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The omohyoid is an infrahyoid muscle with two bellies. It is responsible for lowering and positioning of the hyoid bone. It is morphologically variable in the origin, insertion and morphology of its bellies. Quantitative variations of the superior belly of the omohyoid muscle are not common. We present a case of a five-headed superior omohyoid, and a short clinical review related to this muscle. All the bellies had their origin in an intermediate tendon and were attached to the hyoid bone. The volume of its superior part was greater than usual. Knowledge of the anatomy of this muscle is important, especially for surgeons operating in the anterolateral neck region.

Clinical efficacy of PC transfusions in patients immunized with Human Leukocyte Antigens (HLA) and/or Human Platelet Antigens (HPA) can be improved by relying on platelets from donors typed for HPA and/or HLA. A specific group of PC recipients are newborns with alloimmune thrombocytopenia (FNAIT) resulting from maternal alloimmunization during pregnancy against specific fetal platelet antigens HPA (especially HPA-1a) produced by the mother as a result of fetomaternal HPA incompatibility. The study aim was to assess the demand and availability for HPA/HLA typed donors in Poland. Outcome of a survey distributed to 23 Polish blood transfusion centers (CKiK) supplemented by data acquired in direct contact (phone) revealed that: 1/ demand for PCs from donors with HLA and/or HPA typed antigens was reported in 7/23 (33.3%) CKiK; 2 / over a 1.5 year period, 1 788 PCs were prepared for patients with anti-HLA- antibodies, 63 PCs for patients with anti-HPA-antibodies and 58 PCs - for patients with anti-HLA and anti-HPA antibodies. FNAIT neonates were transfused with 35 PCs from register donors and 176 PCs from casual donors; 3 / in 13/23 CKiK (61.9%) PC selection for immunized patients was mainly based on crossmatching in LCT; 4 / registers report of 12,885 donors typed for HLA Class I antigens including 417 donors typed for HPA; 5 / nation-wide there are 133 HPA-1a negative donors available for immunized patients; they were selected after typing of 5 872 donors; The number of HPA/HLA typed donors for immunized patients is insufficient. as compared to other countries. Moreover, the demand for registered donors is steadily growing due to expension of FNAIT diagnostics currently performed at the Institute of Hematology and Transfusion Medicine (IHiT) but also in the laboratories of CKiK. One of the responsibilities of the blood transfusion service is to provide PCs for immunized patients.

Modern power grid control systems are not isolated islands – disturbances in one system can cause instabilities or even blackouts in adjacent systems. Cyber attacks on power grids could result in significant economic losses. Indeed, cyber weapons have already targeted power systems in Europe. This paper describes a cybersecurity protection approach for power grid control systems. It presents an analysis of a domestic power grid control system that emphasizes the identification of key elements of the infrastructure and their importance to power grid security. In addition, it provides a unique perspective based on experience with the system design process – from the identification of requirements to their application in operator control and supervisory substations. The paper also discusses how to verify the functionality provided by an implemented cybersecurity system. This approach is expected to assist in the design and implementation of power grid protection systems. Moreover, the approach can be adjusted to develop security systems for other critical infrastructure assets such as gas and chemical processing facilities, water and wastewater systems.

