Arthur Bradley Eisenbrey

The major histocompatibility complex (MHC) contains the loci (structural locations of the genes) that encode the human leukocyte antigens (HLA). The human MHC is densely packed, highly complex, and contains the human genes with the most variations (polymorphisms) identified in humans. The physical arrangement of the HLA gene loci reflects the evolu...

Engraftment monitoring is a common non-HLA (human leukocyte antigen) function of histocompatibility laboratories, most frequently performed in laboratories that support hematopoietic stem cell transplantation. The roots of engraftment monitoring are in identity testing and rely on identification and quantification of allelic markers of highly polym...

Until molecular typing methods became available for human leukocyte antigen (HLA) typing, antibody-based methods were the standard for HLA typing and evolved as the number of recognized HLAs increased. The challenges of detecting and identifying HLAs Class I were overcome much more quickly than those of HLAs Class II. Many innovations were introduc...

A fundamental test in solid organ transplantation is the crossmatch: serum from the potential recipient is reacted in vitro with lymphocytes from the potential donor, and compatibility or incompatibility is determined (lymphocytes serving as surrogates for donor tissue cells). The methods used in crossmatching have evolved as technology has advance...

Association of increased risk for some diseases was noted as early as 1967 when only two loci and 15 antigens were proposed. Although statistical association does not prove causation, many disease associations with specific human leukocyte antigens (HLAs) and, later, alleles, have remained informative over decades. Multiple mechanisms have been pro...

The ability to detect and identify human leukocyte antigen (HLA) antibodies in patient sera has improved in parallel to improvements in crossmatching and particularly with the advancements in HLA typing techniques. HLA antibody detection depends on availability of cell donors who have been HLA typed by the most current methods and reagents availabl...

The development of nucleic acid sequencing methods made it possible to predict the nucleic acid sequences of the human leukocyte antigen (HLA) genes. Molecular assays using restriction endonucleases showed the limitations of antibody-based typing methods. The discovery of the polymerase chain reaction (PCR) revolutionized HLA typing and rapidly adv...

Histocompatibility testing has its origin in serological testing (evaluating reactions between antibodies and antigens), transfusion medicine, and population genetics in humans and mice. The field has been rapidly expanding from the recognition that a new, polymorphic genetic system had been identified. Understanding of human histocompatibility gen...

The naming conventions for human leukocyte antigen (HLA) loci, antigens, alleles, and epitopes are complex and confusing to most people outside of the HLA laboratories and transplant services. This chapter builds on basics introduced in Chapter 1 with a presentation of the history of the names given to the antigens and the loci as they were identif...

Advances in computer technology, miniaturization, and novel sequencing technologies have made it possible to perform simultaneous sequencings of nucleotide fragments derived from targeted regions or whole genomes. Frequently called “Next Generation Sequencing” (NGS), a more descriptive name is “massively parallel sequencing” because DNA (or RNA) is...

Endotracheal tubes are intended to protect the airway and assist with mechanical ventilation in sedated patients. The blood vessels of the tracheal mucosa can be compressed by high tracheal tube cuff pressures (> 30 cm H2O), leading to reduced mucosal blood flow with resulting ischemia and morbidity. Previous research showed a direct correlation be...

Aim Testing for HLA-B27 for disease association is performed using a variety of methodologies. Many laboratories use flow cytometry, a method typically not used for other HLA typing purposes. We evaluated five years of College of American Pathologists (CAP) HLA-B27 proficiency test (PT) results in order to compare flow cytometry to other methods. M...

The mean fluorescent intensity obtained using single antigen beads does not represent the titer of the serum sample very well because the degree of saturation of the antigen on the bead varies by individual bead and the human leukocyte antigen antibody-binding site on the bead may not duplicate the activity of the serum's antibodies in vivo. The fl...

