Alloimmune thrombocytopenia: state of the art 2006.

In alloimmune thrombocytopenia maternal immunoglobulin G anti-platelet alloantibodies cross the placenta and cause fetal thrombocytopenia. The diagnosis requires laboratory demonstration of incompatibility between a maternal and paternal platelet alloantigen, and detection of maternal antibody to the discordant paternal alloantigen. This disorder should be treated in utero because of its propensity to cause fetal intracranial bleeding.

Dental safety net: current capacity and potential for expansion.

Objectives: The authors' objectives were to determine the size and characteristics of the dentally underserved U.S. population, describe the capacity of the safety net system to treat the underserved, explore policy options for expanding the system and discuss the policy implications of these findings.

Mechanisms of transfusion-related acute lung injury (TRALI): anti-leukocyte antibodies.

There is abundant evidence that leukocyte antibodies in blood donor products are somehow involved in transfusion-related acute lung injury (TRALI). Human leukocyte antigen (HLA) class I, HLA class II, and neutrophil-specific antibodies in the plasma of both blood donors and recipients have been implicated in the pathogenesis of TRALI. The case for a relationship between leukocyte antibodies and TRALI is more compelling if concordance between the antigen specificity of the leukocyte antibodies in the donor plasma and the corresponding antigen on the cells of the affected recipient is demonstrated.

Immune-mediated thrombocytopenia resulting from sensitivity to oxaliplatin.

Thrombocytopenia developing in the course of chemotherapy for malignant disease is usually attributed to drug-induced marrow suppression and/or marrow replacement by tumor. We describe two patients who developed severe thrombocytopenia and hemorrhagic symptoms while being treated with oxaliplatin, 5-fluorouracil, and leukovorin for metastatic colon cancer in whom platelet destruction appears to have been caused by oxaliplatin-dependent antibodies specific for the platelet glycoprotein IIb/IIIa complex (alpha(IIb)/beta(3) integrin). Drug-induced immune thrombocytopenia (DITP) should be considered in patients who experience a sudden, isolated drop in platelet levels while being treated with chemotherapeutic agents, especially when adequate numbers of megakaryocytes are present in the bone marrow.

Parallel randomized trials of risk-based therapy for fetal alloimmune thrombocytopenia.

Objective: Antenatal therapy with intravenous immunoglobulin (IVIG) and prednisone has been shown to improve fetal thrombocytopenia and reduce the incidence of intracranial hemorrhage in neonatal alloimmune thrombocytopenia. Optimization of this therapy for individual patients, however, has yet to be achieved.

Methods: In these parallel, randomized, multicenter studies, 78 patients in 79 pregnancies were stratified to 2 different treatment arms based on the presence of a peripartum intracranial hemorrhage in a previously affected sibling and/or the initial fetal platelet count.

Guidelines for safe and effective use of NSAIDs in dogs.

NSAIDs are the most widely used analgesics in veterinary medicine, and all have some toxic potential. The most common adverse class effects are gastrointestinal, renal, hepatic, and coagulation disorders. When treating chronic pain associated with osteoarthritis, the effectiveness of NSAIDs can be enhanced by physical therapy, use of chondroprotective agents, certain adjunctive drugs, and diet and exercise to control weight.

Reductive alkylation of proteins using iridium catalyzed transfer hydrogenation.

An efficient transition metal catalyzed procedure for the reductive alkylation of proteins has been developed. Imines formed from the condensation of aldehydes (1 mM) with lysine residues and the N-terminus can be reduced efficiently by a [Cp*Ir(4,4'-dimethoxy-2,2'-bipyridine)(H2O)]SO4 catalyst in the presence of formate ions. The reaction proceeds readily at pH 7.

Evaluating instruments for quality: testing convergent validity of the consumer emergency care satisfaction scale.

Having reliable and valid instruments is a necessity for nurses and others measuring concepts such as patient satisfaction. The purpose of this article is to describe the use of convergence to test the construct validity of the Davis Consumer Emergency Care Satisfaction Scale (CECSS). Results indicate convergence of the CECSS with the Risser Patient Satisfaction Scale and 2 single-item visual analogue scales, therefore supporting construct validity.

