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Biomedical subjects

B A van Dijk

Publications and source records attributed to B A van Dijk.

At least 19 recordsLinked to original sources
PubMed1999

[Irregular blood group antibodies during pregnancy: screening is mandatory].

During pregnancy irregular blood group antibodies, originating either from earlier pregnancies or from blood transfusions, may severely jeopardize both mother and child. Three patients are described with pregnancy-associated blood group incompatibility. In one case of Kell antagonism a previous child had reportedly died of cot death, but in retrospect it had most probably suffered from erythroblastosis fetalis as a result of anti Kell antibodies. In the second case, a twin pregnancy, the diagnosis of neonatal haemolytic anaemia on the basis of blood group incompatibility with a very rare antibody (anti-Kpb) had been established in the previous child. No precautions had been taken during this pregnancy, putting both mother and children at risk. All three children recovered, the twins after repeated transfusion of Kpb-free erythrocytes. The described cases emphasize the importance of being informed about the presence of antibodies during pregnancy. Such information can only be obtained by assessing the antibody status during pregnancy. In the Netherlands, the screening of all pregnant women for the presence of irregular antibodies was introduced last year.

Adult↗
PubMed1999

[Hemolytic disease of the newborn and irregular blood group antibodies in the Netherlands: prevalence and morbidity].

OBJECTIVE: To inventory prevalence and morbidity of haemolytic disease of newborn caused by irregular anti-erythrocyte antibodies other than antirhesus-D. DESIGN: Prospective registration study. METHOD: All paediatricians (n = 380) in general hospitals and contact persons (n = 79) in university hospitals were asked for monthly reports of clinical cases of haemolytic disease of newborn during 2 years (1996-1997). RESULTS: Response was 97%. A total of 130 reports were received in two study years, 49 of which could not be confirmed as non-RhD-non-AB0 antagonism. In the group of which the transfusion history was known (n = 60), 29 pregnant women (48%) had received transfused blood at some time. Of the antibodies found, anti-c, anti-E and anti-K were the most frequent. The direct antiglobulin test was positive in 61 of the 81 cases, negative in 10 cases, while in 10 cases it was unknown or false-negative due to earlier intrauterine transfusions (in three neonates). The highest bilirubin levels recorded were 572, 559 and 520 mumol/l (all three with maternal anti-c antagonism). Therapeutic data were known concerning 80 of the 81 newborn: 21 (16%) received no treatment, 24 (29%) only phototherapy and the others--in addition to phototherapy if any--also blood transfusion, exchange transfusion or intrauterine transfusion, or a combination of these. CONCLUSION: It was calculated that the actual prevalence of irregular anti-erythrocyte antibodies in Dutch pregnant women probably amounts to approximately 0.25%. This finding may possibly be confirmed since starting 1 July 1998 all pregnant women in the country are screened for the presence of these antibodies. It is recommended that girls and women in the reproductive age group should receive primary prevention of development of irregular anti-erythrocyte antibodies by application of a selective blood transfusion policy, taking into account the occurrence of the antigens c, E and K.

Blood Group Incompatibility↗
PubMed1997

[Linguistics in blood group serology].

With a view to terminological uniformity, blood group serologists, immunologists and transfusion physicians should refer only to the "ABo' (zero) in stead of the "ABO' system. They also should use "HLA antibodies' in stead of "anti HLA antibodies'. The new Dutch spelling "resus' in stead of "Rhesus' is incorrect from a historical point of view.

Blood Group Antigens↗
PubMed1996

Blood group chimerism in human multiple births is not rare.

Twin blood group chimerism seems to be very rare in humans. The 30-40 previously reported cases usually were found by mere coincidence during routine blood grouping in hospitals or blood banks. Usually in these cases frank blood group mixtures of, for example, 50/50%, 25/75%, or 5/95% at most were seen. Smaller percentages are very difficult to notice during routine work-up. Using a sensitive fluorescence technique (sensitivity > 0.01%) we detected blood group chimerism in 32/415 (8%) twin pairs and 12/57 (21%) triplet pairs, respectively, which is a higher incidence than reported previously.

Adolescent↗
PubMed1995

Leukocyte depletion of random single-donor platelet transfusions does not prevent secondary human leukocyte antigen-alloimmunization and refractoriness: a randomized prospective study.

We studied the value of leukocyte depletion of platelet transfusions for the prevention of secondary human leukocyte antigen (HLA)-alloimmunization in patients with a high-risk of prior immunization induced by pregnancies. Seventy-five female patients with hematologic malignancies (mostly acute leukemia) and a history of pregnancy were randomized to receive either standard random single-donor platelet transfusions (mean leukocytes, 430 x 10(6) per transfusion) or leukocyte-depleted random single-donor platelet transfusions. Leukocyte depletion to less than 5 x 10(6) leukocytes per platelet transfusion (mean leukocytes, 2 x 10(6) per transfusion) was achieved by filtration. Of the 62 evaluable patients, refractoriness to random donor platelets occurred in 41% (14 of 34) of the patients in the standard group and in 29% (8 of 28) of the patients in the filtered group (P = .52); anti-HLA antibodies developed in 43% (9 of 21) of individuals in the standard group and 44% (11 of 25) of cases in the filtered group. The time toward refractoriness and development of anti-HLA antibodies was similar for both groups. We conclude that leukocyte depletion of random single-donor platelet products to less than 5 x 10(6) per transfusion does not reduce the incidence of refractoriness to random donor platelet transfusion because of boostering of anti-HLA antibodies.