Published version. Source at http://doi.org/10.1007/s00005-015-0371-9. Fetal/neonatal alloimmune thrombocytopenia (FNAIT) is a relatively rare condition (1/1000–1/2000) that was granted orphan status by the European Medicines Agency in 2011. Clinical consequences of FNAIT, however, may be severe. A thrombocytopenic fetus or new-born is at risk of intracranial hemorrhage that may result in lifelong disability or death. Preventing such bleeding is thus vital and requires a solution. Anti-HPA1a antibodies are the most frequent cause of FNAIT in Caucasians. Its pathogenesis is similar to hemolytic disease of the newborn (HDN) due to anti-RhD antibodies, but is characterized by platelet destruction and is more often observed in the first pregnancy. In 75 % of these women, alloimmunization by HPA-1a antigens, however, occurs at delivery, which enables development of antibody-mediated immune suppression to prevent maternal immunization. As for HDN, the recurrence rate of FNAIT is high. For advancing diagnostic efforts and treatment, it is thereby crucial to understand the pathogenesis of FNAIT, including cellular immunity involvement. This review presents the current knowledge on FNAIT. Also described is a program for HPA-1a screening in identifying HPA-1a negative pregnant women at risk of immunization. This program is now performed at the Institute of Hematology and Transfusion Medicine in cooperation with the Department of Obstetrics and Gynecology of the Medical Centre of Postgraduate Education in Warsaw as well as the UiT The Arctic University of Norway.

Background and Objectives Post-transfusion reactions with dyspnoea (PTR) are major causes of morbidity and death after blood transfusion. Transfusion-related acute lung injury (TRALI) and transfusion-associated circulatory overload (TACO) are most dangerous, while transfusion-associated dyspnoea (TAD) is a milder respiratory distress. We investigated blood components for immune and non-immune factors implicated in PTR. Material and Methods We analysed 464 blood components (RBCs, PLTs, L-PLTs, FFP) transfused to 271 patients with PTR. Blood components were evaluated for 1/antileucocyte antibodies, 2/cytokines: IL-1β, IL-6, IL-8, TNF-α, sCD40L, 3/lysophosphatidylcholines (LysoPCs), 4/microparticles (MPs) shed from plateletes (PMPs), erythrocytes (EMPs) and leucocytes (LMPs). Results Anti-HLA class I/II antibodies or granulocyte-reactive anti-HLA antibodies were detected in 18·2% of blood components (RBC and FFP) transfused to TRALI and in 0·5% of FFP transfused to TAD cases. Cytokines and LysoPCs concentrations in blood components transfused to PTR patients did not exceed those in blood components transfused to patients with no PTR. Only EMPs percentage in RBCs transfused to patients with TRALI was significantly higher (P

Tactical ad-hoc networks are evolving today towards complex heterogeneous networks in terms of architecture, pro- tocols and security. Due to the difference in network resources and reliability, end-to-end quality of service provisioning becomes very challenging. If we also take into account communication issues such as unpredictable connectivity, preferential forwarding for special traffic classes, intermittency due to node or commu- nication link failure, the problem is further aggravated. In this article, we examine the major challenges that must be solved in order to provide efficient QoS provisioning in the heterogeneous network. Finally we describe QoS-aware mechanisms for inter-domain and intra-domain heterogeneous networks, also including real-time services provision in highly mobile environments. Keywords—E2E QoS, connectivity, routing, heterogenous net- works

Background: Transfusion-related acute lung injury (TRALI) is a major cause of death associated with transfusion. Nevertheless it is still misdiagnosed and underreported. We present a case of this serious complication in order to make it more familiar to clinicians and indicate proper medical management, which is significant not only for the patients presenting TRALI symptoms but also for future recipients of blood components. Case presentation: A 32-year-old white woman with in-vitro fertilization in anamnesis was admitted to Department of Obstetrics and Gynecology because of abdominal pain. Ultrasonography examination revealed pathological mass in left adnexa. The patient underwent laparoscopic left salpingectomy. The following day she reported progressive pain in lower abdomen with signs of peritoneal irritation. Emergency laparotomy was performed and active bleeding from fallopian tube was stopped. Four units of red blood cells concentrate and six units of fresh frozen plasma were transfused. Within two hours of surgery acute respiratory distress symptoms occurred, bilateral infiltrates were found on chest X-ray. The patient responded to supportive treatment (oxygen therapy, dexamethasone, diuretics) and her state improved within 12 hours. Serological diagnostics revealed anti-HLA antibodies in one donor which reacted with patient’s granulocytes. Clinical picture and anti-leukocyte antibodies detected in blood component allowed to identify the immune-mediated TRALI. Conclusions: Transfusion-related acute lung injury is a life-threatening complication of transfusion which manifests as non-cardiogenic pulmonary edema. Each suspected case of this syndrome should be reported to blood center in order to confirm the diagnosis and implement preventive measures (exclusion of implicated donor from further blood donation).

