[Hemolytic-uremic syndrome in pneumococcal meningitis and infection. Importance of T-transformation]. / Hämolytisch-urämisches Syndrom bei Pneumokokken-meningitis und -sepsis. Bedeutung der T-Transformation.

A 4 month old girl developed a severe hemolytic uremic syndrome (HUS) following pneumococcal sepsis and meningitis. As a result of the hemolytic anemia and thrombocytopenia with associated gastrointestinal bleeding several red blood cell and thrombocyte transfusions became necessary. No plasma was transfused to the patient and all cellular blood components to be transfused were washed thoroughly in order to avoid the administration of eventually dangerous donor anti-T antibodies. Continuous peritoneal dialysis was performed for 23 days until sufficient spontaneous urine production was resumed. From the start of increased hemolysis T-transformation of the patient's red blood cells could be shown; bacterial neuraminidase was proven in the patient's serum, which could be neutralized in vitro by a commercial intravenous IgG preparation. The direct Coombs-Test was negative and no significant amounts of anti-T antibodies were detectable in the patient's serum at any stage of the disease. Our observation suggest that the T-transformation itself has caused the increased hemolysis and not an antigen-antibody (T-anti-T) reaction. In cases of HUS und proven T-transformation, intravenous IgG preparations should be tried therapeutically to inhibit the bacterial neuraminidase.

[Comparative analysis of various plasmapheresis methods--modern procedures of mechanical plasma collection compared with each other and with manual bag centrifugation procedures]. / Vergleichsanalyse verschiedener Plasmapheresemethoden--Moderne Verfahren apparativer Plasmagewinnung im Vergleich untereinander und mit dem manuellen Beutel-Zentrifugationsverfahren.

Four plasmapheresis procedures (manual blood bag centrifugation plasmapheresis, and the three plasmapheresis machines P.C.S./Haemonetics, Autopheresis-C/Baxter-Travenol, Plasmapur Monitor/Organon Teknika) were studied comparatively. The three machine procedures could be performed more easily and more rapidly and were well accepted by donors, autologous donors (patients) and staff. Compared with the traditional, well established manual procedure, a possible impairment of the plasma donors seems reduced rather than raised. Activation of the hemostatic system of the donors, measured with very sensitive methods, was found to be less pronounced when plasmapheresis was performed with the machines than when it was performed conventionally. The plasma product obtained by machine plasmapheresis was found to be of higher quality. All three systems showed less activation of the clotting system. Especially the plasma obtained by the P.C.S. showed a higher clotting factor yield. Plasma obtained by the Autopheresis-C and by the Plasmapur Monitor (both systems are equipped with filters) was markedly less contaminated with cells. The recently found low activation of the clotting system of plasma recipients, however, showed no differences when plasma obtained conventionally or by the Plasmapur Monitor was used. In summary, the new machine plasmapheresis devices offer a good alternative to the conventional blood bag centrifugation method and set new standards for the production of high quality plasma.

[Comparison of 4 procedures in plasmapheresis: studies of modifying the hemostasis potential]. / Vergleich von 4 Verfahren der Plasmapherese: Untersuchungen zur Beeinflussung des Hämostase-Potentials.

The separation of plasma using the systems "Plasmapur Monitor" (Fa. Organon), "Autopheresis-C" (Fa. Baxter) and "PCS" (Fa. Haemonetics) was compared with the conventional blood bag centrifugation. In 16 apheresis per method, several parameters with the main focus on blood coagulation were examined in addition to other criteria. Compared to conventional centrifugation of blood bags, the plasma separation machines led to an only slight activation of the coagulation system, which seems to be negligible for donors as well as recipients. Furthermore, a decrease of coagulation factors and inhibitors in the collected plasma was most pronounced using bag centrifugation. Beyond this, particularly in apheresis systems with plasma filtration the low number of remaining cells meets the aim to reach a high quality of transfused plasma.

Patients with anti-Vel--immunohematological characterization and transfusion management.

As reported by other authors we can confirm that the frequency of the blood group Vel negative in Lower Saxony is 1:4000. We report on a patient whose serological characteristics (IgM- and IgA-anti-Vel) made the transfusion of Vel positive blood impossible. Since it was not possible to obtain sufficient Vel negative red cell units in time, the patient was convinced to donate blood for autologous transfusions. This should be the procedure of first choice in the transfusion management of such patients.

Effects of chemical sympathectomy on insulin receptors and insulin action in isolated rat adipocytes.

Insulin receptors and effects of insulin on lipolysis, lipogenesis and glucose transport were investigated in fat cells obtained from rats chemically sympathectomized with 6-hydroxydopamine. Four days after a single injection of 6-hydroxydopamine (50 mg/kg), the norepinephrine content of the epididymal adipose tissue was reduced by 97.5%. The number of high-affinity insulin binding sites was increased moderately (16%). In parallel, the sensitivity to insulin of the isoprenaline-stimulated lipolysis was increased as judged from insulin concentrations yielding half-maximal inhibition which were lower (40%) in the treated group. Glucose metabolism, however, was inhibited by chemical sympathectomy: the glucose transport rate was significantly reduced and fatty acid synthesis was nearly totally abolished. Insulin was still effective in stimulating both parameters but failed to restore normal levels. The results suggest that the sympathetic innervation of adipose tissue may exert an inhibitory effect on the number of high-affinity insulin receptors as well as on the sensitivity of the lipolysis to insulin, as both parameters were increased by sympathectomy. To explain the inhibitory effect of 6-hydroxydopamine treatment on glucose transport and fatty acid synthesis, a possible trophic effect of the sympathetic innervation is discussed as well as indirect mechanism counteracting the effects of the chemical sympathectomy.