Thrombocytopenia, acid phosphatase

The slight but definite elevations of serum acid phosphatase activity in conditions such as thrombocytopenia (02, Zl), Gaucher s disease (T6, T8), or various myeloproliferative diseases (B6) indicate the possibility that platelets, the marrow, and the reticuloendothelial system may also be sources of acid phosphatase. These aspects will be discussed more fully later in the review. 

Reports on the alteration of serum and/or plasma acid phosphatase activity in thrombocytopenia have not always been consistent. Zucker and Woodard (Z2) described a series of 12 patients with thrombocyte-... 

In a group of six children with acute thrombocytopenia and bone marrow megakaryocytic hyperplasia, the blood plasma, prepared as previously described, showed, in each case, an acid phosphatase activity, as determined by Gutman s method, that was higher than the mean value for that age (p = 0.02). The p value for the comparison of the group as a whole with normals was between 0.01 and 0.02. In all six of these patients the plasma acid phosphatase values returned to normal or near normal levels as the thrombocytopenia was corrected. Oski et al. (02) also studied 15 cases of chronic idiopathic thrombocytopenic purpura in whom the bone marrow showed normal to increased numbers of megakaryocytes. Of these, 13 showed plasma acid phosphatase values that were elevated above the normal mean for their age, albeit some of these differences were small. However, these elevations were statistically significant with a p value less than 0.01. 

In essence, then, these investigators felt that the plasma acid phosphatase activity, unobscured by in vitro destruction of platelets, could reflect the contribution of acid phosphatase from in vivo platelet destruction in various types of thrombocytopenias. To summarize, in thrombocyto-... 

However, Cooley and Cohen (C9) studied nine cases of idiopathic thrombocytopenic purpura in. which they failed to find any consistent correlation between the plasma acid phosphatase activities and platelet counts. Cohen et al. (C6) had shown that this condition could be classi-fifed into two major types, destructive and nondestructive, comprising 80% and 20%, respectively, of the total. In sequential studies of their various patients, Cooley and Cohen (C9) did not find any increased plasma acid phosphatase activity in those showing the destructive type, although in two cases of nondestructive (hypoplastic) thrombocytopenias, the plasma acid phosphatase activities were usually normal or low. Cooley and Cohen (C9) also found that in a group of eight patients with secondary (nondestructive) thrombocytopenias with nearly normal platelet life-spans (mostly 5-7 days) the plasma acid phosphatase levels tended to be low and to be correlated with the platelet count. 

C9. Cooley, M. H., and Cohen, P., Plasma acid phosphatase in idiopathic and secondary thrombocytopenias. Arch. Intern. Med. 119, 345-354 (1967). 

Registration of adverse effects with Lorenzo s oil has been hampered by the absence of controlled trials. In 22 patients treated for at least 12 months, although Lorenzo s oil did not seem to be beneficial, there were possible adverse effects, such as mild increases in liver enzymes (55%), thrombocytopenia (55%), gastrointestinal complaints (14%), and gingivitis (14%). Furthermore, there were falls in hemoglobin concentration and leukocyte count, and an increase in the plasma alkaline phosphatase concentration the reduction in platelet count did not result in hemorrhage (1). Whether some of the adverse effects of Lorenzo s oil are due to low concentrations of essential fatty acids or caused by reduced dietary fat intake is not known. 

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