Long-term outcome of splenectomy for immune thrombocytopenic purpura.
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Adolescent↗
Biomedical subjects
K Maślanka
Publications and source records attributed to K Maślanka.
Isoimmune neonatal neutropenia due to anti-Fc(gamma) RIIIb antibody in a mother with an Fc(gamma) RIIIb deficiency.
A rare case of neutropenia in a newborn due to anti-Fc(gamma) RIIIb antibody is described. The newborn, born from the 5th pregnancy, had severe infection and no neutrophils. Full clinical and neutrophil count recovery was observed when the child was 5 weeks old. In maternal serum, panreactive granulocyte alloantibodies were detected. The mother's and her two sisters' granulocytes appeared to be Fc(gamma) RIIIb deficient as found using pheno- and genotyping methods. All of them were healthy. The anti-Fc(gamma) RIIIb specificity of antibodies was identified by the monoclonal antibody immunobilization of neutrophil antigen assay. Such antibodies were not found in both sisters with the Fc(gamma) RIIIb deficiency, although they were pregnant, one of them on the seventh occasion.
Adult↗
The risk of antibody formation against HNA1a and HNA1b granulocyte antigens during pregnancy and its relation to neonatal neutropenia.
The evaluation of immunization by the HNA1a and 1b antigens during pregnancy was based on (i) their genotyping in 1038 unselected mothers and newborns of homozygous mothers, (ii) granulocyte counting in all born infants and (iii) examination of granulocyte antibodies in maternal sera if an HNA1 incompatibile child was born. A total of 548 (52.8%) mothers were heterozygous--thus further examinations were not done. Four hundred and ninety (47.2%) were homozygous, of whom 203 (41.3%) delivered an incompatible child, i.e. 19.6% of all the infants. Among available sera from 195 mothers with feto-maternal incompatibility, the granulocyte-specific antibodies were found in nine (4.5%); six of these (3%) were HNA1 (four anti-1a, two anti-1b), and in three others the specificity was not determined. In the remaining 28 sera, the only antibodies detected were HLA. Hence, six out of 1000 pregnant women can be expected to develop anti-HNA1. In none of the newborns was the cord neutrophil count below 1.5 x 109 L-1 and signs of infection found, thus the incidence of NAIN seems to be lower than 1 per 1000 infants. A comparison with our previous, unpublished data suggests that the incidence of severe NAIN is roughly 1 per 6000 (four cases among 24101 newborns).
Blood Group Incompatibility↗
[Feto-maternal incompatibility due to the platelet specific antigens: frequency, diagnosis and general rules of management].
In this review actual problems of the frequency, diagnosis and general rules of management of the neonatal alloimmune thrombocytopenia (NAIT) due to platelet antigens are presented.
Adult↗
T cell immunobiology of alloimmune thrombocytopenias.
Allorecognition and generation of alloantisera depend on T cell help. Here we summarize our recent work on identifying the T cells that recognize a specific platelet alloantigen generated by a Pro to Leu polymorphism in beta-chain of the platelet integrin alphaIIb beta3. The ability to generate alloantibodies is restricted by HLA-DRB3*0101. By measuring peptide binding to HLA-DRB3*0101, we have shown that the polymorphism controls the generation of the T cell epitope. This is not a result of the polymorphism changing a T cell contact residue, but rather by its generating a peptide anchor. The result is a directional antibody response in which only the beta-chain that is antigenic is the one that produces a peptide that binds to the HLA-DR. This mechanism of generating alloantibodies may be a paradigm for a whole class of responses.
Animals↗
Molecular analysis of T cell repertoires. Spectratypes generated by multiplex polymerase chain reaction and evaluated by radioactivity or fluorescence.
