Immunogenicity of an acellular pertussis vaccine composed of genetically inactivated pertussis toxin combined with filamentous hemagglutinin and pertactin in infants and children.

We studied the immunogenicity of an acellular pertussis vaccine composed of genetically detoxified pertussis toxin (PT-9K/129G), filamentous haemagglutinin, and a 69-kilodalton protein, pertactin, in 30 children aged 12 to 24 months and in 80 infants aged 2 to 4 months. A significant increase of the neutralizing titer and of the titers against pertussis toxin, filamentous hemagglutinin, and pertactin, as determined by enzyme-linked immunosorbent assay, was achieved after three doses of vaccine in all the children; a significant increase of these antibody titers was obtained in 100%, 96.1%, 93.5%, and 98.7% of the infants, respectively.

Prenatal exclusion of purine nucleoside phosphorylase deficiency.

We report on the prenatal exclusion of purine nucleoside phosphorylase (PNP) deficiency in a fetus whose parents were known to be heterozygotes for the enzyme defect. Prenatal investigation was performed in the 16th week of gestation on amniotic fluid and cultured amnion cells using sensitive techniques. The results suggested that the fetus was either normal or a heterozygote. PNP activity in cord red cells confirmed the heterozygous status of the baby.

Immunologic follow-up of infants treated with granulocyte transfusion for neonatal sepsis.

The immunologic status and the occurrence of alloimmunization against granulocytes, platelets, lymphocytes, and red cells was evaluated in 33 babies who received granulocyte transfusion because of neonatal sepsis. Nine age-matched babies were examined as control. A first group of 19 infants was examined only once between 6 and 23 months of age. Alloantibodies were searched by the following serologic methods: standard techniques for red cell antibodies; lymphocytotoxicity test; agglutination and immunofluorescence tests on granulocytes and platelets. No antibodies were demonstrated. The immunologic profile was investigated by determining the Ig levels, the percentage of E rosette-forming cells, and the lymphocyte blastic response to phytohemagglutinin and concanavalin A. Granulocyte function was studied by phagocytosis and killing of Candida. No significant differences were observed between treated and control babies. In a second group of 14 infants the occurrence of early immunization within 3 to 9 weeks after the last transfusion was investigated. No evidence of early immunization was found. The present data suggest that following neonatal granulocyte transfusion the risk of adverse immune reactions should be low.

Blood transfusion therapy in the newborn.

This review deals with the various indications, the choice of blood products and the main aspects of their administration for transfusing neonates. Some special problems peculiar to neonatal age, that both neonatologists and blood transfusion services have to take into account, are emphasized. Exchange transfusion in the procedure most frequently used in blood transfusion therapy of neonatal hyperbilirubinaemia of various aetiology, severe anaemia and hyperviscosity due to polycythaemia. The procedure also represents a rational therapeutic approach in the bleeding thrombocytopenic newborn. More recently exchange transfusion has been utilized in the management of DIC, RDS and sepsis. Besides its advantages, metabolic, haemorrhagic and cardiac hazards of this "massive transfusion" are considered. Just as at any other age, the red cell preparation is the blood component most frequently utilized in the transfusion therapy of the neonate, considering not only the treatment of anaemia without hypovolaemic shock, but also the cases of iatrogenic blood loss, a common problem in the high risk neonatal intensive care unit. As transfusion of small increments of blood may often be required for the sick neonate and premature infant, different methods to cope with such conditions are discussed.

Blood groups and histocompatibility antigens in habitual abortion.

Forty-six couples with at least two consecutive abortions were examined. The morphological and the functional clinical check-ups were constantly negative. In all the couples a karyotype analysis was carried out including an investigation of C and/or G bands. The phenotypes of ABO, Rh, MNSs and HLA-systems were also determined. No significant difference was observed in the distribution of ABO phenotypes between males and females, or between subjects with abortions and controls. Regarding the Rh system, the most important findings are the absence of phenotypes with the E allele in double dose, the reduction of the frequency of the CCDee phenotype and the increase in the frequency of the ccDEe phenotype. Concerning MNSs system, an increase in the frequency of the phenotypes with the S allele in double dose is observed. Females with habitual abortions show a higher incidence of Bw35 as compared both to males and to the controls. No significant differences were observed for other antigens. The persistence of a genetic disequilibrium both in the Rh and the MNSs systems suggests that the selection might act against certain antigenic combinations, independently from the state of materno-foetal compatibility. Though preliminary, our data seem to give some support to this hypothesis. They also suggest that Bw35 antigen may be important in human reproduction.

Another family with purine neucleoside phosphorylase deficiency.

A brief genetic report is given on a family with a child affected by nucleoside phosphorylase deficiency. Our observations confirm the genetic heterogeneity of this enzyme deficiency which is inherited as a mendelian autosomal trait.

Auto-immune haemolytic anaemia in childhood: follow-up in 29 cases.

We describe 29 children with auto-immune haemolytic anaemia (AIHA). The patients could be followed up for long periods of time. The auto-antibodies, responsible for the AIHA, are described as well as the associated diseases that could be diagnosed, the clinical course and some clinical aspects of special importance. Finally, the treatment given to these patients and its results are discussed.

Maternofetal transfusion during delivery and sensitization of the newborn against the rhesus D-antigen.

The presence of maternal cells was determined in a blood sample of 86 rhesus D-negative newborns with a rhesus D-positive mother using the 'minor cell population technique' of Jones and Silver. Maternal cells were found in 43 percent of the samples, irrespective of ABO incompatibility. Anti-D antibodies were detected in 22.2 percent of serum samples from 53 children taken at 6-10 months after birth. There was no correlation between the presence of anti-D and the results of the minor cell population technique at birth. The results are discussed.