Analysis of clinical characteristics of insulin autoimmune syndrome and related literature review / 中国综合临床

Objective:A retrospective study was conducted to analysis the clinical characteristics of 7insulin autoimmune syndrome (IAS) patients.Methods:Clinical data were collected by searching the computerized database.Results:The male-female ratio of these seven patients was 4:3; age of the four patients was between 60-70 years old;two patients with the history of Hashimoto's disease. Of the seven cases, six wereexogenous IAS. The level of insulin was excessively high, the level of C-peptide was not low, and insulin auto-antibodies (IAA) were positive of all the seven patients. The lowest blood glucose of one patient was 4.2 mmol/L. The insulin to C-peptide molar ratios were >1 in five patients. Symptoms were relieved after discontinuing use of the suspicious drugs, small frequent meals, taking acarbose and metformin.Conclusions:IAS should not be easily excluded in patients without hypoglycemia record. For diabetes patients receiving insulin therapy, exogenous IAS might be mistaken as hypoglycemia induced by insulin overdose. The identification of the genotype might be meaningful in the diagnosing and prevention of IAS.

Solutions to cross-matching incompatibility in clinical: retrospective study of 1 770 cases in Shenzhen / 中国输血杂志

【Objective】 To analyze the blood samples sent by hospitals in Shenzhen to solve ABO cross-match incompatibility during 2011 to 2020, so as to find corresponding solutions to improve the efficacy of blood transfusion. 【Methods】 The clinical data of 1 770 cases of cross-match incompatibility in our laboratory from January 2011 to December 2020 were collected and reviewed. The causes of cross-match incompatibility were analyzed, the types of unexpected antibodies were determined. The overall incidence of antibodies was evaluated by statistical method of classified variables. The safety of blood transfusion was safeguarded by ABO homotype plus cross-matching compatibility. 【Results】 1) The 1 770 samples, presenting cross-matching incompatibility, involved 956 patients. The average number of cross-matching per patient from 2011 to 2015 was 1.32(307/232), which increased from 1.27(103/81) in 2016 to 2.23(286/128) in 2018, and remained stable in 2019 and 2020. 2) Among 956 patients, auto-and/or allo-antibody in plasma were yielded in 90.38%(864/956), including auto-antibody plus alloantibody in 42.26%(404/956), solo auto-antibody in 20.71%(198/956) and solo allo-antibody in 27.41%(262/956). Up to 20 kinds of specific allo-antibodies were detected, belonging to 8 blood groups. Among them, 70.82%(551/778) were Rh blood group, such as anti-E(37.15%)>anti-c(20.95%)>anti-C(5.27%)=anti-e(5.27%)>anti-D(2.19%), followed by MNS [11.40%(112/778)], Kidd [5.66%(44/778)], Leiws [3.21%(25/778)], Duffy [1.80%(14/778)], Diego [1.03%(8/778)], P1 [0.39%(3/778)] and H [0.26%(2/778)]. 3) 86%(37/43) of multiple transfusion recipients, aged below 20 years old, were thalassemia, and 1-4 kinds of allo- and/or auto-antibody were yielded. 【Conclusion】 The cross-matching incompatibility were mainly caused by allo- and/or auto-antibodies, which may be induced by blood transfusion, pregnancy or autoimmune diseases such as autoimmune hemolytic anemia.Those suspicious blood samples in clinical should be sent to blood group reference laboratory for further determination, in order to ensure the safety and efficacy of blood transfusion.

Process solution of autoantibodies in patients of autoimmune hemolytic anemia / 国际检验医学杂志

Objective Serological characteristic analysis for patients with autoimmune hemolytic anemia(AIHA)who has cold and warm auto‐antibody when undergoing blood type and cross‐matching .Methods Choosed 3 donors of red blood cells of group O to absorb autoantibodies of the patient′s serum(by using the methods of cold absorption) and used 2‐mercaptoethanol(2‐Me) to de‐stroyed the IgM antibody .Results The patient of AIHA blood type was B+ .There was cold and warm auto‐antibody in the pa‐tient′s serum ,and the result of cross‐matching is incompatible .Conclusion The patient′s serum contains cold and warm auto‐anti‐body which interferes blood type and cross‐matching .In emergency ,considering the patients condition ,blood transfusion combined with the drug treatment could achieve good effects .

Level of Auto Antibody Against Oxidized LDL in Myocardial Infracted Patients.

