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Biomedical subjects

V A Kunst

Publications and source records attributed to V A Kunst.

At least 19 recordsLinked to original sources
PubMed1995

Erythrocyte repopulation after major ABO incompatible transplantation with lymphocyte-depleted bone marrow.

Forty-four out of 258 allogeneic BMT were performed across the major ABO barrier. Donor erythrocyte repopulation could be evaluated in 30 cases. Fifty-eight patients transplanted with an ABO compatible or minor incompatible graft served as the control group. All patients received a marrow graft depleted of lymphocytes by counterflow centrifugation. Less than 10(8) residual erythrocytes were present in the graft. Cyclosporin A was used as immunoprophylaxis after transplantation. Erythrocyte repopulation was measured using a fluorescent microsphere method. An adapted transfusion policy was applied. Eight out of 30 patients (27%) with major ABO incompatibility had no detectable donor erythrocytes 2 months after BMT. Up to 3 months after BMT donor erythrocyte repopulation was significantly delayed in the ABO incompatible group (P < or = 0.03). Significantly more erythrocyte transfusions were required in the ABO incompatible group (P < 0.001). Six patients with blood group O (20%) developed pure red cell aplasia which resolved in five without therapeutic intervention. In these six patients anti-A antibody titers were persistently high the first 3 months after BMT. This was in contrast with 22 patients with timely recovery of erythropoiesis in whom anti-A and anti-B antibody titers showed a steady decrease after BMT. The incidence of immunohematological complications in these patients who received a lymphocyte depleted major ABO incompatible graft is similar (20%) to the incidence reported in the literature. Serious morbidity related to major ABO incompatibility did not occur.

ABO Blood-Group System↗
PubMed1993

No irregular erythrocyte antibodies observed after bone allografts in 144 patients.

Red cell blood group antigens present in bone allografts may cause the formation of irregular erythrocyte antibodies (IEA). In the literature, 4 such cases have been described; all were Rh(D) negative females who had received Rh(D) positive bone and had made anti-Rh(D). To investigate the immunization by red cells after bone allografting, a retrospective and a prospective study was carried out. Altogether 144 patients were tested for the presence of IEA, before as well as after obtaining frozen allogeneic bone in orthopedic or maxillo-facial surgery. In 9 patients, the tests disclosed IEA preoperatively. No new IEA were detected postoperatively in the 144 patients, including 30 Rh(D) negative patients who received Rh(D) positive bone. We conclude that formation of IEA is a rare phenomenon. Nevertheless, it is recommended to give only Rh(D) negative bone to Rh(D) negative girls and women of childbearing age.

Antibodies↗
PubMed1990

Prevention of primary cytomegalovirus infection after allogeneic bone marrow transplantation by using leukocyte-poor random blood products from cytomegalovirus-unscreened blood-bank donors.

Cytomegalovirus infection was studied in 59 seronegative recipients of bone marrow depleted of lymphocytes by counterflow centrifugation. Eighteen patients died within 3 months after bone marrow transplantation without evidence of CMV infection, and they were excluded from analysis. Twenty-eight valuable seronegative patients received marrow from a seronegative donor, and 13 from a seropositive donor. All but 2 patients received acyclovir orally (4 x 400 mg/day) from days -9 to +60. CMV prophylaxis with immunoglobulin preparations was not given. All blood products were prepared from random, CMV-unscreened blood-bank donors. The red cell concentrates were depleted of leukocytes by filtration, and leukocytes were removed from the platelet concentrates by centrifugation. None of the patients with seronegative donors showed any clinical sign compatible with CMV infection. Two nonfatal primary CMV infections occurred in the recipients of bone marrow from CMV-positive donors. One of the 59 patients developed interstitial pneumonia, in this case caused by Pneumocystis carinii. Leukocyte depletion of blood products from random CMV-unselected blood donors appeared to prevent primary infection in CMV-seronegative BMT recipients. We conclude that prophylactic use of immunoglobulin preparations is not necessary to prevent CMV primo-infection in patients receiving leukocyte-depleted blood products and acyclovir prophylaxis during the first 2 months postgrafting.

Blood Donors↗
PubMed1989

Immune hemolytic anemia associated with tolmetin and suprofen.

