Red-cell alloantibody response in AIDS.
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Acquired Immunodeficiency Syndrome↗
Biomedical subjects
N Blumberg
Publications and source records attributed to N Blumberg.
Neutralization of Lewis blood group antibodies by synthetic immunoadsorbents.
The neutralization of antibodies to the Lewis blood group systems is important in confirming the presence of these antibodies and in investigating complex alloantibody problems. An improved method for neutralizing Lewis antibodies is described. Insoluble immunoadsorbents containing synthetic Lewis antigens are used to physically remove the antibody from serum. Thirty-five sera containing Lewis antibodies were neutralized completely using this technic; 23 non-Lewis alloantibodies were not inhibited. In contrast with current methods, this technic does not dilute the patient serum and results in an affinity purified serum sample.
Humans↗
Immune response to chronic red blood cell transfusion.
Patients receiving chronic transfusion for aplastic anemia or hemoglobinopathy are believed to be at high risk for developing red blood cell alloantibodies, while those undergoing chemotherapy for leukemia are believed to be at low risk. To test this hypothesis, we studied the acquisition of new alloantibodies in 703 transfused patients. While none of 99 patients with lymphocytic leukemia made new antibodies, patients with myelogenous leukemia (16%), hemoglobinopathy (29%), aplastic anemia (11%), gastrointestinal bleeding (11%) or renal failure (14%) made antibodies at statistically similar rates. Lymphocytic leukemia or its treatment is characterized by a lack of immunologic response to transfusion. Patients with hemoglobinopathy or aplastic anemia do not appear at statistically significant greater risk of alloimmunization than many other patients requiring chronic transfusion. Neither intensive chemotherapy for myelogenous leukemia nor the uremia of renal failure significantly suppress the formation of blood group antibodies.
Anemia, Aplastic↗
Treatment of thrombotic thrombocytopenic purpura. Evaluation of plasma exchange and review of the literature.
This report examines the results of treatment in 21 patients with thrombotic thrombocytopenic purpura (TTP) diagnosed over a 4-year time period (1976-1980) with a review of the possible role of each form of therapy in relationship to the various proposed pathogenic mechanisms. There was a 76.2% (16/21) overall survival with no significant difference in initial hematologic values in patients not surviving. Patients not surviving did not achieve a sustained platelet count greater than 150,000/microliters at any time during their clinical course. 16 patients received steroids, antiplatelet agents and plasma exchange, with a total volume exchanged ranging from 20.8 to 1,455 ml/kg, as part of their treatment protocol. In this group of patients there was an 81.2% (13/16) survival, with 4 patients receiving additional therapy including splenectomy and/or vincristine. There was no correlation between the intensity of plasma exchange and the time to hematologic recovery. It is apparent that controlled clinical trials are necessary to better define the effectiveness of the present forms of therapy.
Adult↗
A new technique in quantitative immunohematology: solid-phase kinetic enzyme-linked immunosorbent assay.
A solid-phase kinetic enzyme-linked immunosorbent assay has been developed to measure binding of antibodies to purified or synthetic blood group antigens and tested in the Lewis blood group system. Chemically synthesized Lewis a antigen is used as the target for the binding of serum antibody in this sandwich-type assay. Kinetic, rather than endpoint, determinations are used to calculate the amount of specific antibody. Data are presented showing the assay to be quantitative, sensitive, and specific. It can separately quantitate the amount of IgG or IgM anti-Lewis a present in patient sera. The assay uses commercially available reagents and is semiautomated. Thus, it will be useful for studies in quantitative immunohematology as other blood group antigens become available in purified form.
Antibody Specificity↗
Rh sensitization.
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Cost-Benefit Analysis↗
Do preoperative laboratory tests predict blood transfusion needs in cardiac operations?
We retrospectively compared preoperative prothrombin (PT), partial thromboplastin (PTT), dilute whole blood clot lysis and bleeding times, fibrinogen level, and platelet count with subsequent blood component administration in 92 patients who had undergone cardiac operations with cardiopulmonary bypass (CPB). Abnormal results for one or more tests were found in 34% of 71 adults and 81% of 21 children and teenagers. The patients with abnormal test(s) received no more whole blood and packed red cell units, platelets, or plasma than those with normal tests in either age group. No individual or multiple test abnormalities predicted excess blood component transfusion, even when low-grade abnormalities were excluded. The high rate of abnormal tests in patients less than 20 years of age was not due to polycythemia and may indicate a need for age-specific reference ranges. Baseline PT, PTT, and platelet count may aid in the evaluation of the potential for subsequent development of coagulopathy, but we conclude that further preoperative testing may be reserved for infants, polycythemic individuals, or others in whom history or drug use suggests potential bleeding problems.
