Opinions on treatment of women with habitual abortion based on investigations for blocking antibody and autoantibodies.

Three hundred and thirty-seven women with habitual abortion of unknown etiology were studied for cellular reactivity and blocking antibody in one-way mixed lymphocyte culture. Their sera were investigated for anti-cardiolipin antibodies, antinuclear antibodies, and antibodies against DNA, and the activated partial thromboplastin time (APTT) and complement levels of their plasma were determined. Increased anti-cardiolipin antibody levels were demonstrated in 77 (22%) of the 337 women, all of whom were considered healthy and had no signs of autoimmune disease. Most patients with high anti-cardiolipin antibody levels displayed lowered values of complement factor C4. According to our experiences, the mere occurrence of anti-cardiolipin antibody in women with habitual abortion is no absolute cause for treatment with prednisolone, not even in cases with greatly elevated anti-cardiolipin values. Therapy with prednisolone and acethylsalicylic acid (ASA) during pregnancy should be given to those women who have high levels of anti-cardiolipin antibodies concomitant with high APTT values, low values of complement C4, and strong blocking antibody. Anti-cardiolipin antibody has been investigated during pregnancy in 136 normal pregnant women, 11 of whom (8%) were positive at any sampling occasion, but only one of whom (1%) had high levels. Evidently the development of anti-cardiolipin antibody is no normal feature of pregnancy among Swedish women and thus the high frequency found among healthy Swedish women with habitual abortion remains unexplained. We have introduced an immunization program of leukocyte transfusions in habitual abortion. The development of previously absent blocking antibody seems to be a valuable prognostic sign of possible success for immunization therapy against habitual abortion.

The results of investigations for blocking antibody and autoantibodies help to choose between different immunological treatments for recurrent abortion.

Immunologic investigations were performed on 337 healthy women with unexplained habitual abortion. Their sera were investigated for antinuclear antibodies (ANA), antibodies against DNA, and anti-cardiolipin antibodies, and the activated partial thromboplastin time (APTT) and complement levels of their plasma were determined. Cellular reactivity and blocking antibody were studied in one-way mixed lymphocyte culture (MLC). None of the women had any signs of autoimmune disease. However, in 77 of the 337 women (22%) increased anti-cardiolipin antibody levels were found, in 19 (7%) above 10 units. Most patients with high anti-cardiolipin antibody levels had lowered values of complement factor C4. We consider the mere occurrence of anti-cardiolipin antibody in women with habitual abortion to be no absolute cause for treatment with prednisolone, and this is true even in cases with very elevated anti-cardiolipin values. Treatment with prednisolone and acetylsalicylic acid (ASA) during pregnancy should be given to only those women who have high levels of anti-cardiolipin antibodies concomitant with high APTT values, and low values of complement C4. Anti-cardiolipin antibody was also investigated during pregnancy in 136 normal pregnant women. Eleven of them (8%) were positive at any of four sampling occasions, but only one (1%) had high levels. These data differ significantly from those of the habitual aborters. Thus the development of anti-cardiolipin antibody is no normal feature of pregnancy in Swedish women and so the high frequency found among healthy Swedish women with habitual abortion remains unexplained. We have introduced an immunization programme of third party leukocyte transfusions in habitual abortion.(ABSTRACT TRUNCATED AT 250 WORDS)

Iron absorption during iron supplementation in blood donors.

The total amount of iron absorbed from a total supplementation of 2000 mg of iron was studied after a blood donation. 10 regular blood donors and 10 subjects without previous blood loss were included in the study. No subject had received any iron treatment before the investigation. Both groups were given one sustained release tablet containing 100 mg of iron as Fe SO4 once daily for 20 days. The iron in these tablets was labelled with 59Fe. The total amount of iron absorbed from the tablets was measured by a whole body counting technique. Laboratory tests including haematological data, desferrioxamine tests and sternal marrow punctures were made before and after the iron treatment. The non-donors lost a mean amount of 215 mg iron by phlebotomy and the total iron absorption from the tablets was only 94 mg (4.7%). In the regular blood donors the corresponding iron loss was 276 mg and the absorption was 280 mg (14%). The iron supplementation given in this study covered the iron losses in the regular blood donors but not in the non-donors. This iron prophylaxis will present a depletion but not a reduction of the iron stores in blood donors with high donation frequency.