Identification of anti-HIV-1 antibodies in bloodstains of various ages.

The persistence of anti-HIV-1 antibodies in bloodstains has been studied by ELISA and Western Blot (WB) analysis. The immunoblot technique was found to be specific and more sensitive and the antibodies could be detected in 0.7 mg of bloodstains for up to 6 months. The authors emphasize the importance of such an investigation on non-genetic markers in individual diagnosis for forensic purposes.

Prompt plasma-exchange treatment and coma reversibility in two patients with thrombotic thrombocytopenic purpura.

We report on the cases of two women with acute thrombotic thrombocytopenic purpura (TTP) whose clinical courses were characterized by the onset of a coma state. Prompt commencement of plasma-exchange (PE) treatment led to complete hematological and neurological remission, which can still be observed without any maintenance therapy. No CNS abnormalities were observed in either patient using brain CT and NMR scans.

Ticlopidine in the treatment of thrombotic thrombocytopenic purpura: report of two cases.

The observation of two clinical cases make possible an evaluation of the potential therapeutic activity of platelet function inhibitors in thrombotic thrombocytopenic purpura (TTP). In particular, the clinical and hematological effects of ticlopidine (TC), employed alone in two TTP patients, are reported. The mechanism of action of this peculiar antiplatelet drug is mainly represented by the inhibition of fibrinogen binding on the platelet surface. In the first patient, a 45-year-old female in whom plasma-exchange (PE) and corticosteroids (C) led to a partial remission (platelets 80 x 10(9)/l), treatment with TC at a dose of 750 mg/day was carried out, and after 6 weeks a normal platelet count was observed. A complete remission was maintained for 31+ months, even after reduction of the TC dose to 250 mg/day. In the second patient, an 18-year-old female affected by relapsing TTP, a complete remission obtained with PE and C was maintained for 19 months in concomitance with TC treatment, started at a dose of 750 mg/day and lowered to 250 mg/day. After 11 months of treatment at this low dosage there was a relapse (platelets 20 x 10(9)/l), but the increase of the TC dose to 750 mg/day in a few weeks induced a complete remission again. These data, in accord with a few other recent preliminary reports, suggest that TC, even alone, may play an interesting role in the management of TTP patients.

Human immunodeficiency virus testing in acute leukemia patients transfused between 1978 and 1985: a retrospective study on 91 cases.

Human immunodeficiency virus (HIV-1) can be transmitted by blood transfusions. A recent report focused on the relativey high risk of HIV-1 infection in American patients treated for leukemia and multiply transfused as a consequence of therapy. We therefore conducted a retrospective study on the presence of HIV-1 antibodies among 91 acute leukemia patients diagnosed between 1978 and 1985, before the onset of routine tests for HIV-1 contamination of blood products. The transfusion requirement (platelet units, red blood cell concentrates) involved almost 7,000 donors. We did not find any case of seropositivity in patients transfused with units from the donor pool. The only case of HIV-1 seropositivity was due to a bone marrow transplant donor, retrospectively found to be HIV-1 seropositive. These results differ from the American data previously cited. This is probably due both to differences in diffusion of the HIV-1 infection in the two countries and to differences in the selection of the two donor populations. We conclude that the risk of contracting HIV-1 infections before 1985 through multiple transfusions from registered donors in our Italian area was very low, if not absent, not only for leukemia patients but reasonably for other categories of heavily transfused groups.

Analysis of natural killer cells in patients with idiopathic autoimmune hemolytic anemia.

A functional and phenotypic analysis of the circulating natural killer (NK) cell population was carried out in 9 patients with idiopathic autoimmune hemolytic anemia (IAHA). The NK-cell activity, assessed by a sensitive method based on the inhibition of target clone growth in plasma semisolid medium, was markedly decreased in all patients as compared with normal controls and was not restored by stimulation of the cells with recombinant alpha interferon (alpha-IFN). Analysis of peripheral blood phenotypic markers showed that cells bearing Leu7 and CD16 antigens numbered in the normal range. These findings suggest that IAHA patients exhibit a functional impairment of the NK compartment.

Intravascular intrauterine transfusion for severe erythroblastosis fetalis using different techniques.

