The rapid Bethesda assay is equivalent to the standard Bethesda assay for detection of factor IX inhibitors in patients with severe haemophilia B

INTRODUCTION

The time-dependent nature of factor VIII (FVIII) inhibitors is well described, and the standard FVIII Bethesda assay used to measure inhibitors incorporates a 2-hour incubation. Despite case reports and reviews describing the immediate-acting nature of factor IX (FIX) inhibitors, many coagulation laboratories continue to use a traditional prolonged incubation for FIX Bethesda assays. To our knowledge, a comprehensive evaluation of the FIX Bethesda assay without incubation has not been reported.

AIM

The goal of this study was to evaluate the performance of a rapid FIX Bethesda (ie no incubation) compared with the standard Bethesda assay (2-hour incubation).

METHODS

The analysis used a Bethesda assay configured for either immediate testing or a 2-hour incubation. Samples from 14 haemophilia B patients with inhibitors and 9 non-human controls were tested.

RESULTS

The two assays yielded similar performance overall. The average per cent difference in inhibitor titre between the rapid and standard FIX Bethesda assay was -3% (range -15% to +13%; P = .175) for patient samples and -2% (range -17% to +14%; P = .376) for controls.

CONCLUSION

The rapid Bethesda assay showed good agreement with the standard Bethesda assay for determination of inhibitor levels in patients with severe haemophilia B. The rapid assay allows for faster assessment of inhibitors in patients with severe haemophilia B and has the potential to improve the ability of the coagulation laboratory to perform testing from a logistical viewpoint. Further studies involving larger numbers of patients would be important to confirm our findings.

Biodiversity and dynamics of plant groups of Chebket El Melhassa region (Algeria)

This article examines phytoecological aspects of plant groups in the Chebket El Melhassa region (Tiaret-Ouest Algérien) by several types of analysis: biological, biogeographic and statistical. From the plant analysis, a list of 103 taxa distributed in 36 families was compiled, biologically characterized by a dominance of therophytes (45.6%) with species of the Mediterranean biogeographic type 20 species (19.8%) assuming particular importance. The ordination of the plant community was performed in the search for the optimum solution based on correlation with environmental factors, estimated using the phytoindication approach. The results reveal that the plants represented in the community, mostly prefer strongly lit places. Phytoindication shows a warm sub Mediterranean climate. Continentality corresponds to the sub-oceanic climate. The moisture regime ranges from strongly dry to dry soil. The plant community is formed on moderately acid soils. Plants are able to grow on both strongly acidic and neutral soils. The soil is very poor or poor in nitrogen. A four dimension variant of multidimensional scaling procedure was selected as the most appropriate decision. Dimensions selected after nonmetric multidimensional scaling were interpreted by computing weighted average scores of ecological factors for ordination configuration. Four of the plant species clusters were found to be the optimal solution on the basis of the Calinsky-Harabasz criteria. The clusters can be viewed as a functional group. Functional group A is quite diverse and represented by 42 species. This functional group is closest to the community optimum because in all four space dimensions the corresponding cluster is near the origin, which corresponds to the most typical ecological conditions. Species that constitute the group B prefer minimum values of dimension 2. This indicates a preference for illuminated sites with high temperature regime and low soil humidity. This group includes 32 species. A feature of group С is that it is located in the area of maximum values for dimension 2. Thus, this functional group is opposite to functional group B. This indicates a preference of species included in the functional group C for wetter soils. Functional group C comprises 21 species. Functional group D differs considerably from all others in its ecological characteristics. The difference is in the preference for minimum values for measurement 1. This suggests that more acid soils are optimal for a given functional group. Functional group E comprises 8 species.

ELISA system for detection of immune responses to FVIII: a study of 246 samples and correlation with the Bethesda assay

Inhibitors of FVIII are usually IgG polyclonal antibodies that develop as alloimmune responses in patients with congenital haemophilia A or as autoimmune responses resulting in acquired haemophilia. Their recognition can be difficult, especially when the titre is low. Furthermore, results from a Bethesda assay often require several days as samples are referred to a specialty laboratory. The aim of this study is to assess the utility of an ELISA system for detecting immune responses to FVIII. A total of 246 plasma samples submitted from 176 individuals with immune responses to FVIII, as verified with the Bethesda assay, and samples from 50 control subjects were tested for the presence of FVIII-specific IgG using an ELISA-based assay. Paired sera from 18 of the patients were also tested by the ELISA. Of the 246 samples that were positive for a FVIII inhibitor by the Bethesda assay, 235 (95.5%) were also positive by ELISA. The regression coefficient, using Log BU was r = 0.82. The correlation data were strengthened when 27 inhibitor samples were diluted further. There was a strong correlation between ELISA results for the 18-paired serum and plasma samples (r = 0.99). There is a strong correlation between the ELISA and Bethesda methods in detecting immune responses to FVIII. The ELISA provides rapid screening that could be available well in advance of confirmation by the Bethesda assay.

Performance and Clinical Utility of a Commercial von Willebrand Factor Collagen Binding Assay for Laboratory Diagnosis of von Willebrand Disease

Background: Von Willebrand disease (VWD) diagnosis and classification usually require a combination of nonspecific and VW-factor (VWF)-specific assays. We evaluated the analytical performance of a commercially available collagen-binding assay (CBA) and its usefulness in conjunction with other assays for laboratory diagnosis of VWD.

