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Biomedical subjects

M E Brecher

Publications and source records attributed to M E Brecher.

At least 91 records · Page 5Linked to original sources
PubMed1993

Frequency and significance of antibodies to hepatitis C virus in polyarteritis nodosa.

We tested sera from 56 patients to determine the seroprevalence of antibodies to hepatitis C virus (HCV) in polyarteritis nodosa (PAN), to assess the specificity of these antibodies for hepatitis C virus encoded antigens, and to evaluate the clinical features in patients with HCV infection and PAN. Eleven (20%) were positive for anti-HCV by an enzyme immunoassay. Three (5%) had specific antibodies to HCV encoded antigens detected by recombinant immunoblot assay (RIBA II) and had HCV RNA detected by polymerase chain reaction. Patients with HCV infection were more likely to have liver and skin involvement and a diminished serum complement.

Adult↗
PubMed1992

Prestorage removal of Yersinia enterocolitica from red cells with white cell-reduction filters.

Prestorage removal of phagocytic white cells (WBCs) may increase the survivability of contaminating bacteria in units of stored red cells. Fourteen units of whole blood were inoculated with 65 colony-forming units per mL of Yersinia enterocolitica (serotype O:3) and processed into AS-3-preserved red cells. Five red cell units were filtered with a prototype third-generation filter and five red cell units with a second generation filter. WBC reduction was performed on the day of collection. Four red cell units were not filtered. Three noninoculated whole blood units served as negative controls; two were filtered (one with each type of WBC-reduction filter) and one remained unfiltered. All red cell units were then stored at 4 degrees C for 42 days. One of the five filtered red cell units (20%) in each filter group supported growth of Y. enterocolitica. In contrast, 4 (100%) of 4 unfiltered inoculated red cell units had growth (p = 0.04). Overall, 2 (20%) of 10 units of WBC-reduced red cells supported the growth of Y. enterocolitica, as compared to 100 percent of unfiltered red cell units after inoculation (p = 0.015). Bacterial contamination was not detected in any of the three noninoculated units. It can be concluded that prestorage WBC filtration significantly reduces the potential for growth of Y. enterocolitica in red cells stored at 4 degrees C for 42 days.

Endotoxins↗
PubMed1992

Accurate counting of low numbers of leukocytes. Use of flow cytometry and a manual low-count chamber.

The leukocyte depletion that current filters make possible in erythrocyte and platelet preparations can result in leukocyte concentrations too low to be counted accurately by automated and standard manual methods. A recently described method for counting low numbers (1 to 10 x 10(6) per L) of leukocytes by flow cytometry and the use of a manual low-count chamber on 25 venous samples serially diluted to 1:1,000 were evaluated. The results show that both methods for counting leukocytes can reliably determine counts of 1 to 10 x 10(6) leukocytes/liter (a three-order of magnitude reduction from venous blood) in terms of order of magnitude but lack accuracy for specific measurement. The flow cytometric method is more expensive, less readily available, and suffers from greater sample variability. Use of a low-count chamber is a superior technique to evaluate and maintain quality control of methods for leukocyte depletion, resulting in a final leukocyte concentration of 1 to 10 cells per microliter.

Flow Cytometry↗
PubMed1991

Rejuvenation of erythrocytes preserved with AS-1 and AS-3.

Rejuvenation of erythrocytes (biochemical modification of adenosine triphosphate and 2,3-diphosphoglycerate) preserved with currently available nutrient additive solutions has not been licensed or adequately studied. The ability of the commercially available solution PIPA to modify erythrocytes preserved with AS-1 or AS-3 for 35 and 42 days was studied. Use of PIPA produced greater-than-normal levels of adenosine triphosphate in the preserved erythrocytes. Restoration of 2,3-diphosphoglycerate was suboptimal at both periods. (PIPA treatment produces normal levels of 2,3-diphosphoglycerate in erythrocytes preserved for 35 days with citrate-phosphate-dextrose-adenine-1.) In erythrocytes preserved with AS-1 or AS-3 for 42 days, 2,3-diphosphoglycerate returned to normal levels after a second PIPA rejuvenation. This study demonstrates that biochemical modification is possible in erythrocytes preserved with AS-1 or AS-3 for 42 days.

2,3-Diphosphoglycerate↗
PubMed1990

Posttransfusion purpura: the therapeutic value of PlA1-negative platelets.

A case of PlA1-associated posttransfusion purpura (PTP) is reported, in which a previously sensitized patient developed life-threatening thrombocytopenia, purpura, hematuria, and bronchial bleeding. The patient was transfused with PlA1-negative single-donor apheresis platelets (from four different donors) on four occasions. The first transfusion resulted in a 1-hour posttransfusion increment of 57 x 10(9) per L. The use of two additional PlA1-negative apheresis platelets provided support for a tracheostomy. Bronchial bleeding leading to respiratory arrest was controlled with a fourth transfusion. All PlA1-negative platelet transfusions resulted in transient increases in the patient's platelet count. This is the first reported case of repeated, transiently effective transfusion of PlA1-negative platelets demonstrated during the acute phase of thrombocytopenia.

