Seroprevalence of anti-Helicobacter pylori and anticytotoxin-associated gene A antibodies [corrected] according to ABO blood groups and rhesus status among hemodialysis patients

INTRODUCTION

Correlation between Helicobacter pylori infection and blood group typing has been widely evaluated in both patients and healthy population. However, data addressing this correlation in hemodialysis patients are scarce. The aim of this study was to evaluate the prevalence of anti-Helicobacter pylori and anticytotoxin-associated gene A (anti-Cag A) antigen antibodies and their correlations with ABO blood groups and rhesus blood group status in hemodialysis patients. MATERIALS AND METHODS; In a cross-sectional study, serum samples of 151 hemodialysis patients were tested for anti-Helicobacter pylori IgG antibody. Anti-Cag A antibody (IgG antibody) was tested in Helicobacter pylori-positive patients. ABO blood groups typing and rhesus status were tested by hemagglutination test.

RESULTS

Prevalence of anti-Helicobacter pylori and anti-Cag A antibodies in Helicobacter pylori-positive patients were 65.6% (99 of 151) and 25.3% (25 of 99), respectively. Prevalence of anti-Helicobacter pylori and anti-Cag A antibodies were 69.1% and 36.8% in patients with blood group A, 42.3% and 9.1% in blood group B, 75.0 % and zero in blood group AB, 69.4% and 23.3% in blood group O, 59.0% and 30.6% in rhesus-positive status and 89.7% and 11.5% in rhesus-negative status, respectively. There was a significant correlation between the presence of anti-Helicobacter pylori and anti-Cag A antibodies and rhesus status, but no significant relation between ABO blood groups and anti-Cag A antibodies were found.

CONCLUSIONS

Rhesus status may have an impact on the presence of anti-Helicobacter pylori and anti-Cag A antibodies. More investigations to address this correlation are necessary.

ABO blood groups and malaria related clinical outcome

OBJECTIVES

The study was undertaken to correlate the blood groups and clinical presentations in malaria patients and to understand the differential host susceptibility in malaria.

METHODS

From October 2007 to September 2008, malaria positive patients' samples were evaluated in this study. Hemoglobin, total leukocyte count, and platelet count of each patient were done on an automated cell counter. After determining the blood groups, malarial species and the severity of clinical course were correlated.

RESULTS

A total of 100 patients were included in the study, of which 63 cases were positive for Plasmodium falciparum and 37 cases were positive for P. vivax infection and 11 patients had mixed infection. The results of the blood groups showed 22 - 'A' group, 42 - 'B' group, 35 - 'O' group and 1 was 'AB' group. When the clinical courses between different groups were compared using the following parameters for severe infection--a parasitic load of >10/1000 RBCs, severe anemia with hemoglobin < 6 g%, platelet count of <10,000/mm3, hepato or splenomegaly or clinical signs of severe malaria such as fever >101°F and other organ involvement, it was observed that 'O' group had an advantage over other the groups. The difference in rosetting ability between red blood cells of different 'ABO' blood groups with a diminished rosetting potential in blood group 'O' red blood cells was due to the differential host susceptibility.

CONCLUSION

'O' group had an advantage over the other three blood groups. Based on literature and the results of this study, the diminished rosetting potential in blood group 'O' red blood cells is suggested as the basis for the differential host susceptibility.

Recipient outcomes after ABO-incompatible liver transplantation: a systematic review and meta-analysis

Background

ABO-incompatible live transplantation (ILT) is not occasionally performed due to a relative high risk of graft failure. Knowledge of both graft and patient survival rate after ILT is essential for donor selection and therapeutic strategy. We systematically reviewed studies containing outcomes after ILT compared to that after ABO-compatible liver transplantation (CLT).

Methodology/Principal Findings

We carried out a comprehensive search strategy on MEDLINE (1966–July 2010), EMBASE (1980–July 2010), Biosis Preview (1969–July 2010), Science Citation Index (1981–July 2010), Cochrane Database of Systematic Reviews (Cochrane Library, issue 7, 2010) and the National Institute of Health (July 2010). Two reviewers independently assessed the quality of each study and abstracted outcome data. Fourteen eligible studies were included which came from various medical centers all over the world. Meta-analysis results showed that no significantly statistical difference was found in pediatric graft survival rate, pediatric and adult patient survival rate between ILT and CLT group. In adult subgroup, the graft survival rate after ILT was significantly lower than that after CLT. The value of totally pooled OR was 0.64 (0.55, 0.74), 0.92 (0.62, 1.38) for graft survival rate and patient survival rate respectively. The whole complication incidence (including acute rejection and biliary complication) after ILT was higher than that after CLT, as the value of totally pooled OR was 3.02 (1.33, 6.85). Similarly, in acute rejection subgroup, the value of OR was 2.02 (1.01, 4.02). However, it was 4.08 (0.90, 18.51) in biliary complication subgroup.

Conclusions/Significance

In our view, pediatric ILT has not been a contraindication anymore due to a similar graft and patient survival rate between ILT and CLT group. Though adult graft survival rate is not so satisfactory, ILT is undoubtedly life-saving under exigent condition. Most studies included in our analysis are observational researches. Larger scale of researches and Randomized-Control Studies are still needed.

