bluuebunny/crossref_metadata_2025 huggingface dataset:
Primary Myelodysplasia: Management and Outcome at 3 Years in 45 Patients Age 65 and Older
Authors: Tilly‐Gentric A. , Malo J. P. , Marion V.
Published: March 2003

OBJECTIVES:

To study myelodysplasia in patients age 65 and older.

SETTING:

A French university hospital.

PARTICIPANTS:

Forty‐five patients age 65 and older with a diagnosis of myelodysplasia made in the hospital between January 1993 and December 1998.

MEASUREMENTS:

Clinical presentation, initial hematological features, type of myelodysplasia (French American British classification), treatment, and evolution at 36 months were studied.

RESULTS:

The mean age of the group was 78. Anemia was the initial hematological feature in 30 patients out of 45 and was symptomatic in 24 patients. Refractory anemia was diagnosed in 20 patients; 11 patients presented with refractory anemia with excess blast cells, eight with chronic myelomonocytic leukemia. Thirty‐one patients received erythrocyte transfusions, no patient received chemotherapy. At 36 months, 68.8% of the patients were dead. The median survival (22 months) was lower than in other reported series even in types of myelodysplasia with a classically better prognosis.

CONCLUSION:

Myelodysplasia is probably underdiagnosed in older people and has a poor prognosis (median survival 22 months), and no effective treatment is available in older patients. J Am Geriatr Soc 49:1358–1360, 2001.
Effect of Beta Blockers on Mortality and Morbidity in Persons Treated for Congestive Heart Failure
Authors: Aronow Wilbert S.
Published: March 2003

PURPOSE: To determine the effect of metoprolol controlled release/extended release (CR/XL) administered once daily on mortality in patients with congestive heart failure (CHF) associated with abnormal left ventricular (LV) ejection fraction.

BACKGROUND: CHF with abnormal LV ejection fraction despite treatment with diuretics plus angiotensin‐converting enzyme (ACE) inhibitors plus digoxin has a very high mortality. Previous data suggested that long‐term treatment with beta‐blockers, including metoprolol, could improve survival and improve hemodynamics in patients with CHF and abnormal LV ejection fraction.

METHODS: Three thousand nine hundred and ninety‐one patients aged 40 to 80 years from 313 investigational sites in 13 European countries and in the United States with chronic CHF New York Heart Association (NYHA) functional class II, III, or IV and a LV ejection fraction of 40% or less were stabilized with optimum standard therapy. Of the 3,991 patients, 77% were men, 23% were women; 33% were younger than 60 years of age, 35% were 60 to 69 years of age, 32% were 70 to 80 years of age; 66% had ischemic heart disease; 91% were receiving diuretics, 96% were receiving ACE inhibitors or angiotesin II type 1 receptor antagonists, and 64% were receiving digitalis. Randomization was preceded by a 2‐week single‐blind placebo run‐in period. Following this, 1,990 patients were randomized to metoprolol CR/XL 12.5 mg daily if NYHA functional class III or IV CHF was present (59%) or to 25 mg daily if NYHA functional class II CHF was present (41%), and 2,001 patients were randomized to double‐blind placebo. The target dose was 200 mg once daily of metroprolol CR/XL and doses were up‐titrated over 8 weeks. The primary endpoint was all‐cause mortality analyzed by intention to treat.

MAIN RESULTS: The study was stopped early on the recommendation of the independent safety committee. Mean follow‐up was 1 year. All‐cause mortality occurred in 145 of 1,990 patients (7.2%) treated with metoprolol versus 217 of 2,001 patients (11.0%) treated with double‐blind placebo (P= .0062; relative risk = 0.66, 95% confidence interval = 0.53–0.81). Compared with double‐blind placebo, metoprolol caused a significant reduction in total mortality by 34% (P= .0052), a significant decrease in cardiovascular mortality by 38% (P= .00003), a significant reduction in sudden cardiac death by 41% (P= .0002), and a significant decrease in death from worsening CHF by 49% (P= .0023). Mortality was significantly reduced by metoprolol in patients who were in the upper tertile of age as well as in the middle and lower tertiles of age.

