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- Gustavsen, Alice, et al.
(författare)
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Effect on mother and child of eculizumab given before caesarean section in a patient with severe antiphospholipid syndrome
- 2017
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Ingår i: Medicine. - 0025-7974. ; 96:11
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Tidskriftsartikel (refereegranskat)abstract
- Rationale: Antiphospholipid syndrome (APS) in pregnancy may trigger the life-threatening catastrophic antiphospholipid syndrome (CAPS). Complement activation is implicated in the pathogenesis, and inhibition of complement factor C5 is suggested as an additional treatment option. Patient concerns, diagnosis and interventions: We present a pregnant patient treated with the C5-inhibitor eculizumab due to high risk of developing devastating APS-related complications. The complement inhibitory effects of the treatment were examined both in the patient and the premature infant. Outcomes: Complement activity in the mother recovered considerably faster than anticipated; however, no new thrombosis or CAPS developed during the last week of pregnancy or postpartum. Blood sampling from the umbilical vein and artery, and from the infant after delivery showed low complement activity; however, only 0.3% of the eculizumab concentration detected in the mother, consistent with low placental passage of eculizumab. Lessons: The data underscore the importance of close monitoring of complement inhibition and individualizing dosage regimens in pregnant patients receiving eculizumab. We document how traditional functional complement activity tests cannot assess the effect of eculizumab in premature infants due to the very low levels of complement factors detected in this infant born in gestational week 33. Only trace amounts of eculizumab passed the placenta. In conclusion, complement C5 inhibition might be a safe candidate treatment option for APS during pregnancy and delivery, and additionally, enables prolongation of pregnancy with important weeks.
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| 2. |
- Mostad, Petter, 1964, et al.
(författare)
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The Quest for a Donor: Probability Based Methods Offer Help.
- 2005
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- When a patient in need of a stem cell transplant has no compatible donor within his or herclosest family, and no matched unrelated donor can be found, a remaining option is to searchwithin the patient’s extended family. This situation often arises when the patient is of anethnic minority, originating from a country that lacks a well-developed stem cell donorprogram, and has HLA haplotypes that are rare in his or her country of residence. Searchingwithin the extended family may be time-consuming and expensive, and tools to calculate theprobability of a match within groups of untested relatives would facilitate the search.We present a general approach to calculating the probability of a match in a given relative, orgroup of relatives, based on the pedigree, and on knowledge of the genotypes of some of theindividuals. The method extends previous approaches by allowing the pedigrees to beconsanguineous and arbitrarily complex, with deviations from Hardy-Weinberg equilibrium.We show how this extension has a considerable effect on results, in particular for rarehaplotypes. The methods are exemplified using freeware programs to solve a case of practicalimportance.
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| 3. |
- Siljan, William W., et al.
(författare)
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Low levels of immunoglobulins and mannose-binding lectin are not associated with etiology, severity, or outcome in community-acquired pneumonia
- 2018
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Ingår i: Open Forum Infectious Diseases. - : Oxford University Press (OUP). - 2328-8957. ; 5:2
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Tidskriftsartikel (refereegranskat)abstract
- Background. Disease severity and outcome in community-acquired pneumonia (CAP) depend on the host and on the challenge of the causal microorganism(s). We measured levels of immunoglobulins (Igs) and complement in 257 hospitalized adults with CAP and examined the association of low levels of Igs or complement to microbial etiology, disease severity, and short-term and long-term outcome. Methods. Serum Igs were analyzed in blood samples obtained at admission and at 6 weeks postdischarge if admission levels were low. Serum complement deficiencies were screened with a total complement activity enzyme-linked immunosorbent assay (ELISA), with further analyzes performed if justified. Disease severity was assessed by the CURB-65 severity score. Short-term outcome was defined as a composite end point of intensive care unit (ICU) admission and 30-day mortality, and long-term outcome as 5-year all-cause mortality. Results. At admission, 87 (34%) patients had low levels of at least 1 Ig, with low IgG2 as the most prevalent finding (55/21%). IgG levels were lower in bacterial than viral CAP (8.48 vs 9.97 g/L, P = .023), but low Igs were not associated with microbial etiology. Fifty-five (21%) patients had low lectin pathway activity, of which 33 (13%) were mannose-binding lectin (MBL) deficient. Low admission levels of any Ig or MBL were not associated with disease severity, short-term outcome, or long-term outcome. Excluding patients defined as immunocompromised from analysis did not substantially affect these results. Conclusion. In hospitalized adults with CAP, low admission levels of Igs or complement were in general not associated with microbial etiology, disease severity, short-term outcome, or long-term outcome.
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