[Advancement in the preparation of red cell concentrates and platelet concentrates]

Both Japan Society of Blood Transfusion and Cell Therapy and Japan Society of Anesthesiologists have made a "Guideline of Management at Critical Bleeding in the Operating Room" in 2007. Since 2008, Japan Red Cross Blood Center (JRC) introduced leuko-reduction filter and diversion technique to prevent bacterial contamination. This improvement can easily introduce ABO compatible transfusion at critical situation. We proved the safety of transitional anti-A, anti-B antibody at compatible transfusion. 1) anti-A, anti-B antibody of leuko-reduced red cell concentrates (RCC-LR): Due to 90% plasma removal by centrifugation, antibody titer of anti-A, anti-B antibodies in RCC-LR is less than 2 times dilution. This level of antibodies does not cause hemolysis when more than 100 compatible ABO mismatch RCC-LR bags transfused at once. 2) Neutralization of ant-A, anti-B antibody due to A, B substance containing patient's plasma: ABO blood type is composed by glucan antigen, and it is contained in the plasma, saliva and many organs. When ABO incompatible transfusion has been done, transitional anti-A, anti-B antibodies are neutralized by A, B substances. Our experiment showed neutralizing titer 64 times equal volume of ABO incompatible plasma. 3) Anti-A, anti-B antibody titer of Fresh Frozen Plasma (FFP) and Platelet Concentrates (PC): With ABO mismatch transfusion, FFP and PC do not contain incompatible red cells at all. Therefore, the risk of hemolysis will be caused by transitional anti-A, anti-B antibodies. Both with PC and FFP, anti-A, anti-B antibodies keep normal level (average: 16 times dilution). The safe volume of ABO mismatch PC and FFP administration has limited within 3 liters. When such mismatch transfusion necessarily performed, hydration therapy to protect kidney function should be applied immediately after hemostasis. 4) Red Cell Volume in a PC bag: PC in Japan have processed by single donor apheresis alone since 2004. Our results showed that each PC bag contains less than 5 mm(-3) of RBCs. If this level of RBCs caused hemolysis in ABO mismatch patient, it is too small to cause DIC or renal failure.

Kidney transplantation--a 46-year experience from the Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden

The limiting factor in organ transplantation is the availability of organs. Ongoing work to improve donation rates both at the public and the organizational level in donating hospitals is essential. We also think that encouragement of live donation is important, and the possibility of ABO incompatible transplantation has increased the number of LD transplantations. The one-year graft survival rate is excellent and focus has shifted towards achieving long-term results to reduce the attrition rate. There is also an increasing interest in studying and working to reduce comorbidities on a long-term basis and thus, improve survival rates and recipient quality of life.

Kidney transplantation at Tokyo Women's Medical University

The first case of kidney transplantation at our institution was carried out in 1971, and this first renal transplant recipient is still living with a functioning kidney. From 1971 through the end of 2011, more than 3000 cases of kidney transplantation have been carried out at our institution. Since 1983, cyclosporine-based immunosuppression has been employed at our center. During this period, most of the patients were treated with cyclosporine- or tacrolimus-based immunosuppression. The latest outcomes of kidney transplantation seem to have significantly improved compared to earlier periods. Since 2000, 10 year-graft survival is more than 90% in living donor kidney transplantation and 82% in deceased donor kidney transplantation. To resolve the serious problem of donor organ shortage, expansion of the donor pool by various options such as transplantation using extended criteria donation, donation after cardiac death, ABO-incompatible (ABO-ILKT) donors, or crossmatch-positive donors, has been carried out at our institution over the last decade. We performed the first case of ABO-ILKT in 1989, and have performed more than 400 cases at our institution as of 2011. We will describe our experience of kidney transplantation, including ABO-ILKT, sensitized recipients, pathological analysis, pediatric renal transplantation, laparoscopic donor nephrectomy, and recurrent glomerulonephritis. The data shows good outcomes, however, we still have many issues to resolve to improve long-term renal transplant outcome and to reduce complications.

Eight years of outcomes of the Dutch Living Donor Kidney Exchange Program

In January 2004, the Dutch transplant centers agreed on a protocol for a national Living Donor Kidney Exchange Program for ABO blood type incompatible and positive cross match donor-recipient pairs. Here, we report the results of that program. All transplants performed within the Living Donor Kidney Exchange Program between January 2004 and December 2011 were analysed. We collected demographic data of recipients and donors. Univariate and multivariate Cox proportional hazard analyses were performed, including recipient age, donor age, and reason for participation in the exchange program. We studied overall uncensored survival and graft survival censored for death in both ABO blood type incompatible and positive cross match groups. We enrolled 472 donor-recipient combinations, consisting of 269 ABO blood type incompatible pairs and 203 positive cross match pairs. In the end, we performed 187 kidney transplants (40% of those enrolled) with 83 ABO blood type incompatible and 104 positive cross match pairs. Most of the transplanted recipients (119/187, 64%) had an age difference of less than 5 years with their original incompatible donors. The age differences with their actual donors varied widely, but the number of recipients with a donor > 5 years older was comparable to the number of recipients with a donor > 5 years younger. In the multivariate Cox analysis, age as a continuous variable was found to have a significant influence on graft failure. Nevertheless, the 5-year uncensored survival (85%) and the graft survival censored for death (89%) were excellent and comparable to the results of direct living donation. No differences were found between the ABO incompatible and the positive cross match groups. The Dutch Living Donor Kidney Exchange Program has a high transplant rate of 40%, with excellent 5 year graft survival.

[Clinical study of blood type A donor liver transplantation in type O recipients]

OBJECTIVE

To study the clinical effect and feasibility of blood type A donor liver transplantation in blood type O recipients.

METHODS

The clinical data were analyzed in 6 blood type O patients receiving transplantation of the liver grafts from blood type A donors. The clinical effect and outcomes of the transplantations were evaluated to assess the feasibility of ABO incompatible liver transplantation between type A donors and type O recipients.

RESULTS

The operations and the postoperative recovery were smooth in all the 6 recipients. Only one patient died 5 months postoperatively due to liver tumor metastasis, and the other 5 patients survived with the longest survival reaching 14 months. Acute graft rejection occurred in one patient 1 week after the operation on account of abnormally elevated serum bilirubin level, which was successfully managed with immediate methylprednisolone therapy. No such complications as acute graft rejection, bile duct stenosis or bile leakage was found in the other patients.

