bluuebunny/crossref_metadata_2025 huggingface dataset:
Testing of maternal sera in pregnancies at risk for neonatal alloimmune thrombocytopenia
Authors: McFarland J. G. , Frenzke M. , Aster R. H.
Published: March 2003

The utility of prenatal testing of maternal serum for platelet‐reactive antibody was assessed in 25 women at risk of delivering infants with neonatal alloimmune thrombocytopenia (NAT). Seventeen women were incompatible with their husbands for the PIA1 antigen and three for Baka; in five families, no demonstrable platelet‐specific antigen incompatibility was found. Analysis of the clinical outcome demonstrated that women with platelet‐specific antibody detectable in any of the assays at any time during gestation were at risk of delivering thrombocytopenic infants (neonatal platelet count 31,250/μl if mother did have antibody, as compared with 138,750/μl if she did not; p < 0.005). When only PIA1‐incompatible pregnancies were examined, this association remained significant (mean neonatal platelet count in infants exposed to anti‐PIA1, 34,285/μl; that in infants not so exposed, 243,000/μl; p < 0.001). Changes in antibody strength throughout pregnancy did not correlate with the severity of NAT. The combination of the antigen‐capture enzyme‐linked immunosorbent assay and the indirect immunofluorescence test appeared to be most sensitive in detecting relevant platelet‐specific alloantibodies. It is concluded that the detection of platelet‐specific alloantibody in maternal serum in pregnancies at risk for NAT predicts moderate to severe NAT. However, the failure to detect such antibody does not always predict a normal neonatal platelet count.
Survival of Borrelia burgdorferi in blood products
Authors: Badon S. J. , Fister R. D. , Cable R. G.
Published: March 2003

The incidence of Lyme disease is rapidly increasing in the United States. To assess the potential of transmission of the disease through blood transfusion, we studied the survival of Borrelia burgdorferi in blood products under blood bank storage conditions. Two units of whole blood, separated into red cells (RBCs), fresh‐frozen plasma (FFP), and platelet concentrates (PCs), were inoculated with B. burgdorferi (strain B31) in concentrations of approximately 3000 organisms per mL of RBCs and FFP and 200 organisms per mL of PCs. Products were then stored under blood banking conditions and sampled at several storage times. The viability of the spirochete in blood components was determined by darkfield microscopic examination of cultures in modified Kelly's medium. The organism was shown to survive in RBCs (4° C) and FFP (below ‐18° C) for 45 days and in PCs (20–24° C) for 6 days. The results of this study do not exclude the possibility of transmission of Lyme disease through blood transfusion.
Phosphoenolpyruvate in the rejuvenation of stored red cells in SAGM medium: optimal conditions and the indirect effect of methemoglobin formation
Authors: Matsuyama H. , Niklasson F. , de Verdier C. H. , Högman C. F.
Published: March 2003

Red cells stored in saline‐adenine‐glucose‐mannitol (SAGM) medium were rejuvenated by incubation with phosphoenolpyruvate (PEP) under conditions that can be achieved easily in ordinary blood banking. Regeneration of 2,3 diphosphoglycerate (2,3 DPG) and adenine nucleotides of stored red cells was dependent on the pH of the incubation medium and the incubation time. In red cells stored for 3 and 5 weeks, the optimal pH and incubation time for regeneration of 2,3 DPG and adenine nucleotides were 5.8 and 90 minutes and 6.1 and 60 minutes, respectively. During the incubation of red cells with PEP, methemoglobin was formed; it increased when the medium pH was below 6.0 and the incubation time exceeded 60 minutes. We conclude that incubation at a medium pH of 6.1 for 60 minutes is optimal for the rejuvenation of stored red cells with PEP. Under such incubation conditions, the concentrations of 2,3 DPG and adenine nucleotides in red cells stored for 5 weeks were restored to normal without methemoglobin formation. TRANSFUSION 1989;29:614–619.
Major histocompatibility complex markers and red cell antibodies to the Rh (D) antigen. Absence of association
Authors: Kruskall Margot S. , Yunis Edmond J. , Watson Ada , Awdeh Zuheir , Alper Chester A.
Published: March 2003

Between 20 and 35 percent of Rh(D) antigen‐negative individuals do not develop antibodies to D even after multiple transfusions of Rh‐positive red cells. To evaluate the possibility that antibody production after exposure to the D antigen was related to a major histocompatibility complex immune response gene, analysis of the HLA genotypes of 38 Rh‐ sensitized women and their families was performed. No significant deviations were found in the frequency of any individual HLA class I, II, or III allele or of any extended haplotype (fixed allelic combinations of HLA‐B, HLA‐DR, and the complement components BF, C2, C4A, and C4B). Type 1 errors due to the extreme allelic polymorphism of the HLA system, as well as the ethnic variation in patient groups, may have contributed to HLA allele‐antibody responder relationships reported in earlier studies.
The polymerase chain reaction in transfusion medicine
Authors: Jackson J. Brooks
Published: March 2003

PCR is a sensitive and powerful diagnostic and research tool. Its diagnostic applications in infectious disease, genetics, and cancer will play a prominent role in transfusion medicine in the next several years. However, the indirect effect of PCR on transfusion medicine in terms of increasing our understanding of disease mechanisms and the development of therapeutic agents will be even greater.
Accelerated erythropoiesis: the hidden benefit of autologous donation
Authors: Levine E. , Rosen A. , Sehgal L. , Gould S. , Sehgal H. , Moss G.
Published: March 2003

