[Transfusion medicine in unified Europe. Brief report on the status of transfusion medicine in central and east European countries]. / Transfusionsmedizin im geeinten Europa. Kurzbericht über den Stand der Transfusionsmedizin in den zentralen und osteuropäischen Ländern.

Requests of the Council of Europe are harmonization of policies, encouragement of voluntary, unremunerated donation, self-sufficiency and introduction of EC quality standards. Present conditions were evaluated by a study in 11 countries of Eastern and Central Europe. Quality control is usually done according to USSR guidelines. Alarming are decreasing numbers of blood donations of 15% within 2 years. For satisfaction of FVIII needs plasma production has to be increased 3 times. In the countries of Western Europe too self-sufficiency is not yet reached. Strong efforts should be taken in Eastern, Central and also in Western Europe to reach self-sufficiency in the evolving unified Europe.

[T-helper (CD4+) cytopenia and HLA-A1, -B8, -C27, -DR3]. / T-Helfer(CD4+)-Zytopenie und HLA-A1, -B8, -Cw7, -DR3.

HLA antigen frequencies have been evaluated in a group of 99 AIDS patients who died with low T-helper cell counts. 34 patients also had HIV-associated Kaposi's sarcoma (KS). HLA-A1, Cw7, B8, DR3 has been postulated to be associated with rapid decline of T-helper cells in AIDS patients and with fast disease progression of AIDS. The results of this study support this hypothesis. However, significant elevations of these HLA antigens solely have been found in the group of patients with opportunistic infections, but not in patients with KS.

[Resuscitation necessitated by a transfusion reaction after HLA mismatched platelets substitution]. / Reanimationsbedürftige Transfusionsreaktion nach HLA-unangepasster Thrombozytensubstitution.

A severe nonhemolytic transfusion reaction occurred to a polytransfused leukemic patient as a life-threatening anaphylactic shock with cardio-pulmonary arrest following the transfusion of HLA-nonadapted/mismatched platelets. As the only potential causative agent a lymphocytotoxic antibody with the specificity anti-HLA-A2 has been found. The HLA antibody reacted up to a dilution of 1:2,048. The recipient was negative for the corresponding antigen, but HLA-2 was present on donor's platelets. This observation demonstrates again the clinical value of HLA-matched platelet transfusion in patients who need long-term support.

[Plasminogen activator inhibitor 1--a new thrombosis risk marker]. / Plasminogenaktivator-Inhibitor 1--ein neuer Thromboserisiko-Marker.

The plasma activity of plasminogen activator inhibitor 1 (PAI-1) was measured in 278 clinically healthy subjects (98 men, 180 women; mean age 26 [18-50] years). In 198 of them there were factors increasing the risk of thrombosis, such as smoking, over-weight and/or oral contraceptives. PAI-1 activity was within normal range (less than 4 U/ml) in male nonsmokers of normal weight and in female nonsmokers not taking oral contraceptives. In male smokers (5.76 +/- 1.93 U/ml) and in overweight subjects of both sexes (7.49 +/- 1.87 U/ml) PAI-1 was increased up to 10.6 U/ml as an indication of decreased fibrinolysis capacity. Nonsmoking females on oral contraceptives had lower PAI-1 levels (2.72 +/- 0.86 U/ml) than nonsmokers without hormonal intake (3.21 +/- 1.03 U/ml; P less than 0.001). Apparently the increased risk of thrombosis that occurs on oral contraceptives is not due to increased PAI-1 activity.

[Prevention of HLA-alloimmunization of recipients of platelet concentrates]. / Prophylaxe von HLA-Alloimmunisierung bei Empfängern von Plättchen-Konzentraten.

Over a period of twelve months 7163 HLA-matched, single-donor platelet concentrates were prepared for 557 thrombocytopenic patients with hematologic or neoplastic disorders. 80% of the platelet recipients remained HLA-antibody-negative. Patients who developed HLA-antibodies received random platelets and/or leukocyte-contaminated blood-components simultaneously. Thus, HLA-matching, single-donor-preparations and removal of contaminating leukocytes may prevent HLA-alloimmunisation, and therefore improve the efficacy of platelet-transfusion.

