Detection of a new weak A blood-group allele (Aw11)

BACKGROUND AND OBJECTIVES

Weak ABO variants may escape tests using unlicensed sera.

MATERIALS AND METHODS

Prior to transfusion, ABO grouping was performed using an automated system and in-house diluted sera, and manual and bedside test techniques. Genotyping and sequencing were performed using standard methods.

RESULTS

Initially, the red blood cells (RBC) of the first-time blood donor were typed as B, but pretransfusion testing carried out using the bedside test indicated the presence of an additional A phenotype. Serological re-examination confirmed the bedside test results, and the allele in question was identified, by genotyping, as a new weak A variant (Aw11).

CONCLUSIONS

The use of CE-marked and licensed antisera is recommended to avoid ABO mistyping.

Disclosure Regulation and Accounting Education in the UK: Moving Towards Corporate Accountability 252 and Transparency

This paper was motivated by the current debate over the voluntary approach to environmental disclosures in corporate annual reports and assesses the effectiveness of the current policy of voluntarism in the UK. A brief review of the relevant theories, which explain why managers might choose to voluntarily provide environmental responsibility information to parties outside the organisation, is presented. With this background, the paper then questions whether the UK government’s faith in voluntarism and the pursuit of best practice will be enough to generate any real change in current environmental reporting practices. We argue that voluntarism is not effective and that there is an urgent need to introduce strict governmental regulations on the information that must be disclosed and the form in which it should be presented in corporate annual reports as have been established in several other countries. In addition, further consideration is needed to achieve reforms in academic accounting education in order to improve corporate accountability and transparency in corporate annual reports. Organisations need to respond to the growing demands for corporate social and environmental responsibility and this will be possible with the support of an accounting profession that takes a more proactive approach to engaging with stakeholders. For this to happen, we need to rethink the focus of accounting and business education. We must move away from the dominant model, which treats accountancy as a set of techniques, towards a more holistic approach which recognises the social and environmental impacts of organisational activity.

Osteonecrosis of the Jaw in Multiple Myeloma Patients: Clinical Features and Risk Factors

Purpose

To describe the clinical, radiologic, and pathologic features and risk factors for osteonecrosis of the jaw (ONJ) in multiple myeloma (MM) patients.

Patients and Methods

A retrospective review of 90 MM patients who had dental assessments, including 22 patients with ONJ. There were 62 men; the median age was 61 years in ONJ patients and 58 years among the rest. Prior MM therapy included thalidomide (n = 67) and stem-cell transplantation (n = 72). Bisphosphonate therapy included zoledronate (n = 34) or pamidronate (n = 17) and pamidronate followed by zoledronate (n = 33). Twenty-seven patients had recent dental extraction, including 12 patients in the ONJ group. Median time from MM diagnosis to ONJ was 8.4 years for the whole group.

Results

Patients usually presented with pain. ONJ occurred posterior to the cuspids (n = 20) mostly in the mandible. Debridement and sequestrectomy with primary closure were performed in 14 patients; of these, four patients had major infections and four patients had recurrent ONJ. Bone histology revealed necrosis and osteomyelitis. Microbiology showed actinomycetes (n = 7) and mixed bacteria (n = 9). More than a third of ONJ patients also suffered from long bone fractures (n = 4) and/or avascular necrosis of the hip (n = 4). The variables predictive of developing ONJ were dental extraction (P = .009), treatment with pamidronate/zoledronate (P = .009), longer follow-up time (P = .03), and older age at diagnosis of MM (P = .006).

Conclusion

ONJ appears to be time-dependent with higher risk after long-term use of bisphosphonates in older MM patients often after dental extractions. No satisfactory therapy is currently available. Trials addressing the benefits/risks of continuing bisphosphonate therapy are needed.

