ĮVADAS: Po kraujo perpylimo į organizmą patenka eritrocitų membranoje esantys antigenai, kurie gali sukelti specifinių aloantikūnų gamybą. Pacientams, kuriems taikoma ilgalaikė hemotransfuzinė terapija, antikūnai prieš kliniškai svarbius kraujo grupių antigenus atsiranda 1- 38 % atvejų. Po kurio laiko aloantikūnai prieš eritrocitų antigenus recipientų kraujuje jau nebeaptinkami, todėl po pakartotinio kontakto su tuo pačiu antigenu, po hemotransfuzijos, aloantikūnai sukels hemolizinę potransfuzinę reakciją. TYRIMO MEDŽIAGA IR METODAI: Buvo ištirtas 674 recipientų kraujas, sergančių hematologinėmis ir onkohematologinėmis ligomis. Antikūnų paieška ir identifikavimas buvo atliekami naudojant Kumbso reakcijas (tiesioginę ir netiesioginę). REZULTATAI: Aloantikūnų atsiradimas po hemotransfuzijų ir antikūnų pasiskirstymas buvo analizuojami 2 metų laikotarpyje (2004- 2006). • Aloantikūnai nustatyti 36,36 %, alo- ir autoantikūnai– 52,27 %, autoantikūnai– 11,36 % tiriamųjų. Aloantikūnų prieš kraujo grupių sistemų antigenus paplitimas: Rh (58,75 %), Kell (11,25 %), MNS (7,5 %), Duffy (6,25 %), Lutheran (6,25 %), Lewis (5,00 %), Kidd (5,00 %) • Aloantikūnai po alogeninių eritrocitų masės transfuzijų atsirado 14,77 % pacientų prieš Rh (68,42 %), Lutheran (15,79 %), Kell (10,53 %), Lewis (5,26 %) ir Kidd (5.26 %) kraujo grupių sistemų antigenus. Aloantikūnų išsilaikymas recipientų kraujyje buvo analizuojamas 5 metų laikotarpyje (2000- 2006). • Po 1 mėnesio buvo nebeaptinkami 30,16 % visų... [toliau žr. visą tekstą] / BACKGROUND: Individuals exposed to red blood cell alloantigens through transfusion may produce antibodies. Clinically significant red blood cells alloantibodies develop in 1- 38 % of patient, who receive multiple transfusion. Red cell antibodies, which can become undetectable over time, can cause delayed hemolytic transfusion reactions after incompatible blood transfusions. STUDY DESIGN, METHODS: Blood samples of 674 patients with hematologic and hematooncologic diseases, who undergo transfusion were studied. Antibodies screening and identification were performed by direct and indirect Coombs test. RESULTS: We examined the alloimmmunization risk and antibodies incidence over the period of 2 years (2004-2006). • Alloantibodies were found in 36,36 %, allo- and autoantibodies in– 52,27 %, autoantibodies in– 11,36 % patients. Alloantibodies against blood group system antigens incidence: Rh (58,75 %), Kell (11,25 %), MNS (7,5 %), Duffy (6,25 %), Lutheran (6,25 %), Lewis (5,00 %), Kidd (5,00 %) • We found that overall immunization rate in patients was 14, 77 % against Rh (68,42 %), Lutheran (15,79 %), Kell (10,53 %), Lewis (5,26 %) ir Kidd (5.26 %) blood group systems antigens. We examine the persistence of clinically significant red blood cell alloantibodies over a period of 5 years (2000-2006). • After 1 months 30,16 % antibodies become undetectable, after 3 months- 60,32 %, after 5 years– 88,89 %. Red blood cell alloantibodies persistence (in months): anti-E (9,0± 9,61), anti-C... [to full text]

Thesis (M.F.A.)--Ohio University, November, 2003. / Title from PDF t.p. Includes bibliographical references (p. 105-112)

An examination of the logical relationships between attitude statements suggests that attitudes can be ordered according to favourability, and can also stand in relationships of implication to one another. The traditional representation of attitudes, as points on a single dimension, is inadequate for representing both these relations but representing attitudes as intervals on a single dimension can incorporate both favourability and implication. An interval can be parameterised using its two endpoints or alternatively by its midpoint and latitude. Using this latter representation, the midpoint can be understood as the �favourability� of the attitude, while the latitude can be understood as its �generality�. It is argued that the generality of an attitude statement is akin to its latitude of acceptance, since a greater semantic range increases the likelihood of agreement. When Coombs� Theory of Unidimensional Unfolding is reformulated using the interval representation, the key question is how to measure the distance between two intervals on the dimension. There are innumerable ways to answer this question, but the present study restricts attention to eighteen possible �distance� measures. These measures are based on nine basic distances between intervals on a dimension, as well as two families of models, the Minkowski r-metric and the Generalised Hyperbolic Cosine Model (GHCM). Not all of these measures are distances in the strict sense as some of them fail to satisfy all the metric axioms. To distinguish between these eighteen �distance� measures two empirical tests, the triangle inequality test, and the aligned stimuli test, were