CONCLUSIONS: In patients with chronic CHF NYHA functional class II, III, or IV treated with optimum standard therapy, these data demonstrated that, compared with double‐blind placebo, metoprolol CR/XL 200 mg administered once daily caused significant reductions in all‐cause mortality by 34%, in cardiovascular mortality by 38%, in sudden cardiac death by 41%, and in death from worsening CHF by 49%.
Description of the National Pressure Ulcer Long‐Term Care Study
Authors: Horn Susan D. , Bender Stacy A. , Bergstrom Nancy , Cook Abby S. , Ferguson Maree L. , Rimmasch Holly L. , Sharkey Siobhan S. , Smout Randall J. , Taler George A. , Voss Anne C.
Published: March 2003

OBJECTIVES: To describe and provide baseline data from The National Pressure Ulcer Long‐Term Care Study (NPULS).

DESIGN: Retrospective cohort study of detailed resident characteristics, treatments, and outcomes using convenience sampling.

SETTING: One hundred nine long‐term care facilities throughout the United States.

PARTICIPANTS: Two thousand four hundred twenty adult residents aged 18 and older, with a length of stay of 14 days or longer and who were at risk of developing a pressure ulcer, as defined by a Braden Scale for Predicting Pressure Sore Risk

MEASUREMENTS: More than 500 characteristics were obtained for each resident over a 12‐week period. This paper describes the NPULS database with respect to the resident (sex, age, diagnoses, severity of illness scores, Braden Scale score, activities of daily living, cognitive ability, mobility, bowel or bladder incontinence, laboratory values, nutritional assessment, and pressure ulcer assessment documentation), treatment (nutritional interventions, pressure relieving devices, incontinence interventions, protective devices, turning schedules, and pressure ulcer treatments), and outcome variables (pressure ulcer development and healing, pressure ulcer and systemic infection, changes in nutritional status, and discharge disposition) associated with pressure ulcers. Descriptive statistics and bivariate associations were used for preliminary analyses of resident, treatment, and outcome characteristics.

RESULTS: The average age ± standard deviation was 79.7 ± 14.2; 70% of the residents were female. Fifty‐three percent of residents (n = 1,293) were at risk of developing a pressure ulcer but never developed one during the study (Group 1), 19% developed a new pressure ulcer during the study (n = 457) (Group 2), 22% had an existing pressure ulcer (n = 534) (Group 3), and 6% had an existing pressure ulcer and developed a new ulcer during the study (n = 136) (Group 4). Residents who developed a new pressure ulcer (Group 2) were more likely to be female, older, cognitively impaired, and immobile than residents who had an existing pressure ulcer (Group 3).

CONCLUSIONS: This baseline study describes the NPULS database with respect to the resident, treatment, and outcome variables associated with pressure ulcers. Future studies will focus on multivariate analyses for risk factor prediction of pressure ulcer development and pressure ulcer healing. Research‐based pressure ulcer prevention and treatment protocols can then be developed.
Resistant Pathogens in Respiratory Tract Infections in Older People
Authors: Bonomo Robert A.
Published: March 2003

Bronchitis, bronchiectasis, and pneumonia are the most common respiratory tract infections observed in older people and are the leading causes of morbidity and mortality associated with infection. Accurate diagnosis of respiratory tract infections in older people is problematic because of the lack of clear symptoms and signs that are usually seen in younger patients. In addition, the increasing prevalence of bacterial resistance to antibiotic therapy highlights the importance of appropriate therapy. The following review examines the issues associated with the accurate diagnosis of respiratory tract infections, optimal therapy for older patients, and the mechanisms of emerging bacterial resistance to antibiotic therapy.
Management of Antibiotic‐Resistant Bacteria
Authors: Norman Dean C.
Published: March 2003

Optimizing the management of antibiotic resistance is an important strategy in improving outcomes for infectious diseases in older persons. Strategies that manage antibiotic resistance must take into account all clinical settings, because resistant pathogens previously seen only in acute care facilities are becoming increasingly common in long‐term care facilities. Recently, modest improvement in therapeutic options for the treatment of infections due to resistant pathogens has become available because of the development of newer antibiotics. Some of these drugs are briefly discussed in this review, but the best strategy is to limit the potential for the development of resistance and transmission of these pathogens. This can best be accomplished by minimizing misuse of antibiotics and maximizing adherence to basic hygiene standards.
Epidural Infusion of Opiates and Local Anesthetics for Complex Regional Pain Syndrome
Authors: Moufawad Sami , Malak Osama , Mekhail Nagy A.
Published: March 2003