Adolescent↗
A new approach to washing red blood cells frozen with a high concentration of glycerol in a special freezing container.
We report here on a new approach to washing red blood cells frozen with a high concentration of glycerol in a special freezing container. The wash solution consists of a 150-ml volume of 12% sodium chloride and 2 liters of 0.9% sodium chloride-0.2% glucose-25 mEq/l disodium phosphate. Both the Haemonetics Blood Processor 115 and the IBM Blood Processor 2991 have been used with this protocol, with similar results. The in vitro recovery of red blood cells frozen with 8.6M glycerol was 89%, and that of red blood cells frozen with 6.2M glycerol was 93%. The 24-hour posttransfusion survival values averaged 88% for eight units of outdated-rejuvenated previously frozen red blood cells washed by this protocol and stored at 4 degrees C for 3 days before autotransfusion.
Blood Preservation↗
Granulocyte yields using the Haemonetics 30. Effects of variations in corticosteroid regimen and donor selection.
The factors of donor selection, corticosteroid drug choice, dose, timing and route of administration were studied to optimize granulocyte yield employing the Haemonetics Model 30 Blood Processor. Our data suggest that donors giving one excellent yield do not necessarily do so again. Donors with high initial granulocyte counts had only marginal increases in counts after taking corticosteroids. Selecting donors on the basis of high previous yield or granulocyte count is not a feasible strategy for improving granulocyte yields. Highest yields of granulocytes (16 X 10(9) total; 4 X 10(9)/liter processed) were obtained with any of four split-dose corticosteroid regimen. This increment is almost twice as large as the previously reported improvement using continuous-flow centrifugation. The choice of steroid, the route of administration and the timing of the split doses are not critical.
Administration, Oral↗
Evaluation of individuals deferred from blood donation for medical reasons.
Modern techniques of blood collection require health screening of donors by non-physicians using general guidelines. Health problems of concern to the donor and possible loss to future donation of actually individuals are inherent in this acceptance and deferral process. Of the 108,908 donors presenting at the bloodmobiles of regional blood center from September 1978 to February 1979, 9,542 were deferred. Of these, 1,203 with possible medical problems other than hepatitis, hypertension, or infectious disease were referred to their physician for further information concerning their suitability as donors. Over 80% had irregular pulses or histories suggestive of potential cardiovascular problems. The purpose of this study was to review the evaluation mechanism. Responses for evaluation were received from only 222 out of 1,203 (18%), and of these all but 29 (13%) were granted full permission to donate. Since only one evaluated individual with pulse or cardiovascular findings of possible significance was under the age of 35 years, this age is a reasonable cutoff for such deferrals. The minimum increase in collections with this change in deferral screening would be over 1,000 units per year in Connecticut, and perhaps 60,000 nationwide.
Adult↗
The serology of Sda effects of transfusion and pregnancy.
Pre- and posttransfusion antibody titers were performed on 6 patients with anti-Sda transfused with incompatible blood. In 3 of these patients a significant rise in IgG antibody titer was found. The data suggest that in occasional patients the Sda antigen does evoke a secondary immune response. We evaluated 245 pregnant women for the presence of Sda and found that 30% were Sd(a-). This incidence was significantly higher than that found in normal blood donors (4%), but was lower than that described in previous reports. We found that 22% of pregnant women in their first trimester were Sd(a-) whereas at term 36% were Sd(a-). These significantly different incidences of antigen positivity suggest decreased antigen expression with progressing pregnancy, as seen in the Lewis system. No difference was found in the incidence of anti-Sda between pregnant women, either during their first trimester or at term, and normal donors.
Blood Group Antigens↗
Passive acquisition of new HLA phenotypes by human platelets incubated in plasma.
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Animals↗
Therapeutic plasmapheresis and cytapheresis. A review.
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Cell Separation↗
Long-term granulocyte transfusion in patients with malignant neoplasms.