Transfusion-related acute lung injury (TRALI) is suggested to be a "two hit" event, resulting from priming and activation of pulmonary neutrophils. It is known that neutrophil activation may result from infusion of lysophosphatidylcholines (LysoPCs) accumulated during storage of blood components. The aim of our study was to verify whether the LysoPCs are released into the storage medium of blood components. We measured the LysoPCs concentration in the supernatants from stored apheresis platelet concentrates (PLTs), packed non-leukoreduced red blood cell concentrates (RBCs), leukoreduced red blood cell concentrates (L-RBCs), fresh frozen plasma (FFP) and donor plasma (control). Lipids were separated on high-performance thin-layer chromatography, detected by primulin spray and quantified by photodensitometric scanning. The LysoPCs concentration in donor plasma was similar to that in FFP. During storage the LysoPCs content in PLTs increased almost two-fold as compared to the fresh isolated platelets. In RBCs and L-RBCs the LysoPC level was very low or below detection limit and did not increase throughout the storage period. According to our observations bioactive LysoPCs may be considered a neutrophil-activating factor only following PLT transfusions but not RBCs transfusions.

Summary Introduction: The HPA-15 antigen system is characterized by a low antigen expression on platelets. The antibodies against this antigen are implied in fetal/neonatal alloimmune thrombocytopenia (F/NAIT), post-transfusion purpura, and refractoriness to platelet transfusions. Detection of these antibodies appears to be related to the level of HPA-15 expression on the platelets used in the monoclonal antibody–specific immobilization of platelet antigen (MAIPA) assay. Methods: We performed genotyping of 300 healthy blood donors for HPA-15 by TaqMan real-time PCR technology, and the HPA-15 antigen expression was investigated in 13 HPA-15aa and 19 HPA-15bb individuals. We also investigated the relevance of HPA-15 antigen expression on donor platelets used in MAIPA for antibody detection in 223 multitransfused hematological patients and 271 women with suspected F/NAIT. Results: In Polish donors, the HPA-15a allele frequencies were lower than the HPA-15b (0.480 vs. 0.515). We identified three HPA-15 expression groups: high (36.7 ± 8.36 MFI – eight cases), medium (19.5 ± 6.2 MFI – 21 cases), and low (6.5 ± 5.9 MFI – three cases). The HPA-15 expression was stable over time. The HPA-15aa and HPA-15bb platelets with high antigen expression were used for anti-HPA-15 antibody detection; anti-HPA-15 antibodies were detected in 4/223 (1.8%) patients receiving multiple transfusions but in none of the 271 women with suspected F/NAIT. Further examination of the four sera by MAIPA with various platelets revealed the optical density in the assay to be closely related to the level of HPA-15 antigen expression. Conclusion: Anti-HPA-15 antibody detection should be based on carefully selected platelets with high HPA-15 expression level.

In this study, we evaluated the response to treatment of 409 idiopathic thrombocytopenic purpura (ITP) patients who were tested for the presence of platelet-associated autoantibodies by direct-platelet immunofluorescence test (PIFT) and for the presence of plasma antibodies directed against the GPIIb/IIIa, GPIb and GPIa/IIa by monoclonal antibody immobilization of platelet antigens (MAIPA). In patients with platelet autoantibodies in comparison with patients without antibodies more frequently were observed the chronic form of disease (83.5%vs. 68.5%) and severe symptoms of haemorrhage diathesis (17.3%vs. 6.9%). Evaluation of the treatment response (to corticosteroids, immunosuppressive drugs and splenectomy) referred to patients with complete response, e.g. complete remission defined as platelet count of >100 x 10(9)/l for at least 2 years. The percentage of complete response in the whole population of ITP patients, both with and without autoantibodies regardless of the method of treatment, was similar (about 54%). However, the presence of platelet autoantibodies had effect on patients treated with corticosteroids: complete response approximately 71% (36/51) of patients with autoantibodies and in 60% (72/120) of patients without antibodies, as well as in patients treated with immunosuppressive drugs (cyclophosphamide, azathioprine, vincristin and vinblastin); complete response approximately 51% (11/21) of patients with autoantibodies and in 34.8% (6/17) of patients without autoantibodies. The presence of autoantibodies had no effect on the response of splenectomy patients.

