Identification of a novel HLA-C*02 allele, HLA-C*02:02:09

We report HLA-C*02:02:09 as a novel allele with a transition C->T at position 354.

A new HLA-C*07 variant allele, C*07:108, identified by sequence-based typing

The new HLA-C*07:108 differs from C*07:01:01 by two transversions in exon 3.

Venous anastomoses using microvascular coupler in free flap head and neck reconstruction

PURPOSE

This study is a retrospective review of the experience using the venous coupler for head and neck reconstruction over a 3-year period at the University of Maryland Medical Center, Department of Oral and Maxillofacial Surgery.

MATERIALS AND METHODS

One hundred seventy-eight consecutive cases of microvascular free flaps between May 2007 and September 2010 were retrospectively reviewed. Data were collected by demographic information, flap type, recipient vessels, method of anastomosis, coupler size, coupler orientation, complications associated with coupler, and reconstruction results. Fisher exact test was used for statistical analysis.

RESULTS

There were 294 anastomotic coupler devices used in 173 flaps, with hand-sewn venous anastomoses performed in 5 patients. The overall flap success rate was 94.9% (169/178). Success rate among cases in which the coupler was used was 95.4% (8/173). Total coupler venous thrombosis rate was 4.0% (7/173), with a statistically significant difference (P < .05) in reference to the number of venous anastomoses performed: 58 cases had a single vein anastomosed, 5 cases developed thrombosis; while the 115 flaps with 2 venous anastomoses, only 2 cases had thrombosis.

CONCLUSIONS

The microvascular coupler is reliable for venous anastomosis in free flap head and neck reconstruction; dual-vein anastomoses appear to have better results than single-vein anastomoses. Flow coupler has a promising utility in monitoring buried flaps and flaps that are difficult to observe. The microvascular coupler deserves to be more commonly used in free flap head and neck reconstruction.

Identification of a new HLA-DRB1* 14 allele, DRB1*14:99, by HLA typing of an Asian individual

We report the new HLA-DRB1*14:99 allele differing from DRB1*14:01:01 by one nucleotide in exon 2.

6th International Immunoglobulin Symposium: poster presentations

The posters presented at the 6th International Immunoglobulin Symposium covered a wide range of fields and included both basic science and clinical research. From the abstracts accepted for poster presentation, 12 abstracts were selected for oral presentations in three parallel sessions on immunodeficiencies, autoimmunity and basic research. The immunodeficiency presentations dealt with novel, rare class-switch recombination (CSR) deficiencies, attenuation of adverse events following IVIg treatment, association of immunoglobulin (Ig)G trough levels and protection against acute infection in patients with X-linked agammaglobulinaemia (XLA) and common variable immunodeficiency (CVID), and the reduction of class-switched memory B cells in patients with specific antibody deficiency (SAD). The impact of intravenous immunoglobulin on fetal alloimmune thrombocytopenia, pregnancy and postpartum-related relapses in multiple sclerosis and refractory myositis, as well as experiences with subcutaneous immunoglobulin in patients with multi-focal motor neuropathy, were the topics presented in the autoimmunity session. The interaction of dendritic cell (DC)-SIGN and alpha2,6-sialylated IgG Fc and its impact on human DCs, the enrichment of sialylated IgG in plasma-derived IgG, as wells as prion surveillance and monitoring of anti-measles titres in immunoglobulin products, were covered in the basic science session. In summary, the presentations illustrated the breadth of immunoglobulin therapy usage and highlighted the progress that is being made in diverse areas of basic and clinical research, extending our understanding of the mechanisms of immunoglobulin action and contributing to improved patient care.

Efficacy and safety of Privigen, a novel liquid intravenous immunoglobulin formulation, in adolescent and adult patients with chronic immune thrombocytopenic purpura

Intravenous immunoglobulin (IVIG) has become a mainstay of treatment for acute and chronic immune thrombocytopenic purpura (ITP). The efficacy and safety of Privigen, a new, ready-to-use, 10% liquid human IgG formulation, was evaluated in this open-label, multicentre study. Privigen infusions (1 g/kg per day for 2 consecutive days, days 1 and 2) were given to 57 adolescent and adult patients with chronic ITP and platelet counts < or =20 x 10(9)/l. By day 7, 80.7% of patients (95% CI, 69.2, 89.3) achieved platelet counts of > or =50 x 10(9)/l. Correspondingly, haemorrhage number and severity were significantly reduced. Adverse events were generally mild or moderate and typical of underlying disease and IVIG treatment. Privigen was well tolerated - 104 of 114 infusions were performed at the maximum permitted infusion rate (4 mg/kg/min). Thus, in patients with chronic ITP, a two-day regimen of Privigen was effective in increasing platelet count, reducing bleeding events and was well tolerated.

Rapid typing of the human neutrophil antigen 1a by the particle gel agglutination assay

The human neutrophil antigen 1a (HNA-1a) plays a major role in immune neutropenias and transfusion-associated lung injury. In this study, we describe a simple and rapid particle gel agglutination assay (PaGIA) for HNA-1a phenotyping. A commercially available monoclonal antibody (MoAb) to HNA-1a was biotinylated and coupled onto superparamagnetic streptavidin particles. Diluted anticoagulated whole blood samples from healthy blood donors (n = 147) were incubated with MoAb-coated particles, washed, transferred into an ID-gel card, and, subsequently, centrifuged. HNA-1a-positive samples resulted in a visible agglutination of the particles on top of the gel column and could be evaluated macroscopically. The results obtained by the new test were identical with those obtained by the polymerase chain reaction-sequence-specific priming technique that was performed in parallel. Seventy-four (50.3%) of the 147 samples were found to be HNA-1a positive. The HNA-1a PaGIA is both simple and safe and can be implemented in various laboratory settings.

