Incomplete warm hemolysins. I. Case reports, serology, and immunoglobulin classes

Incomplete warm hemolysins (IWHs) form an independent class of red blood cell (RBC) autoantibodies. We studied eight sera in which autoantibodies with the characteristic features of IWHs were demonstrated. The case reports of those patients revealed that IWHs were predominantly associated with a serious course of autoimmune hemolytic disease. In four sera we found a combination of IWHs and cold agglutinins with the specificity anti-I. The cold agglutinins could be separated from the IWHs by affinity chromatography with immobilized I-active RBC material. The binding of IWHs to RBCs was demonstrated on the RBC surface with a modified enzyme-linked immunoassay (APAAP-EIA: monoclonal anti-immunoglobulin antibodies + bridging antibody + alkaline phosphatase/anti-alkaline phosphatase complexes). With the APAAP-EIA technique and different primary anti-immunoglobulin antibodies we found that seven sera contained IgM-IWHs and one contained IgG-IWHs. In three sera, IgM-IWHs with monotypical kappa light chains were detected.     

Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 28-2001. A 44-year-old woman with chills, fever, jaundice, and hepatic abscesses

BACKGROUND: The introduction of expensive but very effective antiviral medications has led to questions about the effects on the total use of resources for the care of patients with human immunodeficiency virus (HIV) infection. We examined expenditures for the care of HIV-infected patients since the introduction of highly active antiretroviral therapy. METHODS: We interviewed a random sample of 2864 patients who were representative of all American adults receiving care for HIV infection in early 1996, and followed them for up to 36 months. We estimated the average expenditure per patient per month on the basis of self-reported information about care received. RESULTS: The mean expenditure was $1,792 per patient per month at base line, but it declined to $1,359 for survivors in 1997, since the increases in pharmaceutical expenditures were smaller than the reductions in hospital costs. Use of highly active antiretroviral therapy was independently associated with a reduction in expenditures. After adjustments for the interview date, clinical status, and deaths, the estimated annual expenditure declined from $20,300 per patient in 1996 to $18,300 in 1998. Expenditures among subgroups of patients varied by a factor of as much as three. Pharmaceutical costs were lowest and hospital costs highest among underserved groups, including blacks, women, and patients without private insurance. CONCLUSIONS: The total cost of care for adults with HIV infection has declined since the introduction of highly active antiretroviral therapy. Expenditures have increased for medications but have declined for other services. However, there are large variations in expenditures across subgroups of patients.