Anti-Jka, -C, and -E in a single patient, initially demonstrable only by the manual hexadimethrine bromide (Polybrene) test, with incompatibilities confirmed by 51Cr-labeled red cell studies

Published reports have confirmed the superior sensitivity of the manual hexadimethrine bromide (Polybrene) test (MPT) for demonstrating many alloantibodies in vitro; however, the clinical significance of alloantibodies demonstrable exclusively by MPT has not been shown conclusively. A patient with macroglobulinemia experienced chills, fever, hemoglobinemia, and hemoglobinuria following the transfusion of 1 unit of red cells (RBCs) shown to be compatible by the low-ionic-strength antiglobulin (LIS-AG) method. Serologic investigation was negative. Intravascular hemolysis occurred with a second "compatible" unit. Serologic studies were again negative by LIS-AG and ficin-AG methods, but revealed anti-Jka by MPT. Both donors were Jk(a+b-), and 51Cr studies of the second donor's RBCs revealed a t1/2 of less than 30 minutes, with marked intravascular hemolysis. A LIS-AG-compatible Jk(a-) unit was transfused uneventfully, but with no rise in hematocrit. MPT next revealed anti-C; subsequent 51Cr studies with the Jk(a-), Cc donor's RBCs showed a 51Cr t1/2 of 100 minutes with slight intravascular lysis. Four transfusions of Jk(a-), C- blood were uneventful, but 5 days later the patient's hemoglobin declined. The following day, anti-E was demonstrable exclusively by MPT. 51Cr-labeled Jk(a-), C-, E- RBCs had normal 24-hour survival. The patient's hemoglobin rose to 11 g per dl following transfusions of Jk(a-), C-, E- RBCs, and he was discharged. In vitro studies employing the patient's purified IgM paraprotein revealed no interference with alloantibody binding or detection.     

精子释放时精子质量的检测方法

评价新修订的《世界卫生组织人类精液分析实验室技术手册》(简称手册)中涉及精子释放(精子脱离支持细胞从睾丸中排出)时的精子特征。修订手册的目的是在不影响临床应用的情况下改善"精液分析的质量"。手册指出,精液分析还有助于①研究男性生殖状态。②在男性生殖调节期间和之后监测精子的发生状态。但是,如果对射精精液精子的分析是用于上述②的目的,那么就必须识别出精子释放时的异常精子。手册未提出精子释放时精子质量的检测方法。相反,采用了精子穿过宫颈黏液或到达受精位置这一"金标准"。这个标准虽然适合于判断个体使其伴侣妊娠的可能性,但却不适用于研究睾丸本身的疾病。因此,手册介绍的测定精子质量的方法无法鉴别精子异常是发生在精子释放同时还是之后。基于活动或"活"精子的百分率评价精子释放时的精子质量是没有意义的。介绍了能反映精子释放时精子质量的其他特征,基于射出精液中单个精子的质量特征评价精子释放时精子质量可采用以下方法:①采用新的精子质量形态评估体系。②采用现代技术评价一定样本中单个精子的几个合适和独立的特征,以便更准确地确定异常精子的比例。