Autoimmune hemolytic anemia caused by IgG lambda-monotypic cold agglutinins of anti-Pr specificity after rubella infection.

BACKGROUND: In postinfection cold agglutinin (CA) disease, a relation between CA specificity and the underlying infectious agent has been observed. The induction of anti-I by Mycoplasma pneumoniae and that of anti-i by EBV are well-established examples. CASE REPORT: A 5-year-old boy developed severe hemolytic anemia after serologically ascertained rubella infection. Hemolysis was caused by high-titer CAs, which were analyzed by absorption and elution with sialidase-treated RBCs and hemagglutination-inhibition experiments. RESULTS: After elimination of normal anti-I and anti-T, the predominant CA was found to be an IgG lambda autoantibody with anti-Pr(1) specificity. CONCLUSION: This case seems to be of interest because it is the first report of severe CA-induced hemolysis after rubella infection, it is the first description of an IgG lambda-monotypic CA, and, along with previous case reports (three established and three suspected cases), it indicates a relationship between rubella infection and the CA specificity anti-PR:

Verification of the drug history given by potential blood donors: results of drug screening that combines hair and urine analysis.

BACKGROUND: Besides modern virus-screening methods, the avoidance of transfusion transmission of viral diseases is based on the best possible selection of healthy donors. Unfortunately, most of the relevant behavior-related risk factors are not accessible to objective verification. Drug screening can be used to validate a defined section of donor statements. It may be assumed that donors who conceal drug consumption may also conceal other relevant risk factors. STUDY DESIGN AND METHODS: Hair and urine samples from 186 young potential donors who denied having consumed drugs were investigated by gas chromatography with mass selective detection and a urine fluorescence polarization immunoassay for cannabinoids, amphetamine and amphetamine derivatives, cocaine, and opiates. RESULTS: Ten potential donors with 14 positive results on hair and urine analyses (6x cannabinoids, 4x cocaine, 1x opiates, 3x dihydrocodeine) could be identified in the population investigated. CONCLUSIONS: The donor history is not adequate for identifying potential donors with risk factors. Deliberately false statements concerning risk factors are a clear breach of trust between the blood bank and potential donors. These unreliable donors represent an incalculable risk for the transfusion recipient. Therefore, it is appropriate to validate donor statements about drug consumption by random hair and urine analyses and to exclude from the donor pool all persons revealed as drug users.

[Hepatitis after blood transfusion in inpatients. Post-transfusion hepatitis, or infection of other etiology?]. / Hepatitis nach stationärer Bluttransfusion. Posttransfusionshepatitis oder Infektion anderer Atiologie?

BACKGROUND AND OBJECTIVE: Hepatitis after a transfusion of blood products is often uncritically called post-transfusion hepatitis (PTH). It was the aim of this study to ascertain in how many reported cases of suspected PTH a causal relationship between transfusion and the infection in the recipient can be proven. PATIENTS AND METHODS: Full investigations (look-back method) were made of 23 cases of PTH reported in the 10-year period of 1987-1997 (11 cases of PTH B and 12 of PTH non-A-non-B or C). The recipients had been given a mean of 7.7 blood components (range 1-57). The clinical diagnosis had been made a mean of 5.2 (range 1-27) months after transfusion. RESULTS: One case each of hepatitis B and C had been caused by transfusion of blood products. In 5 of 12 suspected cases of PTH non-A-non-B hepatitis C, PTH could not be definitively excluded (despite absent seroconversion for anti-hepatitis C virus [HCV]), because HCV-RNA findings were not available. In 16 of 23 investigated cases serological and molecular-biological tests firmly excluded PTH B or C. CONCLUSIONS: The small number of confirmed cases of PTH indicates that hepatitis that has occurred post-transfusion is frequently due to a cause not related to the transfusion. The number of transfusion-associated cases will be further reduced with the introduction (standard since 1.4.1999) of VCH-RNA screening of donors. This will raise the importance of hepatitis cases not associated with transfusion.

[Severe neonatal alloimmune thrombocytopenia with delayed antibody detection]. / Schwere neonatale Alloimmunthrombozytopenie mit verzögertem Antikörpernachweis.

Neonatal alloimmune thrombocytopenia (NAIT) is caused by maternal immunisation against a paternal antigen on fetal platelets. The antigen involved in the majority of cases is HPA-1 a (PIA1). Usually circulating platelet alloantibodies are detectable in the mother. In this report, we present a thrombocytopenic newborn with severe hemorrhagic diathesis due to materno-fetal HPA-1 a (PIA1) incompatibility. Platelet antibodies could initially not be demonstrated in the mother's serum but became detectable after four weeks. Because of the severe and protracted course of the disease, repeated platelet substitution was necessary throughout the first two months of life.

Incidence and persistence of anti-Kell after transfusion of Kell-positive blood.

116 Kell-negative patients who had received at least one Kell-positive blood unit were tested about 3 and 12 months after transfusion. Antibody screening was performed by tube test and by gel centrifugation; both methods yielded identical results. After 3 months, anti-Kell was detected in 11 (9.5%) patients. Antibody titers using K+, k+ cells ranged from 1:1 to 1:128 with a predominance of low titers. Titers using K+, k- cells tended to be higher by one step; one anti-Kell could only be demonstrated with K+, k- cells. After about 12 months, anti-Kell could no longer be detected in 5 of the 11 patients (45.5%).

