| 1. |
- Jablonowska, Barbara, 1948-, et al.
(författare)
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Blocking antibodies in blood from patients with recurrent spontaneous abortion in relation to pregnancy outcome and intravenous immunoglobulin treatment
- 2001
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Ingår i: American Journal of Reproductive Immunology. - : Wiley. - 1046-7408 .- 1600-0897 .- 8755-8920. ; 45:4, s. 226-231
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Tidskriftsartikel (refereegranskat)abstract
- PROBLEM: To study whether the occurrence of mixed lymphocyte culture (MLC) blocking antibodies is associated with pregnancy outcome in women with unexplained recurrent spontaneous abortion (RSA) and the in vivo effect of intravenous immunoglobulin (IVIG) treatment on MLC blocking effect.METHOD OF STUDY: Blood samples from 41 RSA patients were obtained before and after pregnancy, and blocking antibodies were estimated by one-way MLC assay. The patients received IVIG or placebo (saline) during pregnancy. Additionally, pre-pregnancy blood samples from 31 RSA women and 10 controls were obtained.RESULTS: We found no correlation between blocking antibodies before pregnancy and the pregnancy outcome. The occurrence of blocking antibodies was not affected by pregnancy or IVIG treatment.CONCLUSIONS: Blocking antibodies have no predictive value for the pregnancy outcome in RSA patients, and their production seems not to be affected by IVIG.
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| 2. |
- Jablonowska, Barbara, 1948-, et al.
(författare)
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Prevention of recurrent spontaneous abortion by intravenous immunoglobulin : a double-blind placebo-controlled study
- 1999
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Ingår i: Human Reproduction. - : Oxford University Press (OUP). - 0268-1161 .- 1460-2350. ; 14:3, s. 838-841
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to evaluate the therapeutic efficacy of intravenous immunoglobulin (IVIG) in the prevention of recurrent spontaneous abortion (RSA). In a double-blind, randomized, placebo-controlled study, 41 women with a history of unexplained recurrent spontaneous abortion were treated with IVIG or saline infusions during pregnancy. The birth of a child was considered a successful outcome. The overall success rate was 77% in the IVIG group compared with 79% in the placebo group. For women with primary RSA the success rates were 82 (IVIG) and 89% (placebo), and for women with secondary RSA the rates were 73 (IVIG) and 70% (placebo). We found no statistically significant difference in treatment results between IVIG and placebo.
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| 3. |
- Jablonowska, Barbara, 1948-, et al.
(författare)
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T and B lymphocyte subsets in patients with unexplained recurrent spontaneous abortion : IVIG versus placebo treatment
- 2002
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Ingår i: American Journal of Reproductive Immunology. - : Wiley. - 1046-7408 .- 1600-0897. ; 48:5, s. 312-318
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Tidskriftsartikel (refereegranskat)abstract
- Jablonowska B, Palfi M, Matthiesen L, Selbing A, Kjellberg S, Ernerudh J. T and B Lymphocyte subsets in patients with unexplained recurrent spontaneous abortion: IVIG versus placebo treatment. AJRI 2002; 48:312–318 © Blackwell Munksgaard, 2002PROBLEM: To investigate circulating lymphocyte subsets in women with recurrent spontaneous abortion (RSA) in relation to pregnancy outcome and to treatment with intravenous immunoglobulin (IVIG).METHOD OF STUDY: Forty-one women with a history of unexplained RSA were examined during first trimester of pregnancy before IVIG or placebo treatment and after pregnancy. The results were compared with five healthy, non-pregnant women and five women in the first trimester of normal pregnancy. Circulating lymphocyte subsets with focus on T-cell subpopulations were determined by flow cytometry.RESULTS: The proportions of human leukocyte antigen (HLA)-DR positive T cells (CD3+ HLA-DR+), T-killer/effector cells (CD8+ S6F1+) and B cells (CD19+) were increased, whereas the proportion of T-suppressor/inducer cells (CD4+ CD45RA+) was decreased during first trimester pregnancy of RSA women compared with pregnant normal controls. T and B lymphocyte subsets did not correlate with pregnancy outcome on either IVIG or placebo group.CONCLUSIONS: In RSA patients, the immune system seems to be activated in contrast to the suppression noted in normal pregnancy.
