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.     

Correcting post‐keratoplasty anisometropia with the implantable collamer phakic intraocular lens

Background: We evaluate the Visian Implantable Collamer Lens (Staar, Monrovia, CA, USA) phakic intraocular lens for treating post‐keratoplasty anisometropia. Methods: Case series of three eyes (2 phakic and 1 pseudophakic). Results: The mean age was 47.3 years (range 30–73 years), with a minimum of 3‐month follow up. The mean preoperative spherical equivalent was ?8.75 ± 5.17 D (?4.00 to ?14.25 D) improving to ?0.29 ± 1.21 D postoperatively (range 0.75 to ?1.625 D). Mean logMAR uncorrected visual acuity improved from 1.66 ± 0.60 (6/240) preoperatively to 0.41 ± 0.52 (6/15²). Mean logMAR best spectacle‐corrected visual acuity improved from 0.32 ± 0.15 (6/12) preoperatively to 0.10 ± 0.11 (6/7.5). Anisometropia improved from a difference of 6.37 ± 2.59 D preoperatively to 2.09 ± 1.37 D postoperatively, and there were no complications. Conclusion: Our technique for this clinical indication shows that the Visian Implantable Collamer Lens is a safe and effective alternative for treating post‐keratoplasty anisometropia.