The aim of this study was to evaluate the level of auto antibody against oxidized LDL in myocardial infracted (MI) patients and normal healthy subjects of West Bengal (India) and to establish it to be also a cofactor for MI. Patients and Methodology : This study was carried out on 285 patients with MI as well as 75 healthy volunteers of comparable age and gender as control group. Blood was collected immediately after admission of the patients. Auto antibody against oxidized LDL, Nitric Oxide and malondialdehyde (MDA) were measured in all groups. Results : Mean serum level of auto antibody against oxidized LDL, MDA, total Cholesterol and LDL Cholesterol levels (118 ± 9.0, 7.4 ± 1.3, 233 ± 30, and 145 ± 38) were significantly (p<0.05) higher in MI patients when compared with control subject. The mean serum levels of nitric oxide (NO) and HDL, cholesterol were significantly (p<0.05) lower as compared to control group. Conclusion : Significantly high level of auto antibody against oxidized LDL associated with high level of MDA, total cholesterol and decreased level of NO and HDL cholesterol appear to be the factors responsible for the increase risk of coronary artery disease i.e., myocardial infarction in the population of West Bengal, India.

A Case of Autoimmune Hypoglycemia Complicated with Diabetic Ketoacidosis

Autoimmune hypoglycemia is characterized by hyperinsulinemia, fasting hypoglycemia, and the presence of insulin auto- antibodies without previous exposure to exogenous insulin. We experienced a case of autoimmune hypoglycemia without diabetes mellitus or any evidence of insulinoma. The insulin auto-antibody and insulin receptor auto-antibody were present. We diagnosed the patient as having autoimmune hypoglycemia and treated with glucocorticoid. After treatment, the hypoglycemic symptoms were resolved. However, four months later, the patient was readmitted with transient diabetic ketoacidosis. After recovery, he showed no signs of diabetes mellitus. We believe that insulin auto-antibodies may play a role in autoimmune hypoglycemia and diabetic ketoacidosis, but its role and mechanism are not precisely known. Further studies are needed to define the action mechanisms and the functions of insulin auto-antibodies: here we present case with a relevant literature.

The clinical significance of thyroid auto-antibodies in patients with chronic idiopathic urticaria / 천식및알레르기

BACKGROUND AND OBJECTIVES: Chronic idiopathic urticaria refers to recurrent hives of more than six weeks duration and in approximately 80% of cases, the etiology is unknown. Recently, involvement of an autoimmune mechanism in the pathogenesis of chronic idiopathic urticaria has been suggested. Thyroid autoimmunity has been reported in patients with chronic idiopathic urticaria and treatment with thyroxine in selected cases induced clinical remission. MATERIALS AND METHODS: We studied 99 patients with chronic idiopathic urticaria to evaluate the clinical significance of anti-thyroid auto-antibodies including anti-thyroglobulin and antimicrosomal antibodies. Thirty-four normal volunteers were selected as controls. The prevalence of these two auto-antibodies as well as laboratory findings and clinical features between these two groups were compared. RESULTS: Thyroid auto-antibodies were positive in 24% of patients compared to 8.7% of control patients and the duration of the disease was significantly longer in the patients with thyroid auto-antibodies than in those without thyroid auto-antibodies, respectively (p<0.05). There was no significant difference in age, positive rate of ANA and total eosinophil count. Administration of thyroxine to five patients with refractory urticaria resulted in improvement in three patients. CONCLUSION: Thyroid autoimmunity is associated with chronic idiopathic urticaria in some patients. Administration of thyroxine resulted in improvement of symptoms in some of these patients. Therefore, we recommend routine testing of thyroid auto-antibodies in patients with retractable chronic idiopathic urticaria.

Predictive value of combined determination of ICA、64KDAb and IAA in the first-degree relatives of type I diabetics / 中国糖尿病杂志

Objective　To study the predictive value of islet cell antibody (ICA),64KD protein antibody(64KDAb) and insulin auto-antibody (IAA) in the first-degree relatives of type 1 diabetics.Methods　The determination of islet autoantibody distribution in type 1 diabetes patients,first-degree relatives without diabetes and normal individuals was made.Results　The results revealed that ICA and 64KDAb positive rate in type I diabetes patients and their first-degree relatives was significantly higher than normal individuals.The positive rate of 64KDAb is higher than that of ICA and IAA. Conclusion　These results suggest that 64KDAb's sensitivity is higher than ICA and IAA's,so 64KDAb is more valuable as the marker of predicting type 1 diabetes.The combined determination of ICA,64KDAb and IAA might improve the value for predicting diabetes.

Predictive value of combined determination of ICA、64KDAb and IAA in the first-degree relatives of type Ⅰ diabetics / 中国糖尿病杂志

Objective To study the predictive value of islet cell antibody (ICA),64KD protein antibody(64KDAb) and insulin auto-antibody (IAA) in the first-degree relatives of type 1 diabetics. Methods The determination of islet autoantibody distribution in type 1 diabetes patients,first-degree relatives without diabetes and normal individuals was made. Results The results revealed that ICA and 64KDAb positive rate in type I diabetes patients and their first-degree relatives was significantly higher than normal individuals. The positive rate of 64KDAb is higher than that of ICA and IAA. Conclusion These results suggest that 64KDAb's sensitivity is higher than ICA and IAA's,so 64KDAb is more valuable as the marker of predicting type 1 diabetes. The combined determination of ICA, 64KDAb and IAA might improve the value for predicting diabetes.