bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of iron status in women identified by copper sulfate screening as ineligible to donate blood
Authors: Morse Edward E. , Cable Ritchard , Pisciotto Patricia , Kakaiya Ram , Kiraly Thomas
Published: March 2003

Assessment of venous hemoglobin (Hb), serum ferritin, and zinc protoporphyrin (ZPP) levels was carried out in women identified by CuSO4 screening as ineligible to donate blood. The correlation of log ferritin with ZPP was relatively poor (r = −0.580) but significant (p > than 0.01). However, a ZPP level of 2.0 micrograms per g Hb or greater (upper limit of normal for first‐time female donors) showed a predictive value of 0.85 for a ferritin level of 12 ng per ml or less in these donors. The correlation of hemoglobin concentration with ZPP level was significant (r = −0.667; p < than 0.001) in blood donors with ferritin levels at or below 12 ng per ml. ZPP level appears to be increased in iron‐depleted (hypoferritinemic) blood donor in whom animals had developed or was developing (Hb < than 12.5 g/dl). Although direct measurements of venous hemoglobin and ferritin levels most accurately evaluate such blood donors, these tests are time‐ consuming and expensive and are currently not adaptable to bloodmobile operations. Copper sulfate screening has proved feasible in the bloodmobile setting, and the measurement of ZPP level has been used for mobile screening for lead poisoning. ZPP may be an inexpensive and useful screening test to determine a subset of donors who should receive supplemental iron or reduce their frequency of blood donation.
Risk of hepatitis B exposure in regional blood services
Authors: Page P. L.
Published: March 2003

The incidence of positive tests for anti‐HBs in 464 staff members of regional blood services between 1980 and 1983 (5.4%) was closer to that in the general population than to that in hospital staffs. Only two of the employees at risk developed antibodies during this interval, but neither seroconversion was attributable to employment in the regional blood center. The administration of hepatitis B vaccine, a recommendation based on data from health care workers potentially exposed to patient samples, may not be pertinent to regional blood center staff members potentially exposed only to volunteer donor products.
Nomifensine‐induced immune hemolytic anemia and posttransfusion purpura in the same patient
Authors: Mueller‐Eckhardt C. , Allolio B. , Salama A. , Kiefel V. , Deuss U.
Published: March 2003

A 53‐year‐old white woman had severe hemolytic anemia while taking nomifensine. A drop of hemoglobin to 61 g per I prompted the transfusion of two units of packed red cells. Nine days later, severe thrombocytopenia with multiple petechiae ensued. Both hemolysis and thrombocytopenia resolved promptly upon withdrawal of the drug and short‐term prednisolone treatment. Serologic studies showed nomifensine‐ dependent, metabolite‐specific red cell antibodies as the cause of immune‐mediated hemolysis and, in serum samples obtained after purpura, strong platelet‐specific PlA1 and weak HLA antibodies suggested a diagnosis of posttransfusion purpura.
The 24‐hour shelf‐life of cytapheresis platelet concentrates stored in polyvinyl chloride containers should be extended only with caution
Authors: Strauss R. G. , Snyder E. L. , Eckermann I. , Stewart L.
Published: March 2003

A recent publication suggested that the 24‐hour allowable shelf‐life of apheresis platelet concentrates collected by open‐system techniques be extended to 48 hours because platelets collected in this fashion usually remain sterile for that length of time. The current studies, however, show that the quality of platelet concentrates deteriorates rapidly after storage for more than 24 hours in the relatively small‐ volume, polyvinyl chloride containers of currently marketed, open‐ system software, as evidenced by the falling pH, the disintegration of platelets, and the inability of platelets to recover from hypotonic shock. Platelets were markedly defective within 48 hours. Thus, it seems unwise to extend the shelf‐life of such platelet concentrates beyond 24 hours solely because they are likely to remain sterile. Collection techniques and software must also be modified to ensure satisfactory platelet quality before the period of storage should be extended.
Hemagglutination enhancement by bovine serum albumin is affected by octanoate, Reactive Blue 2 (Cibacron Blue), and polymer
Authors: King M‐J.
Published: March 2003

An AutoAnalyzer system was used to study factors that influence the albumin enhancement of agglutination of Rh(D)‐positive red cells by IgG anti‐D. An albumin consisting of trimer and higher oligomer was more efficient than a preparation composed mainly of monomer and dimer. Modification of the hemagglutination‐enhancing property of albumin was obtained by the addition of ligands (octanoate [caprylate] and Reactive Blue 2 [Cibacron Blue]). Irrespective of the polymer content, neither ligand alone had any effect on low‐fatty‐acid albumins. However, when mixtures of octanoate and Cibacron Blue were added to the same albumins, hemagglutination was initially increased, and then diminished with increasing concentrations of ligands. The enhancing property of high‐fatty‐acid, nonpolymerized albumin was markedly reduced by the addition of octanoate or Cibacron Blue. On the other hand, only Cibacron Blue could produce the same inhibitory effect on a polymerized albumin with high fatty acid content. The implication is that the total free fatty acids bound and polymer content are two independent variables that can affect the performance of an albumin as a hemagglutination enhancer.
Use of a continuous‐flow cell separator in density gradient isolation of lymphocytes
Authors: Carter C.S , Leitman S.F. , Cullis H. , Muul L.M. , Nason‐Burchenal K. , Rosenberg S A. , Klein H.G.
Published: March 2003

