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Biomedical subjects

S B Moore

Publications and source records attributed to S B Moore.

At least 91 records · Page 5Linked to original sources
PubMed1990

Persistent centrilobular necroses in hepatic allografts.

A biopsy study of 60 allografts from 53 patients after orthotopic liver transplantation (OLT) revealed prominent centrilobular necrosis (CN) in 18% of the grafts that were suitable for analysis. The lesions often had a "punched-out" appearance, sometimes with unusual features such as giant cell formation. Persistent CN developed 4 weeks to 6 months after OLT, and persisted in two cases for 2 years and longer. In some instances, CN disappeared or healed by scarring. We found no association between CN and rejection arteritis or arteriopathy. Ductopenic (chronic) rejection subsequently occurred in six of eight livers with CN. Overall, patients with persistent CN had a worse prognosis than control patients. A comparison of cases with matched controls failed to reveal significant differences with respect to perioperative factors such as ischemia time, immunologic test results such as lymphocyte crossmatches, drug administration--in particular, of azathioprine, frequency of cellular (acute) rejection or infection episodes, or frequency of complications affecting major hepatic vessels or bile ducts. Morphologic evidence suggests that in some instances, rejection-induced endotheliitis/phlebitis of hepatic vein branches may lead to sinusoidal outflow blockage, sinusoidal dilatation, and dropout of hepatic cell plates. Although potentially reversible conditions such as ischemia or adverse drug reactions are among the possible causes of CN, severe rejection leading to ductopenia appears to be the most important underlying condition. Thus, presence of CN in repeated biopsy specimens from allografts should be considered a warning sign of irreversible rejection.

Adult↗
PubMed1990

Posttransfusion purpura: the therapeutic value of PlA1-negative platelets.

A case of PlA1-associated posttransfusion purpura (PTP) is reported, in which a previously sensitized patient developed life-threatening thrombocytopenia, purpura, hematuria, and bronchial bleeding. The patient was transfused with PlA1-negative single-donor apheresis platelets (from four different donors) on four occasions. The first transfusion resulted in a 1-hour posttransfusion increment of 57 x 10(9) per L. The use of two additional PlA1-negative apheresis platelets provided support for a tracheostomy. Bronchial bleeding leading to respiratory arrest was controlled with a fourth transfusion. All PlA1-negative platelet transfusions resulted in transient increases in the patient's platelet count. This is the first reported case of repeated, transiently effective transfusion of PlA1-negative platelets demonstrated during the acute phase of thrombocytopenia.

Antigens, Human Platelet↗
PubMed1990

Minimal-exposure transfusion and the committed donor.

Autologous blood (collected preoperatively or salvaged intraoperatively) is the safest blood available for transfusion, but its use is not always feasible. It may be possible to decrease a patient's exposure to homologous donors. Pediatric cardiac surgery patients frequently are unable to donate autologous blood preoperatively. Since 1984, attempts have been made to provide parental apheresis platelets and intraoperative blood salvage to such patients to decrease their donor exposure. Further decreases in donor exposure have been the object of a program of collecting from one committed donor all the blood a patient is anticipated to need. This article reviews the experience with 50 pediatric cardiac surgery patients on such a program, in whom the mean decrease in homologous-donor exposure was 57 percent (range, 12-93%). Thirteen of these patients received only homologous blood products from one committed donor, for a mean decrease in homologous-donor exposure of 80 percent (range, 50-93%). A comparison of 12 of these 13 recipients with a matched control group showed no significant difference in red cell transfusion practice but a significant difference in the number of homologous-donor exposures per m2 of body surface area (BSA) (mean donor exposures/m2 of BSA: patients = 1.5, controls = 10.5). The use of one committed donor and autologous blood can provide a minimal-exposure transfusion.

Adolescent↗
PubMed1989

Roles of the neutrophil and other mediators in adult respiratory distress syndrome.

The adult respiratory distress syndrome (ARDS) and transfusion-related acute lung injury (TRALI) are characterized by diffuse, acute lung injury. Most likely, TRALI is a type of ARDS although it is associated with a much lower morbidity and mortality than found with classic ARDS. For years, the pathogenesis of ARDS has been explained by the complement hypothesis in which pulmonary neutrophilic sequestration and degranulation follow complement-mediated neutrophil chemotaxis. A definitive role for the neutrophil in diffuse, acute lung injury, however, has not been established. Although numerous chemoattractants for neutrophils are generated in the lungs and, through degranulation and formation of toxic oxygen free radicals, the neutrophil is fully capable of causing tissue injury, substantial evidence refutes the requirement for neutrophils in diffuse, acute lung injury. Other potential factors in the pathogenesis of ARDS include primary endothelial cell injury, alveolar macrophage activity, and hemostatic disorders.

Chemotaxis, Leukocyte↗
PubMed1989

Morning admission for a same-day surgical procedure: resolution of a blood bank problem.

