[Immunologic methods of diagnosing rheumatism].
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Autoantibodies↗
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[Experiences in serological diagnosis of tuberculosis].
Serological tests complete clinical diagnosis of tuberculosis. Passive hemagglutination and passive hemolysis are of greater usefulness than complement fixation, precipitations, flocculation or agglutination reactions. Antiglobulin technique and combination of several tests are of value. False negative results in cases of tuberculosis and healthy persons serologically false positive are still a problem. New tests with standardized purified polysaccharide, phosphatide and protein are expected to be of value in future.
Agglutination Tests↗
Autoimmune hemolytic anemia in children.
Autoimmune hemolytic anemia may represent an acute medical emergency. The anemia is normocytic normochromic and is usually associated with an elevated reticulocyte count. The diagnosis is confirmed by positive direct and indirect Coombs tests. Treatment consists of blood transfusion if the anemia is life-threatening. Steroids promote a decrease in the serum immunoglobulin level and block binding of antibody to the red blood cell. Splenectomy is reserved for those patients who fail to respond to steroids.
Anemia, Hemolytic, Autoimmune↗
[Autoimmune thrombocytopenic purpura. Clinical and therapeutic retrospective study of 544 cases (author's transl)].
A retrospective study of 544 patients with autoimmune thrombocytopenic purpura showed that 81 had immunological abnormalities (antinuclear factors and/or positive direct Coombs; test and/or anti-smooth muscle antibodies). After one year, 58-8% of all patients were still in complete remission, irrespective of treatment. The outcome of the disease was studied in relation to therapeutic regimens. Prognosis was worst in patients with immunological abnormalities, since 11% died as compared with 4% of the whole patient population. Most relapses occurred during the first two years following remission.
Adolescent↗
[The Liss-technique in comparison with conventional methods for cross-matching-procedure (author's transl)].
The Liss (Low Ionic Strength Solution) technique was compared with the enzyme- and saline-albumin-technique for the cross-matching-procedure. The tests were performed in parallel. The main advantage of Liss in erythrocyte-antibody-detection is to hasten and to raise the sensitivity of the reaction. The investigations in Liss show a remarkable decrease of the performing time for the corss-matching-procedure. Despite extended incubation time during Liss-antiglobulin-testing false positive results did not occur.
Blood Grouping and Crossmatching↗
[Perinatal hemolytic disease due to incompatibility in the U system (author's transl)].
We report the case of a 3 week-old black infant who presented with hemolytic anemia due to an incompatibility with his mother in the U blood group system. Jaundice, present on the 3rd day of life, was considered as physiologic jaundice. A positive Coombs test led to the discovery in the mother's serum of an immune antibody against the U public antigen.
Adult↗
[Anti-RaRBC antibodies in human serum. I. The presence of complete anti-RaRBC antibodies in the serum of healthy persons and their isotype specificity].
Agglutinins against rabbit erythrocytes (RaRBC) were detected in 60 investigated normal human ser in titres ranging 1:20 - 1:1280. Titres of saline anti-RaRBC were not dependent to temperature nor to the blood groups of donor sera. Saline agglutinins were identified as antibodies of IgM class based on the result of gelfiltration and absorptions on anion exchanger and SpA-Sepharose immunoadsorbent as well as on mercaptoethanol and sulfitolysis sensitivity. IgG anti-RaRBC antibodies incapable to agglutinate RaRBC in saline were detected using indirect Coombs test in the second protein peak of gelfiltration. Some characteristics of anti-RaRBC saline agglutinins were compared with human natural isohemagglutinins.
Adult↗
Clinical trials with diglycoaldehyde (NSC-118994): review and reasons for withdrawal from clinical trial.
All Phase II studies with diglycoaldehyde with leukemia and solid tumors have been reviewed. The dose schedules employed ranged from 1.5 to 2.0 g/m2/day for 3 to 5 days. The most common side effects have been gastrointestinal (nausea and vomiting), which occurred in 22% of the patients. Renal toxicity (rise in BUN, creatinine, and urinary proteins) was seem in 17% of the patients treated. Other infrequent toxicities include hypocalcemia (9%) and local complications such as phlebitis. Leukopenia, thrombocytopenia, positive Coombs' test and impairment in coagulation profile were also reported. In contrast to the hints of therapeutic efficacy described during Phase I trials, in phase II trials no activity was noted among 96 patients with solid tumors and only minimal antileukemic action among 49 other patients. These disappointing Phase II trials coupled with prominent toxicities have prompted the decision to terminate further clinical testing. This report summarizes all clinical observations as an example of circumstances which curtail clinical testing of anticancer drugs.
