Summary. The variation in immune responses to standard inoculation of the hepatitis-B virus vaccine suggest that host factors influence response in ways that are not presently understood. We studied 25 low/nonresponding health care workers (anti-HBs titer < 50 IU/1) after the third inoculation of an experimental hepatitis-B vaccine to determine their immune status (through lymphocyte phenotypes) and HLA type. After application of a fourth inoculation, the seroconverting subjects showed only low anti-HBs levels; three male subjects remained anti-HBs negative. Twelve months after the fourth inoculation only 9 of 25 subjects (36%) maintained anti-HBs titer >10 IU/1. Almost all subjects had normal B-cell and CD-4 and CD-8 counts and ratios. Relative to other European populations HLA-A-10 (P<0.05), B-12 ( P < 0.025), CW-5 (P<0.05), DR-3 (P<0.025), and DR-5 (P<0.025) were increased, whereas DR-2 (P<0.05) was decreased. However, after correction of the P-values for the number of HLA antigens determined, these differences were no longer significant. Furthermore, these HLA types were n o t the same as those reported in other studies (except for DR-3). We suggest that larger sample sizes or even not yet available immunogenetic markers wilt be required to prove a n " immunogenetic background" in low/nonresponders, if it exists.
HLA typing was performed in 40 thyroid carcinoma patients. No association was found between antigens of the HLA system and papillary, follicular or medullary thyroid carcinomas. Literature reports on different HLA associations are probably due more to the small number of cases in the studies involved than to ethnic or geographic differences.
A patient with autoimmune hemolytic anemia of the warm antibody type developed a hyperacute hemolytic crisis with acute renal failure under conventional treatment with corticosteroids. Because of the life-threatening situation it was decided to start a combined treatment with immunosuppression and plasmapheresis. Already after the first plasma exchange the direct antiglobulin test became weakly positive, the hemoglobin level rose from 4.1 to 8.1 g/dl, and the hemolytic crisis subsided. Four more exchanges were performed; thereafter, the patient's clinical condition and laboratory data stabilized.
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