The risks associated with the administration of blood products have increased efforts to avoid homologous transfusions. Preoperative autologous donation has received renewed interest as a method of decreasing homologous transfusion requirements. Autologous donations may also stimulate postoperative erythropoiesis. The purpose of this study is to evaluate the effect of an aggressive autologous donation program on postoperative erythropoiesis. Ten adult male baboons were divided into two groups. The autologous group (n = 5) donated an average of 2 units of blood per week for 5 weeks before operation. The control group (n = 5) had no preoperative treatment. All animals then underwent a laparotomy and exchange transfusion with hetastarch to a final hematocrit of 15 percent. The time required to recover to hematocrits of 20 percent (3.3 vs. 5.7 days, p<0.01), 25 percent (7.0 vs. 8.8 days, p <0.05), and 30 percent (11.1 vs. 17.7 days, p<0.01) was shorter in the autologous group. The autologous group had more intense reticulocytosis during the first 4 postoperative days (p <0.03). The data show that participation in an aggressive autologous donation program improves the erythropoietic response to anemia in the postoperative setting. This represents a hidden benefit of preoperative autologous donations and suggests that more aggressive donation schedules may be clinically beneficial. Recognition of the acceleration of erythropoiesis by autologous donation could further reduce the need for transfusion of homologous blood.
Surgeons' knowledge, attitude, and use of preoperative autologous blood donation
Authors: Strauss R.G. , Ferguson K.J. , Stone G.G. , McVay P.A. , Black D. , Stehling L. , Toy P.T.C.Y. , Daniels M. , Randels J. , Sears R. , Skettino S. , Esposito B. , Andrews A.
Published: March 2003

Before a comprehensive educational program on preoperative autologous blood donation was begun, 118 surgeons from three different areas of the country were tested to assess their baseline knowledge and attitude about this practice. Test results were correlated with the percentage of eligible patients that the surgeons actually referred for preoperative donation during a period of observation. The purpose of this preliminary effort was to identify areas in the educational program that required emphasis. Overall, the surgeons' attitude toward preoperative donation was quite favorable, but their depth of knowledge varied. Misunderstandings may have led to diminished use of this service (eg, about 50% didn't realize that many patients with medical conditions or low hematocrits are permitted to donate). However, it is not clear that simply bolstering surgeons' knowledge will increase their appropriate use of preoperative donation. When all 118 surgeons were studied, their knowledge and attitude were unrelated to the percentage of eligible patients referred. However, when 44 surgeons who managed the largest number of eligible patients were analyzed separately, their use of preoperative donation was directly correlated with their knowledge and attitude. The local awareness of AIDS also significantly influenced the use of this service. It is proposed that knowledge of preoperative donation may be important for inducing surgeons to begin referring patients for this service. Once a pattern of successful participation is established, referral seems to increase with the acquisition of working knowledge.
Characterization of a pyridoxalated hemoglobin‐polyoxyethylene conjugate as a physiologic oxygen carrier
Authors: Yabuki A. , Yamaji K. , Ohki H. , Iwashita Y.
Published: March 2003

A pyridoxalated hemoglobin‐polyoxyethylene conjugate (PHP) is an oxygen carrier prepared from outdated human red cells through chemical modifications of hemoglobin (Hb). PHP was evaluated as a physiologic oxygen carrier. PHP was synthesized from a pyridoxalated hemoglobin (PLP‐Hb) and an activated diester of polyoxyethylene (POE). The average numbers of molecules of PLP and POE conjugated to a Hb molecule were 3.3 and 6.2, respectively. The p50 of PHP was 20.4 torr, which was much higher than the 14.0 torr of stroma‐free Hb. At a Hb concentration of 6 g per dL, PHP had a physiologic colloid osmotic pressure (29 torr) and a lower viscosity (2.6 cP at 37°C) than whole blood (4.2 cP at 37°C). At temperatures below 20°C, the p50 of PHP was higher than that of the red cells. PHP, which had an average molecular weight of 90,000, consisted of 83 percent monomeric PLP‐Hb‐POE conjugate, 12 percent dimeric PLP‐Hb‐POE, and 4 percent trimeric PLP‐Hb‐POE. The consistency of the relative contents of the components was well controlled through seven lots, and each component had sufficient oxygen‐carrying capacity. The dimeric and trimeric components contributed to the prolongation of the residence of PHP in the circulation. The results indicate that PHP has favorable properties as an oxygen‐carrying blood substitute and perfusate.
Incubation of platelet concentrates before transfusion does not improve posttransfusion recovery
Authors: Hussein M. A. , Schiffer C. A. , Lee E. J.
Published: March 2003

Incubation of stored platelet concentrates (PCs) at 37 degrees C for 1 hour has been reported to result in a better morphology score and improved platelet recovery. A study was conducted in adult patients with leukemia to determine whether incubation of stored PCs results in an improved platelet recovery as measured by 10‐minute posttransfusion corrected count increments (CCI). Eligible patients had platelet counts of less than 30,000 per microL and were clinically stable. Patients were transfused with 6 to 10 units of PC stored for 3 days (15 studies) or 4 days (5 studies). Platelets were pooled and then split in two equal volumes so that each patient received two sequential half‐ transfusions, one incubated at 37 degrees C for 1 hour and the other kept at 22 degrees C for 1 hour. Patients were randomized as to which half‐transfusion was received first. The mean CCI of the incubated half‐ transfusions was 13.6 × 10(3) when they were given first and 14.5 × 10(3) when given second; this was not significantly different from the mean CCI of the nonincubated half‐transfusions: 13.8 × 10(3) when they were given first and 13.8 × 10(3) when given second. In contrast to earlier reports, it can be concluded that incubation of pooled PCs does not improve platelet recovery.
Human T‐cell lymphotropic virus in volunteer blood donors
Authors: Taylor Patricia E. , Stevens C.E. , Pindyck J. , Schrode J. , Steaffens J.W. , Lee H.
Published: March 2003