Fetal/Neonatal Alloimmune Thrombocytopenia (FNAIT) is caused by destruction of fetal blood platelets due to maternal antibodies. This condition, which most commonly results from incompatibility between the mother and the fetus for the Human Platelet Antigen-1a (HPA-1a), may lead to intracranial hemorrhage, damage of the central nervous system (CNS) and even death of the fetus or the newborn. It can be the cause of strokes in term newborns. FNAIT is usually attributed to the presence of anti-HPA-1a antibodies. Its incidence rate is estimated at approximately 1/1000- 2000 live births. In the absence of a screening program, it is usually diagnosed after birth of a child with symptoms of thrombocytopenia or CNS hemorrhage. Monitoring of antibody production and thrombocytopenia treatment to effectively minimize the risk of stroke are therefore launched only at the next pregnancy. Testing indications are broader to include fetal ultrasound for symptoms of stroke to the CNS, ventricular enlargement or hydrocephalus, and obstetric failure. Diagnostic process is also recommended prior to the planned cordocentesis, in vitro fertilization and in sisters of mothers with children with FNAIT history. HPA-1a testing remains the best method for diagnosing pregnancies at risk. The detection frequency for FNAIT in Poland remains low Therefore, the Institute of Hematology and Transfusion Medicine (IHTM ) will have performed such HPA-1a antigen testing in 30000 Polish women within the framework of the PREVFNAIT program by March 2016. HPA-1a negative women (2% of the population) are a risk group for production of anti- HPA-1a antibodies responsible for FNAIT therefore all of them will be monitored for the presence and activity of anti-HPA-1a antibodies. Such testing will be performed free of charge for the women. The scientific goals related to the grant include 1) estimation of FNAIT prevalence in Poland and 2) search for biomarkers to predict the risk of the antibody production and severity of fetal thrombocytopenia.

The process of ensuring security of citizens requires access to information from sensors placed in various points of monitoring and data acquisition systems. IP video monitoring networks are nowadays the main element of a system that combines a variety of software and hardware architectures forming a heterogeneous environment. Ensuring implementation of monitoring services with a predictable quality level is an important challenge for monitoring systems. The paper includes presentation of a QoS platform that offers the possibility of support for monitoring services based on the information on video stream quality parameters. The proposed solution is part of the quality support system for monitoring and data acquisition system implemented in the INSIGMA project.

The HPA-15 antigen system is characterized by a low antigen expression on platelets. The antibodies against this antigen are implied in fetal/neonatal alloimmune thrombocytopenia (F/NAIT), post-transfusion purpura, and refractoriness to platelet transfusions. Detection of these antibodies appears to be related to the level of HPA-15 expression on the platelets used in the monoclonal antibody-specific immobilization of platelet antigen (MAIPA) assay.We performed genotyping of 300 healthy blood donors for HPA-15 by TaqMan real-time PCR technology, and the HPA-15 antigen expression was investigated in 13 HPA-15aa and 19 HPA-15bb individuals. We also investigated the relevance of HPA-15 antigen expression on donor platelets used in MAIPA for antibody detection in 223 multitransfused hematological patients and 271 women with suspected F/NAIT.In Polish donors, the HPA-15a allele frequencies were lower than the HPA-15b (0.480 vs. 0.515). We identified three HPA-15 expression groups: high (36.7 ± 8.36 MFI - eight cases), medium (19.5 ± 6.2 MFI - 21 cases), and low (6.5 ± 5.9 MFI - three cases). The HPA-15 expression was stable over time. The HPA-15aa and HPA-15bb platelets with high antigen expression were used for anti-HPA-15 antibody detection; anti-HPA-15 antibodies were detected in 4/223 (1.8%) patients receiving multiple transfusions but in none of the 271 women with suspected F/NAIT. Further examination of the four sera by MAIPA with various platelets revealed the optical density in the assay to be closely related to the level of HPA-15 antigen expression.Anti-HPA-15 antibody detection should be based on carefully selected platelets with high HPA-15 expression level.

