Histoblood groups other than HLA in organ transplantation.

Immunological matching of a living related donor and recipient of an allograft is precise, but for cadaver organs matching is controversial, including at least detection of specific sensitization in the recipient against the donor, especially for HLA-DR. With the publication of some cases of ABO histoblood group incompatible transplantations with favorable outcomes, transplantation immunologists now focus on many of the 29 International Society of Blood Transfusion-approved histoblood group systems. So far, research lags behind knowledge about which system occurs in which organ, but modern molecular biology tests, like basic local alignment search tools (BLAST) and the recent inclusion of some systems into the CD classification, make possible the tracking of some histoblood group epitopes to specific tissue components. We have conducted such a search. With respect to tissue distribution, mRNA transcripts, and expressed sequence tags (EST), we observed a huge variety of distribution patterns. The total number of EST in the embryo pool was 752,991 and in the adult pool 1,227,835. Representative results were described for umbilical cord, bone marrow, peripheral stem cells, the nervous system, and the embryo. The ABO histoblood group systems maintain high priority for matching, because of the occurrence of naturally occurring anti-A/B antibodies. Substantial progress has been made in monitoring their levels and immunoglobulin isotypes in recipients, which, beyond hemagglutination, can now be quantitated using ELISA or cytofluorometry. A picture of ever-improving compatibility matching in solid organ and stem cell transplantation beyond mere HLA typing is the consequence.

Cost-effectiveness of solvent/detergent-treated fresh-frozen plasma.

BACKGROUND AND OBJECTIVES: Although transfusion-transmitted infections are rare, non-infectious complications occur relatively frequently. Solvent/detergent-treated fresh-frozen plasma (SD-FFP) has been shown to reduce the frequency of both types of complication, although previous economic evaluations failed to consider non-infective events and subsequently underestimated the benefits of SD-FFP. MATERIALS AND METHODS: A time-series analytical model was used to estimate the incremental cost/life year saved for SD-FFP compared with untreated FFP, having controlled for post-transfusion mortality and patient age. Various infective and non-infective transfusion-related complications were considered. RESULTS: The discounted cost/life year saved for SD-FFP use in the UK was pound sterling 22,728 [95% confidence interval (95% CI): pound sterling 22,604-22,853] for neonates and pound sterling 98,465 (95% CI: pound sterling 97,924-99,005) for patients aged 70. The cost-effectiveness ratio was below pound sterling 50,000/life year saved for patients < or = 48 years of age, and below pound sterling 30,000/life year saved for those < or = 21 years of age. In transfusion recipients with no significant morbidity, the cost-effectiveness ratio was pound sterling 12,335 for neonates and pound sterling 61,692 for 70-year olds. The most important driver of cost-effectiveness was transfusion-related acute lung injury (TRALI), on account of its relatively high incidence and mortality rate. CONCLUSIONS: Previous analyses greatly underestimated the cost-effectiveness of SD-FFP. Inclusion of non-infectious complications suggests that SD-FFP is cost-effective in patients < or = 48 years of age and in older patients with good clinical prognosis, which may justify the wider use of this technology.

[Type and Screen: immunohematological safety is ensured and costs are lowered]. / "Type and screen": die immunhämatologische Sicherheit ist gewährleistet und die Kosten werden gesenkt.

UNLABELLED: TYPE AND SCREEN: (T + S) means: no routine cross match before transfusion. ABO- and Rh-(Blgr) blood groups (type) are done and irregular allo-antibodies are sought (screen). If screen is negative, instant saline test (IST) or Blgr control, and if screen is positive, conventional cross match is done. GOALS: Are all clinically relevant antibodies discovered with T + S? Are laboratory costs lower? METHODS AND STUDY DESIGN: Prospective study over more than 3 years. Blgr and cross match were done in tubes and AB screen and antibody identification (panel) were sought using the gel-test (DiaMed) with bromelin (enz) and LISS antiglobulin test (IAT). Underlying all testing were the directives of the Swiss blood donation services. RESULTS: Enzyme-only positive antibodies are not relevant for blood transfusion, as shown by our data from more than 10000 comparisons of enz- and IAT-screens. 32 patients with positive enz-antibodies and negative cross match were transfused without problems. The enz-screen was abandoned for more than 12 months' follow-up in more than 20000 transfused patients. Before using the T + S, one unit of transfused RBC needed (on average) 3.7 cross matches, and after introduction of T + S only 0.3. Although the number of T + S increased significantly, we effectively saved some CHF 280000 per year.

