Volume 5, Number 3

Emma Kalk MRCP Senior House Officer in Haematology; Peter Rose FRCP FRCPATH Consultant Haematologist, Department of Haematology, Warwick Hospital

Ninety per cent of patients with acute promyelocytic leukaemia (APL) present with a severe haemorrhagic syndrome, out of proportion with the degree of thrombocytopaenia.1 Initially, this phenomenon was ascribed to disseminated intravascular coagulopathy (DIC) due to the release of tissue thromboplastins from blast cells. However, new data favour a fibrinolytic/protolytic process. The plasminogen receptor, annexin 11, is present in abnormally high amounts on the surfaces of leukaemic cells. This receptor is responsible for the linking of plasminogen to tissue plasminogen activator (tPA), activating plasmin and favouring fibrinolysis. Plasmin formation increases by a factor of 60, depleting normal inhibitors, and a haemorrhagic diathesis ensues.2

Amjid Riaz MRCGP Clinical Research Fellow; Ellen T Murray MSc Research Fellow; Professor F D Richard Hobbs FRCGP; David A Fitzmaurice MB CHB MRCGP MD Senior Clinical Lecturer, Department of Primary Care and General Practice, The Medical School, University of Birmingham

Increased recognition of the benefits of oral anticoagulation management in a primary care setting has led to the development of computerised decision support software (CDSS) that is specifically designed for use in the primary care environment. This article reports on a recent study, carried out at the University of Birmingham’s Department of Primary Care and General Practice, to evaluate the performance of such software, and highlights the need for rigorous evaluation of anticoagulation software before routine use is recommended.

David A Fitzmaurice MB ChB MRCGP MD Senior Clinical Lecture; Ellen T Murray MSc Research Fellow; Pat Marsh RGN; Kirsten M Gee BNurs, Department of Primary Care and General Practice, The Medical School, University of Birmingham

Near-patient testing (NPT) technology for International Normalised Ratio (INR) estimation and computerised decision support software (CDSS)
have facilitated devolution of oral anticoagulation management to primary care. A study day with the specific aim of increasing primary care knowledge of anticoagulation management, and involvement in such practice, was set up in 1997 by the Department of Primary Care and General Practice at the Universityof Birmingham.

Davina Gallagher RGN Anticoagulant Specialist Nurse; Abdul Shlebak MD FRCP MRCPATH Consultant Haematologist, St Mary’s Hospital, London

St Mary’s NHS Trust in London has recently developed a protocol to facilitate the outpatient treatment of deep vein thrombosis (DVT). This service was set up not only to make long-term improvements to the quality of patient care, but also to relieve pressure on hospital beds.

Peter Rose, Editor

In the early 1960s, it became apparent that a small cohort of patients with systemic lupus erythematosis (SLE) were at increased risk of developing either arterial or venous thromboembolic disease. These patients were more likely to have a chronic biological false test for syphilis, and also to have prolonged whole blood clotting and prothrombin times. Due to the prolonged clotting times observed and the evidence of an aspecific inhibitor, this activity was referred to as the lupus anticoagulant.