Recommendations for the evaluation and treatment of neonatal autoimmune and alloimmune thrombocytopenia. The Working Party on Neonatal Immune Thrombocytopenia of the Neonatal Hemostasis Subcommittee of the Scientific and Standardization Committee of the ISTH

The following recommendations of the Neonatal Hemostasis Subcommittee of the Scientific and Standardization Committee of the ISTH for the management of neonatal immune thrombocytopenia were prepared by the working party on neonatal immune thrombocytopenia. Evaluation, diagnosis, and treatment of the mother and neonate with alloimmune and autoimmune thrombocytopenia are discussed and current recommendations provided. This document is likely to require frequent future revision(s).     

Neonatal alloimmune thrombocytopenia after maternal immunization with paternal mononuclear cells: successful treatment with intravenous gamma globulin.

We report a case of neonatal alloimmune thrombocytopenia and intracranial hemorrhage in an infant whose mother received immunizations of paternal mononuclear cells. This therapy is designed to prevent unexplained first trimester miscarriages. No previous cases of platelet autoimmunization associated with maternal immunization with paternal mononuclear cells has been reported. Treatment with antenatal maternal infusions of intravenous gamma globulin (IVGG) did not prevent fetal thrombocytopenia, but IVGG may become the treatment of choice for postnatal, antibody-mediated thrombocytopenia of the newborn.     

A continuous sampler with background suppression for monitoring alpha-emitting aerosol particles.

A continuous air monitor has been developed that includes provisions for improving the detection of alpha-emitting aerosol particles in the presence of radon/thoron progeny that are unattached to ambient aerosol particles. Wind tunnel tests show that 80% of 10-microns aerodynamic equivalent diameter particles penetrate the flow system from the ambient air to the collection filter when the flow rate is 57 L min-1 (2 cfm) and the wind speed is 1 m s-1. Uniformity of aerosol collection on the filter, as characterized by the coefficient of variation of the areal density deposits, is less than 15% for 10-microns aerodynamic-equivalent-diameter aerosol particles. Tests with unattached radon daughters in a flow-through chamber showed that approximately 99% of the 218Po was removed by an inlet screen that is designed to collect radon daughters that are in the size range of molecular clusters. The inlet screen offers the opportunity to improve the signal-to-noise ratio of energy spectra in the regions of interest (subranges of the energy spectrum) of transuranic elements and thereby enhance the performance of background compensation algorithms.     

A review of applications of MRI in soft tissue and bone tumors

Due to excellent soft tissue contrast and multiplanar imaging capability, MRI is assuming a major role in recognition, staging, and treatment planning of soft tissue and bone tumors. Direct sagittal, coronal, and axial images permit assessment of intraosseous and extraosseous extension of tumors and their relationship to the joints and neurovascular structures, and detection of "skip" lesions. MRI allows improved detection of recurrent tumors in the presence of non-ferromagnetic metallic implants as compared to CT. In the evaluation of soft tissue tumors, MRI is more sensitive than CT and allows differentiation among fat, muscle, tendon, bone, and vascular structures based on signal characteristics. Over a period of 18 months, 100 soft tissue masses and bone tumors were evaluated using MRI. Spin echo sequences with T1 and T2 weighted images were most valuable in differentiating normal and abnormal tissues. Calculated comparative measurements of relaxation times showed no reliable difference between benign and malignant tumors.     

Measurement of total bile acids in gastric juice

An established method for the assay of total bile acids was validated for use in fasting and post-prandial gastric juice samples. Fasting and post-prandial intragastric bile acid concentrations were measured in 29 healthy volunteers, 15 patients after vagotomy and gastrojejunostomy (V and GJ) and 15 patients after vagotomy and pyloroplasty (V and P). Healthy female volunteers had higher post-prandial bile acid concentrations than age matched healthy males (p less than 0.02). Patients with V and GJ had higher fasting and post-prandial bile acid concentrations than age and sex matched control subjects (p less than 0.01). Patients with V and P had higher bile acid concentrations than control subjects only in post-prandial samples (p less than 0.05).