Twenty-one patients with primary humoral immunodeficiency were treated for 1 year with a chemically intact immunoglobulin, 300 mg/kg body weight given intravenously every 3 weeks, to compare immunoglobulin levels and clinical status with results achieved after standard treatment with intramuscular immunoglobulin given previously for 1 year. A substantial reduction of specific acute illnesses and antibiotic use was found for 18 of the 21 patients, particularly during the second 6 months of treatment. Average IgG levels before intravenous infusion were increased 243 mg/dL over previous intramuscular pre-injection levels. Adverse effects were recorded for 2.5% of infusions.

Antithrombin III (Human) (AT III) was administered to 18 patients with documented hereditary AT III deficiency. In eight patients with no ongoing clinical symptoms of thrombosis, the percent increase per unit AT III infused per kilogram of body weight ranged from 1.56% to 2.74%, and the half-life from 43.3 to 77.0 hours. No significant difference was noted between patients receiving and those not receiving coumarin therapy. In clinically ill patients, the in vivo recovery was significantly lower and ranged from 0.64% to 1.90% increase per unit AT III infused/kg. Efficacy of AT III was evaluated in 13 patients for the prevention or treatment of thrombosis. AT III was efficacious as assessed by the absence of thrombotic complications after surgery and/or parturition, and the nonextension and nonrecurrence of thrombosis in patients exhibiting an acute thrombotic episode. No side effects were noted. Follow-up studies indicated no hepatitis B seroconversion and no alanine aminotransferase elevations in patients who were not transfused with other blood products.

Iron-deficiency anemia (IDA) is a condition where objective iron deficiency is at the origin of the anemia. The World Health Organization (WHO) defines anemia as a hemoglobin value of < 120 g/l for nonpregnant women, and < 130 g/l for men. IDA is a very common condition, particularly in women. In industrialized countries, it is estimated that 23 % of pregnant women, 10 % of all women (15 -59 years), 4 % of men (15 -59 years) and 12 % of elderly individuals ≥ 60 years are anemic [1]. IDA is commonly (62 %) caused by chronic blood loss from the gastrointestinal tract. Peptic ulcerations are the commonest lesions found in the upper gastrointestinal tract, while cancers are one of the most common abnormalities discovered in the colon. Other causes of IDA include cumulative menstrual blood loss or pregnancy in premenopausal women, decreased gastrointestinal absorption (malabsorption syndromes), and chronic intravascular hemolysis, among others. Lower gastrointestinal bleeding (LGIB) usually refers to blood loss originating from a lesion distal to the ligament of Treitz [2], even though approximately 10 % of patients with hematochezia may have an upper gastrointestinal source of bleeding [3,4]. LGIB may manifest itself as hematochezia (rectal bleeding: visible bright red or maroon blood per rectum), as opposed to melena (dark stools), which is most often a manifestation of upper gastrointestinal bleeding. Acute LGIB is of recent duration (< 3 days) and may result in hemodynamic instability, rapid hemoglobin decrease and/or the need for blood transfusion [5]. Chronic LGIB corresponds to the passage of blood per rectum over > 3 days. The patient with chronic bleeding may present with fecal occult blood (IDA and/or positive fecal occult blood test Background and study aims: To summarize the published literature on assessment of appropriateness of colonoscopy for the investigation of iron-deficiency anemia (IDA) and hematochezia, and report appropriateness criteria developed by an expert panel, the 2008 European Panel on the Appropriateness of Gastrointestinal Endoscopy, EPAGE II. Methods: A systematic search of guidelines, systematic reviews and primary studies regarding the evaluation and management of IDA and hematochezia was performed. The RAND/UCLA Appropriateness Method was applied to develop appropriateness criteria for colonoscopy for these conditions. Results: IDA occurs in 2 % -5 % of adult men and postmenopausal women. Examination of both the upper and lower gastrointestinal tract is recommended in patients with iron deficiency. Colonoscopy for IDA yields one colorectal cancer (CRC) in every 9 -13 colonoscopies. Hematoche-

Intravenous gammaglobulin (IVIgG) was used to treat autoimmune neutropenia of infancy in two males with repeated infections. The neutrophil count increased significantly in both patients with the initial IVIgG therapy; 1 patient went into remission. The neutrophil count in the other remained above baseline for 3 wk, and a subsequent booster infusion also caused the neutrophil count to increase. The patients have remained clinically well since their treatment began. Serial studies of antineutrophil antibody and serum lysozyme, performed to elucidate the mechanism of action, suggested decreased neutrophil destruction, perhaps by Fc receptor blockade, as well as decreased synthesis of antineutrophil antibody. Neutrophil function was not impaired after the neutrophil count increased. Many patients with immune neutropenia have a benign course, but those who have significant infections could be treated, acutely or prophylactically, with intravenous gammaglobulin.