Aldehydes↗
[Anti-RaRBC antibodies in human serum. II. Presence of incomplete anti-RaRBC antibodies in the serum of healthy persons].
Non-agglutinating character of some anti-rabbit erythrocytes (RaRBC) antibodies was demonstrated. Non-agglutinating ("incomplete") antibodies were identified mainly as IgG but in some sera were detected also in IgA and IgD class using indirect Coombs test with monospecific antisera. Neutralization and separation of "complete" (IgM) antibodies were performed using 2-mercaptoethanol treatment and/or preparative immunochemical techniques. Some kind of restriction to kappa light chains and to IgG2 subclass has also been observed but monoclonal character of "incomplete" antibody was excluded. Specificity of reaction of IgG anti-RaRBC antibodies with RaRBC membrane antigens was documented using multiple adsorption-identification experiments. Non-specific (Fc-mediated) reaction was excluded in contrast to previously published results on the presence of Fc receptor on RaRBC.
Agglutination Tests↗
[Chronic neurobrucellosis with negative Wright's reaction. 2 cases (author's transl)].
In two patients suffering from chronic neurobrucellosis with negative Wright's reaction the diagnosis could be made by other serological methods: complement fixation, demonstration of blocking antibodies by indirect immunofluorescence or Coombs'test. The therapeutic problems raised by chronic neurobrucellosis are discussed.
Adult↗
Hemolytic-uremic syndrome associated with neuraminidase-producing microorganisms: treatment by exchange transfusion.
In two infants with pneumonia, Coombs test positive hemolytic anemia and hemolytic uremic syndrome (HUS), exposure of the Thomsen cryptantigen, probably due to the action of circulating neuraminidase, was demonstrated. Reaction between the exposed T-antigen and anti-T agglutinin, normally present in human blood, can lead to difficulties in serological testing and during blood transfusion. The place of exchange transfusions using washed RBC or heparinized whole blood in the management of this subgroup of HUS is discussed.
Antigens↗
[Low titer cold agglutinin disease due to anti-HI antibody and a review of this disease in Japan].
A 79 year-old Japanese man was admitted because of brownish urine and Raynaud phenomenon. Laboratory data showed mild anemia with reticulocytosis, positive direct Coombs test against anti-C3, elevated level of lactate dehydrogenase, undetectable level of serum haptoglobin and low titer of cold agglutinin (1:256 at 4 degrees C), the immunoglobulin subclass of which was IgM. Cold agglutinin disease is usually associated with very high levels of cold agglutinins, the specificity of which is anti-I. This case had low titer cold agglutinin disease due to anti-HI cold agglutinin.
Adolescent↗
Complications of blood transfusion. How to recognize and respond to noninfectious reactions.
Severe transfusion reactions occur much less often than minor reactions, but it is difficult to discriminate clinically between impending severe reactions and minor reactions. Therefore, whenever a reaction occurs, the transfusion should be discontinued and a laboratory workup initiated to rule out an acute hemolytic transfusion reaction. At a minimum, a direct antiglobulin (Coombs') test should be performed, and specimens obtained before and after transfusion should be assayed for hemoglobinemia and hemoglobinuria. If the product transfused included red blood cells, then typing and crossmatching should be repeated on a posttransfusion blood specimen. Routine premedication with antipyretics is not recommended, since they may mask early signs and symptoms of more severe reactions and their efficacy is questionable. Recent insights into the mechanisms of transfusion reactions have suggested interventions that may help minimize or prevent potentially serious sequelae.
Anaphylaxis↗
[The role of enzyme tests in antibody screening before blood transfusion].
In Poland as well as in other European countries there are two obligatory serological tests for antibody screening and crossmatching: indirect antiglobulin test (IAT) and enzyme test. Because of development of some new sensitive laboratory techniques serologists discuss the following questions: should enzyme techniques be still used, should they be replaced by other new methods, may investigations be performed only by the well standardized IAT?
