bluuebunny/crossref_metadata_2025 huggingface dataset:
Lipid peroxidation in stored red cells
Authors: KNIGHT J.A. , VOORHEES R.P. , MARTIN L. , ANSTALL H.
Published: March 2003

Lipid peroxidation is initiated by the production of oxygen‐free radicals; it is increased in a wide variety of diseases, including various hemolytic anemias, and in hemoglobin disorders. Increased lipid peroxidation occurs in red cells in the presence of reactive iron species and some heme moieties. In this study, greatly reduced concentrations of malondialdehyde, an indicator of lipid peroxidation, were observed in stored blood upon the addition of both deferoxamine mesylate and diethylenetriaminepentaacetic acid (p less than 0.001). The antioxidant glutathione was much less effective (p less than 0.01 or less than 0.05, depending on incubation time). On the other hand, the addition of dimercaptosuccinic acid and ascorbic acid both significantly increased malondialdehyde production over controls (p less than 0.001 and p less than 0.05, respectively). Ascorbic acid, in the presence of deferoxamine mesylate, added no red cell protection over that of deferoxamine mesylate alone. The addition of metal chelators and, possibly, certain antioxidants to stored blood may be effective in increasing the viability and longevity of transfused red cells.
Large‐volume leukapheresis for peripheral blood stem cell collection in patients with hematologic malignancies
Authors: MALACHOWSKI M.E. , COMENZO R.L. , HILLYER C.D. , TIEGERMAN K.O. , BERKMAN E.M.
Published: March 2003

Large‐volume leukapheresis (LVL, 15–35 L) was performed in two groups of patients (n = 10) with hematologic malignancies to obtain peripheral blood stem cells for bone marrow rescue following high‐dose chemotherapy. The target cell count was 7 × 10(8) mononuclear cells (MNCs = lymphocytes and monocytes) per kg of body weight. Group A patients (n = 4) were studied on Day 1 of LVL, and components were collected from them as four sequential samples. Total MNCs collected averaged 1.29 × 10(10), total colony‐forming‐units granulocyte‐ macrophage (CFU‐GM) averaged 12.1 × 10(6), and a 1.8‐fold mobilization of CFU‐GM was observed (p < 0.05, Sample 1 vs. Sample 4). Group B patients (n = 6) were studied throughout the three consecutive planned days of 5‐hour LVL. An average of three LVL procedures per patient was performed (range, 1.25‐4), and an average of 27 L (range, 24–33) of blood per LVL was processed. The blood:ACD‐A ratio was 24:1 with 3000 units of heparin per 500 mL of ACD‐A; heparin was also added to the collection bags. The component had an average hematocrit (Hct) of 0.02 and MNC content of 93 percent. The patients' pre‐LVL and post‐LVL average Hct varied significantly (before Day 1, 0.36 +/− 0.08; after Day 3, 0.28 +/− 0.06; p < 0.05). Platelet counts also decreased, with post‐Day 3 counts averaging 19 percent of the average pre‐Day 1 counts (p < 0.05). A decrease in the average MNC count after LVL was significant on Day 1 only (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
Frequency of delayed hemolytic transfusion reactions following antibody screening and immediate‐spin crossmatching
Authors: PINKERTON P.H. , COOVADIA A.S. , GOLDSTEIN J.
Published: March 2003

In view of the continuing controversy regarding the use of immediate‐ spin crossmatch procedures in preparing blood for transfusion to patients in whom unexpected clinically significant antibodies have not been found by antibody screening by the indirect antiglobulin test (IAT), a review of 8 years' experience with such a policy was conducted. In that period, 54,725 units of packed red cells or whole blood were transfused to 10,146 patients. Four clinically overt delayed hemolytic transfusion reactions and 18 clinically silent delayed serologic transfusion reactions were found. In 3 of the 22 patients, the offending antibody(ies) were detectable in the pretransfusion serum by an enzyme IAT, but none was detectable by routine saline IAT against either a three‐cell screening panel or the transfused cells. Thus, the incorporation of saline indirect antiglobulin crossmatch would not have prevented the delayed reactions. It can be concluded that the use of a saline indirect antiglobulin crossmatch offers no significant advantage over the current policy of using only immediate‐spin crossmatch for those patients whose pretransfusion serum gives negative results in a three‐cell screen using a saline IAT.
The mechanism of white cell reduction by synthetic fiber cell filters
Authors: Callaerts A. J. , Gielis M. L. , Sprengers E. D. , Muylle L. M.
Published: March 2003

The mechanism of white cell (WBC) retention by synthetic fiber‐based WBC filters was studied. Filters were made of nonwoven fleece prepared from polyester, surface‐modified polyester, or polypropylene fibers. Human platelet concentrates were filtered through experimental filters consisting of 8 to 54 layers of nonwoven fleece with mean pore sizes from 7.3 to 14.2 microns. Filters made of fleece of smaller pore size removed WBCs less effectively than filters with larger‐pore fleece. Retention of lymphocytes and granulocytes gradually dropped to 0 percent as increasing loads were applied to the filters. The maximal retention capacity for these cell types (i.e., the number of cells retained when “saturating” numbers of WBCs were applied) was proportional to the number of layers of filter material used. Platelet retention did not correlate with WBC retention. Depth filtration, rather than mechanical sieving, seems to be the principal means of WBC removal by nonwoven fiber filters. A low initial number of WBCs in the component to be filtered is important for successful WBC filtration.
Collection and transfusion of blood and blood components in the United States, 1989
Authors: Wallace E. L. , Surgenor D. M. , Hao H. S. , An J. , Chapman R. H. , Churchill W. H.
Published: March 2003

