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Biomedical subjects

I A Shulman

Publications and source records attributed to I A Shulman.

At least 73 records · Page 4Linked to original sources
PubMed1986

Two examples of low ionic strength-dependent autoagglutinins with anti-Pr1 specificity.

Two low ionic strength-dependent autoagglutinins were studied and found to have anti-Pr1 specificity. This specificity was determined by studies with enzyme-treated and neuraminidase-treated human red blood cells (RBCs), animal RBCs and chemically-modified sialoglycoproteins, all suspended in a low ionic strength solution (LISS). Both IgM complement-binding cold agglutinins had a wide thermal range and caused in vitro hemolysis of some LISS-suspended RBCs at 37 degrees C. Compatible blood was found for these patients by using techniques that did not employ LISS.

Agglutination Tests↗
PubMed1985

Experience with a cost-effective crossmatch protocol.

Pretransfusion blood samples were routinely tested for ABO group, Rh type, and the presence of unexpected red blood cell antibodies. Patients who had unexpected red blood cell antibodies received transfusions of blood that was crossmatched using an immediate spin test, a 37 degrees C incubation step, and an indirect antiglobulin test. Patients who did not have unexpected red blood cell antibodies received transfusions with blood that was crossmatched by an immediate spin crossmatch only. Because the average immediate spin crossmatch required only 3.25 minutes to be performed, crossmatches were not done for patients without unexpected antibodies until blood was actually requested to be issued for transfusion. During the first 8 1/2 months this protocol was used, 27,742 crossmatches were performed and 46,959 unnecessary crossmatches were avoided, thus reducing direct costs by at least +49,300. This protocol also allowed for optimal blood inventory control and minimized the outdating of units of blood to only 0.19%.

Blood Banks↗
PubMed1984

Experience with the routine use of an abbreviated crossmatch.

Three years' experience with the routine use of an abbreviated crossmatch procedure is reported. If a patient had no known history of and/or no currently demonstrable unexpected antibodies, ABO and Rh type specific blood was crossmatched at the time of need by using an immediate spin saline abbreviated crossmatch. Once blood was issued, both a 37 degrees C incubation and an antiglobulin crossmatch were done using the same tube employed for the abbreviated crossmatch. This served as a check that clinically significant antibodies were not overlooked. None of the 19,818 patients transfused following an abbreviated crossmatch suffered an acute hemolytic transfusion reaction as a result of this strategy; however, two patients may have manifested asymptomatic hemolysis. This approach to compatibility testing might be appealing to hospitals faced with fiscal limitations and new regulations affecting hospital reimbursement.

Adult↗
PubMed1984

Neonatal exchange transfusions complicated by transfusion-induced malaria.

Two neonates who became infected with Plasmodium vivax subsequent to exchange transfusion are described. This complication of neonatal exchange transfusion is unusual in that only two other similar cases have been reported to the Centers for Disease Control. Although malaria is an unusual complication, it should be kept in mind when considering the differential diagnoses of fever following neonatal exchange transfusion. The risk of transfusion-induced malaria may be increasing due to the influx of immigrants from areas endemic for malaria. Careful blood donor selection and blood donor education may minimize this risk.

Diagnosis, Differential↗
PubMed1984

Two distinct categories of warm autoantibody reactivity with age-fractionated red cells.

Using age-fractionated erythrocytes, warm autoantibodies can be classified into two distinct categories, depending on their reactivity with reticulocyte-enriched (younger) or reticulocyte-poor (older) red cell fractions. The strength of the direct antiglobulin test (DAT) on the age-fractionated red cells of 24 patients indicated that 19 (79%) had an IgG warm autoantibody that reacted preferentially with older red blood cells. In 7 of these 19 patients (37%), the DAT was negative using reticulocyte-enriched red cell fractions. We have termed this preferential reactivity of warm autoantibodies with older red cells as type I. Five of the 24 patients studied (21%) had an IgG warm autoantibody that demonstrated no preference for young or older red cells. We have termed this pattern of warm autoantibody reactivity as type II. All 5 patients having type II warm autoantibodies had severe anemia. In contrast, 6 of 19 patients having type I warm autoantibody did not have clinical evidence of anemia when tested, and 11 of the 19 had only slight to moderate anemia. Additionally, our results using type I warm autoantibody raise questions regarding the blood group specificity of warm autoantibodies. The antigen recognized by type I warm autoantibody may be a cryptantigen. Rh specificity or relative Rh specificity, often associated with warm autoantibodies, may simply be a coincidental finding.

Anemia, Hemolytic, Autoimmune↗
PubMed1984

Serologic and biochemical studies of a previously unclassified blood type B variant.

The designation B4 is proposed for a weak variant of type B blood found in a Salvadorian woman and her two daughters. The red cells were weakly agglutinated by anti-B and anti-A,B; the serum contained anti-B; and the saliva contained H but not B substance. Biochemical studies of the serum showed that the enzyme specified by the variant B gene had low activity and low affinity for both sugar donor and acceptor.

