PURPOSE: Childhood idiopathic thrombocytopenic purpura (ITP) is an acute, self-limited disease of several weeks, but 10~20% of cases may have chronic courses. This study was aimed to evaluate factors that might predict the progression to chronic ITP. METHODS: Ninty-four patients with ITP were divided into acute and chronic on the basis of disease duration of 6 months. Clinical and laboratory characteristics were compared between the two groups. Response to intravenous immunoglobulin (IVIg) of either 400 mg/kg for 5 days or IVIg 1, 000 mg/kg for 2 days and progression to chronic ITP was compared. RESULTS: 67 cases (71.3%) were acute and 19 (28.7%) were chronic ITP. Sex, preceding viral infection history, clinical manifestations were not significantly different, but acute ITP was more prevalent in less than 1 year of age (P=.001). The initial WBC count was higher in acute than in chronic ITP (9, 600/microL vs. 7, 600/microL) (P < .01), as was initial AST (51 U/L vs. 34 U/L) (P < .05). PCT (platelet hematocrit), MPV (mean platelet volume), PDW (platelet distribution width) of chronic ITP tended to be higher in chronic ITP, but only MPV was significantly different (P < .05). After IVIg infusion, hemoglobin level in acute ITP was significantly decreased (P < .05), and MPV of chronic ITP was significantly increased (P < .05). IVIg 1, 000 mg/kg for 2 days was associated with faster platelet recovery than IVIg 400 mg/kg for 5days (P> .05). The relapse rate and progression to chronic ITP were not different. CONCLUSION: The intial WBC counts, AST, MPV, the changes of hemoglobin level and MPV after IVIg infusion could be useful predictors of developing chronic ITP in children.
Blood Platelets ; Child ; Humans ; Immunoglobulins ; Immunoglobulins, Intravenous ; Purpura, Thrombocytopenic, Idiopathic* ; Recurrence

BACKGROUNDS: The Rh antigens are important m clinical practice. The classification of Rh phenotype is usually based on the antigen detection done by conventional serologic method, but it has many limitation such as delicate grading of antigen expression. Recently, Flowcytometry has been introduced in immunohematology to detect and quantitate cell bound immunoglobulins to assess blood cell antigens and related antibodies. So, we tried these method to detect Rh(D) antigen and measure its density and evaluated the possibility of clinical usage. MATERIALS AND METHODS: We performed a flowcytometric analysis for the expression of D antigen in D-positive, negative and weak D group in indirect immune fluorescence assay by using polyclonal antibodies. We measured the intensity of immunofluorescence as a degree of antigen density and analysed the difference of mean channel fluorescence value(MCF) among these groups. RESULTS: Weak D groups had the lower fluorescence than D-positive group, while D-negative sample showed the same fluorecence as negative ntrol. The difference of fluorescence intensity of D antigen between that of C antigen were not observed and were statistically insignificant. CONCLUSION: Flowcytometry appear to be a good tool for antigen density measurement in immunohematologic areas and shows the possibility of application to other aspect.
Antibodies ; Blood Cells ; Classification ; Fluorescence ; Fluorescent Antibody Technique ; Immunoglobulins ; Phenotype

BACKGROUND: In spite of a trend of automation for conducting most clinical laboratory tests, many blood banks are still dependent on manual tests. The aim of this study was to evaluate a full automation system called the Galileo (Immucor, USA) for conducting pretransfusion tests. METHODS: From August to October in 2009, a total of 3,002 cases of ABO-RhD typing and 1698 cases of antibody screening were compared between using manual tests and the Galileo system at Seoul National University Hospital, Seoul, Korea. For the manual tests, we used the slide method for ABO-RhD typing and the anti-human immunoglobulin treated microplate method for antibody screening. The Galileo system used the microplate method for ABO-RhD typing and the solid-phase red cell adherence (SPRCA) method for antibody screening. We calculated the overall concordance rate and the false positive or negative rates regarding the manual method as a standard test and the Galileo system as a comparative test. RESULTS: When comparing 3,002 cases of ABO-RhD typing, 52 cases (1.7%) were retested. A discrepancy between the two tests remained in 17 cases (0.6%) after repetition, which led to a concordance rate of 99.4% (2,985/3,002). On the comparison of 1,698 cases of antibody screening, 54 cases (3.2%) were retested. A discrepancy between the two tests remained for 30 cases (1.8%) and the concordance rate was 98.2% (1,615/1,698). Among the 20 false negative cases (1.2%), nine were thought to be cold antibodies with no cases of confirmed warm antibody. CONCLUSION: The automated Galileo system and the preexisting manual tests showed very good concordance for ABO-RhD typing and antibody screening. The Galileo system can be used with confidence for routine pretransfusion tests.
Antibodies ; Automation ; Blood Banks ; Cold Temperature ; Immunoglobulins ; Korea ; Mass Screening