Summary. Two women with post-transfusion purpura (PTP) are presented, one with anti-HPA1a and the other with anti-HPA3a antibodies. Platelet-specific antibodies were identified using the platelet immunofluorescence test (PIFT) and the monoclonal antibody immobilization of platelet antigens (MAIPA) assay. Lymphocytotoxic and red cell antibodies were also detected in both patients, the latter being responsible for a delayed haemolytic transfusion reaction (DHTR). In the patient with anti-HPA1a antibody, red cell anti-c alloantibody was found in the serum and in the eluate from red cells; it was active in the monocyte monolayer assay (MMA). The patient with anti-HPA3a antibody had the red cell alloantibodies anti-D, -M and -S detected in the serum, the last being responsible for DHTR.

A rare case of neutropenia in a newborn due to anti-Fc(gamma) RIIIb antibody is described. The newborn, born from the 5th pregnancy, had severe infection and no neutrophils. Full clinical and neutrophil count recovery was observed when the child was 5 weeks old. In maternal serum, panreactive granulocyte alloantibodies were detected. The mother's and her two sisters' granulocytes appeared to be Fc(gamma) RIIIb deficient as found using pheno- and genotyping methods. All of them were healthy. The anti-Fc(gamma) RIIIb specificity of antibodies was identified by the monoclonal antibody immunobilization of neutrophil antigen assay. Such antibodies were not found in both sisters with the Fc(gamma) RIIIb deficiency, although they were pregnant, one of them on the seventh occasion.

Reticulated platelets (RP) are the youngest forms of platelets in blood and reflect the rate of bone marrow platelet production. In the present study, we used flow cytometric analysis to determine the percentage of RPs in patients undergoing allogeneic stem cell transplantation. We investigated 10 patients after transplantation from HLA identical siblings: five with acute myeloid leukemia (AML), four with chronic myeloid leukemia (CML), and one patient with myelodysplastic syndrome (MDS). Of the patients examined, four patients underwent allogeneic bone marrow transplantation and six patients underwent peripheral blood stem cell transplantation. It was observed that the initially reduced percentage of RPs (2.9 +/- 1.7%; mean +/- SD) was significantly higher (P = 0.0109) in all patients (13.6 +/- 6.4%) in the following 10-26 days. The RP percentage peak preceded the recovery of peripheral platelet count up to 45.6 x 10(9)/l on average by 3 days. We found no difference in RP% between the AML and CML patients but we did observe that in CML patients the RP percentage increased on average 7 days earlier than in AML patients. The elevated RP percentage reflects increased bone marrow regeneration and can be considered an additional marker of thrombopoietic recovery in the patients undergoing allogeneic stem cell transplantation.

