Noninfectious complications of blood transfusion.

The noninfectious complications of blood transfusion consist of a diverse group of immune-mediated transfusion reactions that range from immediate life-threatening to subclinical reactions. Each reaction involves the recognition and interaction of the both the humoral and cellular immune systems. In the past, many of the noninfectious complications of transfusion were attributed solely to antigen-antibody interactions. Today, an emerging body of evidence suggests that cytokines and cytokine inhibitors play a central role in the pathophysiology of immune-mediated transfusion reactions and account for the broad diversity of clinical presentations.

Some ascites monoclonal antibody preparations contain contaminants that bind to selected Golgi zones or mast cells.

A small proportion of mouse ascites fluid induced by hybridomas producing monoclonal antibodies or myelomas secreting immunoglobulin yielded staining that was confined to the Golgi zone of certain epithelial cell types in rats and gerbils but not in mice. In addition, a commercial IgG fraction from mouse plasma similarly labeled the Golgi area, unlike IgG from mouse serum from another source. Culture supernatant from one hybridoma line contrasted with ascites fluid produced by the same hybridoma in failing to stain the Golgi region. The capacity of a fluid to react with the Golgi cisternae bore no relationship to the class of immunoglobulin secreted by the hybridoma or myeloma. Absorption of an ascites fluid with blood group A1 human erythrocytes eliminated its affinity for Golgi cisternae. Adsorption with blood group A2 or B or two type O cells used for screening for blood group antibodies had no effect on Golgi zone labeling by this ascites fluid. The positive cells included most serous secretory cells in rats, serous cells of sublingual and tracheal glands, and some endometrial and oviduct-lining cells in gerbils, and columnar lining cells of small intestine and cecum and all or part of the lining cells in some prostate lobes in both genera. Some of the tested ascites fluids stained mast cells. The agent accounting for mast cell labeling differed, however, from that reacting with Golgi cisternae in its distribution among the mouse ascites fluids examined, lack of relationship to the ABO blood group system, occurrence additionally in normal rat serum, and capacity to stain cells in mice as well as rats and gerbils.

Postfiltration factor VIII and fibrinogen levels in cryoprecipitate stored at room temperature and at 1 to 6 degrees C.

The 13th edition of the standards of the American Association of Blood Banks specified storage at 1 to 6 degrees C for cryoprecipitated anti-hemophilic factor (Cryo) administered up to 6 hours after thawing if the Cryo is used for factor VIII (FVIII) content (Standard J4.210). Previous editions specified room-temperature (RT) storage for up to 6 hours. Currently, the temperature specification has been deleted. There are few data addressing the optimal storage temperature and maximum storage time for FVIII and fibrinogen in thawed Cryo. Thirty bags of Cryo were assayed for FVIII and fibrinogen. Each bag was divided into two aliquots; one was stored at RT and the other at 1 to 6 degrees C. Assays were performed immediately after thawing (Base) and 6 and 24 hours after thawing, respectively. All samples were filtered through 200-mu blood component infusion sets before assay. Three hundred analyses were performed, 150 each for FVIII and fibrinogen by conventional clotting technique. Data were analyzed by using a paired t test. Cryo stored at 1 to 6 degrees C for 6 and 24 hours showed an FVIII loss of 35 percent (p less than 0.0001) and 63 percent (p less than 0.0001), respectively. Cryo stored at RT for 6 and 24 hours had an FVIII loss of 8 percent (p greater than 0.05) and 20 percent (p less than 0.0001). Cryo stored at 1 to 6 degrees C for 6 and 24 hours had a fibrinogen loss of 20 percent (p less than 0.0001) and 43 percent (p less than 0.0001). Cryo stored at RT for 6 hours had no fibrinogen loss and a 2 percent loss at 24 hours (p greater than 0.05). These preliminary data show a significant loss of FVIII and fibrinogen activity in Cryo stored at 1 to 6 degrees C and filtered before assay. The FVIII and fibrinogen activity at RT is clearly maintained up to 6 hours after thawing.

Techniques for lumbar discography and computed tomography/discography in clinical practice.

The technique for lumbar discography is not well standardized. To better understand lumbar pathology, we have developed a consistent, reproducible, and relatively simple procedure for lumbar discography. We describe our technique and discuss variables that may differ among individual lumbar discography procedures.

Dallas discogram description. A new classification of CT/discography in low-back disorders.

A new classification method for CT/discography was developed. The Dallas discogram description (DDD) related five separate categories of information. Degeneration and annular disruption were regarded as separate phenomena. Additionally, provoked pain response, contrast volume, and miscellaneous information were recorded. Discogram findings of 59 patients with low-back and/or leg pain were graded according to the new method and compared with standard methods using routine anteroposterior and lateral discographic images. Findings from routine discography and CT/discography were graded and correlated with myelographic and plain computerized axial tomography (CAT) scans. This study demonstrated that the contrast-enhanced axial view provided by CT/discography served as a useful projection for demonstrating disc pathology. CT/discography analyzed according to DDD offered a more sensitive discriminator of disc degeneration from annular disruption (disc protrusion/leaking). This evaluation can be recommended as the procedure of choice when revision of spine surgery is considered or when there is an equivocal or negative correlation between clinical information and myelography or CAT scan.

The relationship of pain provocation to lumbar disc deterioration as seen by CT/discography.

The CT/discographic findings from 225 discs in 91 low-back pain patients were compared to the pain provocation during the injection of contrast into the disc. The radiographic appearance of disc deterioration demonstrating disc degeneration and annular disruption of each disc was classified separately using a fourpoint scale: normal, slight, moderate, or severe. Pain reaction to the discogram at each level was recorded as follows: no pain, dissimilar pain, similar pain, or exact reproduction of the patient's clinical pain. This more precise analysis demonstrated a significant relationship between pain and deterioration of discs. The CT/discogram presents an axial view of the disc that allows a subgrouping of disc deterioration that can discriminate between peripheral deterioration (degeneration) and internal deterioration (disruption). The disruption supposedly occurs earlier and is more likely to be the source of exact pain reproduction.

Hemolytic disease of the newborn due to anti-Jsb.

A case of hemolytic disease of the newborn due to anti-Jsb is described. The immunohematologic status of the mother and her offspring is presented.