OBJECTIVETo study the changes in the serum levels of 25-(OH)D3 and immunoglobulins in children with bronchiolitis, and the clinical significance of these changes.

METHODSSerum levels of 25-(OH)D3 were measured using ELISA in 35 children with bronchiolitis in the acute and recovery phases and 20 healthy children. Serum levels of immunoglobulins were determined by rate nephelometry.

RESULTSCompared with the healthy children, serum 25-(OH)D3, IgG and IgA levels in children with bronchiolitis in the acute phase were significantly lower and, in contrast, serum IgE levels were significantly higher (P<0.05). Serum 25-(OH)D3 levels increased and serum IgE levels decreased significantly in the recovery phase compared with the acute phase in children with bronchiolitis (P<0.05). However, compared with the healthy children, serum 25-(OH)D3 and IgA levels were significantly lower and serum IgE levels were significantly higher in children with bronchiolitis in the recovery phase (P<0.05). Serum 25-(OH)D3 levels in children with bronchiolitis in the acute phase were positively correlated with serum IgG (r=0.36, P<0.05) and IgA levels (r=0.63, P<0.01), and negatively correlated with serum IgE levels (r=-0.72, P<0.01). A negative correlation was found between serum 25-(OH)D3 and IgE levels in children with bronchiolitis in the recovery phase (r=-0.34, P<0.05).

CONCLUSIONSSerum 25-(OH)D3 levels decrease and there is immunoglobulin level imbalance in children with bronchiolitis, suggesting that 25-(OH)D3 and immunoglobulins may play important roles in the pathogenesis of bronchiolitis.

Bronchiolitis ; blood ; etiology ; Calcifediol ; blood ; Female ; Humans ; Immunoglobulins ; blood ; Infant ; Male

OBJECTIVETo study the possible role of human β-defensins 1 (Hbd-1) and immunoglobulins A, G and M (IgA, IgG and IgM) in the development of recurrent pneumonia by measuring serum concentrations of the above indexes in infants with recurrent pneumonia and healthy infants.

METHODSSerum samples were obtained from 35 healthy children and 35 children aged from 2 to 24 months with recurrent pneumonia. Serum Hbd-1 concentration was measured using ELISA. Serum IgA, IgG and IgM concentrations were measured by immunonephelometry. The correlation of hBD-1 with IgA, IgG and IgM was evaluated.

RESULTSThe serum concentration of hBD-1 in infants with recurrent pneumonia (14±11 μg/mL) was significantly lower than in controls (18±11 μg/mL) (P<0.05), as was the serum concentration of IgA in infants with recurrent pneumonia (1.3±0.6 g/L vs 1.5±0.8 g/L; P<0.05). The serum concentration of IgG in infants with recurrent pneumonia was also significantly lower than in controls (9±3 g/L vs 13±5 g/L; P<0.05). There were no linear relationships between serum Hbd-1 and IgA, IgG and IgM (P>0.05).

CONCLUSIONSThe serum levels of hBD-1, IgA and IgG decrease in infants with recurrent pneumonia, suggesting disorders in the immune defensive function of the respiratory tract, and this may be one of the immunity related reasons for recurrent pneumonia in infants. It is of great clinical value to measure serum levels of Hbd-1, IgA, IgG and IgM in infants with recurrent pneumonia.

