Biomedical subjects

T S Kickler

Publications and source records attributed to T S Kickler.

88 records · Page 5Linked to original sources

PubMedDate not supplied

Red cell sensitization due to anti-D in anti-lymphocyte globulin.

Four Rh-positive patients with severe aplastic anemia received equine anti-lymphocyte globulin. Each developed a positive direct antiglobulin test. Anti-D was identified in eluates prepared from the patients' sensitized red cells. The administered lot of anti-lymphocyte globulin was found to contain anti-D. Red cell sensitization due to passively acquired Rh antibodies can result from the administration of anti-lymphocyte globulin.

Adolescent↗

PubMedDate not supplied

A microtiter plate technique for the detection of platelet antibodies and platelet antigen typing.

A microtiter plate assay is described for platelet serologic studies. The assay is based on an indirect radiolabeled antiglobulin test. The test was performed in microtiter wells of 400 microliter capacity manufactured to form strips that fit into a standard 96-well carrier. The strips were broken apart and placed into tubes for counting in a gamma counter. The technique does not require fixation of the platelets to the wells. Freshly collected platelets or platelets that have been stored frozen in 5 percent dimethylsulfoxide can be used. Results are presented using the technique for platelet alloantibody identification, platelet antigen typing, and platelet crossmatching.

Antibodies↗

PubMedDate not supplied

In vivo studies of the long-term 51Cr red cell survival of serologically incompatible red cell units.

The long-term survival of serologically incompatible red cell units was measured in five patients with antibodies to high-frequency antigens. Initially, the survival of 1 ml of 51Cr-labeled incompatible red cells was measured over 1 hour. After demonstrating that the 1-hour survival times were successful (greater than 70%), each patient then received 5 ml of the same 51Cr-labeled red cells followed by the transfusion of the remainder of the red cell unit. The long-term T 1/2Cr survival for each case was patient 1 (anti-McCa), 15 days; patient 2 (anti-JMH), 12 days; patient 3 (anti-Kna), 31 days; patient 4 (anti-McCa), 12 days; and patient 5 (anti-Hya), 14 days. Each antibody tested in an in vitro homologous macrophage assay showed less than 5 percent phagocytosis. Anti-JMH was the only antibody to react with IgG subclass antisera and was determined to be IgG4. The macrophage assay, IgG subclass testing, and short-term (1 hour, 1 ml) 51Cr survival studies all indicated that the short-term survival was good. However, only the measurement of long-term survival with transfused units of serologically incompatible red cells was able to determine the actual survival, and "clinical significance" of the alloantibodies. Determining the actual long-term survival by the method described here can be of importance for patients requiring chronic red cell transfusion.

Aged↗

PubMedDate not supplied

The predictive value of crossmatching platelet transfusion for alloimmunized patients.

To determine the predictive value of a radiolabeled antiglobulin test for platelet crossmatching to select platelets for transfusion, we evaluated 230 transfusions in 42 alloimmunized oncology patients. Transfusions were classified according to the degree of HLA match. The value of the crossmatch in predicting platelet transfusion outcome was analyzed for each HLA category. For predicting the 1-hour corrected platelet count increment of all transfusions, the sensitivity of the test was 86 percent, specificity 84 percent, and total predictive value 84 percent. The crossmatch technique had similar predictive ability in all categories of HLA match, whether analyzing the results on the basis of the 1- or 24-hour platelet count rise.

Blood Grouping and Crossmatching↗

PubMedDate not supplied

Estimation of transfused red cell survival using an enzyme-linked antiglobulin test.

An enzyme-linked antiglobulin test (ELAT) method was developed to estimate survival of transfused red cells. This procedure is based on a principle analogous to that of the Ashby technique were antigenically distinct red cells are transfused and their survival studied. We compared the ELAT survival to the 51Chromium method (51Cr) in four patients. Three patients with hypoproliferative anemias showed T 1/2 by ELAT of 17.5, 18, and 17 days versus 18.5, 20, and 19 days by the 51Cr method. A fourth patient with traumatic cardiac hemolysis had two studies performed. In this case, the ELAT showed a T 1/2 of 10 and 8.1 days while 51Cr T 1/2 values were 11 and 10.5 days. The ELAT method for measuring red cell survival yielded data which agreed closely with the results of the 51Cr method. Although 51Cr is the accepted method for red cell survival, the ELAT method can be used to estimate transfused red cell survival.