Abstract: Complex Regional Pain Syndrome Type‐I (CRPS‐I) is a neuropathic pain syndrome resulting from complex pain mechanisms that involve several levels and components of the nervous system. CRPS‐I consists of multiple signs, including autonomic dysfunction, in the form of edema, vasomotor changes, motor dysfunctions, muscle spasms, tremors and dystonia, as well as burning pain, hypersensitivity and allodynia that could present in any combination. The treatment is progressive physical therapy rehabilitation program. Multiple analgesic modalities have been used to facilitate the rehabilitation program with varying rates of success. The most successful treatment is a multi‐disciplinary comprehensive approach, where initial pain control allows for physical and psychological interventions that are believed to be the basis for successful treatment.1 The pain in CRPS‐I may be mediated through the sympathetic nervous system, sympathetic maintained pain (SMP) or sympathetic independent pain (SIP)2.
Positive direct antiglobulin tests at birth without demonstrable maternal antibody
Authors: MARSH W. L. , MAWBY L. J. , MUELLER K. A. , HALL J. W. , COLUCCI J.
Published: March 2003

A healthy 38‐year‐old white woman had two abortions and three live children. Red cells from each of her living children at birth had a strongly positive direct antiglobulin test. Detailed studies on the third child showed that the cells were sensitized by IgG. Maternal serum, tested by a range of techniques against reagent red cells and the husband's cells, showed no unusual antibody. Maternal serum and eluates prepared from red cells of the third child did not react with fresh cells from the older siblings (aged 7 and 10 years). Follow‐up on the third child showed that the direct antiglobulin test was positive at 2 months, weakly positive at 4 months, and negative at 8 months. Red cells collected at 8 months of age did not react with the stored eluate prepared from the baby's sensitized red cells at birth. The most likely explanation of these data is that the children inherited a paternal antigen that is only present as a red cell surface‐active structure during fetal development.
Concentration of platelet units into small volumes
Authors: Simon T.L. , Sierra E.R.
Published: March 2003

To determine the best procedure for concentrating platelets in a smaller volume after storage, we studied platelet loss after concentration at various centrifugation g forces for various times. In vitro studies demonstrated the need to let platelets sit for 1 hour prior to resuspension by gentle kneading. 500 × g gave unacceptable results. Losses were minimal at 1500 × g for 7 minutes, 2000 × g for 10 minutes and 5000 × g for 6 minutes. Reinfusion of 51 Cr‐labeled platelets into normal volunteers after concentration at both 2000 × g for 10 minutes and 5000 × g for 6 minutes showed normal viability. Numbers and viability of platelets stored up to 5 days in 50 ml plasma and then concentrated in 10 ml plasma after centrifugation at 1500 × g for 7 minutes, 2000 × g for 10 minutes or 5000 × g for 6 minutes should be clinically acceptable.
Automated reading of red cell antibody identification tests by a solid phase antiglobulin technique
Authors: Moore H.H.
Published: March 2003

A new solid phase antiglobulin (SPAG) test is described which makes possible the automated reading of erythrocyte antibody identification tests. This new test uses microplates coated with anti‐human globulin as a solid phase onto which previously sensitized erythrocytes adhere. A wash stage removes unsensitized erythrocytes and a chromogenic substrate is reacted with the hemoglobin peroxidase of the adhering, sensitized red cells. The color produced is read automatically on a spectrophotometer interfaced with a computer programmed to produce printouts of results. Comparative tests between conventional anti‐human globulin tests and the SPAG test using titrated antibodies showed equivalent sensitivity. Comparisons of the present test system in use in our laboratory, consisting of saline, 0.5 percent bromelin, and indirect anti‐human globulin techniques for identifying antibodies, with a SPAG test used in conjunction with a bromelin‐enzyme test system, showed agreement in 224 (90%) of the 249 sera tested. This methodology is compared with current enzyme‐linked immunosorbent assay (ELISA) techniques.
Erythrocyte antigens on human platelets. Absence of Rh, Duffy, Kell, Kidd, and Lutheran antigens
Authors: Dunstan R.A. , Simpson M.B. , Rosse W.F.
Published: March 2003