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| 4. |
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| 5. |
- Palfi, Miodrag, 1954-, et al.
(författare)
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A case of severe Rh (D) alloimmunization treated by intensive plasma exchange and high-dose intravenous immunoglobulin
- 2006
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Ingår i: Transfusion and apheresis science. - : Elsevier BV. - 1473-0502 .- 1878-1683. ; 35:2, s. 131-136
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Tidskriftsartikel (refereegranskat)abstract
- Background: In extremely severe Rh (D) alloimmunization, during pregnancy, early diagnosis and treatment is essential to avoid hydrops fetalis. Intrauterine transfusion (IUT) is of utmost importance in the prevention of fetal anemia but it is usually feasible only after 20 weeks of pregnancy. Therefore, additional treatment options in early pregnancy are needed. Study design and methods: A 27-year-old severely D + C immunized woman was admitted at 8 weeks of gestation in her fifth pregnancy with an extremely high concentration of anti-D. Her first pregnancy was uneventful but resulted in D + C alloimmunization. The next two pregnancies were unsuccessful, because of hydrops fetalis resulting in fetal death in pregnancy week 20 and 24, respectively, despite treatment with high-dose intravenous immunoglobulin (IVIG) and IUT treatment. A fourth pregnancy was terminated with legal abortion. The patient was eager and persistent to accomplish a successful pregnancy. Therefore, a combination of treatments consisting of plasma exchange (PE) three times/week and IVIG 100 g/week was started in pregnancy week 12. PE was performed 53 times and totally 159 L of plasma was exchanged. Results: The anti-D concentration was 12 μg/mL (IAT titer 2000) before start of treatment by PE and IVIG in pregnancy week 12. The concentration of anti-D was gradually reduced to approximately 3 μg/mL after only two weeks of treatment and was maintained at that level until pregnancy week 22. In pregnancy week 26 and 27, signs of hydrops were detected by ultrasonography and IUT were performed at each occasion. Sectio was inevitable at pregnancy week 28 + 1 and a male baby was born: Hb 58 g/L (cord sample) and 68 g/L (venous sample), weight 1385 g, Apgar score = 4-5-7, Bilirubin 56-150 mmol/L (4 h). Exchange transfusion was performed on day two and day five. Phototherapy was also implemented for eight days. The newborn's recovery thereafter was uneventful and complete. Conclusion: A combination of PE and IVIG may be an efficient treatment possible to start in early pregnancy in patients with extremely severe Rh (D) alloimmunization, with a history of hydrops fetalis in previous pregnancies. © 2006 Elsevier Ltd. All rights reserved.
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| 6. |
- Palfi, Miodrag, 1954-, et al.
(författare)
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A randomized controlled trial of transfusion-related acute lung injury : Is plasma from multiparous blood donors dangerous?