Efficient antibody screening using gel centrifugation.

In a prospective study including 6,674 sera, antibody screening was performed (1) by tube test (saline/albumin/antiglobulin), (2) by gel centrifugation (Diamed) using two tests, saline/room temperature and antiglobulin/37 degrees C, and (3) by gel centrifugation using a single test antiglobulin (IAT)/ room temperature (RT). By gel centrifugation (saline RT + IAT 37 degrees C), compared to tube test, 40% more Coombs-reactive antibodies but 60% fewer cold-reactive antibodies were detected. Similar results were obtained by gel centrifugation using a single test IAT RT instead of the two tests saline RT + IAT 37 degrees C. A case of delayed hemolytic transfusion reaction was observed caused by anti-C demonstrable only by gel centrifugation. [table: see text]

[Virus safety of fresh frozen plasma]. / Virussicherheit von gefrorenem Frischplasma.

Despite donor selection and screening procedures, the transmission of viruses by blood and blood products remains a serious problem. Fresh frozen plasma and the other blood components carry the same risk of transmitting viruses as whole blood. The virus inactivation in fresh frozen plasma appears to be feasible and would lead to a substantial improvement of virus safety of this product.

Antibodies to hepatitis B core antigen in blood donors screened for alanine aminotransferase level and hepatitis non-A, non-B in recipients.

Four-hundred and seventeen patients undergoing open-heart surgery were followed for more than 9 months after transfusion. All 2270 blood units transfused had alanine aminotransferase levels less than or equal to 30 U/l. Blood units positive for antibodies to hepatitis B core antigen (anti-HBc) were more frequently associated with recipient hepatitis non-A, non-B (HNANB) (13.7%) than anti-HBc-negative units (4.2%) (p less than 0.001). The frequency of HNANB among recipients of at least 1 anti-HBc-positive blood unit (8/79, 10.1%) was fivefold greater than among recipients of exclusively anti-HBc-negative blood units (7/338, 2.1%) (p less than 0.01). In this study the exclusion of donors positive for anti-HBc (4.2%) might have reduced the incidence of recipient HNANB by 42 percent. These results support the introduction of anti-HBc donor screening to prevent recipient HNANB.

Positive minor cross-reaction due to red blood cell T-activation in a neonate with perforated colon.

We report the case of a prematurely born, 39-day-old male infant with a history of mechanical ileus and perforated colon in which blood grouping showed group 0 Rh (D)-positive without particularities. Minor tests, however, were distinctly positive in 4 units of blood, whereas all major tests were negative. There is strong evidence that the positive minor cross-reaction was caused by in vivo RBC T-activation with subsequent donor serum anti-T agglutination.

Red blood cell T-activation and hemolysis in surgical intensive care patients with severe infections.

The exposure of Thomsen-Friedenreich (T) antigens on RBCs, serum neuraminidase, and serum hemoglobin levels were investigated in 53 adult surgical intensive care unit (ICU) patients with septicemia. Unmasked T-antigens were assayed by a hemagglutination test using peanut agglutinin (PNA) (direct anti-T test), and by an indirect anti-T test employing rabbit anti-PNA globulin. RBC T-activation was demonstrated in 17/53 patients (32%); in 2/53 patients (4%) the direct anti-T test was positive, indicating strong T-exposure. No polyagglutination phenomena were observed. Serum neuraminidase was elevated in 12/17 (71%) patients with T-activation and in 7/36 (19%) patients without T-activation. Free serum hemoglobin was elevated in 12/17 (71%) patients with T-activation and in 5/36 (14%) patients without T-activation. Correlations between T-activation and serum neuraminidase and between T-activation and serum hemoglobin were significant (p less than 0.001). Potentially neuraminidase-releasing bacteria were demonstrated in 13/17 (76%) patients with RBC T-exposure. We conclude that neuraminidase-induced RBC T-activation and subsequent hemolysis may be involved in the pathomechanism of hemolytic anemia in patients with severe infections.

Virus safety of beta-propiolactone treated plasma preparations. Clinical experiences.

Sterilization of human plasma with beta-propiolactone and UV-irradiation (cold sterilization) has been shown to be effective for a number of common pathogenic viruses. We have published data on the hepatitis safety of cold sterilized factor IX concentrates (PPSB) in healthy volunteers. This study has now been extended to include 6 virgin hemophilia B patients, who have been treated with cold sterilized PPSB for a period of up to 5 years. None of these volunteers or patients exhibited clinical symptoms or laboratory data indicating the transmission of either viral hepatitis (B or NANB) or acquired immunodeficiency syndrome (AIDS). Hyperimmunoglobulin (HIg) preparations from cold sterilized plasma, offering protection against hepatitis B and NANB are also safe regarding HTLV-III virus transmission, even though these preparations may contain HTLV-III antibody titers up to 1:1000.