Adult↗
PubMed1995

Red cell antibodies in pregnancy: there is no 'critical titre'.

The purpose of this study was to determine the predictive value and reliability of using a 'critical titre' when assessing the ability of red cell alloantibodies to cause haemolytic disease of the newborn. Titration studies and clinical follow-up of 418 antenatal cases where the mothers had red cell antibodies were studied retrospectively. The antibody specificities were anti-D (n = 359), anti-c (n = 34), anti-E (n = 19) and anti-K (n = 6). Depending on the titre being lower or higher than 16 in the indirect antiglobulin test, the severity of disease was established on the given therapy. Anti-D antibodies with a titre 16 were present in 20% of all cases associated with transfusion need of the child; for anti-c, -E and -K the figure was 4%. Titres > or = 16 resulted in both groups in 50% of the cases in phototherapy only, or no therapy at all. Titres are therefore not reliable indicators for predicting the severity of haemolytic disease of the newborn. Neither should they be used as a guide to whether or not antenatal intervention is indicated. Alternative quantitative or functional assays that measure cytotoxic lysis or phagocytosis or a combination of both should be performed instead.

Blood Group Antigens↗
PubMed1993

No irregular erythrocyte antibodies observed after bone allografts in 144 patients.

Red cell blood group antigens present in bone allografts may cause the formation of irregular erythrocyte antibodies (IEA). In the literature, 4 such cases have been described; all were Rh(D) negative females who had received Rh(D) positive bone and had made anti-Rh(D). To investigate the immunization by red cells after bone allografting, a retrospective and a prospective study was carried out. Altogether 144 patients were tested for the presence of IEA, before as well as after obtaining frozen allogeneic bone in orthopedic or maxillo-facial surgery. In 9 patients, the tests disclosed IEA preoperatively. No new IEA were detected postoperatively in the 144 patients, including 30 Rh(D) negative patients who received Rh(D) positive bone. We conclude that formation of IEA is a rare phenomenon. Nevertheless, it is recommended to give only Rh(D) negative bone to Rh(D) negative girls and women of childbearing age.

Antibodies↗
PubMed1993

[Effect of age of erythrocyte concentration administered to premature infants: a retrospective study].

Traditionally fresh red blood cells (RBCs, age less than 10 days) are used for neonatal transfusion. Retrospectively we studied the influence of the age (range 2-34 days, divided into age groups 1-7, 8-14, 15-21, 22-28, 29-35 days) of RBCs on hemoglobin, pH, bicarbonate, and potassium after administration of a small amount of packed RBC (10-15 ml/kg). We reviewed the hospital records of 58 preterm infants (mean birth weight 1316 +/- 543 g, mean gestational age 30 6/7 +/- 3 weeks) who received 201 transfusions (mean of 3.5 RBC transfusions per infant; range 1-22). Following transfusion there was a significant increase in hemoglobin in all age groups. No significant change occurred in pH, bicarbonate or potassium. We conclude that RBCs used for neonatal transfusions do not need to be fresh. Multiple donor exposure of neonates can be limited by splitting blood of a single donor into small portions and using them up to 35 days.

Anemia↗
PubMed1992

Exchange transfusion: evaluating the use of a mixture of citrated red cells and heparinized plasma.

In 1987 a mixture for exchange transfusion was introduced in the Netherlands. It was composed of citrated red cells, heparinized plasma and third-party platelets if necessary. Selected biochemical and haematological properties of this mixture were compared to fresh heparinized whole blood, which was at that time the blood product of choice for exchange transfusion. The parameters of the mixture were less physiological than fresh heparinized whole blood. In addition, retrospective analysis of the same parameters was performed upon 149 blood samples from newborn infants who had undergone exchange transfusion. The bilirubin decreasing capacity of the mixture was adequate. Most other parameters did not change considerably and remained within the physiological range. This mixture may be an adequate product for exchange transfusion. However, to be certain of its safety and suitability, several other biochemical and haematological aspects must be studied in addition to the immunological and infectious risks.

Bacterial Infections↗
PubMed1989

Immune hemolytic anemia associated with tolmetin and suprofen.

This article reports the first case of immune hemolytic anemia possibly associated with the ingestion of suprofen. The patient suffered from massive hemoglobinuria and acute renal failure. Serologic studies of the patient's serum revealed suprofen-dependent red cell antibodies. However, tolmetin-dependent antibodies were also found in the serum, showing the same properties as the suprofen antibodies and an even higher titer. The patient not only had drug-dependent antibodies in the serum, but also had developed autoantibodies, a phenomenon that has been described for several other drugs. The working mechanism by which suprofen and tolmetin caused immune hemolysis had properties of both the immune complex model and the induction of autoimmunity. Although it was unclear whether the immune hemolytic anemia was the result of suprofen, tolmetin, or cross-reacting antibodies, we feel that suprofen should be added to the list of nonsteroidal anti-inflammatory drugs associated with a positive direct antiglobulin test.

Anemia, Hemolytic, Autoimmune↗