There is considerable controversy as to whether antigens of the Rh, Duffy, Kidd, Kell, or Lutheran red cell systems are present on human platelets. The majority of previous investigators of this topic have reported them to be present. We have used a sensitive two‐stage radioimmunoassay to examine human platelets for the presence of antigens of these five red cell systems. Platelets from donors of appropriate red cell phenotype were incubated with monospecific anti‐ erythrocyte IgG, followed by a second‐stage incubation with 125I‐ labeled mouse IgG monoclonal anti‐human IgG (Fc). Analysis of ligand bound per cell demonstrated no significant difference in binding of erythrocyte antibodies to platelets from donors homozygous, heterozygous, or negative for D, C, c, E, e, Fya, Fyb, Jka, Jkb, K, k, and Lub antigens. These findings indicate that major antigens of the Rh, Duffy, Kidd, Kell, and Lutheran systems are not expressed on the surface of human platelets.
Hydroxyethyl starch serum levels in leukapheresis donors measured by modified periodic acid‐Schiff staining technique
Authors: Trivedi S.M. , Humphrey R.L. , Braine H.G. , Frondoza C.G.
Published: March 2003

Hydroxyethyl starch (HES), a glucopyranose polymer used to enhance the yield of granulocytes during leukapheresis, was detected by periodic acid‐Schiff (PAS) staining of 1‐microliter samples following electrophoresis on thin agarose film. HES migrated with restricted electrophoretic mobility in the far gamma region, and the intensity of staining was found to be concentration dependent. Densitometer scanning showed a linear curve from 30 mg to 600 mg per dl, although bands were identified at concentrations lower than 30 mg per dl. Sera from 46 leukapheresis subjects showed the same restricted bands. HES measured retrospectively in sera obtained on days 1 to 400 following apheresis ranged from 675 to 30 mg per dl. The clearance of HES from the sera of four donors measured serially appeared biphasic with the first T1/2 of 0.4 to 6.4 days and the second T1/2 of 58 to 240 days. HES also was detectable in urine concentrated 100fold for as long as 7 days following leukapheresis. This simplified, and sensitive PAS glycoprotein staining method can be used to detect and follow HES concentrations in serum and may provide a new tool for the study of HES in leukapheresis donors.
Iron supplementation for menstruating female blood donors
Authors: Simon T. l. , Hunt W.C. , Garry P.J.
Published: March 2003

Depletion of body iron stores is a major factor limiting regular blood donations by menstruating females. To determine if regular iron supplementation would solve this problem, we conducted a double‐blind study in which menstruating female donors were randomly placed into one of three groups: one taking 39 mg elemental iron, a second taking 39 mg of iron plus 75 mg vitamin C, and a third taking 100 mg vitamin C daily. The women were requested to donate every 8 weeks for at least 1 year. Blood samples were taken on each donation for measurements of hemoglobin, total iron binding capacity (TIBC), and ferritin. In the two groups taking iron supplements hemoglobin and ferritin increased from baseline values and the TIBC decreased. The vitamin C control group showed decreases from baseline for hemoglobin and ferritin and increases in TIBC. Differences between groups taking iron supplements and the group not taking supplements were highly significant. Drop‐out from the study was due to various causes; however, iron intolerance was uncommon. Minimal daily iron supplementation was beneficial in maintaining body iron stores and hemoglobin levels in menstruating females on a schedule of blood donation as often as every 8 weeks.
The preparation of leukocyte‐poor red cells for transfusion by a simple cost‐effective technique
Authors: Parravicini A. , Rebulla P. , Apuzzo J. , Wenz B. , Sirchia G.
Published: March 2003

A modification of the microaggregate filtration technique for the production of leukocyte‐poor red cell concentrate is described. The modified technique, termed ‘spin, cool, and filter’, removed leukocytes more efficiently from relatively fresh blood than the original microaggregate filtration procedure. The residual leukocyte content of 4‐ to 9‐day‐old units processed by the modified procedure averaged less than 0.4 × 10(9) white cells per unit. The microaggregate filtration technique, supplemented by buffy‐coat exclusion, removed more than 93 percent of the units' white cells. These red cell products were prepared easily and did not elicit febrile reactions in highly susceptible patients.
Test cells for use with anti‐IgG sub‐typing antisera in the antiglobulin test
Authors: Rawlinson V. I. , Stratton F. , Merry A. H.
Published: March 2003