developed and tested using two sets of attitude statements. The subject matter of the sets of statements differed but the underlying structure was the same. It is argued that this structure can be known a priori using the logical relationships between the statement�s predicates, and empirical tests confirm the underlying structure and the unidimensionality of the statements used in this study. Consequently, predictions of preference could be ascertained from each model and either confirmed or falsified by subjects� judgements. The results indicated that the triangle inequality failed in both stimulus sets. This suggests that the judgement space is not metric, contradicting a common assumption of attitude measurement. This result also falsified eleven of the eighteen �distance� measures because they predicted the satisfaction of the triangle inequality. The aligned stimuli test used stimuli that were aligned at the endpoint nearest to the ideal interval. The results indicated that subjects preferred the narrower of the two stimuli, contrary to the predictions of six of the measures. Since these six measures all passed the triangle inequality test, only one measure, the GHCM (item), satisfied both tests. However, the GHCM (item) only passes the aligned stimuli tests with additional constraints on its operational function. If it incorporates a strictly log-convex function, such as cosh, the GHCM (item) makes predictions that are satisfied in both tests. This is also evidence that the latitude of acceptance is an item rather than a subject or combined parameter.

An examination of the logical relationships between attitude statements suggests that attitudes can be ordered according to favourability, and can also stand in relationships of implication to one another. The traditional representation of attitudes, as points on a single dimension, is inadequate for representing both these relations but representing attitudes as intervals on a single dimension can incorporate both favourability and implication. An interval can be parameterised using its two endpoints or alternatively by its midpoint and latitude. Using this latter representation, the midpoint can be understood as the �favourability� of the attitude, while the latitude can be understood as its �generality�. It is argued that the generality of an attitude statement is akin to its latitude of acceptance, since a greater semantic range increases the likelihood of agreement. When Coombs� Theory of Unidimensional Unfolding is reformulated using the interval representation, the key question is how to measure the distance between two intervals on the dimension. There are innumerable ways to answer this question, but the present study restricts attention to eighteen possible �distance� measures. These measures are based on nine basic distances between intervals on a dimension, as well as two families of models, the Minkowski r-metric and the Generalised Hyperbolic Cosine Model (GHCM). Not all of these measures are distances in the strict sense as some of them fail to satisfy all the metric axioms. To distinguish between these eighteen �distance� measures two empirical tests, the triangle inequality test, and the aligned stimuli test, were developed and tested using two sets of attitude statements. The subject matter of the sets of statements differed but the underlying structure was the same. It is argued that this structure can be known a priori using the logical relationships between the statement�s predicates, and empirical tests confirm the underlying structure and the unidimensionality of the statements used in this study. Consequently, predictions of preference could be ascertained from each model and either confirmed or falsified by subjects� judgements. The results indicated that the triangle inequality failed in both stimulus sets. This suggests that the judgement space is not metric, contradicting a common assumption of attitude measurement. This result also falsified eleven of the eighteen �distance� measures because they predicted the satisfaction of the triangle inequality. The aligned stimuli test used stimuli that were aligned at the endpoint nearest to the ideal interval. The results indicated that subjects preferred the narrower of the two stimuli, contrary to the predictions of six of the measures. Since these six measures all passed the triangle inequality test, only one measure, the GHCM (item), satisfied both tests. However, the GHCM (item) only passes the aligned stimuli tests with additional constraints on its operational function. If it incorporates a strictly log-convex function, such as cosh, the GHCM (item) makes predictions that are satisfied in both tests. This is also evidence that the latitude of acceptance is an item rather than a subject or combined parameter.