Antigens, Human Platelet↗
PubMed1990

Minimal-exposure transfusion and the committed donor.

Autologous blood (collected preoperatively or salvaged intraoperatively) is the safest blood available for transfusion, but its use is not always feasible. It may be possible to decrease a patient's exposure to homologous donors. Pediatric cardiac surgery patients frequently are unable to donate autologous blood preoperatively. Since 1984, attempts have been made to provide parental apheresis platelets and intraoperative blood salvage to such patients to decrease their donor exposure. Further decreases in donor exposure have been the object of a program of collecting from one committed donor all the blood a patient is anticipated to need. This article reviews the experience with 50 pediatric cardiac surgery patients on such a program, in whom the mean decrease in homologous-donor exposure was 57 percent (range, 12-93%). Thirteen of these patients received only homologous blood products from one committed donor, for a mean decrease in homologous-donor exposure of 80 percent (range, 50-93%). A comparison of 12 of these 13 recipients with a matched control group showed no significant difference in red cell transfusion practice but a significant difference in the number of homologous-donor exposures per m2 of body surface area (BSA) (mean donor exposures/m2 of BSA: patients = 1.5, controls = 10.5). The use of one committed donor and autologous blood can provide a minimal-exposure transfusion.

Adolescent↗
PubMed1990

In vivo viability and functional integrity of filtered platelets.

The in vivo viability and functional integrity of filtered platelets were compared with those of nonfiltered platelets in a controlled study. On two occasions, after template bleeding time, 14 healthy volunteers underwent plateletpheresis and received 600 mg of aspirin. Autologous 111In-labeled platelets were transfused without further manipulation (control) on one occasion and after filtration on a second occasion. The filter was primed and flushed with a buffered 12.6-percent solution of ACD-A in 0.9-percent normal saline (pH 6.5). After transfusion, the bleeding time was measured at 1, 4, and 24 hours and platelet survival at 10 minutes; 1, 4, and 24 hours; and daily for 6 days. The decrease in the bleeding time was not significantly different from that after transfusion of nonfiltered platelets (p greater than 0.2). Filtering of platelets did not affect 1-hour in vivo recovery (filtered, 69.5%; nonfiltered, 66%: p = 0.56) or the platelet survival (filtered platelet t1/2 = 83.0 hours, nonfiltered platelet t1/2 = 82.9 hours: p = 0.96). It can be concluded that filtration does not adversely affect in vivo recovery, survival, or functional integrity of platelets.

Bleeding Time↗
PubMed1989

Intraoperative blood loss and patient and graft survival in orthotopic liver transplantation: their relationship to clinical and laboratory data.

We reviewed the records of 83 patients who underwent 100 orthotopic liver transplantations in order to determine the following: (1) the methods to predict blood usage, (2) the consequences of an ABO-incompatible transplant, (3) the benefit of providing cytomegalovirus (CMV)-negative blood products to CMV-negative patients receiving a liver from a CMV-negative donor, (4) the association of donor anti-hepatitis B core antigens and subsequent hepatitis B, and (5) the prognostic consequences of rouleaux observed in pretransplant blood compatibility testing. Patient diagnosis, the presence of ascites, a preoperative prothrombin time greater than 15 seconds, and a multifactorial "risk category" were all predictive of intraoperative blood loss. A history of previous gastrointestinal bleeding or an operation that involved the right upper abdominal quadrant was not predictive of intraoperative blood loss. Although CMV infection is common after liver transplantation, the prophylactic use of CMV antibody-negative blood products in CMV-negative recipients receiving a liver from a CMV-negative donor in our series was not associated with postoperative CMV infection. The transplantation of a liver positive for anti-hepatitis B core antigen was associated with subsequent hepatitis B surface antigen seroconversion in two of four cases. Transplantation of an ABO-incompatible liver and the presence of rouleaux observed in pretransplant blood compatibility testing were both associated with a significantly higher mortality. A careful review of laboratory data and medical records of patients undergoing liver transplantation should enhance the ability to modify the approach to the allocation of limited blood resources and the care and management of these patients.

Adult↗
PubMed1989

Blood bank support of a liver transplantation program.

Successful implementation of a liver transplantation program is dependent on extensive blood bank support. Careful planning, organization, and coordination of the blood bank and other clinical services are necessary. In our first 100 orthotopic liver transplantations, our median intraoperative erythrocyte use was 12.6 units, and 30% of the erythrocytes were provided by intraoperative cell salvage. Thus, the need for homologous blood and the number of donors to whom recipients were exposed were reduced. Use of intraoperative cell salvage and expansion of our erythrocyte inventory through the use of AS-1 preservative helped us meet the demands of the liver transplant program without compromising the availability of blood products for all other surgical and medical patients.

Blood Banks↗
PubMed1989

Paroxysmal nocturnal hemoglobinuria and the transfusion of washed red cells. A myth revisited.

