Moderate hemolytic disease of the newborn (HDN) due to anti-Rh17 produced by a black female with an e variant phenotype.

The Rh blood group antigen e is of high incidence and has many epitopes. Partial expression may occur, more commonly in black persons. Individuals with e variant phenotypes can make antibodies to epitopes they lack. While some of these antibodies may be specific for an antigen, e.g., hrB, others, like anti-Rh17 (anti-Hro), show broader specificity, compatible only with D-- and Rhnull red blood cells (RBCs). Anti-Rh17 in persons of the D-- phenotype has been reported to cause mild to fatal HDN. We report an example of anti-Rh17 produced by a black female with an e variant RBC phenotype that caused moderate HDN. A panel of seven monoclonal anti-e demonstrated her RBCs carried a variant e antigen, and her genotype was RHD, RHce by PCR-RFLP analysis. Amniotic fluid with.OD450 values from 30 to 35 weeks' gestation predicted moderate HDN probability by the Liley method. At 38+ weeks, a viable 3165 g female infant was delivered. The infant's direct antiglobulin test was 2+ with anti-IgG. Total bilirubin rose to 14.2 mg/dL within 48 hours. Indirect bilirubin peaked at 14.7 mg/dL. The bilirubin responded to triple phototherapy. The infant was discharged on day 6. Potential for infant morbidity due to anti-Rh17- mediated HDN and the importance of specifying risks to women with this antibody if they contemplate pregnancy are discussed.

Hepatocellular carcinoma embolus to the common hepatic duct with no detectable primary hepatic tumor.

Obstruction of the common bile duct (CBD) by direct extension of tumor is occasionally found in patients with hepatic neoplasms. Tumor embolus to the CBD is very rare, however, when no primary hepatic tumor is found. The patient described herein was a 74-year-old man who presented with a new onset of jaundice, nausea, anorexia, and epigastric pain. There was a history of dark urine and clay-colored stools, but no fever. Endoscopic retrograde cholangiopancreatography (ERCP) showed partial obstruction of the common hepatic duct and dilated intrahepatic bile ducts. A computed tomography (CT) scan of the upper abdomen showed no masses. Results of a mesenteric and selective hepatic arteriogram were normal. On abdominal exploration, no tumor was noted. There were no palpable stones in the gallbladder, but a firm mass was felt in the common hepatic duct. Exploration of the CBD produced light-colored debris organized into a cast of the common hepatic duct. Frozen section analysis was negative for tumor cells, but review of the permanent sections confirmed the presence of hepatocellular carcinoma. When non-calculous material is found to be obstructing the CBD, even in the absence of an obvious primary hepatic tumor, tumor embolus or metastasis from a distant site must be considered and the material sent for pathological evaluation.

Automated review of blood donor screening test patterns at a regional blood center.

Regional blood centers recently increased the number of tests used to protect transfusion recipients from infectious disease. The Food and Drug Administration has noted that computer systems for managing these data have lost donor data or failed to recognize all deferrals. Of 118,396 consecutive donations, including 4,859 records with at least one positive test result, records were analyzed to determine the number and frequency of distinct combinations of test data. A modular precedence-logic expert system assigned donor deferrals and unit dispositions. Ten combinations of data accounted for 4,334 records (89%); the remaining 525 records (11%) were distributed among 85 combinations of test data. The expert system correctly assigned all records. Regional blood centers must interpret a growing number of test results, including donations with a complicated pattern of multiple positive screening test results. The distribution of these data is described and the expert system's ability to monitor deferrals and ensure database completeness is demonstrated.

PRELOG: precedence logic inference software for blood donor deferral.

Blood collection facilities have recently witnessed a substantial increase in the complexity of tests used to detect infectious disease in donor populations, and there is a stringent regulatory effort by the Food and Drug Administration (FDA) to validate the software for managing this information. PRELOG is precedence-based inference software used to determine a donor's suitability for continued donations and whether the donation can be released for transfusion. PRELOG accepts ternary input for test results (positive, negative, or undetermined), and solves the logic rules sequentially, so that the rulebase can be validated in a concise and consistent manner.

Comparative analysis of glycopeptides derived from human platelet membrane glycoprotein Ib.

Although several purification procedures have been reported for platelet glycocalicin and macroglycopeptide, compositional data suggest that contamination with tightly associated peptide fragments is a continuing problem. This, together with the lack of a reliable estimate of molecular weights, has delayed a clear resolution of the relationship of intact platelet membrane glycoprotein Ib and these proteolytically derived glycopeptides. A new procedure was developed for purification of both macroglycopeptide and glycocalicin from human platelet plasma membranes. It consists of ion-exchange chromatography on diethylaminoethyl-Sephacel, lectin affinity chromatography on wheat germ agglutinin coupled to Sepharose, and gel filtration chromatography under denaturing conditions and avoids exposure of these sialylated glycoproteins to acidic conditions. Electrophoretic evidence for the purity of macroglycopeptide and glycocalicin prepared by this procedure was obtained by Laemmli (1970) [Laemmli, U.K. (1970) Nature (London) 227, 680-685] sodium dodecyl sulfate-polyacrylamide gel electrophoresis of samples radiolabeled by sequential sodium metaperiodate oxidation and borotritide reduction. Electrophoresis gave apparent molecular weights of 108 000 and 118 000 for macroglycopeptide and glycocalicin, respectively. However, sedimentation equilibrium centrifugation experiments using the meniscus-depletion method in 6 M guanidine hydrochloride established the weight-average molecular weights of macroglycopeptide and glycocalicin as 59 700 and 105 600, respectively. The molecular weight determinations are the first by a primary physical method for platelet macroglycopeptide and glycocalicin and, together with compositional analyses, permitted calculation of the compositions of the two glycopeptides in terms of residues per molecule, which is consistent with the derivation of macroglycopeptide from glycocalicin by proteolysis.