Female ; Humans ; Immunoglobulin A ; blood ; Immunoglobulin G ; blood ; Immunoglobulin M ; blood ; Immunoglobulins ; blood ; Infant ; Male ; Pneumonia ; immunology ; Recurrence ; beta-Defensins ; blood

BACKGROUND AND OBJECTIVES: The prevalence of incomplete Kawasaki disease (iKD) is progressively increasing. We aimed to retrospectively investigate the predictors of intravenous immunoglobulin (IVIG) resistance in iKD patients and compare them with those of IVIG resistance in complete Kawasaki disease (cKD) patients. We also compared the prognosis of coronary artery lesions (CALs) between the IVIG non-responders and responders in both iKD and cKD groups. SUBJECTS AND METHODS: A total of 234 cKD and 77 iKD patients were treated with IVIG between February 2009 and April 2012. Among these 311 patients, we reviewed the data of 77 iKD patients and 75 age-matched cKD patients. RESULTS: Patients with iKD having an elevated neutrophil count {percentage of segmented neutrophils (SEG%) > or =79.0} were at risk of IVIG resistance, while patients with cKD having SEG% > or =79.25 and serum total bilirubin (TB) > or =0.56 mg/dL were at risk of IVIG resistance as shown by multivariable logistic regression analysis. Fractional changes of laboratory data before and after IVIG treatment showed that Creactive protein (CRP) and N-terminal B type natriuretic peptide (NT-proBNP) levels were significantly elevated in IVIG non-responders of the iKD group, whereas erythrocyte sedimentation rate was significantly elevated in IVIG non-responders of the cKD group. Among the patients who had CALs at 10 months after the start of illness, the z scores of coronary arteries were higher in IVIG non-responders of the iKD group, when compared with IVIG non-responders of the cKD group. CONCLUSION: Elevated SEG%, changes in CRP and NT-proBNP levels may help in early detection of IVIG resistance in patients of the iKD group, which may aid in predicting the prognosis of CALs in these patients. Further studies with a larger number of patients are warranted.
Bilirubin ; Blood Sedimentation ; Coronary Vessels* ; Humans ; Immunoglobulins* ; Immunoglobulins, Intravenous ; Logistic Models ; Mucocutaneous Lymph Node Syndrome* ; Neutrophils ; Prevalence ; Prognosis* ; Retrospective Studies

Little is known about platelet dynamics and the effect of antiplatelet therapy in Kawasaki disease (KD). This study sought to define platelet activation dynamics in KD patients by assaying platelet-derived microparticles (PDMPs). We measured plasma PDMPs levels in 46 patients with KD using an enzyme-linked immunosorbent assay (ELISA). Blood samples were collected before, at 2–5 days, and 9–15 days after intravenous immunoglobulin (IVIG) infusion, 2 months and 4–5 months after the onset of KD. We measured PDMP levels in 23 febrile and 10 afebrile control patients. In the acute phase of KD patients, PDMP levels increased significantly after IVIG treatment (12.04 ± 5.58 nmol before IVIG infusion vs. 19.81 ± 13.21 nmol at 2–5 days after IVIG infusion, P = 0.006). PDMP levels were negatively correlated with age and positively correlated with procalcitonin levels in the acute phase of KD. No significant difference was found in PDMP levels between KD patients with and without coronary artery lesion (CAL). Elevated PDMP levels after IVIG therapy significantly decreased below the pre-IVIG level in subacute phase (19.81 ± 13.21 nmol at 2–5 days after IVIG infusion vs. 8.33 ± 2.02 nmol at 9–15 days after IVIG infusion, P < 0.001), and PDMP levels stayed below the pre-IVIG level in the convalescent phase, during which antiplatelet therapy was given. However, PDMP levels rebounded after discontinuing aspirin in 17 patients. In conclusion, enhanced platelet activation was noted before treatment of KD and peaked immediately after IVIG treatment. Recurrent rising of PDMP levels was observed after discontinuing aspirin, although there were no significant differences between the PDMP levels at 2 months after the onset of KD and those at 4–5 months after the onset of the disease.
Aspirin ; Blood Platelets ; Coronary Vessels ; Enzyme-Linked Immunosorbent Assay ; Humans ; Immunoglobulins ; Immunoglobulins, Intravenous ; Mucocutaneous Lymph Node Syndrome* ; Plasma ; Platelet Activation