Maternal alloimmunization against the rare platelet-specific antigen HPA-9b (Max a) is an important cause of neonatal alloimmune thrombocytopenia.

Background: Neonatal alloimmune thrombocytopenia (NATP) is an important cause of morbidity and mortality in the newborn. Optimal management of subsequent pregnancies requires knowledge of the alloantigen that caused maternal immunization, but this is possible only in a minority of cases. This study investigated whether this can be explained in part by maternal immunization against the "rare" alloantigen HPA-9b (Max(a)), implicated previously only in a single NATP case.

Clinical and diagnostic comparison of neonatal alloimmune thrombocytopenia to non-immune cases of thrombocytopenia.

Background: Affected patients with neonatal alloimmune thrombocytopenia (AIT) are often severely thrombocytopenic and, if so, may suffer an intracranial hemorrhage (ICH). This study was undertaken to compare the outcome of cases of AIT to cases of neonatal thrombocytopenia shown not to be AIT and to identify clinical features that would facilitate the diagnosis.

Procedure: Two hundred twenty two cases of neonatal thrombocytopenia for which serologic testing was obtained by the referring physician were accrued for this study from 11 testing laboratories.

Transfusion-related acute lung injury: definition and review.

Background: Transfusion-related acute lung injury (TRALI) is now the leading cause of transfusion-associated mortality, even though it is probably still underdiagnosed and underreported.

National Heart, Lung, And Blood Institute Action: The National Heart, Lung, and Blood Institute convened a working group to identify areas of research needed in TRALI. The working group identified the immediate need for a common definition and thus developed the clinical definition in this report.

Prospective evaluation of a new platelet glycoprotein (GP)-specific assay (PakAuto) in the diagnosis of autoimmune thrombocytopenia (AITP).

Assays measuring platelet-associated immunoglobulin G (PAIgG), while highly sensitive, lack specificity in diagnosing autoimmune thrombocytopenia (AITP). We prospectively evaluated a new commercially available glycoprotein (GP)-specific assay, the PakAuto (GTI, Brookfield, WI), for its clinical usefulness in distinguishing immune from nonimmune thrombocytopenia (TP), in 216 patients with autoimmune TP (both primary "idiopathic" and "secondary") and 46 patients with TP due to other causes. This assay is designed to detect both platelet-associated (direct assay) and plasma (indirect assay) antiplatelet antibodies specific for GPs IIb/IIIa, Ib/IX, and Ia/IIa.

Fetal and neonatal alloimmune thrombocytopenia in pregnancies involving in vitro fertilization: a report of four cases.

Objective: We report four cases of neonatal alloimmune thrombocytopenia (NATP) in pregnancies achieved with in vitro fertilization.

Study Design: Three cases used surrogate carriers, and the fourth a donor egg. Sera from gestational carriers were tested for platelet antibodies by flow cytometry and enzyme-linked immunosorbent assay.

Factors affecting posttransfusion platelet increments, platelet refractoriness, and platelet transfusion intervals in thrombocytopenic patients.

A variety of patient and product-related factors influenced the outcome of 6379 transfusions given to 533 patients in the Trial to Reduce Alloimmunization to Platelets (TRAP). Responses measured were platelet increments, interval between platelet transfusions, and platelet refractoriness. Patient factors that improved platelet responses were splenectomy and increasing patient age.

Human platelet antigen-specific alloantibodies implicated in 1162 cases of neonatal alloimmune thrombocytopenia.

Background: Neonatal alloimmune thrombocytopenia (NATP) caused by fetomaternal mismatch for human platelet (PLT) alloantigens (HPAs) complicates approximately 1 in 1000 to 1 in 2000 pregnancies and can lead to a serious bleeding diathesis, intracranial hemorrhage, and sometimes death of the fetus or neonate. As a national reference center for NATP investigations, our experience with this entity over a 12-year period was reviewed.