The analysis of T-cell repertoires has been facilitated by the introduction of methods in which the length heterogeneity of the third complementarity region (CDR3) is used to further refine V-family-specific PCR. We call our implementation of this technique T-cell spectratyping. This method is especially important in analysis of specific expansion or retention of T cells in human immune system function. Current methodologies are cumbersome in the number of PCR reactions and gels needed for complete analysis of TCR BV repertoires. We describe here the optimized conditions for using 11 TCR BV primer pairs in multiplex PCR which allow for a more compact analysis. In addition, the two primers act as controls for each other in the PCR. The use of these primers is shown using either fluorescent or radiolabeled constant primers. The two labeling methods give comparable results. Fluorescent primers avoid the difficulties associated with use of radioactivity. Autoradiography with 32P-labeled primers is simpler, requiring less instrumentation.
Autoradiography↗
Effects of human neutrophil elastase and cathepsin G on the reactivity of platelets with antiplatelet antibodies.
Two human neutrophil serine proteases, elastase (HNE) and cathepsin G (CathG), are known to change the structure and hemostatic function of platelet surface membrane. The platelet membrane contains glycoproteins (GPs) which function as alloantigens, autoantigens and targets of drug-induced antibodies. The aim of this study was to investigate whether proteolysis of platelet GPs by HNE and CathG is associated with changes in the reactivity of platelets to antiplatelet antibodies. The platelet immunoreactivity was examined using the MAIPA (monoclonal antibody-specific immobilization of platelet antigens) assay and PSIFT (platelet suspension immunofluorescence test). The treatment of platelets with HNE led to a moderate increase in their reactivity to quinidine-dependent (anti-GP Ib) antibody and to a slight decline in the expression of HPA-1a. In contrast, CathG did not provoke any significant changes in platelet reactions with quinidine dependent and anti-HPA-1a antibodies. Both enzymes had no significant effect on the expression of HLA-A2, HLA-A3, HLA-B7 and HLA-B8 on platelets.
Antibodies↗
Analysis of 15 cases with platelet EDTA-dependent antibodies.
In 15 patients with thrombocytopenia EDTA-dependent platelet antibodies (IgM agglutinins active in 20 degrees C) were detected. These antibodies were found in patients with autoimmune diseases, infections and neoplasma as well as in healthy persons (including pregnant woman). In 10 persons pseudothrombocytopenia (PTCP) was diagnosed since the low platelet counts were found only in EDTA-blood, and the patients did not have bleeding symptoms. In 5 other cases EDTA-dependent antibodies were not the only cause of thrombocytopenia since the low platelet counts were also observed in the citrate-blood and occassionally the bleeding symptoms occurred; in 3 of them in addition autoantibodies were suspected. Due to the proper diagnosis of PTCP, in five patients unnecessary corticotherapy was discontinued, one person avoided splenectomy, in two patients previously postponed surgery was performed and one person could be passed for employment.
Adult↗
[Platelet transfusion from HPA typed donors in alloimmune thrombocytopenia of newborns and fetuses].
The registry of donors typed for HPA-1 and HPA-3 antigens is presented. Three cases of fetal/neonatal alloimmune thrombocytopenia (F/NAIT) transfused with typed platelets either from mother or from registered donors are discussed. All children were transfused just after delivery, one in addition in utero: they survived not having any haemorrhagic complications in central nervous system inspite of such complications in previous born siblings. In the paper the general rules of platelet transfusions in F/NAIT are discussed.
Antigens, Human Platelet↗
[Evaluation of the microplate enzyme-linked assay with isolation of glycoprotein IIb/IIIa from platelet membranes: comparison with immunofluorescent tests and monoclonal antibodies].
The enzyme test with GPIIb/IIIa has been used to detect antibodies in 500 sera from patients with thrombocytopenia and mothers of infants with thrombocytopenia. The results were compared with antibody detection in the platelet suspension immunofluorescence test (PIFT) and in the monoclonal antibody immobilization of platelet antigens (MAIPA). Platelet antibodies were detected in 125 sera (25%). In 46.2% the results were positive in all three tests. However, in 38.4% the ELISA was negative while the PIFT and MAIPA were positive. On the other hand, in 14.4% the ELISA was positive while the PIFT and/or the MAIPA were negative. The ELISA appears to be useful in the detection of anti-HPA-1a antibodies, which are the main cause of AIMN and PTP. This test, however, seems to be less useful in the detection of autoantibodies. The significance of the ELISA in the detection of platelet alloantibodies responsible for refractoriness to platelet transfusions is not clear yet and requires further investigations.