The preparation of test cells coated with specific IgG of known subclass is described. Such cells are required in the standardization of IgG subtyping reagents. At present, these test cells usually are prepared by coating cells with IgG myeloma paraproteins. However, these paraproteins may not be generally available and an alternative method is presented using more readily obtainable materials. Quantification of cell‐bound IgG showed that the subclass did not affect the sensitivity of the antiglobulin test when using broad‐spectrum anti‐IgG and that the test cells produced had an optimal IgG coating. Reactions with subclass‐specific antisera were however, considerably weaker that those obtained with broad‐spectrum anti‐IgG. A modified spin‐layering technique for use with subclass‐specific antisera is described.
Microtest for red cell typing
Authors: Leong Sau Wa , Terasaki Paul I.
Published: March 2003

A simple microtest for red cell (RBC) typing was developed which required 0.002 ml of reagents per test. After mixing RBCs with antibody, the microtray was incubated upside down for 10 to 15 minutes at 37 degrees C, and 10 minutes at room temperature. The trays were read after reinversion and allowing 10 to 15 minutes for the RBCs to settle. Antibodies must be selected that react under these conditions. Two examples each of anti‐A, ‐B, ‐C, ‐D, ‐E, ‐c, ‐M, and ‐N were tested against a panel of 500 individuals. The results were generally concordant with each other and with the conventional tube test results. The procedure is simple to perform and involves minimal costs for reagent antisera.
Extension of platelet concentrate storage by addition of sodium bicarbonate
Authors: Shah G. Ali , Lenferink Josephine C. M.
Published: March 2003

Viability of platelet concentrate (PC) stored in polyvinylchloride bags in an elliptical rotator at 22 degrees C (standard PC) was assessed by in vitro tests, and an alternate approach to extending the shelf‐life of PC by the addition of hypertonic sodium bicarbonate (test PC) was investigated. The fall in the pH which occurred during storage in standard PC was arrested in test PC. Furthermore, platelets stored under these test conditions maintained their morphology better than in standard PC as judged by their mean platelet volume and platelet distribution width. Recovery of stored platelets from hypotonic shock at 37 degrees C following resuspension in fresh plasma was better for test platelets. Results indicated that platelets in standard PC were viable up to day 3 but were not viable at day 7. Platelets store better in PC to which sodium bicarbonate has been added and behave as viable platelets up to 7 days.
Antibodies to granulocytes detected by an indirect immunofluorescence method not requiring chemical modification of cells
Authors: Schmidt‐Melbye Anne , Kolstad Arne , Hannestad Kristian
Published: March 2003

IgG antibodies to neutrophil polymorphonuclear cells (PMNs) were detected by a simple indirect immunofluorescence method that did not require chemical or enzymatic modification of the cells. Based on recent information about the human PMN Fc gamma‐receptor, nonspecific binding of IgG to PMNs was virtually completely prevented by incubating cells at 37 degrees C with human serum diluted 1 to 3 in the presence of a high concentration of rabbit IgG. This also facilitated distinction of sera with weak anti‐PMN activity from normal sera. On the other hand, nonspecific staining remained on a fraction (10‐25%) of mononuclear leukocytes. Following first‐time transfusion of 0.5 to 5 units of whole blood or red cell concentrate, 4 of 27 patients (15%) developed anti‐leukocyte antibodies. Anti‐leukocyte antibodies were detected in 51 percent of 47 patients with reported febrile transfusion reactions; the IgG antibodies bound to PMNs in 38 percent of these 47 patients. Since only about one in three patients with febrile transfusion reactions had detectable IgG anti‐PMN antibodies, fever may be caused by lysis of leukocytes other than PMNs.
rG: Potential pitfall in parentage testing
Authors: Schornack J. L. , Beattie K. M.
Published: March 2003

Extensive studies were done on the family of an infant investigated for possible hemolytic disease of the newborn (HDN). Fourteen members in four generations were shown to carry the rG gene with r, R1 or R2. If testing had not included anti‐CD(G) serum, three false exclusions of paternity and four of maternity might have resulted in this large Caucasian family. The findings also demonstrated that titration of Rh antisera against the red cells of family members could not be relied upon to assess zygosity or dosage.
Destruction of the S antigen by sodium hypochlorite
Authors: Rygiel S. A. , Issitt C. H. , Fruitstone M. J.
Published: March 2003

