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Biomedical subjects

S Kleinman

Publications and source records attributed to S Kleinman.

At least 37 records · Page 2Linked to original sources
PubMed1993

Hyperkalaemia: a complication of warm heart surgery.

A case is presented of hyperkalaemia (13.6 mEq.L-1) occurring during cardiopulmonary bypass using warm blood cardioplegia (K+ 40-60 mEq.L-1). Treatment with epinephrine, calcium chloride, sodium bicarbonate, and furosemide reduced K+ to 6.5 mEq.L-1 within 30 min and myocardial performance was enhanced with amrinone and cardiac rhythm was controlled with A-V segmental pacing. It is believed that the hyperkalaemia resulted from a combination of the surgical procedure (mitral valve replacement) and the use of warm cardioplegia. The purpose of this report is to increase the awareness of the possibility of hyperkalaemia with warm cardioplegia and to describe a successful therapeutic regimen.

Anesthesia, Intravenous↗
PubMed1993

Transfusion transmission of human T-lymphotropic virus types I and II: serologic and polymerase chain reaction results in recipients identified through look-back investigations.

To determine the transmissibility of human T-lymphotropic virus types I and II (HTLV-I and HTLV-II) via transfusion, persons who, from 1983 to 1989, received blood components donated by persons who subsequently tested anti-HTLV-I-positive were evaluated. It was found that 16 (30%) of 54 evaluable recipients of transfused cellular components became infected with one of the HTLVs: 8 had HTLV-I and 8 had HTLV-II. Forty percent of platelet recipients and 28 percent of red cell recipients acquired infection. The rate of transmission of HTLV-I and HTLV-II was significantly correlated with storage age of red cell units prior to transfusion: 47 percent for red cells stored < or = 14 days and 0 for red cells stored > 14 days (p < 0.01). Multiple confirmatory serologic tests performed in 46 anti-HTLV-I enzyme immunoassay-negative recipients revealed that HTLV infection could not be excluded in 3 recipients of blood components from HTLV-II-infected donors. Polymerase chain reaction established HTLV-II infection in one recipient, and the other two recipients could not be classified with respect to HTLV infection status. It appears that some HTLV-II-infected transfusion recipients will not be detected by existing HTLV-I antigen-based reagents. If it is deemed necessary to initiate or continue look-back programs to detect transfusion transmission of HTLV-II infection, it is suggested that the current testing algorithm be modified in selected cases.

Erythrocyte Transfusion↗
PubMed1991

Immunologic correlates of spontaneous lymphocyte proliferation in human T-lymphotropic virus infection.

Previously we showed that mononuclear cells from about half of human T-lymphotropic virus (HTLV)-seropositive persons exhibit spontaneous proliferation in vitro. We sought to determine if proliferation was associated with other immunologic changes characteristic of HTLV infection. The parameters assessed were (1) percentages of lymphocytes expressing CD4 and/or CD25 (interleukin-2 receptor), (2) serum levels of soluble CD25, (3) serostatus for other viruses, (4) anti-HTLV antibody levels, and (5) HTLV type determined by polymerase chain reaction or serologic reactivity with type-specific peptides. The proliferation+ HTLV (PROL+) group, proliferation HTLV (PROL-) group, and control group showed similar percentages of CD4+, CD25+, and CD4+CD25+ lymphocytes; serum levels of soluble CD25 were also similar. Antibodies to cytomegalovirus, hepatitis B core, and hepatitis C were present in similar proportions of PROL+ and PROL+ groups. However, a significant association was found between spontaneous proliferation and anti-HTLV antibody levels; sera from 67% of PROL+ persons, but only 18% of PROL- persons, required dilution to yield absorbance values within the linear range of the anti-HTLV antibody assay. In the PROL+ group, persons whose sera required the most dilution had proliferative responses significantly higher than those whose sera required no dilution. The PROL+ and PROL groups were similar with regard to the relative distribution of HTLV-I and HTLV-II infection. These findings indicate that HTLV-related spontaneous lymphocyte proliferation is related to levels of circulating anti-HTLV antibodies, and characterizes both HTLV-I and HTLV-II infection.

Antibodies, Viral↗
PubMed1991

Safety of blood donations following a natural disaster.