Paroxysmal nocturnal hemoglobinuria (PNH) is an uncommon, acquired clonal stem cell disorder primarily affecting red cells that have an abnormal sensitivity to complement lysis. Since 1948, the use of saline-washed red cells (WRBCs) has been advocated to minimize hemolysis after transfusion to patients with PNH. Thirty-eight years of experience (1950 through 1987) with patients who had PNH were reviewed. Twenty-three patients with a positive Ham's test had been transfused with 556 blood components, including 431 RBC products: 94 units of whole blood, 208 units of packed RBCs, 80 units of white cell-poor RBCs, 38 units of WRBCs, 5 units of frozen RBCs, and 6 units of intraoperatively salvaged RBCs. Only one documented episode of posttransfusion hemolysis related to the underlying diagnosis of PNH was found, and it was associated with the transfusion of a unit of type O whole blood to an AB-positive individual. This unit contained ABO-incompatible plasma; this case was similar to one in an earlier report from which originated the recommendation for using WRBCs. The posttransfusion increment in hemoglobin concentration in patients receiving ABO-identical packed RBCs was comparable to that in patients receiving frozen or washed RBCs. These findings indicate that the use of WRBCs is unnecessary and that patients with PNH should be transfused with group-specific blood and blood products.

ABO Blood-Group System↗
PubMed1989

Delayed hemolysis resulting from anti-A1 after liver transplantation.

The authors report a case of a delayed hemolytic transfusion reaction in a type A2 recipient of a type O liver allograft. An anti-A1 antibody reactive at 37 degrees C in the indirect antiglobulin test was identified both in the patient's serum and in an eluate. Hemolysis secondary to the production of anti-A1 has been reported to be extremely rare. The English-language literature has six cases before 1979. During the 1980s, an additional seven cases were reported; six involved transplantation of a solid organ, and in each such case the donor was type O and the recipient was type A1 or A2. Recommendations regarding transfusion practice in such cases are made. An association among the transplantation of a type O organ to a type A recipient, the use of cyclosporine, and an apparent increase in the occurrence of clinically significant anti-A1 is suggested.

Autoantibodies↗
PubMed1988

Chondroblastoma: an immunohistochemical study.

Five chondroblastomas were examined for the presence of monocyte/macrophage-associated antigens by an alkaline phosphatase-anti-alkaline phosphatase immunohistochemical method. The tumor cell populations were analyzed with eight antibodies reacting with separate antigens on cells of monocyte/macrophage lineage and with antibodies directed against glycoprotein IIIa and factor VIII. The "chondroblastic" tumor cells did not stain with any of the macrophage-associated antibodies. Osteoclast-like giant cells stained with the macrophage-associated antigens EBM11, KB90, leukocyte common antigen, and with the megakaryocyte/platelet-associated antigen C17. Only endothelial cells were reactive with antibody to factor VIII. Our data do not support the postulated histiocytic origin of the neoplastic cells within chondroblastomas; the osteoclast-like giant cells present within these tumors are felt to be both reactive and of monocyte/macrophage lineage.

Adolescent↗
PubMed1986

Absence of mononuclear phagocyte antigens in malignant fibrous histiocytoma.

Nine malignant fibrous histiocytomas (MFHs) were tested for the presence of macrophage-associated antigens by an alkaline phosphatase-anti-alkaline phosphatase immunohistochemical method. One myxoid and eight pleomorphic-storiform tumors were analyzed with eight antibodies reacting with separate antigens previously found on cells of mononuclear phagocyte lineage. Malignant cells did not react with any of the antibodies, while benign histiocytes within tumor were consistently labeled with all of the antibodies tested. While the malignant cells of MFH previously have been found to share some functional and morphologic properties with histiocytes, they do not possess the surface and cytoplasmic antigens that have been found on various macrophage populations. The malignant cells of MFH are fibroblastic or poorly differentiated mesenchymal cells rather than neoplastic histiocytes.

Antibodies, Monoclonal↗
PubMed1986

Immunohistochemical study of mononuclear phagocyte antigens in giant cell tumor of bone.

The cytogenesis of giant cell tumor of bone (GCT) was assessed by immunohistochemical methods. Three GCT were analyzed by a sensitive immunoalkaline phosphatase technique with a panel of monoclonal antibodies, including eight reacting with separate antigens previously found to be present on mononuclear phagocytes (MPs) and one specific for the endothelial marker, coagulation Factor 8. Among the MP-associated antigens evaluated were leukocyte common antigen (LCA), HLA-DR, C3b receptor, and C3bi receptor. Also incorporated in the panel were antibodies to MP-associated antigens with well-characterized tissue distribution but of currently unknown function. Constituent cells of the tumors varied in their reactions with the antibodies of the panel. Although mononuclear cells in tumor stroma were labeled with all of the antibodies against the MP markers, giant cells reacted strongly only with antibodies to LCA and the MP-associated antigen recognized by the antibody EBM11. Giant cells were weakly and focally labeled with antibodies (KB90 and UCHM1) against two additional MP-associated determinants and were unreactive with the remaining antibodies in the panel. Spindled stromal cells, which appeared to produce collagen, were not labeled with any of the antibodies in the panel. Only endothelial cells reacted with antibody to Factor 8. The results of this study suggest that giant cells of GCT are derived from stromal cells of mononuclear phagocyte lineage, and that the stromal precurser cells lose some, but not all, MP-associated antigens as they mature into giant cells.

Adolescent↗