Serum samples collected in 1985 and 1986 from 18,257 donors to the Greater New York Blood Program were screened by enzyme‐linked immunoassay for antibody to human T‐cell lymphotropic virus (anti‐ HTLV). Fifteen samples (0.08%) were confirmed positive: 7 by radioimmunoprecipitation assay (RIPA) alone, 6 by Western blot alone, and 2 by combined results from both tests. One donor, whose original test result was uninterpretable because multiple nonspecific bands were present on RIPA, clearly tested positive on subsequent specimens. Follow‐up testing of individuals with this type of result may be needed to resolve their HTLV status. Anti‐HTLV prevalence increased with age and was significantly more common in black or Hispanic donors and in those born in the Caribbean than in other donors. All anti‐HTLV‐ positive donors were negative for antibody to HIV‐1, and only one donor (7% of those positive) would have been excluded by any of the routine donor screening tests used at that time.
Effect of an 8‐hour holding period on in vivo and in vitro properties of red cells and factor VIII content of plasma after collection in a red cell additive system
Authors: Moroff Gary , Holme S. , Heaton W.A.L. , Kevy S. , Jacobson M. , Popovsky M.
Published: March 2003

Extension of the holding time for whole blood units from 6 to 8 hours at ambient temperature should provide enhanced flexibility in the preparation of platelet concentrates (PCs). A paired study was conducted to evaluate the characteristics of stored red cells (RBCs) and plasma prepared from whole blood collected into a red cell additive system (CPD‐ADSOL) after an extended holding time. An individual donated a unit of whole blood on two occasions; 1 unit was held for 6 hours before processing and the other for 8 hours. Autologous RBC 24‐ hour survival levels after 42 days of storage were comparable. Laboratory A, using a 99mTc‐51Cr technique, found mean survival levels of 79 percent (6‐hour hold) and 78 percent (8‐hour hold) (n = 8). Analysis by the single‐label procedure found the mean levels to be 82 and 81 percent. Laboratory B, using an albumin 125I‐51Cr technique, found mean survival levels of 74 and 72 percent (n = 10). Mean hemolysis and ATP levels were found to be comparable after 42 days of storage following 6‐ and 8‐hour holding periods. 2,3 DPG levels were reduced to a greater degree during the longer hold. The factor VIII levels in plasma frozen for at least a month after 6‐ and 8‐hour holding periods were comparable; thawed plasma contained mean levels of 0.77 and 0.76 units per mL (n = 21). These studies indicate that components prepared by using a CPD‐ADSOL system after holding periods of 6 and 8 hours have comparable properties.
Hemolytic disease of the newborn caused by anti‐Rh32 and demonstration that Rn encodes rhi (Ce, Rh7)
Authors: Issitt P. D. , Gutgsell N. S. , Martin P. A. , Forguson J. R.
Published: March 2003

A family is described in which the mother made anti‐Rh32 as a result of pregnancy; her second liveborn child had hemolytic disease of the newborn and required an exchange transfusion. In investigating the family, it was found that the father's Rn gene did not make rhi and that his second Rn gene made normal amounts of c and e but a reduced amount of f. In the two children of the couple, who inherited a normal r or Ro from their mother, the paternally derived RN encoded an amount of rhi that could be detected in direct typing tests. In the father, lack of production of rhi by RN may have represented a suppressive effect of the ce(f) gene in trans to Rn or the presence of an unlinked suppressor of Rh that might also have been responsible for the reduced production of f by his r or Ro gene. The two children in this family are the first persons in whom RN has been shown to make rhi.
Prevalence of antibody to hepatitis C virus in a blood donor population
Authors: Richards C. , Holland P. , Kuramoto K. , Douville C. , Randell R.
Published: March 2003

Blood samples from 2000 accepted blood donors and 343 deferred donors with antibody to hepatitis B core antigen (anti‐HBc) and/or an alanine aminotransferase (ALT) elevation were evaluated for antibody to hepatitis C virus (anti‐HCV). Sixteen (0.8%) of the 2000 sera initially reacted on enzyme‐linked immunosorbent assay (ELISA); 12 (0.6%) were repeatably reactive. One repeatably reactive sample had an elevated ALT; two reacted on anti‐HBc testing and had ALT elevations. When the repeatably reactive ELISA samples were tested by an immunoblot assay, four reacted, three were indeterminate, and five did not react. Among the 343 deferred donors, HCV antibodies were detected in 8 (3.8%) of 210 anti‐HBc‐reactive samples, 12 (11.8%) of 104 elevated‐ALT samples, and 15 (52%) of 29 combined elevated‐ALT and anti‐HBc‐reactive samples; 25 of 28 reacted on immunoblot. The anti‐HBc‐reactive sera were subdivided into groups according to strength of anti‐HBc reactivity (weak or strong) and antibody to hepatitis B surface antigen status and then were compared for anti‐HCV reactivity rates. The group of samples showing the greatest frequency of anti‐HCV had strong anti‐HBc reactivity. For blood donors, the anti‐HCV test correlates with the surrogate tests for non‐A, non‐B hepatitis (anti‐HBc and ALT); however, most anti‐HCV‐reactive units remain undetected by surrogate tests, so that implementation of anti‐HCV screening should further reduce the transmission of HCV via transfusion.
Adverse reactions in patients transfused with cryopreserved marrow
Authors: Stroncek DF , Fautsch SK , Lasky LC , Hurd DD , Ramsay NK , McCullough J
Published: March 2003

