Neonatal Immune Neutropenia due to Isoantibodies against the Granulocyte Receptor FcγRIIIb.

INTRODUCTION: Neonatal neutropenia is often secondary to sepsis, low birth weight, pregnancy-induced maternal hypertension, and other conditions. CASE REPORT: We report a case of asymptomatic isoimmune neutropenia in a pair of preterm twins. Genotyping confirmed that the mother was negative for HNA-1a, 1b, and 1c, consistent with an FcγRIIIb deficiency. The father was 1(a+b+c-) and the neonates were 1(a-b+c-). A strongly positive result was observed in the granulocyte immunofluorescence test against paternal neutrophils (IgG antibodies). IgG anti-CD16b isoantibodies were detected in the mother's breast milk. Neutropenia resolved after 28 days without requiring any specific treatments. DISCUSSION: Even though neonatal alloimmune neutropenia (NAN) is usually benign and self-limiting, some patients pre-sent with delayed separation of the umbilical cord, mild skin infections, omphalitis, or severe infections like pneumonia, sepsis, and meningitis. Thus, it is important to rule out NAN in case of neonatal neutropenia.

Massive intrasplenic arterial thrombosis in a patient with chronic ITP during the development of an Evans syndrome.

Long-term safety and efficacy of eltrombopag in adults with persitent/chronic primary immune thrombocytopenia (ITP) evaluated in EXTEND study, showed a high response rate (80%) but, in the clinical safety study, it was observed that 6% of the patients presented venous and arterial thrombotic events. In addition, in the course of the disease, autoimmune hemolytic anemia (Evans syndrome, ES) may occur and could increase the risk of thrombosis. We report an interesting case of splenic rupture due to massive intrasplenic arterial thrombosis in the course of ES in a patient with chronic ITP treated with eltrombopag. The purpose of this case report is to highlight the potential increase in thrombotic risk that may involve the use of eltrombopag in hemolysis situations in patients with ITP.

Host immune genetic variations influence the risk of developing acute myeloid leukaemia: results from the NuCLEAR consortium.

The purpose of this study was to conduct a two-stage case control association study including 654 acute myeloid leukaemia (AML) patients and 3477 controls ascertained through the NuCLEAR consortium to evaluate the effect of 27 immune-related single nucleotide polymorphisms (SNPs) on AML risk. In a pooled analysis of cohort studies, we found that carriers of the IL13rs1295686A/A genotype had an increased risk of AML (PCorr = 0.0144) whereas carriers of the VEGFArs25648T allele had a decreased risk of developing the disease (PCorr = 0.00086). In addition, we found an association of the IL8rs2227307 SNP with a decreased risk of developing AML that remained marginally significant after multiple testing (PCorr = 0.072). Functional experiments suggested that the effect of the IL13rs1295686 SNP on AML risk might be explained by its role in regulating IL1Ra secretion that modulates AML blast proliferation. Likewise, the protective effect of the IL8rs2227307 SNP might be mediated by TLR2-mediated immune responses that affect AML blast viability, proliferation and chemorresistance. Despite the potential interest of these results, additional functional studies are still warranted to unravel the mechanisms by which these variants modulate the risk of AML. These findings suggested that IL13, VEGFA and IL8 SNPs play a role in modulating AML risk.

Photosynthetic bacteria-based membrane bioreactor as post-treatment of an anaerobic membrane bioreactor effluent.

Anaerobic membrane bioreactors have attracted increasing interest in the field of wastewater treatment. However, significant amounts of organic matter, nitrogen and sulphide in the effluent may limit its reuse. A photosynthetic bacteria-based membrane bioreactor is proposed for the further treatment of this effluent. A pilot-scale unit was run outdoor for over 900h to assess the process performance at short hydraulic retention time. After an initial biomass development, simultaneous removal of soluble organic matter and nitrogen was achieved (65% and 39%, respectively). In addition, a significant concentration of sulphate was detected in the permeate, revealing an evident sulphide oxidation. Despite the accumulation of biopolymer clusters in the biological suspension, membrane fouling was effectively mitigated by air-aided backwashing, allowing a sustainable operation. Several strains of bacteria were identified including the photoheterotrophic bacteria Rhodopseudomonas sp. and the nitrifying and denitrifying bacteria Chryseobacterium sp.