Study Design And Methods: The laboratory records of all cases of suspected NATP referred for evaluation from January 1, 1990, to December 31, 2002, were analyzed.

Neonatal neutropenia and bacterial sepsis associated with placental transfer of maternal neutrophil-specific autoantibodies.

Background: Passively acquired neonatal neutropenia is an infrequently reported complication of maternal autoimmune neutropenia (AIN). Two affected siblings are described. The firstborn developed Citrobacter meningitis and was permanently disabled.

Effect of an HIV counseling and testing program on AIDS-related knowledge and practices in tuberculosis clinics in Abidjan, Côte d'Ivoire.

Setting: Two out-patient tuberculosis treatment centers, Abidjan, Côte d'Ivoire.

Objective: To assess the effect of a human immunodeficiency virus (HIV) counseling and testing program on acquired immune-deficiency syndrome (AIDS) related knowledge and behaviors among persons with newly diagnosed tuberculosis.

Design: Since 1994, patients with newly diagnosed tuberculosis have received individual or group HIV pretest counseling, informed consent, free HIV testing for those who consent, and post test counseling.

Translation of the human angiotensin II type 1 receptor mRNA is mediated by a highly efficient internal ribosome entry site.

Activation of the angiotensin II type 1 receptor (AT1R) is closely involved in the pathogenesis of cardiovascular disease. The human AT1R (hAT1R) mRNA splice variants have long 5'-untranslated regions (5'-UTRs) ranging from 272 to 414 bp that have the potential to form stable secondary structures. In this study, we show that the 5'-UTR of hAT(1)R mRNAs contains an internal ribosome entry site (IRES) located within the first 40 bp of the proximal end of exon 1.

Severe neonatal alloimmune thrombocytopenia caused by antibodies to human platelet antigen 3a (Baka) detectable only in whole platelet assays.

Background: Maternal antibodies that cause neonatal alloimmune thrombocytopenia are commonly identified by solid-phase assays that detect the causative antibodies on the basis of their reactions with specific PLT glycoproteins. Two cases of severe neonatal alloimmune thrombocytopenia caused by maternal antibodies specific for human PLT antigen 3a (HPA-3a [Baka]) that failed to give the expected reactions in some solid-phase assays were recently encountered.

Study Design And Methods: PLT-reactive antibodies were characterized by three different solid-phase assays and by flow cytometry.

Detection and identification of platelet antibodies in clinical disorders.

Serologic assays to detect and identify platelet-reactive antibodies have progressed from less sensitive and specific Phase I tests based on platelet functional endpoints through more sensitive Phase II assays that detect platelet-associated immunoglobulins, to highly specific Phase III assays that detect antibodies bound to alloantigens located on isolated platelet surface glycoproteins. Phase II and III assays are useful in the evaluation of patients with suspected platelet alloimmune syndromes neonatal alloimmune thrombocytopenia (NATP) and post-transfusion purpura (PTP) as well as in platelet crossmatching. Flow cytometry, a Phase II assay, can be modified to detect drug-dependent platelet-reactive antibodies.

Accelerated measles control in the Western Pacific region.

By the 1990s, an immunization program in the western Pacific had dramatically reduced measles morbidity and mortality. Building on the region's successful elimination of polio, several countries and areas achieved or are close to measles elimination, thus showing the potential for global eradication. The diverse challenges for measles control in different parts of the region have produced lessons that will help with future control, including the need for surveillance of sufficient standard to guide and monitor progress.

Palliative irradiation of the spleen.

We analyzed the efficacy of splenic irradiation in a population of patients with hematologic diseases. The records of the Radiation Oncology Division, Naval Medical Center San Diego were retrospectively reviewed for all patients treated with splenic irradiation (SI) between January 1, 1990 and March 1, 2001. The charts of 17 patients were identified: 5 patients had chronic myelogenous leukemia, 4 had chronic lymphocytic leukemia, 4 had idiopathic myelofibrosis, 2 had polycythemia vera, and 1 patient each had idiopathic thrombocytopenic purpura and acute myelogenous leukemia.