Marrow is cryopreserved for use in autologous bone marrow transplants, but little is known of the incidence of reactions in patients transfused with these cryopreserved marrows. Reactions in patients transfused during a 4‐year period with 134 autologous marrows cryopreserved in dimethyl sulfoxide (DMSO) were compared with those in patients transfused with marrow that had been collected from HLA‐ compatible donors and that had not been cryopreserved. Patients transfused with cryopreserved marrow had significantly more nausea (44.8 vs. 14.1%; p less than 0.0005), vomiting (23.9 vs. 8.5%; p less than 0.01), chills (31.3 vs. 1.4%; p less than 0.0005), and fever (17.9 vs. 0%; p less than 0.005) than patients transfused with fresh allogeneic marrow. The incidence of emesis correlated with the dose of DMSO received, but that of nausea did not. All cryopreserved marrows were cultured for bacteria at the time of transfusion and 17 (12.7%) were found to be positive. Only 1 of the 17 patients transfused with culture‐positive marrow developed sepsis during the transplant course with the same organism that was present in the transfused marrow. Although the reactions in donors transfused with cryopreserved marrow were readily treated, this study suggests that the incidence of some reactions might be decreased by reducing the dose of DMSO transfused. Bacterial contamination of transfused marrow was a worrisome complication, and efforts should be made to improve marrow collection and processing techniques to minimize that risk.
Evaluation of a new polyacrolein microsphere (acrobead) protein A column: an in vitro study using the blood of patients with immune thrombocytopenia or malignancies
Authors: Dvilansky A. , Aharon M. , Riesenfeld G. , Nathan I.
Published: March 2003

The present study describes the use of a new polyacrolein microsphere (acrobead) protein A column. This method enables immunomodulation by the perfusion of whole blood. The efficacy of the column and its adverse effects following perfusion of blood of patients with immune thrombocytopenic purpura (ITP) or malignancies were investigated. Concurrent experiments in which blood was perfused through an acrobead lactoglobulin column were carried out. Cellular blood components were mildly affected during the procedure. A moderate decrease in platelet number, to a nadir of 90 × 10(3) per microL (90 × 10(9)/L), was documented. During the hemoperfusion of ITP patients' blood, plasma hemoglobin reached levels of 25 to 40 mg per dL, a level similar to that found in banked blood during storage. Plasma tumor necrosis factor level, which serves as an indicator of monocytic activation, increased after 90 minutes of hemoperfusion. IgG and immune complexes were removed. The specific activities (removal of mg Ig/mL bead) of acrobead protein A columns, using blood from patients with ITP or malignancies, were 4.9 and 4.5 mg IgG per mL of bead, respectively. The diminution of platelet‐specific IgG in the plasma of patients with ITP was documented as well. There was no activation of the fibrinolytic system as examined by D‐dimers. The use of this new technique, which incorporates the method of direct hemoperfusion, is suggested for future clinical studies.
Anti‐hepatitis C virus (HCV) screening at a Canadian Red Cross center: significance of a positive c100 HCV enzyme‐linked immunosorbent assay
Authors: GIULIVI A. , AYE M.T. , GRAY E. , Scam V. , GILL P. , CHENG G.
Published: March 2003

The c100 hepatitis C virus (HCV) enzyme‐linked immunosorbent assay (ELISA) has been used to screen blood donors to prevent transfusion‐ associated non‐A, non‐B hepatitis. This test is not specific, and only about 25 percent of c100 HCV ELISA‐positive blood samples appear to transmit hepatitis C. However, the intensity of the ELISA (sample/cutoff ratio [S/C], greater than 2) could identify a subpopulation of donors that are at high risk for transmitting hepatitis. Blood samples from 20,186 volunteer blood donors at a Canadian Red Cross blood transfusion center were screened for antibodies to HCV using the c100 HCV ELISA. Fifty‐nine (0.3%) of these donors were repeatably reactive on ELISA. When their samples were tested with the c100 recombinant immunoblot assay (RIBA) and second‐ generation RIBA (RIBA‐2), 26 (44%) and 31 (52%) samples, respectively, were found to be positive. Thirty‐three of the 59 ELISA‐reactive donors had an S/C greater than 2. Of these 33 donors, 30 (91%) had elevated alanine aminotransferase (ALT), 27 (82%) were RIBA‐2 positive, and 22 (67%) had risk factors for hepatitis. In contrast, of the 26 ELISA‐ reactive donors with S/C less than 2, only 7 (27%) had elevated ALT, and 4 (15%) were RIBA‐2 positive and also had high risk factors for hepatitis. Thus, while the HCV ELISA may lack specificity, its intensity can serve to identify a subgroup of donors that are at high risk for transmitting hepatitis.
Failure to detect human cytomegalovirus DNA in peripheral blood leukocytes of healthy blood donors by the polymerase chain reaction
Authors: Bitsch A. , Kirchner H. , Dupke R. , Bein G.
Published: March 2003

