Biomedical subjects
Publications and source records attributed to S G Sandler.
Since 1973 a number of studies have been conducted on the association of HLA with myasthenia gravis (MG). (Safwenberg et al. 1973, Fritze et al. 1973, Naeim et al. 1978, Bodmer & Bodmer 1978, Behan 1980). Most of these studies involved Caucasians. In this paper we report on a study carried out in Chinese patients with M.G.
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The increasing use of normal donors for leukapheresis to provide granulocyte concentrates requires careful monitoring of recruitment and operational procedures to minimize donor health risks. Of 18,288 leuka- and leukaplateletphereses performed in American Red Cross regional blood services during a 12-month period, only 0.27% were discontinued because of acute donor reactions. None of these reactions had serious or long-term consequences for the donors. The potential toxicities of corticosteroids and hydroxyethyl starch, and the theoretical hazards of lymphocyte depletion, raise unanswerable questions concerning long-term safety, although no serious adverse reactions related to these factors have been observed. Critical factors for leukapheresis donor safety are: selective donor recruitment, adherence to operational protocols, and continuous and informed interest of physicians responsible for pheresis programs. Additional data are needed to assess the effects of repeated leukapheresis on donors and to establish rational guidelines for donor recruitment.
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From January 1975 to December 1978, 19,140,169 units of blood were collected by the American Red Cross at 57 regional locations. Each unit was tested for hepatitis B surface antigen (HBsAg) by a single commercial radioimmunoassay test system. A total of 15,954 donations were reported reactive, representing a rate of HBsAg reactivity of 0.83/1,000 units tested. The rate during 1975 was 0.94/1,000 units tested, decreasing to 0.71/1,000 units tested in 1978 (p < 0.005). The prevalence of HBsAg among first-time donors was 2.08/1,000 during 1977 and 1978, 2.7 times higher than that calculated for repeat donors (0.77/1,000 donors). Substantial geographic variation in the prevalence and rate of detection of HBsAg was observed.
During the year 1978 this laboratory evaluated the specificity of all samples found reactive for hepatitis B surface antigen (HBsAg) by 44 of 57 regions of the American Red Cross Blood Services. Radioimmunoassay detected a total of 1.921 HBsAg-reactive sampled among more than three million donor units tested. A vast majority (96%) of the samples had high level of HBsAg (greater than or equal to 20 ng/ml). Only about 50% of the samples with low level of HBsAg (less than 20 ng/ml) were reactive in reversed passive hemagglutination. There were 13 samples that were repeatable for HBsAg but were considered nonspecific as they were nonneutralizable in radioimmunoassay, 2 donors who showed nonspecific reactivity were further tested and it was found that the reactivity in radioimmunoassay persisted for more than 9 months, and this reactivity was also detectable by a second commercial kit for HBsAg. Antibodies to core and surface antigen were not found in any of the nine samples that were tested. The explanation of this nonspecific reactivity is unclear, but the data suggest that the nonspecific factor(s) may be an inherent property of the sample rather than a deficiency of the test reagents.
The unusual occurrence of both beta o-thalassemia and autoimmune hemolytic anemia (AIHA) in a 28-month-old child is reported to illustrate special diagnostic and therapeutic studies. The diagnosis of beta o-thalassemia was established by clinical, family and globin synthesis studies. The diagnosis of AIHA was confirmed by the shortened survival of transfused autologous and homologous red blood cells and by positive direct antiglobulin tests. During treatment of the AIHA were corticosteroids and various immunosuppressive drugs, globin synthesis studies were performed to evaluate the coincidental effects on gamma/alpha-globin chain synthetic ratios. A 50% increase in the gamma/alpha synthetic ratio during cyclophosphamide treatment suggests that further studies of the possible benefits of cytotoxic drug therapy in beta-thalassemia may be indicated.
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The distribution of the Fy gene was studied in 1,207 Israeli Jews and 509 Arabs. The Fy(a--b--) phenotype (FyFy) was observed in Moslem, Christian and Druze Arabs, and in Jewish immigrants from Yemen and Iraq, but not in Sephardi or Ashkenazi Jews. The Fy gene frequencies in Arabs and Jews were compatible with historical evidence of interactions with native African and admixed regional populations. Compared with Rho (cDe) and Jsa, Fy(a--b--) is a more useful genetic marker for recognizing African admixture in Middle Eastern populations.
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The application of autologous and frozen red blood cell (RBC) programs is described for 3 pregnant women with antibodies to high-incidence blood group antigens (anti-Lutheranb, anti-Cellano, anti-Vel). The cases illustrate how readily available supplies or rare blood types can be maintained throughout pregnancy using autologous and frozen RBC techniques, including selective predeposit, "family-sharing," and intensive phlebotomy with fluid replacement. The RBC phenotypes described in this paper are exceedingly rare since they occur in only 0.1-0.001% of random donors. However, the principles of autologous blood transfusions are universal and they can be applied to the general problems of blood group incompatibility in pregnancy.