- 2001
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Ingår i: Transfusion. - : Wiley. - 0041-1132 .- 1537-2995. ; 41:3, s. 317-322
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Transfusion-related acute lung injury (TRALI) and other posttransfusion reactions may be caused by granulocyte and/or HLA antibodies, which are often present in blood from multiparous donors. The purpose of this study was to compare the effects of plasma from multiparous donors with those of plasma from donors with no history of transfusion or pregnancy (control plasma) in a prospective, randomized, double-blind, crossover study. STUDY DESIGN AND METHODS: Intensive care patients, judged to need at least 2 units of plasma, were randomly assigned to receive a unit of control plasma and, 4 hours later, a plasma unit from a multiparous donor (=3 live births) or to receive the plasma units in opposite order. The patients were closely monitored, and body temperature, blood pressure, and heart rate were recorded. Blood samples for analysis of blood gases, TNFa, IL-1 receptor antagonist, soluble E selectin, and C3d complement factor were collected at least on four occasions (before and after the transfusion of each unit). RESULTS: Transfusion of plasma from multiparous donors was associated with significantly lower oxygen saturation and higher TNFa concentrations than transfusion of control plasma. The mean arterial pressure increased significantly after the transfusion of control plasma, whereas plasma from multiparous donors had no effect on it. Five posttransfusion reactions were observed in 100 patients, in four cases after the transfusion of plasma from multiparous donors. CONCLUSION: Plasma from multiparous blood donors may impair pulmonary function in intensive care unit patients.
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| 7. |
- Palfi, Miodrag, 1954-
(författare)
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Antibodies during pregnancy : Aspects on complications during pregnancy and complications related to transfusion
- 1999
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The fetus acquires half of its genetic infonnation from the father and represents a foreign graft in pregnancy. The overall mechanisms contributing to immunologic tolerance and successful pregancy still are an enigma. Accumulating results of immunologic research, however, offer an explanation for many events in pregnancy. The purpose of this study was to investigate immune responses in pregnancy, antibody production, fetomatemal transport of antibodies and their impact on complications during pregnancy and complications related to transfusion.The human immune system exerts its effects by cellular (T-cell mediated, Thl dominated) and humoral (antibody mediated, Th2-dominated) immunity. Cellular immunity provides protection against foreign and infected cells while humoral immunity protects against extracellular pathogens. According to the Thl/Th2 paradigm successful pregnancy is Th2 dominated. We found elevated numbers of cytokine secreting cells of both Th-1 and Th-2 type in normal pregnancy and recurrent spontaneous abortions. However, the overall immune response may functionally be Th2-dominated and possibly more pronounced locally, at the fetomaternal interface.The fetus, despite the fetomaternal barrier, represents a huge antigenic challenge for the mother. As a consequence, the mother produces a variety of antibodies, directed against fetal antigens of paternal origin. In pregnancy, only IgG antibodies are, by an active process, transported from the mother to the fetus. Normal fetal IgG concentrations during pregnancy were established, as reliable published data were rare. The calculated regression line for f/m IgG ratio can be considered an accurate description of the nonnal IgG distribution in the fetus in relation to the mother.It has been proposed that lgG transport may be decreased in Rh (D) immunizations. According to this hypothesis, the impaired transport of anti-D should represent a protective mechanism against hemolytic disease of the newborn. Our studies gave controversial results. We could partly confirm the hypotesis as measured by correlation of fetal IgG vs maternal anti-D concentrations and fetal/newborn hemoglobin concentrations. In contrast we did not find significantly lower fetal IgG concentrations in Rh (D) immunizations compared with normal pregnancy.The lgG subclass composition of anti-D in Rh (D) immunizations was studied by an established test performed in microtiter plates and our own novel gel-test. Comparison of these two test showed that the same IgG subclasses of anti-D were detected by both methods. However, the gel-test had two major advantages: it was much more rapid and most importantly, interpretation of results was easier than with the microtitre assay.Women immunized during pregnancy may later become blood donors. The concentration of antibodies produced during pregnancy may afterwards decrease. However, the antibodoes do not disappear, and may thereby cause post-transfusion reactions. It has been reported that granulocyte- and I-ILA antibodies may cause transfusion-related acute lung injury (TRALI). TRALI is a rare but life-threatening complication of blood transfusion. Data from our study suggest that multiparous donors(≥ 3 pregnancies) should donate only plasma for fractionation or, if cell concentrates must be used, they shouid be washed before transfusion.
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| 8. |
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| 9. |
- Palfi, Miodrag, 1954-, et al.