CONCLUSION

Blood type A donor liver transplantation in type O recipient is feasible in emergency or other special conditions.

Composition of erythrocytic (ABO, Rh-Hr, Kell, MN) group antigens characteristic of the Ozurgeti district's population

Erythrocytic group antigens represent a genetically stably determined trait. Investigation of antigens of the said system in different regions is of the greatest importance in terms of both the creation of demographic data of the region as well as practical medicine, especially for transplantology and transfusiology. The peripheral or venous blood of 232 local natives (healthy donors) of Ozurgeti district of Guria region has been taken as the test subject. The test subject was taken by random methods in different vilifies (Bakhvi, Mshvidobauri, Ozurgeti, Likhauri, Gurianta, Bokhvauri, Dvadzu, Pampaleti) To identify the ABO, Rh-Hr, Kell, MN system antigens, an express-method using monoclonal antibodies has been applied. In studying the ABO system, it was fixed that the highest distribution frequency was characteristic of the 0(I) group (52.3±3.2%), then follows the group A(II) (38.5±3.2%). The distribution frequency of the B(III) group is (8.2±1.8%) and that of AB(IV)--(0.8±0.5). The population's 85.2±2.32% is the carrier of the Rh+ phenotypic group, while 14.7±2.3% belongs to the Rh-phenotypic group. In studying the concentration of alleles, the low concentration of p(K) allele was detected that equaled 0.2; the concentration of q(K) allele made 0.8, that of p(M)--0.65, and that of q (N) - 035.

[Serologic characteristics and population distribution of subtypes B2 and AB2 of ABO blood group]

This study was aimed to investigate the serologic characteristics, genetic background and population distribution of B2 and AB2 subtype in Chinese ABO blood group. The classic blood group serological technology was used to detect ABO blood group of the propositus and their family members, the anti-B1 serum prepared by yourself was used to investigate the distribution of B1/B2 and AB1/AB2 subtype of the blood donor. The results indicated that the antigen of propositus was AB2 subtype and that of his child was B2 subtype. The anti-B1 antibody was detected in blood serum of propositus; the antigen of 3 from 2318 blood donors with B blood group were found to be B2 subtype, the antigen of 2 from 826 blood donors with AB blood group were found to be AB2 subtype. The investigation on propositus and the 3 B2 blood donor families showed that B2 antigen displays genetic characteristics of blood group. It is concluded that B2/AB2 subtype is from family inheritance, while B2 subtype is amounted to 0.129% in B blood group, and AB2 subtype is amounted to 0.224% in AB blood group.

Imbalance in A₂ and A₂B phenotype frequency of ABO group in South India

BACKGROUND

The heterogeneity of A and B alleles results in weak variants of these antigens. Subgroups of A differ from each other quantitatively and qualitatively. The expected frequencies of A₁ and A₂ subtypes will be in Hardy-Weinberg equilibrium for the Mendelian inheritance of the allelic A₁ and A₂ genes. The frequency of A subgroups in the population from south India is not known. The aim of our study was to study the frequency of A subtypes and the prevalence of anti-A₁ antibody among this population.

METHODS

Over a period of 3 years, patients' blood group was typed using a standard tube technique. Anti-A₁ lectin studies were done for all patients with groups A and AB. Based on serological reactivity the samples were classified into A₁/A₁B, A₂/A₂B and weak A subgroups. The prevalence of A subgroups was determined. The significance of differences in proportions was analysed using the chi-square test.

RESULTS

A total of 40,113 patients' samples were typed for ABO, Rh group and A subgroups in our blood bank attached to a tertiary care hospital. Among 10,325 group A samples, 98.14% classified as A₁, 1.07% as A₂, and 0.01% as weak A; the remaining group A samples were from neonates and reacted poorly with anti A₁-lectin. The majority of AB samples (n=2,667) were of A₁B type (89.28%). However, the proportion of A₂B (8.99%) among AB samples was significantly higher than that of A(2) in group A samples (p < 0.0001). The prevalence of anti-A(1) antibodies among A₂ and A₂B samples was 1.8% and 3.75%, respectively, and none of them showed reactivity at 37°C.

CONCLUSION

The results of our study show a significantly higher proportion of A₂B subtypes than A₂ subgroups. A similar imbalance is seen in blacks and Japanese. The incidence of anti-A₁ antibodies is also higher among A₂B patients.

Liver transplantation with ABO incompatible graft under immunoadsorption protocol--case report

BACKGROUND

ABO incompatible liver transplantation is still controversial, but accepted in selected cases. Recently several authors reported use of the new technology aimed at elimination anti-donor ABO specific hemagglutinins to assist immunosuppression in preventing acute rejection after transplantation.

CASE REPORT

We report two cases of liver transplantation in children with ABO incompatible graft under immunoadsorption protocol. Both patients were transplanted urgently (one due to acute decompensation of chronic liver failure and second due to acute liver failure) with ABO incompatible liver grafts. Both patients were in very poor general condition with deterioration of neurological status and there were no suitable ABO compatible grafts at the time. In both cases immunosuppressive protocol consisted of induction with basiliximab, followed by tacrolimus, mycophenolate mofetil and corticosteroids. Additionally in both patients 3 immunoadsorption sessions with Glycosorb ABO® system (Glycorex AB, Sweden), were performed. There were no any acute rejection episodes till now. The only problem observed after transplantation was mild anemia due to low grade hemolysis in the postoperative period. Both patients are alive and well with very good liver function 20 and 26 months after transplantation.

CONCLUSIONS

Immunoadsorption therapy can be safely and effectively introduced in recipients of ABO incompatible donor liver.

