Summary. The PFA-100Ò (PFA) diagnostic system for the detection of platelet dysfunction was evaluated to determine reference ranges in a normal population. The PFA determines the primary haemostasis capacity (PHC) of anticoagulated whole blood, expressed by the system's closure time (CT). In this study the CT reference ranges were determined for blood samples collected in 105 mmol/l (3´2%) buffered citrate and the effect of gender, smoking, and use of oral contraceptives on reference ranges was assessed. Each of the 309 healthy blood donors from ®ve blood centres was con®rmed to have normal platelet function before inclusion in the study. Blood samples were tested in duplicate with both the collagen/epinephrine (Col/Epi) and collagen/ADP (Col/ADP) test cartridges.PFA reference ranges (90% central intervals of measured closure times) for both cartridge types were similar for all groups. Subgroup analysis showed that neither gender nor oral contraceptive usage had any effect on PHC. The 95% cut-off value for the Col/Epi CT was slightly higher for smokers than for non-smokers, an effect more pronounced in female than in male donors. However, the small difference did not justify establishment of speci®c reference ranges for smokers. Data from all included subjects were pooled to calculate the CT reference ranges for blood samples collected in 105 mmol/l buffered citrate (Col/Epi 82±150 s; Col/ADP 62±100 s). Normal levels of ®brinogen, as well as normal platelet counts and normal haematocrit levels, appeared not to in¯uence the PHC. Because slight but signi®cant differences of the reference ranges were observed between some of the participating sites, in-house con®rmation of these reference range guidelines is recommended.
The aim of the study was the comparison of the influence of fresh frozen plasma (FFP) (Freiburg, Germany) and Biseko, Biotest Pharma GmbH (Dreieich, Germany), as a plasma substitute (a standardized, virus inactivated human serum protein solution) on the coagulation factors, inhibitors, proteins, and complement factors in the plasma of autoimmune disease patients following membrane plasma separation. Patients (n = 24) with autoimmune disease were randomized to receive either FFP or Biseko for membrane plasma separation therapy. During each plasma exchange, 100% of the plasma volume was replaced by the respective substitute. Plasma exchange volume was performed once daily for 3 days. Target test parameters of the coagulation system were fibrinogen, fibrinopeptide A, factor VIII (FVIIIC), von Willebrand factor antigen (vWFAg), partial thromboplastin time (PTT), thromboplastin time (Quick value), and antithrombin (AT III). The immunoglobulins were IgG, IgA, and IgM and C-reactive protein (CRP). The thrombocytes were platelet factor 4 (PF4), and complement factors were C3 and C4. Biseko was well tolerated with 1 mild adverse drug reaction (ADR) (n = 1) while FFP gave rise to ADR on 7 occasions (n = 4). Statistically significant differences in the 2 groups were observed for fibrinogen, PTT, Quick value, and AT III. From the clinical point of view, all fluctuations and differences in parameter levels remained clinically silent. The differences had no clinical consequences. Reflecting on a potential decrease in the risk of infections in comparison to FFP therapy and the lower rate of adverse drug reactions, it is possible to postulate an advantage of Biseko for plasma exchange therapy.
Mononuclear phagocytes are a bone-marrow-derived subgroup of white blood cells which circulate as monocytes and, after differentiation into macrophages, become resident in many tissues. By synthesizing the important proteinase inhibitors a,-macroglobulin and al-proteinase inhibitor mononuclear phagocytes contribute to the control of proteolysis both in blood and tissues. Applying a culture system which enables human blood monocytes to differentiate into macrophages in vitro, synthesis of a,-macroglobulin and al-proteinase inhibitor was studied. The normal course of monocyte -macrophage maturation is accompanied by a strong increase of specific a,-macroglobulin synthesis and a concomitant slight decrease of al-proteinase inhibitor. a,-Macroglobulin can be designated as a marker protein of the monocyte/macrophage differentiation. Endotoxin (Salmonella ryphi) in a concentration as low as 100 ng/ml strongly represses a,-macroglobulin synthesis both in monocytes and macrophages. Furthermore, endotoxin completely abolishes the induction of a,-macroglobulin synthesis during the course of normal monocyte in vitro cultivation, indicating that endotoxin is a strong inhibitor of the monocyte -macrophage maturation. In contrast to a,-macroglobulin, al-proteinase inhibitor synthesis is strongly stimulated by endotoxin in monocytes as well as in macrophages.The cells of the mononuclear phagocyte system derive from stem cells in the bone marrow, linking monoblasts, promonocytes, monocytes and the heterogeneous tissue macrophages (for review see [l -31). Cells of this lineage develop over several days in the marrow and circulate as monocytes in the peripheral blood for a few further days before migrating into different tissues, where they remain resident for up to several months as macrophages. Macrophages are present in the liver (as Kupffer cells), lung (as alveolar macrophages), bone (as osteoclasts) and several other tissues. The development of the blood monocytes into macrophages is accompanied by marked morphological and biochemical changes and is designated as terminal maturation. Differentiation of monocytes into macrophages can be studied in vitro by cultivation of purified populations of human peripheral blood monocytes within hydrophobic Teflon foils in the presence of human serum [4]. In vitro maturation closely resembles differentiation in vivo [5].Secretory products of mononuclear phagocytes are involved in several macrophage functions, such as immunoregulation and the killing of bacteria (for review see [3,61). Several proteinase inhibitors were found to belong to the proteins secreted by mononuclear phagocytes including azCorrespondence to J. Bauer, Medizinische Universitatsklinik, Hugstetter StraSe 55, D-7800 Freiburg, Federal Republic of Germany This work is dedicated to Prof. Dr Georg Wilhelm Lohr on the occasion of his 65th birthday.Abbreviations. E~M , a2-macroglobulin, q P I , ccl-proteinase inhibitor; RPMI, Roswell Park Memorial Institute 1640 medium. macroglobulin (azM) [7] and a]-proteinase inhibitor (a...