To probe recent trends in transfusion practice and their effect on the adequacy of the national blood resource, transfusions and collections in the United States in 1989 were studied, by using data shared by the American Association of Blood Banks, the American Red Cross, and the Council of Community Blood Centers, together with results from a sample survey of the 3600 hospitals that were not members of the national organizations. Statistical methods were used to estimate national activities. The total US supply of blood in 1989 was 14,229,000 units, an increase of 1.2 percent over the supply in 1987. Red cell transfusions were 12,059,000 units. A total of 3,159,000 patients underwent transfusion with whole blood and/or red cells (mean, 3.8 units/patient). Preoperative autologous deposits of 655,000 units by 310,000 patients represented an increase of 65 percent over the level in 1987. However, only 356,000 units (54%) were transfused to the patients who preoperatively deposited them; of the remainder, 13,000 units were crossed over for transfusion to other patients, while 286,000 units were never used. Directed donations, 350,000 units, were provided for 130,000 intended recipients, but only 97,000 units (28%) were transfused to their intended recipients; of the balance, 59,000 units (17%) were crossed over and 194,000 units (55%) were never transfused. Total platelet transfusions were equivalent to 7,258,000 units in 1989, for an increase of 13.7 percent over totals in 1987.
Transfusion‐associated transmission of human T‐lymphotropic virus types I and II: experience of a regional blood center
Authors: Herr V , Ambruso D , Fairfax M , Neumann A , Swanson P , Lee H
Published: March 2003

During a 22‐month period, 78,000 blood donors were screened for human T‐ lymphotropic virus types I and II (HTLV‐I/II) at Belle Bonfils Memorial Blood Center (Denver, Colorado). Positive donors and the living recipients of their previously donated blood components were evaluated for risk factors and symptoms related to HTLV‐I infection, were screened by enzyme immunoassay, confirmed by Western blot for HTLV‐ I/II, and subsequently tested by polymerase chain reaction and peptide enzyme immunoassay to distinguish between HTLV‐I and ‐II infection. Six seropositive blood donors (0.008%) were identified; four were typed as having HTLV‐I infection and two as having HTLV‐II. Of 18 living recipients of components from seropositive donors, none had risk factors for HTLV‐I infection prior to transfusion and none had signs or symptoms of HTLV‐I infection at follow‐up. The mean time from transfusion to testing was 6.4 years. Seven recipients of HTLV‐I‐ infected components were HTLV seropositive; all were typed as having HTLV‐I. A possible case of posttransfusion HTLV‐I‐associated myelopathy was identified in one patient who died before complete evaluation. One possible case of transfusion‐associated HTLV‐II was identified. These data further support the continued screening of blood donors for HTLV‐ I/II.
Strategies for the avoidance of bacterial contamination of blood components
Authors: Barrett B.B. , Andersen J.W. , Anderson K.C.
Published: March 2003

Gram staining and bacterial culturing methods were used to determine the incidence of bacterial contamination of cellular blood components at the time of transfusion reactions. Over a 5‐year period, 2208 (4.3%) of 51,278 transfusions were complicated by reactions. Overall bacterial contamination occurred in 5 (0.03%) of 17,928 transfusions of single‐ donor apheresis platelets, 1 (0.14%) of 712 transfusions of pooled random‐donor platelet concentrates, 1 (0.003%) of 31,385 transfusions of red cells, and 0 of 1253 transfusions of fresh‐frozen plasma. Gram staining done at the time of positive cultures was positive in three of six cases. Although six of seven recipients of contaminated components suffered no clinical sequelae, contaminated transfusions may have been a contributing cause of death in one case. Attempts were made to avoid the transfusion of contaminated cellular blood components by performing routine bacterial cultures: 0 of 341 quality control cultures were positive. To avoid the transfusion of contaminated platelets by identifying bacteria, Gram staining was performed in all single‐donor apheresis platelet units collected on open systems and daily in platelets stored > 48 hours: 8 (0.15%) of 5334 smears done on 3829 platelet units were interpreted as positive, and those units were not transfused, but only two of eight units were culture positive. These studies suggest that bacterial contamination can result in adverse clinical sequelae in transfusion recipients and that both culturing and Gram staining are poor methods of screening for contaminated units. More sensitive and specific methods of generalized screening for bacterial contamination are needed.
Pure red cell aplasia following ABO‐incompatible bone marrow transplantation: response to erythropoietin
Authors: Paltiel O. , Cournoyer D. , Rybka W.
Published: March 2003

Allogeneic bone marrow transplants with major ABO incompatibility may be associated with delayed erythroid engraftment. A case of a male patient with erythroleukemia (blood group O) who received a bone marrow transplant from an HLA‐identical sibling (blood group AB) is reported. The bone marrow transplantation was followed by normal myeloid and megakaryocytic engraftment, but pure red cell aplasia was present for more than 230 days after bone marrow transplant. Despite documentation of an elevated endogenous erythropoietin level (360 mU/mL; normal value, < 19 mU/mL) during the period of absent erythropoiesis, erythroid engraftment was observed soon after the initiation of human recombinant erythropoietin at a dose of 50 U per kg daily. This experience suggests that high‐dose erythropoietin may stimulate sufficient production of erythroid precursors to overcome circulating inhibitors resulting in the correction of pure red cell aplasia.
Demographic characteristics and prevalence of serologic markers among donors who use the confidential unit exclusion process: the Retrovirus Epidemiology Donor Study
Authors: KORELITZ J.J. , WILLIAMS A.E. , BUSCH M.P. , ZUCK T.F. , OWNBY H.E. , MATIJAS L.J. , WRIGHT D.J.
Published: March 2003