Over a 3-year period, 44 ultrasound-guided intravascular transfusions were performed between 18 and 32 weeks on 15 patients with severe erythroblastosis fetalis due to Rh immunization. In 4 fetuses, the first transfusion was performed before 20 weeks, in 6 between 20 and 25 weeks and in the remaining 5 between 25 and 31 weeks. Eight of the 15 fetuses were hydropic at the time of referral. Five transfusions were done in the intrahepatic umbilical vein, 6 were simple transfusions via percutaneous umbilical cord puncture, and 33 were partial exchange. There were 4 intrauterine deaths before 26 weeks, despite successfully performed transfusions: 3 of these fetuses were severely hydropic, while in the remaining fetus hydrops had been reversed in utero. Following delivery by cesarean section at 32 weeks of gestation, 1 of the neonates developed respiratory distress syndrome and died 17 h after birth. The overall survival rate was 67% (10 of 15 cases): 4 of the 8 hydropic fetuses (50%) and 6 of the 7 nonhydropic fetuses (83%) were alive at birth and survived the perinatal period. Three of the 5 losses occurred among the first 4 cases, while in the last 11 cases the survival rate increased to 82% (9 of 11).

Serological screening for the prevention of transfusion-acquired cytomegalovirus infection.

The presence of antibodies against cytomegalovirus (CMV)-induced immediate-early antigens (IEA), early antigens (EA) and late antigens (LA) was sought in 500 healthy blood donors. Antibodies to late antigens were detected in 76% and antibodies to immediate-early and early antigens were detected in 9.6% and 10.2%, respectively. The incidence of antibodies to CMV-induced immediate-early and early antigens increased with age, was higher in females than in males and was related to high values for antibodies against CMV late antigens. Since antibodies to CMV immediate-early and early antigens are significantly associated with active CMV infection, criteria for choosing blood samples unlikely to transmit infective CMV are evaluated.

The rationale for plasmapheresis in renal graft rejection.

The present study reports on 15 transplanted patients with acute vascular rejection unresponsive to high-dose steroids, who underwent plasmapheresis treatment. Cyclophosphamide was combined with plasmapheresis in 11 patients in whom specific anti-HLA antibodies against the donor's mismatched antigens were detected. The treatment proved effective in removing the antibodies from circulation and in improving the graft function. Nine of these patients have a well-functioning graft 3 to 24 months after treatment. Plasmapheresis failed to reverse rejection in two out of the four patients where anti-HLA antibodies were not found, while the remainder have a satisfactory renal function after 18 and 32 months respectively. We conclude that in transplanted patients plasmapheresis associated with an appropriate immunosuppressive therapy may be of value in the treatment of acute vascular rejection that is unresponsive to high-dose steroids, particularly when specific anti-HLA antibodies are detected.

Short-term plasmapheresis in acute lupus nephritis.

This study reports 11 cases with acute lupus nephritis who underwent short-term plasmapheresis treatment combined with immunosuppressive therapy. 68 plasma exchanges (mean/patients: 6.2) were performed by either centrifuge or membrane filter, exchanging 80% of total plasma volume per session. A rapid improvement of clinical symptoms was observed in all cases treated. 5 patients with renal insufficiency at the beginning of treatment, showed a reduction in serum creatinine and proteinuria after plasmapheresis. Immunological investigations demonstrated a rapid decreasing of circulating immune complexes and anti-DNA antibodies and an improvement of lymphocyte function, studied by E rosettes and Con A induced suppressor activity.

Plasma exchange in renal allograft rejection.

Circulating anti-HLA antibodies against mismatched donor antigen have been found in 7 patients during acute rejection episodes, where renal biopsy showed severe vascular lesions. 4 patients were submitted to combined therapy with plasmapheresis and cyclophosphamide, while the other 3 were treated by cyclophosphamide alone. In the 4 patients treated plasmapheresis induced a rapid disappearance of circulating cytotoxic antibodies, which remained negative in 3 cases where cyclophosphamide was continued after plasmapheresis. No change in antibody occurred in the three cases treated by cyclophosphamide alone. Renal function showed an improvement in 3 of the 4 patients treated by plasma exchange; all patients on drug therapy alone showed a rapid and progressive impairment of renal function and returned to RDT within 2 months.