinc Supplementation on Somatomedin-C Level, in Beta Thalassemia
To the Editor: Growth retardation is a common problem in beta thalassemia patients. There are many contributing factors, such as chronic anemia, iron overload, chronic zinc (Zn) deficiency, and growth hormone deficiency [I]. We have previously reported the positive effect of zinc supplementation on linear growth in beta thalassemia [I]. We proposed that zinc deficiency may affect the generation of somatomedin-C (SM-C), as decreased SM-C levels were reported 121. SM-C mediates growth by contributing to the effect of growth hormone and requires Zn to be synthesized in liver [ I ] . We conducted a study in order to evaluate the effect of Zn supplementation on SM-C levels in beta thalassemia major patients. R. COSTELLO Twelve beta thalassemia patients, five males and seven females ranging Unite lNSERM U 119, 27 13006 Marseille, France in age from 4 to 22 years (5.90 t 11.6), were included in this study. All F. DUFFAUDhad growth retardation (below 3rd percentile). Diagnosis of thalassemia Sce Reanimation Dr Garrigues, Centre Hospitalier was made by clinical, hematological, and genetic studies. Standard methD’Aix-en-Provence, 13600 Aix-en-Provence, France ods were used for routine hematological, hormonal, and biochemical tests. Zn levels were determined by an atomic absorption spectrophotometer (Perkin Elmer 103 and 2380) [3]. SM-C levels were determined by RIA at the Reference Laboratories, Nichols institute (Los Angeles, CA). REFERENCES All patients showed compliance with Zn supplementation. Zn was given as zinc sulphate (100 mg ZnSO, , 7H,O) containing 22.5 mg elemental Zn I . Cyran EM, Rowe JM, Bloom R E Intravenous gammaglobulin treatment for immune thrombocytopenia associated with infectious mononucleosis. Am J Hematol in gelatin capsules, twice daily at the dose of 2 mgikg124 hr for 12 months. 38:124-129, 1991. Twenty children were taken as normal controls within the same age range. 2. Waitkins SA: Update on leptospirosis. Br J Med 290:1502-1503, 1985. Student’s t test was used for statistical analysis 3. Routy JP, Blanc AP, Costello R, Eucalipto 1, Lee Poeyio W, Chardon H. Interet Plasma SM-C levels and Zn levels were found to be decreased prior to Zn forte i dose au cours d u n e thrombopenie des gammaglobulines intraveineuses ? supplementation. After 12 months of supplementation, there was no change dans un cas de leptospirose. Presse Med 17:37, 1988. in SM-C (0.36 t 0.19 uiml and 0.25 ? 0.14; D 0 . 0 5 ) levels, although an 4. Schwenk HU, Baenkler, HW: Effect of gammaglobulin injection on circulating increase in plasma Zn levels occurred (78.12 t 18.12 pgldl, 104.33 t immune complexes in various diseases. Eur J Ped 131:4348, 1979. 2 8 . 3 0 P
