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Immune thrombocytopenia (ITP) is an autoimmune disease characterized by isolated low platelet counts often leading to mucocutaneous bleeding. Administration of rituximab was shown to increase platelet counts in patients relapsing chronic ITP. However, duration of response with rituximab and the long-term benefit remains unknown. Herein, the authors presented a case of a 36-year-old splenectomised man with a relapsing ITP who received a total of 10 cycles of rituximab over the last decade with the concomitant assessments of circulating B cells. The data show that rituximab can be an effective therapy over 10 years, and monitoring B cells may help to herald ITP recurrence.

I have always been the scientific one in a family of artists: actors, painters and illustrators. As a child I was sent for art lessons with my sister, who is now an illustrator, but I was too self-conscious to express myself artistically. And if I did dare to pick up a paintbrush, my father would

OBJECTIVE: Critically ill neonates frequently require multiple small volume red blood cell (RBC) transfusions. RBC units assigned to individual infants, used sequentially in small aliquots until the original expiration date, can substantially reduce donor exposures. In 1993, adenine–saline solution (AS-3) was introduced by the Canadian Red Cross as the red cell storage medium to replace citrate–phosphate–dextrose–adenine anticoagulant–preservative solution (CPDA-1). We surveyed the safety and efficacy of using AS-3 split packs, stored up to 35 days, for premature infants. STUDY DESIGN: Units of packed cells were aseptically welded to three satellite bags using a sterile connecting device. When blood was requested for a small volume transfusion, the first satellite bag was used and the others were set aside for the same baby, for use up until their expiration date of 35 days. RESULTS: Over a 1-year period, 56 infants received a total of 263 AS-3 transfusions from 97 donors, with a mean of 4.7 transfusions and 1.7 donor exposures per infant. Following a 7-ml/kg RBC transfusion, mean rise in hematocrit (hct) was 0.04, regardless of the age of the unit, mean change in serum potassium was −0.16 mmol/l and mean change in total bilirubin was +1.86 μmol/l. The posttransfusion hct was not reduced with the use of the older red cell packs. CONCLUSION: Designated AS-3–preserved split RBC packs effectively limit donor exposures, can safely be used for neonatal small volume transfusions, and give a constant transfusion effect after up to 35 days of storage.

Tsud (ref. 1) is an alloantigen on mouse suppressor T cells, coded for by a gene downstream from the immunoglobulin locus on chromosome 122. We now report a second T-cell alloantigen, Tindd, which is closely linked to Tsud. Both antigens may be products of a family of genes coding for conserved, non-antigen binding site regions of T-cell receptors. Tindd is defined by a monoclonal BALB/c (Igh-1a) anti-C.AL-20 (Igh-1d) antibody and is expressed preferentially on Lyt 1+2−3− peripheral lymphoid cells, whereas Tsud is expressed on Lyt 1−2+3+ suppressor cells. The interpretation that these determinants represent antigen binding molecules is in part based on the antibody-mediated induction of cell function. In vivo treatment of C.AL-20 animals with anti-Tsud antiserum at day 4 suppresses the primary immune response to sheep red blood cells (SRBCs)3–5. Pretreatment with limiting dilutions of anti-Tindd antibody induces cyclic waves of either suppression or enhancement of the plaque-forming cell response. The genes coding for these determinants have now been mapped in inbred congeneic mice having recombination events in or near the immunoglobulin locus. Monoclonal anti-Tindd antibodies precipitate a group of polypeptides of molecular weights (MWs) 62,000, 45,000 and 17,000 from 35S-methionine-labelled spleen cells activated with concanavalin A (Con A) whereas the polypeptides associated with the Tsud specificity have MWs 69,000, 45,000 and 25,000. The differences in molecular weights and contrast in the Lyt phenotype of cells expressing these antigens suggest they are separate molecules and may imply discrete isotypes of T-cell receptor.