In this study, we evaluated the response to treatment of 409 idiopathic thrombocytopenic purpura (ITP) patients who were tested for the presence of platelet-associated autoantibodies by direct-platelet immunofluorescence test (PIFT) and for the presence of plasma antibodies directed against the GPIIb/IIIa, GPIb and GPIa/IIa by monoclonal antibody immobilization of platelet antigens (MAIPA). In patients with platelet autoantibodies in comparison with patients without antibodies more frequently were observed the chronic form of disease (83.5%vs. 68.5%) and severe symptoms of haemorrhage diathesis (17.3%vs. 6.9%). Evaluation of the treatment response (to corticosteroids, immunosuppressive drugs and splenectomy) referred to patients with complete response, e.g. complete remission defined as platelet count of100 x 10(9)/l for at least 2 years. The percentage of complete response in the whole population of ITP patients, both with and without autoantibodies regardless of the method of treatment, was similar (about 54%). However, the presence of platelet autoantibodies had effect on patients treated with corticosteroids: complete response approximately 71% (36/51) of patients with autoantibodies and in 60% (72/120) of patients without antibodies, as well as in patients treated with immunosuppressive drugs (cyclophosphamide, azathioprine, vincristin and vinblastin); complete response approximately 51% (11/21) of patients with autoantibodies and in 34.8% (6/17) of patients without autoantibodies. The presence of autoantibodies had no effect on the response of splenectomy patients.

Background and Aim The role of leucocyte antibodies in donors is poorly understood in pathogenesis of transfusion-related acute lung injury (TRALI). We examined antibodies in donors and traced recipients transfused with their blood components. Material and Methods Antibodies were examined in 1043 donors by five methods, look back performed in 26 recipients. Results Anti-human leucocyte antigen detected by enzyme-linked immunosorbent assay in 9·8% women but none in men. Specificities identified using FlowPRA, antibodies detected after several months. TRALI reported in one recipient from immunized donor. In 11 of 26 recipients without TRALI, cognate antigens were identified. Conclusion Detection of antibodies in donors cannot predict TRALI, even in recipients with cognate antigen(s).

The evaluation of immunization by the HNA1a and 1b antigens during pregnancy was based on (i) their genotyping in 1038 unselected mothers and newborns of homozygous mothers, (ii) granulocyte counting in all born infants and (iii) examination of granulocyte antibodies in maternal sera if an HNA1 incompatibile child was born. A total of 548 (52·8%) mothers were heterozygous – thus further examinations were not done. Four hundred and ninety (47·2%) were homozygous, of whom 203 (41·3%) delivered an incompatible child, i.e. 19·6% of all the infants. Among available sera from 195 mothers with feto-maternal incompatibility, the granulocyte-specific antibodies were found in nine (4·5%); six of these (3%) were HNA1 (four anti-1a, two anti-1b), and in three others the specificity was not determined. In the remaining 28 sera, the only antibodies detected were HLA. Hence, six out of 1000 pregnant women can be expected to develop anti-HNA1. In none of the newborns was the cord neutrophil count below 1·5 × 109 L−1 and signs of infection found, thus the incidence of NAIN seems to be lower than 1 per 1000 infants. A comparison with our previous, unpublished data suggests that the incidence of severe NAIN is roughly 1 per 6000 (four cases among 24101 newborns).

In this review actual problems of the frequency, diagnosis and general rules of management of the neonatal alloimmune thrombocytopenia (NAIT) due to platelet antigens are presented.

Allorecognition and generation of alloantisera depend on T cell help. Here we summarize our recent work on identifying the T cells that recognize a specific platelet alloantigen generated by a Pro to Leu polymorphism in beta-chain of the platelet integrin alphaIIb beta3. The ability to generate alloantibodies is restricted by HLA-DRB3*0101. By measuring peptide binding to HLA-DRB3*0101, we have shown that the polymorphism controls the generation of the T cell epitope. This is not a result of the polymorphism changing a T cell contact residue, but rather by its generating a peptide anchor. The result is a directional antibody response in which only the beta-chain that is antigenic is the one that produces a peptide that binds to the HLA-DR. This mechanism of generating alloantibodies may be a paradigm for a whole class of responses.

