Acute autoimmune hemolytic anemia due to anti-Ena autoantibody successfully treated with rituximab.

BACKGROUND: Autoimmune hemolytic anemia (AIHA) due to anti-Ena has been previously reported in association with massive intravascular hemolysis, disseminated intravascular coagulation, and fatal outcomes. Here we report a case of successfully treated AIHA due to anti-Ena . CASE REPORT: A 69-year-old male with a past medical history of cirrhosis due to nonalcoholic steatohepatitis status post-orthotopic liver transplant presented with 1-month history of progressive anemia. At presentation, his hemoglobin (Hb) was 5.6 g/dL, hematocrit (Hct) 16%, reticulocytes 0.3%, direct bilirubin (bili) 4 g/dL, lactate dehydrogenase 533 units/L (reference, 125-220 units/L), and haptoglobin 254 mg/dL (reference, 40-273 mg/dL). Blood bank testing revealed an autoantibody present in his plasma and a direct antiglobulin test positive for immunoglobulin G (IgC) but negative for complement. He received 1 unit of an incompatible blood group O phenotypically matched red blood cell unit. RESULTS: Over the course of the next 5 days, the Hb and Hct decreased to 4.1 g/dL and 12%, respectively, direct bili increased to 12.3 mg/day, reticulocytes slightly increased to 0.9%, and haptoglobin decreased to less than 8 mg/dL. Marrow study showed a hypercellular marrow with erythroid hyperplasia. Additional workup performed at a reference laboratory identified an anti-Ena autoantibody. He received prednisone and weekly rituximab infusions and was monitored weekly. At the 2-month visit, Hb and Hct were 10 g/dL and 32%, respectively. CONCLUSION: Unlike two of the previously reported fatal cases of AIHA with anti-Ena specificity, this 69-year-old male treated with weekly rituximab infusion underwent clinical recovery and significant anemia improvement.

Residue specific partitioning of KL4 into phospholipid bilayers.

KL4, which has demonstrated success in the treatment of respiratory distress, is a synthetic helical, amphipathic peptide mimetic of lung surfactant protein B. The unusual periodicity of charged residues within KL4 and its relatively high hydrophobicity distinguish it from canonical amphipathic helical peptides. Here we utilized site specific spin labeling of both lipids and the peptide coupled with EPR spectroscopy to discern the effects of KL4 on lipid dynamics, the residue specific dynamics of hydrophobic regions within KL4, and the partitioning depths of specific KL4 residues into the DPPC/POPG and POPC/POPG lipid bilayers under physiologically relevant conditions. KL4 induces alterations in acyl chain dynamics in a lipid-dependent manner, with the peptide partitioning more deeply into DPPC-rich bilayers. Combined with an earlier NMR study of changes in lipid dynamics on addition of KL4 (V.C. Antharam et al., 2009), we are able to distinguish how KL4 affects both collective bilayer motions and intramolecular acyl chain dynamics in a lipid-dependent manner. EPR power saturation results for spin labeled lipids demonstrate that KL4 also alters the accessibility profiles of paramagnetic colliders in a lipid-dependent manner. Measurements of dynamics and depth parameters for individual spin-labeled residues within KL4 are consistent with a model where the peptide partitions deeply into the lipid bilayers but lies parallel to the bilayer interface in both lipid environments; the depth of partitioning is dependent on the degree of lipid acyl chain saturation within the bilayer.

Computational modeling of first responders' willingness to accept radiation exposure during radiological or nuclear events.

Since the events of 9/11, a concerted interagency effort has been undertaken to create comprehensive emergency planning and preparedness strategies for the management of a radiological or nuclear event in the US. These planning guides include protective action guidelines, medical countermeasure recommendations, and systems for diagnosing and triaging radiation injury. Yet, key areas such as perception of risk from radiation exposure by first responders have not been addressed. In this study, we identify the need to model and develop new strategies for medical management of large-scale population exposures to radiation and examine the phenomena of radiation dread and its role in emergency response using an agent-based modeling approach. Using the computational modeling platform NetLogo, we developed a series of models examining factors affecting first responders' willingness to work (WTW) in the context of entering areas where radioactive contamination is present or triaging individuals potentially contaminated with radioactive materials. In these models, the presence of radiation subject matter experts (SMEs) was found to increase WTW. Degree of communication was found to be a dynamic variable with either positive or negative effects on WTW dependent on the initial WTW demographics of the test population. Our findings illustrate that radiation dread is a significant confounder for emergency response to radiological or nuclear events and that increasing the presence of radiation SME in the field and communication among first responders when such radiation SMEs are present will help mitigate the effect of radiation dread and improve first responder WTW during future radiological or nuclear events.