Unacknowledged adverse transfusion reactions: Are they a mine to dig?

OBJECTIVES: Haemovigilance has long tried to characterize and understand transfusion reactions in order to prevent them. Unacknowledged ones are now a minority but they question us. Are they the result of incomplete clinical setting and/or insufficient medical reasoning, or can they contain real new entities we have not yet understood? MATERIAL AND METHODS: Ten volunteer experts reviewed 30 recent unacknowledged cases. Their diagnostic propositions were compared with data issued from a five-year repository we have analysed in terms of statistical links between clinical signs and diagnoses. RESULTS: Experts' opinions are only quite unanimous in 60% of the cases, and the proposed diagnosis remains unacknowledged in 53%. Repository comparison shows that signs like pain or digestive symptoms are far more frequent in unknown reactions. However, it is more the absence of some other signs which drives to that conclusion, in a default diagnosis mechanism. CONCLUSION: Errors in transfusion reactions medical analysis are rare. Unacknowledged cases are more often linked to poor or unspecific clinical setting. But a particular attention must be paid with infrequent diagnoses which are far less characterised, like metabolic complications. Pain high occurrence in unknown cases also commands us to go further in the characterisation of acute pain transfusion reaction diagnosis, which is suggested by some authors.

Expanded phthalocyanine analogues: synthesis and characterization of new triazole-derived annulenes containing six heterocyclic subunits.

A series of heteroannulenes 3a-f containing four subunits of isoindole, two 1,2,4-triazole moieties, and six aza bridges have been synthesized by dimerization of the corresponding metallated, three-unit intermediates 5a-f. All these 28 pi-electron triazolephthalocyanine derivatives coordinate two metal ions within their central cavity and are the first examples of expanded heterophthalocyanines. Spectroscopic properties of these macrocycles show evidence for extended conjugation and antiaromaticity. The nature of the metal ions plays a definite role in the electronic properties of these derivatives.

Synthesis of nickel(II) triazolenaphthalocyanine and related macrocycles.

The synthesis of novel monbenzotriazolephthalocyanines (3-6), low-symmetry phthalocyanine analogues, is described for the first time using a novel and simple stepwise strategy which involves the use of substituted naphthalodinitriles 8-11 and appropriately substituted three-unit compounds such as 7. Belonging to the same family, compound 1, which we have called triazolenaphthalocyanine, has been prepared by a statistical method from compound 2 and 3,5-diamino-1,2,4-triazole. Compound 1 shows a bathochromic shift of the Q-band in UV-vis spectrum due to the fusing of benzene rings to the triazolephthalocyanine core.

Self-complementary

Three [3]catenanes with cavities large enough to accommodate aromatic guests have been designed and synthesized (yields = 5-20 %) by means of kinetically controlled self-assembly processes. The X-ray structural analysis of one of three [3]catenanes confirmed the presence of a rectangular cavity (dimensions = 7 x 11 A) lined by pi-electron-rich recognition sites and hydrogen-bond acceptor groups. In spite of their apparently ideal recognition features, none of these [3]catenanes bind guests incorporating a pi-electron-deficient bipyridinium unit. However, the template-directed syntheses of the [3]catenanes also produce, in yields of 2-23%, [2]catenanes incorporating a 1,5-dioxynaphtho[38]crown-10 interlocked with a bipyridinium-based tetracationic cyclophane. The X-ray structural analyses of two of these [2]catenanes revealed that a combination of [pi...pi] and [C-H...pi] interactions is responsible for the formation of supramolecular homodimers in the solid state. 1H NMR spectroscopic investigations of the four [2]catenanes demonstrated that supramolecular homodimers are also formed (Ka= 17-31M(-1), T= 185 K) in (CD3)2CO solutions. Dynamic 1H NMR spectroscopy revealed that the 1,5-dioxynaphtho[38]crown-10 and tetracationic cyclophane components in the four [2]catenanes and in the three [3]catenanes circumrotate (deltaGc(not equal to) = 9-14 kcal mol(-1)) through each other's cavity in (CD3)2CO. Similarly, the 1,5-dioxynaphthalene and the bipyridinium ring systems rotate (deltaGc(not equal to) =10-14 kcal mol(-1)) about their [O...O] and [N...N] axes, respectively, in solution.

A Self-Complexing

A supramolecular homodimer is formed in solution and in the solid state by a self-complementary [2]catenane incorporating a 1,5-dioxynaphthalene-based macrocyclic polyether interlocked with a bipyridinium-based tetracationic cyclophane (shown schematically). This unique example of self-recognition is the result of a combination of cooperative pi small middle dot small middle dot small middle dotpi and C-H small middle dot small middle dot small middle dotpi interactions.