Scand .I Haematol(l976) 16, 141-143
S H O R T COMMUNICATION
Streptokinase Resistance Test in Patients with Streptococcal Infection and/or High Antistreptolysin Titers J. AZNAR, M.D.,PH.D., F. DELGADO, M.D.
A. ESTELLBS, M.D.
Department of Clinical Pathology (Chief, J . Aznar), Ciudad Sanitaria ‘La Fe’, Valencia, Spain
The streptokinase resistance test (SRT) has been studied in a group of patients with recent streptococcal infection and/or titres of antistreptolysin higher than 625 units. These patients generally had a higher SRT. Key words: streptokinase - streptococcal infection - antistreptolysin
Accepted for publication December 10, 1975 Correspondence to: Dr. J. Aznar, Departamento de Biopatologia Clinica, Ciudad Sanitaria ‘La Fe’, Valencia, Espafia
A low antibody titres against streptokinase (SK) is present in the blood of most adults (Spottl & Kaiser 1974). As a result of previous streptococcal infections, antibodies can be produced which cross-react with and neutralize streptokinase (Hirsh et a1 1970). These antibodies - should be neutralized to induce effective thrombolysis and the neutralizing dose of streptokinase, especially in patients with previous streptococcal infection, should be calculated on basis of a streptokinase resistance test (SRT). The object of this work was to study SRT in a group of patients with previous streptococcal infections and/or more than 625 U of antistreptolysin titres.
MATERIAL AND METHODS The study included 16 patients with recent streptococcal infection and 10 patients with antistreptolysin titers higher than 625 U. The control group included 160 general hospital patients with antistreptolysin titers lower than 125 U, 85 men and 75 women aged between 10 and 75 years old, 48 patients between 10-25, 54 between 26-50 and 58 between 51-75. Plasma samples were obtained from anticoagulated blood with sodium citrate at 3.8 % (9 parts of blood and 1 part of anticoagulant). The sample was centrifuged at 1500 X g for 10 min. The supernatant was used to carry out the SRT according to the scheme proposed by the manufacturers (Hoestch), and which, in principle, consists in preparing seven SK dilutions (50, 100, 200, 300, 400, 500 and 750 U), considering as adequate a dosis of
This work was supported by a grant (No. 12/121/72) from the Instituto Nacional de Previsi6n.
J. AZNAR, F. DELGADO & A. ESTELLBS
TABLE I Streptokinase resistance test in I 6 patients with streptococcal infections Age
64 38 43 65 55 42 73 60 60 13 59 9 12 43 64 20
250 50 425 150 315 250 100 200 200 100 150 250 200 200 200 250
I 8 12 61 44 13 8 10 26 30 32
Resistance streptokinase (Units x lo3) 425 425 450 25 375 150 425 425 425 425
M F M M M M M M F F X
Control hosuital patient group
Resistance streptokinase (Units x loJ)
F F F F M M F F M M F M M M M F -
TABLE I1 Streptokinase resistance test in 10 patients with antistreptolysinines titres 625 U
355.000 145.201 p 132.969 102.269
streptokinase that could lyse a clot from the patient’s blood in 10 min. In order to calculate the dosis to be administratered, the SK concentration of the chosen dilution was multiylied by 5 X lo3, which is considered as being an average patient’s total blood volume. RESULTS
The SRT in patients with recent streptococcal infection was higher than in the generaI hospital community (Table I). The 10 patients with antistretolysin titers above 625 U needed a higher neutralizing streptokinase dose than the general hospital community in order to neutralize the SKantibodies (Table 11). DISCUSSION
A low titer against streptokinase is present in - most patients with recent streptococcal
infection (Hirsch et a1 1970). Recently, Spottl & Kaiser (1974) studied the SK-antibodies in a group of 320 unselected patients. They established a high titre in 7 of them, 3 of whom showed a history of recent streptococcal infection. James (1973) showed an increase of the anti-SK titres in 2 out of 4 confirmed cases of streptococcal infection. In our work, the group of patients with streptococcal infection needed a neutralizing dose of streptokinase higher than the general hospital community (Table I). This higher antibody titre against SK was also present in the blood of patients with an antistreptolysin titre of over 625 units. REFERENCES Fletcher A P, Alkjaersig N & Sherry S (1959) The maintenance of a sustained thrombolytic state in man. I. Induction and effects. J CIin Invest 38, 1096-110. Hirsch J, O’Sullivan E F & Martin M (1970) Evaluation of a standard dosis schedule with streptokinase.
STREPTOKINASE A N D STREPTOCOCCAL INFECTION James D C 0 (1973) Anti-streptokinase levels in various hospital patient groups. Postgrad Med J 49, (Suppl, Num 5) 26-29.
Spottl F & Kaiser R (1974) Rapid detection and quantitation of precipitating streptokinase antibodies. Thromb Diath Haemorrh 32, 608-16.