The transmission of cytomegalovirus (CMV) by blood transfusion may have a major effect on certain immunocompromised patients. To protect susceptible blood recipients from infection, it is advisable to use blood components from CMV‐seronegative donors. However, serologic tests are not capable of indicating which blood component actually harbors infectious virus and can transfer it to the recipient. Therefore, a sensitive method is needed for the detection of the virus itself. There have been three reports on the detection of CMV in healthy volunteer blood donors by the polymerase chain reaction (PCR). CMV DNA was found in all seropositive and most seronegative blood donors. However, many other authors have failed to confirm these data. A highly sensitive and specific PCR assay was developed for the detection of CMV DNA in peripheral blood leukocytes. With this protocol, blood samples from 116 volunteer blood donors were investigated. None of these samples proved to be positive for CMV DNA. In contrast, CMV DNA was detected in 10 of 10 renal transplant patients early in the course of active CMV infection. It can be concluded that the CMV genome copy number in the peripheral blood leukocytes of healthy individuals is beyond the detection limit of current PCR technology.
The binding of human alloantibodies to recombinant glycophorin A
Authors: Blackall D.P. , Ugorski M. , Smith M.E. , Pahlsson P. , Spitalnik S.L.
Published: March 2003

Chinese hamster ovary (CHO) cells were transfected with the wild‐type, M allele of glycophorin A cDNA. The binding of human alloantibodies to recombinant glycophorin A was assessed with a modified hemagglutination‐ inhibition assay. Patient sera were incubated with acetone powders derived from CHO cells, and the adsorbed supernatants were tested in standard hemagglutination assays. Five M antibodies and one sample containing anti‐En(a) bound to transfected CHO cells expressing glycophorin A but did not bind to untransfected CHO cells. Three N antibodies as well as 21 other alloantibodies (representing other major red cell blood group specificities) bound to neither CHO cell line. The M allele specificity of recombinant glycophorin A was further verified by the demonstration that a high‐titer D alloantibody maintained the same titer of agglutination after incubation with recombinant glycophorin A. Transfected CHO cells thus express an M blood group antigen that appears to be serologically equivalent to that found on human red cells. A panel of cell lines expressing mutant glycophorin A molecules with defined variations in amino acid sequence and carbohydrate composition will be useful in studies of the fine specificity of human glycophorin alloantibodies. This approach may also provide an abundant source of artificial antigens for clinical use in blood group serology.
Identifying elective orthopedic surgical patients transfused with amounts of blood in excess of need: the transfusion trigger revisited
Authors: Goodnough L.T. , Verbrugge D. , Vizmeg K. , Riddell J.
Published: March 2003

The discharge hematocrit has been analyzed as a clinical indicator of the transfusion trigger by which to identify patients undergoing elective orthopedic surgery who were transfused with blood in excess of need. The volume of red cells lost by each patient during surgical hospitalization was compared to the volume of red cells transfused. Three clinical indicator levels were considered. Red cell losses of 10, 20, and 30 percent of each patient's baseline red cell volume at admission were considered to be appropriate before subsequent blood transfusion replacement, representing generous, intermediate, or strict clinical indicator levels, respectively. With Level I as a generous clinical indicator, 110 (25%) of 525 patients were transfused in excess of blood needs; by Level II (intermediate) and Level III (strict) criteria, 221 (42%) and 314 (60%) of 525 patients, respectively, were transfused in excess of blood needs. Significant differences were found for transfused patients analyzed by gender (26% of women vs. 13% of men; Level I, p less than 0.001) and preoperative autologous blood donation (25% of autologous blood donors vs. 11% of those who did not donate autologous blood; Level I, p less than 0.001). It can be concluded that the discharge hematocrit and amount of blood lost during hospitalization can be used as clinical indicators with which to identify patients receiving transfusions in excess of needs in the elective surgical setting. With this method, it was found that the transfusion trigger is different for women and for men as well as for autologous blood donors and those who did not donate autologous blood undergoing elective orthopedic surgery.
Diagnosis of transfusion‐associated graft‐versus‐host disease by genetic fingerprinting and polymerase chain reaction
Authors: KUNSTMANN E. , BOCKER T. , ROEWER L. , SAUER H. , MEMPEL W. , EPPLEN J.T.
Published: March 2003

A patient with Hodgkin's disease (clinical stage IIIB) received chemotherapy and total nodal irradiation. After the transfusion of filtered packed red cells, this patient developed transfusion‐ associated graft‐versus‐host disease (TA‐GVHD). The genetic fingerprint of the patient's peripheral blood lymphocytes (PBLs) differed completely from that of her other body tissues. Normally, after transfusion, only the patient's own genetic fingerprints are observed in the PBLs, as exemplified in more than 10 control cases in which the transfused blood had not been filtered before transfusion. No signal bands corresponding to those of the blood donor could be demonstrated in samples of the patient's tissue DNA. Moreover, chimerism was detected in the hybridization pattern of the patient's PBLs on the ninth day after the onset of symptoms. Polymorphic simple repeats in the HLA‐DRB gene after amplification by polymerase chain reaction were also investigated, which confirmed the fingerprinting results. The advantages of these methods for the diagnosis of TA‐GVHD include the rapid and unequivocal diagnosis as well as the fact that there is no need for the relatives to be HLA typed.
Expression of the Tn antigen in myelodysplasia, lymphoma, and leukemia
Authors: ROXBY D.J. , PFEIFFER M.B. , MORLEY A.A. , KIRKLAND M.A.
Published: March 2003