This chapter covers the specific aspects of immunohematology and transfusion medicine that are relevant to the laboratory practice of hematology. It discusses the major erythrocyte blood group antigens and basic blood bank testing for alloantibodies and autoantibodies. Basic principles of transfusion and component therapy are covered, as are immuno...

Histocompatibility testing for stem cell and solid organ transplantation has become increasingly complex as newly discovered HLA alleles are described. HLA typing assignments reported by laboratories are used by physicians and donor registries for matching donors and recipients. To communicate effectively, a common language for histocompatibility t...

Diagnosis of liver allograft antibody-mediated rejection (AMR) is difficult and requires a constellation of clinical, laboratory and histologic features that support the disease and exclude other causes. Histologic features of AMR may intermix with those of biliary obstruction, preservation/reperfusion injury, and graft ischemia. Tissue examination...

Histocompatibility testing for stem cell and solid organ transplantation has become increasingly complex as newly discovered human leukocyte antigen (HLA) alleles are described. HLA typing assignments reported by laboratories are used by physicians and donor registries for matching donors and recipients. To communicate effectively, a common languag...

The aim of this study was to describe the epidemiology and utilization of anti-hepatitis B core protein(+) and anti-hepatitis C virus(+) organ donor referrals in a large organ procurement organization. Between 1995 and 2006, 3,134 deceased organ donor referrals were tested for anti-HBc and anti-HCV using commercial assays. The prevalence of anti-HC...

Because of the increase in the use of warfarin in the population in recent years, reversal of warfarin-related coagulopathy has become common in daily hospital practice. Transfusion of fresh frozen plasma (FFP) is the preferred treatment method for urgent warfarin reversal in the USA. We have undertaken a 1-month audit of FFP usage to ascertain the...

The clinical impact of increasing levels of blood loss has been shown to increase morbidity and mortality after percutaneous coronary intervention (PCI). The impact of red blood cell (RBC) transfusion for severe bleeding is unknown. We systematically collected baseline and 8-h postprocedure hematocrit (HCT) values on patients undergoing PCI. The in...

This audit encompassing a six-month period on the current practice of red blood cell transfusion following elective primary total hip arthroplasty showed that the rate of allogeneic blood avoidance was 84.8% for preoperative autologous blood donors and 47.8% for non-donors (p<0.001). Lower preoperative hemoglobin level was associated with an increa...

Tissue for transplantation belongs in the hospital hlootl bank. No other sen-ice in the hospitil has the experience with the regulatory environmcnt and mmplinnct., Good Manufacturing Practices (GMR], diverse storage require-ments, inventary and record nlanagemcnt, and trilcking and t r a c i n ~ of human products. Like blood products, tissues have...

Tissue banking has evolved from an obscure, highly specialized medical practice with little oversight to a highly visible and fully regulated business under federal regulations, some state laws, and standards established by voluntary accrediting organizations. The transformation has been driven by revelations of transmission of viral, bacterial, an...

We describe 2 male patients in whom hepatosplenic gamma/delta T-cell lymphoma (HSTL) developed 6 and 10 years after renal transplantation. The onset was abrupt with systemic symptoms, cytopenia, and hepatosplenomegaly. The histologic examination of the spleen (case 1), liver, and bone marrow revealed sinusoidal infiltrates of markedly abnormal lymp...

We describe 2 male patients in whom hepatosplenic gamma/delta T-cell lymphoma (HSTL) developed 6 and 10 years after renal transplantation. The onset was abrupt with systemic symptoms, cytopenia, and hepatosplenomegaly. The histologic examination of the spleen (case 1), liver and bone marrow revealed sinusoidal infiltrates of markedly abnormal lymph...

Objective: To evaluate the cost effectiveness of routine admission type and screen testing for expected vaginal delivery.Methods: A retrospective review was conducted in patients transfused with blood during an admission that anticipated a vaginal delivery over a 3-year period, at Hutzel Hospital, in Detroit, Michigan.Results: Of 16,291 patients ad...