BACKGROUND: Most blood centers utilize a confidential unit exclusion (CUE) process, intended to reduce the risk of transfusion‐associated infectious diseases by allowing high‐risk donors confidentially to exclude their blood from use for transfusion. The effectiveness of this method remains controversial. STUDY DESIGN AND METHODS: Confirmatory or supplemental test results for antibodies to human immunodeficiency virus, human T‐lymphotropic virus type I, and hepatitis C virus, as well as hepatitis B surface antigen and syphilis and screening test results for antibodies to hepatitis B core (antigen) and alanine aminotransferase levels were obtained for approximately 1.8 million units donated during 1991 and 1992 at five blood centers within the United States. The prevalences of these infectious disease markers in units that the donors confidentially excluded (CUE+) and units that the donors did not exclude (CUE‐) were calculated and examined within demographic subgroups. RESULTS: Units that were CUE+ were 8 to 41 times more likely to be seropositive for antibodies to human immunodeficiency virus and hepatitis C virus, hepatitis B surface antigen, and syphilis and three to four times more likely to react for antibody to hepatitis B core (antigen) or to have elevated alanine aminotransferase levels than units that were CUE‐ (p < 0.001). The positive predictive value of CUE (the percentage of CUE+ units that were confirmed seropositive for any marker) was 3.5 percent, and the sensitivity of CUE (the percentage of confirmed‐seropositive units that were CUE+) was 2.3 percent. CONCLUSION: The current CUE process has low sensitivity and apparently low positive predictive value, and in many cases, it appeared that donors misunderstood it. Yet, CUE was not a “random process,” as CUE+ units were more likely to be seropositive for any infectious disease marker than CUE‐ units. This suggests that efforts to improve the CUE system may be warranted. As risk factors for transfusion‐transmitted infection become more difficult to identify by history‐based screening, however, such efforts may have limited effect.
Transfusions to group O subjects of 2 units of red cells enzymatically converted from group B to group O
Authors: Lenny L.L. , Hurst R. , Goldstein J. , Galbraith R.A.
Published: March 2003

Background: It has previously been shown that full‐unit (200 mL) transfusions of red cells (RBCs) enzymatically converted from group B to group O by treatment with α‐galactosidase (ECO RBCs) are both safe and efficacious for normal group O or A subjects.

Study Design and Methods: The present study describes the results of a comprehensive clinical and serologic assessment of 2‐unit (400 mL) ECO RBC transfusions to each of four normal group O subjects (after each had donated 1 unit of whole blood).

Results: Clinical (hematologic tests, chemistry analysis, urinalysis) and serologic analyses revealed no evidence of immediate or delayed transfusion reaction, despite a threefold to fivefold elevation in pre‐existing anti‐B antiglobulin titer. 51Cr‐labeled ECO RBCs were administered to one of the four subjects to allow direct measurement of ECO RBC survival in the circulation, which indicated that it was normal (24‐hour survival, 95%; t½, 29.5 days). The observed increases in hemoglobin (by 1.3 ± 0.4 g/dL [13 ± 4 g/L]) and hematocrit (by 3.2 ± 0.8% [0.032 ± 0.008]) in transfused subjects provide further evidence of the efficacy of these cells in vivo.

Conclusion: These results extend those observed in our earlier 1‐unit transfusion studies and suggest that ECO RBCs pose little risk and will be useful in transfusion medicine.
Differential sensitivities of viruses in red cell suspensions to methylene blue photosensitization
Authors: Wagner S.J. , Robinette D. , Storry J. , Chen X.Y. , Shumaker J. , Benade L.
Published: March 2003

Background: Previous studies explored the feasibility of using the photosensitizer methylene blue (MB) as a virucidal agent in red cell suspensions. Under treatment conditions (5 μM [5 μmol/L] MB, 3.4 × 10(4) J/m2) that resulted in more than 6 log10 inactivation of vesicular stomatitis virus (VSV) or of the enveloped bacteriophage φ6, red cell membrane alterations were observed. Increased red cell ion permeability and the binding of plasma proteins to the red cell surface were the most sensitive indicators, which varied in a dose‐dependent fashion.

Study Design and Methods: Inactivation of three additional extracellular viruses and intracellular human immunodeficiency virus type 1 (HIV‐1) was assessed after MB phototreatment of red cell suspensions. Potassium leakage and IgG binding also were characterized in MB‐treated red cell suspensions that were exposed to low‐fluence light (6 × 103 J/m2).

Results: Different viruses exhibit a wide range of sensitivities to MB photoinactivation. For example, phototreatment conditions (5 μM [5 μmol/L] MB, 3.4 × 104 J/m2) that inactivated more than 6 log10 of VSV did not inactivate the nonenveloped picornavirus, encephalomyocarditis virus. In contrast, lower fluences (6 × 103 J/m2) inactivated approximately 5 log10 or more of Sindbis virus and approximately 4log10 of extracellular HIV‐1. These less stringent phototreatment conditions (5 μM [5 μmol/L] 6 × 103 J/m2) caused lower rates of red cell potassium leakage (reduction by 6‐ fold) and little or no binding of plasma proteins to the red cell surface, compared to values observed previously with higher fluences. However, neither 6 × 103 nor 4.1 × 104 J per m2 fluences resulted in any inactivation of intracellular HIV as represented by changes in the amount of p24 antigen produced during co‐culture of actively infected H9 cells.

Conclusion: MB‐based protocols would require the use of high‐efficiency (> 6log10) white cell‐reduction filters or additional inactivation steps to deplete or inactivate intracellular virus.
The effect of methylene blue phototreatment on plasma proteins and in vitro coagulation capability of single‐donor fresh‐frozen plasma
Authors: ZEILER T. , RIESS H. , WITTMANN G. , HINTZ G. , ZIMMERMANN R. , MÜLLER C. , HEUFT H.G. , HUHN D.
Published: March 2003

BACKGROUND: Photodynamic virus inactivation of fresh‐frozen plasma (FFP) may result in its impaired coagulation capability.