Modulation of hematopoietic colony formation of stem cells in peripheral blood by anti-TGF-beta in patients with severe immunosuppression.

The influence of transforming growth factor-beta (TGF-beta) on hematopoiesis has been evaluated by adding blocking antibodies against TGF-beta to colony forming assays (CFU-c). When optimum concentrations of recombinant growth factors, granulocyte-macrophage colony stimulating factor (GM-CSF), and interleukin-3 (IL-3) were added to stem cells from the peripheral blood of healthy individuals and certain patients with tumors or HIV infection, the anti-TGF-beta capable of blocking 5 ng/ml of active TGF-beta had no significant influence on erythroid or myeloid colony formation. However, in certain immunosuppressed individuals, anti-TGF-beta resulted in a significant decrease of erythroid colony formation and slight suppression of myeloid colony formation. The significant inhibition of hematopoiesis by plasma of HIV patients could be due to the presence of active forms of TGF-beta. The results of the blocking experiments are consistent with the concept that TGF-beta in low concentrations is essential for erythropoiesis and myelopoiesis but that higher levels of TGF-beta primarily inhibit erythropoiesis in vitro. TGF-beta serves as a coordinating factor when efficient recruitment of granulocytes and monocytes is more essential than erythropoiesis and stem cell growth.

High efficiency of a new immunological magnetic cell sorting method for T cell depletion of human bone marrow.

Fresh human bone marrow (BM) mononuclear cells containing a mean of 11% T cells underwent T cell depletion utilizing a newly developed magnetic cell sorter. In order to remove T cells, 10(8) cells were labeled with either a specific CD3 monoclonal antibody or a cocktail of monoclonal CD2 + CD5 + CD7 antibodies and biotin-conjugated magnetic microparticles (size 100-150 nm) employing a streptavidin-FITC complex. Labeled cells were removed by using columns filled with a ferromagnetic matrix and placed within a recess in a strong permanent magnet. Recovery of non-T cells was 79% after the first passage and 61% after the second. The absolute recovery of BFU-E and CFU-GM was 70% and 51% respectively (n = 11). Limiting dilution analysis revealed less than 0.1% residual clonable BM T cells (cloning efficiency greater than 50%) which corresponds to a 2.1 (1st passage) and to a 2.3 (2nd passage) log depletion. This new separating system is a highly efficient, reproducible, and quick method of depleting T cells from human BM. It could be easily adapted to process large scale marrow specimens or for the elimination of residual tumor cells from BM in autologous transplantation.

Time-dependent variation of HLA-antigen-frequencies in HIV-1-infection (1983-1988).

In a 5-year-study of HLA-phenotypes in 411 HIV-1-infected individuals, a progressive decrease of the formerly elevated frequency of HLA-DR5 has been observed. HLA-DR3 seems to have a protective effect. These results are discussed with respect to the mimicry-hypothesis of HLA and disease associations. Further preliminary results indicate that HIV-associated Kaposi's sarcoma could be associated with HLA-A28, and therefore might be a different etiologic entity than HIV-infection alone.

[Successful bone-marrow transplantation after eleven years (author's transl)]. / Nachweis einer erfolgreichen Knochenmarkstransplantation 11 Jahre nach Ubertragung.

Bone-marrow transplantation for severe aplastic anaemia was performed in a 14-year-old boy in 1969. The transplanted marrow was not HLA identical: there was HLA-D incompatibility between the female donor and the recipient. The patient had had several blood transfusions and one course of cytostatic conditioning before the transplantation. Six years later he had carcinoma of the colon which was completely removed at surgery. Ten years after transplantation, chimaerism was demonstrated in the recipient who was then haematologically and clinically healthy and in full employment. The bone-marrow transplantation can thus be considered as successful.