To minimize the risks associated with an elective surgical procedure on the day of admission without adequate time for blood bank serologic analysis, we implemented two administrative changes: (1) collection of blood samples from patients on the evening before operation and (2) a system for recommending a 3-hour delay of the operation in those cases without such a sample. During a 4-month period before implementation of these changes, 70 patients had serologic problems; morning blood samples had been obtained from 36 of these patients. For a comparable time after implementation of these changes, a serologic problem was encountered in 41 surgical cases, in 7 of which morning blood samples had been obtained. Similarly, the number of cases in which the operation was begun before resolution of a serologic problem decreased from 19 to 3. These decreases occurred despite a 13.4% increase in total morning-admission cases between the first and second study periods. Although no patient experienced adverse transfusion-related events during either study period, simple administrative changes that necessitated no increases in costs were instrumental in substantially decreasing the risks to patients.

Blood Banks↗
PubMed1989

Delayed hemolysis resulting from anti-A1 after liver transplantation.

The authors report a case of a delayed hemolytic transfusion reaction in a type A2 recipient of a type O liver allograft. An anti-A1 antibody reactive at 37 degrees C in the indirect antiglobulin test was identified both in the patient's serum and in an eluate. Hemolysis secondary to the production of anti-A1 has been reported to be extremely rare. The English-language literature has six cases before 1979. During the 1980s, an additional seven cases were reported; six involved transplantation of a solid organ, and in each such case the donor was type O and the recipient was type A1 or A2. Recommendations regarding transfusion practice in such cases are made. An association among the transplantation of a type O organ to a type A recipient, the use of cyclosporine, and an apparent increase in the occurrence of clinically significant anti-A1 is suggested.

Autoantibodies↗
PubMed1989

Severe thrombocytopenia in Epstein-Barr virus-induced mononucleosis.

Severe thrombocytopenia is a rare complication of Epstein-Barr virus-induced infectious mononucleosis. We evaluated the clinical and laboratory data from seven patients seen between 1976 and 1985 whose lowest platelet counts varied from 3 to 25 x 10(9) per liter. Five of the seven patients were initially thought to have either acute leukemia or idiopathic thrombocytopenic purpura; eventually, however, primary Epstein-Barr virus infections were confirmed in all patients. Two of six patients tested had antiplatelet antibodies during the acute phase of their illnesses. Eight additional patients with acute disease who had only mild thrombocytopenia (94 to 144 x 10(9) per liter) were also tested for platelet antibodies with negative results. Steroid therapy was administered to three patients and platelet transfusions to one. All seven patients recovered with no serious hemorrhagic sequelae.

Adolescent↗
PubMed1989

Blood bank support of clinical transplantation programs.

Blood banks play a key role in the support of transplantation programs and can exert a considerable positive influence on the quality of care for the patients. Although each organ transplantation program has its idiosyncrasies, the basic necessities are the same for all programs and include careful long-term and short-term planning and the establishment of lucid, specific procedures for every activity related to the program.

Blood Banks↗
PubMed1989

Passively acquired antibody to hepatitis B surface antigen. Pitfall in evaluating immunity to hepatitis B viral infections.

Antibody to hepatitis B surface antigen (anti-HBs) has been used clinically to indicate an immune response to hepatitis B virus (HBV) and a protection against reinfection with the virus. We describe a child with hemophilia who had high-titer IgG anti-HBs in his serum and who subsequently developed viral B hepatitis. The child had received a unit of fresh frozen plasma 17 days prior to the determination of anti-HBs. The fresh frozen plasma donor was later found to be anti-HBs positive. The patient's anti-HBs was most likely passively acquired and therefore did not signify immunity to HBV. Various tests, including hepatitis B surface antigen group-specific and subtype determinants, ratio units of anti-HBs, and antibody class, have been used to determine whether or not anti-HBs will confer immunity. Although these tests have been thought to accurately predict immune status against infection with HBV, our case shows this may not be true, especially in patients who have been recently transfused. Anti-HBs testing may be predictive of immunity to HBV in the absence of a source of passively acquired anti-HBs.

Antigen-Antibody Reactions↗
PubMed1988

Investigating unexplained infertility.

In an attempt to reduce the number of couples whose basic infertility evaluation fails to reveal any abnormality, 57 couples with the diagnosis of unexplained infertility were further investigated by ultrasound monitoring for folliculogenesis, sperm antibody testing, hamster egg penetration assay, and major histocompatibility (human leukocyte antigen) typing. The use of these techniques allowed the diagnosis of luteinized unruptured follicle in 5% (three patients), sperm antibodies in 5% (three patients), low sperm penetration in 11% (six patients), and human leukocyte antigen-B locus homozygosity in 37% (21 couples). When the incidence of B locus homozygosity among the 57 couples with unexplained infertility was compared with that in 51 fertile couples, the difference was significant at p = 0.025. Thus by adding the diagnostic tools of ultrasound monitoring of folliculogenesis, sperm antibody testing, hamster egg penetration assay, and major histocompatibility antigen typing, the diagnosis of unexplained infertility can be reduced by 60%.