STUDY DESIGN AND METHODS: Double‐volume plasmapheresis samples from 11 donors were divided in pairs of 250 mL. One group underwent methylene blue (MB) phototreatment (MB‐FFP). The other group was treated according to the standards of the American Association of Blood Banks for preparation and storage of FFP. Parameters of hemostasis and clinically important plasma proteins were tested in native plasma, thawed MB‐FFP, thawed FFP, and twice‐frozen and thawed FFP (FFP‐II).

RESULTS: Mean activities of factor V (73.4 vs. 94.5%; p < 0.01), factor VIII (58.1 vs. 86.7%; p < 0.001), and fibrinogen (1.8 vs. 2.8 g/L; p < 0.001) were reduced in MB‐FFP as compared to those in FFP. The comparison of MB‐FFP to FFP‐II revealed reduced activities of factor VIII (58.1 vs. 85.2%; p < 0.001) and fibrinogen (1.8 vs. 2.8 g/L; p < 0.001) but no changes in factor V. Activated partial thromboplastin time in MB‐FFP was prolonged beyond the upper normal range (+5.3 sec; p < 0.001) and prothrombin time increased in MB‐FFP versus FFP (+0.96 sec; p < 0.001). CONCLUSION: MB phototreatment reduces the in vitro coagulation capacity of FFP, most likely as a result of the effects of an additional freezing and thawing procedure and photooxidation‐induced protein damage.
Retrograde transmission of Proteus mirabilis during platelet transfusion and the use of arbitrarily primed polymerase chain reaction for bacteria typing in suspected cases of transfusion transmission of infection
Authors: Engstrand M. , Engstrand L. , Hogman C.F. , Hambraeus A. , Branth S.
Published: March 2003

BACKGROUND: When bacteria are found, after a platelet transfusion, in the recipient's blood as well as in the platelet concentrate (PC), a causal relationship is normally suspected, with the PC as the causative agent. The other alternative, that the patient has bacteremia and contaminated the PC, is less well documented in the literature. CASE REPORT: Arbitrarily primed polymerase chain reaction (AP‐PCR) was used for testing strains of Proteus mirabilis isolated from a patient's blood before and after a platelet transfusion and from the PC. Because of a febrile reaction after a platelet transfusion, bacterial culture was performed on the PC used, showing growth of P. mirabilis. The same species was found in the patient's blood after the transfusion. Posttransfusion sepsis caused by a contaminated PC was suspected, and anti‐sepsis treatment was given to the recipient. Later, it became apparent that the patient had had bacteremia before the transfusion and that P. mirabilis was one of the species in the isolate. With AP‐PCR, the identity of the three P. mirabilis isolates could be distinguished.

CONCLUSION: AP‐PCR is a useful technique for distinguishing the identity of bacterial isolates from patients and blood components. A patient with bacteremia can contaminate a PC in conjunction with a platelet transfusion. With AP‐PCR, the PC could be ruled out as the cause of the posttransfusion sepsis.
Low incidence of red cell and HLA antibody formation by bone marrow transplant patients
Authors: Abou‐Elella A.A. , Camarillo T.A. , Allen M.B. , Barclay S. , Pierce J.A. , Holland H.K. , Wingard J.R. , Bray R.A. , Rodey G.E. , Hillyer C.D.
Published: March 2003

BACKGROUND: Bone marrow transplant (BMT) patients, although immunosuppressed, are at risk for the development of red cell (RBC) and HLA antibodies, and they often are given filtered blood in an effort to prevent the latter complication. This study attempts to determine the rate of formation and the specificity of both RBC and HLA alloantibodies in this patient population.

STUDY DESIGN AND METHODS: BMT patients (148 received autologous marrow; 45 received allogeneic marrow) from an 18‐month period, including patients with leukemia (57 patients), lymphoma (54), breast cancer (68), myeloma (8), myelodysplastic syndrome (5), and aplastic anemia (1), were studied to determine the rate of alloantibody formation to RBC and HLA antigens. A total of 2,410 RBC antibody screens were performed. The patients received 3,921 packed RBCs and 5,915 single‐donor platelet units; all were irradiated and administered via white cell‐reduction filters.

RESULTS: Seven (3.6%) of 193 patients had RBC antibodies upon hospital admission. Four (2.1%) of 193 developed RBC antibodies during the course of BMT: 3 patients had one RBC antibody and 1 patient had two RBC antibodies. RBC antibodies included anti‐E (n = 2), anti‐M (n = 1), anti‐Jkb (n = 1), and anti‐Lu14 (n = 1). Thus, 98 percent of patients (189/193) did not develop new (182/186) or additional (7/7) RBC antibodies during BMT. BMT patients were also screened weekly for HLA antibody formation (60‐cell panel). Upon admission, 170 (85%) patients were negative. Of these, 8 (4.7%) developed persistent HLA antibodies (mean panel‐reactive antibody score, 33 +/− 29%) and 9 (5.3%) were variably positive. Thus, in our setting and population, RBC antibody formation was 0.1 percent per unit transfused, and the HLA alloimmunization rate was 5 to 10 percent.

CONCLUSION: As RBC antibody screens are done every Monday, Wednesday, and Friday on this BMT service and as RBC antibody formation is low in these patients, screening for unexpected antibodies might be possible on a more infrequent basis. Also, the rate of HLA alloimmunization in this population receiving filtered blood components is low.
Mislabeling of elutriation medium: a demonstration of the need to improve the quality control of reagents produced for cell processing
Authors: Stroncek D.F. , Fautsch S. , Burger S. , Wagner J.E. , McCullough J.
Published: March 2003

BACKGROUND: The processing of hematopoietic cells to remove red cells, T‐lymphocytes, or malignant cells has become common. However, few of the reagents used are produced specifically for marrow processing and approved by the Food and Drug Administration. CASE REPORTS: A labeling error is reported in a commercially manufactured, research‐grade reagent used in an elutriation procedure to deplete T cells from mononuclear cells obtained from bone marrow for allogeneic transplantation. The elutriation medium used in the procedure had been labeled as containing 0.9‐percent sodium chloride, 0.1‐percent dextrose, and 0.3 mM EDTA, but it actually contained 3.0 mM EDTA. When this medium was not available from the manufacturer, it was prepared in this hospital, according to the stated formulation, with 0.3 mM EDTA. When marrows from two unrelated donors were processed with this 0.3 mM EDTA‐containing medium, cell loss due to aggregation occurred, and, in one recipient, the marrow did not engraft. After the error in the medium composition was discovered, marrow was collected a second time from the same donor. The marrow was processed with medium containing 3.0 mM EDTA, and no cell aggregation was observed.