ABSTRACT: A continuous‐flow technique was developed to isolate and concentrate lymphocytes over Ficoll‐Hypaque (FH) density gradients using an automated cell separator (Model CS‐3000, Fenwal). Lymphocyte concentrates (LC) containing 6.51 × 10(9) mononuclear cells were obtained by standard leukapheresis techniques. Disposable apheresis kits were modified to allow the LC to be pumped into a separation chamber along with a counter‐centrifugal flow of saline, removing the platelets and plasma by elutriation. The remaining cells were underlaid with 300 ml of FH, displacing the lymphocytes into a collection bag, where they were washed and concentrated. Mean leukocyte recovery was 59.2 percent (99.9% lymphocytes, n = 14). The final product contained 6.7 percent of the initial platelets and had a hematocrit of less than 1 percent. In paired studies using split leukocyte concentrates (n = 15), lymphocyte recovery obtained by the automated apheresis technique compared favorably with that obtained by standard manual FH gradients (59.8 +/− 3.4% versus 67.3±/− 4.2%, p greater than 0.05) and platelet contamination was significantly reduced (2.7±/− 0.5% versus 26.6±/− 5.7% residual platelets, p less than 0.001). Equivalent lymphokine‐ activated killer (LAK) activity was generated from cells isolated by both manual and automated techniques. An automated continuous‐flow cell separator can be used for rapid FH isolation of large numbers of lymphocytes, providing a sterile product suitable for human use.
Storage‐induced changes in human newborn red cells
Authors: Horn S. , Mazor D. , Zmora E. , Meyerstein N.
Published: March 2003

Fetal red cells are well suited for intrauterine life; however, little is known about their response to postnatal environments. The purpose of this work was to investigate the metabolic and membrane changes affecting newborn red cells during their exposure to storage in citrate‐ phosphate‐dextrose (CPD) and citrate‐phosphate‐dextrose‐adenine (CPDA‐ 1). The findings suggest that newborn red cells are affected more by storage than are adult cells. These accelerated storage changes in the red cells of newborns may be related indirectly to the rapid adenosine triphosphate (ATP) decline. As is the case with adult red cells, fetal cells withstand storage in CPDA‐1 better than in CPD. The storage lesion in these cells was partly reversible, as in adult cells, by incubation with adenosine. It was therefore concluded that newborn red cells obtained from placentas and stored for several weeks in CPD or CPDA‐1 media or other media that improve the metabolic profile of these cells may be acceptable for transfusion.
Current tests for antibody to hepatitis B core antigen used to screen donors for non‐A, non‐B hepatitis are comparable to the original radioimmunoassay for hepatitis B core antigen
Authors: Troisi C.L. , Hollinger F.B.
Published: March 2003

ABSTRACT: Prospective studies have shown a relationship between the transfusion of donor blood which is positive for antibodies to hepatitis B core antigen (anti‐HBc) and an increased incidence of non‐A, non‐B hepatitis. The anti‐HBc test was selected on the assumption that epidemiologic circumstances predisposing donors to hepatitis B infection also might favor exposure to non‐A, non‐B hepatitis. Current radioimmunoassays (RIA) and enzyme‐linked immunoassays (EIA) for anti‐ HBc utilize hepatitis B core antigen (HBcAg) prepared by recombinant DNA technology, whereas the original RIA anti‐HBc assay used HBcAg derived from hepatitis B virions. In the current study, 1329 sera were evaluated of which 23.3 percent were anti‐HBc positive. The results indicate that sensitivity, specificity, and positive and negative predictive values of the current EIA and RIA tests for anti‐HBc (Abbott Diagnostic Laboratories) are virtually identical to the original RIA test kit. In addition, all donor samples (128 specimens) administered to 57 cases of non‐A, non‐B hepatitis that were prospectively followed at Baylor College of Medicine for the Transfusion‐Transmitted Viruses (TTV) Study group were retested with the EIA‐recombinant anti‐HBc assay. All 21 samples which were reactive in the original RIA anti‐HBc test also were positive by the current EIA procedure. One sample was EIA positive/RIA negative, and 106 other samples were negative by both assays. Thus, commercial anti‐HBc kits based on HBcAg derived by recombinant DNA technology, should retain their predictive value for reducing the incidence of non‐A, non‐B hepatitis as described in the prospective studies.
The occurrence of precipitating antibodies in transfused Japanese patients with hereditary ninth component of complement deficiency and frequency of C9 deficiency
Authors: Inaba S. , Okochi K. , Fukada K. , Kinoshita S. , Maeda Y. , Yoshinari M.
Published: March 2003

Antibodies to the ninth component of complement (C9) were found in a patient with hereditary C9 deficiency (C9D) who had received multiple transfusions. The incidence of anti‐C9 precipitating antibodies following transfusion was investigated in 63,625 patients treated at Kyushu University Hospital, and 475,886 blood donors at the Fukuoka Red Cross Blood Center were studied to determine the frequency of C9D in Japan. Transfusion reactions in recipients having anti‐C9 were also monitored. One hundred and eighty‐six subjects (15 patients and 171 donors) with C9D were identified (a prevalence of 0.036%). Four of 15 C9‐deficient patients had received transfusions. One of the patients who had received several units of blood within 1 week developed low‐ titer C9‐precipitating antibody. This patient was transfused in the presence of the antibody without evidence of adverse reactions. No precipitating antibody was detected in the remaining three patients who had received several units of blood on a single day. These observations suggest that multiple transfusions may contribute to the development of anti‐C9.
Screening and evaluation of blood donors with upper‐limit hematocrit levels
Authors: Zanella A. , Silvani C. , Banfi P. , Bellone A. , Fumagalli G. , Sirchia G.
Published: March 2003