BACKGROUND: Childhood immune thrombocytopenic purpura (ITP) is a common acquired bleeding disorder. Even though most children recover, either spontaneously or with therapy, 10-20% of newly diagnosed ITP cases have a chronic course beyond 12 months. This study evaluated whether clinical and laboratory findings can predict the response to intravenous immunoglobulin (IVIG) and progression to persistent or chronic ITP in children. METHODS: During the period between March 2003 and June 2015, we retrospectively analyzed 72 children, newly diagnosed with ITP, who received IVIG treatment. Peripheral blood counts were obtained at diagnosis and at 1, 3, 6, and 12 months after IVIG treatment. RESULTS: After 6 months of IVIG treatment, 14 of 72 patients (19.4%) had persistent ITP, and after 12 months, 7 of 40 patients (17.5%) had chronic ITP. Age at diagnosis, gender, history of viral infection, or vaccination before disease onset were not statistically correlated with platelet recovery at 6 and 12 months. However, a platelet count recovery of ≥100×10(3)/µL at 1 and 3 months was significantly correlated with platelet recovery at 6 (P<0.001 and P<0.001, respectively) and 12 (P=0.007 and P=0.004, respectively) months. CONCLUSION: This study demonstrated that early platelet count recovery, at 1 and 3 months after IVIG treatment, predicts a short disease duration and a favorable outcome in children with newly diagnosed ITP. Further investigation in a larger group of patients is warranted to validate these findings.
Blood Platelets* ; Child* ; Diagnosis ; Hemorrhage ; Humans ; Immunoglobulins* ; Immunoglobulins, Intravenous ; Platelet Count* ; Purpura, Thrombocytopenic, Idiopathic* ; Retrospective Studies ; Vaccination

PURPOSE: The platelet synthesis is extremely variable after intravenous immunoglogulin injection (IVIG) in acute idiopathic thrombocytopenic purpura (ITP). To investigate the size variation of platelet according to the time sequence of ITP, the relationship between platelet number and mean platelet volume (MPV) was analyzed. METHODS: Twenty acute ITP patients who showed abrupt increase of platelets within 48 hours after IVIG were selected. We checked the platelet number and MPV, thereafter analyzed the relationship. RESULTS: At the early phase of ITP before IVIG, MPV was normal or slightly decreased. However, as the number of platelet increased after IVIG, MPV increased together until platelet count reached 100, 000/mm3. The MPV decreased afterward, therefore the platelet mass was preserved. CONCLUSION: At the early phase of ITP before the increase of platelet, MPV decreased in spite of low number of platelet. After IVIG, there was an abrupt increase of MPV with platelet number. There might be some contributing factors for these, particularly IL-6, IL-11 and thrombopoietin. Now, we need more experimental data to explain these findings.
Blood Platelets* ; Humans ; Immunoglobulins* ; Immunoglobulins, Intravenous ; Interleukin-11 ; Interleukin-6 ; Mean Platelet Volume* ; Platelet Count* ; Purpura, Thrombocytopenic, Idiopathic* ; Thrombopoietin

PURPOSE: This study aimed to evaluate the clinical course of childhood immune thrombocytopenia (ITP) and to assess the risk factors for developing chronic ITP. METHODS: The records of 64 children diagnosed with ITP from November 2005 and December 2014 at single center were retrospectively analyzed. RESULTS: The median age at diagnosis and the median platelet count were 1 year (range, 1 month to 15 years) and 9×10⁹/L (range, 0–84×10⁹/L), respectively. No patient experienced severe bleeding. Nineteen children (29.7%) spontaneously recovered their platelet count to ≥100×10⁹/L at a median of 10 days. In total 45 patients (70.3%) received intravenous immunoglobulin (IVIG) as first-line therapy, and showed platelet recovery at 1 week. The final diagnosis of 55 (85.9%) and 9 patients (14.1%) was acute and chronic ITP, respectively. Older age, absence of prior infection and insidious onset of symptoms were significantly associated with the development of chronic ITP. Among the patients who received IVIG, those with platelet count <45×10⁹/L at 1 month after IVIG showed a significantly higher incidence of chronic ITP compared to those with platelet count ≥45×10⁹/L (88.8% vs. 44.4%, P<0.01). CONCLUSION: In most patients, ITP runs a benign course and approximately 86% of them recover within 1 year of their initial diagnosis. The potential impact of the risk factors of chronic ITP on clinical practice needs to be explored and further studies are warranted to determine whether IVIG influences the course of ITP.
Blood Platelets ; Child ; Diagnosis ; Hemorrhage ; Humans ; Immunoglobulins ; Immunoglobulins, Intravenous ; Incidence ; Platelet Count ; Purpura, Thrombocytopenic, Idiopathic* ; Retrospective Studies ; Risk Factors