Antibodies, Monoclonal↗
[Immunology of blood platelets].
Platelet specific antigen systems, their molecular structure and localization in cell membrane is presented. New techniques for the detection of platelet antibodies are discussed.
Antibodies↗
[Platelet antigens].
Platelet specific antigens and platelet antigens shared with other peripheral blood cells are presented. The molecular characteristics of membrane glycoproteins which are platelet specific determinants is discussed.
Antibodies, Monoclonal↗
[Quinidine-induced thrombocytopenia].
We present the case of drug-dependent thrombocytopenic purpura due to the treatment with quinidine. IgG quinidine-dependent antibodies in patient serum were detected in the platelet immunofluorescence test. They were bound to GP Ib on platelet membrane.
Autoantibodies↗
[Pseudothrombocytopenia].
Pseudothrombocytopenia in four patients has been described. It was due to platelet "++EDTA-dependent" antibodies. The number of platelets was described only in EDTA blood while the number was normal when platelet were evaluated in citrate blood. The importance of distinguishing pseudothrombocytopenia from thrombocytopenia is discussed, especially in view of unnecessary treatment, delayed operation etc.
Adult↗
Shedding of Fc receptor from mononuclear cells and their ability of binding IgG1 and IgG3 anti-Rh/D antibodies.
Fc receptors for IgG1 and IgG3 on peripheral blood lymphocytes and monocytes were studied before and after temperature shift from 4-37 degrees C. The investigations were performed in the EA test using human erythrocytes sensitized with anti-Rh/D/antibodies of IgG1 (EA IgG1) and IgG3 (EA IgG3) subclasses. It occurred that lymphocytes and monocytes were able to bind IgG1 and IgG3 antibodies before and after shedding, however, lower percentage of rosette was observed after temperature shift. This decrease was similar in the EAIgG1 and EAIgG3 tests. The supernatants obtained during shedding occurred to contain active Fc receptors since the inhibition of rosette formation was obtained after the incubation of sensitized erythrocytes with these supernatants. IgG1 as well as IgG3 myeloma proteins inhibited rosette formation in both EAIgG1 and EAIgG3 tests. Our data might suggest that IgG1 and IgG3 anti-D antibodies are able to bind to the same Fc receptor on lymphocytes as well as on monocytes.
Antigen-Antibody Reactions↗
Immune deficiency in malignant lymphomas.
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Adult↗
A comparison between Fc receptors for IgG1 and IgG3 on human monocytes and lymphocytes using anti-Rh antibodies.
In a rosette assay with human erythrocytes equally sensitized with anti-Rh antibodies, the Fc receptor-bearing (FcR) cells are much more numerous among monocytes than among lymphocytes. FcR monocytes could be detected using IgG1 and/or IgG3 antibodies although a higher percentage of FcR cells is observed with sera containing IgG3. FcR lymphocytes are detectable almost only with sera containing IgG3 antibodies. If the anti-Rh antibodies are restricted to IgG1 none or single FcR cells could be found. The application of mixed rosette assay with fluorescein-stained erythrocytes sensitized with IgG3 and unstained red cells sensitized with IgG1 allowed documentation of the presence of receptors for both subclasses on monocytes as well as on lymphocytes although some differences between these cells were observed. Almost all FcR monocytes bind both IgG subclasses, although in different proportions. On the contrary, most FcR lymphocytes bind only or mainly IgG3, but receptors for IgG1 can also be detected.
Humans↗
Clinical significance of platelet alloantibodies detected in immunofluorescence test (neonatal alloimmune thrombocytopenia and post-transfusion purpura).
Three cases of neonatal alloimmune thrombocytopenia and one patient with post-transfusion purpura could be diagnosed only by introducing the platelet immunofluorescence test. Thrombocytopenia was caused by anti-PlA1 platelet alloantibodies detected neither in the agglutination nor by the complement fixation test.
Adult↗