ABSTRACT
Alloimmune thrombocytopenia of the newborn (AITN) is due to the transplacental passage of maternal antibodies directed against fetal platelet antigens, most commonly PLA, (HPA-1a). Sensitization and clinical manifestations of disease can occur in the first pregnancy. It carries a mortality rate of 15%, usually due to intracranial hemorrhage (ICH). Twenty-four cases of AITN were reviewed, five of whom had radiological evidence of ICH in utero. Petechiae and/or bruising were present in 14 babies. Platelet counts at birth ranged from 5 to 206 x 10(9)/L. One infant died. The duration of follow-up for the four survivors of ICH ranged from 15 to 71 months. All had serious neurodevelopmental sequelae, including severe mental retardation, cortical blindness, seizures, and cerebral palsy. The emotional and financial cost created by the care of these children is immeasurable. Steps to identify and prevent AITN should be part of routine prenatal care if we are to reduce the morbidity and mortality caused by this disorder.
Subject(s)
Nervous System Diseases/etiology , Thrombocytopenia/complications , Antigens, Human Platelet/immunology , Cerebral Hemorrhage/etiology , Female , Follow-Up Studies , Humans , Infant, Newborn , Intellectual Disability/etiology , Isoantibodies/immunology , Maternal-Fetal Exchange , Pregnancy , Thrombocytopenia/immunologySubject(s)
Blood Component Transfusion/adverse effects , Blood Platelets/immunology , Immunization , ABO Blood-Group System/immunology , Antigens, Human Platelet/immunology , Autoantibodies/immunology , HLA Antigens/immunology , Histocompatibility , Humans , Isoantibodies/biosynthesis , Platelet TransfusionSubject(s)
Antigens, Human Platelet/analysis , Blood Platelets/immunology , HLA Antigens/analysis , Serology/methods , Antibodies, Monoclonal/immunology , Blood Component Transfusion , Blotting, Western , Cytotoxicity Tests, Immunologic , Enzyme-Linked Immunosorbent Assay , Fluorescent Antibody Technique , Histocompatibility Testing , Humans , Isoantibodies/immunology , Male , Platelet TransfusionSubject(s)
Antilymphocyte Serum/analysis , Blood Donors , Platelet Transfusion , Staphylococcal Protein A/analysis , Adolescent , Adult , Aged , Blood Grouping and Crossmatching , Blood Platelets/immunology , Blood Transfusion , Child , Child, Preschool , False Negative Reactions , False Positive Reactions , Female , Humans , Infant , Male , Middle Aged , Thrombocytopenia/therapyABSTRACT
Platelet bound IgG (PBIgG) measured by antiglobulin consumption assay was compared with indices of clinical and laboratory disease activity in 37 nonthrombocytopenic patients with systemic lupus erythematosus. There was no correlation with clinical disease activity. When patients with a PBIgG level over 50 ng/10(7) platelets were compared to those with normal PBIgG levels (less than 20 ng/10(7) platelets), however, they had a significantly higher DNA binding level (p less than 0.05). In 17 patients there was no correlation between PBIgG levels and circulating immune complexes as measured by the Raji cell assay. Ten patients with PBIgG levels over 50 ng/10(7) platelets were followed for a mean of 23 months (5-26 months). None developed thrombocytopenia.
Subject(s)
Blood Platelets/metabolism , Immunoglobulin G/metabolism , Lupus Erythematosus, Systemic/blood , Adult , Aged , Antigen-Antibody Complex/metabolism , Female , Humans , Lupus Erythematosus, Systemic/physiopathology , Male , Middle AgedABSTRACT
Automated analysis of lymphoblast cell morphology is being evaluated as a basis for predicting the response to therapy of patients with acute lymphoblastic leukemia. A new technique of scene segmentation particularly applicable to the "cluttered" images of cells in routine bone marrow smears is described. Morphologic characteristics of lymphoblasts found in bone marrow smears made at time of diagnosis were measured by an automated, interactive image-processing system using the new scene segmentation technique. These characteristics, on a patient by patient basis, are being compared to remission length and survival data to develop and test new prognostic methods.