ABO Blood-Group System↗
PubMed1983

Histocompatibility antigens in sympathetic ophthalmia.

Twenty patients with histopathologically confirmed sympathetic ophthalmia (Group 1) and eight patients with "presumed sympathetic ophthalmia," based on a clinical history of bilateral uveitis occurring within four months of a perforating ocular injury (Group 2), were typed for HLA-A, HLA-B, and HLA-C antigenic determinants by a micro-lymphocytotoxicity technique. HLA antigenic determinants found in Groups 1 and 2 were compared to a control group of 107 patients with sequelae of perforating ocular injuries from accidents, intraocular surgery, or corneal ulcers (Group 3). HLA-A11 antigen showed an increased frequency of 30% in Group 1 (relative risk = 11.0; P less than .002) and an increased frequency of 32% in Groups 1 + 2 (relative risk = 10.5; P less than .0005) compared to Group 3 (frequency = 4%). This finding was validated against a second control group of 453 healthy subjects without ocular disease or trauma (Group 4). This association suggests that a genetic factor may play an important role in the pathogenesis of sympathetic ophthalmia.

HLA Antigens↗
PubMed1983

Reticuloendothelial cell function in alpha-methyldopa-induced hemolytic anemia.

2 patients having alpha-methyldopa-induced hemolytic anemia were followed sequentially using an in vitro assay of autologous monocyte-macrophage activity to determine if their reticuloendothelial system (RES) function was abnormal and thus could be related to the mechanism of lysis. RES function was evaluated while the patients were actively hemolyzing and during remission, following discontinuance of the drug. The results indicated that RES activity is normal in patients having hemolytic anemia due to alpha-methyldopa administration. Also, following cessation of drug therapy, the patients' IgG-coated red cells interacted significantly for a prolonged period (4-5 months) with autologous or normal allogeneic monocyte-macrophages. This was associated with a concurrent reticulocytosis and indicates a persistent low-level hemolytic phase throughout this period, even though hemoglobin and hematocrit values remained within the normal ranges. Although levels of IgG sensitizing the patients' red cells were essentially constant during the hemolytic phase and when the patients were in complete remission, significant monocyte-macrophage activity was only evident during the hemolytic period. In an attempt to explain this phenomenon, it is postulated that hemolysis in patients receiving alpha-methyldopa is related to the interaction of drug with red cell membrane proteins which results in a variably expressed 'altered' antigen which is recognized by 'autoantibody'. The proper expression of the Fc portion of the immunoglobin molecule to result in specific recognition by receptors on monocyte-macrophages depends upon the extent of the antigen alteration by alpha-methyldopa. If the drug does not result in appropriate antigen alteration, then, although 'autoantibody' may still bind to the red blood cell, its Fc region is not readily recognized by monocyte-macrophages and little or no erythrophagocytosis occurs.

Aged↗
PubMedDate not supplied

Thimerosal dependent agglutination, a newly described blood bank problem.

A number of ABO grouping, Rh typing, antibody screening, and antibody identification problems are associated with chemicals in blood bank reagents. We describe a newly discovered agglutination phenomenon due to a thimerosal (Merthiolate)-dependent agglutinin found in the serum of a normal blood donor. Thimerosal is used as a preservative in several low-ionic strength reagents. This agglutination phenomenon is detected only in test systems (low-ionic-strength, albumin, saline, ficin treated test cells) in which test cells are incubated in the presence of thimerosal. Agglutination does not occur in the absence of thimerosal. The thimerosal-dependent agglutinin behaves like an IgG IgG autoantibody. There is no evidence that the thimerosal-dependent agglutinin is responsible for increased red cell destruction.

Adult↗
PubMedDate not supplied

Thimerosal-dependent agglutination complicating the serologic evaluation for unexpected antibodies.

Thimerosal (merthiolate) is a preservative present in several low-ionic-strength blood bank reagents. Thimerosal-dependent panagglutinins were found in the serum of a hospitalized patient during serologic testing for unexpected red cell antibodies. The agglutinins behaved like a mixture of IgG and IgM and reacted with all red cells tested. Once the true nature of the serum panagglutinins was determined, blood bank reagents free of thimerosol were used, and no further serologic problems were encountered. Agglutination of this type should be considered whenever sera appear to contain panagglutinins and thimerosal is present in the test system.

Aged↗
PubMedDate not supplied

Cefotaxime-induced immune hemolytic anemia due to antibodies reacting in vitro by more than one mechanism.

Until recently, all cephalosporin-induced immune hemolytic anemias appeared to react by a "penicillin-type" drug adsorption mechanism, and hemolysis was extravascular. In 1987 and 1988, the first two cases of cephalosporin-induced immune hemolytic anemia with intravascular hemolysis associated with a so-called immune complex mechanism were reported. This report describes a case of extravascular hemolysis due to a third-generation cephalosporin, cefotaxime, which, to the authors' knowledge, is the first to show in vitro characteristics of both the drug adsorption and the so-called immune complex mechanisms.

Adult↗