International collaborative study to establish reference preparations to standardise haemagglutination testing for anti-A and anti-B in normal intravenous immunoglobulins by the direct method

A joint project (coded BSP089) was run by the European Directorate for the Quality of Medicines & HealthCare (EDQM) of the Council of Europe, the National Institute for Biological Standards and Control (NIBSC) on behalf of the World Health Organization (WHO) and the Center for Biologics Evaluation and Research (CBER) of the U.S. Food and Drug Administration (FDA) to evaluate, in an international collaborative study, 3 lyophilised intravenous immunoglobulin (IVIG) preparations for their suitability to serve as Reference Preparations to standardise and control the highly variable haemagglutination testing for anti-A and anti-B in IVIG products. 23 laboratories tested candidate IVIG reference preparations consisting of a Positive control, a Negative control and a specifically formulated Limit test reference preparation to define the maximum (e.g., pharmacopoeial) limits of anti-A and anti-B haemagglutinins in IVIG products, where limits are applicable. Laboratories performed direct haemagglutination using papain-treated erythrocytes and/or indirect anti-globulin tests. For both methods, there was up to 16-fold variation in anti-A and anti-B titres, although there was good agreement over a 2-fold titre range for anti-A and anti-B between laboratories using the direct method for both the Positive control and Limit reference preparations. Comparative titration data for the Positive control and Limit reference preparations indicated that the use of a 'Limit' test reference preparation would facilitate identification of higher titre batches when the direct haemagglutination method is used. The Positive control, Negative control and Limit test preparations were adopted in November 2008 by the Commission of the European Pharmacopoeia (Ph. Eur.) as Biological Reference Preparations. The same preparations have been established as reference reagents by the WHO and the U.S FDA, including the maximal specifications defined by the Limit test preparation. This will facilitate global standardisation of haemagglutination tests for anti-A and anti-B, ensure that such tests are sufficiently sensitive and specific, and facilitate identification of batches that exceed maximum recommended levels of anti-A and anti-B antibodies.

[What blood tests to predict severe hyperbilirubinemia in early maternity discharge?]

OBJECTIVES

To evaluate the efficiency of blood tests (blood group, direct antiglobulin test) to assess severe hyperbilirubinemia in full-term newborns, delivered from mothers with rhesus negative or O group and to determine clinical and biological factors that may improve the prediction characteristics of this blood test.

PATIENTS AND METHODS

We included all the full-term newborns, delivered from mothers with rhesus negative or O group, in a tertiary maternity ward, in 2005, from January6th to December31st.

RESULTS

One thousand and ninety-two children were included. Newborns of A, B or AB group delivered from a mother 0 were at increased risk of presenting severe hyperbilirubinemia (OR=2.35 [1.22-4.52]). The negative predictive value was 96%. Yet, the determination of the Coombs test does not increase NPV.

CONCLUSION

Systematic performance of blood test for newborns delivered from mother with O group does increase the ability to predict severe hyperbilirubinemia in a newborn infant. Direct antiglobulin test systematic performance remains questionable.

Alternatives for unsuccessful living donor kidney exchange pairs

Living donor kidney exchange has become an efficient solution for recipients with incompatible donors. Here we describe the fate of all patients that were enrolled in our program during 2004-2010.

METHODS

Data on registration, computerized matching, cross matching, and transplantations within or outside the program were collected.

RESULTS

Between January 2004 and December 2010, 422 pairs were registered. To create new combinations a match procedure was run 28 times with a median input of 14 (7-22) new pairs and a median of 55 (16-92) participating pairs. Matches were found for 127/185 (69%) cross match-incompatible pairs and 91/237 (38%) ABO-incompatible pairs. 141 of the 218 matched pairs successfully donated and received kidneys in exchange. There were 77 transplants cancelled for medical or psychological reasons, and an alternative solution was found for 26 of these. So in total 167 (141 + 26) patients received a transplant. Of the remaining 51 cancelled transplants, 26 pairs dropped out, 22 patients found an alternative transplantation outside the program and 3 are still waiting. For the 204 unmatched couples, 46 are still in the program while 34 others dropped out, and 124 found an alternative living kidney donor. After 7 years, 39% of participants received a kidney within the exchange program, 35% were transplanted outside the program, 14% of the pairs were delisted and 12% are still waiting. Among the 146 patients who received a kidney outside the program, 47 were transplanted with a deceased donor kidney, 21 found another donor, 37 received an ABO-incompatible transplant and 41 were transplanted in a domino-paired procedure triggered by an non-directed donor.

CONCLUSION

In the 7 years of our Living Donor Kidney Exchange Program 313/422 (74%) of the participating patients were transplanted. Approximately half of them (167/313, 53%) received a kidney through the exchange program, while 47 (15%) received a deceased donor kidney and 99 (32%) were transplanted through other living donation programs. The exchange program proved to be highly successful not only in its direct results but also indirectly by triggering alternative solutions.

Options for successful renal transplantation in recipients with incompatible living donors: Severance Hospital experience

Exchange donor programs and desensitization protocols are available options for ABO-incompatible and positive cross-match living donor kidney transplantations. Patient and donor blood types, the degree of sensitization, and DSA titers should be considered to achieve successful kidney transplantation in recipients with incompatible living donors. Highly sensitized blood type O patients with ABO-incompatible living donors, or highly sensitized patients with a positive cross-match (with low DSA titer) to their AB donors should be considered for a desensitization protocol as a first priority. Narrowly sensitized patients with a positive cross-match (and high DSA titer) should be considered for an exchange donor program if possible. Patients with positive cross-match O donors can be easily matched and benefit from an exchange program. Exchange donor programs and desensitization protocols are complementary strategies to overcome HLA and ABO antibody barriers.

Maternal IgG anti-A and anti-B titres predict outcome in ABO-incompatibility in the neonate

AIM

To evaluate predictors for risk of severe hyperbilirubinaemia and kernicterus in ABO-incompatible neonates with emphasize on maternal IgG anti-A/-B titres.