CONCLUSION: Food and Drug Administration‐approved reagents, prepared specifically for use in cell processing and produced according to good manufacturing practices, should be used whenever possible.
Donor screening for antibody to hepatitis B core antigen and hepatitis B virus infection in transfusion recipients
Authors: Mosley James W. , Stevens Cladd E. , Aach Richard A. , Hollinger F. Blaine , Mimms Larry T. , Solomon Larry R. , Barbosa Luiz H. , Nemo George J.
Published: March 2003

BACKGROUND: Testing for antibody to hepatitis B core antigen (anti‐HBc) as a surrogate for hepatitis C viremia is no longer needed for blood donor screening. Currently, the important question is how much its use supplements hepatitis B surface antigen (HBsAg) donor screening in preventing transfusion‐transmitted hepatitis B virus (HBV) infection. STUDY DESIGN AND METHODS: In a study conducted in the 1970s, 64 blood donors were associated with 15 cases of HBV (1.0%) in 1533 transfusion recipients. Sera from 61 donors at donation and 29 follow‐up visits were available for present‐day assays for HBsAg, HBV DNA, anti‐HBc, and antibody to HBsAg (anti‐HBs). RESULTS: HBsAg was found in four previously negative blood donors; HBV DNA was limited to three of these four. Anti‐HBc was detected in six HBsAg‐negative donors. Two other donors were negative in all assays at donation, but positive for anti‐ HBc and anti‐HBs 2 to 4 months later. The remaining donors were negative for all HBV markers, which left five recipient cases unexplained. No HBV transmission was observed when anti‐HBs sample‐to‐ negative control values were > or = 10. CONCLUSION: Some 33 to 50 percent of cases of hepatitis B that could be transmitted by transfusion of blood from HBsAg‐negative donors are prevented by anti‐ HBc screening. Anti‐HBc‐positive donors unequivocally positive for anti‐ HBs should be considered noninfectious for HBV and should be allowed to donate. Anti‐HBc screening of paid plasmapheresis donors, supplemented by anti‐HBs testing, would reduce the amount of HBV to be processed by virus inactivation and increase the content of anti‐HBs in plasma pools.
Evaluation of a new citrate‐acetate‐NaCl platelet additive solution for the storage of white cell‐reduced platelet concentrates obtained from half‐strength CPD pooled buffy coats
Authors: van Rhenen Dick J. , Vermeij Hans , Kappers‐Klunne Mies , Payrat Jean‐Marc
Published: March 2003

BACKGROUND: A new citrate‐acetate‐NaCl platelet additive solution, identified as PAS 2, was developed to prepare platelet concentrates (PCs) from pooled 0.5 CPD buffy coats (BCs). STUDY DESIGN AND METHODS: A study was undertaken to evaluate PAS 2 in vitro (n = 8) and in vivo (n = 9) against a commercially available solution (Plasma‐Lyte A). In a paired in vitro study, a comparison was made of platelet and white cell concentration; blood gases and bicarbonate; glucose and lactate concentration; total intracellular concentration of adenine nucleotides and beta‐thromboglobulin release. RESULTS: A lower platelet yield (p < 0.0001) and a higher beta‐thromboglobulin release (p < 0.01) are observed with Plasma‐Lyte A. For this reason, half‐strength (0.5) CPD was changed to full‐strength CPD in the clinical study with Plasma‐Lyte A. In a clinical evaluation of nine patients with bone marrow failure, all received PCs with both PAS 2 and Plasma‐Lyte A that had a shelf life of at least 4 days. Corrected count increments (CCls) were as follows, on average (95% Cl): the CCl at 1 to 4 hours was 22.4 (95% Cl, 15.2‐29.4) for PAS 2 and 24.0 (95% Cl, 16.9‐31.2) for Plasma‐Lyte A; that at 12 to 24 hours was 11.3 (95% Cl, 4.1‐18.4) for PAS 2 and 14.2 (95% Cl, 7.1‐21.3) for Plasma‐Lyte A; and that at 36 to 48 hours was 4.2 (95% Cl, ‐3.0‐11.3) for PAS 2 and 8.7 (95% Cl, 1.1‐16.2) for Plasma‐ Lyte A. No significant difference between the two solutions was found. CONCLUSIONS: PAS 2 and Plasma‐Lyte A make important contributions to platelet transfusion quality improvement and give an excellent CCl even after 4 days of storage.
Effect of filtration of platelet concentrates on the accumulation of cytokines and platelet release factors during storage
Authors: Aye M. T. , Palmer D. S. , Giulivi A. , Hashemi S.
Published: March 2003

BACKGROUND: Platelet transfusions are frequently accompanied by febrile nonhemolytic transfusion reactions. These may be due, in part, to the release of cytokines interleukin 1 beta (IL‐1 beta), interleukin 6 (IL‐ 6), interleukin 8 (IL‐8), and tumor necrosis factor alpha (TNF‐alpha) by white cells (WBCs) into the plasma during storage of platelet concentrates (PCs). Acting as endogenous pyrogens, these agents may induce inflammatory responses. STUDY DESIGN AND METHODS: This study proposed to determine if WBC reduction in PCs by filtration significantly reduced the levels of cytokines normally generated during storage of unfiltered PCs up to 5 days. Serotonin, platelet‐derived growth factor (PDGF‐AB), and von Willebrand factor levels were also assessed to establish whether or not filtration or storage elicited significant platelet activation and granule release. RESULTS: Filtration significantly reduced total WBC counts by 99.1 percent before storage (p < 0.001) without affecting total platelet counts. Compared to unfiltered PCs, filtration prevented a rise in the levels of each cytokine by Day 3 for IL‐1 beta (27.7 vs. 0.6 pg/mL; p < 0.05), IL‐6 (114.2 vs. 0.4 pg/mL; p < 0.001), and IL‐8 (4.2 vs. 0.02 ng/mL; p < 0.001). By Day 5, further increases in the levels of all cytokines were noted in unfiltered PCs, but Day 0 levels remained in filtered PCs (IL‐1 beta: 105.4 vs. 0.4 pg/mL, p < 0.001; TNF‐alpha: 42.2 vs. 7.5 pg/mL, p < 0.025; IL‐6: 268.8 vs. 0.4 pg/mL, p < 0.001; and IL‐8: 7.6 vs. 0.02 ng/mL, p < 0.001). From Day 0 to Day 5, there were significant increases in serotonin (21.3 vs. 6.3 ng/mL, p < 0.05), PDGF‐AB (72.6 vs. 25.8 ng/mL, p < 0.001), and von Willebrand factor (4.7 vs. 2.7 IU/mL, p < 0.05) in unfiltered PCs, with similar increased levels being observed in filtered PCs during storage. CONCLUSION: These data indicate that the accumulation of high levels of cytokines in stored PCs could be prevented by WBC‐reduction filtration of PCs without the induction of significant platelet activation or granule release. As cytokines have the potential to induce febrile nonhemolytic transfusion reactions in patients, the transfusion of WBC‐reduced PCs would be expected to reduce the frequency and severity of such reactions.
Changes in peripheral blood CD5 (Bla) B‐cell populations and autoantibodies following blood transfusion
Authors: Paglieroni T. G. , Ward J. , Holland P. V.
Published: March 2003

BACKGROUND: CD5 B cells and the natural autoantibodies they produce play a role in antigen presentation, tolerance induction, and maintenance of an idiotypic immune network. The effects of transfusion on autoantibodies and peripheral blood CD5 B cells were studied. STUDY DESIGN AND METHODS: Eight previously transfused patients with sickle cell anemia and five patients who underwent orthopedic surgical procedures with transfusion were enrolled in the study. Patients in both groups received 1 to 2 units of allogeneic packed red cells. Ten untransfused healthy adults and five patients who underwent orthopedic surgery without transfusion were enrolled as controls. Peripheral blood CD5 B cells, serum levels of IgM, antinuclear antibodies, rheumatoid factor, and anticardiolipin IgM were quantitated either at the beginning of the study (baseline sample), before transfusion, or before surgery and either at 1‐, 2‐, 4‐, 6‐, and 8‐week intervals after transfusion, after surgery, or after the baseline sample was obtained. RESULTS: IgM levels and the absolute number of B cells that coexpressed CD5 rose to twice pretransfusion levels in six of eight transfused sickle cell anemia patients and in four of five transfused orthopedic surgery patients. No comparable increases in CD5 B cells were noted in untransfused controls. Preexisting rheumatoid factor and antinuclear antibody levels increased in four of five transfused orthopedic surgery patients. One sickle cell anemia patient developed anti‐Fya despite receiving Fya‐negative blood. Increasing titers of anti‐Fya paralleled the increases in IgM and CD5 B cells after transfusion. One patient who developed a positive direct antiglobulin test after transfusion had large increases in serum anticardiolipin IgM. Anticardiolipin IgM was subsequently eluted from direct antiglobulin test‐positive red cells obtained after transfusion. Antibodies with anti‐Fya‐like activity and anticardiolipin IgM were produced in vitro by CD5 B cells and not by conventional CD5‐negative B cells. CONCLUSION: An association was found between transfusion‐induced increases in CD5 B cells and increased autoantibody production. These data may have implications for immunologic intervention to prevent the induction of red cell antibodies and other changes in the immune system caused by exposure to foreign antigens via blood transfusion.
The platelet‐specific alloantigen PlA1 (HPA‐1a): a comparison of flow cytometric immunophenotyping and genotyping using polymerase chain reaction and restriction fragment length polymorphism in a Swedish blood donor population
Authors: Forsberg B. , Jacobsson S. , Stockelberg D. , Kutti J. , Rydberg L. , Wadenvik H.
Published: March 2003

BACKGROUND: There is an increasing interest in the development of rapid and reliable techniques for platelet alloantigen typing. STUDY DESIGN AND METHODS: By use of standardized flow cytometry and a specific human alloantiserum, 236 Swedish blood donors were immunophenotyped for the platelet‐specific alloantigen, PlA1 (HPA‐1a). RESULTS: Ten individuals (4.2%) had low fluorescence intensities and were considered PlA1‐ negative (HPA‐1a‐negative); all of them also demonstrated a PlA2/PlA2 (HPA‐1b/1b) genotype in a polymerase chain reaction and restriction fragment length polymorphism (PCR‐RFLP) assay of the underlying DNA polymorphism. The remaining population had clear positive fluorescence and was regarded as PlA1‐positive (HPA‐1a‐positive). The fluorescence distribution histogram among PlA1‐positive (HPA‐1a‐positive) individuals was dome‐shaped, and those individuals who were homozygous for PlA1 (HPA‐1a) could not be distinguished from those who were heterozygous. This finding was further substantiated by PCR‐RFLP analysis of the PlA1/PlA2 (HPA‐1a/1b) genotype; a heterozygous genotype was found among those having a medium fluorescence intensity as well as among those having a strong fluorescence intensity. CONCLUSION: Flow cytometry is a valuable tool for large‐scale detection of PlA1 (HPA‐ 1a). However, flow cytometry based on only one antiserum cannot distinguish between homozygous and heterozygous carriers of PlA1 (HPA‐ 1a). For zygosity testing and when platelets are difficult to obtain, the PCR‐RFLP technique is the assay of choice.
The effect of solvent/detergent‐treated plasma on red cells stored in vitro
Authors: Geiger Terrence L. , Pisciotto Patricia T. , Baril Laurene L. , Snyder Edward L.
Published: March 2003

BACKGROUND: The potential use of solvent/detergent‐treated plasma (S/D plasma) in transfusion practice raises concerns about the cytolytic effects that any residual solvent and detergent in the virally inactivated blood component might have on units of red cells in vitro, if the two components are mixed during preparation. STUDY DESIGN AND METHODS: S/D plasma was mixed with variously processed units of stored red cells, in vitro, to evaluate the effect the residual solvent and detergent would have on cell membrane integrity. A paired protocol design was used in which half‐units of red cells were exposed to S/D plasma (test), and the matched half‐units were exposed to either the supernatant additive solution from the original red cell unit or standard fresh‐frozen plasma (FFP) (control). After incubation for up to 5 days, the units were evaluated for evidence of hemolysis or changes in other red cell storage assays. RESULTS: This study showed that, for fresh additive solution red cells (AS‐1), the 5‐day storage plasma hemoglobin levels were comparable in the red cells exposed to S/D plasma (21 mg/dL) and in the paired half‐units stored in the original AS‐1 supernatant (31 mg/dL) (p > 0.05). Similar findings were recorded for stored AS‐1 red cells (S/D plasma; 111 mg/dL vs. AS‐1 supernatant, 147 mg/dL; p > 0.05); stored CPDA‐1 red cells (S/D plasma, 133 mg/dL vs. FFP, 103 mg/dL; p > 0.05); frozen red cells (S/D plasma, 28 mg/dL vs. FFP, 18 mg/dL; p > 0.017); and stored irradiated AS‐1 red cells (S/D plasma, 608 mg/dL vs. AS‐1 supernatant, 726 mg/dL; p > 0.05). Comparable results were found for other assays, including levels of plasma potassium, osmotic fragility, and red cell antigen titer. CONCLUSION: These data show that S/D plasma does not induce red cell lysis even after 5 days of in vitro storage. These results are consistent with previous findings by this laboratory that platelets are not harmed by storage in S/D plasma. Red cells resuspended in S/D plasma and stored for up to 5 days maintain in vitro storage characteristics that are acceptable for the use of the cells in clinical transfusion practice.
The Canadian Hemophilia Registry as the basis for a national system for monitoring the use of factor concentrates
Authors: Walker I. R. , Pai M. K. , Akabutu J. J. , Ritchie D. Bruce , Growe G. H. , Poon M.‐C. , Card R. T. , Ali S. Kaiser , Israels S. , Teitel J. M. , Garvey B. , Blanchette V. , Giles A. , Lillicrap D. , Drouin J. , Luke B. , Gill K. , Herst J. , Lépine‐Martin M. , Inwood M. , Rivard G. , Strawczynski H. , Jobin F. , Demers C. , Jardine L. , Whitman L. , Ingram L. , Robinson S. , Rubin S. , Scully M.‐F. , Dolan S. , Ross E.
Published: March 2003

BACKGROUND: Canada's publicly funded blood system has recently introduced high‐purity concentrates as the standard treatment for individuals with hemophilia. The added cost and the need to document patient outcomes have prompted the consideration of a national blood product monitoring system.

STUDY DESIGN AND METHODS: This study investigates the suitability of the Canadian Hemophilia Registry (CHR) as the basis of such a monitoring system by assessing the degree to which it represents users of factor concentrates.

RESULTS: Currently, there are 1978 individuals registered with the CHR, of whom 1594 (81%) have hemophilia A and 384 (19%) have hemophilia B. The total prevalence is 7.2 per 10(5) population, with the prevalence of severe cases being 2.3 per 10(5). This overall prevalence is similar to that seen in other countries with national registries. The CHR national prevalence also compares favorably with that in the province of Quebec, where registration of users of blood products is compulsory. The CHR figures indicate that the number of persons currently infected with human immunodeficiency virus, both alive and dead, is 652, which is similar to the number of applicants (658) to the federal government's assistance program. The registry is stable, and the number of persons with severe cases, other than young children, newly registered or lost to follow‐up during the last 2 years is very small.

CONCLUSION: The CHR includes the vast majority of factor concentrate users and is therefore ideal as the basis for a national monitoring system.
Platelet refractoriness and alloimmunization in pediatric oncology and bone marrow transplant patients
Authors: Hogge D.E. , McConnell M. , Jacobson C. , Sutherland H.J. , Benny W.B. , Massing B.G.
Published: March 2003

BACKGROUND: The purposes of this study were to determine the overall incidence of platelet refractoriness and alloimmunization among multiply transfused children on a medical oncology and bone marrow transplant service and to evaluate the effect of routine white cell reduction in blood components on that incidence.

STUDY DESIGN AND METHODS: The platelet transfusion records of 128 consecutive children admitted to the hospital and requiring blood component support for the treatment of disease were evaluated retrospectively. Mean corrected count increments (CCIs) for each patient were calculated for all random‐ donor platelet transfusions given within 7 days of the routine weekly testings of the patient's serum for lymphocytotoxic antibodies (LCTAbs). Mean CCIs for HLA‐matched platelet transfusions were calculated separately for the patients receiving them.