Antibodies against protein Z and fetal loss: current perspectives

Protein Z (PZ) is a vitamin K-dependent plasma protein that serves as a cofactor for the inactivation of factor Xa. A number of investigators found low PZ levels in patients with haemorrhagic as well as thromboembolic diseases, although there is no clear evidence of a pathogenic link between PZ deficiency and these clinical disorders. Nevertheless, low PZ levels have been found in association with early fetal losses, especially those occurring before the 15th week of gestation and in patients with detectable antiphospholipid and anti-PZ antibodies. The current diagnostic relevance and therapeutic consequences of these parameters will be discussed.

Human platelet antigen genotyping by using sequence-specific primers and the particle gel agglutination assay

BACKGROUND AND OBJECTIVES

Polymerase chain reaction using sequence-specific primers (PCR-SSP) is currently the most widely used technique for human platelet antigen (HPA) genotyping. Here, we describe a novel particle gel-agglutination technique for simplified visualization of the amplified products.

MATERIALS AND METHODS

Biotinylated primers were used to amplify HPA-1, -2, -3, -4, -5, -6, and -15, and the PCR products were incubated with streptavidin particles. Fluorescein isothiocyanate (FITC)-labelled primers [amplifying a fragment of the human growth hormone (HGH) gene] and anti-FITC-coated particles were used as internal controls. Agglutination of the particles in or on top of the gel indicated specific amplification. A total of 100 samples from blood donors was tested by using this new technique and a standard PCR-SSP protocol.

RESULTS

The use of biotinylated sequence-specific primers resulted in PCR products that agglutinated streptavidin particles, and the FITC-labelled HGH primers led to agglutination of anti-FITC-coated particles. Negative reactions were clearly distinguishable from positive reactions. The results of the particle gel agglutination method were in concordance with those of the electrophoretic visualization in all cases tested.

CONCLUSIONS

The new particle agglutination method is reliable and easy to use.

Tumor necrosis factor alpha enhances the adenoviral transduction of CD34+ hematopoietic progenitor cells

The purpose of this study was to improve the transduction efficiency of adenoviral vectors (Ad) in human CD34+ hematopoietic progenitor cells. CD34+ cells from cord blood or mobilized peripheral blood were incubated with tumor necrosis factor-alpha (TNF-alpha). After removal of free TNF-alpha, the cells were infected with an Ad encoding green fluorescent protein (GFP). One day later, viable cells were counted and analyzed for GFP and CD34 by flow cytometry. To visualize vectoral trafficking, CD34+ cells were incubated with fluorophore-conjugated Ad. Plating efficiencies of hematopoietic progenitors before and after transduction were evaluated by methylcellulose assays. Pretreatment with TNF-alpha increased the transduction efficiency more than twofold (39.2% versus 15.5%) in a dose-dependent manner and strongly improved the survival of GFP-positive CD34+ cells. Time course experiments showed that TNF-alpha incubation times as short as 10 minutes were still effective. Neutralizing antibodies to TNF receptor II and RGD peptides diminished the TNF-alpha-dependent increase in transduction efficiency. No TNF-alpha-dependent increase in adenoviral receptors (coxsackie-adenovirus receptor, alphavbeta3-integrin) occurred. Analysis of viral binding demonstrated a significantly higher incidence of local concentrations of Ad along the cell surface (caps) in virus-positive cells of the TNF-alpha-treated group. Plating efficiency, especially the formation of granulocyte-macrophage colony forming units, was enhanced by TNF-alpha pretreatment. We conclude that brief incubation with TNF-alpha before addition of the Ad significantly increased the Ad transduction efficiency in CD34+ cells, and improved post-transduction survival of progenitors of the granulocyte-macrophage lineage. This finding correlates with increased Ad capping at the cell surface and suggests an alteration of Ad trafficking.

Identification and characterization of a novel HLA-DRB1 allele, DRB1*0830*

Here, we report on the identification and characterization of a novel human leukocyte antigen (HLA) DRB1 allele, DRB1*0830. This allele was identified in a candidate for hematopoietic stem cell donation. While the DNA sequence of HLA-DRB1*0830 most closely matches to DRB1*080202, its amino acid sequence resembles DRB1*080202 and DRB1*0813. Due to a substitution at nucleotide position 286 HLA-typing using sequence-specific oligonucleotide hybridization or amplification using sequence-specific primers gave inconclusive results. Allele-specific DNA sequencing confirmed a 286 T-->A substitution resulting in Phe67Ile.

