[The diagnosis of Gougerot-Sjorgen syndrome in rheumatology. I. Evaul ation of the principal complementary examinations]

The examination of a patient with Sjögren's syndrome includes evaluation of the eye, the buccal cavity, and a search for certain factors in the blood. Schirmer's blotting-paper test is a good test but is not specific. In addition, a decreased amount of tearing is difficult to interpret after the age of 45. Slit-lamp examination (rose bengal and fluorescein) yields lesions which confirm keratoconjunctivitis due to decreased tearing. The buccal component is difficult to evaluate. A biopsy of the buccal mucosa gives the best results with minimum risk and expense. Nucleotide scanning is sensitive, but less specific. Salivary flow decreases with age. After 60 years of age this decrease can not be interpreted. The chemical composition of tears or of saliva is promising, but it is not yet a part of the usual diagnostic work-up. Of the available laboratory tests, anti-SS-A antibodies and/ or anti-SS-B antibodies are of value, but they are not found consistently.

[Hemolytic disease of newborn infants caused by anti-Diego antibodies]

A native Cambodian woman delivered a third full-term female baby who had a strongly positive direct antiglobulin test. During the pregnancy and after the delivery, the woman had a negative irregular antibody screening test using standard red blood cell panels, but the indirect antiglobulin test between the mother's serum and the father's red blood cells was strongly positive. The antibody could be eluted from the baby's red blood cells and its was identified as an anti-Dia (Diegoa). The child developed a mild hyperbilirubinemia and recovered without treatment.

Improvement of enzyme-linked antiglobulin test by using an antiglobulin linked to glucose oxidase: description of the technique

The classic enzyme-linked antiglobulin test (ELAT) used to detect and quantify the amount of IgG antibodies on red blood cells (RBC) is sensitive to hemolysis and erythrocyte enzymatic activities. We describe a new ELAT by using glucose oxidase (GO) linked to antihuman IgG. The optical density base line of GO-ELAT, alkaline phosphatase-ELAT and peroxidase-ELAT were, respectively, 0.180, 0.350 and 0.550. This very low baseline of GO-ELAT was due to the absence of hemolysis (the pH of the GO substrate is 6.5). This technique is ten times more sensitive than the indirect antiglobulin test and detects up to 1 ng/ml of anti-D alloantibodies. Additional advantages of the technique are (1) there is no intrinsic GO enzyme in RBC, and (2) it is not necessary to fix the RBC.

[A case of hemolytic disease in a newborn associated with anti-Wra (WRIGHT) antibodies]

A french woman delivered a third full-term male baby who had a strongly positive direct antiglobulin test. During the pregnancy and after the delivery, the woman had a negative irregular antibody screening test using standard red blood cell panels. The compatibility testing between the mother's serum and the father's red blood cells was strongly positive and the antibody was identified as an anti-Wra. The baby developed a mild hyperbilirubinemia and recovered without treatment. This child was probably responsible for his mother's immunization since the two previous children were Wra negative and the mother had no history of blood transfusion or abortion.

[Fetomaternal blood incompatibility: the situation in 1983]

56 cases of allo-immunization were collected over a period of 4 1/2 years, i.e. 4.3 per 1 000 births. The authors analyse the aetiologies of these cases of allo-immunization and the therapeutic indications for the more severe cases. They discuss the indications for plasmapheresis, in utero transfusion and premature extraction of the fetus. Five deaths were recorded from this series of 56 births.

[124 cases of hemolytic diseases in newborn infants other than ABO and Rhesus D observed in the Blood Transfusion Center of Lyon between 1970 and 1982]

Between 1970 and 1982, 124 cases of hemolytic diseases of the newborn due to antigens other than A, B and Rhesus-D were observed in the Blood Bank of Lyon (France). These cases represent 10,3% of all the hemolytic diseases of the newborn (ABO excluded). This percentage has raised during this period: 2,1% in 1970 until 39,2% in 1982. The variation is due both to the fall of the Rhesus-D hemolytic diseases and to the raise of non Rhesus-D hemolytic diseases. The alloantibody titer is not a good criteria in order to predict the anemia level of the newborn but the amniotic fluid delta OD 450 is satisfactory whatever the alloimmunisation is.

[Hemolytic disease of the newborn caused by maternal allo-immunization against erythrocyte antigens other than A, B and rhesus D]

The authors analyse numerous publications dealing with hemolytic disease of the newborn due to erythrocyte antigens other than A, B and Rhesus D. They emphasize the frequency of these diseases and the clinical presentation according to the antibody specificity. Finally, they suggest a practical management to treat these hemolytic diseases of the newborn.

Identification of canine T lymphocytes by membrane receptor to peanut agglutinin: T-lymphocyte identification in dogs with lupus-like syndrome

Canine T lymphocytes were detected, using fluorescent peanut agglutinin (PNA) as a marker. Using a fluorescent technique and cytofluorometry, 70 +/- 11% and 72.4%, respectively, of peripheral blood lymphocytes were bound to PNA. Of thymocytes, 97 +/- 4.5% were detected by fluorescent PNA, but less than 1% were detected for lymphocytes from bone marrow. The T-lymphocyte depletion and enrichment indicated that PNA was bound to lymphocytes recognized by anti-T-lymphocyte heterologous serum. A T-lymphocyte deficiency was detected among 8 dogs with a lupus-like syndrome.

[Multiple vascular thromboses in severe acute autoimmune hemolytic anemia with Mycoplasma pneumoniae serology treated by plasma exchange and immunosuppressive agents]

A 5,9 year old girl presented a severe and acute auto-immune hemolytic anemia, unresponsive to steroids, treated by 10 plasma exchanges, immunosuppressive agents and splenectomy. Despite an anticoagulant treatment, occurrence of multiple thrombosis. Unusual evolution of Mycoplasma serological tests.