Eighty‐one consecutive repeat male blood donors with hematocrit levels ranging from 0.49 to 0.54 underwent hematologic investigation, blood gas analysis, and respiratory function tests in order to ascertain whether they represent the upper end of the reference distribution or have underlying causes of erythrocytosis. Three of the 81 (3.7%) proved to have early‐stage polycythemia rubra vera, nine (11.1%) to have erythrocytosis secondary to respiratory failure, and two (2.4%) to have relative erythrocytosis due to reduced plasma volume. Detection and evaluation of blood donors with high hematocrit values are ways in which blood banks could contribute to health screening and become involved in preventive medicine.
Plasma exchange using dextran 40‐electrolyte solution as the sole replacement fluid in malignant paraproteinemia
Authors: Fujii H.
Published: March 2003

The relative safety of 3 percent Dextran 40‐electrolyte solution alone as replacement fluid during plasma exchange is described. Using an automated blood cell separator, the authors exchanged 3.21 of plasma 64 times in 11 patients with paraproteinemia secondary either to Waldenstrom's macroglobulinemia or multiple myeloma (malignant paraproteinemia). Then they replaced the plasma with an equal volume of 3 percent Dextran 40‐electrolyte solution. They administered no protein‐ containing solutions during or after the plasma exchanges. Despite marked hypoalbuminemia immediately after plasma exchange, the plasma colloid osmotic pressure level fell only slightly because of the high concentration of plasma low‐molecular dextran. The hemostatic abnormalities were similar to those seen in patients whose plasma was replaced with albumin solution. The exchanges were tolerated well clinically and no serious complications occurred during or after exchange. The authors believe that the 3 percent Dextran 40‐electrolyte solution can be used safely as the sole replacement fluid in intensive plasma exchange programs for patients with malignant paraproteinemia.
Stimulus‐response coupling in fresh and stored granulocytes
Authors: Lane T. A. , Lamkin G. E.
Published: March 2003

Granulocytes stored in the blood bank prior to transfusion undergo progressive decrements in their ability to circulate and migrate in vivo and to migrate in vitro (chemotaxis). The pathogenesis of granulocyte (PMN) chemotaxis (CTX) dysfunction after room‐temperature storage of PMN is unclear. Previous work in the authors' laboratory and others led to the hypothesis that intracellular transmission of chemotactic signals, referred to as stimulus‐response coupling (SRC), might be abnormal in stored PMN. This report presents an investigation of the ability of fresh and stored PMN to generate and respond to leukotriene‐B4 (LTB4), the chief intracellular amplifier of SRC for CTX. PMN were sampled from concentrates within 4 hours of collection and after 24 and 48 hours of storage in transfer packs at room temperature (RT). Fresh, stimulated PMN synthesized 202 ± 51 ng of LTB4 and 110 ± 11 ng of 5‐hydroxyeicosatetraenoic acid (HETE) per 107 PMN. Synthesis of LTB4, but not HETE was significantly decreased after 24 hours' storage, and LTB4 and HETE synthesis decreased after 48 hours. The incubation of stored PMN with arachidonic acid (AA) maintained levels of LTB4 synthesis in PMN stored for 24 but not 48 hours. Also, the CTX defect of stored PMN to F‐Met‐Leu‐Phe (FMLP) was not improved by the supplementation of PMN with exogenous sources of LTB4 or AA. It was concluded that: 1) Room‐temperature storage of PMN is accompanied by a progressive defect in the synthesis of LTB4; 2) These data suggest a defect in one and possibly more steps in the enzymatic conversion of AA to LTB4 in stored PMN; and 3) These CTX studies suggest that defective LTB4 synthesis is not likely to be the principal cause of impaired CTX in stored PMN.
Effect of ABO incompatibility on the fate in vivo of 111Indium granulocytes
Authors: McCullough J. , Clay M. , Loken M. , Hurd D.
Published: March 2003

The effect of ABO incompatibility on the in vivo fate of 111Indium granulocytes was determined. The intravascular recovery and survival (t½) and extravascular migration into a skin window of normal‐donor granulocytes did not differ in 15 subjects from the values obtained in four controls who received ABO‐compatible granulocytes. Nor was the correlation between the ABO antibody titers and the in vivo measurements strongly positive. It is concluded that ABO incompatibility did not alter the in vivo fate of granulocytes.
Iron supplementation in female blood donors deferred by copper sulfate screening
Authors: Cable R. G. , Morse E. E. , Keltonic J. , Kakaiya R. , Kiraly T.
Published: March 2003

Female blood donors with low hematocrit levels detected by copper sulfate screening were selected randomly to receive either 75 mg of iron per day, as ferrous gluconate, or a calcium phosphate placebo. Their ferritin, serum iron, total iron‐binding capacity, zinc protoporphyrin, and hemoglobin values, as well as their suitability to donate blood, were determined initially (Visit 1) and at four follow‐up visits (Visits 2–5). By the second visit, the serum ferritin and iron values of donors receiving iron supplementation differed significantly from those of donors receiving placebo. By the fifth visit, a less marked but significant increase in hemoglobin had occurred in the iron group, but not in the placebo group. At no time was there a significant difference between the groups' suitability to donate blood, with each group donating at almost half of their visits. The authors conclude that iron supplementation at this dose level in deferred female blood donors improves their iron status and hemoglobin levels, but does not significantly increase their suitability to donate blood as compared with the suitability of placebo‐treated donors.
Establishment of a system to standardize acceptability criteria for alanine aminotransferase activity in donated blood
Authors: AuBuchon J. P. , Wilkinson J. S. , Kassapian S. J. , Edwards G. C.
Published: March 2003