Anemia↗

PubMedDate not supplied

An anti-i biphasic hemolysin in chronic paroxysmal cold hemoglobinuria.

Paroxysmal cold hemoglobinuria (PCH) was diagnosed in an elderly patient with a history of chronic lymphocytic leukemia. In this case, the Donath-Landsteiner antibody demonstrated anti-i specificity rather than the more commonly reported anti-P specificity. This unusual case of a biphasic hemolysin with anti-i specificity emphasizes the importance of performing a Donath-Landsteiner test when presented with serological or clinical findings that are suggestive of PCH.

Aged↗

PubMedDate not supplied

The efficacy of performing red cell elution studies in the pretransfusion testing of patients with positive direct antiglobulin tests.

In order to evaluate the efficacy of performing red cell elutions in pretransfusion testing, the serologic records of 638 patients with positive direct antiglobulin tests (DAT) were reviewed. These patients were identified by routine antibody screening procedures that included an autologous control. DAT results on the red cells of these patients showed 279 with IgG and C3d sensitization, 319 with IgG alone, and 40 with C3d sensitization alone. Of 638 patients' red cell eluates, 401 demonstrated no reactivity, 154 demonstrated panagglutination, and 60 demonstrated passively acquired anti-A,B. Only 23 of 638 patients had alloantibody sensitization of their red cells. Of the 23, 19 had serum antibody corresponding to the specificity of antibody detected in the eluate. Thus, only four of 638 (0.6%) eluates gave results unavailable by serum testing alone. This study indicates that routine eluate investigation provides little useful information in assuring compatibility. Serum antibody testing and careful review of the clinical and transfusion history constitute appropriate pretransfusion testing in patients with positive direct antiglobulin tests. Eluate testing should be restricted to cases in which immune hemolysis is suspected clinically.

Blood Transfusion↗

PubMedDate not supplied

Bacterial sepsis secondary to platelet transfusion: an adverse effect of extended storage at room temperature.

In a 3-month period four episodes of bacterial sepsis related to contaminated random donor platelet concentrates were observed. Evaluation incriminated extended (5 or more days) platelet storage. To determine if platelets stored for longer periods were likely to have greater bacterial contamination, platelet concentrates were inoculated with bacteria and daily quantitative bacteriology was performed. In vitro studies using polyolefin bags indicated contamination could occur with a single organism of Staphylococcus epidermidis. By 72 hours, platelet concentrates contained from 10(3) to 10(8) organisms per 0.1 ml depending on the inoculum size. By 6 days all inoculated units contained 10(7) to 10(9) organisms per 0.1 ml.

Blood Preservation↗

PubMedDate not supplied

The association of anti-P and early abortion.

The current report details the serologic findings in a case reported previously of a P1k woman, para 0 gravida 13, who was treated during her fourteenth pregnancy with plasmapheresis to reduce the anti-P titer. These studies suggest that anti-P can induce early abortion in Pk women and that the abortions are immunologically mediated. Further, this case supports the disputed proposal that the anti-P component of anti-PP1Pk is responsible for pregnancy loss in p women.

Abortion, Spontaneous↗

PubMedDate not supplied

Th activation in congenital hypoplastic anemia.

The authors identified persistent Th activation in five of seven children (71.4%) diagnosed as having Fanconi's anemia or Diamond-Blackfan syndrome. Th reactivity was no longer present in one patient after bone marrow transplantation. Tests on family members and other patients with bone marrow dysfunctions of childhood showed no Th activation. Less than 1 percent of healthy children or blood donors had Th activation. Patients with a variety of hemolytic and hypoplastic conditions also had a low incidence of Th activation. However, 13.5 percent of cord blood specimens demonstrated Th reactivity. This study indicates that Th activation may be a red cell developmental marker present in congenital hypoplastic anemias and also expressed on newborn red cells.

