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A case report of discolored anterior primary teeth is presented. Medical history and clinical findings suggest an etiology of hemolytic anemia and jaundice secondary to ABO blood group incompatibility. There are no previous reports of tooth discoloration resulting from ABO blood group incompatibility.
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Samples of maternal and fetal blood from 32 cases of placental intervillous thrombosis have been analysed for blood group incompatibility and compared to a control group of 21 cases. No overall link has been demonstrated between intervillous thrombosis and ABO incompatibility. Red cell antibody reactions of all types probably account for only a small proportion of thrombi and it is suggested that the principle mechanism may be a thromboplastin release from the damaged vasculo-syncytial membrane, causing a coagulation of the mixed maternal and fetal cells.
The immunization with incompatible blood groups substances of the ABO system yielded distinct increases in the isohemagglutinin titers and their scores in 16 patients suffering from systemic sclerosis (scleroderma) and in 16 controls. The difference between these two groups was not statistically significant, which suggests an intact humoral immunological reactivity of these antigens. However, investigations with further antigens would be necessary to judge the immunological factors supposed to be involved in the pathogenesis of systemic sclerosis. The method may be recommended for testing the humoral immunological response in similar problems.
PURPOSE: To examine the development during the past 30 years of diagnostic and therapeutic procedures in pregnancies with blood group incompatibility. PATIENTS AND METHODS: We evaluated 193 pregnancies with maternal red blood alloimmunisation treated at our hospital. At least one amniotic fluid spectrophotometry was performed. RESULTS: We observed a reduced average age of the patients, a reduced parity and an increase in the number of amniotic fluid examinations per pregnancy in the course of time. Amniotic fluid examinations tended to be performed earlier in pregnancy. Gestational time was reduced, the rate of spontaneous vaginal deliveries remained unchanged. The proportion of anti-D-alloimmunisation decreased in relation to other antigens and the severity of the cases increased (assessed according to the findings of the spectrophotometric amniotic fluid examinations performed while using the semiquantitative method of Liley). The haemoglobin values of the newborn, without intrauterine transfusions, were unchanged and the number of intrauterine deaths decreased. The rate of postnatal transfusions decreased dramatically, whereas the rate of phototherapeutic approaches increased. CONCLUSION: The spectrum of the antigens causing fetal haemolytic disease has changed during the last 30 years and so have the diagnostic and therapeutic procedures.
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OBJECTIVE: To compare incidence, severity, and treatment of jaundice in ABO-compatible and -incompatible infants. DESIGN: Retrospective chart review. SETTING: A 340-bed acute-care public and teaching hospital. PATIENTS OR OTHER PARTICIPANTS: All infants with blood groups A or B delivered in 1990 by Rh-positive mothers with blood group O. On direct antiglobulin testing 65 infants had positive and 78 had negative results. The control group comprised 78 infants with blood group O born to mothers of blood group O. INTERVENTION: None. RESULTS: Infants who were ABO-incompatible and showed positive results to the direct antiglobulin test had the highest incidence of jaundice and underwent more tests and phototherapy. Infants who showed negative results to the direct antiglobulin test had jaundice incidence rates between those seen for control infants and infants who tested positive. Mean peak bilirubin levels did not differ significantly among the groups. CONCLUSION: Incompatibility of ABO blood group is associated with an increased incidence of jaundice and higher phototherapy rates. Clinicians should continue to be concerned about possible ABO incompatibility in infants with jaundice born to mothers with blood group O.
In contrast to solid organ transplantation (SOT), ABO-histo blood group incompatibility is of minor importance for hematopoietic stem cell transplantation (HSCT). Patients receiving ABO-incompatible HSCT are at an increased risk for immune-mediated hematological complications including immediate and delayed hemolysis, late red blood cell engraftment and pure red cell aplasia, but seem not to have a worse overall survival or increased transplant-related mortality. This review gives an overview of the immunological mechanisms leading to complications associated with ABO-incompatible HSCT and describes approaches to prevent them. The current organ shortage in SOT stimulates the exploration of new strategies to expand the donor pool including ABO-incompatible SOT and xenotransplantation. Here, we discuss the hypothesis that ABO-incompatible transplantation may be viewed as a human in vivo model for the humoral immune mechanisms of antigen-mismatched transplantation. ABO-incompatible HSCT and SOT provide excellent possibilities to analyze graft accommodation and transplantation tolerance. Understanding the underlying mechanisms of graft survival in ABO-incompatible transplantation may facilitate new strategies to overcome the immunological barriers in SOT and xenotransplantation.