A multilaboratory study was conducted to develop a system for standardizing alanine aminotransferase (ALT) acceptability criteria (“cutoffs”) for donated blood. Without standardized cutoffs, each laboratory must develop its own cutoff, and this may not make optimal use of ALT testing to reduce transmission of non‐A,non‐B hepatitis (NANB). Defining an ALT acceptability criterion in absolute terms is necessary because relative cutoffs based on local donor populations may be affected by the prevalence of NANB in each community. This study involved 16 laboratories using 23 different analytic systems. The ALT results of the analysis of a plasma reference sample could be used to translate mathematically a single, absolute cutoff to units applicable to each analytic system. The distribution of ALT results in 1.4 million donations from across the country was established; basing the cutoff on this sample avoids the problems inherent in using a local donor base to establish a cutoff. We propose the implementation of a system to standardize ALT acceptability criteria to an activity level defined by analysis of a nationwide donor sample.
Paternity testing with an absent mother
Authors: Walker R. H. , Pohl B. A.
Published: March 2003

Blood tests in cases of disputed paternity can be extremely useful even when the mother's blood sample is not available. The mean probability of exclusion (Ā) of red cell surface antigen, Gm, Hp, and HLA systems was determined in this situation for North American whites and blacks by creating pairs of a man and an unrelated child. In whites, the most valuable of the systems investigated to indicate nonpaternity for false fathers were HLA, Rh, Fy, and MNSs, in that order. HLA, MNSs, and Gm were the most valuable systems in blacks. With all of the genetic systems used in this study, the combined probability of exclusion (CPE) of men falsely accused of paternity, in cases where the mother is absent, is approximately 95 percent for whites and 92 percent for blacks. Since only indirect exclusions are possible without the mother, the common test panel of HLA and red cell antigens may not always allow an adequate study. Extended testing is recommended to include additional genetic systems in order to achieve an average combined probability of exclusion of at least 95 percent.
Effect of diltiazem and a prostaglandin derivative (PGBx) on platelet function during long‐term storage
Authors: Smith D. J. , Odom D. G. , Cheney B. A.
Published: March 2003

Calcium is an intermediate messenger between platelet stimuli and platelet response. Published studies have shown that the decreased ability of platelets to control calcium flux during long‐term storage leads to platelet senility. Platelet metabolism might be more efficient during storage if pharmacologic agents that limit calcium movement were incorporated into the platelet concentrate storage solution. This hypothesis was tested by storing platelets with the calcium channel blocker, diltiazem, or with a prostaglandin B1, derivative, PGBx. During a 15‐day storage period, platelets incubated with either diltiazem or PGBx showed improved function, as measured by aggregation, as compared to control platelets. The PGBx‐enhanced platelet function during storage was accompanied by a significant decrease in glucose and an increase in adenosine triphospate concentrations. Platelet function after storage with PGBx improved in spite of significantly lower pH levels of the platelet concentrates at all time points tested. These studies suggest that the maintenance of calcium ion homeostasis during long‐term platelet storage is important to in vitro platelet function even if the Ca2+ balance is maintained at the expense of pH and the glucose concentrations.
A new polyvinylchloride blood bag plasticized with less‐leachable phthalate ester analogue, di‐n‐decyl phthalate, for storage of platelets
Authors: Shimizu T. , Kouketsu K. , Morishima Y. , Goto S. , Hasegawa I. , Kamiya T. , Tamura Y. , Kora S.
Published: March 2003

To compare changes in platelets stored in the new di‐n‐decyl phthalate (DnDP)‐plasticized polyvinyl chloride (PVC) bag with those in a di‐(2‐ethylhexyl) phthalate (DEHP)‐plasticized PVC bag, single‐donor apheresis platelet concentrates (PCs), 133 ± 11 × 107 platelets per ml (n = 7), were stored with 94 ± 3 ml of plasma in a new 1‐liter bag with a surface area of 44 ± 7.1 cm2 per 1010 platelets. Oxygen and carbon dioxide gas diffusion properties of PVC‐DnDP films were respectively, 1.6 and 2 times those of standard PVC‐DEHP films. The amounts of DnDP leaked into the plasma of PCs were low at 0.58 ± 0.06 mg per bag after 5‐day storage, which is about one‐eightieth the amount of DEHP leaked. The pH of PCs in PVC‐DnDP bags amounted to 6.99 ± 0.03 after 5‐day storage, with glycolysis accelerated somewhat in the new bags. However, the platelet oxygen consumption was no different from that in the PVC‐DEHP bags. Platelet aggregation and responses to hypotonic shock were significantly better in the new bags at the end of storage. Shape changes of platelets into spherical forms with dendrites were more frequently observed in PVC‐DnDP bags than in PVC‐DEHP bags. The study indicated that platelets stored in the new DnDP‐plasticized PVC bags have retained aggregation and responses to hypotonic shock more than platelets in the PVC‐DEHP bags, but spherical forms and anaerobic metabolism increased in the new bags.
Evaluation of the appropriateness of blood and blood product transfusion using preset criteria
Authors: MozesMD B. , Epstein M. , Ben‐Bassat I. , Modan B. , Halkin H.
Published: March 2003