The analysis of T-cell repertoires has been facilitated by the introduction of methods in which the length heterogeneity of the third complementarity region (CDR3) is used to further refine V-family-specific PCR. We call our implementation of this technique T-cell spectratyping. This method is especially important in analysis of specific expansion or retention of T cells in human immune system function. Current methodologies are cumbersome in the number of PCR reactions and gels needed for complete analysis of TCR BV repertoires. We describe here the optimized conditions for using 11 TCR BV primer pairs in multiplex PCR which allow for a more compact analysis. In addition, the two primers act as controls for each other in the PCR. The use of these primers is shown using either fluorescent or radiolabeled constant primers. The two labeling methods give comparable results. Fluorescent primers avoid the difficulties associated with use of radioactivity. Autoradiography with 32P-labeled primers is simpler, requiring less instrumentation.

Two human neutrophil serine proteases, elastase (HNE) and cathepsin G (CathG), are known to change the structure and hemostatic function of platelet surface membrane. The platelet membrane contains glycoproteins (GPs) which function as alloantigens, autoantigens and targets of drug-induced antibodies. The aim of this study was to investigate whether proteolysis of platelet GPs by HNE and CathG is associated with changes in the reactivity of platelets to antiplatelet antibodies. The platelet immunoreactivity was examined using the MAIPA (monoclonal antibody-specific immobilization of platelet antigens) assay and PSIFT (platelet suspension immunofluorescence test). The treatment of platelets with HNE led to a moderate increase in their reactivity to quinidine-dependent (anti-GP Ib) antibody and to a slight decline in the expression of HPA-1a. In contrast, CathG did not provoke any significant changes in platelet reactions with quinidine dependent and anti-HPA-1a antibodies. Both enzymes had no significant effect on the expression of HLA-A2, HLA-A3, HLA-B7 and HLA-B8 on platelets.

In 15 patients with thrombocytopenia EDTA-dependent platelet antibodies (IgM agglutinins active in 20 degrees C) were detected. These antibodies were found in patients with autoimmune diseases, infections and neoplasma as well as in healthy persons (including pregnant woman). In 10 persons pseudothrombocytopenia (PTCP) was diagnosed since the low platelet counts were found only in EDTA-blood, and the patients did not have bleeding symptoms. In 5 other cases EDTA-dependent antibodies were not the only cause of thrombocytopenia since the low platelet counts were also observed in the citrate-blood and occassionally the bleeding symptoms occurred; in 3 of them in addition autoantibodies were suspected. Due to the proper diagnosis of PTCP, in five patients unnecessary corticotherapy was discontinued, one person avoided splenectomy, in two patients previously postponed surgery was performed and one person could be passed for employment.

The registry of donors typed for HPA-1 and HPA-3 antigens is presented. Three cases of fetal/neonatal alloimmune thrombocytopenia (F/NAIT) transfused with typed platelets either from mother or from registered donors are discussed. All children were transfused just after delivery, one in addition in utero: they survived not having any haemorrhagic complications in central nervous system inspite of such complications in previous born siblings. In the paper the general rules of platelet transfusions in F/NAIT are discussed.

The enzyme test with GPIIb/IIIa has been used to detect antibodies in 500 sera from patients with thrombocytopenia and mothers of infants with thrombocytopenia. The results were compared with antibody detection in the platelet suspension immunofluorescence test (PIFT) and in the monoclonal antibody immobilization of platelet antigens (MAIPA). Platelet antibodies were detected in 125 sera (25%). In 46.2% the results were positive in all three tests. However, in 38.4% the ELISA was negative while the PIFT and MAIPA were positive. On the other hand, in 14.4% the ELISA was positive while the PIFT and/or the MAIPA were negative. The ELISA appears to be useful in the detection of anti-HPA-1a antibodies, which are the main cause of AIMN and PTP. This test, however, seems to be less useful in the detection of autoantibodies. The significance of the ELISA in the detection of platelet alloantibodies responsible for refractoriness to platelet transfusions is not clear yet and requires further investigations.