Immunoadsorption patients with multiple sclerosis: an open-label pilot study

BACKGROUND

Immunoadsorption (IA) is occasionally applied in patients with acute relapses of multiple sclerosis (MS). This pilot study was undertaken to determine whether IA might help in secondary progressive and relapsing-remitting multiple sclerosis.

DESIGN

IA was performed at 1-week intervals in 12 patients with secondary progressive or relapsing-remitting MS. These patients had an extended disability status scale (EDSS) score of 4.5-7 and an EDSS increase of 0.5 within 6 months before inclusion in the study despite conventional drug therapy. The change in the EDSS and that in the MS functional composite (MSFC) score, which consisted of quantitative tests of arm function, ambulation, visual acuity and cognition, served as the primary outcome variables, which were measured at baseline and at 3, 6 and 12 months. Changes in quality of life and cerebral lesions by magnetic resonance imaging (MRI) were also assessed at baseline and after the last immunoadsorption (month 3).

RESULTS

A significant reduction of the median EDSS change was observed after the treatment period, which reversed 3 months after the immunoadsorptions had been stopped. Ten of 12 patients remained stable during the first year of follow-up with no significant changes of the MSFC scores. No significant changes in magnetic resonance imaging T2-hyperintense brain lesions or in the number of gadolinium-positive lesions and in the patients' quality of life were observed. Western blot analyses demonstrated a reduction of serum myelin-specific antibodies, which were collected in the adsorber eluates.

CONCLUSIONS

Removal of immunoglobulins, including myelin-specific antibodies by immunoadsorption, seems to delay disease progression as defined by EDSS, MSFC and MRI, while the patients' quality of life did not deteriorate.

B*4440: a novel HLA-B allele identified by sequence-specific oligonucleotide hybridization and sequence-specific amplification

A novel human leukocyte antigen B (HLA-B) allele, B*4440, is described. The allele was identified in an adult stem cell donor of Caucasian origin. HLA-B*4440 most closely matches to B*4403 differing by a substitution of three nucleotides at codon 44, 45, and 50. Thus, low-resolution HLA typing using sequence-specific oligonucleotide hybridization or amplification using sequence-specific primers gave inconclusive results. DNA sequencing confirmed a variation of codons 44 and 45 (AGG AAG-->AGA GAG) and codon 50 (CCA-->CCG), resulting in an amino acid substitution Lys-->Glu at codon 45.

SERF: a new antigen in the Cromer blood group system

The Cromer blood group system consists of eight high incidence and three low incidence antigens carried on decay-accelerating factor (DAF). This report describes the identification and characterization of a new Cromer high incidence antigen, named SERF. Sequence analyses of DNA from a Thai female whose serum contained the alloantibody to a high incidence antigen in the Cromer blood group system (anti-SERF) and from her two children were performed. Reverse transcriptase-polymerase chain reaction (RT-PCR) and sequence analysis on cDNA from the proband and PCR-restriction fragment length polymorphism analysis on DNA from Thais were also performed. To map the epitope, DAF deletion mutants were tested by immunoblotting with anti-SERF. Sequence analysis revealed a substitution of 647C>T in exon 5 DAF in the proband. The proband's two children and two of 100 Thais were heterozygotes 647C/T. Analysis using DAF deletion mutants revealed the antigenic determinant to be within short consensus repeat 3 (SCR3), which is encoded by exon 5. This study describes a novel high incidence antigen (SERF) in the Cromer blood group system characterized by the amino acid proline at position 182 in SCR3 of DAF. The SERF-negative proband has a substitution mutation that predicts for leucine at this position. SERF has been provisionally assigned the International Society of Blood Transfusion number 021.012 (CROM 12).