The use of 1930 units of blood or blood products during 765 transfusion episodes in 560 patients was reviewed. This represented one‐half of all transfusions in a large medical center over a 2‐month period. By clearly defined, present criteria, 42.3 percent of the episodes were found not to be appropriate. Whole blood and platelet transfusions were used more appropriately than those of red cells, cryoprecipitate, and fresh‐frozen plasma. Blood transfusions were used more appropriately in the management of acute bleeding or anemia associated with cardiovascular problems. Three groups of patients were especially prone to inappropriate transfusions: those with end‐stage renal disease or terminal cancer and cancer patients on chemotherapy. Age, sex, and specific hospital wards were not associated with inappropriate use. Most unjustified episodes occurred as a result of the overestimation of the immediate risk incurred by withholding transfusion.
The importance of ABH antigens in platelet crossmatching
Authors: Heal J. M. , Mullin A. , Blumberg N.
Published: March 2003

In the present study, the frequency with which ABH incompatibility could be detected in platelet crossmatches was determined. The effect of chloroquine elution on ABH antigens was also evaluated, and a technique was developed to remove IgG anti‐A from group O plasma using a chemically synthesized human blood group A trisaccharide antigen covalently linked to crystalline silica (Synsorb‐A). Group O plasmas were found to be incompatible with 52 percent of group A platelets and 17 percent of group B platelets (p<0.05). In contrast, anti‐A from group B plasmas rarely produced a positive crossmatch, and no anti‐B that reacted with platelets could be demonstrated in group A plasmas. IgG anti‐A reactions with group A platelets were eliminated in 100 percent of the group O plasmas tested after treatment with the synthetic solid‐phase immunoadsorption technique. Synsorb‐A may be a useful adjunct to platelet serologic testing when group O sera need to be tested against A platelets. Group A platelets bound less anti‐A after exposure to chloroquine, but only 17 percent of platelets became negative when crossmatched with group O plasma. It was concluded that increased IgG binding occurs in a majority of platelet crossmatches using a k‐ELISA technique when group O recipients are tested against group A donors. These results offer a potential explanation for conflicting results in studies of transfusion results with ABH‐incompatible platelets. Transfusions of group B platelets to incompatible recipients may be more likely to yield satisfactory increments than incompatible transfusions of group A platelets, but this remains to be proven. There appear to be significant differences between red cells and platelets in regard to serologic reactivity in the ABH system.
Prevalence of antibodies to human immunodeficiency virus type 1 among blood donors prior to screening, The Transfusion Safety Study/NHLBI Donor Repository
Authors: Kleinman S. H. , Niland J. C. , Azen S. P. , Operskalski E. A. , Barbosa L. H. , Chernoff A. I. , Edwards V. M. , Lenes B. A. , Marshall G. J. , Nemo G. J. , Norman G. L. , Perkins H. , Pindyck J. , Pitlick F. , Rasheed S. , Shriver K. , Toy P. , Tomasulo P. A. , Waldman A. , Mosley J. W. ,   Transfusion Safety Study Group
Published: March 2003

The Transfusion Safety Study (TSS) and the National Heart, Lung, and Blood Institute (NHLBI) established a repository of approximately 200,000 sera from blood donors in late 1984 and early 1985. Collections were made in the four metropolitan areas with the highest prevalence of AIDS. Retrospective testing showed an overall anti‐HIV‐1 prevalence of 16 cases per 10,000 donations. In this study, the predictive value of a negative initial enzyme‐linked immunoassay was estimated from both quality control specimens and the rescreening of 13,461 sera to be >99.99 percent with respect to technical error. Among anti‐HIV‐1‐positive persons, there was a 1.3‐ to 1.5‐fold excess of first‐time donors. The anti‐HIV‐1 prevalence among donors showed that infection was more common among young men than suggested by national reporting of AIDS cases. Anti‐HIV‐1 prevalence varied among the four metropolitan areas less than did reported AIDS cases, but, by 1987, the differences in the latter had decreased. Anti‐HIV‐1 prevalence in collection areas outside of the four major cities differed much more widely than that among the cities themselves. The TSS/NHLBI Donor Repository will remain available for the indefinite future for further evaluation of screening procedures for HIV‐1 and other viruses for which transfusion is found to be an important route of transmission.
Estimating the incubation time distribution and expected number of cases of transfusion‐associated acquired immune deficiency syndrome
Authors: Kalbfleisch J. D. , Lawless J. F.
Published: March 2003

The number of cases of transfusion‐associated acquired immune deficiency syndrome (TA‐AIDS) that will be seen over the next few years is difficult to estimate, because of the uncertainty about the number of persons infected with the human immunodeficiency virus (HIV) via blood transfusion and about the duration of the incubation period from HIV infection via transfusion to diagnosis of AIDS. Presented here are a mathematical model and nonparametric and parametric statistical analyses of recent data on TA‐AIDS that indicate clearly the existing estimability problems. The methods provide short‐term projections of new TA‐AIDS cases to be reported; the results suggest about 1100 new cases to be reported in the United States between July 1988 and June 1989 and about 1500 more between July 1989 and June 1990. Estimates of the number of eventual TA‐AIDS cases to be seen are considerably more uncertain and require additional assumptions about the incubation distribution. Under the assumption that the probability of an infected person developing AIDS within 8 years of infection is 0.40 (an estimation derived from cohort studies in homosexual men and hemophiliacs), parametric and nonparametric analyses give, respectively, point estimates of 14,300 and 15,000 for the number of eventual cases of AIDS (in the age group 13–69) attributable to infection by blood transfusion prior to July 1985. The parametric analysis gives a corresponding 95 percent confidence interval (12,300, 16,800).
Recruiting blood donors into a local bone marrow donor registry
Authors: Beatty P. G. , Atcher C. , Hess E. , Meyer D. M. , Slichter S. J.
Published: March 2003

