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Publications (16)90.81 Total impact

  • E M Richards · G J Alexander · J L Nichol · T P Baglin
    Thrombosis and Haemostasis 12/1997; 78(5):1420-1. · 4.98 Impact Factor
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    E M Richards · G. J. M. Alexander · RY Calne · T P Baglin
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    ABSTRACT: Thrombocytopenia frequently occurs immediately after orthotopic liver transplantation. We have investigated the cause of this phenomenon in a cohort of 45 consecutive liver transplant recipients. The median preoperative platelet count (range) of 129 x 10(9)/l (14-719) fell to 56 x 10(9)/l (23-334) by the fourth postoperative day. The median preoperative reticulated platelet percentage (range) of 6.7% (2.2-23.9) increased to 16.4% (4.6-40.8) on day 7. There was a significant rise in prothrombin fragment F1.2 by the first postoperative day which was followed by rises in fibrinogen and fibrin degradation products. There was no increase in platelet-associated immunoglobulin or markers of endothelial activation. We conclude that there is an increased rate of platelet consumption associated with thrombin generation that reflects the magnitude of liver transplant surgery.
    British Journal of Haematology 09/1997; 98(2):315-21. DOI:10.1046/j.1365-2141.1997.2363056.x · 4.71 Impact Factor
  • P Mahendra · E M Richards · P Sinclair · E Nacheva · R E Marcus
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    ABSTRACT: A 42-year-old male patient with a history of occupational exposure to benzene presented with pancytopenia. His bone marrow showed evidence of trilineage dysplasia and cytogenetic analysis revealed a unique t(9;13)(q34;q12) translocation. Five months after diagnosis he developed secondary AML. He was treated with four courses of chemotherapy and an autologous bone marrow transplantation (BMT). Four years post-transplantation he remains in haematological and morphological remission though the cytogenetic abnormality is still present in all metaphases examined.
    Clinical & Laboratory Haematology 07/1996; 18(2):121-2. DOI:10.1046/j.1365-2257.1996.00162.x · 1.30 Impact Factor
  • E M Richards · H K Jestice · P Mahendra · M A Scott · R E Marcus · T P Baglin
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    ABSTRACT: Neutrophil and platelet engraftment times are significantly shorter in patients undergoing PBPCT compared with ABMT. The explanation for this is unclear. The reticulated platelet percentage (RP%) has been established as a measure of bone marrow platelet production. Using this measurement we have followed thrombopoiesis over the transplant period in 10 patients undergoing PBPCT, eight ABMT and four alloBMT. Neutrophil and platelet engraftment times were significantly shorter in patients undergoing PBPCT than either ABMT or alloBMT. The RP% fell to a nadir in parallel with the platelet count in all patients following conditioning therapy consistent with an aplastic state and rose before platelet recovery as young platelets were released. The peak rise in the RP% was significantly greater and occurred earlier in PBPCT compared with BMT. The total number of reticulated platelets released during the time of engraftment was significantly greater in PBPCT than BMT. The potential role of the RP% in the timing of thrombopoietin therapy is explored. Finally the diagnostic use of the RP% in post-transplant thrombocytopenia is illustrated by a case in which a persistently high RP% accurately predicted a consumptive aetiology.
    Bone Marrow Transplantation 07/1996; 17(6):1029-33. · 3.57 Impact Factor
  • S Ager · P Mahendra · E M Richards · G Bass · T P Baglin · R E Marcus
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    ABSTRACT: We have investigated the toxicity of dose-escalation of BCNU, etoposide and melphalan ('BEM') chemotherapy with autologous stem cell transplantation in patients with haematological malignancies. Seventy-two patients with haematological malignancies were treated with BCNU (600 mg/m2, 450 mg/m2 or 300 mg/m2), etoposide 2 g/m2 and melphalan 140 mg/m2 followed by autologous bone marrow transplantation (ABMT), n = 51, or autologous peripheral blood progenitor cell transplantation (APBPCT), n = 21. Liver and pulmonary function was monitored pretransplant and at regular intervals post-transplant. Mucositis was graded daily during in-patient stay. There was a significantly higher incidence of symptomatic pulmonary toxicity in the patients who received BCNU at 600 mg/m2 than in the other two groups, and there was a significant increase in the incidence of asymptomatic decrease in carbon monoxide (KCO) in the patients who received BCNU 450 mg/m2. There was no significant difference between the three groups in the incidence and severity of mucositis or in the incidence of transiently abnormal liver function. We conclude that etoposide at 2 g/m2 can be used without unacceptable mucositis. BCNU at 600 mg/m2 is associated with an unacceptably high incidence of lung toxicity, but at 450 mg/m2 there is minimal symptomatic lung toxicity.
    Bone Marrow Transplantation 04/1996; 17(3):335-40. · 3.57 Impact Factor
  • E M Richards · T P Baglin
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    ABSTRACT: A practical technique for the preparation and analysis of reticulated platelets is described. The use of fixed platelet-rich plasma has given optimal results and sample stability. This technique has detected consumptive causes of a platelet count < 80 x 10(9)/l with a positive predictive value of 96% and negative predictive value of 100%. The course of the reticulated platelet percentage (RP%) in patients with resolving thrombocytopenic states is described, contrasting the elevation seen in consumptive disorders with the fall in aplastic states. In patients undergoing stem cell transplant procedures a rise in the RP% precedes the rise in the platelet count, indicating that the reticulated platelets represent cells that are recently released from the bone marrow. The RP% peak in patients receiving autologous peripheral blood progenitor cell transplants is higher and more closely temporally related to the recovery of platelet count than it is in patients receiving autologous bone marrow transplants.
