Determination and Successful Transfusion of Anti-Gerbich-Positive Red Blood Cells in a Patient with a Strongly Reactive Anti-Gerbich Antibody.

Background: The clinical relevance of antibodies directed against members of the Gerbich (GE) family of antigens is not invariably clear. Given the scarcity of serologically compatible red blood cells (RBC), various methods may have to be applied to assess the safety of transfusing serologically incompatible RBC. Patient and Methods: The serum of a 57-year-old male Caucasian admitted to hospital for gastrectomy was found to contain a highly reactive anti-GE2 antibody (IgG(1)). In addition to a monocyte monolayer assay, 50 ml of GE2-positive RBC were transfused, and blood samples were taken before and 1 and 24 h after transfusion for flow-cytometric determination of transfused cells. Results: Both tests showed no increased destruction of GE2-positive RBC. The transfusion of 4 units of GE2-positive RBC was well tolerated, and hemoglobin increased adequately. Conclusion: This case may extend the information available not only on antibodies directed against members of the GE family of antigens but also on methods to estimate the survival of transfused RBC. Copyright 2000 S. Karger GmbH, Freiburg

Supply and need of factor VIII concentrates.

Demand for factor VIII varies greatly and exceeds supply in many places. Logical analysis of this difficult situation has been undertaken by observing actual usage, calculating potential need, and analysing factors which limit or influence production and distribution. Usage exceeds production potential in some places. It is concluded that factor VIII production/usage in the range of 20 000-60 000 IU per hemophilia A patient per year is both feasible and adequate. Production/use below 10 000 IU is not adequate. Production above 60 000 IU is not practicable using current technology.

[Fibrinolytic treatment with urokinase in older phlebothrombosis (author's transl)]. / Die fibrinolytische Terapie mit Urokinase bei älterer Phlebothrombose.

28 patients with 1 to 6 week old occlusions of the femoral and/or iliac veins as well as the subclavian veins were treated with a standardised urokinase-heparin-scheme. The fibrinolytic therapy was generally performed over a period of 7 to 14 days. In 2 patients, the 1 and 6 weeks respectively old thromboses of the iliac, femoral and tibial veins, and in 4 patients the 5 to 16 days old thromboses of the subclavian veins could be dissolved completely, 16 patients showed clinically and phlebographically a substantial amelioration. In 6 patients no marked success was found.

[Fibrinolytic treatment with urokinase of post acute phlebothromboses (author's transl)]. / Ergebnisse der fibrinolytischen Therapie mit Urokinase bei älteren Phlebothrombosen.

Standardised urokinase-heparin treatment was administered to 32 patients one to six weeks after deep-vein thrombosis. Treatment generally continued over 7-14 days. Complete recanalisation occurred in six, partial in 18 patients. In eight patients there was no evidence of thrombolysis in the phlebogram.

[Therapy of a refractory idiopathic thrombocytopenic purpura by vinblastine-loaded thrombocytes (author's transl)]. / Therapie einer refraktären idiopathisch-thrombozytopenischen Purpura mit Vinblastin-beladenen Thrombozyten.

A 15-year-old patient with ITP which was refractory to corticosteroids, splenectomy, and immunosuppressive therapy with vincristine was twice treated with platelets loaded with vinblastine. Five days after the application of the platelets vinblastine complex the platelets began to rise up to 600 X 10(9)/l. The remission has lasted until now for more than 15 weeks. The therapy showed no major side effects except for a transient granulocytopenia.

[Disturbances of the clotting mechanism in severe cerebro-cranial injuries (author's transl)]. / Gerinnungsstörungen nach schweren Schädel-Hirn-Verletzungen.

Factors II, V, X, VIII, thrombin time, platelet count and the thrombelastogram were estimated in 58 persons who had suffered cerebrocranial injuries of varying degree of severity. The aim of the investigation was to elucidate whether and to what extent the injury affected these parameters and whether the destruction of brain tissue could be regarded as the sole cause of the impairment of the clotting mechanism. First estimations in cases of cerebrocranial trauma uncomplicated by other injuries and in cases of cerebrocranial trauma complicated by moderately severe other injuries showed changes in factors II, V, X, VII as well as a pathological thrombelastogram, viz.: hypercoagulability. More pronounced changes were observed in cases where the cerebrocranial injuries were associated with severe complicating lesions: factors II, V, VII, X and the platelet count were reduced by 50-70 per cent of their normal values. Subsequent estimations carried out over a period of 15 days showed that the clotting mechanism had returned to nearly normal within 6-10 days. The use of heparin for normalizing disturbances of the clotting mechanism in cerebrocranial injuries is discussed.

[Prevention of thromboembolism with heparin in gynecological and obstetric surgery]. / Thromboembolie-Prophylaxe mit Heparin bei gynäkologischen und geburtshilflichen Operationen.

During a period of 28 months 983 gynaecological patients had major abdominal or vaginal operations under Heparin prophylaxis. In no case thrombosis or pulmonary embolism occurred. 5 hemorrhages required surgical revision and temporary reduction of Heparin dose. Global tests for preoperative diagnosis of hemostasis and for postoperative control of Heparin effect are discussed. Possible reactive fibrinolysis under Heparin administration, its complications and control are mentioned. Peri- and postoperative prophylaxis of thrombo-embolism with Heparin in daily dosages up to 20,00 I.U. seems well suitable.

Thrombolysis by ultrasound.

1. A new method of destroying thrombi in blood vessels by ultrasound and simultaneously removing them is reported. 2. Experiments were performed in twenty dogs with artificial thrombi in the iliac and femoral arteries and veins. The length of the thrombi ranged from 4 to 5 cm and the age from 12 h to 10 days. The unit used consisted of a generator, a frequency counter, an ultrasonic transducer with the hollow waveguide and a vacuum pump. For protection of the vessel wall the guide is surrounded by a plastic tube. The ultrasonic frequency is 26-5 kHz, the amplitude 25-30 micronm. The time needed to destroy the thrombus by ultrasound and suck out the thrombotic material ranged from 2-5 to 5 min. 3. To check side effects, experiments were performed in forty-four dogs. No significant changes were seen in the fibrinolytic system or microscopic structure of the vessel wall after ultrasound.

Diagnostic criteria and long term therapy of bleeding disorders in von Willebrand's disease.

PIP: 42 patients, 11 males and 31 females, were studied in the diagnostical evaluation of von Willebrand's disease. The 28 adult females suffered from uterine hemorrhagia. The parameters used in the determination of the coagulation system and platelet function are listed. The findings of prolonged bleeding time and reduced factor 8 were obligatory in confirming the diagnosis of von Willebrand's disease, supported by impared platelet adhesiveness, an abnormal capillary resistance, in severely affected patients by a prolongation of reaction and clot formation time and finally by an increase of widely spread platelets. There was evidence of reactive platelet behavior. 14 patients received prophylactic cyclic or continuous long-term therapy using an estrogen and progestin (Eugynon, Orgaluton, and Orgametril) for from 6 months to 4 years. Therapy was without improvement of hemostaseologic findings, although cyclic long-term therapy resulted in normalization of menstrual bleeding.^ieng