Blood Grouping and Crossmatching↗
[Immunoblastic lymphadenopathy (IBL)-like T cell lymphoma associated with granulocytopenia and autoimmune hemolytic anemia].
A 65 year-old woman was admitted in May 1990, because of fever, generalized lymphadenopathy and eruption. Laboratory examination showed granulocytopenia, polyclonal hypergammaglobulinemia, positive Coombs' test, positive cold antibody and positive anti-E erythrocyte antibody. 7 days after admission autoimmune hemolytic anemia developed. The appearance of the anti neutrophil leukocyte antibody was suspected because of the absence of the segmented neutrophils in marrow specimen. Histological findings of the biopsied lymph node and the marker study of the tumor cell disclosed IBL-like T cell lymphoma. The patient was treated with G-CSF and VEPA chemotherapy. Granulocytes increased and she showed marked symptomatic improvement with complete remission. Our case showed various clinical pictures with hemolytic anemia and granulocytopenia, which could be based on the autoimmune mechanisms.
Aged↗
[Angiocentric lymphoma associated with anemia secondary to parvovirus B19 infection].
A 50-year-old woman was admitted to our hospital in May 1993 because of papules, cervical lymphadenopathy and interstitial pneumonia. Oxygen inhalation and pulse therapy of corticosteroid were started. A biopsy of the left inguinal lymphnode showed T zone enlargement and marked vascularization with polymorphous atypical lymphoblasts, consistent with angiocentric lymphoma (immunohistochemically T cell type). In situ hybridization with EBER-1 did not show association of EB virus. She was subsequently treated with ProMACE-CytaBOM successfully, but anemia had progressed before that treatment showing a reticulocyte count 0/1000, LDH 870 U/l, positive direct Coombs test. Bone marrow aspiration revealed red cell aplasia and the existence of giant pronormoblasts. The hemoglobin dropped to the level of 4.7 g/dl, requiring anabolic steroid and frequent blood transfusion. Parvovirus B19-specific antibodies were negative initially by western blot assay, but IgM antibody appeared after 35 days and IgG after 71 days. In August anemia improved following a reticulocyte burst and recovery of bone marrow erythroblasts. This patient is the first reported case of angiocentric lymphoma complicated with severe anemia, perhaps resulting from autoimmune hemolytic process and parvovirus B19 infection.
Anemia↗
Brucellosis in childhood in the Western Cape.
Human brucellosis, a multisystem disease which may mimic other conditions, has a low incidence in childhood and the diagnosis may easily be missed. Over a 7-month period 9 children with brucellosis presented to the Department of Paediatrics and Child Health, Tygerberg Hospital. Six of the children had consumed unpasteurized milk. The main presenting symptoms were fever, fatigue, headache, myalgia and haematuria. Clinical signs included lymphadenopathy (3), nasopharyngitis (2), features of lower respiratory tract infection (2), splenomegaly (2) and pyrexia (1). The diagnosis was made on the basis of a positive serological titre (> 1:160) for Brucella abortus. The prozone phenomenon was encountered in 6 cases; however, the Coombs test confirmed the diagnosis in these cases. Children under 7 years were treated with co-trimoxazole and rifampicin and those over 7 years with tetracycline and rifampicin, for at least 6 weeks. No relapses were detected on follow-up.
Adolescent↗
[Autoimmune hemolytic anemia associated with multicentric Castleman's disease with a 28-year history].
A 49-year-old female admitted because of anemia. had skin rashes since age 20. Generalized lymphadenopathy and fever appeared and the patient was diagnosed as multicentric Castleman's disease (MCD) at 40 years of age. Lymphadenopathy and fever improved with combined chemotherapy. In November, 1992, anemia increased with reticulocytosis (11.8%) and laboratory examination revealed a positive result for Coombs test and increased indirect bilirubin. A diagnosis of autoimmune hemolytic anemia (AIHA) was made. Steroid and plasmapheresis showed temporary effects, but anemia relapsed when steroids were decreased. Immunosuppressive drugs, vincristine and danazole were ineffective. Anemia improved on the second attempt at steroid therapy. The level of Hb rose to 11.2 g/dl after 3 months. The relationship between MCD and AIHA was discussed.
Anemia, Hemolytic, Autoimmune↗