Expression of the normally cryptic blood group antigen Tn has occasionally been reported in hematologic disease, but the true frequency of this change is not known. A mouse monoclonal antibody (FBT3) and immunohistochemistry were used to examine expression of the Tn antigen. Expression was not detected in 35 normal bone marrow aspirates examined, but it was detected in 5 of 725 abnormal bone marrow aspirates, including 2 (3.6%) of 55 cases of de novo acute nonlymphocytic leukemia and 2 cases that terminated in acute nonlymphocytic leukemia. In two patients, one with acute myeloblastic leukemia and the other in blast transformation of chronic myeloid leukemia, the Tn antigen was expressed on 2 percent of blast cells. In one case of non‐Hodgkin's lymphoma, 4 percent of normal myeloid cells expressed the antigen. In the other two cases, one of acute myelomonocytic leukemia and the other of myelodysplasia, only 2 to 8 percent of myeloid and erythroid cells initially were Tn positive. Subsequent serial immunohistochemical studies of bone marrow aspirates and peripheral blood in these two cases showed increasing numbers of Tn‐ positive erythroid and myeloid cells 8 to 12 months before polyagglutination was detected serologically. Tn‐positive cells increased to > 90 percent in the terminal phase in both cases of both diseases. The results suggest that Tn expression in these two patients may have conferred a growth advantage to the cells and could be related to disease progression.
Human T‐cell lymphotropic virus type I and II DNA amplification in seropositive and seronegative at‐risk individuals
Authors: de Montalembert M. , Wattel E. , Lefrère F. , Mariotti M. , Agis F. , Ferrer‐le‐coeur F. , Girot R. , Lefrère J. J.
Published: March 2003

To determine the presence or the absence of human T‐lymphotropic virus type I and/or II (HTLV‐I/II) DNA in at‐risk individuals who were persistently negative for specific serologic assays, polymerase chain reaction with two primer pairs in common and conserved regions of HTLV‐ I and ‐II genomes was used. Seronegative individuals at risk for HTLV‐ I/II infection (15 heterosexual partners of seropositive individuals, 17 breastfed children born to HTLV‐I‐infected mothers, 47 multiply transfused patients, 22 intravenous drug users) were studied (n = 101); 35 seropositive individuals and 25 seronegative low‐risk individuals were used as positive and negative controls, respectively. No positive polymerase chain reaction was observed in the seronegative at‐risk individuals or in the negative controls. Positive controls gave positive results with at least one primer pair in all cases except one. A latent HTLV‐I/II infection with a persistently negative serologic test for HTLV‐I/II seems unlikely.
Plasma exchange does not improve survival in a canine model of human septic shock
Authors: Natanson C. , Hoffman W.D. , Koev L.A. , Dolan D.P. , Banks S.M. , Bacher J. , Danner R.L. , Klein H.G. , Parrillo J.E.
Published: March 2003

Whether plasma exchange would improve survival in antibiotic‐treated canines with septic shock was investigated. Escherichia coli O86H8 (1.4 × 10(10)) was surgically implanted as an intraperitoneal clot in 18 two‐ year‐old (10–12 kg) purpose‐bred beagles. Beginning 4 hours after surgery, all animals received cefoxitin and gentamicin for 5 days. Three treatment groups were defined: 1) a no apheresis, or control group, (n = 6); 2) a sham apheresis group, whose whole blood plasma was removed, separated, and then transfused (n = 6); and 3) a plasma exchange group from whom blood and plasma were removed and separated, to whom the blood was returned, and in whom infected plasma was replaced with compatible fresh‐frozen canine plasma (n = 6). For the sham apheresis and plasma exchange groups, a commercial blood cell processor was used to separate 1.5 blood volumes of plasma at 5 and 24 hours after surgery. Serial radionuclide left ventricular ejection fractions and femoral and pulmonary arterial catheter hemodynamics were measured simultaneously in awake animals. All six animals in the plasma exchange group died. In both the sham and control groups, only one of six animals survived. Survival times were ordered (median in hours) (control [372 h] > sham apheresis [48 h] > plasma exchange [24 h] [p < 0.038]). Decreases in mean cardiac index and mean arterial pressure (from before apheresis to after) at 5 to 7 hours after surgery were ordered (plasma exchange > sham apheresis > control; p < 0.03). Thus, plasma exchange in this controlled trial of septic shock was associated with decreased survival and worsened hemodynamics. When extrapolated to humans, these results suggest that plasma exchange would be unlikely to provide therapeutic benefit and might produce harmful effects in patients with septic shock.
Transfusion‐associated graft‐versus‐host disease: report of an occurrence following the administration of irradiated blood
Authors: Lowenthal R.M. , Challis D.R. , Griffiths A.E. , Chappell R.A. , Goulder P.J.
Published: March 2003

Patients who are heavily immunosuppressed, such as those undergoing intensive anti‐cancer chemotherapy, are at risk for development of accidental engraftment and graft‐versus‐host disease when they undergo transfusion with cellular blood components, a condition known as transfusion‐associated graft‐versus‐host disease (TA‐GVHD). To prevent this complication, it is routine to irradiate such blood components prior to their transfusion, although the minimum irradiation dose required is uncertain. The development of probable TA‐GVHD is reported in a 10‐year‐old child following transfusions of platelets and packed red cells that had been irradiated at a nominal dose of 15 Gy. The transfusions were given during treatment for relapse of acute myeloid leukemia. Although the child developed complications including exfoliative dermatitis, delayed bone marrow regeneration, renal failure requiring dialysis, and respiratory failure requiring assisted respiration, she recovered from the episode of TA‐GVHD after treatment with high‐dose methylprednisolone and antithymocyte globulin. However, her leukemia relapsed, and she died. This experience suggests that the irradiation of cellular blood components at a nominal dose of 15 Gy prior to their transfusion to heavily immunosuppressed patients may be insufficient to prevent TA‐GVHD.
Resolution by erythrocytapheresis of the exposure of an Rh‐negative person to Rh‐positive cells: an alternative treatment
Authors: Werch J. , Todd C.
Published: March 2003

