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Background: Granulocyte transfusion is used in the treatment of severe, sustained or complicated infection and neutropenia. In recent years, the method's efficacy has improved and its availability increased. After the introduction of granulocyte colony-stimulating factor (G-CSF) there has been a growing interest for granulocyte transfusion, and effective methods for collection and transfusion of granulocytes are now in clinical use. This paper presents clinical, immunological and ethical challenges, our own experience with granulocyte harvesting and documentation of efficacy., Material and Methods: The paper is based on our own experience with granulocyte transfusion and literature retrieved though a non-systemic search., Results: The efficacy of granulocyte transfusion with respect to morbidity and mortality is still debated, and the method currently has no place in routine treatment of documented infection and neutropenia. However, the treatment could be an alternative for patients with inadequate response to conventional treatment and for whom sustained neutropenia is expected. The combined use of G-CSF, hydroxyethyl starch and corticosteroids considerably increases the yield of granulocytes collected for transfusion., Interpretation: Granulocyte transfusion is clinically feasible, but more research is needed to define clinical indications and to document the procedure's efficacy. Larger randomized controlled efficacy trials are needed.

Essential thrombocythemia is a chronic myeloproliferative disease characterized by persistent thrombocytosis and an increased risk of thromboembolic complications. Most patients are asymptomatic at the time of diagnosis. In this article guidelines for diagnosis and treatment of this disorder are presented on behalf of the Norwegian Society of Hematology. On the basis of a literature search in international databases (Medline) and international medical journals, articles have been selected according to their clinical relevance. The risk of major thrombosis is higher in patients older than 60 years and highest among those with a previous occlusive event. In individual patients there is no clear relationship between platelet count and risk of thrombosis. Low-dose aspirin (75-100 mg/day) is recommended to all patients with platelet count < 1,000 x 10(9)/l and in the absence of previous bleeding episodes. All patients with disease-related complications and asymptomatic patients with platelet count above 1,000-1,500 x 10(9)/l should receive cytoreductive treatment. Hydroxyurea is recommended for patients over 60 years of age. In younger patients, potential leukemogens should be avoided, and anagrelide or interferon-alpha is recommended.

Today there are not enough specialists in haematology in Norway. During the period 1990-1995 2.5 specialists in haematology qualified per year. In order to meet future requirements for haematologists at Norwegian municipal and university hospitals, it has been estimated by the Norwegian Society for Haematology that the number of specialists qualifying per year should be increased to ten for the next ten years.

Large granular lymphocyte leukaemia (LGL leukaemia) is a rare, chronic lymphoproliferative bone marrow disease which can be considered a subtype of chronic T-cell lymphocytic leukaemia (T-CLL). We describe three patients with large granular lymphocyte leukaemia. They all suffered from chronic disease with neutropenia and relative lymphocytosis. An expansion of mature lymphocytes with the CD3+, CD8+, CD57+ immunophenotype was demonstrated in all three patients. Two patients had a history of recurring infections. Serological findings compatible with rheumatic disease were present in all three patients, and two suffered from rheumatoid arthritis. We have made a brief survey of this disease, which is characterized by relative or absolute lymphocytosis, neutropenia, and an increased risk of infection. Rheumatoid arthritis and other associated autoimmune manifestations occur frequently. Large granular lymphocyte leukaemia should be considered a possible diagnosis in patients with chronic neutropenia and relative lymphocytosis, in particular if rheumatic manifestations are also present. Flow cytometric immunophenotyping is a sensitive method in diagnosing this disease.

The article reviews immunological reactions to streptokinase. The humoral immune response to streptokinase involves antibodies of different subclasses, including IgG, IgM, and IgE. A T cell response to streptokinase can also be demonstrated, involving both CD4 and CD8 positive cells. Streptokinase therapy involves increased risk of all kinds of allergic reactions, including urticaria, bronchial obstruction, shock and serum sickness.