Thesis (M.A.) - Carleton University, 2005. / Includes bibliographical references (p. 214-225). Also available in electronic format on the Internet.

Thesis (M.Sc. (Clinical Pathology))--Mahidol University, 1986.

BRUNETTA, D. M. Prevalência e fatores de risco para hemólise imune nos pacientes submetidos a transplante hepático. 2016. 133 f. Tese (Doutorado em Cirurgia) - Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, 2016. / Submitted by Erika Fernandes (erikaleitefernandes@gmail.com) on 2017-03-16T11:50:36Z No. of bitstreams: 1 2016_tese_dmbrunetta.pdf: 3436954 bytes, checksum: 2c336a327ea98342785512d377075ee1 (MD5) / Approved for entry into archive by Erika Fernandes (erikaleitefernandes@gmail.com) on 2017-03-16T11:50:45Z (GMT) No. of bitstreams: 1 2016_tese_dmbrunetta.pdf: 3436954 bytes, checksum: 2c336a327ea98342785512d377075ee1 (MD5) / Made available in DSpace on 2017-03-16T11:50:45Z (GMT). No. of bitstreams: 1 2016_tese_dmbrunetta.pdf: 3436954 bytes, checksum: 2c336a327ea98342785512d377075ee1 (MD5) Previous issue date: 2016-12-09 / Liver transplant (LT) anemia is multifactorial. Immune hemolysis occurs due to auto-antibodies, drug induced or not, or due to allo-antibodies, formed by transfusion or passenger lymphocyte syndrome (PLS). The aim of this study was to evaluate the prevalence and risk factors for immune hemolysis in LT. Between September 2014 and April 2016, 175 patients submitted to 178 LT were included. Multi-organ recipients were excluded. Samples from before, seven consecutive days and weekly for four weeks were analyzed for complete blood cound, reticulocyte count, lactate dehydrogenase (LDH), indirect bilirrubin (IB) and imummohematological tests. SPSS 24 was used for statistical analysis, p<0.05 was considered significant. The mean age was 52.1 ± 14.6 years old, with 105 male patients (60%). The most frequent causes of cirrhosis were hepatitis C virus (HCV, 59 – 33.7%) and alcohol (44 – 25.1%). Anemia before LT was present in 140 patients (74.2%), with lower hemoglobin (Hb) concentration in those with positive direct antiglobulin test (DAT, p=0.014). Nine patients (5.1%) presented positive antibody screen (AS) before transplant, with 2.3% of clinical significance. This finding was more frequent in RhD negative patients (p=0.017). Positive DAT occurred in 53 patients (30.3%) and was related to high MELD score (p=0,048), HCV (p=0.005) and furosemide use (p=0.001). These patients presented higher levels of IB (p<0.001). Ninety six patients (55%) were transfused in the studied period. One hundred and fourty five patients (87.8%) were still anemic on the fourth week. Twenty two patients (12.5%) presented positive AS after LT, with nine patients (5.7%) presenting clinically significant antibodies. Positive AS occurred more frequently in RhD negative (p=0.021) and in those transfused with red blood cells units (RBCU, p=0.022). Sixteen patients received grafts with minor ABO incompatibility. Post-transplant positive DAT was associated with higher levels of LDH (p=0.006), piperacillin-tazobactam use (p=0.021) and was more frequent in the non identical ABO group (p=0.0038). In this group, five of eleven positive DAT patients presented anti-A (2) or anti-B (3) on the eluate, representing PLS. All PLS patients received liver graft O and were using mycofenolate, tacrolimus and steroids. Four patients presented hemolysis and three were transfused due to PLS. These patients, compared to all the other patients, presented lower Hb concentration (p=0.043) and higher LDH levels (p=0.008) and reticulocyte counts (p=0.008). The presence of auto and allo-antibodies against red blood cell antigens is frequent in LT, but clinical significant hemolysis occurred in only 2.8%. Antibodies are more frequent in patients with higher MELD scores, with HCV, in use of pre-transplant furosemide, in those transfused patients with RBCU, RhD negative and piperacillin-tazobactam use after LT. The only risk factor for PLS is minor ABO mismatch between donor and recipient. / Anemia no transplante hepático (TH) é multifatorial. Hemólise imune ocorre por autoanticorpos, com ou sem relação com drogas, ou aloanticorpos, formados por transfusão ou síndrome do linfócito passageiro (SLP). O objetivo deste estudo foi avaliar a prevalência e fatores de risco para hemólise imune no TH. Foram incluídos, entre setembro de 2014 e abril de 2016,175 pacientes submetidos a 178 TH, sendo excluídos transplantes de múltiplos órgãos. Amostras pré-TH, de 7 dias consecutivos e semanalmente até 4 semanas foram avaliadas com hemograma, reticulócitos, lactato desidrogenase (LDH), bilirrubina indireta (BI) e testes imuno-hematológicos. SPSS 24 foi usado para estatística, com p<0,05 significante. A idade média foi de 52,1 ± 14,6 anos, com 105 homens (60%). As etiologias mais frequentes da cirrose foram vírus da hepatite C (VHC, 59 - 33,7%) e álcool (44 - 25,1%). Anemia pré-transplante estava presente em 140 pacientes (74,2%), com menores concentrações de hemoglobina (Hb) naqueles com teste direto da antiglobulina (TAD) positivo (p=0,014). Nove pacientes (5,1%) apresentaram pesquisa de anticorpos irregulares (PAI) positiva pré-TH, sendo 2,3% clinicamente significantes. Esse achado foi mais frequente em RhD negativo (p=0,017). TAD positivo pré-TH ocorreu em 53 pacientes (30,3%), com relação com escore MELD elevado (p=0,048), VHC (p=0,005) e uso de furosemida (p=0,001). Esses pacientes apresentaram BI mais elevada (p<0,001). Noventa e seis pacientes (55%) receberam hemocomponentes no período estudo. Cento e quarenta e cinco pacientes (87,8%) ainda estavam anêmicos na 4a semana. Vinte e dois pacientes (12,5%) apresentaram PAI positiva pós-TH, sendo nove pacientes (5,7%) com anticorpos clinicamente significantes. PAI positiva foi mais frequente em RhD negativo (p=0,021) e nos transfundidos com concentrado de hemácias (CH - p=0,022). Dezesseis pacientes receberam enxerto ABO não idêntico. TAD positivo pós-TH esteve associado a aumento de LDH (p=0,006), uso de piperacilina-tazobactam (p=0,021) e foi mais frequente no grupo ABO não idêntico (p=0,0038). Nesse grupo, cinco dos 11 com TAD positivo apresentaram eluato com anti-A (02) ou anti-B (03), configurando SLP. Todos receberam fígado O e estavam em uso de micofenolato, tacrolimus e corticoide. Quatro apresentaram hemólise e três foram transfundidos pela SLP. Esses pacientes, quando comparados aos demais, apresentaram Hb menor (p=0,043) e LDH (p=0,008) e reticulócitos (p=0,008) maiores. A presença de auto e aloanticorpos contra antígenos eritrocitários é frequente no TH, porém hemólise clinicamente manifesta ocorreu em apenas 2,8%. A presença de anticorpos é mais frequente em pacientes com escore MELD mais elevado, com VHC, que utilizam furosemida pré-transplante, naqueles transfundidos com CH, RhD negativo e que utilizam piperacilina-tazobactam pós-transplante. O único fator de risco para o desenvolvimento de SLP encontrado é a incompatibilidade ABO menor entre doador e receptor.

OBJETIVO: O objetivo deste estudo foi avaliar fatores clínicos, laboratoriais, dopplervelocimétricos e hematimétricos preditivos da velocidade de hemólise entre a primeira e a segunda transfusões intrauterinas em gestantes aloimunizadas. MÉTODOS: Este estudo retrospectivo compreendeu gestações únicas, com fetos não hidrópicos, submetidos à primeira e à segunda transfusões intrauterinas pela técnica intravascular direta simples, acompanhadas no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Foram coletados os seguintes dados das gestantes: idade materna, antecedente obstétrico, antecedente obstétrico relacionado à aloimunização (classificado em grave, moderado, leve e nenhum), tipos e títulos dos anticorpos antieritrocitários e dados da transfusão intrauterina (TIU) (idade gestacional da TIU, valores da concentração da hemoglobina antes e depois da primeira e antes da segunda TIU, medida da velocidade sistólica máxima da artéria cerebral média antes da primeira e da segunda TIUs, volume de sangue infundido, concentração de hemoglobina do sangue transfundido, intervalo de tempo entre as transfusões e o tipo de punção uterina transplacentária ou não). Foram calculados a razão entre a quantidade de hemoglobina endógena em relação à quantidade total de hemoglobina após a primeira transfusão, a expansão de volume e taxa de hemólise. RESULTADOS: Quarenta e uma gestantes foram incluídas e apresentaram na primeira TIU, idade gestacional média de 26,1 ± 4,6 semanas, média de volume de sangue infundido de 44,4 ± 23,5 ml e média de expansão de volume de 51,3 ± 14,5%. A média do intervalo entre as transfusões foi de 15,7±6,5 dias. A média da taxa de hemólise foi de -0,40 ± 0,25 g/dl/d entre a primeira e a segunda transfusões e não houve diferença estatisticamente significante da taxa de hemólise nos distintos grupos de antecedente obstétrico relacionado à aloimunização (p = 0,21). Não houve diferença significante entre a média da hemólise e o tipo de punção intrauterina (p = 0,387). A análise multivariada anterógrada demonstrou correlação significativa da taxa de hemólise com a concentração de hemoglobina depois da 1ª TIU (r = 0,60, p<0,001), o intervalo de tempo entre as transfusões (r = 0,64, p<0,001) e a Vmáx ACM antes da segunda TIU (r = 0,56, p<0,001). A equação encontrada que melhor representa a taxa de hemólise foi: 0,31517 + 0,03463 x Intervalo 0,314038 x Vmáx ACM pré 2 0,068719 x Hb DP pós 1 (r2 = 0,58). CONCLUSÃO: A taxa de hemólise fetal entre a primeira e a segunda transfusões intrauterinas em gestantes aloimunizadas pode ser predita pela combinação da concentração de hemoglobina após a primeira TIU, do intervalo de tempo entre as transfusões e medida da Vmáx ACM antes da segunda TIU / OBJECTIVE: To evaluate clinical and laboratory factors, dopplervelocimetric and hematimetric values in the prediction of fetal hemolysis between first and second intrauterine transfusion in alloimmunized pregnant women. METHODS: This retrospective study involved singleton pregnancies with non hydropic fetus, that underwent to first and second intrauterine transfusions (IUT) by simple direct intravascular technique, accompanied at Hospital das Clínicas da Faculdade de Medicina de São Paulo. The following data were collected: maternal age, obstetric history, previus history of alloimmunization (classified in severe, moderate, mild and none), antibodies type and titre and data from the IUT (gestational age, hemoglobin levels before and after first IUT and before second IUT, middle cerebral artery peak systolic velocity before first and second IUT, transfused blood volume, transfused blood hemoglobin concentration, time interval between transfusions and type of intrauterine puncture). The ratio between amount of endogenous hemoglobin and total amount of hemoglobin after IUT, volume expansion and hemolysis rate were calculated. RESULTS: Forty-one pregnant women were included and presented at first IUT, mean gestational age of 26.1 ± 4.6 weeks, mean of transfused blood volume of 44.4 ± 23.5ml and mean expansion volume of 51.3 ± 14.5%. The mean interval between the transfusions was 15.7±6.5 days. The mean hemolysis rate was 0.40 ± 0.25 g/dl/d between the first and second transfusions and there was not significant difference between the distinct groups of previous history of alloimmunization (p = 0.21). There was not significant difference between mean hemolysis rate and the type of intrauterine punction (p = 0.387). Stepwise multiple regression analysis demonstrated that hemolysis correlated significantly with hemoglobin levels after the first transfusion (r = 0.60, p<0,001), the interval of time between transfusions (r = 0.64, p<0,001) and middle cerebral artery peak systolic velocity before the second transfusion (r = 0.56, p<0.001). The best-fit equation for hemolysis rate was: 0.31517 + 0.03463 x Interval 0.314038 x MCA PSV pre 2 0.068719 x Hb zeta pos1 (r2 = 0.58). CONCLUSION: Fetal hemolysis rate between first and second transfusions in alloimmune disease can be predicted by a combination of hemoglobin levels after the first transfusion, interval between both procedures and middle cerebral artery peak systolic velocity before the second transfusion

OBJETIVO: O objetivo deste estudo foi avaliar fatores clínicos, laboratoriais, dopplervelocimétricos e hematimétricos preditivos da velocidade de hemólise entre a primeira e a segunda transfusões intrauterinas em gestantes aloimunizadas. MÉTODOS: Este estudo retrospectivo compreendeu gestações únicas, com fetos não hidrópicos, submetidos à primeira e à segunda transfusões intrauterinas pela técnica intravascular direta simples, acompanhadas no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Foram coletados os seguintes dados das gestantes: idade materna, antecedente obstétrico, antecedente obstétrico relacionado à aloimunização (classificado em grave, moderado, leve e nenhum), tipos e títulos dos anticorpos antieritrocitários e dados da transfusão intrauterina (TIU) (idade gestacional da TIU, valores da concentração da hemoglobina antes e depois da primeira e antes da segunda TIU, medida da velocidade sistólica máxima da artéria cerebral média antes da primeira e da segunda TIUs, volume de sangue infundido, concentração de hemoglobina do sangue transfundido, intervalo de tempo entre as transfusões e o tipo de punção uterina transplacentária ou não). Foram calculados a razão entre a quantidade de hemoglobina endógena em relação à quantidade total de hemoglobina após a primeira transfusão, a expansão de volume e taxa de hemólise. RESULTADOS: Quarenta e uma gestantes foram incluídas e apresentaram na primeira TIU, idade gestacional média de 26,1 ± 4,6 semanas, média de volume de sangue infundido de 44,4 ± 23,5 ml e média de expansão de volume de 51,3 ± 14,5%. A média do intervalo entre as transfusões foi de 15,7±6,5 dias. A média da taxa de hemólise foi de -0,40 ± 0,25 g/dl/d entre a primeira e a segunda transfusões e não houve diferença estatisticamente significante da taxa de hemólise nos distintos grupos de antecedente obstétrico relacionado à aloimunização (p = 0,21). Não houve diferença significante entre a média da hemólise e o tipo de punção intrauterina (p = 0,387). A análise multivariada anterógrada demonstrou correlação significativa da taxa de hemólise com a concentração de hemoglobina depois da 1ª TIU (r = 0,60, p<0,001), o intervalo de tempo entre as transfusões (r = 0,64, p<0,001) e a Vmáx ACM antes da segunda TIU (r = 0,56, p<0,001). A equação encontrada que melhor representa a taxa de hemólise foi: 0,31517 + 0,03463 x Intervalo 0,314038 x Vmáx ACM pré 2 0,068719 x Hb DP pós 1 (r2 = 0,58). CONCLUSÃO: A taxa de hemólise fetal entre a primeira e a segunda transfusões intrauterinas em gestantes aloimunizadas pode ser predita pela combinação da concentração de hemoglobina após a primeira TIU, do intervalo de tempo entre as transfusões e medida da Vmáx ACM antes da segunda TIU / OBJECTIVE: To evaluate clinical and laboratory factors, dopplervelocimetric and hematimetric values in the prediction of fetal hemolysis between first and second intrauterine transfusion in alloimmunized pregnant women. METHODS: This retrospective study involved singleton pregnancies with non hydropic fetus, that underwent to first and second intrauterine transfusions (IUT) by simple direct intravascular technique, accompanied at Hospital das Clínicas da Faculdade de Medicina de São Paulo. The following data were collected: maternal age, obstetric history, previus history of alloimmunization (classified in severe, moderate, mild and none), antibodies type and titre and data from the IUT (gestational age, hemoglobin levels before and after first IUT and before second IUT, middle cerebral artery peak systolic velocity before first and second IUT, transfused blood volume, transfused blood hemoglobin concentration, time interval between transfusions and type of intrauterine puncture). The ratio between amount of endogenous hemoglobin and total amount of hemoglobin after IUT, volume expansion and hemolysis rate were calculated. RESULTS: Forty-one pregnant women were included and presented at first IUT, mean gestational age of 26.1 ± 4.6 weeks, mean of transfused blood volume of 44.4 ± 23.5ml and mean expansion volume of 51.3 ± 14.5%. The mean interval between the transfusions was 15.7±6.5 days. The mean hemolysis rate was 0.40 ± 0.25 g/dl/d between the first and second transfusions and there was not significant difference between the distinct groups of previous history of alloimmunization (p = 0.21). There was not significant difference between mean hemolysis rate and the type of intrauterine punction (p = 0.387). Stepwise multiple regression analysis demonstrated that hemolysis correlated significantly with hemoglobin levels after the first transfusion (r = 0.60, p<0,001), the interval of time between transfusions (r = 0.64, p<0,001) and middle cerebral artery peak systolic velocity before the second transfusion (r = 0.56, p<0.001). The best-fit equation for hemolysis rate was: 0.31517 + 0.03463 x Interval 0.314038 x MCA PSV pre 2 0.068719 x Hb zeta pos1 (r2 = 0.58). CONCLUSION: Fetal hemolysis rate between first and second transfusions in alloimmune disease can be predicted by a combination of hemoglobin levels after the first transfusion, interval between both procedures and middle cerebral artery peak systolic velocity before the second transfusion

In December 22, 2010, the hockey clubs AIK and Djurgården played against each other in front of an audience of more than 11 000 people in Ericsson Globe Arena, Stockholm. Although it was one of the biggest games of the year, afterwards no one was talking about the actual game on the ice. The reason; several times during the game, hooligans from both sides started big quarrels and the hockey dome felt more like a war scene than a place for a hockey game. From a branding point of view, and along with similar incidents from the past, the night in December did not create a good situation for AIK and their image.   Therefore, in this essay I want to investigate how AIK communicated through the crisis. I also want to evaluate whether their communication was good or bad from the perspective of different crisis communication theories. The essay’s research questions are: How did media describe the crisis and AIK´s part in it? What effect did AIK´s previous history of similar problem have on the ongoing crisis? How did AIK communicate through the crisis? How was AIK´s image affected by the crisis? What did AIK do well/what could AIK have done better? To be able to answer these questions, several news articles from the sports paper “Hockeyexpressen” has been analyzed as well as a text from AIK itself. The answers from the analysis has then been weighed against Hearit´s and Benoit´s theories on apologia as well as Coombs theory on the impact from previous crisis. An important conclusion is that AIK protects its image during the crisis by using the strategy “shifting the blame”. AIK also redefines the picture of a true supporter by questioning the acts of some of their so called “fans”. AIK´s redefinition also serve to correct the news papers misleading use of different epithets on the same category of people. However, although their image stays more or less intact AIK fail to communicate the need of a broader responsibility from the society when it comes to the problems caused by sports related hooliganism.