Anemia↗

PubMedDate not supplied

The utility of platelet washing using an automated procedure for severe platelet allergic reactions.

Increased use of platelets in patients requiring chronic platelet support has increased platelet transfusion reactions. The authors reviewed more than 300 platelet transfusion reactions, evaluated an automated platelet washing technique, and studied the effectiveness of washing platelets to reduce reactions. Febrile reactions (66%) were most frequently reported, followed by moderate and severe allergic reactions (15%), and urticaria alone (19%). Washed platelets were prepared by an automated technique (IBM/COBE 2991). In vitro studies indicated no apparent adverse effects to the platelets due to the wash procedure, and in vivo studies demonstrated good platelet increments in 10 thrombocytopenic patients. Twenty-two patients with histories of platelet transfusion reactions received a total of 554 washed platelet transfusions. Washed platelets were not effective in reducing febrile transfusion reactions in 16 patients receiving 347 washed products. The efficacy of washed platelets in reducing transfusion reactions was demonstrated in six patients with histories of severe allergic reactions who received 207 washed products. Severe allergic reactions were completely alleviated in this group. In conclusion, automated platelet washing is simple and efficacious in preventing or reducing the severity of allergic reactions to platelet transfusions.

Adult↗

PubMedDate not supplied

Characterization of antibody and selection of alternative drug therapy in hydrochlorothiazide-induced immune hemolytic anemia.

The authors report the clinical and laboratory findings of a patient who had severe immune hemolytic anemia due to hydrochlorothiazide (HCTZ). In this case, the HCTZ antibody reacted not only with other thiazide and thiazide-like drugs, but also with a chemically unrelated diuretic, ethacrynic acid. These results indicate that HCTZ antibody activity is not restricted solely to the thiazides and imply that therapy with any of the reactive drugs would be contraindicated for this patient. The serologic screening for drug reactivity may be useful for selecting alternative therapy for patients with drug-induced immune hemolytic anemia.

Anemia, Hemolytic, Autoimmune↗

PubMedDate not supplied

Alloimmunization to D antigen and HLA in D-negative immunosuppressed oncology patients.

D-negative patients may be divided into responders and nonresponders when immunized with D-positive red cells (RBC). Forty-nine D-negative oncology patients who received D-positive RBCs via platelet and white cell transfusions were studied to determine if nonresponders to D were likely to form lymphocytotoxic antibody (LCA). Nine patients developed anti-D in 16 to 390 days (mean = 112) after 2.6 to 481 ml (mean = 106) of D-positive RBCs. Forty patients had no evidence of anti-D after 0.8 to 535 ml (mean = 98) of D-positive RBCs and were followed for 14 to 1275 days (mean = 192). The anti-D group had no prior D-positive RBC transfusions, and two of five women making anti-D had previous pregnancies but no record of anti-D. LCA was found in four of nine (44%) patients with anti-D and in 12 of 40 (30%) patients without anti-D (p less than 0.50). Since both D and antigens HLA are considered highly immunogenic, it is of interest that the ability to form anti-D or LCA does not correlate. In fact, more patients (16/49; 32%) made LCA than anti-D (9/49; 18%). Of the 21 alloimmunized patients, 4 made both antibodies, while 17 had selective alloimmunization. It would thus appear that alloimmunization to D and HLA are not strongly linked and may indeed be unrelated.

Adolescent↗

PubMedDate not supplied

Detection and significance of alpha granule membrane protein 140 expression on platelets collected by apheresis.