METHODS

Blood group O women in labour at Oslo University Hospital, Ullevål, were included in the years 2004-2006. Offspring with blood group A or B had direct antiglobulin test performed and IgG anti-A/-B levels measured in maternal plasma. Blood group A or B infants developing severe hyperbilirubinaemia, received in addition to phototherapy, immunoglobulin treatment and/or exchange transfusion (EXT).

RESULTS

Of 253 neonates, 61.3% had blood group O, 29.6% blood group A and 9.1% blood group B. Twenty neonates with blood group A or B received at least one immunoglobulin treatment. In multivariate analysis, maternal antibody-titres were the only significant predictors for immunoglobulin treatment (p < 0.0001), EXTs (p < 0.05) and duration of phototherapy (p < 0.0001). The need for invasive treatment increased sharply for antibody titres > or =512. Receiver operating characteristic analyses demonstrated that titres > or =512 had a sensitivity of 90% and a specificity of 72% for predicting immunoglobulin treatment and thus severe hyperbilirubinaemia.

CONCLUSION

Maternal IgG anti-A/-B titres contribute to the prediction of risk of severe hyperbilirubinaemia in ABO-incompatible neonates, in addition to blood-grouping and direct antiglobulin-testing, especially following early discharge after delivery.

[Significance of the isoantigen A2 and immune anti-A1 antibodies in transfusiology]

The paper gives data on the frequency of A2 and A2B blood groups in the blood samples of 3590 donors and patients and on the carriage of irregular anti-A1 antibodies. To define the belonging of anti-A1 antibodies to various classes of immunoglobulins, their resistance and temperature optimum, at which the antibodies showed the highest activity, the authors examined the irregular anti-A1 antibodies-containing sera from 43 subjects with A2 and A2B blood groups. The necessity of identifying the carriage of irregular anti-A1 antibodies is determined by the fact that there may be posttransfusion reactions or complications in recipients, the carriers of such antibodies, who are transfused donor red blood cells containing the antigen A1. The risk of the development of such events is particularly great when anti-A1 antibodies are active at 37 degrees C and belong to the IgG class, i.e. they are immune; transfusion to a recipient is carried out during surgery under artificial hypothermia (below 28 degrees C). The red blood cells (A2 or A2B) from a donor having the same group should be selected for recipients having an A2 or A2B blood groups, respectively, and immune anti-A1 antibodies; if the latter are absent, in accordance with the instruction, there may be a selection of other-group donor red blood cells: 0 group red blood cells to recipients with A2 blood group and 0 or B group red blood cells to recipients with A2B blood group. An individual selection should be without fail made for the compatibility of bloods from a donor and a recipient in salt tests (at 4-8, 20-22, and 37 degrees C) and indirect Coombs' test. When plasma components (fresh frozen plasma, native plasma and its concentrate) are transfused to recipients with A2 and A2B blood groups having immune anti-A1 antibodies, one should use the same plasma group--A and AB, respectively.

[Establishment of genotyping method for fetal ABO group from pregnant maternal peripheral blood]

This study was aimed to establish a genotyping method to detect ABO group gene of fetus from peripheral blood of pregnant women for prenatal diagnosis of hemolytic disease of newborn (HDN) resulting from ABO blood group incompatibility. 4 pairs of primers were designed according to ABO blood group gene DNA and mRNA sequences. 20 plasma DNA samples from healthy donors were extracted and amplified to explore the best conditions for plasma DNA extraction and PCR amplification. The O group plasma DNA was mixed with A group or B group plasmas by the ratios of 1:1, 2:1, 4:1, 8:1, 10:1, 20:1, 40:1, 100:1 to simulate the status of mixed ABO gene from pregnant maternal blood and to establish the mixed blood group ABO genotyping technology. The pregnant maternal blood samples with more than 30 weeks of gestation were selected for detecting the fetal ABO blood group genotype. The blood samples should be taken as possible as after birth for identification of ABO blood group and evaluation of sensitivity and accuracy of fetal ABO blood group genotyping technology through peripheral blood of pregnant women. The results indicated that the minimal amount of template DNA from single blood plasma for accuracy identification was at least about 0.625 ng, the DNA amount extracted from 500 microl of plasma could meet the requirement for PCR amplification. When the proportion of O group plasma DNA in mixed plasma DNA was <or=10, the non-O group gene could be accurately detected. Among 14 peripheral blood samples from O-group pregnant women, the non-O group gene was amplified in 9 samples; the non-O group gene was not amplified in 5 samples. The identification of peripheral blood ABO group for 5 newborns using serologic method showed that the A group 3 cases, B group 2 cases, O group 1 case, which consisted with genotyping results with consistent rate 100%. It is concluded that in middle and late pregnancy the fetal ABO group gene can be detected accurately by means of established fetal ABO group gene extraction and typing technology, that provides some guidances for the prenatal diagnosis and prevention of HDN.

The role of antibodies in transplantation

For the past 40 years, T cells have been considered the primary threat to the survival of allografts. However, antibodies can induce severe vascular disease of organ transplants, and this disease, particularly "antibody-mediated" rejection, has become a major clinical challenge. Not only do antibodies cause rejection, the rejection caused by antibodies resists treatment by conventional drug regimens. On the other hand, antibodies can induce a condition in which grafts seemingly resist antibody-mediated injury, which is accommodation. In this communication, we discuss the role of antibodies in the diagnosis and pathogenesis of rejection and accommodation, and suggest what we considered the major gaps in knowledge and directions research into this subject might productively take.