To evaluate the relative safety of blood donations given in response to a major disaster, donor demographics and infectious disease test results were compared for donations made during the 10 days following the October 17, 1989, San Francisco Bay Area earthquake and those made during the preceding 6 months. These comparisons were made for donations given to the regional blood center in the area that was immediately affected by the disaster (Irwin Memorial Blood Centers) and for those given in an unaffected region (Los Angeles/Orange Counties Region, American Red Cross Blood Services). The rate of donation increased more than 200 percent during the 5 days following the earthquake in both the disaster-affected and unaffected regions. Both the disaster-affected and unaffected regions observed significant increases in the proportions of donations by first-time donors, by persons aged 20 to 39 years, and by women. The rates of confirmed positivity for infectious disease markers for post-earthquake donations did not differ significantly from rates for homologous donations given during the preceding 6 months, particularly when the rates were adjusted for the increased representation of first-time donors. Approximately 39 percent of post-earthquake first-time donors gave blood again within the following 6-month period. It is concluded that donations given after major disasters are essentially as safe as routine donations and that active efforts to recruit these donors again can be undertaken without reservation.

Blood Banks↗
PubMed1990

Interrelationships between serologic markers of immune activation and T lymphocyte subsets in HIV infection.

Relationships among four serologic activation markers and T cell subsets were measured in HIV-seropositive former blood donors (N = 64) and seronegative controls (N = 61). Significant correlations were observed for the HIV group in pairwise comparisons of soluble IL-2 receptor (sIL-2R), beta 2-microglobulin (beta 2M), neopterin (NEOP), and soluble CD8 (sCD8). CD4 cell levels (number/microliter) in the HIV group showed significant negative correlation with all four serologic markers; CD8 cell levels, in contrast, showed no significant correlation with any serologic activation marker measured. Significant correlations were observed, however, among various cell surface activation markers and serologic activation markers. Specifically, the proportion of CD8 cells expressing CD45RA showed significant negative correlations with NEOP and B2M levels, whereas the proportion of CD8 cells expressing HLA-DR showed significant positive correlations with B2M and sIL-2R levels. Further, the proportion of CD8 cells expressing CD38 showed significant positive correlations with all four serologic activation markers. These findings indicate that sIL-2R, B2M, NEOP, and sCD8 show similar quantitative changes and correlational relationships to CD4 cell destruction in HIV infection; they differ, however, in their relationships to proportional changes in activated CD8 cell subsets.

Antigens, CD↗
PubMed1990

The significance of HIV-1-indeterminate western blot results in blood donor populations.

Until recently it has been difficult to counsel blood donors with human immunodeficiency virus-1 (HIV-1)-indeterminate Western blot results due to a lack of information concerning the significance of this finding. Reports from several investigators have provided laboratory, epidemiologic, and prospective follow-up data that have clarified the potential significance of this laboratory finding. It has been established that the band patterns observed in an HIV-1-indeterminate Western blot result are important in predicting the significance of the result; specifically, the absence of p24 or envelope glycoprotein reactivity has not been associated with HIV-1 infection, whereas the presence of p24 reactivity has infrequently been the first sign of HIV-1 seroconversion. These data provide the basis for formulating policies concerning the notification and counseling of blood donors with HIV-1-indeterminate Western blot patterns.

Blood Donors↗
PubMed1988

Soluble IL-2 receptor levels in serum from blood donors seropositive for HIV.

Serum levels of soluble IL-2R (sIL-2R) were measured in blood donors seropositive for HIV. Approximately one-half (53/101) of these seropositive donors exhibited increased serum sIL-2R levels compared with seronegative controls (n = 65). Further, a significant inverse correlation was observed between serum sIL-2R levels and CD4 cell levels in seropositive study participants. These findings suggest that increased serum sIL-2R levels in HIV infection may be linked to CD4 cell loss, and thus reflective of the stage of HIV-induced disease.

Blood Donors↗
PubMed1986

Anti-HTLV III ELISA and Western blot testing in a blood donor population: implications for donor notification.

We have evaluated the western blot (WB) test for distinguishing anti-HTLV III ELISA-positive donors who have likely been exposed to HTLV III from those that are false positives. Of 1,955 donors, 26 were positive for anti-HTLV III by ELISA testing. Only 6 (23%) were positive by WB: 5 of these 6 were male homosexuals with multiple partners and 5 of 6 had low Th/Ts ratios. The WB-positive donors gave the highest absorbance values in the anti-HTLV III ELISA assay. The immunologic abnormalities in the WB-positive donors suggest that they should be notified of their test results. We conclude that basing a donor notification policy on WB results is the optimum public health strategy for blood banks at the present time.

Antibodies, Viral↗
PubMed1985

Influence of racial background on the distribution of T-cell subsets and Leu 11-positive lymphocytes in healthy blood donors.