Activation of platelets may be measured by using the monoclonal antibody S12 to detect alpha granule membrane protein 140 (GMP-140) antigen expressed only on activated platelets. S12 was used to measure activation of apheresis platelet concentrates by flow cytometry. Eleven platelet concentrates obtained by one method and nine obtained by another were analyzed 4 hours after collection. Means +/- 1SD of 25.3 +/- 14.8 percent and 28.9 +/- 11.6 percent, respectively, of platelets were found to be activated (range, 4.8-53.1%). Six of the platelet concentrates obtained by the second method were filtered. There was a drop of 17.8 percent (range, 10-25%) in the mean total number of platelets recovered after filtration, but there was no difference in the proportion of activated platelets measured immediately before and after filtration. The 1-hour posttransfusion platelet count increment was obtained after 12 of these apheresis platelet concentrates were transfused to eight patients who were not refractory from either a clinical or alloimmune standpoint. There was a significant inverse correlation between the platelet count increment and the proportion of activated platelets in the component (p less than 0.05, r = -.58). These data suggest that apheresis platelet concentrates with more activated platelets have a reduced 1-hour recovery. Filtration did not enhance activation or selectively remove activated platelets. Expression of GMP-140 may serve as a useful quality control measurement.

Blood Platelets↗

PubMedDate not supplied

Neonatal alloimmune thrombocytopenia associated with maternal anti-HLA antibody: a case report.

PURPOSE: Although neonatal alloimmune thrombocytopenia (NAIT) due to maternal sensitization to human platelet antigens is well described, the role of maternal anti-human lymphocyte antigen (HLA) antibodies in NAIT is not yet firmly established. PATIENT: A 31-week-old girl born prematurely to a G2POA1 mother was noted to have thrombocytopenia which lasted 18 days without any evidence of infection. MATERIALS AND METHODS: Platelet-associated IgG, anti-platelet antibody, and platelet PL(A1) antigen typing were determined using a commercial solid-phase red cell adherent test. Antibodies to platelet glycoproteins human platelet antigen (HPA) 1 to 5 were determined using a commercial ELISA. Anti-HLA antibodies were assayed using a standard lymphocytotoxicity test. Activities and IgG subclass of anti-HLA antibodies in plasma of the mother and other postpartum mothers were measured using purified HLA antigens in an enzyme linked immunoassay. RESULTS: Both mother and infant were positive for HPA-1 (PL(A1)) antigens. The mother's HLA phenotype was A3, A31, B7, B27. The level of platelet-associated IgG was not increased on maternal platelets; however, increased platelet-associated IgG was detected on the infant's platelets. Antibodies to platelet glycoproteins HPA1 to 5 were not detectable in the maternal plasma. Maternal serum was positive for anti-HLA antibodies, which reacted to 23 of 27 panel cells. The presence of HLA antibodies was confirmed by enzyme-linked immunoassay. Of note, the maternal antibodies reacted positively to the infant's platelets and anti-IgG anti-HLA antibodies were detected in the serum sample from the infant collected at birth. When the activity and IgG subclass of the maternal anti-HLA antibodies were compared with those of other mothers known to have high anti-HLA antibody activity, no differences were noted. CONCLUSION: This report documents a patient with neonatal thrombocytopenia induced by maternal IgG anti-HLA antibody. Neither activity nor IgG subclass could explain the occurrence of NAIT. The factors that contribute to NAIT induced by maternal anti-HLA antibodies remain to be identified.

Adult↗

PubMedDate not supplied

Septic reactions to platelet transfusions. A persistent problem.

OBJECTIVE: To determine the medical and laboratory characteristics of bacteremia secondary to transfusion of microbiologically contaminated platelet concentrates. DESIGN: Febrile transfusion reactions were prospectively monitored over 42 months. Units involved in reactions were evaluated with Gram's stain and culture tests. SETTING: Comprehensive cancer center. PATIENTS: Patients receiving platelet transfusions for thrombocytopenia secondary to bone marrow failure. RESULT: Seven cases of transfusion-associated sepsis were observed. Multidonor platelet products stored for 5 days resulted in an incidence of sepsis five times higher than those stored for 4 days or less (P less than .01). Investigation indicates that contamination most likely occurred at the time of blood collection. Clinically, septic reactions were associated with greater temperature elevations (average increase, 2.0 degrees C) than febrile reactions to sterile products. CONCLUSIONS: Contamination of platelet concentrates remains a significant clinical problem. Septic episodes may be reduced by transfusion of platelets with shorter storage intervals.

Adult↗