To date, most persons joining bone marrow donor registries have been recruited from platelet‐pheresis panels. The potential of recruiting regular blood donors into a bone marrow donor registry (BMDR) was explored. It was found that, with minimal effort, 6.2 percent of the age‐eligible blood donors were recruited. A distinguishing feature of those who joined the BMDR was a history of frequent blood donations. Although local media attention had a major impact on recruitment, even those joining as a result of the publicity usually were regular blood donors. This program has the potential to recruit nearly 8000 volunteers from 120,000 regular blood donors over an 18‐month period.
A study of HLA (Bg) on red cells and platelets by immunoblotting with monoclonal antibodies
Authors: Giles C.M. , Botto M. , King M.J.
Published: March 2003

HLA class I antigens (Bg) on red cells (RBCs) are expressed by some normal donors and by many patients with systemic lupus erythematosus (SLE). To identify the membrane components previously detected by hemagglutination with HLA class l‐specific monoclonal antibodies (MoAbs), RBC membrane preparations were separated by sodium dodecyl sulfate‐polyacrylamide gel electrophoresis and immunoblotted with the HLA class I MoAbs. Two components were obtained that reacted with the MoAbs: a heavy chain of 45 kDa and a light chain termed β2‐microglobulin (β2‐M) of 11 kDa. The effect of chloroquine and acid elution in stripping HLA antigens is shown to be due to the removal of β2‐M, as only that component was detected in eluates from reactive RBCs. Neither antibody elution method affected the heavy chain expression assessed by immunoblotting. It is concluded that HLA class I antigens on RBCs are integral membrane components of the type normally found and widely distributed on many nucleated cells. Platelets, which have stronger HLA class I antigen expression, were also studied, and their membrane preparations yielded heavy chain and β2‐M molecules; the effect of chloroquine treatment was harder to assess than that of acid elution, owing to the sensitivity with which both components are detected in immunoblotting. In eluates obtained from acid treatment only β2‐M is detected.
MONITORING BLOOD DONORS FOR HIV‐2 INFECTION BY TESTING ANTI‐HIV‐1 REACTIVE SERA
Authors: BUSCH MICHAEL P. , PETERSEN LYLE , SCHABLE CHARLES , PERKINS HERBERT
Published: March 2003

Anti‐HIV‐1 EIA tests currently used for screening blood donors in the United States are estimated to detect 55 to 91% of HIV‐2 infections; Western blots for HIV‐1 antibodies may be positive, negative or indeterminate with HIV‐2‐positive sera. We reasoned that we could exploit the cross‐reactivity of the anti‐HIV‐1 EIA as a means to monitor the blood supply for the appearance of HIV‐2 infected or co‐infected persons, and thus decide if and when routine HIV‐2 screening should be adopted. We tested 913 anti‐HIV‐1‐reactive donor sera using an anti‐HIV‐2 screening EIA, with confirmation by an anti‐HIV‐2 env‐peptide EIA and an anti‐HIV‐2 Western blot. These 913 sera were derived from anti‐HIV‐1 screening of approximately 242,000 donations over a three year period. No HIV‐2 infections were identified. This approach may warrant adoption in blood centers serving populations with persons from countries where HIV‐2 is prevalent.
Murine monoclonal antibody with anti‐e‐like specificity: suitability for screening for e‐negative cells
Authors: Fraser R.H. , Inglis G. , Allan J.C. , Murphy M.T. , Allan E.K. , Mackie A. , Mitchell R.
Published: March 2003

A directly agglutinating murine monoclonal antibody of the IgG3 isotype has been produced after mice were immunized with papain‐treated Bombay phenotype, e‐positive red cells (RBCs). The antibody strongly agglutinated all e‐positive RBCs and gave negative reactions with RBCs from Rhnull persons and those homozygous for Rh deletion genes. Variable reactivity was found with e‐negative RBCs, ranging from weak to negative with R2R2, slightly stronger with r″r″, and stronger still with RZRZ. These reactions, together with results from tests with a large panel of Rh‐variant RBCs, suggested a specificity for an epitope that is part of the e mosaic but is also expressed at least partially on e‐negative RBCs and is influenced by the presence of C. This antibody has been standardized for use as a screening reagent for R2R2 cells by a microplate technique, and over 6000 donations have been screened in this way. No discrepancies have been found in confirmatory tests for e‐negative status using human anti‐e.
Directed‐donor programs may adversely affect autologous donor participation
Authors: Chambers L.A. , Kruskall M.S. , Drago S.S. , Ellis A.M.
Published: March 2003