Description of a novel HLA-B allele, B*5613, identified during HLA-typing using sequence-specific oligonucleotide hybridization and sequence-specific amplification

Here, we report on the characterization of a novel human leukocyte antigen (HLA)-B allele, B*5613. The allele was identified in an adult male from North Africa who was suffering from sickle cell anemia. HLA-B*5613 most closely matches to B*5601 differing only by a substitution of three nucleotides of codon 180. Due to this substitution, low-resolution HLA-typing using sequence-specific oligonucleotide hybridization or amplification using sequence-specific primers gave inconclusive results. DNA sequencing confirmed a variation of codon 180 (CTG-->GAC) resulting in an amino acid substitution Leu156Asp.

Therapie der tiefen Beinvenenthrombose mit Dalteparin

Ziel: Untersuchung des Laborwertverlaufes und des individuellen Wirksamkeitsnachweises bei ambulanter Therapie tiefer Beinvenenthrombosen mit Dalteparin. Patienten, Material, Methoden: Wir behandelten ambulant 10 Patienten mit einer frischen TVT täglich mit 2 × 100 IE Dalteparin (Fragmin®)/kg Körpergewicht abweichend von den Leitlinien für die Dauer von 14 Tagen durch subkutane Selbstinjektion. Ergebnisse: Die HepZeit (Anti-FXa-Aktivität) lag bei 9/10 Patienten innerhalb und bei einem Patienten unterhalb des therapeutischen Bereichs. Die D-Dimere bildeten sich unter der Antikoagulationsbehandlung vollständig zurück. Die Thrombusgröße änderte sich im Beobachtungszeitraum nicht. Schlussfolgerung: Die ambulante Therapie ist eine sichere, wirksame und ökonomisch überlegene Alternative zur stationären Therapie. Die D-Dimere erwiesen sich als aussagefähiger Verlaufsparameter.

Massive haemolysis after intramuscular diclofenac in a patient who apparently tolerated oral medication

BACKGROUND AND OBJECTIVES

Administration of diclofenac may lead to immune haemolytic anaemia (IHA) owing to the presence of drug-dependent antibodies and/or autoantibodies. A relationship with oral or intramuscular drug administration is unknown. Here, we describe a patient who apparently tolerated oral diclofenac but developed severe IHA following intramuscular injection of the drug.

PATIENTS AND METHODS

A 66-year-old-female was admitted to hospital because of jaundice and nausea, which were initially presumed to be manifestations of a postcholecystectomy syndrome. The patient soon developed haemolysis and renal failure. Although the symptoms and signs were suggestive of autoimmune haemolytic anaemia (AIHA), the patient had diclofenac-induced IHA.

RESULTS

Serological testing, including detection of drug-dependent antibodies, was performed using standard techniques. The patient's serum was found to contain a highly reactive diclofenac-dependent red cell antibody of the immune complex type (titre 256 000). She recovered after 7 weeks of treatment with prednisolone, blood transfusions, haemodialysis and plasma exchange.

CONCLUSIONS

Diclofenac-induced IHA should always be considered when a patient on diclofenac develops haemolysis.

Impact of the Gulf war on congenital heart diseases in Kuwait

BACKGROUND

There has been concern over the increase in the number of babies born with congenital heart diseases (CHD) in Kuwait after the Gulf War.

METHODS

We evaluated retrospectively the number of Kuwaiti infants who were diagnosed to have CHD within the first year of life. The comparison was made between those presented from January 1986 to December 1989 (preinvasion) and those presented after the liberation of Kuwait (from January 1992 to December 2000). The number of cases was considered per 10,000 live births in that year.

RESULTS

The numbers of cases were 2704 (326 before the invasion and 2378 after liberation). The mean annual incidence of CHD was 39.5 and 103.4 (per 10,000 live births) before and after the Gulf War, respectively (P<0.001). There was an increase in the number of babies with CHD during the immediate 3 years postliberation with a relative reduction in the trend from 1995 to 2000, in some types of CHD.

CONCLUSIONS

In our series, there was an increased incidence of CHD almost immediately following the end of the Gulf War period. The cause of this increase remains relatively obscure. Environmental pollution may be a contributing factor; others such as possible psychological trauma remain subject to speculation.