Thirty-eight episodes of culture-documented antibiotic-resistant bacterial or fungal infection in patients with malignant neoplasms were treated with daily granulocyte transfusions until the infection improved or the patient died. Cumulative summation temperature plotting allowed easier interpretation of recipient fever response. Seventy-one percent of recipients had a favorable response to transfusion. There was no difference in mortality between patients treated with cells collected by filtration (FL) or intermittent flow centrifugation (IFCL) leukapheresis techniques. Transfusion reactions were more than twice as common with FL than IFCL collected cells. Seventy-four percent of recipients were alive 21 days after completion of transfusions; of the ten deaths, five could be classified as granulocyte transfusion failures. This study suggests that long-term granulocyte transfusion may be required in infected recipients when autologous granulocytes do not return after chemotherapy.
Abscess↗
Un-cross-matched blood for emergency transfusion. One year's experience in a civilian setting.
One year's experience (56 cases) in the use of un-cross-matched blood for emergency transfusion in a large civilian teaching hospital showed that 49 transfusions were given as un-cross-matched, group-specific (ABO and Rh) blood in emergencies. Seventy-seven percent (43) of blood requests were for patients with trauma, unexpected massive intraoperative hemorrhage, or ruptured aneurysm. The indications for emergency transfusion were questionable in ten cases. There were no adverse effects noted even though complete serologic testing had not been done. While the use of un-cross-matched blood is usually safe, the potential for serious reaction exists. Overuse should be discouraged.
ABO Blood-Group System↗
Collection of granulocytes for transfusion. The effect of collection methods on cell enzyme release.
When granulocytes are collected by either discontinuous-flow centrifugation or filtration leukapheresis, lysozyme is released. More lysozyme is released during the filtration procedure than during the centrifugation procedure. A small amount of red cell lysis occurs during the centrifugation but not the filtration procedure. A rise in lactate dehydrogenase levels consonant with the amount of hemolysis is observed. These findings suggest that granulocytes collected by either filtration or discontinuous-flow centrifugation undergo degranulation but not lysis sufficient to cause cytoplasmic enzyme release during the donation.
Blood Transfusion↗
Ureteral triplication.
A case of ureteral triplication is presented. There was reflux of the middle ureter, which did not end in the kidney, but rather ended blindly. There was atrophic pyelonephritis of the upper pole because of an obstructed ureter, and a normal lower caleceal system and ureter. There were three ureters but only two originated in the kidney and two entered the bladder, with only one ureter originating from the kidney entering the bladder normally. The refluxing ureter and the obstructed upper pole and ureter were removed.
Child↗
Tumor angiogenesis factor. Speculations on an approach to cancer chemotherapy.
Tumor angiogenesis factor (TAF) and its importance in determining a strategy for cancer chemotherapy are discussed. It is suggested that inhibition of RNA synthesis or increased RNA catabolism might interfere with the metabolism of solid tumor cells more so than in normal cells, and thus hinder angiogenesis and pursuant tumor growth by preventing the synthesis of the RNA component of TAF. An attempt is made to indicate potential models for anti-angiogenesis agents of this type. The drugs offered as initial prototypes for investigations along these lines are actinomycin D (which likely has antimetabolite and anti-angiogenesis activities), polyriboinosinic-polyribocytidylic acid (which likely has adjuvant and anti-angiogenesis activities) and ribonuclease (which in theory might be a purely anti-angiogenetic agent). It is noted that these models may turn out to be less than ideal as therapeutic agents due to problems of toxicity, metabolism, potency, or distribution, but nonetheless might serve to yield insights into the design of new cancer chemotherapeutic drugs. In addition, some evidence is cited suggesting that actinomycin D may be more effective against certain tumors when employed in lower, chronic dosages rather than its present use in "loading" dosages.The concept of anti-angiogenesis agents as fundamentally "tumoristatic" therapies is discussed, and the likelihood that such agents might be effectively "tumoricidal" in immunocompetent hosts is mentioned. The main promise of an anti-angiogenetic strategy is efficacy against presently intractable slowly growing human cancers when used in combination with other treatment modalities. In summary, a strategy of cancer chemotherapy predicated upon interference with RNA synthesis or increase in RNA catabolism is offered as a potential mechanism for establishing anti-angiogenesis, and as a promising alternative and adjunct to present methods.
Antineoplastic Agents↗