Sixty-three patients have provided evidence that platelets are highly immunogenic even in recipients of potentially immunosuppressive therapy for malignant diseases. Approximately 70 per cent of patients who receive repeated transfusions of platelets from random donors over a prolonged period can be expected to develop lymphocytotoxic antibodies. Antibodies became detectable in one patient ten days after his first exposure to HLA antigens in the form of platelet concentrates, and as early as four days in two patients with prior exposure to HLA antigens. In the most heavily immunized patients, the presence of antibody correlated with poor increments of platelets after transfusion. Patients with prior exposure to HLA antigens are more likely to have antibodies resulting in poor platelet survival. On the other hand, 30 per cent of recipients of repeated platelet transfusions show no tendency to form cytotoxic antibodies.

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In 1954, 253 Marshallese were accidentally exposed to fallout radiation from the hydrogen bomb, BRAVO. The Marshall Islands Medical Program (MIMP) was established by the Department of Energy in 1955 to monitor and treat radiation-related disease pursuant to this accident. Medical teams from Brookhaven National Laboratory, a federal institution, regularly visit the Marshall Islands to give medical care to the exposed population. The most significant complication of the exposure has been found to be thyroid disease due to the ingestion of radioactive iodides from the fallout. In 1963 the first thyroid nodules were found in Rongelap subjects and in 1969 in Utirik. Non-neoplastic adenomatous nodules were associated with higher doses of radiation and neoplastic nodules developed in individuals receiving lower doses of radiation. Women were more susceptible to the development of palpable thyroid nodules than men. In 1994 the MIMP initiated examination of the thyroid by ultrasound to supplement the clinical examination. One hundred and sixty-four patients were evaluated. No significant differences were found in the incidence of thyroid nodules or the mean nodule count between the three groups of Rongelap and Utirik exposed and a comparison patient population. There was no significant difference in the incidence of thyroid nodules in males vs. females. Five exposed patients were referred for surgical excision of a nodule detected only by ultrasound. These ultrasound findings are unexpected in that females are known to have a higher incidence of thyroid disease than males and we expected that the incidence of ultrasound nodules would be higher in the exposed population.

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