Low concentrations of sodium hypochlorite (chlorine bleach) destroyed S antigen on intact fresh red cells (RBCs). At levels of 0.0005 percent sodium hypochlorite in a 3 percent RBC suspension, S+s+ cells immediately became nonreactive with anti‐S. S+s‐ cells required approximately 1.5 times this level of sodium hypochlorite to destroy S antigen reactivity. Anti‐S absorbed three times with treated S+RBCs demonstrated no significant reduction in titer. In addition to its effect on S, the Rh antigens D, C, E, and e appeared slightly reduced in strength after treatment with sodium hypochlorite. However, the c antigen, as well as 20 other red cell antigens tested, appeared unaffected. Osmolality and pH determinations of supernatants from treated and untreated RBCs showed no significant differences. The proposed mechanism of S antigen destruction is an oxidation of the methionine residue in the S determinant. When sodium hypochlorite is used as a disinfectant, it should be rinsed thoroughly from all surfaces that might contaminate solutions that contact test RBCs. The destruction of the S antigen by sodium hypochlorite may be useful in testing complex antibody mixtures when a limited cell selection is available.
Acquired immune deficiency syndrome in the Middle East from imported blood
Authors: Kingston M. E. , Harder E.J. , Al‐Jaberi M. M. , Bailey T. M. , Roberts G. T. , Sheth K. V.
Published: March 2003

In Saudi Arabia, a native patient with no known risk factors for the acquired immune deficiency syndrome (AIDS) developed both clinical and laboratory evidence of AIDS 2 years after receiving transfusion of 11 units of blood obtained from a commercial distributor in the United States. This case suggests that a history of transfusions of blood components imported from areas where AIDS is prevalent should be elicited from patients in the Middle East with symptoms and physical findings suggesting AIDS.
Development of an optimized additive solution containing ascorbate‐2‐ phosphate for the preservation of red cells with retention of 2,3 diphosphoglycerate
Authors: Moore G. L. , Ledford M. E.
Published: March 2003

An additive solution containing adenine, ascorbate‐2‐phosphate, sodium phosphate, dextrose, and saline was developed for packed red cell preservation. The combination of all components was simultaneously optimized so that the resulting solution produced the maximum retention of both red cell adenosine triphosphate (ATP) and 2,3 diphosphoglycerate (2,3 DPG) concentrations. Fourteen nutrient combinations were tested; each combination was evaluated for 42 days of storage using cells from three donors. The nutrient combinations were chosen with the aid of a computerized experimental design process. Results of the experiments were modeled by regression analysis, and the model was optimized to produce the “best” formulation for simultaneous maintenance of ATP and 2,3 DPG. The resulting mathematically optimal formulation was tested in the laboratory using 10 units of red cells. With this solution, it was possible to store red cells for 42 days with retention of 45 to 55 percent of the initial ATP and 85 to 150 percent of the initial 2,3 DPG. Red cell lysis was low (0.8 percent), and most of the cells were biconcave discs (by scanning electron microscopy) at the end of storage. The studies were carried out in an efficient manner by using computer‐optimized experimental design techniques coupled with multiple regression modeling and subsequent computer optimization of the models. This experimental approach has potential application to many current blood banking procedures. This additive solution should maintain viable red cells for 42 days. In addition, the solution will maintain red cell 2,3 DPG throughout storage.
Performance of the indirect antiglobulin test does not show a circadian rhythm
Authors: Douglas R.
Published: March 2003

Performance of the indirect antiglobulin test by workers in a blood bank was examined for signs of a rhythmical relationship between the time of day and the frequency of error. All participants were experienced in blood group serology and completed sets of 12 antiglobulin tests at 4‐hour intervals over a 24‐hour period. Ten of the original 17 participants repeated the experiment after an interval of 7 months. About 50 percent of participants made more errors in the daytime or the nighttime in each experiment; however, these groups were unstable and contained different individuals in each experiment. Significant (p less than or equal to 0.05) time‐related cosinor rhythms could be demonstrated for four individuals in one experiment, but this finding was not reproduced in a second experiment. There was no indication that the amount of sleep deprivation which occurred had a significant influence on the investigation, and the individual frequencies of error at 0800 hours appeared to be a stable individual characteristic. The results highlight the importance of examining workplace‐related performance as an individual rather than a group phenomenon.
A proposal for compatibility testing incorporating the manual hexadimethrine bromide (Polybrene) test
Authors: Steane E. A. , Steane S. M. , Montgomery S. R. , Pearson J. R.
Published: March 2003