One hundred autologous whole blood donors (11 men, 89 women; 49 preoperative, 51 prenatal) completed a questionnaire concerning their motivations as autologous donors, their perceptions of the relative safety of blood donor options, and their interest in directed donations. Concern about acquiring AIDS from transfusion was the most prevalent reason for autologous donation. Nearly all participants knew that autologous blood was safer than volunteer blood, and most also believed that directed‐donor blood was safer than volunteer blood. Most would have used a directed‐donor program if available, particularly if they were ineligible as autologous donors. Furthermore, their interest in directed donations was unaffected by written material, provided partway through the questionnaire, that included a statement that no scientific evidence exists to support directed donations' being safer than volunteer blood. One donor in five believed that autologous and directed donations were equivalent in safety, and 19 (15 of whom were prenatal donors) indicated that they probably or surely would not have participated in the autologous program if directed donations had been available. This study demonstrates that a sizable proportion of autologous donor candidates might not participate if a directed donation program were available. The unrestricted availability of directed donations may thus contribute to suboptimal use of autologous donor programs.
Blood component therapy during the neonatal period: a national survey of red cell transfusion practice, 1985
Authors: Sacher R.A. , Strauss R.G. , Luban N.L.C. , Feil M. , Anstall H.B. , Barnes A. , Blanchette V.S. , Butch S.H. , Hume H.A. , Kevy S.V. , Levy G.J. , McMican A. , Starling K. , Williams A.K.
Published: March 2003

A questionnaire to determine patterns of neonatal red cell transfusion practice during 1985 was mailed to 2200 blood banks of American Association of Blood Banks (AABB) institutional members and children's hospitals. There were 915 responses (41.6%); 785 responses (86%) contained sufficient data for analysis. The majority (70.6%) of 785 responding hospitals were community/urban institutions. However, more highly specialized, pediatric hospitals were also represented by 92 university/ tertiary‐care hospitals (11.7% of respondents) and 29 children's hospitals (3.7% of respondents). Two‐thirds of hospitals performed a major antiglobulin crossmatch (rather than an abbreviated one) before all neonatal red cell transfusions. The red cell preparation most frequently selected for small‐volume transfusions was ABO and Rh group‐specific red cell concentrates. When performing only large‐volume exchange transfusions, 19.2 percent of hospitals used whole blood; all others prepared reconstituted units of red cells plus fresh‐frozen plasma, a practice that frequently causes exposure to two donors per unit. Another practice likely leading to multiple donor exposure is the use of fresh‐frozen plasma to adjust the hematocrit of red cell preparations to a predetermined value prior to a small‐volume transfusion. Over one‐half of hospitals adjusting hematocrits used plasma, presumably from one donor, to dilute packed red cells from another donor, a practice that has no apparent medical benefit. Most hospitals (63.4%) provided red cells with a reduced risk of transmitting cytomegalovirus; blood from seronegative donors was selected by 65 percent of hospitals. The majority of hospitals, including most of the community/urban hospitals, did not irradiate blood products before transfusion. Thus, neonatal red cell transfusion practices during 1985 were widely diverse, some of which are judged to be less than ideal. The data in this report offer a resource for comparative studies and provide a basis for education, peer review, and research.
Effect of white cells on platelets during storage
Authors: Sloand E.M. , Klein H.G.
Published: March 2003

White cells (WBCs) present in stored platelet concentrates have adverse effects on platelet function and on posttransfusion recovery. Although these effects have been attributed to the fall in pH that results from active WBC metabolism, platelets stored in gas‐permeable storage bags still exhibit abnormalities, despite maintenance of a stable pH of greater than 6.0. The changes in platelet proteins and function brought about by storage with a controlled number of WBCs were studied. Twelve platelet‐pheresis specimens were centrifuged at 180 x g to achieve a WBC count of less than 2 times 105 per mL (which contained less than 10% granulocytes). These specimens were split into two aliquots and placed in platelet bags for storage at 22° C with constant horizontal agitation. Neutrophils, obtained from the same donor by centrifugation of 50 mL of whole blood through a discontinuous ficoll gradient, were added to one of the two platelet storage bags to achieve a final neutrophil count of 1 times 106 per mL. Platelet aliquots were removed and studied on Days 3 and 5. In platelets stored without neutrophils, the average response to ristocetin, using the mean slope as an index of platelet responsiveness, was 10.3 (n = 9, SD = 11) on Day 3, whereas for the platelets stored with neutrophils, it was 1.25 (n = 12, SD = 0.9, p<0.01). Significant differences were also seen on Day 5 (slope = 4.5 for platelets stored without neutrophils, slope = 0.3 for platelets stored with neutrophils, p<0.01). Platelet aggregation with 8 μM ADP and 1.5 mg per mL of collagen did not differ significantly. In four similar experiments using lymphocytes (107/mL) instead of neutrophils, no significant change in platelet function was noted. Platelet lysates of similar protein concentration, analyzed by polyacrylamide gel electrophoresis and stained with Coomassie blue, showed decreased or absent staining of a band of molecular weight of 170,000 in platelets stored with neutrophils, as compared to control. Immunoblot analysis of seven sets of platelet lysates using antiserum to glycocalicin, a fragment of glycoprotein Ib (GPIb), demonstrated decreased staining at molecular weight of 140,000 in the platelets stored with neutrophils by Day 3 of storage. Platelets stored for 3 days at 22° C with 106 per mL of neutrophils showed decreased responsiveness to ristocetin, decreased quantities of GPIb, and decreased amounts of a 170‐kDa protein with electrophoretic properties similar to thrombospondin. These findings are consistent with proteolysis of GPIb by one of the neutrophil proteolytic enzymes.
Immunoglobulin G subclass responses to cytomegalovirus in seropositive patients after transfusion
Authors: Rodriguez G.E. , Adler S.P.
Published: March 2003