Impacts of papain and neuraminidase enzyme treatment on electrohydrodynamics and IgG-mediated agglutination of type A red blood cells

The stability of native and enzyme-treated human red blood cells of type A (Rh D positive) against agglutination is investigated under conditions where it is mediated by immunoglobuline G (IgG) anti-D antibody binding. The propensity of cells to agglutinate is related to their interphasic (electrokinetic) properties. These properties significantly depend on the concentration of proteolytic papain enzyme and protease-free neuraminidase enzyme that the cells are exposed to. The analysis is based on the interpretation of electrophoretic data of cells by means of the numerical theory for the electrokinetics of soft (bio)particles. A significant reduction of the hydrodynamic permeability of the external soft glycoprotein layer of the cells is reported under the action of papain. This reflects a significant decrease in soft surface layer thickness and a loss in cell surface integrity/rigidity, as confirmed by nanomechanical AFM analysis. Neuraminidase action leads to an important decrease in the interphase charge density by removing sialic acids from the cell soft surface layer. This is accompanied by hydrodynamic softness modulations less significant than those observed for papain-treated cells. On the basis of these electrohydrodynamic characteristics, the overall interaction potential profiles between two native cells and two enzyme-treated cells are derived as a function of the soft surface layer thickness in the Debye-Hückel limit that is valid for cell suspensions under physiological conditions (approximately 0.16 M). The thermodynamic computation of cell suspension stability against IgG-mediated agglutination then reveals that a decrease in the cell surface layer thickness is more favorable than a decrease in interphase charge density for inducing agglutination. This is experimentally confirmed by agglutination data collected for papain- and neuraminidase-treated cells.

[Accomodation process: ABO-incompatible liver transplantation. Report of one case]

We report a 33 year-old female with a diagnosis of halothane-induce fulminant hepatic failure who was subjected to a liver transplant with an ABO-incompatible graft. The patient received a therapeutic protocol that included total plasma exchange, splenectomy and quadruple immunosuppression. After 5 years, the patient remains asymptomatic and with normal liver enzymes, while she has been treated with low dose of immunosuppressive drugs. This case demonstrates an example of how the immunological process of accommodation opens the possibility of using ABO-incompatible organs as a definitive grafts.

Early plasmapheresis and rituximab for acute humoral rejection after ABO-compatible liver transplantation

Acute humoral rejection (AHR) is uncommon after ABO-compatible liver transplantation. Herein, we report two cases of AHR treated with plasmapheresis and rituximab in two ABO-compatible liver-transplant patients with preformed anti-human leukocyte antigen donor-specific antibodies. Patient 1 experienced a biopsy-proven AHR at day 10 post-transplant. She was treated by steroid pulses, and OKT3. Because of persisting signs of biopsy-proven AHR at day 26, she was treated by plasmapheresis and rituximab. Liver enzyme levels did not improve, and she died on day 41. Patient 2 experienced a biopsy-proven AHR on day 10 post-transplant. She was treated by steroid pulses, plasmapheresis, and rituximab. Liver enzymes returned to within normal range 18 d after diagnosis. Liver biopsies, at 3 and 9 mo post-transplant, showed complete resolution of AHR. We conclude that plasmapheresis should be started as soon as AHR is diagnosed, and be associated with a B-cell depleting agent. Rituximab may be considered as a first-line therapy.

Anti-carbohydrate antibodies of normal sera: findings, surprises and challenges

We have used microchip format glycan array to characterize the individual carbohydrate recognition patterns by antibodies (Ab) in sera of 106 healthy donors. The glycan library included blood group antigens and other most frequent terminal oligosaccharides and their cores of mammalian N- and O-linked glycoproteins and glycolipids, tumor-associated carbohydrate antigens, and common components of bacterial/pathogenic polysaccharides and lipopolysaccharides, totally 205 glycans. The serum Ab interacted with at least 50 normal human glyco-motifs. Apart from expected blood group-, xeno- (heterophil) and infection-related binding activities, we observed a number of new and unexpected features. The surprising, relatively high antibody binding was found to the blood group P(1) and P(k) trisaccharides and H(type 2) trisaccharide. Novel and very high binding activities have been observed towards Galbeta1-3GlcNAc (Le(C)) related glycans, especially 3'-O-Su-Le(C), and towards 4'-O-sulfated lactosamine. Relatively high and uniform Ab binding to GalNAcalpha1-3Gal disaccharide demonstrated absence of correlation with fucosylated blood group A GalNAcalpha1-3(Fucalpha1-2)Gal antigen-similarly to well known relationship between Galalpha1-3Gal and true, fucosylated blood group B Galalpha1-3(Fucalpha1-2)Gal antigen. The binding intensity to Galalpha1-3Galbeta1-4GlcNAc xenoantigen was shown to be rather modest. Absence or very low Ab binding was found against oligosialic acid, sialooligosaccharides except SiaT(n), type 2 backbone glycans such as Le(y), and biantennary N-chain as well as its truncated forms, i.e. without terminal Sia, SiaGal, and SiaGalGlcNAc motifs. We have also found that Ab are capable of recognizing the short inner core typical for glycolipids (-Galbeta1-4Glc) and glycoproteins (-GalNAcalpha) as a fragment of bigger glycans.

Placental transfer of tetanus-specific immunoglobulin G in Iranian mothers

OBJECTIVES

To investigate placental transfer of anti-tetanus immunoglobulin (Ig)G antibodies in Iranian mothers.

METHODS

Sera collected from 209 pregnant women and their paired infants were evaluated for tetanus-specific antibodies by a commercial enzyme-linked immunosorbent assay.

RESULTS

In total, 15 (7.2%) out of 209 mothers and 12 (5.7%) out of 209 newborns were negative for anti-tetanus IgG. A highly significant correlation was observed between maternal and fetal anti-tetanus IgG (r = 0.80). The mean cord/maternal blood ratio of anti-tetanus IgG was 1.22 +/- 0.97. The mean cord/maternal blood ratio of anti-tetanus IgG in mothers with blood groups B+ and AB+ was lower than in mothers with other blood groups (p = 0.027). In addition, among mothers who had more than 0.5 IU/ml anti-tetanus IgG, a higher percentage of cases with cord/maternal blood ratio of < 1 was observed in carriers of blood groups B+ and AB+ compared to those with other blood groups (45.2% vs. 41.8%). Parity of more than 4 had a significant negative effect on both frequency of high positive sera and the mean of anti-tetanus IgG level in maternal and neonatal sera.