Pseudothrombocytopenia in four patients has been described. It was due to platelet "++EDTA-dependent" antibodies. The number of platelets was described only in EDTA blood while the number was normal when platelet were evaluated in citrate blood. The importance of distinguishing pseudothrombocytopenia from thrombocytopenia is discussed, especially in view of unnecessary treatment, delayed operation etc.

We present the case of drug-dependent thrombocytopenic purpura due to the treatment with quinidine. IgG quinidine-dependent antibodies in patient serum were detected in the platelet immunofluorescence test. They were bound to GP Ib on platelet membrane.

Two cases of neonatal alloimmune granulocytopenia due to fetomaternal incompatibility with granulocyte-specific antigen NA1 are presented. The diagnosis was based on the detection of anti-NA1 alloantibodies in maternal and neonates sera in leukoaglutination and immunofluorescence tests with granulocytes. Both children (twins) had severe granulocytopenia and unfortunately died.

In a rosette assay with human erythrocytes equally sensitized with anti-Rh antibodies, the Fc receptor-bearing (FcR) cells are much more numerous among monocytes than among lymphocytes. FcR monocytes could be detected using IgG1 and/or IgG3 antibodies although a higher percentage of FcR cells is observed with sera containing IgG3. FcR lymphocytes are detectable almost only with sera containing IgG3 antibodies. If the anti-Rh antibodies are restricted to IgG1 none or single FcR cells could be found. The application of mixed rosette assay with fluorescein-stained erythrocytes sensitized with IgG3 and unstained red cells sensitized with IgG1 allowed documentation of the presence of receptors for both subclasses on monocytes as well as on lymphocytes although some differences between these cells were observed. Almost all FcR monocytes bind both IgG subclasses, although in different proportions. On the contrary, most FcR lymphocytes bind only or mainly IgG3, but receptors for IgG1 can also be detected.

Three cases of neonatal alloimmune thrombocytopenia and one patient with post-transfusion purpura could be diagnosed only by introducing the platelet immunofluorescence test. Thrombocytopenia was caused by anti-PlA1 platelet alloantibodies detected neither in the agglutination nor by the complement fixation test.

Three anti-Rh sera useful for the EAhum test were found (one comparable to Ri serum). It was shown that the usefulness of anti-Rh sera for the EAhum test depends on the amount of anti-Rh antibodies absorbed onto red cells demonstrated in the manual antiglobdin test. It does not depend on the quality of antibodies and the ability of complement binding.

13 anti-Rh sera were compared for their usefulness in the detection of Fc-receptor-bearing lymphocytes (EAhum test). IgG subclasses of anti-Rh antibodies were determined by the antiglobulin test with monospecific sera and by the detection of Gm allotypic markers in the haemagglutination inhibition test. Six sera with IgG1 + IgG3 or IgG1 + IgG2 + IgG3 antibodies and one with pure IgG3 antibodies were found to be useful, whereas six other sera with only IgG1 were unsuitable for the EAhum test. G3m markers were detected only on the anti-Rh antibodies which were capable of forming rosettes with lymphocytes. The data show that human peripheral lymphocytes possess Fc receptors for IgG3 immunoglobulins.

Using a Technicon autoanalyzer method of Marsh 752 sera of patients, Rh-negative subjects in the initial stage of immunization with Rh-positive blood, and healthy blood donors were investigated. In 56 sera (8.7%) positive reactions with standard erythrocytes were found. In 21 of these cases (36%) specificity of antibodies was established. They were mostly alloantibodies or autoantibodies against Rh antigens. In 1 case anti-Ika alloantibody and in 1 case anti-K autoantibody were demonstrated. Antibodies with undetermined specificity belonged to the so called "analyzer antibodies", which are detected only by the automatic methods, and probably have no clinical importance. The possibility of recording by the autoanalyzer of subthreshold levels of alloantibodies undetected by other methods may be of great practical importance of patients receiving multiple transfusions of blood and for immunized blood donors.