RESULTS: Thirty‐ one patients (24%) had or developed persistently positive LCTAbs (patient's serum reacted with > or = 3/10 panel lymphocytes); 22 (71%) of these patients had a mean CCI < 7.5 to random‐donor platelet transfusions. In contrast, of the 97 patients with negative or transiently positive LCTAbs, only 25 (26%) had a mean CCI < 7.5. The overall incidence of platelet refractoriness (CCI < 7.5) was 37 percent. Patients with acute myelogenous leukemia had a significantly (p < 0.01) reduced incidence (17%) of low CCIs, with or without positive LCTAbs, as compared to patients with other malignant or nonmalignant disorders (41%). No difference in the incidence of LCTAbs or low CCIs was seen in patients undergoing allogeneic or autologous bone marrow transplant or receiving drug therapy only. Among the 24 patients who received HLA‐matched platelets, only those with positive LCTAbs showed a significant improvement in CCIs over that achieved with random‐donor platelet transfusions. Routine white cell reduction in red cell and platelet components with third‐generation white cell filters was performed prior to transfusion in 73 of the patients. There was no significant difference between the incidence of LCTAbs and/or low CCIs in this group and that in the 55 children receiving unfiltered transfusions.

CONCLUSION: Alloimmunization and platelet refractoriness occur in pediatric oncology and bone marrow transplant patients, but the incidence‐particularly in children with acute myelogenous leukemia‐ ‐appears to be low. The detection of LCTAbs predicts a poor response to random‐donor platelet transfusion, but most such patients show improved CCIs with HLA‐matched platelets. Routine use of white cell‐reduction filters has thus far failed to eliminate alloimmunization in children requiring prolonged blood component support.
Red cell surface cysteine residue (285) of D polypeptide is not essential for D antigenicity
Authors: Suyama K. , Lunn R. , Goldstein J.
Published: March 2003

BACKGROUND: Only one surface cysteine residue (285) has been thought to be involved in D antigenicity, according to studies using lyophilized or nonlyophilized red cell membranes. However, it has been reported that a 17‐kDa chymotryptic fragment containing the N‐terminus but not this cysteine residue is associated with D antigenicity.

STUDY DESIGN AND METHODS: The role of the sulfhydryl (SH) group in D, c, and E antigenicity is assessed by using intact red cells treated with the reagents N‐ethylmaleimide, 5,5′‐dithiobis(2‐nitrobenzoic acid), and 2‐ (4′‐maleimidylanilino)‐ naphthalene‐6‐sulfonic acid. Antigenicity was appraised by hemagglutination titers and immunoprecipitation using human anti‐D, ‐c, and ‐E.

RESULTS: Treatment with N‐ethylmaleimide or 5,5′‐dithiobis(2‐nitrobenzoic acid) at various concentrations (< or = 5 mM) or for various times (< or = 120 min) did not cause significant decrease in hemagglutination titers as compared to untreated intact red cells. Moreover, immunoprecipitation of Rh antigen‐carrying peptides by human anti‐D was not affected by prior treatment with N‐ethylmaleimide or 2‐(4′maleimidylanilino)‐naphthalene‐6‐sulfonic acid. Efficacy of blockage of SH groups was demonstrated by inhibition of palmitic acid uptake by the Rh polypeptides for prior treatment with N‐ethylmaleimide and by the presence of fluorescent Rh polypeptides for prior treatment with 2‐(4′maleimidylanilino)‐naphthalene‐6‐sulfonic acid.

CONCLUSION: SH group involvement is not essential for D, c, or E antigenic expression in intact red cells.
Prevention of transfusion‐associated Chagas' disease: efficacy of white cell‐reduction filters in removing Trypanosoma cruzi from infected blood
Authors: Moraes‐Souza H. , Bordin J.O. , Bardossy L. , MacPherson D.W. , Blajchman M.A.
Published: March 2003

BACKGROUND: Transfusion‐associated Chagas' disease (TA‐CD) is a worldwide problem. Measures adopted to prevent TA‐CD include the clinical and serologic screening of blood donors and/or the inactivation of Trypanosoma cruzi present in collected blood, using gentian violet as the trypanocidal agent. This study investigated the efficacy of white cell‐reduction filters in removing T. cruzi from infected blood.

STUDY DESIGN AND METHODS: Human blood was contaminated with 2 or 150 T. cruzi parasites per mL and then left unfiltered or filtered with white cell‐reduction filters that provided either 2, 3, or 6 log10 white cell removal. The efficacy of the parasite removal of these filters was evaluated by microscopic enumeration of active forms of T. cruzi both in vivo and in vitro. The in vivo experiments were done in Swiss mice that had been intraperitoneally inoculated with T. cruzi‐infected human blood. The in vitro experiments were performed with fresh human blood that had been deliberately contaminated with T. cruzi.

RESULTS: The number of parasites seen in mice inoculated with unfiltered blood containing 2 or 150 parasites per mL was significantly higher than the number of parasites seen in mice inoculated with blood from the same sample, but filtered with white cell‐reduction filters providing 3 or 6 log10 white cell removal. Fifty to 70 percent of the mice given T. cruzi‐infected (2 parasites/mL) filtered blood did not develop T. cruzi infection. In vitro, the use of white cell‐reduction filters, providing 2, 3, or 6 log10 white cell removal, significantly reduced the number of parasites seen in culture.

CONCLUSION: The present experimental data provide evidence that white cell‐reduction filters are effective in reducing the number of parasites in T. cruzi‐ infected blood and that this efficacy depends, in part, on the concentration of parasites in the artificially infected blood. Properly designed clinical studies of known carriers of T. cruzi must be conducted to determine whether the use of white cell‐reduction filters may be an alternative method of reducing the incidence of TA‐CD.