CONCLUSIONS

A relatively high percentage of pregnant women were not immune against tetanus. It was also found that the main factors that affect infants' tetanus-specific IgG are maternal concentration of this immunoglobulin, parity and maternal blood group.

The alphaGal epitope of the histo-blood group antigen family is a ligand for bovine norovirus Newbury2 expected to prevent cross-species transmission

Among Caliciviridae, the norovirus genus encompasses enteric viruses that infect humans as well as several animal species, causing gastroenteritis. Porcine strains are classified together with human strains within genogroup II, whilst bovine norovirus strains represent genogroup III. Various GI and GII human strains bind to carbohydrates of the histo-blood group family which may be shared among mammalian species. Genetic relatedness of human and animal strains as well as the presence of potentially shared ligands raises the possibility of norovirus cross-species transmission. In the present study, we identified a carbohydrate ligand for the prototype bovine norovirus strain Bo/Newbury2/76/UK (NB2). Attachment of virus-like particles (VLPs) of the NB2 strain to bovine gut tissue sections showed a complete match with the staining by reagents recognizing the Galalpha1,3 motif. Alpha-galactosidase treatment confirmed involvement of a terminal alpha-linked galactose. Specific binding of VLPs to the alphaGal epitope (Galalpha3Galbeta4GlcNAcbeta-R) was observed. The binding of Galalpha3GalalphaOMe to rNB2 VLPs was characterized at atomic resolution employing saturation transfer difference (STD) NMR experiments. Transfection of human cells with an alpha1,3galactosyltransferase cDNA allowed binding of NB2 VLPs, whilst inversely, attachment to porcine vascular endothelial cells was lost when the cells originated from an alpha1,3galactosyltransferase KO animal. The alphaGal epitope is expressed in all mammalian species with the exception of the Hominidaea family due to the inactivation of the alpha1,3galactosyltransferase gene (GGTA1). Accordingly, the NB2 carbohydrate ligand is absent from human tissues. Although expressed on porcine vascular endothelial cells, we observed that unlike in cows, it is not present on gut epithelial cells, suggesting that neither man nor pig could be infected by the NB2 bovine strain.

Spectrum and outcome analysis of marked neonatal hyperbilirubinemia with blood group incompatibility

BACKGROUND

Blood group mismatch between a mother and newborn carries a substantial risk for neonatal hyperbilirubinemia and kernicterus. In the current study, we investigate the spectrum and outcome of marked neonatal hyperbilirubinemia with blood group incompatibility.

METHODS

We retrospectively assessed a cohort of 413 neonates with peak total serum bilirubin (TSB) values > or = 20 mg/dL between 1995 and 2007. Those with a gestational age< 34 weeks, birth weight < 2000 grams or G6PD deficiency were excluded. A total of 83 subjects with blood group incompatibility were enrolled. Neonates with unknown etiology of hyperbilirubinemia (except breast milk feeding) were selected as the controls (n = 168). Kernicterus referred to classic neurological signs after follow up for more than 1 year.

RESULTS

The clinical symptoms of acute bilirubin encephalopathy included apnea (2.4%), tachypnea (6.0%), fever (1.2%), irritability (2.4%), lethargy (4.8%), seizures (1.2%) and poor feeding (19.3%). Hyperbilirubinemia was more severe among babies with Rh incompatibility than those with ABO incompatibility. After double-volume exchange transfusion, the TSB levels significantly decreased from 25.8 3.5 to 17.6 4.0 mg/dL. Using logistic regression analysis, we found neonates with blood group incompatibility more often had a reticulocyte count> 7 %, a hemoglobin value< 13 g /dL and a peak TSB at age< 3 days old than the controls (p < 0.01). Furthermore, kernicterus was more common in neonates with blood group incompatibility (9.8 %) than in the controls (0.0%) (p< 0.01).

CONCLUSIONS

This survey depicts the clinical profiles of babies with marked neonatal hyperbilirubinemia with blood group incompatibility. Neonates with blood group incompatibility often develop early-onset, hemolysis-mediated hyperbilirubinemia. Our findings show they are at great risk of kernicterus.

[Single-stage detection of A and B antigens in the hair by absorption-elution and mixed agglutination techniques]

The proposed method is intended for single-stage detection of A and B antigens in ultrafine hair fragments by means of absorption-elution and mixed agglutination techniques with the use of a mixture of anti-A and anti-B sera.

[Combination of absorption-elution and gel-filtration methods for group identification of blood spot specimens]

It is proposed to combine the traditional method of microscopic assessment of the results of absorption-elution reaction and the gel-filtration technique with the use of the ScanGel immunohematology system (Bio-Rad Laboratories, USA) in blood grouping tests. The study was designed to select monoclonal antibodies suitable for the purpose and optimize conditions of gel filtration. It is concluded that the combined method allows for rapid differential grouping of the large number of blood spots, promotes objectivization of assay results, and lightens the work of the operator carrying out serial analyses.

The AB blood group system of cats

Holmes (1950) and Eyquem, Podliachouk & Milot (1962) classified feline erythrocytes into two types according to their reactions with naturally occurring antibodies in cats' plasmas. Eyquem et al. (1962) designated the two antigens, A and B, and this nomenclature has been retained in the present study. The blood group system, AB, was investigated in more detail, both genetically and serologically. Frequencies of 73.3% A and 26.3% B were found in a survey of 1895 Brisbane cats and in addition, a new phenotype, AB, was discovered with a low incidence of 0.4%. The results of the serological testing and limited family information suggested that the AB phenotype is inherited and not due to blood chimaerism. Preliminary genetic studies indicated that the A gene is dominant to the B in the usual situation and hypotheses to explain the occurrence of the AB phenotype are discussed. The incidence of naturally occurring antibodies was investigated in cats, with 95% of blood type B having anti-A and only 35% of type A having anti-B. No subgroups of the A and B antigens were detected and no blood group substances were found in the salivas of 37 cats. There was no evidence of any serological relationship of the feline A and B antigens with the human ABO antigens.