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BACKGROUND: For most organ transplantation (Tx), ABO blood group incompatibility (ABOI) is an absolute contraindication because of the high incidence of hyperacute rejection (HAR). While HAR occurs in ABOI liver Tx (LTx), it is known that some liver grafts can be accepted. METHODS: ABO-incompatible (ABOI) liver allografts were used in seven of 355 orthotopic LTx operations performed at our institution over a 10-year period. All seven recipients were in fulminant hepatic failure (FHF) prior to Tx. RESULTS: Following Tx, all grafts functioned immediately. One patient died without recovering consciousness. Six patients recovered consciousness following Tx but three patients subsequently required re-transplantation (with ABO-compatible grafts (ABOC)) because of severe acute rejection (2) and chronic rejection (1). Hyper-acute rejection did not occur. All six patients are now well, with a mean survival of 61.5 months. When compared to 36 other FHF patients who received ABOC grafts, graft survivals were 3/7 (43%) for ABOI versus 23/36 (64%) for ABOC (P = not significant (NS)). Patient survivals were 6/7 (85.7%) for ABOI patients and 23/36 (64%) for ABOC (P = NS). The re-transplantation rate was significantly higher in the ABOI group (P = 0.001). CONCLUSIONS: The results confirm that ABOI liver grafts should be used in urgent circumstances when compatible grafts are not available. Some grafts function indefinitely, while those that fail may function for sufficient time to allow successful retransplantation with ABOC grafts.
ABO blood group substances were determined in either the seminal plasma (male patients) or saliva of 100 infertile couples and 100 control subjects. Comprehensive infertility evaluation was performed in all patients. Results were analysed in groups of couples with respect to their ABO blood group and compared with fertile control subjects. Over 70% of fertile marriages were compatible. Comparison of infertile and fertile couples for either ABO compatibility or incompatibility did not reveal any statistically significant difference (P greater than 0.05). This suggests some measure of low zone tolerance to ABO antigens on spermatozoa, for only a small minority of sperm introduced during coitus gains access to the oviduct and ultimately to the peritoneal cavity.
OBJECTIVE: Cryopreserved valved homograft has become the conduit of choice for right ventricular outflow tract reconstruction in pediatric cardiac surgery. Aortic homografts have been frequently used in pulmonary position, but accelerated aortic homograft fibrocalcification may occur. Blood group incompatibility between receiver and homograft donor may play a central role in this context. METHODS: Between 1993 and 2000, 59 children (mean age 6.4 +/- 4.4 years) received cryopreserved valved homografts for right ventricular outflow tract reconstruction and were followed from 2 to 10 years clinically, with echocardiography and chest radiography for detection of development of homograft calcifications. Seventeen patients were 3 years or younger. Fifty aortic (85%) and 9 pulmonary homografts were all used in pulmonary position. Thirty-three patients (56%) had the same blood group (ABO) as the homograft donor (iso group), and 26 were blood group-incompatible (non-iso group). RESULTS: No deaths occurred during follow-up. Six patients (10.2%) required homograft replacement because of severe fibrocalcifications, and another 3 showed moderate homograft calcifications (5.1%) at last examination. Freedom from moderate to severe homograft calcification at 8 years (Kaplan-Meier) was 95.2% for the iso group and 72.9% for the non-iso group (P <.0001). Homograft calcifications occurred within 2 years of implantation in 6/9 patients (67%) in the non-iso group. CONCLUSIONS: Blood group incompatibility between receiver and homograft donor seems to play an important role in the development of accelerated fibrocalcifications in cryopreserved homografts, particularly in the very young (3 years old or younger). Blood group compatibility should therefore be respected to avoid accelerated homograft fibrocalcifications.
A 47-year-old patient with blood group O inadvertently received a mismatched kidney from a donor of blood group A. Two days after transplantation, the clinical, biochemical manifestation of an intrarenal, intravascular coagulation was seen. This was treated by plasma exchange with the rapid reversal of all parameters, and reduction of both the IgG and IgM component of the circulating anti-A antibody. The patient, 20 months after transplantation, has normal renal function. Subsequent repeated biopsies have shown no recurrence or manifestation of the effects of the intravascular coagulopathy. This case report documents, for the first time, the reversal of the known deleterious effects of major blood group incompatibility on renal transplantation by the use of a new technique, modified plasmapheresis. Furthermore, it implies that the limitation of transplantation of kidneys on the basis of major ABO blood groups may not be justifiable in all instances.
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The antigens present in a gastric tumor obtained from a patient of blood group p,O,Le(a-,b+) were studied. The neutral glycolipids were isolated from the cancer tissues and characterized chemically and immunologically. The glycolipid pattern of the tumor was similar to that of the surrounding uninvolved mucosae. The major neutral glycolipids were found to be glucosylceramide, galactosylceramide, lactosylceramide, and the lacto series glycolipids, including the H, Lea, and Leb active fucolipids. The cancer tissues and the uninvolved mucosae did not contain galabiosylceramide, globotriaosylceramide, or globotetraosylceramide after separations by both thin layer chromatography and gas-liquid chromatography. Thin layer chromatography immunostaining was performed to detect incompatible blood group antigens. Immunostaining revealed the presence of globotriaosylceramide, globotetraosylceramide, Forssman glycolipid, and A active glycolipids in the cancer tissues. These incompatible blood group active glycolipids were absent from the uninvolved mucosae. The results indicate that the cancer tissues possess the ability to produce the globo series of glycolipids and the A active antigens but that the surrounding uninvolved mucosae could not synthesize these glycolipids.
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