As part of a study to define the factors affecting the distribution of lymphocyte subpopulations in healthy blood donors, we have measured lymphocyte surface markers in various racial groups. Markers tested were T3 (all T cells), T4A (T helper cells), T8 (T suppressor cells), and Leu 11 (natural killer cells). Racial groups included three Asian groups (Chinese, Japanese, Other Orientals) and three non-Asian groups (Caucasians, Hispanics, American Blacks). The mean percentage of T3 + cells and T4A + cells were significantly lower in Asians compared with non-Asians, while T8 levels did not differ. These changes resulted in a significantly lower mean T4A:T8 ratio in Asians compared with non-Asians. The mean percentage of Leu 11 + cells was higher in Asians compared with non-Asians. Within the Asian group, Chinese had a higher mean Leu 11 + value than the other two Asian groups combined. Further, pairwise comparisons showed that Chinese had a significantly higher mean Leu 11 + value compared with each of the other five racial groups. This increased mean Leu 11 + level in the Chinese group reflected a distinct cluster of high values for about half the subjects. These findings show that racial background should be a major consideration when defining the normal range for lymphocyte subpopulations detected by surface markers.

Adult↗
PubMed1985

Distinctive lymphocyte subpopulation abnormalities in patients with congenital coagulation disorders who exhibit lymph node enlargement.

The majority of patients with congenital clotting disorders who use clotting factor concentrate exhibit lymphocyte subpopulation abnormalities. A subset of these patients develop lymph node enlargement (LNE), part of the spectrum of clinical disease associated with the acquired immune deficiency syndrome (AIDS). It is therefore important to determine if these patients with LNE exhibit specific immune alterations suggestive of early infection with the AIDS agent. We used one- and two-color immunofluorescence to distinguish the lymphocyte subpopulation alterations associated with concentrate use from those associated with LNE. Patients who use concentrate had elevated levels of Leu-2+ (T suppressor phenotype) cells and Leu-7+ (phenotype of some natural killer) cells. These increased levels were largely caused by a dramatic (2.6-fold) increase in the number of lymphocytes co-expressing Leu-2 and Leu-7 (2+7+). A dose-response effect between amount of concentrate infused during the preceding year and level of 2+7+ cells was observed. Concentrate recipients, as a group, also showed increased levels of T cells expressing Dr antigen (T+Dr+ phenotype, characteristic of activated or immature T cells) and cells expressing the T10 antigen (phenotype of some null cells and activated/immature T cells). Patients with LNE showed a further increase in T10+ cells as well as a distinctive decrease in Leu-3+ (T helper phenotype) lymphocytes. All LNE patients exhibited either low Leu-3+ levels, high T10+ levels, or both. Thus, concentrate use was associated with increased levels of Leu-2+ (particularly 2+7+) cells and T+Dr+ cells, whereas LNE was associated with decreased levels of Leu-3+ cells and high levels of T10+ cells.

Acquired Immunodeficiency Syndrome↗
PubMed1984

Positive direct antiglobulin tests and immune hemolytic anemia in patients receiving procainamide.

To characterize the autoimmune phenomena in patients receiving procainamide, we studied the prevalence of positive direct antiglobulin (Coombs') tests and immune hemolytic anemia in 100 such patients and compared them with 100 age-matched and sex-matched controls. There was a significant increase in the frequency of positive direct antiglobulin tests in patients receiving procainamide (21 vs. 10 per cent, P = 0.05). The mechanism of red-cell sensitization in patients receiving procainamide was the production of red-cell autoantibody, which was serologically indistinguishable from that seen in warm autoimmune hemolytic anemia. In contrast, positive direct antiglobulin tests in control patients were due to the presence of complement components. Red-cell autoantibody production secondary to procainamide was not correlated with a higher-than-expected frequency of antinuclear antibodies or the clinical syndrome of drug-induced lupus erythematosus. In the series of 100 patients receiving procainamide, we identified three cases of immune hemolytic anemia. In two of the three cases, the anemia resolved after the medication was discontinued and did not require steroid therapy. We conclude that procainamide often results in the production of red-cell autoimmune phenomena.

Aged↗
PubMed1982

Use of lymphoplasmapheresis or plasmapheresis in the management of acute renal allograft rejection.

Several recent reports have documented the value of intensive plasmapheresis as an adjunct to standard immunosuppressive therapy for patients suffering acute renal allograft rejection. We have treated four rejection episodes in three patients with intensive plasmapheresis and two rejection episodes in two additional patients with intensive lymphoplasmapheresis. Five of six rejection episodes were reversed, and four of the five patients treated have retained functioning grafts for follow-up periods ranging from 4 months to 3 years. Previous investigators have reported encouraging results using plasmapheresis, and we believe our experience supports the requirement for further controlled studies with this procedure. Moreover, we note that no previous work has been described with lymphoplasmapheresis and suggest that removal of lymphocytes, in addition to plasma, may further augment immunosuppression in the treatment of renal allograft rejection.

Acute Disease↗