PLASMA LACTOFERRIN AS A MARKER OF WHITE CELL DEGRANULATION IN VENOUS DISEASE

Objective: To measure plasma lactoferrin as a marker of neutrophil deg ranulation in groups of patients with varying severity of venous disea se and compare with age- and sex-matched control subjects. Design: Pro spective study of patients with varicose veins compared with a group o f control subjects with no history or clinical findings of varicose ve ins. Setting: The Middlesex Hospital Vascular Laboratory, Mortimer Str eet, London W1N 8AA, UK. Patients: Patients referred to the Middlesex Hospital Vascular Laboratory for investigation of venous disease. Cont rol subjects were obtained from within the laboratory and hospital sta ff, and from a group of patients attending the London Foot Hospital fo r routine chiropody. Neither group had arterial disease nor any other illness or medication known to alter white cell activity. Intervention s: 10 ml of blood taken from an arm vein into EDTA for a neutrophil co unt and measurement of plasma lactoferrin using an ELISA. Results: Sig nificantly raised plasma lactoferrin was found in all four groups of p atients compared with their controls (p = 0.0156 for uncomplicated var icose veins, p = 0.01 for lipodermatosclerosis, p = 0.0413 for active venous ulceration, and p = 0.0005 for healed ulcers, Mann-Whitney U-te st). Differences between medians (95% confidence interval) for the fou r groups were 269 (62-603), 199 (60-314), 133 (44-218) and 215 (98-349 ) ng/ml respectively. There was no difference in the neutrophil count between the patient and control groups, and correcting plasma lactofer rin for the neutrophil count did not remove significance in any group. Conclusions: This study shows evidence of increased neutrophil activa tion as shown by increased degranulation in patients with venous disea se.