The pattern of serum total proteins showed a state of hypoproteinemia ranging from 4-5 gm/dl and the albumen fraction is usually is decreased but globulin fraction may be in‐ creased.

2. Millis and Bale 1976 [13], stated that a feature of their cases is the partial immune deficien‐ cy. However, such a state of hypogammaglobulinemia reported by them goes parallel with findings in the acute cases only, that their cases were quite a different group of patients suf‐ fering from genetic immunodeficiency as observed from the very early appearance of the syndrome in some of them being as early as days.

3. Serum procollagen type III is an early and sensitive marker in VOD after BM transplanta‐ tion, usually above 100 ng /ml.

4. Serum protein S,C, liedin factor

#### **4.2. Ultrasonographic scaning of the liver:**

It is of *definite help* in the diagnosis of this syndrome, it showed that the liver is enlarged es‐ pecially the caudate lobe, splenic enlargement is usually of mild degree and ascites is always found in acute cases. Narrowing of inferior vena cava could be detected in 40% of cases. Ex‐ amination of the terminal parts of the hepatic veins demonstrated their occlusion or attenua‐ tion, a finding which is considered a new and significant contribution to the early diagnosis of this syndrome [14].

#### **4.3. Inferior vena cava angiogram:**

Presented as narrow or closed intra-hepatic portion of the inferior vena cava with marked collaterals [14].

#### **4.4. Liver biopsy:**

In the acute stage it shows centrilobular hemorrhage, necrosis and sinusoidal dilatation. In the chronic stage it presents picture of micronodular cirrhosis with normal portal tracts [7].

#### **4.5. Other tools of investigations [14]**

*4.1. Laboratory Studies***:**

be normal.

552 Hepatic Surgery

creased.

1. Safouh et al; 1965 [11] reported the following results:
