THE PHILOSOPHY OF QUALITY ASSURANCE IN THE BLOOD BANK H. F. Taswell One year before this symposium, Cees Smit Sibinga and I began to discuss an approach to quality assurance in the blood bank which we felt would be both important and practical and could serve as the basis for the choice of subjects to be presented in the symposium. As an introduction to this book, I would like to outline our approach, the subjects chosen and the rationale behind our choice. What is the fundamental purpose of a blood bank and trans fusion service? Simply stated, the purpose of a blood bank and transfusion service and of a quality assurance program in blood banking is, for the one to provide and, the other to assure safe and effective transfusion therapy. This objective is in contrast to that of other clinical laboratories. The objective in a clinical chemistry laboratory is to produce accurate test results which will be meaningful to the clinician taking care of his patient. In most clinical laboratories, therefore, the goals of a quality assurance program are largely quantitative, that is, to assure accurate numerical test results. In contrast, in the blood bank, the goals of quality assurance are primarily qualitative, that is, to assure safe and effective transfusion. As a result, two somewhat different approaches to quality assurance are necessary.

Multiple myeloma is a plasma cell malignancy characterized by complex heterogenous cytogenetic abnormalities that accounts for 1.4% of all cancers, and approximately 10% of hematologic malignancies. The clinical manifestations of multiple myeloma include lytic bone lesions, cytopenia, hypercalcemia, renal dysfunction, hyperviscosity of the blood, immunodeficiency, and peripheral neuropathy. Based on the clinical and genetic data, probably all cases of multiple myeloma arise from an asymptomatic monoclonal gammopathy of unknown significance. The exact mechanism of the transition from MGUS to overt multiple myeloma is still not well understood. Recent oncogenomic studies have further advanced our understanding of the molecular pathogenesis of multiple myeloma. This book will give a comprehensive overview of the genetic and molecular epidemiology of multiple myeloma in order to get a more refined and conclusive understanding of this disease.

It is an honour and a pleasure to welcome you all at this 20th annual International Symposium on Blood Transfusion in the Netherlands. This year you celebrate its 20th anniversary and I congratulate the Staff of the Blood Bank Noord Nederland and especially Dr. Smit Sibinga for this great achievement. As most of you know, the name of the person of Dr. Smit Sibinga is unbreakably con nected with the annual symposium in Groningen which he has organized each year from the very start, 20 years ago. The reputation of any symposium depends heavily on the quality of the lectures. I think it is not possible to organize 20 symposia in a row if the topics lack actual relevance and the speakers are not of excellent reputation. Dr. Smit Sibinga has proven to have a keen eye for selecting interesting themes and eminent speakers. Although a lot of different topics have been dealt with in the past 20 years, which each attracted the attention of a different group in the field of blood transfusion, it is not surprising that after a tradition of 20 years several speakers but also a lot of attendees are not for the first time in Groningen to participate in this event. It gives the symposium a unique atmosphere of intimacy. It is not hard to admit that most of the newer developments in transfusion medicine take place outside the Netherlands."

Teleologically, the hemostatic mechanism is among The of Coronary Thrombosis and the most fundamental yet complex physiologic pro- in essence, represents a heartfelt gift of cesses in humans. Early scientists and physicians were knowledge from a dedicated group of scientists and fascinated by the blood's ability to remain in a liquid clinicians, who collectively have set out on a mission state only to clot in response to vascular injury. The to minimize the societal impact of"hemostasis in the cellular and noncellular components of normal wrong place. " The book is divided into four distinct hemostasis took centuries to discover, and the intrica- sections: Part 1, Scientific Principles, lays down the cies of their delicate interactions are still being unrav- supporting foundation; Part 2, Clinical Application eled today. As is so often the case, an in-depth of Scientific Principles, places the knowledge base in appreciation of physiologic hemostasis, representing a a working perspective, directly applying science to basic life-sustaining sequence of events, paved the patient care; Part 3, New Dimensions, provides a way for understanding abnormal hemostasis or glimpse of tomorrow. Steering the field clear of se- pathologic thrombosis. Aristotle, Malpighi, and proclaimed victory and the dangers of complacency as Osier, representing but a few of the founding fathers we move into the 21st century, Part 4, Evolution of in the field, would undoubtedly be honored to see Thrombocardiology, focuses on laboratory standards, their observations form the template for lifesaving clinical trials, and drugs in development.

This monograph is a collection of invited contributions from a group of investiga tors who share a common interest in the interrelationships between the shape, struc ture, and functional characteristics of normal and pathologic erythrocytes. Most of the authors participated in a workshop on red cell shape held in June, 1972 at the Institute of Cell Pathology, Hopital de Bicetre, Paris. We hope that these various contributions on the physiology, pathology, and ultrastructure of red cell shape will be useful and stimulating for other investigators interested in the correlation of shape and structure with the biochemistry and biophysics of the red cell. The text is divided into four sections. Section I deals with red cell shape, including the presentation of a rational descriptive nomenclature and a discussion of post splenectomy changes. Section II deals with biochemical factors that underlie the disco cyte-echinocyte (crenated) and discocyte-stomatocyte (cup-shaped) transformation. This section includes discussions of plasma factors, and of the biochemical dynamics of erythrocyte lipids and consideration of the effects of such factors as cellular ATP, calcium, aging, and various chemical agents as determinants of shape. Section III, which deals with biophysical measurements, includes studies of the deformability of cells of different shapes, descriptions of ways to define precisely the geometric dimensions of the red cell under various circumstances, and a model of membrane structure, which is proposed to account for the dimensions of red cells that undergo shape change."

Coronary heart disease remains the leading cause of death for men and women in the United States and other industrialized nations. Acute myocardial infarction accounts for a majority of these deaths, approaching 750,000 yearly. Thrombolytic therapy has revolutionized the treatment of myocardial infarction, saving lives to a greater extent than any treatment developed to date. The identification of patients best suited for thrombolytic therapy has been a challenging task, as has the ideal adjuvant strategy. Further, the noninvasic diagnosis of treatment successes and failures, as well as the expeditious triaging of patients requiring mechanical/surgical revascularization have been difficult to define, but progress has been made recently. The emergence of information vital for patient care has appeared at an extraordinary pace, with hundreds of articles being published yearly. Unfortunately, a resource devoted to the area of thrombolysis does not exist, making the dissemination of information to physicians, scientists and health care providers problematic. The Modern Era of Coronary Thrombolysis is designed to bring the medical and scientific communities up to date. It will serve as a foundation for future investigation, as well as a resource which can be referred to for many years to come.

A number of exciting new developments have occurred during the last few years concerning the platelet-vessel wall interaction. Although they may be obvious and clear to the specialist in the field, for the clinician the area has become rather confusing. Time has come to review current knowledge on the pathophysiology of the platelet-vessel wall interaction and show how this knowledge can constitute the rationale for pharmacotherapeutic interventions. A symposium was organized in Antwerp during which a number of outstanding speakers gave an overview of what is new on a particular topic and how this information can be translated to possible clinical applications. The proceedings of the symposium are not only of interest to the practising physician, but contain enough new fundamental data to be of use for all those who are interested in the role of platelets in the etiopathogenes ofcardiovascular diseases. Arnold G. Herman Antwerp, July 1-991 vii ListofContributors A.G. Herman DepartmentofPharmaceutical Sciences M.R. Buchanan University Hospital DepartmentofPathology Universiteitsplein I McMaster Clinic B-261O ANTWERP (Wilrijk) Hamilton General Hospital Belgium 237 Barton Street East HAMILTON, Ontario G. Homstra Canada L8L 2X2 DepartmentofHuman Biology UniversityofLimburg Co-author: SJ. Brister P.O. Box 616 6200MD MAASTRICHT J.-P. Cazenave The Netherlands Regional Centre ofBlood Transfusion 10, Rue Spielmann J.F. Martin F-67085 STRASBOURG Cedex Department ofMedicine France King's College School ofMedicine and Dentistry Co-authors: C. Gachet and F. Lanza LONDON SE5 9PE U.K.

In transfusion medicine the scientific fundamentals of immunology have had a considerable clinical impact. Transfusion may suppress the immunity but some patients could suffer disadvantages including GvHD, alloimmunisation and possible cancer, where white cells (WBC) play pivotal roles in this phenomenon, presenting antigens and producing cytokines. A clinical application of this practice is LAK-cells targeted against cancer. MHC on the WBC may provide additional immunological modulations through series of secondary messengers. Thus reduction of WBC in the blood and bone marrow may be advantageous for patients. On the other hand, sharing a part of MHC or making the transplanted white cells anergic by storage may be even more advantageous for patients. CMV infection could mimic part of this MHC. UV radiation is effective in the inactivation of the WBC although filters are easy means for such removal. However, their accurate quantification requires flow cytometry that has considerable potential application in blood transfusions. Idiotypic antibody could play an important role in platelet theory. However, the potential infection risks in transfusion like HIV and HCV remain, but application of molecular biological methods like PCR or RT/PCR has great potentials in detection of infectious diseases, transplantation and genetic disorders. Immuno affinity purified concentrates, like factor IX and protein C, could reduce patients' immune functions, where in the future protein C could be derived from transgenic animals. Advances are sure to emerge through adoptive immunotherapy and gene therapies are exciting prospects when genes transferred into lymphocytes could be used to correct cell mediated immune deficiency, as in ADA.

The mammalian erythrocyte is a very suitable model for the study of aging at the cellular and molecular level. It is not only a matter of apparent simplicity in terms of biochemistry, biophysics and physiology but more likely this cell offers a great possibility for elucidating some basic problems in the process of aging. In fact, nowadays, it is possible to follow individual cells all along their life span in circulation, it is possible to obtain these cells when young, middle aged or old and it is possible to obtain cells from individuals of defined ages and transfuse them into compatible recipients to investigate the role of the environment where the cell lives, and finally it is possible to easily manipulate the red cell content in terms of enzymatic activities and/or metabolic properties to investigate the possible effect of these manipulations on cell survival. This book, Red Blood Cell Aging, is based on a symposium held in Urbino, Italy, at the end of 1990 and examines the impact of age on the membrane, metabolism, structural and enzymatic proteins of mammalian erythrocytes. The various contributions to this symposium not only described those processes of aging which affect the cell but also provided a nearly complete picture of the event{s} and mechanism{s} that every day permits to recognize among 25 trillion circulating red cells {in an average adult} that 1 percent that have reached the end of their 120 day life span in circulation.

The European Study Group for Cell Proliferation held its XVth Meet ing at Sundvolden, Norway, in September 1987. The program included a symposium on the cell kinetics of the in flammatory reaction, with invited speakers. This volume of Current Topics in Pathology contains the manuscripts submitted by the speak ers. Inflammation is a very broad area, and the cell kinetics of the inflammatory reaction comprises a large number of topics. A full cover age would fill more than one book. This volume therefore contains only a few of the important aspects of the cell kinetics of the inflammatory reaction. It is hoped that it will serve as inspiration for further research in this important area. Inflammatory diseases are even more important than cancer, and there is a great need for a more detailed information about inflammation. OLAV HILMAR IVERSEN Contents Chapter I The Cell Kinetics of the Inflammatory Reaction. Introduction and Overview."

Battle is a practical and sometimes lasting way of solving man's problems. It relies on the strength of the combatants and ignores the truth of the dispute. Discussion face to face can dissolve attitudes which have incorrectly determined judgements. The most striking example of this that I know is a Battle in Ireland in the eleventh century, where the king of Leinster fought a Viking prince. The Icelanders had raided Ireland for several generations in search of women, which they lacked since most of the population of Iceland were men who had arrived there by rowing long-boats from Norway. The prince was leading such a raid for the first time. Standing in the prow of the leading boat he saw Irish cavalry galloping along the beach to meet them. As they approached the shore the Irish king rode out of the band to challenge single combat. The Icelander jumped into the surf to meet him. As they raised their swords each realized that the other's face was like his own. When the Irish king spoke the other recognized the language. It had been spoken in Iceland by his grandmother who had been captured and taken there from Ireland. Swords were dropped and replaced by drinking horns. It was soon established that they were cousins. The battle gave way to a life-time of close co-operation.

The monograph edited by Drs. Wunder and Henon on "Peripheral Blood Stem Cell Autogtafts" is extremely useful as well as timely. It covers the "state of the arts" with respect to the use of hemopoietic stem cells collected from the peripheral blood for the reconstitution of hematopoiesis after myeloablative therapy. If is is accepted that hematopoietic function in the mammalian organism is the result of stem cell seeding of an appropriate stromal matrix, then the use of blood derived stem cells for hematopoietic reconstitution represents the "physiological form" of the (re) establishment of a hematopoietic bone marrow. All observations to date are compatible with the assumption that stem cells migrate via the blood stream from extraembryonic hematopoietic tissue to the fetal liver to establish there a first intraembryonic site of blood cell formation and especially of stem cell replication and proliferation. This fetal liver tissue appears then to be the major source for the seeding offetal bone marrow stroma as it develops sequentially in all the bones of the skeleton - in other words during most of the entire embryonic development. There is a very high concentration of stem cells in the blood of the embryo (more than 20000 CFU-GM per ml in the 22nd week) and the stem cells in cord blood seem to be the "tail end" of a dramatic "stem cell traffic" in the embryo to establish the hemopoietic as well as lymphopoietic tissue."

This book is not a "proceedings" volume. Rather the chapters are essays by experts in the field of blood substitutes, invited by the editors to con tribute to the 1996 "Current Issues in Blood Substitutes Research and Development" course given in San Diego, March 18-21. The contributors were selected because of their expertise in areas deemed by the editors to be critical to the advancement of the field. The course, as in past years, is heavily influenced by feedback from par ticipants, and by research in this and related fields. In addition to the didactic lectures (for which these chapters are the foundation), the course also offers the opportunity for presentation of research reports, progress reports from the various companies currently commercializing products, and round table discussions of selected subjects. Thus, we are grateful to past participants for their helpful comments. Production of a book, especially on a short timeline, is not an easy feat."

Sixty years ago, G. Fanconi published a paper entitled: "Familiiire infantile pemiziosaartige Aniimie (pemizioses Blutbild und Konstitu- tion)", in which he reported that this type of severe aplastic anemia represents a hereditary disease distinct from other pancytopenias of childhood (Fanconi 1927). Later this syndrome was named Fan- coni anemia (FA; van Leeuwen 1933). A more recent study of the genetics of FA confirmed that the syndrome is inherited in an au- tosomal recessive manner (Schroeder et al. 1976). Prenatal diagno- sis in FA families showed that about 25% of fetuses are affected (Auerbach et al. 1985, 1986). In 1964, Schroeder et al. discovered high frequencies of chro- mosomal aberrations in cultured peripheral blood lymphocytes from patients with FA. Schuler et al. (1969) reported that cells from FA patients are particularly sensitive to the chromosome-breaking activity or clastogenic effect of a polyfunctional alkylating agent. Since that time, studies of baseline and induced frequencies of chromosomal aberrations have been used for the identification of patients with FA. There is now a large body of data concerning the possible mechanism(s) underlying the hypersensitivity of FA cells to DNA cross-linking agents, the biochemical basis for which is still unknown. Complementation analysis, using cells from different FA pa- tients, has demonstrated genetic heterogeneity in the syndrome.

The idea for this volume was conceived during a discussion in the hallway at a conference in early 1990. "What is the best way to detect and define pluripotent hematopoietic stem cells?" was the question posed by Dr. Fritz Melchers. After discussing the pros and cons of the available assays for quite some time, it became apparent that this topic required a wider expertise and merited a larger forum. Thus, we decided to extend the discussion and to compile the results in this volume. Much to our delight. many of the pioneers of recent experimental and theoretical developments in stem cell research agreed to contribute their expertise to answer the question. These authors review both past findings and present insights, thus providing an overview of the evolution that has been and is occurring in the field of stem cell research. In the light of recent trailblazing developments in both experimental models and in clinical application it is indeed time to reevaluate our knowledge about stem cells. Trans plantation of hematopoietic stem cells has become more and more prevalent as a curative therapy in a variety of acquired and genetic diseases, including cancer, radiation accident, as an agent for gene therapy, and perhaps even as treatment for autoimmune diseases. Stem cells are now derived not only from bone marrow but also from peripheral blood, cord blood, and fetal liver, greatly increasing their availability for human transplantation and in some cases (fetal tissues) obliterating the need to match donors and hosts."

The 6th volume of the book series Acute Leukemias presents both therapeutic and prognostic updates of the most recent results of major multicenter clinical trials. Additional chapters report on new trends in leucemia cell biology, the monitoring of minimal residual disease and secondary leucemias as well as new antileucemic drugs, antimicrobial strategies and the use of cytocines. Acute Leukemias VI provides a new update on the rapid progress being made internationally concerning leucemic diseases.

51 worldwide leading experts in the field of erythrocyte research contributed to this first book on transport processes in red blood cells. It explains the latest findings on the basis of well-established principles, in an accessibly structured and carefully organized compilation.

The 11 th meeting in "Modern Trends in Human Leukemia" took place from June 19 to 21, 1994 in Wilsede in the middle of the Liineburger Heide, South of Hamburg. Interwoven with the Leukemia program was the Nato-sponsored Symposium of the ASI-Series "Gene Technology in Analysis of Malignant and Inherited Human Diseases Related to Development" . The Wilsede meeting was continued on a ship of the Neva leading through lake Ladoga and lake Onega. The topics of both meetings included discussion on recent progress isolation and development of hematopoietic stem cells, genes crucial for development and diseases, methods of gene transfer, application of gene transfer; oncogenes and anti-oncogenes as targets for gene therapy; receptors and their ligands in normal development and diseases, immunology and immunotherapy, radiation biology, clinical leukemias and bone marrow transplantation. The Nato workshop concentrated not only on analysis of cell systems useful for somatic gene therapy, but also on actual themes directly related to correction of human diseases. The latter aspects emphasized themes related to biotechnology, the first part was by nature more general. We also included a few contributions that discussed perspectives for the future of gene therapy and possible relationships to evolution.

Cytokines are cellular growth factors which also provide communication between cells and their milieu. This clearly is an exciting area in modern medicine that will have significant impact on various facets of transfusion. Erythropoietin therapy stimulates red cell production while thrombopoietin seems to positively affect megakaryopoiesis and can be an added armamentarium for the thrombocytopenic patient. Using haematnopoietic growth factors, stem cells could be mobilized early to the peripheral blood for collection and subsequent transplantation into haemato-oncology patients instead of bone marrow transplantation. Using a cocktail of cytokines in cell culture, stem cells could be expanded and selected for therapy. Cytokines and growth factors can even be modified, which may lead to successful gene therapy in malignancies, including solid tumour vaccines. However, the presence of cytokines in certain blood products could have biological effects following transfusion, although its clinical relevance needs to be ascertained. There is much potential for the use of cytokines in the treatment of infections. Early diagnostic methods are now available to monitor their levels and relevance. It is likely that cytokines will increasingly play a role in therapy and could develop our fundamental knowledge about the development of T-cells. An ethical dilemma remains, however, regarding the use of cytokines in healthy donors for harvesting suitable specific cells. Longer clinical observation will be necessary to gather the necessary information. Cytokines and growth factors in blood transfusion was the theme of the 21st International Symposium in Blood Transfusion, where twenty clinicians and scientists, experts in their own fields, were invited to update the above information. Their findings are presented in four sections in this volume: Fundamental aspects - cytokines in development of T-cells, growth factors in haematopoiesis, growth factor receptors and signal transduction, cytokine response in platelet and whole blood transfusions. Function, production and diagnosis &endash; laboratory diagnostics of cytokines and growth factors, cytokines in blood components, cytokines and growth factors in cell expansions, cytokines for genetic modification towards gene therapy, progenitor cells from healthy donors. Application in clinical medicine &endash; clinical relevance of cytokines in transfusion products, cytokines and growth factors in solid tumours, gene therapy in malignancies, vaccine strategies inducing T-cell immunity against tumours, cytokines in the treatment of infections, thrombopoietin and megakaryopoiesis. Future potential use in transfusion medicine &endash; erythropoietin, immunotherapy, ethical aspects of the use of cytokines and growth factors in donors, potential of cytokines and growth factors in transfusion medicine.

This symposium is devoted to Biotechnology in Blood Transfusion; there are 22 experts discussing the state of the art in the application of monoclonal anti bodies, recombinant DNA technologies and heterologous expression systems to the improvement and sometimes replacement of blood products, charac terization of blood constituents, and the effect of these developments on blood transfusion procedures. Ten and maybe five years ago the title of a symposium such as this would have been Biosciences in blood transfusion, informing what basic developments in molecular biology, biochemistry and human physiology might pertain to blood transfusion in the distant future. That future is getting closer, and not only one is interested in basic developments in immunology, recognition and identification of viral and bacterial components and products, tissue and blood bloodgroup blood group typing, typing, but also in the potential application of these developments and their economic perspectives. That is what biotechnology is all alI about: basic science telIs tells us where and how we might look for new technologies, and the development of such tech nologies is only possible if there is a perspective for improvement in quality, safety, acceptance or performance to cost ratio.

This book describes all human leukemia-lymphoma cell lines that have been established and that grow continuously under standardised in vitro conditions. These lines are derived from cells belonging to all the major hematopoietic cell lineages, i.e. B- and T-lymphocytes, natural killer cells, granulocytic cells and megakaryocytic cells. The clinical data, the culture conditions and the major phenotypic features of the cell lines are described with citations. This book is the first book describing human leukemia-lymphoma cell lines and will be of interest to scientists involved in the areas of hematology, oncology, immunology, molecular biology and cytogenetics. Cancer Cell Lines, Volumes 1-3: These 3 volumes provide a comprehensive text on the culture of established cell lines from every type of human cancer. The volumes provide a basic manual and reference resource for every cancer research scientist using human cancer cells.

It is with great pleasure that I write this Foreword to the Proceedings of the International Conference on Behcet's Disease which was held in Berlin in June 2002. This was the first International Conference held under the auspices of the International Society for Behcet's Disease which was founded in 2000 in Seoul. First, I congratulate our colleagues in Berlin, led by Professor Christos Zouboulis of the Department of Dermatology at the Free University of Berlin, for having organised a most successful conference and for having compiled these proceedings so rapidly. It will be realised immediately on scanning the contents of this book that the conference was truly international with 210 participants from 26 countries, as Professor Zouboulis has noted in his preface. These included basic scientists, epidemiologists, pathologists, clinicians and, importantly, representatives from patient organisations. The latter held their own conference alongside the scientific-medical conference to mutual benefit. The combined session of patients and doctors (abstracts on pp 601 - 626) gave the opportunity for an exchange of information and fruitful discussion. The wide ranging scope of the communications is evident from the index and it was most encouraging to see their origin - from all parts of the world, from senior and junior colleagues and, from many different disciplines. Many communications may be regarded as preliminary reports of research in progress and we look forward to seeing the definitive publications in appropriate journals in due course."

Bone marrow transplantation has emerged as a major form of treatment for a broad range of human diseases. Marrow transplantation has many unique biologic features and its principles differ markedly from the transplantation of solid organs. This volume overviews the present status of bone marrow transplantation and summarizes recent progress and controversies. Ad vances in defining the underlying biology of marrow transplantation are discussed. The current status of several major clinical problem areas are reviewed, including engraftment, acute and chronic graft-versus-host dis ease, immunodeficiency, and opportunistic infections. The therapeutic role of allogeneic and autologous bone marrow transplantation is discussed, and results are compared with alternative therapies. lX List of contributors ANASETII, CLAUDIO, M. D. , Fred Hutchinson Cancer Research Center, 1124 Columbia Street, Seattle, Washington 98104 APPELBAUM, FRED, M. D. , Fred Hutchinson Cancer Research Center, 1124 Columbia Street, Seattle, Washington 98104 ARMITAGE, JAMES 0. , M. D. , Department of Internal Medicine, Univer sity of Nebraska Medical Center, 42nd and Dewey Avenue, Omaha, Nebraska 68105 BEATIY, PATRICK G. , M. D. , Fred Hutchinson Cancer Research Center, 1124 Columbia Street, Seattle, Washington 98104 BIERMAN, PHILIP J. , M. D. , Department of Internal Medicine, Univer sity of Nebraska Medical Center, 42nd and Dewey Avenue, Omaha, Nebraska 68105 BUTTURINI, ANNA, M. D. , Department of Pediatrics, University of Parma School of Medicine, Parma, Italy CHAMPLIN, RICHARD, M. D.

Is the nephrology community facilitating excess cardiovascular deaths in patients with kidney failure and anemia by treating to a subnormal hematocrit? Why have clinicians and nephrologists permitted health insurance companies and the government to decide when anemia therapy should begin in persons with progressive kidney failure? Is iron the only variable that can be manipulated to maximize response to recombinant erythropoietin? Are we using too much intravenous iron in kidney failure patients, and is oral iron supplementation worthless in sustaining iron stores during long-term erythropoietin treatment? When does left ventricular hypertrophy begin to emerge in patients with progressive renal disease and is there convincing evidence that anemia is a significant cause of LVH in this setting? Is darbepoetin alfa, a new novel, long-acting erythropoietin, really superior to recombinant erythropoietin? This book is a compilation of proceedings from a conference in Brooklyn convened to address these and other controversial and unresolved issues in renal anemia management.

Mononuclear phagocytes, which include macrophages, monocytes and their precursor cells, are the most important cells in the host defence against micro-organisms and tumor cells. During the last twenty-five years research on the biology of mononuclear phagocytes has increased tremendously. This motivated Professor R. van Furth to organize five international conferences on this subject in Leiden, the Netherlands. The edited proceedings of these meethings were published: in 1970 Mononuclear Phagocytes; in 1975 Mononuclear Phagocytes in Immunity, Infections and Pathology; in 1980 Mononuclear Phagocytes -- Functional Aspects; and in 1985 Mononuclear Phagocytes -- Characteristics, Physiology and Function. Reviews of these volumes, published in international journals, praised them as the most up-to-date state of the art publications. The publication of 1991 includes 88 chapters written by more than 200 authors.