Methods: We used a commercial CBA ELISA (Life Technologies) to evaluate 3085 plasma samples. We used standard procedures to perform other assays, including factor VIII activity (FVIII:C), VWF antigen (VWF:Ag), ristocetin cofactor activity, VWF collagen binding capacity (VWF:CB), and VWF multimeric analysis.

Results: CBA intra- and interassay CVs were <6% and <13%, respectively. Reference intervals were 45%–198% for VWF:CB and 0.75–1.32 for the VWF:CB/Ag ratio. Of 3085 samples tested, 235 (8%) had results commonly associated with VWD. Multimer analysis and phenotypic data in 156 samples identified VWD types as: 91 (58%) type 1, 62 (40%) type 2, and 3 (2%) type 3. Of the 91 type 1 samples, proportional decreases in functional activity were seen in 75 samples (82%) according to CBA and in 63 samples (69%) according to the ristocetin cofactor assay. Of the type 2 samples, 10 were further identified as probable type 2A, 26 as probable type 2B, 12 as probable type 2M, and 14 could not be subtyped. VWF:CBA/Ag ratios <0.5 occurred in 83% of VWD type 2A and 2B samples, indicating characteristic functional discordance. Mean (SD) VWF:CB values were significantly higher in individuals without group O blood [113 (45)] than in those with group O blood [83 (32)] (t-test, P = 0.007).

Conclusions: The commercial CBA assay produces reliable results and is useful for laboratory diagnosis of VWD.

Treatment of factor XI inhibitor using recombinant activated factor VIIa

A 30-year-old female with severe factor XI deficiency of 0-2% acquired factor XI inhibitor following many infusions for fresh frozen plasma (FFP) for surgical procedures starting at 4 years of age. Seven months before this inhibitor was diagnosed, surgery was complicated by prolonged bleeding resistant to FFP, requiring epsilon aminocaproic acid (EACA) and surgical packing. The inhibitor was measured at 2.2 Bethesda units, 7 months since the last FFP. The inhibitor was confirmed as specific anti-XI and anti-XIa binding by patient's IgG to immobilized factor XI and factor XIa from whole plasma and purified IgG. For repair of a painful anterior cruciate ligament (ACL) defect she was given recombinant factor VIIa (rVIIa) at 90 mug kg(-1), starting one-half hour preoperatively and continued every 2 h for 8 h when haemostasis was complete. Thereafter the rVIIa was given every 3 h for two doses, and then every 4 h for four doses at which time she was discharged on EACA which was continued for 6 days. There was excellent haemostasis during and following the surgery. There was no evidence of consumptive coagulopathy, with no change in the fibrinogen, platelet count, or D-D dimer; and no increase of platelet factor 4, beta-thromboglobulin, or prothrombin fragment F 1.2. The thrombin-antithrombin complex increased over baseline after 24 h. There was no postoperative deep vein thrombosis or pulmonary embolus. In this patient with a factor XI inhibitor, the recombinant factor VIIa was effective and safe, ensuring adequate haemostasis with no thrombotic complications. This product which was designed for patients with inhibitors to factor VIII or factor IX, and factor VII deficiency, has now been given successfully to four patients with factor XI inhibitors.

Incorporation of labelled N-acylethanolamine (NAE) into rat brain regions in vivo and adaptive properties of saturated NAE under x-ray irradiation

Regional distribution of exogenous N-palmitoylethanolamine in the rat brain was investigated in the study. Possible protective and adaptive effect of N-stearoylethanolamine under 2 Gy whole-body X-irradiation and changes of brain lipid composition were also studied. It was found that after per os administration to rats N-([9,10-3H]-palmitoyl)-ethanolamine was primarily accumulated in hypothalamus, pituitary and adrenal glands and the label amount in brain was 0.95% of the oral dose. Quantities of palmitic acid in total brain phospholipids and plasmalogen form of phosphatidylcholine were increased; free cholesterol and diacyl form of phosphatidylcholine were decreased in 2 weeks after irradiation. 11-OH-corticosteroid level in the blood of exposed rats was decreased in comparison with control animals. N-stearoylethanolamine pre-treatment prevented from increasing the plasmalogen form of phosphatidylcholine and decreasing its diacyl form and restored 11-OH-corticosteroid level in the blood of irradiated rats. Recovering of brain free cholesterol level was observed when N-stearoylethanolamine was post-treated. So, the accumulation of N-([9,10-3H]-palmitoyl)ethanolamine in brain indicates its penetration through blood-brain barrier and suggests the possible role of saturated N-acylethanolamines in brain functioning, particularly, in stress response regulation of the organism by hypothalamus-pituitary-adrenal system. N-stearoylethanolamine treatment of irradiated rats causes protective effect concerning the of irradiation induced changes in the brain lipid composition and in 11-OH-corticosteroid level and modifies phospholipid fatty acid composition.

[Complete intestinal lavage in the complex treatment of incompetence of large intestine anastomoses]

The work gives substantiation of using complete intestinal lavage for certain indications in the complex treatment of incompetent colonic anastomoses. The method was efficiently used in 6 patients.