Amlodipine-induced immune thrombocytopenia

BACKGROUND AND OBJECTIVES

Drug-induced thrombocytopenia is a serious, but rare, side-effect of treatment with a number of drugs. In this report, we investigate the suspicion that amlodipine, a calcium-channel blocker, was responsible for immune thrombocytopenia in a 79-year-old patient.

PATIENT AND METHODS

Our patient experienced two attacks of thrombocytopenic purpura after 10 years of treatment with amlodipine. Antibodies to platelets were tested by standard methods.

RESULTS

Initially, the platelet count increased owing to treatment with prednisolone and intravenous immunoglobulin G, but decreased shortly after discontinuation of this treatment. The patient's serum was found to contain amlodipine-dependent antibodies to platelets, and he recovered after stopping the drug.

CONCLUSIONS

Amlodipine can induce immune thrombocytopenia, which may strongly resemble autoimmune thrombocytopenia.

Erworbene immunhämolytische Anämien

Die erworbenen Immunhämolytischen Anämien werden nach klinischen und serologischen Kriterien in Autoimmunhämolytische Anämie (AIHA) vom Wärmetyp, Kälteagglutinin-Krankheit, Paroxysmale Kältehämoglobinurie, medikamentös induzierte Immunhämolyse und Paroxysmale nächtliche Hämoglobinurie unterteilt. Bei der AIHA vom Wärmetyp reagieren die Autoantikörper auch bei Körpertemperatur (37°C). Diese Antikörper gehören vorwiegend zur IgG-, selten zur IgM- und/oder IgA-Klasse. Die Ursache der Autoimmunisierung ist bei etwa 50% der Patienten unklar (idiopathische AIHA). Bei den übrigen Patienten ist die AIHA mit einer Grunderkrankung assoziiert. Die Therapie der ersten Wahl bei dieser Erkrankung ist die Gabe von Kortikoiden, allerdings brauchen die meisten Patienten langfristig zusätzlich Azathioprin oder andere Medikamente. Die Kälteagglutinine sind die Ursache der Hämolyse bei etwa 10% der Patienten mit AIHA. Die Paroxysmale Kältehämoglobinurie (Donath-Landsteiner) ist selten und kommt fast ausschließlich bei Kindern nach Infektionen vor. Medikamente sind die Ursache der Hämolyse bei rund 10% der Patienten mit AIHA. Die genaue Inzidenz der Alloimmunhämolytischen Anämie und des Morbus haemolyticus neonatorums ist nicht bekannt. Die Paroxysmale nächtliche Hämoglobinurie ist selten. Die Erkrankung wird durch Komplementaktivierung als Folge erworbener Membrandefekte verursacht.

Immune hemolysis-serological and clinical aspects

The differential diagnosis of anemia must consider immune hemolytic anemias as a frequent cause. Whereas detection of anti-red blood cell (RBC) alloantibodies frequently induced by immunogenic stimuli (transfusion, pregnancy) is performed by routine serology, diagnosing autoimmune hemolytic anemias or drug-induced hemolytic anemias remains a challenge, usually requiring close collaboration of a number of disciplines. Positive direct antiglobulin test (Coombs' test) represents a central criterion in diagnosing immune hemolytic anemias, leading to further detailed analyses. The most-severe type of immune-mediated hemolysis is acute intravascular hemolysis after ABO incompatible RBC transfusion. This review highlights underlying biochemical aspects, immunohematological diagnostics, and the clinical relevance of RBC allo- and autoantibodies, including paroxysmal nocturnal hemoglobinemia and drug-induced hemolysis. Finally, current and partly experimental therapeutic strategies of immune hemolytic anemias are summarized.