Interaction of the B locus and the GVHR-selected lines in the graft-versus-host reaction in chickens

Genetic differences affecting the degree of splenomegaly in the graft-versus-host reaction (GVHR) of chickens were studied. Two B genotypes, B9 B9 and B11 B11, and two GVHR-selected lines, H and L, were examined. The degree of splenomegaly of B9 B9 leads to B11 B11 was significantly higher than that of B11 B11 leads to B9 B9 for all line combinations. In contrast, the inoculation of H into L gave consistently higher splenomegaly than that of L into H. This suggested that the effects of B locus were higher in hosts than in donors, while those of the GVHR-selected lines were higher in donors than in hosts. The analysis of variance revealed that both the differences between the reciprocal combination of B genotypes and between the GVHR line combinations were statistically highly significant. Furthermore, the interaction of B genotypes and GVHR lines was also highly significant.

Effects of different blood groups on the reproduction of periodontal pocket bacteria

BACKGROUND

Many studies have been conducted proving the relation between different blood groups and certain diseases. It was claimed in these studies that H pylori showed different distribution according to different blood groups. In dentistry, the relation between blood groups and dental diseases was investigated in a limited number of studies and it was concluded that there might be a relation between them. The aim of the present study was to determine whether the bacteria isolated from the periodontal pockets of individuals with periodontal diseases indicated differences in CFU amounts to form colonies in different ABO blood groups.

METHODS

Bacterial samples obtained from the individuals with periodontal diseases from the worst affect sites were inoculated into culture media formed by blood taken from 32 individuals who were systemically and periodontally healthy and who had different blood groups. The colony numbers of these bacteria were observed.

RESULTS

Although periodontal pocket bacteria formed colonies in different numbers in different ABO blood groups (p < 0.05), no statistically significant difference was determined in the reproduction of these bacteria in different Rh blood groups and different sexes (p > 0.05).

CONCLUSION

Different ABO blood groups may show differences in significant rates in the colonisation numbers of the bacteria that are the main cause of periodontal diseases.

A nonsimultaneous, extended, altruistic-donor chain

We report a chain of 10 kidney transplantations, initiated in July 2007 by a single altruistic donor (i.e., a donor without a designated recipient) and coordinated over a period of 8 months by two large paired-donation registries. These transplantations involved six transplantation centers in five states. In the case of five of the transplantations, the donors and their coregistered recipients underwent surgery simultaneously. In the other five cases, "bridge donors" continued the chain as many as 5 months after the coregistered recipients in their own pairs had received transplants. This report of a chain of paired kidney donations, in which the transplantations were not necessarily performed simultaneously, illustrates the potential of this strategy.

The effect of ABO blood incompatibility on corneal transplant failure in conditions with low-risk of graft rejection

PURPOSE

To determine whether corneal graft survival over a 5-year follow-up period was affected by ABO blood type compatibility in participants in the Cornea Donor Study undergoing corneal transplantation principally for Fuchs dystrophy or pseudophakic corneal edema, conditions at low-risk for graft rejection.

DESIGN

Multi-center prospective, double-masked, clinical trial.

METHODS

ABO blood group compatibility was determined for 1,002 donors and recipients. During a 5-year follow-up period, episodes of graft rejection were documented, and graft failures were classified as to whether or not they were attributable to immunologic rejection. Endothelial cell density was determined by a central reading center for a subset of subjects.

RESULTS

ABO donor-recipient incompatibility was not associated with graft failure attributable to any cause including graft failure because of rejection, or with the occurrence of a rejection episode. The 5-year cumulative incidence of graft failure attributable to rejection was 32 (6%) for recipients with ABO recipient-donor compatibility and 12 (4%) for those with ABO incompatibility (hazard ratio, 0.65; 95% confidence interval, 0.33 to 1.25; P = .20). The 5-year incidence for a definite rejection episode, irrespective of whether graft failure ultimately occurred, was 64 (12%) for ABO compatible compared with 25 (8%) for ABO incompatible cases (P = .09). Among clear grafts at 5 years, percent loss of endothelial cells was similar in ABO compatible and incompatible cases.

CONCLUSIONS

In patients undergoing penetrating keratoplasty for Fuchs dystrophy or pseudophakic corneal edema, ABO matching is not indicated since ABO incompatibility does not increase the risk of transplant failure attributable to graft rejection.

[Clinical significance of anti-D IgG screening and titer detection in 286 RhD negative pregnant women]

OBJECTIVE

Anti-D IgG in RhD negative pregnant women is the main antibody of Rh-induced hemolytic disease of newborn (HDN). The study aimed to investigate the clinical significance of anti-D IgG screening and titer detection in RhD negative pregnant women.

METHODS

Sera of 286 RhD negative pregnant women were collected. Microtube column indirect antiglobulin test was used to screen and identify anti-D IgG. The indirect antiglobulin test was used to test the titer of anti-D IgG.

RESULTS

Anti-D IgG was identified in 21 cases (7.3%). The titer of anti-D showed an increasing trend with pregnancy progresses. The clinical outcomes of 12 fetuses (newborns) from positive anti-D pregnant women were observed. Two cases died in utero, 2 cases did not show abnormality and 8 cases had hemolysis. The 8 cases with hemolysis were treated with exchange transfusion or blood transfusion, and they had a good prognosis.

CONCLUSIONS

The screening and titer detection of anti-D IgG in RhD negative pregnant women are valuable in the prediction and treatment of HDN.