Reclaimed wastewater quality enhancement by oxygen injection during transportation.

In-sewer treatments have been studied in sewer systems, but few have been carried out on reclaimed wastewater systems. A study of oxygen injection has been performed in a completely filled gravity pipe, 0.6 m in diameter and 62 km long, in cast iron with concrete inside coating, which is part of the reclaimed wastewater reuse scheme of Tenerife (Spain). A high pressure oxygen injection system was installed at 16.0 km from pipe inlet and a constant dosage of 30 mg/L O(2) has been injected during six months, under three different operational modes (low COD, 63 mg/L; high COD, 91 mg/L; and partially nitrified water). Oxygen has been consumed in nitrification and organic matter reduction. Generally, nitrification is clearly favored instead of the organic matter oxidation. Nitrification occurs, in general, with nitrite accumulation due to the presence of free ammonia above 1 mg/L. Denitrification is in all cases incomplete due to a limitation of easily biodegradable organic matter content, inhibiting the appearance of anaerobic conditions and sulfide generation. A notable reduction of organic matter parameters is achieved (TSS below 10 mg/L), which is significantly higher than that observed under the ordinary transport conditions without oxygen. This leads to a final cost reduction, and the oxygen injection system helps water reuse managers to maintain a final good water quality in the case of a treatment plant malfunction.

Nitrogen transformation of reclaimed wastewater in a pipeline by oxygen injection.

A study of oxygen injection was performed in a completely filled gravity pipe, which is part of the South Tenerife reclaimed wastewater reuse scheme (Spain), in order to inhibit the appearance of anaerobic conditions by a nitrification-denitrification process. The pipe was 0.6 m in diameter and 62 km long and made of cast iron with a concrete inner coating, A high-pressure oxygen injection system was installed at 16 km from the pipe inlet, where severe anaerobic conditions appear. Experiments on oxygen injection were carried out with three different concentrations (7, 15 and 30 mg l(-1) O2). In all experiments, oxygen dissolved properly after injection, and no gas escapes were detected during water transportation. Most oxygen was consumed in the nitrification process, due to the low COD/NH4-N ratio, leading to a maximum production of oxidized nitrogen compounds of 7.5 mg l(-1) NO(x)-N with the 30 mg l(-1) O2 dose. Nitrification occured with nitrite accumulation, attributed to the presence of free ammonia within the range 1.2-1.4 mg l(-). Once the oxygen had been consumed, an apparent half-order denitrification took place, with limitation of biodegradable organic matter. The anoxic conditions led to a complete inhibition of sulphide generation.

Ammonia removal in a deep reclaimed wastewater reservoir before agricultural reuse.

An experimental study has been carried out to determine the ammonia removal in a deep reclaimed wastewater reservoir of 50,000 m3. The reservoir is part of the Reuse System of Reclaimed Wastewater of South Tenerife (Spain). The study has been conducted under batch mode operation, in three different periods (winter, spring-summer and winter-spring), with an average storage time of 85 days. Vertical profiles of temperature, dissolved oxygen and pH were determined together with NH3-N, NO2-N and NO3-N concentrations at different points and different depths in the reservoir. Maximum removal efficiency was obtained during the winter periods, in absence of stratification and with good mixing conditions throughout the water column. During these periods, nitrification took place in some extension, favoring the ammonia removal. Average NH3-N concentrations in the reservoir were calculated and apparent first-order rate constants were determined for different stratification conditions. Although ammonia nitrogen could be used as nutrient in the agricultural reuse, its removal from reclaimed wastewater could be useful in order to diminish the chlorine needs for disinfection.