(författare)
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Hypocalcemic symptoms during plateletpheresis using the COBE Spectra : A comparison of oral combination of 600 mg calcium + 300 mg magnesium + 100 IU vitamin D3 vs. a 1000 mg calcium in symptomatic donors
- 2007
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Ingår i: Transfusion and apheresis science. - : Elsevier BV. - 1473-0502 .- 1878-1683. ; 36:3, s. 291-295
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Tidskriftsartikel (refereegranskat)abstract
- Background: The aim of this study was to find an effective treatment for hypocalcemic symptoms during plateletpheresis and to evaluate if a combination of calcium, magnesium and vitamin D3 is more effective in comparison to routine calcium supplementation. Material and methods: A study group consisting of 10 donors, having a history of previous hypocalcemic symptoms during plateletpheresis, donated platelets twice in a one-month period. During the first donation combination tablets (600 mg Ca + 300 mg Mg + 100 IU vitamin D3) were used to treat hypocalcemic symptoms while routine treatment calcium carbonate tablets (1000 mg Ca) were used during the second donation. If symptoms persisted after 10 min the same dose was repeated. A control group, with no supplementation, consisting of five donors, with no history of hypocalcemic symptoms, were included. Donor subjective symptoms were graded and recorded on four occasions: at the start of plateletpheresis, when symptoms appeared, 10 min after the first tablet and at the end of donation. Samples for analysis of ionized calcium (iCa), magnesium and potassium were also taken at the same occasions. Results: All donors from the study group experienced minor or medium hypocalcemic symptoms and needed a second dose of supplementation. Calcium carbonate tablets completely relieved the hypocalcemic symptoms in six donors, it had no effect on three donors and one donor experienced aggravated symptoms. The combination tablets completely relieved the symptoms in three donors, one donor experienced a partial relief and six donors had no relief of symptoms. There were no significant differences in iCa, potassium and magnesium levels were noted in the study group irrespective of which tablets were used for treatment of hypocalcemic symptoms. After plateletpheresis the median iCa levels declined by 30% and potassium levels declined by 3-11% in all donors while the magnesium levels were not significantly affected. There was no correlation between the presence of symptoms and the changed levels of iCa or magnesium. Conclusion: Addition of magnesium and vitamin D3 to calcium seems to have no beneficial effect in the treatment of hypocalcemic symptoms in plateletpheresis donors. © 2007 Elsevier Ltd. All rights reserved.
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| 10. |
- Palfi, Miodrag, et al.
(författare)
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The frequency of anti-C + anti-G in the absence of anti-D in alloimmunized pregnancies
- 2001
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Ingår i: Transfusion Medicine. - : Wiley. - 0958-7578 .- 1365-3148. ; 11:3, s. 207-210
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Tidskriftsartikel (refereegranskat)abstract
- Anti-D+C are often initially identified in sera from alloimmunized women. Anti-G may be present in these samples, mimicking anti-D+C, and therefore the differentiation of anti-D, -C and -G may be important. Sera from 27 alloimmunized women, initially identified as containing anti-D + anti-C, were analysed by adsorption/elution studies in the presence of polyethylene glycol (PEG) using R0r (D+C-G+) and r'r(D-C+G+) red blood cells (RBC). Additionally, 15/27 samples were tested by adsorption in the presence of PEG and subsequently warm elution, using rGr (D-C-G+) RBC. Anti-G + anti-C, without anti-D, were identified in 4/27 samples (14.8%) and none of the newborn children needed postpartum treatment. The combination of D+G, D+C and D+C+G antibodies occurred in 25.9%, 11.1% and 48.1% of the women, respectively. Overall, anti-G was detected in 24/27 samples (88.9%). Pregnant women shown to have anti-G+C but not anti-D should receive Rh immune globulin. Additionally, the finding of apparent anti-D+C during pregnancy in D-negative spouses may lead to paternity testing and therefore a correct antibody identification is necessary.
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