Autologous blood transfusion: evaluation of an alternative strategy in reducing exposure to allogeneic blood transfusion.

The perceived risk of transfusion-transmitted disease led to the rejuvenation of autologous blood transfusion (ABT). ABT, a process in which the blood donor and recipient are the same, is increasingly becoming an integral component of the elective surgical protocol in many institutions. Various methods of ABT are being utilized. These include: preoperative blood donation, in which the patient donates blood prior to surgery and the blood is stored for an expected need during or after surgery; acute normovolemic hemodilution, in which blood is collected immediately prior to surgery and replaced with cell free fluids and then returned to the patient upon need; intraoperative blood salvage in which blood is collected from the surgical field and is reinfused after being washed and finally, postoperative blood salvage in which collected shed blood from surgical drains is reinfused to the patient. Although ABT is known to reduce the risk of allogeneic blood transfusion, it is not risk free and should be evaluated in relation to the patient's clinical picture. The combination of various methods of ABT in addition to the proper utilization of blood may consequently lead to the elimination of patients' exposure to allogeneic blood transfusion in many surgical procedures.

Survey of 1725 bone scans in patients with malignant disease with particular emphasis on carcinoma of the breast.

1725 bone scans, done for evaluation of metastatic involvement from malignant neoplasms, were reviewed. The fraction of positive scans (multiple lesions in the bone scan) was 34% of the patients with different malignancies. In 251 patients (12%) a single bone lesion was detected and 114 of these patients were followed-up and re-scanned once or twice within 1 to 4 years. 39 of the 93 patients with solitary bone lesion who on follow-up developed multiple lesions had carcinoma of the breast as the primary.

A distinct stratum corneum antigen in psoriasis and its reactions with stratum corneum autoantibodies.

Stratum corneum antibodies are ubiquitous and can be detected by various immunological methods. Of these, the ones detected by hemagglutination undergo changes in antibody titers and have been implicated in psoriasis. The purpose of our study was to examine if differences exist in the activities of the antigens isolated from psoriatic scales in comparison to normal callus. Stratum corneum antigens were prepared by trypsin-phenol-water extraction. The water phase, which contains the stratum corneum antigen, was used to sensitize the red blood cells in the hemagglutination assay. The antibody activity in human sera was determined before and after absorption with antigens isolated from callus, psoriatic scales, and cell envelopes. We found notable differences in the antigens obtained from callus and psoriatic scales. These include higher antibody titers to the antigens of the scales, the presence of unique antigenic determinants on psoriatic scales and the localization of the antigen on cell envelopes. These immunological differences were corroborated by the marked biochemical differences of certain amino acids, most notably glycine and proline, and these differences were unique to psoriatic scales as they were not shared with other hyperproliferative disorders.

Stratum corneum antibodies detected by hemagglutination are not directed against keratin intermediate filaments.

Autoantibodies to stratum corneum (SC) occur in virtually all normal adult human sera. These antibodies may be directed against various antigens of the SC. They have been detected by indirect immunofluorescence, passive hemagglutination (HA), immune adherence, and most recently by enzyme immunoassay and immunoblot methods. The purpose of our study was to examine whether antibodies to SC antigens as detected by passive HA are similar to the keratin intermediate filament (KIF) reactive antibodies. SC antigen preparation was prepared from psoriatic scales by the trypsin-phenol-water (TPW) extraction method. KIFs were prepared by 8 M urea extraction of normal callus or psoriatic scales. The anti-SC antibody titers of normal human sera were determined by passive HA before and after absorption with TPW-SC antigen preparation and upon absorption with KIFs. Similarly, titers of anti-KIF antibodies were determined on absorbed and unabsorbed sera by immunoblot assay. The results of this study indicate that the absorption of the sera with KIFs did not affect the titer of antibodies to TPW-extractable SC antigens whereas the titer of KIF antibodies dropped. KIF-reactive antibodies, on the other hand, were not affected by absorption with TPW-SC antigen, whereas the latter absorbed out the corresponding reactive antibodies. These results indicate that antibodies directed against SC antigen are different from the KIF-reactive antibodies.

Scl-70 antigen stability and its effect on antibody detection in scleroderma.

We examined 38 patients with scleroderma, 10 with systemic lupus and 10 normal subjects for Scl-70 antibodies by the gel precipitation and by the immunoblot methods. Increased incidence of Scl-70 antibodies in scleroderma were found by the immunoblot method (55%) compared to the gel precipitation methods (40 or 42% depending on the test kits used). Immunoblot analysis of the antigen prepared with 4.0 M NaCl extraction of rabbit thymus acetone powder revealed antigen to be 100, 86, 80 and 70 kDa. However, mainly a single band of 70 kDa was obtained upon extraction of rabbit thymus with 0.3 M NaCl and of calf thymus antigen. Our data support the suggestion that different molecular species of the Scl-70 antigen have variable binding affinities to nuclear DNA. We suggest that the presence of various molecular forms of the antigen may be a result of this differential binding affinity to DNA and the partial proteolytic digestion of 100 kDa from the antigen as reported by others.