We describe a modification of a previously described serum iron procedure applied to the Bayer DAX48 (Bayer Diagnostics, Tarrytown, NY) automated chemistry analyzer. The iron-ligand used in this assay, 2-(5-nitro-2-pyridylazo)-5-(N-propyl-N-sulfopropylamine) phenol (nitro-PAPS), has a molar absorptivity of 94,000 L mol(-1) cm(-1), which is three to...

This evaluation was undertaken to verify the application protocol for the CK-MB assay on the ACCESS Immunoassay Analyzer (Sanofi Diagnostics Pasteur, Chaska, MN). The results show that the ACCESS CK-MB assay total imprecision was 6.8% to 9.1%. Analytical linearity of the ACCESS CK-MB assay was excellent in the range of < 1-214 micrograms/L. A compa...

To the Editor. —Despite their obvious enthusiasm for point-of-care testing for cardiac troponin T (cTnT), Dr Antman and colleagues1 have not provided convincing evidence that this technology is either applicable or appropriate in the clinical setting. Many of the arguments used to justify using a test with a false-positive rate of 35% and a sensit...

Identifying risk factors that lead to graft failure may reduce morbidity and mortality after bone marrow transplantation (BMT) for hematologic malignancies. We evaluated engraftment of all patients with acute myelogenous leukemia (AML), chronic myelogenous leukemia (CML) and myelodysplastic syndrome (MDS) receiving an unmanipulated marrow allogenei...

Squamous-cell carcinoma of the cervix and its precursor lesions are associated with human papillomavirus (HPV) infection. Epidemiological studies indicate that HPV infection in itself is not sufficient for cervical-cancer induction, suggesting that other factors contribute to carcinogenesis. We have investigated the potential role of host genetic b...

SINCE its introduction in the early 1980s, pulse oximetry has been one of the most rapidly diffusing electronic monitoring technologies in medicine.1 Use of pulse oximetry during procedures requiring general anesthesia quickly became standard practice in the United States because it is noninvasive, requires no special training, gives continuous rea...

Testing for histocompatibility antigens of donor-recipient pairs is a crucial component in solid organ and bone marrow transplantation. The technology behind this testing has developed substantially from the first observations in the 1950s of leukoagglutination using sera of multiparous women to the polymerase chain reaction methodologies of the 19...

Evidence collected over the last 20 years indicates that physical and sexual violence against women is an enormous problem. Much of this violence is perpetrated by women's intimate partners or in relationships that would presumably carry some protective aura (eg, father-daughter, boyfriend-girlfriend). This violence carries with it both short- and...

Evidence collected over the last 20 years indicates that physical and sexual violence against women is an enormous problem. Much of this violence is perpetrated by women's intimate partners or in relationships that would presumably carry some protective aura (eg, father-daughter, boyfriend-girlfriend). This violence carries with it both short- and...

MOST of the scientific research relating to firearms and their effects on public health has concentrated on handguns. Despite the severity of the firearm problem in this country, and the wealth of publicity associated with it, more scientific investigation is needed on all firearm injuries1 and those due to special classes of guns like assault weap...

The rapid proliferation of health care technology and the increasing concern about cost containment are major converging forces in today's health care system. These forces argue persuasively for the rigorous evaluation of the safety and effectiveness of technologies and for the use of such evaluative information as the foundation of both clinical d...

The system paternity index (PI) is derived from the phenotypes of the trio and its value in non-exclusion cases is primarily determined by the gene frequency of the paternal gene (obligatory gene) transmitted to the child. This study was undertaken to determine: 1) The range of HLA phenotype frequencies observed in our laboratory among non-excluded...

The use of animals in general medical education is essential. Although several adjuncts to the use of animals are available, none can completely replace the limited use of animals in the medical curriculum. Students should be made aware of an institution's policy on animal use in the curriculum before matriculation, and faculty should make clear to...

