Polyvalent group B streptococcal immune globulin for intravenous administration: overview.

Immunoglobulin therapy is becoming an important modality for the prevention and treatment of bacterial and viral infection. Standard intravenous immunoglobulin (IVIG) is made from large pools of plasma obtained from normal blood donors. However, lot-to-lot variation in titers of antibody to specific microbial pathogens may diminish therapeutic efficacy. Since group B Streptococcus (GBS) is an important neonatal pathogen, a preparation with high titers of activity against GBS was prepared and studied. Plasma was obtained from volunteers immunized with a polyvalent GBS vaccine and was processed by the Swiss Red Cross for intravenous infusion. This high-titered GBS intravenous immunoglobulin (GBS-IVIG) was shown to be superior both in vitro and in vivo to standard IVIG. GBS-IVIG provided protection when therapy was delayed for up to 24 hours after infection. Standard IVIG did not protect animals against all GBS strains. However, GBS-IVIG enhanced survival from infection with all strains tested, even when the challenge dose of GBS was increased by 2 log units. Specific hyperimmune globulins to pathogens such as Haemophilus influenzae and Streptococcus pneumoniae have also been studied. Immunization of adult volunteers as a means of obtaining hyperimmune globulin appears to be an effective method of producing high-titered pathogen-specific preparations of IVIG.

Intravenous immunoglobulin in the treatment of neonatal sepsis: therapeutic strategies and laboratory studies.

IGIV appears to have a promising future in treating and perhaps preventing neonatal bacterial infections. However, all IGIV lots do not contain equal amounts of pathogen-specific IgG with functional opsonic activity. To ensure effective therapy it will be important to inform physicians that the IGIV lots available for use contain functional antibacterial antibody to the responsible pathogens. To optimize therapy IGIV may need to be given early in the infection and doses may need to be repeated if pathogen-specific antibody is rapidly depleted. Further, clinical studies will be necessary to determine if IGIV will be a valuable adjunct to antibiotic therapy in neonatal GBS infections.

[Experience with the Hickman catheter in bone marrow transplantation and intensive cytostatic chemotherapy]. / Erfahrungen mit dem Hickman-Katheter bei Knochenmarkstransplantation und intensiver zytostatischer Chemotherapie.

Long-Term indwelling right atrial (Hickman) catheters were placed in 37 patients undergoing bone marrow transplantation or intensive chemotherapy for acute leukemia and other malignancies. Blood sampling, application of blood products or intravenous drugs and parenteral nutrition were impressively facilitated. Parents were easily trained for catheter care at home. The median duration of function has been 85 (2-312) days. 7 catheters had to be changed because of dislocation - especially in smaller children - or fluid leakage. In 6 severely neutropenic patients bacteremia was observed which resolved without catheter removal. The cause of death in 9 children with functioning catheter was due to the underlying disease (graft rejection, relapse). The use of Hickman-catheters improved venous access and supportive care in children with acute leukemia or other malignancies at an acceptable complication rate.

[Comparison of indirect and direct measurement of transferrin in healthy and sick children (author's transl)]. / Vergleichende Bestimmung von indirekt (totale Eisenbindungskapazität) und direkt gemessenem Transferrin bei gesunden und kranken Kindern.

In 207 children chemical measurement of total iron binding capacity (TIBC) and direct immunological evaluation of transferrin by radial immunodiffusion were compared. In addition, serum ferritin was measured in nearly all cases, to exclude iron deficiency. In 14 newborns, 20 infants and 35 older children TIBC and transferrin values correlated significantly (p < 0.001), as well as in various disorders (infections, hyporegenerative anemia, beta-thalassemia, acute blood loss) and in prelatent, latent and manifest iron deficiency. Standard deviations of both methods were comparable. Anemia and hyposideremia due to infection could be clearly distinguished from iron deficiency of all stages. The diagnosis of prelatent iron deficiency, however, can be definitely established only by measurement of serum ferritin or other more complicated procedures (59Fe2+-whole body retention test, estimation of diffuse iron in bone marrow macrophages). An interesting finding was the negative significant correlation (r = 0.69) between the two iron binding proteins in serum, transferrin and ferritin. In summary, the simple radial immunodiffusion technique for transferrin with its minimal requirement of serum can be recommended for pediatric routine laboratories in the differential diagnosis of anemia and hyposideremia, before unnecessary iron medication is institued.

[New results on hyperglobulinemic purpura of Waldenström in childhood (author's transl)]. / Neue Befunde bei der benignen Purpura hypergammaglobulinaemica Waldenström im Kindesalter.

The case of a 13 year old girl with benign purpura hypergammaglobulinemica Waldenström. Besides the characteristic clinical symptoms and the respective laboratory results new findings we demonstrated, which might shed some light into the pathogenesis of this disease. The transformation rate of lymphocytes was decreased particularly after stimulation with ConA. The T-lymphocytes which are reduced in their function are unable to sufficiently control the activity of mesenchymal cells which results in an increased production of glycosaminoglycans. The demonstration of glycosaminoglycan-inclusion-bodies in the mononuclear bone marrow cells of the patient could be explained by the above mentioned mechanism. Upon therapy with D-penicillamine the clinical state improved along with a reduction of the sedimentation rate, the serum protein and the serum gamma-globulin.