Acute trauma with severe bleeding caused the unavoidable transfusion of Rh‐positive red cells (RBCs) to a young, childless, Rh‐negative woman during surgery. Of the 10 units of RBCs given, 6 were Rh positive. An alternative treatment for large‐volume exposure involves the removal of some of the Rh‐positive cells transfused at a time when the patient's condition could not be jeopardized by the shortage of Rh‐negative RBCs. It is believed that the combination of erythrocytapheresis followed by Rh immune globulin treatment was successful, when immunoprophylaxis alone might not have been. It is strongly recommended that partial RBC exchange for the removal of the unwanted RBCs be considered in addition to Rh immune globulin treatment in cases of large‐volume exposure such as the one presented.
Blood donor‐, apheresis‐, and transfusion‐related activities: results of the 1991 American Association of Blood Banks Institutional Membership Questionnaire
Authors: Devine P. , Linden J.V. , Hoffstadter L.K. , Postoway N. , Hines D.
Published: March 2003

Approximately 2154 regional blood centers and hospital‐based blood banks and transfusion services responded to the 1991 American Association of Blood Banks Institutional Membership Questionnaire that elicited data from 1990. Information from 2144 institutions was considered valid. Questionnaire topics were donor blood collections, hemapheresis, perioperative cell salvage, component usage, and transfusion‐associated diseases. Institutional members reported collecting 9.3 million units, of which 90.9 percent were for allogeneic use in the community, 6.0 percent were for autologous use, and 3.1 percent were directed donations. The percentage of directed‐donor units that were crossed over for allogeneic use (51%) was greater than the percentage of units transfused to the designated patient (49%). Only 12.5 percent of institutions reported obtaining specific consent for transfusion. Of the 15.4 million transfused blood components, 8.5 million were red cells, 4.1 million were platelets, 1.8 million were fresh‐frozen plasma, and 0.9 million were cryoprecipitate. There were 1263 reported cases of transfusion‐associated hepatitis. Approximately 44 percent of the patients who were tested proved positive for hepatitis B surface antigen, and 80 percent of the patients who were tested proved positive for antibody to hepatitis C. The questionnaire's aggregate results can be used to assess current patterns of blood donation and transfusion activities.
Transfusion of blood components to persons infected with human immunodeficiency virus type 1: relationship to opportunistic infection
Authors: Sloand E. , Kumar P. , Klein H.G. , Merritt S. , Sacher R.
Published: March 2003

BACKGROUND: Although a recent study reported shorter survivals in human immunodeficiency virus type 1 (HIV‐1)‐infected patients who received transfusions, no study has analyzed the relationship in such patients between the frequency of opportunistic infection and transfusion. STUDY DESIGN AND METHODS: Records of 196 HIV‐1‐infected subjects with CD4 lymphocyte counts below 250 cells per mm3 were reviewed to determine if there were more opportunistic infections in patients who previously received transfusions than in those who received no transfusions. The decline in CD4 cells was also compared, and the frequency of transfusion reactions and red cell alloantibodies was assessed. RESULTS: The frequency of cytomegalovirus (CMV), wasting, and bacterial infections (p < 0.01), but not the frequency of Pneumocystis carinii pneumonia (PCP) (p > 0.2), was significantly increased in the patients who had previously received transfusions, and this effect was independent of CD4 count, race, or risk factor. The frequency of CMV infection, but not of PCP, was also related to the number of units of blood received (p < 0.01). Significant bacterial infections occurred primarily in persons with CMV infection, of whom there were more in the transfusion cohort. When analyzed separately in the group of patients without CMV infection, the frequency of bacterial infection was unrelated to transfusion. The death rate in those who received transfusions was also greater than that in patients who had never received a transfusion. None of the 130 patients who received red cell transfusions developed red cell alloantibodies. CONCLUSION: The higher incidence of certain infectious complications in HIV‐1‐infected patients who received transfusions indicates that the relationship of transfusion to virus activation in patients with acquired immunodeficiency syndrome and the potential benefits of modifying the preparation of blood components should be investigated further.
Epidemiology of hepatitis C virus: a study of male blood donors in Saudi Arabia
Authors: Abdelaal M. , Rowbottom D. , Zawawi T. , Scott T. , Gilpin C.
Published: March 2003

Background: Few epidemiologic reports on the prevalence of hepatitis C in Saudi blood donors have been published.

Study Design and Methods: Men (of several nationalities) donating blood at the King Khalid National Guard Hospital (Jeddah, Saudi Arabia) were randomly selected (n = 744) for this study examining the prevalence of hepatitis C virus (HCV) in the local donor population, the relationship of antibody to HCV (anti‐HCV) to the surrogate markers alanine aminotransferase (ALT) and antibody to hepatitis B core antigen (anti‐HBc), and the effect of the use of these markers on the discard rate.

Results: The prevalence of anti‐HCV in the group examined was 3.2 percent (24/744), with a significantly high prevalence of 24.5 percent (12/49) in donors who were Egyptian (p < 0.0001). Exclusion of this group would lower the prevalence to 1.7 percent (12/695). Anti‐HCV prevalence peaked in the group aged 30 to 39, and a significant relationship was found between anti‐HCV and ALT level > 65 U/L (p < 0.0001). There was no significant relationship between anti‐HCV and anti‐HBc (p = 0.66). The prevalence of anti‐HCV in the Saudis studied was 1.7 percent (9/528). The prevalence of anti‐HCV in non‐Bedouin Saudis was significantly greater than that in Bedouin Saudis (7/165 [4.2%] vs. 2/363 [0.5%]; p < 0.01). The prevalence of anti‐HBc was found to be 28.7 percent (214/744). The use of elevated ALT (> 90 U/L) and anti‐HBc as surrogate markers would increase the current discard rate (8.3%) by 2.8 and 23.8 percent, respectively.