This article reports the first case of immune hemolytic anemia possibly associated with the ingestion of suprofen. The patient suffered from massive hemoglobinuria and acute renal failure. Serologic studies of the patient's serum revealed suprofen-dependent red cell antibodies. However, tolmetin-dependent antibodies were also found in the serum, showing the same properties as the suprofen antibodies and an even higher titer. The patient not only had drug-dependent antibodies in the serum, but also had developed autoantibodies, a phenomenon that has been described for several other drugs. The working mechanism by which suprofen and tolmetin caused immune hemolysis had properties of both the immune complex model and the induction of autoimmunity. Although it was unclear whether the immune hemolytic anemia was the result of suprofen, tolmetin, or cross-reacting antibodies, we feel that suprofen should be added to the list of nonsteroidal anti-inflammatory drugs associated with a positive direct antiglobulin test.

Anemia, Hemolytic, Autoimmune↗
PubMed1989

Host and donor erythrocyte repopulation patterns after allogeneic bone marrow transplantation analysed with antibody-coated fluorescent microspheres.

Analysis of erythrocyte populations, using red blood cell antigen differences between host and donor as marker, was performed with a sensitive fluorescent microsphere assay to monitor marrow engraftment and mixed red cell chimaerism after allogeneic bone marrow transplantation (BMT). An adapted transfusion policy, using marker negative erythrocyte transfusions, was required for this analysis. In all patients the marrow graft was depleted of lymphocytes by counterflow centrifugation. Thirty-seven patients were evaluable for donor repopulation at one or more points in the first 6 months after BMT. At 0.5 month donor erythrocytes were detectable in 19 out of 22 patients. At 6 months donor erythrocytes were detectable in 100% of the evaluable patients. In the first 3 months after BMT the average donor erythrocyte repopulation in recipients of major ABO mismatched transplantations was delayed. Thirty-eight patients were evaluable for chimaerism at 6 months or later after BMT. A high incidence of mixed red cell chimaerism was observed varying from 50% to 71% at different points of analysis. Mixed red cell chimaerism with low percentages (less than 1%) of host cells was not related with relapse, nor did high percentages (greater than 10% of host cells necessarily indicate relapse.

ABO Blood-Group System↗
PubMed1988

A fluorescent microsphere method for the investigation of erythrocyte chimaerism after allogeneic bone marrow transplantation using antigenic differences.

A method for the investigation of erythrocyte chimaerism in patients after bone marrow transplantation (BMT) has been developed using fluorescent microspheres coated with anti-human IgG. Blood group antigens different in patient and donor were used as marker. The specificity and reliability of this method was evaluated measuring artificial mixtures of blood group positive and negative red cells. Red cell antigens tested were D, c, K, Fya, Fyb, Jka, Jkb, S and s. Mean linear regression lines for mixtures with percentages positive cells ranging from 0.01 to 1% and 1 to 100% were 0.91X-0.03 (r = 0.99) and 1.00X-0.05 (r = 0.99), respectively. The sensitivity level of the assay was one positive cell per 10,000 blood group negative cells. In negative control samples (n = 15) a mean percentage positive cells was found of 0.002 +/- 0.004 (SD). Intra- and inter-assay coefficients of variation were 4.9 and 5.3% for mixtures of 10%, and were 11.1 and 24.6% for mixtures of 0.1% blood group positive cells. It is concluded that the described method can be used both to establish the take of donor marrow in an early phase after transplantation and to investigate mixed erythrocyte chimaerism long after BMT.

Antibodies, Anti-Idiotypic↗
PubMed1987

Erythrocyte repopulation after allogeneic bone marrow transplantation. Analysis using erythrocyte antigens.

Blood samples from 31 of 50 consecutive patients receiving bone marrow from an HLA-identical and mixed lymphocyte culture-nonreactive sibling were investigated for the presence of donor and autologous erythrocytes. Simple serological techniques using antigenic differences between donor and recipient and a blood transfusion policy taking these differences into account made this study possible. A total of 71% of the patients had donor erythrocytes demonstrable 4 weeks after bone marrow transplantation; almost all patients did so after 2 months. Disappearance or absence of donor red cells indicated poor patient prognosis. Persistence or reappearance of autologous erythrocytes in small percentages (0.05-10%) occurred without relapse of leukemia. Reappearance in high percentage (50-100%) indicated relapse.

Antigens, Differentiation↗