Resolution 193 (A-90), which was adopted by the House of Delegates of the American Medical Association, called on the Council on Scientific Affairs to study the situation regarding asbestos abatement, the risks to health, and the appropriateness of Environmental Protection Agency regulations, policies, and control measures. This report reviews the...

A murine monoclonal antibody (E10) was made against cultured cartilage cells. The E10 antibody binding is localized to the surface of cultured cartilage cells in suspension and is present in the cytoplasm in paraffin embedded sections. There is no reactivity with cartilage matrix, or with the matrix of cartilaginous tumors. Reactivity is removed by...

This report reviews some current and future problems in elder care that face physicians. Between 1900 and 1985, the number of Americans aged 65 years and older increased from about 3 million to 28 million. By 2020, it is estimated that the elderly population will reach 64 million. The elderly make extensive use of the health care system: approximat...

Resolution 109 (1988 Annual Meeting), referred to the Board of Trustees, calls for the American Medical Association to urge the US Congress to establish and support a permanent US-Mexico border environmental health commission and to assist Mexico and the United States in developing programs designed to address substandard environmental health in co...

Phosphatidylglycerol (PG) in amniotic fluid is recognized as a good indicator of fetal lung maturity and is unaffected by moderate amounts of blood or meconium contamination. A rapid immunologic agglutination assay, Ultrasensitive AmnioStat-FLM (FLM), was compared with two-dimensional thin-layer chromatography (TLC) and an enzymic, colorimetric pro...

The in vivo and in vitro effects of glucocorticoids on eosinophilopoiesis were examined with soft agar cultures of bone marrow and peripheral blood cells. Prednisone, 10 mg four times daily for three days, administered to normal volunteers, caused a significant drop in circulating eosinophil numbers (p less than 0.005) but did not decrease eosinoph...

Seasonal variation of symptoms and IgE response to short ragweed (SRW) allergens is well documented. Clinical symptoms generally parallel the rise and fall of the SRW-pollen count, whereas total and specific-IgE levels peak after the SRW-pollen season with a more gradual return to preseason levels. Because IgE synthesis is under T-lymphocyte contro...

Bronchial epithelial damage occurs regularly in bronchial asthma, but it is not known whether such damage occurs in the mucosa of nasal polyps. We obtained nasal polyp tissues from thirty patients and we examined these tissues for evidence of epithelial damage. Immediately after resection, polyp tissue was fixed in Karnovsky's fixative, embedded in...

Because the study of human IgE synthesis and regulation requires exquisitely sensitive and rapidly performed methods for assay of in vitro IgE production, we compared 4 methods for radiometric immunoassay (RIA) of human IgE: double antibody RIA (DARIA), ultrasensitive enzymatic RIA (USERIA), sensitive paper radioimmunosorbent test (SPRIST) and micr...

We investigated the membrane markers of the eosinophil colony-forming cell (EO-CFC). Eosinophil colonies were identified by their ability to show densely packed cell growth and by staining for cyanide-resistant peroxidase activity. Bone marrow cells were characterized prior to soft agar culture by one of two methods: (1) standard erythrocyte (E) an...

Several hypothetical mechanisms have been proposed to explain the existence of histocompatibility diversity in parthenogenetic species of the poeciliid fish genus Poeciliopsis. These mechanisms include recurring hybridizations, introgression of genes from the supporting sexual populations, and mutation of preexisting, or ancestral, clonal genotypes...

A triggering circuit is described for direct-current fish shockers employing thyristors. Pulse rate can be switched from one to 200 pulses/second in over 200 discrete steps while duty cycle can be varied continuously from 8 to 92%. Adjustments of rate and duty cycle are wholly independent of one another.

Genotypic diversity in populations of asexually reproducing species in homogeneous environments must necessarily be a balance between new clones entering the population via mutation, de novo synthesis via hyridization, immigration and aberrant recombinational events, and clonal extinction. Population size, then, should affect clonal diversity becau...