    British Journal of Haematology 11/1995; 91(2):445-51. DOI:10.1111/j.1365-2141.1995.tb05320.x · 4.71 Impact Factor
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    ABSTRACT: We report the results of peripheral blood progenitor cell (PBPC) harvesting in 22 patients with lymphoma who underwent leucapheresis after cells were mobilised using 3 g/m2 cyclophosphamide and G-CSF. In 19 patients, the total CFU-GM collected was greater than 7.5 x 10(4)/kg. These patients underwent successful autologous PBPC transplantation. This group of patients was compared to a historical group of 24 patients with lymphoma who underwent ABMT with the same conditioning chemotherapy. The time to engraftment of neutrophils to 0.5 x 10(9)/l was significantly reduced (median 11 days vs 19 days, P < 0.0001) and consequently in-patient stay was reduced (median 21 days vs 28 days, P < 0.001). Blood product support (median 3 vs 4 units blood, P = 0.02; median 15 vs 40 units platelets, P = 0.005) and use of TPN (median 0 days vs 8 days, P < 0.001) were reduced. We estimate a saving of approximately pounds 2370 per patient using PBPC for autologous transplantation compared to bone marrow progenitor cells. This saving is significant (P < 0.001).
    Bone Marrow Transplantation 07/1995; 16(1):79-83. · 3.57 Impact Factor
  • E M Richards · J M Shneerson · T P Baglin
    Clinical & Laboratory Haematology 04/1994; 16(1):89-90. DOI:10.1111/j.1365-2257.1994.tb00392.x · 1.30 Impact Factor
  • E M Richards · T G Wreghitt · T P Baglin
    Transfusion Medicine 04/1994; 4(1):91-2. DOI:10.1111/j.1365-3148.1994.tb00247.x · 1.65 Impact Factor
  • D M Keeling · E M Richards · T P Baglin
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    ABSTRACT: A simple rapid platelet aggregation test was used to evaluate cross-reactivity of four low molecular weight heparins and the heparinoid ORG 10172 in three patients with heparin-induced thrombocytopenia. The low molecular weight heparins cross-reacted in 11 out of 12 tests. The heparinoid ORG 10172 did not cross-react in any of the patients. One patient was treated with ORG 10172 and thrombocytopenia resolved.
    British Journal of Haematology 03/1994; 86(2):425-6. DOI:10.1111/j.1365-2141.1994.tb04760.x · 4.71 Impact Factor
  • E M Richards · D M Bloxham · E Nacheva · R E Marcus · A R Green
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    ABSTRACT: The presence of the Philadelphia chromosome is a major determinant of the prognosis of patients with myeloproliferative disorders. We describe a case of apparent essential thrombocythaemia in whom cytogenetic analysis was normal. However, the presence of basophilia, the absence of abnormal megakaryocytes in a trephine biopsy and the female sex of the patient prompted Southern analysis of peripheral granulocyte DNA. This revealed a BCR rearrangement and the patient has therefore undergone allogeneic bone marrow transplantation. This case emphasizes the importance of both cytogenetic and molecular analysis of patients with apparent essential thrombocythaemia.
    British Journal of Haematology 12/1993; 85(3):625-6. DOI:10.1111/j.1365-2141.1993.tb03361.x · 4.71 Impact Factor
  • E M Richards · R E Marcus
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    ABSTRACT: We report a patient in whom Stage 1A Hodgkin's Disease was established by lymph node biopsy and radiology. Further lymphadenopathy developed accompanied by sweats and fever. Initially this was thought to represent further extensive Hodgkin's disease however repeat biopsy of the newly enlarged nodes showed reactive changes only. We discuss the importance of histological staging in this disease.
    Leukemia and Lymphoma 04/1993; 9(4-5):413-8. DOI:10.3109/10428199309148543 · 2.89 Impact Factor
  • T.P. Baglin · R Luddington · I Jennings · E.M. Richards
    The Lancet 03/1993; 341(8843):504-5. DOI:10.1016/0140-6736(93)90270-Q · 45.22 Impact Factor
  • E M Richards · R E Marcus
    Clinical & Laboratory Haematology 02/1993; 15(1):55-8. DOI:10.1111/j.1365-2257.1993.tb00121.x · 1.30 Impact Factor
  • E M Richards · J F Apperley · R E Marcus
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    ABSTRACT: We describe a case of proven invasive pulmonary aspergillosis in a neutropenic patient in whom disease progression occurred during treatment with conventional amphotericin B despite neutrophil recovery. Treatment with liposomal encapsulated amphotericin B resulted in clinical and radiological improvement and the clearance of aspergillus spores from the sputum.
    Clinical & Laboratory Haematology 02/1992; 14(2):127-30. DOI:10.1111/j.1365-2257.1992.tb01069.x · 1.30 Impact Factor
  • E M Richards · R E Marcus · P Harper · D W Flanagan · T P Baglin
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    ABSTRACT: We have found a high incidence of ocular haemorrhage in patients with acute promyelocytic leukaemia (APL). We describe a series of seven consecutive cases of APL, five of which developed ocular haemorrhage. There were no consistent detectable abnormalities in coagulation predictive of ocular damage. Ocular haemorrhage occurred despite the use of aggressive blood product support and its incidence was not altered by the use of the anti fibrinolytic agent tranexamic acid or by the use of heparin. Complete spontaneous resolution of the ocular pathology occurred in three of the five cases of ocular haemorrhage and partial recovery occurred in one. The fifth patient required surgical intervention. The mechanisms underlying the coagulopathy associated with APL are poorly understood. We discuss the evidence in support of primary disseminated intravascular coagulation and primary fibrinolysis. A logical approach to the management of the bleeding complications in APL can only follow greater understanding of the underlying pathophysiology.
    Clinical & Laboratory Haematology 02/1992; 14(3):169-78. · 1.30 Impact Factor