Antibodies↗
PubMed1988

Eosinophilic fasciitis: clinical spectrum and therapeutic response in 52 cases.

The clinical course of 52 cases with eosinophilic fasciitis observed at the Mayo Clinic has been described. Cutaneous changes included pitting edema, peau d'orange, and induration, and may affect virtually any body surface area. In addition, localized morphea was present in 15 cases. Arthritis was observed in 21 patients; 29 patients had flexion contractures and 12 had carpal tunnel syndrome. Associated hematologic diseases were found in five patients; thrombocytopenia in two, myeloproliferative disorder in one, myelomonocytic leukemia in one, and chronic lymphocytic leukemia in one. Peripheral blood eosinophilia was noted in 33 of 52 patients, hypergammaglobulinemia was noted in 17 of 49, and elevated sedimentation rate was noted in 15 of 52. Nonspecific EMG changes were seen in 11 of 15 patients. None had clinical involvement of the kidneys, lungs, or heart. No significant association between any HLA-A, -B, or -DR and eosinophilic fasciitis was seen. Prednisone and hydroxychloroquine seemed equally beneficial in treatment; however, some cases showed spontaneous recovery, making evaluation of therapeutic efficacy difficult. Relapses occurred in some cases.

Adolescent↗
PubMed1988

Evidence for linkage of IgA deficiency with the major histocompatibility complex.

A 57-year-old woman with IgA deficiency and Still's disease was the proband in a 20-member, three-generation kindred in which we studied the possible linkage of IgA deficiency with her HLA-A1-B8 haplotype. The presence of paternal A1-B8 haplotype complicated the analysis. Known maternal HLA-A1-B8 haplotype, present in three of the children of the proband, was associated with IgA deficiency, whereas all five family members with exclusively paternal A1-B8 had normal IgA. Of three third-generation family members whose A1-B8 haplotype was of indeterminate origin--that is, potentially either maternally or paternally derived--two had IgA deficiency and one did not.

Adult↗
PubMed1988

Influence of positive lymphocyte crossmatch and HLA mismatching on vanishing bile duct syndrome in human liver allografts.

Among the first 52 recipients of primary liver allografts with follow-up of 2 weeks or greater, 6 patients had biopsy-confirmed vanishing bile duct syndrome (VBDS) and required retransplantation. Five of these six patients had positive lymphocyte crossmatches. Of the 46 remaining liver transplant recipients, 11 had positive crossmatches. Thus, the incidence of VBDS was 5/16 in recipients with a positive crossmatch and 1/36 in recipients with a negative crossmatch. The positive-crossmatch group was significantly more likely to develop VBDS than the negative-crossmatch group (P less than 0.004, log rank test). Additional HLA studies comparing degree of donor-recipient mismatch at the various HLA loci showed no significant difference between the groups for class I disparity. However, class II mismatch was of borderline significance (P less than 0.056). When evaluated individually, the DQ mismatch (P less than 0.04) appeared to be more important than the DR mismatch (P = NS). Our data suggest that a positive lymphocyte crossmatch and a class II mismatch, in particular HLA DQ disparity, may play an important role in the pathogenesis of VBDS.

Actuarial Analysis↗
PubMed1988

Thrombocytopenia after liver transplantation.

Thrombocytopenia occurs in postoperative liver transplant patients, with platelet counts reaching a nadir on the third postoperative day. Significant bleeding episodes are not uncommon during the first five days postoperatively when platelet counts are low. This thrombocytopenia may be the result of platelet sequestration in the newly grafted liver. The sequestration phenomenon does not appear to be on the basis of antiplatelet antibody activity. Further work defining the time course of this organ sequestration and evaluating the possible release of previously sequestered platelets back into the circulation need to be done. Also, it may be productive to study medications known to inhibit platelet activation (ie, cyclooxygenase inhibitors, prostacyclin, and calcium channel blockers) with the intent of interrupting platelet adhesiveness-sequestration at the time of recirculation of the newly grafted liver.

Hemorrhage↗
PubMed1987

Platelet crossmatch evaluation in refractory hematologic patients.

Although previous investigators have attempted to identify platelet crossmatching methods that could be used routinely for pretransfusion testing, such studies have excluded patients with underlying clinical conditions inherently associated with low corrected platelet increments. Because many refractory hematologic patients have such underlying conditions, we decided to assess the usefulness of platelet crossmatching (in addition to HLA matching) in determining the posttransfusion corrected platelet count increment in eight medically complicated patients who received a total of 35 single-donor platelet transfusions. In this limited study, the predictive value of a negative crossmatch was only 55%, whereas that of a positive crossmatch was 88%. The test used had a sensitivity of 65% and a specificity of 83%. The results of our study suggest that platelet crossmatching may be a useful additional study for predicting the outcome of transfusion--even in medically complex cases--if it can be done rapidly and relatively inexpensively.

Adult↗