[Gynecologic interventions in von Willebrand-Jürgens syndrome (2 case reports)]. / Gynäkologische Eingriffe bei von-Willebrand-Jürgens-Syndrom (2 Fallberichte).

Gynecological procedures were performed in two patients with von Willebrand-Jürgens Syndrome. Although both patients were known to have the disorder and appropriate measures were taken, severe bleeding complications occurred in both cases, in the one shortly postoperatively and in the other after discharge from hospital. Based on our experience and a review of the literature, we recommend the following therapeutic concept: preoperative increase of vWF to over 50% and normalization of bleeding time by administration of FFP and AHF, postoperative substitution with 2-3 units FFP and 1-2 units AHF daily through the 15th day postsurgery.

[Hodgkin's disease in a Swiss family]. / Morbus Hodgkin in einer Schweizer Familie.

Hodgkin's disease was found in five members of the same generation in a large Swiss family. At presentation, the patients were between 20 and 30 years old. The histological diagnosis was confirmed in three patients. In one woman the differential diagnosis of histiocytic non-Hodgkin's lymphoma was considered. The patient history did not provide any conclusive evidence for environmental factors shared by all patients. Three siblings had grown up in the same household. They had never been in contact with the other pair of affected sisters. No clustering of cases in time occurred, as individual cases were diagnosed at least two years apart. Antibodies against Epstein-Barr viral capsid antigen were found in four patients (IgG: 1:10 to 1:160). There was no single HLA-haplotype common to all patients. However, two affected sisters were HLA-identical (paternal haplotype: Aw24(9), Bw62(15), DRw6; and maternal haplotype: A2, B7, DR2). Their brother with Hodgkin's disease was homozygous for A-, B- and DR-antigens. He shared all these antigens with his two affected sisters (A2, Bw62(15), DR2). A genetic predisposition in combination with environmental factors, in particular subclinical Epstein-Barr virus infection, may have been responsible for the development of Hodgkin's disease in this family.

[Recurring, histologically confirmed Moschcowitz syndrome during pregnancy]. / Rezidivierendes, histologisch gesichertes Moschcowitz-Syndrom während der Schwangerschaft.

A report is presented on a young woman who survived two episodes of thrombotic thrombocytopenic purpura, 5 years apart, in the 31st week of a twin and a singleton pregnancy respectively. The rare clinical picture of Moschcowitz syndrome during pregnancy is described with reference to this unique case report, and the diagnosis, etiology, therapy and clinical course are discussed.

[Changes in the blood picture in liver diseases]. / Veränderungen des Blutbildes bei Lebererkrankungen

The occurrence of hematologic changes has been studied in 256 patients with various liver diseases. Macrocytosis on smears and by MCV was found in 50% of acute and in over 70% of chronic liver diseases. MCV increased from 98 +/- 8 mu3 (acute hepatitis) up to 108 +/- 12 mu3 in alcoholic cirrhosis. Anemia, which occurred rarely in hepatitis but in 67% of cirrhosis, was always macrocytic, not correlating with reticulocyte counts. Target cells were found in 20% of acute hepatitis and 41% of cirrhosis. In patients with chronic liver disease target cells were associated with macrocytosis and increased bilirubin. Thrombocytopenia was found in 11% of acute, in 53% of chronic inflammatory and in over 60% of cirrhotic liver disease.