The biosynthesis and secretion of M-type and Z-type «i-antitrypsin was studied in human monocytes. In monocytes of PiMM individuals a\-antitrypsin represented 0.08% of the newly synthesized proteins and 0.44% of the secreted proteins. Two molecular forms of a r antitrypsin could be identified: a 51-kDa intracellular form, susceptible to endoglucosaminidase H, thus representing the highmannose type precursor form and a 56-kDa form resistant to endoglucosaminidase H which was secreted into the medium. Inhibition of de novo glycosylation by tunicamycin impaired the secretion of M-type OL\-antitrypsin by about 75% whereas inhibition of oligosaccharide processing by the mannosidase II inhibitor swainsonine did not alter the secretion of Mtype c^-antitrypsin. «i-Antitrypsin secreted by human monocytes was functionally active as measured by complex formation with porcine pancreatic elastase. Even unglycosylated a r antitrypsin secreted by human monocytes treated with tunicamycin formed a complex with elastase. In monocytes of PiZZ individuals the secretion of a r antitrypsin was decreased. 72% of newly synthesized M-type «i-antitrypsin, but only 35% of newly synthesized Z-type a r antitrypsin were secreted during a labeling period of 3 h with [ 35 S]methionine.The 51-kDa form of Z-type «i-antitrypsin accumulated intracellularly, whereas the 56-kDa form was secreted. Inhibition of oligosaccharide processing by swainsonine did not alter the decreased secretion of Z-type a r antitrypsin, whereas inhibition of de novo glycosylation by tunicamycin blocked the secretion of Z-type «i-antitrypsin completely. Biosynthese und Sekretion von M-und Z-Typ-a r Antitrypsin in menschlichen Monozyten. Einflu von Inhibitoren der Glycosylierung und des Oligosaccharid-"Processings" auf Sekretion und FunktionZusammenfassung: Die Biosynthese von M-und ZTyp-a r Antitrypsin wurde in menschlichen Monozyten untersucht. In Monozyten von PiMM-Individuen stellte «i-Antitrypsin 0.08% der neu synthestisierten und 0.44% der sezernierten Proteine dar. Es konnten 2 molekulare Formen von a r Antitrypsin identifiziert werden: eine 51 kDa intrazellul re Form, die Endoglucosaminidase-H-spaltbar war und somit die Mannose-reiche Vorl uferform darstellte, und eine 56-kDa-Form, die nicht durch Endoglucosaminidase H gespalten werden konnte und die ins Medium sezerniert wurde. Hemmung der De-novo-Glycosylierung durch Tunicamycin hemmte die Sekretion von M-Typ-«i-Antitrypsin um etwa 75%, wohingegen eine Hemmung des Oligosaccharid-"Processings" durch den Mannosidase-II-Inhibitor Swainsonin die Sekretion von M-Typ-cxi-Antitrypsin nicht ver nderte. «i-Antitrypsin, das von menschlichen Monozyten sezerniert
Three certified reference materials for thromboplastins are available from the Community Bureau of Reference (BCR) of the European Commission for calibration of commercial thromboplastins used for control of oral anticoagulant therapy. The long-term stability of these reference materials has been monitored by two independent laboratories, using deep-frozen and lyophilized plasma samples. Prothrombin times and prothrombin time ratios measured on 19 occasions in the period 1981-86 have been analysed for trend with time. Although significant trends of prothrombin time and ratio (P less than 0.05) were observed, a consistent pattern of trends could not be recognized. The significant trends of prothrombin time and prothrombin time ratio are most probably due to changes in local laboratory conditions. There is no indication that the reference materials have deteriorated since the beginning of the study. It is recommended that long-term stability monitoring of thromboplastins be performed by at least two laboratories simultaneously.
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