Can ischemia-modified albumin be a valuable indicator of tissue ischemia in polycythemia vera?

The red cell expansion in polycythemia vera (PV) causes hyperviscosity affecting blood flow, which plays a major role in the pathogenesis of both microcirculatory disturbances and ultimately thromboses. Ischemia-modified albumin (IMA) is produced during an ischemic states and is present in blood in early and easily detectable levels. This study investigated whether IMA is a useful adjunct in the determination of ischemia in patients with PV, prior to them exhibiting clinical evidence of thrombotic complications. Blood IMA levels were determined in 20 PV patients and in 20 healthy individuals using a method described by Bar-Or. Mean IMA levels in the PV group were significantly higher than those of the control group (P<0.05). At the optimum cutoff point (0.193 absorbance units), the sensitivity and specificity of IMA were 80 and 100% to ischemia, respectively. In conclusion, IMA may be a valuable biochemical marker in predicting tissue ischemia in PV before the signs of vascular disturbances occur.

Ischemia-modified albumin reduction after coronary bypass surgery is associated with the cardioprotective efficacy of cold-blood cardioplegia enriched with N-acetylcysteine: a preliminary study.

BACKGROUND: The aims of this preliminary study were to determine the alteration of serum ischemia-modified albumin (IMA) levels and to investigate whether IMA may be used as an indicator of the cardioprotective efficacy of N-acetylcysteine (NAC) in patients undergoing coronary bypass grafting (CABG). PATIENTS AND METHODS: Forty-four patients were randomized into one of two groups on the basis of cardioplegic strategies, either cold-blood cardioplegia enriched with NAC (50 mg/kg) or cold-blood cardioplegia alone. Serum IMA, cardiac troponin T (cTnT) and malondialdehyde (MDA) levels determined in NAC-enriched patients before and after CABG were compared with those of the NAC-free group. The albumin cobalt binding assay was used for IMA determination. RESULTS: Serum IMA levels were significantly elevated after cross-clamping and peaked at 6 h after reperfusion in the two groups. In NAC-enriched patients, IMA levels determined 6, 12, 24 and 48 h after reperfusion were significantly lower than those of the NAC-free group (p < or = 0.001, p < 0.001, p < 0.001 and p < 0.001, respectively). IMA returned to baseline 24 h after reperfusion differently from cTnT and MDA in the NAC-enriched group. CONCLUSIONS: IMA may be used as not only an indicator of myocardial ischemia-reperfusion injury, but also as a useful indicator of the cardioprotective effect of NAC in CABG.

Serum anti-carbonic anhydrase I and II antibodies and idiopathic recurrent pregnancy loss.

In up to 50% of recurrent pregnancy losses (RPL), the underlying pathophysiological mechanisms remain undetermined. Immunological factors may be involved. The objective of this study was to compare serum concentrations of autoantibodies to carbonic anhydrase (CA) I and II in women with and without RPL. Serum anti-CA-I and anti-CA-II concentrations in 29 women with RPL and 39 women without RPL on menstrual cycle day 3 were assessed and compared for this prospective age-matched controlled study. The mean serum anti-CA-I (0.287 +/- 0.177 versus 0.184 +/- 0.093, P = 0.003) and anti-CA-II (0.496 +/- 0.240 versus 0.344 +/- 0.108, P = 0.001) antibody concentrations were significantly higher in women with RPL, compared with controls. For serum anti-CA-I, an absorbance higher than 0.463 was taken as positive (mean + 3 SD of controls) and was detected in four of 29 patients with RPL (13.79%, 0.287 +/- 0.177). For serum anti-CA-II, an absorbance higher than 0.668 was taken as positive (mean + 3SD of controls) and was detected in seven of 29 patients with RPL (24.14%, 0.496 +/- 0.240). All patients with positive anti-CA-I antibody also had positive anti-CA-II antibody. Antibodies specifically reactive to CA-I and CA-II were found to be present at a higher frequency in the serum of subjects with RPL.

Investigation of the possibility of using ischemia-modified albumin as a novel and early prognostic marker in cardiac arrest patients after cardiopulmonary resuscitation.

BACKGROUND: Early and accurate prediction of survival to hospital discharge following resuscitation after cardiac arrest (CA) is a major challenge. Our aim was to investigate the levels of ischemia-modified albumin (IMA) and malondialdehyde (MDA) in CA patients and whether IMA levels are valuable early marker of post-cardiopulmonary resuscitation prognosis in CA patients. METHODS: We enrolled 52 in- or out-of-hospital CA patients, with 47 healthy volunteers as the control group (CG). Blood samples were taken for IMA and MDA measurement at the beginning or within 5 min of commencement of CPR. The patients were classified according to the Glasgow Outcome Score (GOS) into a poor outcome group (POG) and a good outcome group (GOG). RESULTS: Mean IMA levels were higher in POG (0.25+/-0.07 ABSU) than in GOG (0.19+/-0.07 ABSU, p=0.002) and also than CG (0.16+/-0.04 ABSU, p=0.0001). The IMA levels were not significantly higher in GOG than in CG (p=0.32). The mean MDA levels in POG (0.77+/-0.27 nmol/ml) were comparable to the levels in GOG (0.75+/-0.18 nmol/ml, p>0.05), but were significantly higher than in CG (0.60+/-0.15 nmol/ml, p=0.001). MDA levels were not significantly higher in GOG than in CG (p=0.06). The optimum cut-off point for IMA maximizing sensitivity and specificity was 0.235 ABSU, with sensitivity of 65.8% and specificity of 78.6%. The corresponding +PV and -PV were 85.3% and 45.8%, respectively. CONCLUSION: In conclusion, though the result may not be applied clinically in every patient, the ischemia-modified albumin may be a valuable prognostic marker in cardiac arrest patients following CPR.