Scalp cooler efficacy to reduce anthracycline-induced alopecia and its QOL impact in breast cancer

e13539

Background: Hair loss is a common, unavoidable, and stressful side effect of chemotherapy. This work was performed to evaluate the role of scalp cooling in reducing anthracycline-induced hair loss and its impact on Quality of life (QOL). Methods: The study was conducted from July 2007 to August 2008. It included 120 females with breast cancer, treated in adjuvant setting. Patients were chosen according to certain criteria (age ≤ 70 years, WHO performance status 0–1, no cardiac disease, no serious psychiatric conditions, no previous chemotherapy). Patients were divided randomly into 2 groups according to whether scalp cooler was used or not during chemotherapy. Chemotherapy consisted of doxorubicin (50 mg/m2), 5-FU (500 mg/m2) and cyclophosphamide (500 mg/m2) for 6 cycles. Paxman Scalp Cooler was used. The cap was applied 20 minutes before, during and 2 hours after infusion. Hair loss was assessed using WHO criteria at each cycle and after 6 cycles of chemotherapy. QOL was assessed using EORTC QLQ-C30 and BR23. Results: After 4 cycle, 61.7 % of patients in scalp cooling group had grade 4 hair loss compared to 81.7 % of patients in control group. After 6 cycles, 85% of patients in scalp cooling group experienced grade 4 hair loss compared to 100% of patients in the control group. Only 9 patients (15%) in the scalp cooling group developed grade 1–2 hair loss. No significant relation was found between the degree of hair loss and the liver function tests. Most patients (73.3%) were comfortable during cooling. QOL scores were comparable between the two groups except for emotional functioning and body image. In the hair loss group, 71.2% of patients showed severe disturbance of emotional functioning and 54.1% of patients had moderate disturbance in body image. In hair preservation group (9 patients), 77.8% developed moderate disturbance of emotional functioning and all patients had mild disturbance in the body image. Conclusions: The role of scalp cooling is limited at the total dose of 300 mg/m2 doxorubicin. It may be more effective with fewer cycles or less aggressive drug combination. Hair loss affects various aspects of QOL, especially emotional functioning and body image. More time is needed to assess the long term effect of hair loss on QOL and the incidence of scalp metastasis in the two study groups.

No significant financial relationships to disclose.

Bisphosphonates and osteonecrosis: potential treatment or serious complication?

They are commonly used to treat osteoporosis and other diseases that involve osteoclast-mediated bone resorption, including Paget's disease and multiple myeloma. Their use in treating osteonecrosis of the femoral head has been studied and theoretically holds promise. There are complications associated with these medications, however, including the development of osteonecrosis in the jaw.

[Autoimmune thrombocytopenia, neutropenia and hemolysis]

Autoantibodies reduce the life span of platelets, granulocytes, and red blood cells. This may result in thrombocytopenia with bleeding, in neutropenia with infection, and in anemia, respectively. Immune-hemocytopenias can manifest as primary disease without another cause, or they are associated with other underlying morbidities such as autoimmune diseases, lymphoproliferative diseases, immune defects, or viral infections. Diagnosis is confirmed by laboratory tests showing autoantibodies against the respective blood cells. Indication for treatment is the clinical manifestation of symptoms: bleeding in autoimmune thrombocytopenia, infections in neutropenia, and symptomatic anemia, respectively. Especially in case of thrombocytopenia patients should not be treated because of abnormal laboratory values, only. To date steroids are the basic treatment in autoimmune thrombocytopenia and hemolytic anemia, while prophylactic antibiotics are the main treatment in autoimmune neutropenia. Growth factors like the new thrombopoietin receptor agnonists in autoimmune thrombocytopenia or G-CSF in autoimmune neutropenia, and anti-CD20 antibodies are new options for treatment.

Influence of blood donation on levels of water-soluble vitamins

Iron depletion is a well-known side effect of blood donation. Research evidence also suggests an increasing prevalence of vitamin deficiency in apparently healthy subjects, but there is little information regarding the relationship between blood donation and vitamin status. A total of 217 volunteers (80 first-time and 137 repeat blood donors) were consecutively enrolled in the study. All subjects completed self-administered medical history and food intake forms, which included questions regarding alcohol consumption and smoking as well as on vitamin supplement, iron and contraceptive use (females). Vitamin B6, folic acid, vitamin B12 and biotin levels were measured using standard techniques. The mean vitamin levels of first-time and repeat blood donors did not significantly differ. Vitamin deficiencies occurred in both first-time and repeat blood donors but not on vitamin supplements. Vitamin status was affected by alcohol, nicotine and contraceptives. Blood donation does not decrease the level of water-soluble vitamins. Vitamin deficiencies occur in apparently healthy first-time as well as in repeat blood donors and can be prevented by vitamin supplementation.

Haplotype-specific sequencing reveals a novel HLA-B*37 allele, B*3714

We report on a novel human leukocyte antigen (HLA)-B allele, HLA-B*3714. This allele differs from HLA-B*3711 by two nucleic acid substitutions at positions 317 and 319 in exon 2, both resulting in amino acid exchanges. The first one leads to the exchange from arginine to leucine at position 82, and the latter one from glycine to arginine at position 83.