The immunoglobulin G subclass responses to cytomegalovirus (CMV) after red cell (RBC) transfusion were studied in 26 seropositive surgery patients and 34 transfused seropositive oncology patients. Also included as controls were 18 surgical patients who received no RBCs during surgery. None of the 78 patients studied had IgG2 to CMV before or after transfusion. The absence of a total IgG response to CMV after transfusion could not be attributed to preexisting deficiencies in one or more subclasses, because all 78 patients had similar levels of IgG1, IgG3, and IgG4 to CMV before transfusion. Discriminant analysis was used for statistical evaluation of the combined CMV subclass responses in each patient and the individual subclass responses. Individual patients responded to CMV antigens with an increase in concentration in any of the three subclasses or any combination of the subclasses, excluding IgG2. IgG subclass analysis showed that 10 of 27 patients who did not respond with at least a fourfold total IgG titer rise had a significant increase in IgG subclass antibodies to CMV. Three of 33 patients with at least a fourfold total IgG titer rise lacked a subclass response. These results suggest that the measurement of IgG subclasses may be a sensitive indicator of immune response to CMV.
Lymphocyte subpopulations in long‐term dialysis patients: a case‐ controlled study of the effects of blood transfusion
Authors: Crowley J.P , Valeri C.R , Metzger J.B , Pono L. , Chazan J.A
Published: March 2003

Lymphocyte subsets in a group of intensely transfused (> 10 units/year) patients on long‐term hemodialysis were compared with those in a carefully controlled population of lightly transfused (1–10 units/year, no units during study period) long‐term dialysis patients. The data confirm previous reports of lymphopenia and a symmetrical reduction of both T‐ and B‐cell subpopulations in patients on long‐term dialysis. Eleven (36.7%) of 30 intensely transfused dialysis (ITD) patients had a low T8 population when expressed as a percentage value, while 0 of 25 lightly transfused dialysis (LTD) control patients exhibited a low percentage of T8 cells. There were no significant absolute differences between the lymphocyte subsets in the ITD and LTD patients. These data contrast with previous reports of other groups of ITD patients in whom there was an observed increase in T8 cytotoxic suppressor cells. Our findings suggest that the immunologic effects of renal failure and long‐term dialysis largely override the increase in T8 lymphocyte subsets observed in other groups of transfused patients. There is little difference between ITD and LTD patients, but both groups are significantly different from nontransfused controls. Further longitudinal studies are needed in completely untransfused patients to resolve the contribution of minimal transfusion therapy to the immunologic deficits observed in long‐term dialysis patients.
Autoimmune hemolytic anemia in Kawasaki disease: a case report
Authors: Hillyer C. D. , Schwenn M. R. , Fulton D. R. , Meissner H. C. , Berkman E. M.
Published: March 2003

A 3‐year‐old boy presented with the fever, conjunctivitis, rash, and lymphadenopathy diagnostic of Kawasaki disease. Treatment with antibiotics, aspirin, and intravenous immunoglobulin was instituted. The hematocrit decreased from 35 percent on admission to 11 percent by hospital Day 10, and the white cell count had increased from 13.7 to 42 × 10(3) per microL, and the patient had a leukoerythroblastic blood smear. The direct antiglobulin test demonstrated IgG but not complement on the red cell (RBC) surface. An acid eluate reacted (titer of 4) with all panel cells in the antiglobulin phase. Intravenous immunoglobulin from the same lot used for treatment did not contain antibody that reacted with the patient's group O RBCs or a panel of group O RBCs, but did contain IgG anti‐A and ‐B (titer of 4). The patient received a transfusion and was given methylprednisone. The direct antiglobulin test and acid eluate were negative 4 days later. The patient had an uneventful recovery. The distinction between antibody‐mediated hemolytic anemia and autoimmune hemolytic anemia is important in the treatment of this disease.
An unexcluded paternity case investigated with hypervariable DNA loci
Authors: Yokoi Tsuyoshi , Nata M. , Aoki Y. , Sagisaka K.
Published: March 2003

A paternity case involving a putative father, a child, and the mother was referred to our laboratory for testing. Parentage was not excluded with 23 kinds of standard blood group markers and HLA, but the putative father requested more‐affirmative evidence of paternity. Seven kinds of DNA probes that recognize hypervariable loci were applied. On the basis of the allelic frequencies and their confidence intervals previously reported among unrelated Japanese individuals, as well as confirmed codominant segregation of the polymorphism, the exclusion probability and paternity index were calculated for this case. The cumulative paternity index from the seven DNA probes was 1.4 × 10(6), which was 316 times higher than that from the 23 standard blood group markers and HLA. Accordingly, DNA polymorphism is considered to be informative enough for paternity testing.
Postthaw stability of fibrinogen in cryoprecipitate stored between 1 and 6°C
Authors: Howard P. L. , Bovill E. G. , Golden E.
Published: March 2003

The fibrinogen activity in thawed cryoprecipitate stored between 1 and 6 degrees C is maintained essentially unchanged in most bags for a month. Occasionally, a bag will have a reduction in fibrinogen. If pooling has not occurred, thawed cryoprecipitate should be useful as a source of fibrinogen for a period of time considerably in excess of the 6 hours allowed for its use as a source of factor VIII or von Willebrand factor.