Frequencies of alpha4 A3061G variants and identification of three new variants of the human integrin alpha4-subunit

Human integrin alpha4beta1 (VLA-4) is thought to play a key role in immune responses. Only two variants of alpha4-subunit (alpha4-tex and alpha4-mas) have been described until now, and the information regarding these variants is scanty. In this study, we measured the frequency of both variants in healthy blood donors (n=252). Surprisingly, the frequency of alpha4-mas (3061G, 0.31) was lower than that of alpha4-tex (3061A, 0.69). In addition, we sequenced and analyzed the mRNA of the entire alpha4-subunit in eight unselected healthy blood donors. These studies revealed three new variants, including a C to A transversion at position 269 in the promoter region of exon 1 (accession no. AJ504733); a G to A transversion at position 2273 in exon 16 (accession no. AJ510246, AJ510247), and a T to C exchange at position 3311 in exon 26 (accession no. AJ510248, AJ510249). None of these variants led to amino acid (AA) substitutions. Interestingly, homozygosity of the new variant 269A was not found.

The clinical significance of HLA antigens on red cells. Survival studies in HLA-sensitized individuals

To investigate the clinical significance of HLA determinants expressed on red cells (RBCs), 51Cr survival studies were carried out in six women (four healthy individuals, two patients with solid carcinoma) immunized against HLA antigens by pregnancy or blood transfusions, respectively. Donors were selected who were compatible in typical RBC antigen systems assayed by conventional techniques but were mismatched for the HLA antigens in question. Crossmatches also were performed with RBC, as well as with lymphocytes, by means of a radioimmune anti-IgG test (RIAT). We found that RBC survival was shortened in all cases. The mean life-span of RBCs depended on antigen specificity rather than on the antibody strength. HLA incompatibility of RBCs could be monitored by the RIAT in all donor/recipient pairs. We conclude that a shortened mean life-span of RBC is to be expected by HLA antibodies, especially when HLA-B7 is involved, but the severity of an in vivo immune reaction in HLA incompatible transfusions cannot be predicted from the in vitro tests used.

Comparison of two leukapheresis programs for computerized collection of blood progenitor cells on a new cell separator

BACKGROUND

Peripheral blood progenitor cells (PBPCs) can be collected on various cell separators. Two leukapheresis programs (LP-MNC and LP-PBSC-Lym) were evaluated for computerized collection of PBPCs on a new cell separator.

STUDY DESIGN AND METHODS

Leukapheresis assisted by the LP-MNC or LP-PBSC-Lym software was performed for the harvesting of PBPCs in 52 oncology patients after chemotherapy plus G-CSF treatment and in 18 healthy subjects after G-CSF mobilization alone.

RESULTS

A total of 38 components from 33 donors via LP-MNC and 43 components from 37 donors via LP-PBSC-Lym were collected with a median of one (range, one to two) standard-volume leukapheresis procedures (9.2-13.3 L) per donor. There were no significant differences between the two groups concerning median counts of WBCs, CD34+ cells, CD34+ cell yields per harvest, and CD34+ cell yields of cumulative harvests. The blood cell counts after leukapheresis revealed that the LP-MNC resulted in significantly higher platelet loss than LP-PBSC-Lym (p = 0.024): 35.9 percent (range, 19.2%-66.1%) versus 29.7 percent (11.6%-52.3%). Regarding the CD34+ cell collection efficiency, the LP-MNC program was significantly better than the LP-PBSC-Lym program (p < 0.001): 77.5 percent (range, 35.5%-98.9%) versus 58.3 percent (range, 20.4%-98.9%). However, concentrates collected by the LP-PBSC-Lym program had significantly higher percentages of MNCs (p < 0.001) and CD34+ cells (p = 0.028) than harvests with the LP-MNC program: 90 percent (range, 69%-99%) versus 70 percent (range, 35%-98%) and 1.2 percent (range, 0.2%-7.3%) versus 0.7 percent (range, 0.2%-6.0%), respectively. No leukapheresis-related serious adverse events were seen, and time for hematopoietic engraftment was equivalent to data published in the literature.

CONCLUSION

The LP-MNC program shows a significantly better CD34+ cell collection efficiency than the LP-PBSC-Lym program. However, collections with the LP-MNC program result in PBPC components with a lower MNC and CD34+ cell concentrations and a higher apheresis-related loss of patient's platelets.