Safety of the antibody screening test as the sole method of pretransfusion testing.
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Biomedical subjects
Publications and source records attributed to M L Marty.
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After demonstrating through animal models that progenitor cells with haemopoietic regenerative capability are present in peripheral blood, such precursor cells were also found in the mononucleated cell (MNC) fraction of human peripheral blood. It was shown that such cells increase in the recuperative period following chemotherapy. A number of studies have demonstrated that autologous infusion of such MNC achieved by cytapheresis may lead to a quick restoration of haemopoiesis. The initial results of peripheral blood MNC achievement in 18 patients with different malignancies of the blood are presented in this paper. Ninety-one cytapheresis sessions were carried out, 88 with a Fenwall CS-3000 continuous-flow machine, and the remaining three with a Haemonetics V-50 discontinuous-flow cell separator. The number of sessions per patient ranged from three to six and the harvested MNC count was 19.3 x 10(9)/L, the percentage of recovery being 56.4%. Some studies are currently in course aimed to analyse the MNC subpopulations in order to measure the progenitor-cell fraction and to establish the viability of such cells for further transplants. Since only five patients have recently been transplanted, all successfully, no definite conclusions can be drawn presently in this connection.
The results of "in vitro" culture of granulomonocytic precursor cells (CFU-GM) of the bone marrow from 44 patients were analysed in the present work. The correlation with the patient's haematological characteristics, their FAB subtypes (i.e., 6 cases of refractory anaemia (RA), 11 of acquired sideroblastic anaemia (ASA), 15 cases of refractory anaemia with excess blasts (RAEB), 5 cases of RAEB in transformation (RAEBT) and 7 cases of chronic myelomonocytic leukaemia (CMML), and the survival were examined as well. The technique used for cell culture was that of Pike and Robinson, following the classification proposed by Florensa for estimating the growth patterns. Anomalies of the myeloid clonal proliferation were found in 81% of the cases. There was direct correlation between the number of aggregates and the polymorphonuclear cell count, whereas the highest number of blast cells coincided with increased number of clusters in cultures. CNNL showed the highest aggregate counts. The B growth pattern (both colony and aggregate growth) was most frequently seen in CMML; pattern C2 (decreased colonies with increased aggregate count) appeared in RAEB, RAEBT and CMML, and pattern C3 (decrease of both colony and aggregate counts) was found only in RA and ASA. None of the culture findings appreciably associated with the survival.
A woman with multiple anti-red cell antibodies (anti-c, anti-K, anti-Jkb, anti-Fyb) due to previous transfusions was admitted to the hospital for valvular replacement. To ensure enough transfusional supply, a high number of packed red cell units was typed and screened prior to previous operation. Haemorrhagic complications developing during surgery led to transfusion of 32 blood units, 20 of them compatible. Besides this, measures directed to prevent complications derived from haemolytic disease were instituted. These included intravenous fluids and diuretics to maintain circulatory integrity and improve renal cortical blood flow. High-dose gammaglobulin was also administered in an attempt to decrease extravascular haemolysis. Despite therapy, severe adult distress respiratory syndrome caused patient's death nine days after surgery. We remark the need of storing frozen blood of low-frequency phenotypes in blood banks to face significant transfusional problems, providing sufficient numbers of antibody-compatible blood.
The relationship between donor status for antibody to hepatitis B core antigen and the occurrence of non-A, non-B posttransfusion hepatitis in the recipient was prospectively studied in 112 patients undergoing open-heart surgery who were followed for 6.5 months after surgery. Non-A, non-B posttransfusion hepatitis occurred in five (7.93%) of 63 patients who had received at least one anti-HBc-positive blood unit compared to seven (14.28%) of 49 patients who received anti-HBc-negative blood only. Statistical analysis revealed that the incidence of non-A, non-B posttransfusion hepatitis was independent of the use of blood positive for anti-HBc. Based upon these results and the high prevalence (17.3%) of anti-HBc among our blood donor population, the exclusion of anti-HBc-positive blood does not seem appropriate to achieve a reduction in the incidence of non-A, non-B posttransfusion hepatitis.
An autoantibody mimicking anti-S specificity is described in an S-s+ patient. The antibody was detected 2 weeks after transfusion. The direct antiglobulin test (DAT) was positive and the antibody was thought to be an alloantibody formed after the transfusion. Eighteen months later, the DAT was still positive and anti-S could be eluted from the patient's red blood cells in spite of the fact that these were S-s+. The autoantibody was characterized as mimicking anti-S specificity by in vitro absorption studies. It was present during the 3 years in which the patient was observed without causing hemolitic anemia.
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Autoantibodies the specificity of which mimicks Kpb specificity are described in a patient whose phenotype is Kp(a+b-). Manual typing of the patient's red cells revealed a depression of the Kell-related antigens. However, this weak reactivity was not found in the Autoanalyzer using bromeline PVP, the percentage of agglutination being similar to that of red cells of normal blood donors. Alloanti-K antibodies were present in the patient's serum. The specificity of the autoantibodies was considered to be mimicking because they could be absorbed by and eluted from Kpb- and Ko (AET-treated) red cells.
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Nineteen adolescents and adults with relapsed acute lymphoblastic leukemia (ALL) were treated with teniposide (VM-26) plus cytarabine (ara-C). Eight patients (42%) achieved complete remission. Infection and bleeding secondary to myelosuppression were the most serious complications seen. Responders received periodic reinductions with VM-26 and ara-C, but all relapsed within 16 weeks from remission. Our data demonstrate the effectiveness of combination chemotherapy with VM-26 plus ara-C in adolescent and adult ALL in relapse and suggest testing of this combination in first-line protocols. For remission maintenance, the association of other drug combinations is necessary.
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