Conclusion: These findings demonstrate the practical difficulties of using anti‐HBc as a surrogate marker for hepatitis C in areas endemic for hepatitis B virus.
Duration of time from onset of human immunodeficiency virus type 1 infectiousness to development of detectable antibody
Authors: Petersen L.R. , Satten G.A. , Dodd R. , Busch M. , Kleinman S. , Grindon A. , Lenes B. ,   The HIV Seroconversion Study Group
Published: March 2003

Background: For persons newly infected with the human immunodeficiency virus type 1 (HIV‐1), the time from the onset of infectivity to the development of detectable HIV‐1 antibody is unknown. Persons who donate blood during this period account for nearly all instances of HIV‐1 transmission from HIV‐1 antibody‐screened blood transfusions.

Study Design and Methods: To estimate the window period from infectivity to HIV‐1 antibody positivity, 701 HIV‐1‐seropositive blood donors who made a previous seronegative donation at 40 United States blood centers were studied. The HIV‐1 antibody status was determined for at least one recipient of blood from the seronegative donation preceding the seropositive donation made by 182 of the 701 donors.

Results: There were 39 seropositive recipients of blood from these 182 donors. Three donors were excluded from further analysis because the seropositive recipients of their blood had other HIV‐1 risk factors or had HIV‐1 infection before transfusion. The final study population comprised the remaining 179 donors, of whom 36 (20%) transmitted HIV‐1 infection to recipients. When the interval between the seropositive donation and the preceding seronegative donation was less than 180 days, 46 percent of the donors transmitted HIV‐1. In contrast, when that interval exceeded 540 days, only 2 percent transmitted HIV‐1. A mathematical model was developed to explain the relationship between the probability that the previous seronegative donation occurred during the donor's window period of infectiousness, and hence transmitted HIV‐1, as a function of both the window period and the duration between the seropositive and previous seronegative donations. This model indicated that the transmission data were most consistent with an average window period of 45 days. Assuming a log‐normal window period distribution, it was estimated with 95 percent certainty that at least 90 percent of persons had a window period of less than 141 days.

Conclusion: The window period averages 45 days, with few, if any, donors remaining infectious and seronegative for longer than 6 months.
Comparison of a transfusion preparation of newly formed red cells and standard washed red cell transfusions in patients with homozygous β‐ thalassemia
Authors: Collins A.F. , Gonçalves‐Dias C. , Haddad S. , Talbot R. , Herst R. , Tyler B.J. , Zuber E. , Blanchette V.S. , Olivieri N.F.
Published: March 2003

Background: Previous studies of transfusions of newly formed red cells (neocytes) demonstrated modest extensions of transfusion interval in patients with homozygous beta‐thalassemia.

Study Design and Methods: The clinical benefits of a new system of neocyte preparation (Neocel, Cutter Biological, Berkeley, CA), reported to combine ease of preparation with reduction in the transfusion requirements of thalassemia patients, were evaluated. Sixteen thalassemic patients who had undergone splenectomy received eight consecutive, standard, automated, washed red cell transfusions (standard transfusions), followed by eight transfusions with the neocyte preparation (neocyte transfusions). In each arm of the study, mean pretransfusion hemoglobin and mean red cell mass transfused were carefully controlled and were similar.

Results: A significant (p < 0.0001) extension of transfusion interval was observed in patients receiving neocyte transfusions (mean ± SD; 38.7 ± 34 days; range, 35.0–44.5), over that in those receiving standard transfusions (32.9 ± 2.5 days; range, 29.6–38.5). The mean prolongation of transfusion interval by neocyte transfusion corresponded to a mean reduction of 25 mL in packed red cells transfused per kg of body weight per patient per year and a mean reduction in transfused iron of 15 percent per year per patient. During neocyte transfusions, blood preparation costs were considerably increased and donor exposure was significantly (p < 0.0005) higher than during the standard transfusion period.

Conclusion: These data demonstrate that extension of the transfusion interval, and reduction in transfused iron, may be achieved in thalassemic patients by use of the Neocel system. These benefits are achieved, however, with substantial increases in donor exposure and in component preparation costs.
Accuracy of statistical methods in TRANSFUSION: a review of articles from July/August 1992 through June 1993
Authors: KANTER M.H. , TAYLOR J.R.
Published: March 2003

BACKGROUND: Statistical errors have been noted in a large percentage of articles appearing in medical journals. Their incidence in a blood banking journal, however, has not been studied.

STUDY DESIGN AND METHODS: Original articles appearing in the journal TRANSFUSION from July 1992 through June 1993 were analyzed for correctness of statistical methods. Each article was reviewed by both a transfusion medicine physician and a statistician.

RESULTS: There were 122 original articles, of which 59 contained statistical methods and were reviewed. Of these, 23 (39%) contained an error in the statistical description of their data, 47 (80%) failed to describe clearly the statistical tests performed, and 44 (75%) involved an incorrect statistical test or contained an error in test calculation or interpretation. As a result of these errors, 13 (22%) of the 55 articles analyzed reported conclusions not supported by the data. CONCLUSION: Misuse of statistical methodology may not be uncommon in transfusion medicine research, and it would be prudent to give more attention to statistical methodology in such research