Solid-phase radioimmunoassay (RIA) and counterimmunoelectrophoresis (CIE) were compared for the detection of hepatitis B surface antigen (HBsAg) carriers among blood donors in Jerusalem, which is in a region characterized by a high prevalence of HBsAg and a predominance of the ayw subtype. RIA detected 84% more HBsAg carriers than CIE, with the resultant exclusion of 1.8 times as many potentially infective donors. The results provide additional information concerning the specific increases in donor-carrier detection that are associated with the introduction of highly sensitive HBsAg tests in different geographic and epidemiologic circumstances.
Families of 11 patients with hepatitis B surface antigen (HBsAg)-positive cirrhosis were studied to evaluate the immunologic correlates and extent of intrafamilial HBsAg clustering. Of 76 family contacts, 12 were identified to be asymptomatic carriers of HBsAg and two were diagnosed to have HSsAg-positive cirrhosis. The over-all HBsAg prevalence for the 76 contacts was 18% and that for all 87 members studied 29.0%. Serologic evidence of hepatitis B virus (HBV) infection (either HBsAg, anti-HBs, or both) was detected in 59% of all family members. HBsAg was more prevalent in males (47%) compared with females (16%), and anti-HBs was more prevalent in females (42%) compared with males (18%). Evidence of an immunologic response in clinically unaffected HBsAg-negative family contacts consisted of elevated serum IgG levels (mean 1660 mg/100 ml) and increased prevalence of anti-smooth muscle and antimitochondrial antibodies (16% and 6%, respectively). The prevalence of one or more autoantibodies in all HBsAg-negative family contacts was 20%, and it was higher in females (25%) than in males (13%). The present study demonstrates that HBsAg clustering occurs in families of patients with cirrhosis in the Jerusalem area and indicates that HBsAg-negative family contacts may have increased B-cell activity.
A survey of w variants of the hepatitis B surface antigen (HBsAg) among native and immigrant Israelis revealed that the subtype ayw2 predominated among asymtpomatic HBsAg carriers (69%), and patients with acute (83%) and chronic active hepatitis B (81%). The subtypes ayw3, ayw4 and adw2, uncommon in native populations, were detected in carriage by immigrants and transients. Nevertheless, the high prevalence of ayw2 among native Israeli carriers (87%), and in particular natives with acute 93%) and chronic active hepatitis B (86%), indicates that the introduction of nonindigenous viral strains has not overtly altered the anticipated geographic distribution of hepatitis B viruses.
Sera from 576 healthy adults were tested for the hepatitis B surface antigen (HBsAg) and antibody (anti-HBs) to evaluate the role of routine dental care as a factor in the spread of hepatitis B virus (HBV) infection. Serological evidence of prior HBV infection, manifested by acquisition of anti-HBs, was detected in 97 (16.8%) individuals, and 6 (1.0%) were identified to be asymptomatic HBsAg carriers. The anticipated correlations of HBsAg and anti-HBs with age, country of birth, and socioeconomic status were observed in the study population. However, prevalences of both HBsAg and anti-HBs were inversely related to the lifetime total of dental care visits. These findings indicated that, in a region in which the HBsAg carrier state and hepatitis B are prevalent, routine dental care is not identified as an important factor in the spread of HBV infection. While the results do not exclude the obvious possibility that cross-infections with HBV may occur during dental care in specific situations, they indicate that this mode of infection is exceptional.
As an approach to investigating the origin of sickle cell hemoglobin (hemoglobin S) in white persons of Sicilian ancestry, two groups of native Sicilians were tested for blood group evidence of African admixture. Among 100 unrelated Sicilians, the phenotypes cDe(Rho) and Fy(a-b-), and the antigens V(hrv) and Jsa, which are considered to be African genetic markers, were detected in 12 individuals. Among 64 individuals from 21 families with at least one known hemoglobin S carrier, African blood group markers were detected in 7 (11%). These findings indicate that hemoglobin S is only one of multiple African genes present in contemporary Sicilian populations. The occurrence of hemoglobin S in white persons of Sicilian ancestry is considered to be a manifestation of the continuing dissemination of the original African mutation.
Seventy-one hemodialysis patients were tested for antibodies to red blood cell antigens; 19 of the 71 had been treated with formaldehyde-sterilized dialysis membranes. The sera of 3 (16%) of these 19 contained anti-N-like antibodies and those of 17 (89%) contained a second agglutinin specific for formaldehyde-treated red blood cells. Anti-N-like and "antiformaldehyde" antibodies appear to be serologically distinct. We suggest that residual formaldehyde in formaldehyde-sterilized dialysis membranes reacts with red blood cells to form an immunogen responsible for antiformaldehyde in patients treated with these membranes.