In November 1984, the Standards Committee of the American Association of Blood Banks changed the requirements for pretransfusion testing by making the performance of an antiglobulin crossmatch optional when the antibody screening test is negative. The crossmatch would be necessary only to confirm ABO compatibility. Many will welcome this change; others will persist in their current methods. This article presents data supporting the use of the manual hexadimethrine bromide (Polybrene) test, a 1‐minute room temperature procedure, as a crossmatch technique when the antibody screening test is negative. The manual Polybrene test (MPT) is an effective method for detecting ABO incompatibility. Forty‐seven randomly selected serums gave expected results with A1, A2, and B red cells. Only 66 percent of 84 group B sera were serologically incompatible with A2B red cells by MPT, but the same results (69% positive) were observed using a 5‐minute low‐ionic‐ strength solution (LISS) room temperature technique. As only 37 percent of these crossmatches were incompatible using a LISS immediate spin (IS) method, the reliability of an IS method is questioned. An MPT crossmatch provides added security in that most unexpected blood group antibodies are demonstrable by this method. Of 106 serums tested which contained antibodies, 83 reacted. We believe that the MPT provides a rapid and sensitive test that, accompanied by a carefully performed antibody screening test, meets the requirements of Standards and will provide for safe red cell transfusion without the need for an antiglobulin crossmatch.
Ultraviolet irradiation of platelet concentrate abrogates lymphocyte activation without affecting platelet function in vitro
Authors: Kahn R. A. , Duffy B. F. , Rodey G. G.
Published: March 2003

We studied the effect of ultraviolet (UV) radiation on platelet concentrates. Samples irradiated at 310 mm for 30 minutes at a dose of 1782 J per m2 showed no loss of platelet function in vitro as determined by adenosine diphosphate, collagen, or ristocetin‐induced aggregation. Lymphocytes isolated from irradiated units were unable to act as responders or stimulators in a mixed‐lymphocyte reaction. These data suggest that UV radiation of platelet concentrates may result in a cell suspension that is unable to evoke an immunological response.
The effect of mode of agitation and type of plastic bag on storage characteristics and in vivo kinetics of platelet concentrates
Authors: Snyder E. L. , Pope C. , Ferri P. M. , Smith E. O. , Walter S. D. , Ezekowitz M. D.
Published: March 2003

We studied the characteristics of platelet concentrates stored for 5 days at 22°C. Platelets were prepared in three plastic bags (PL 732, PL 1240, and CLX) and stored on one of four platelet agitators, 1‐ or 6‐rpm elliptical and 2‐ or 6‐rpm circular rotators. A total of 76 studies were divided among 12 groups, each group being composed of a different storage bagrotator combination. In vivo recovery and survival were calculated using Indium‐111 oxine‐labeled platelets injected into autologous volunteers. Platelet recovery was assessed at 2 hours postinjection or as the y‐intercept of the multiple‐hit model survival curve. Survival was calculated using linear, exponential, and multiple‐hit computer models. Linear T 1/2 also was calculated as an index of platelet survival.

At 5 days, the pH of all concentrates was above pH 7.0 and platelet counts were above 5.5 × 1010 per bag except for the PL 732 with the 6‐rpm elliptical rotator, which was 4.6 × 1010 per bag. This combination also showed a significantly higher poststorage lactic dehydrogenase (LDH) discharge compared to the mean of the other 11 groups (23.6 ± 5.4% vs. 10.4 ± 3.0%, p < 0.05); however, the β‐thromboglobulin (β‐TG) release was not statistically different. The lowest in vivo recovery and survival T 1/2 were found for the PL 732 with the 6‐rpm elliptical rotator: 2‐hour recovery of 28.0 ± 3.2 percent vs. 40.0 ± 10.6 percent for the other 11 groups (p < 0.05) and survival T 1/2 of 2.1 ± 1.4 days vs. 2.9 ± 0.6 days (p<0.05). Survivals using the three computer models, however, were similar for all 12 groups and were 7.2 ± 1.3 days (linear), 3.3 ± 0.9 days (exponential), 5.7 ± 2.0 days (multiple hit) (n = 76). The percent in vitro release of β‐TG or discharge of LDH during storage did not predict in vivo recovery. We conclude that storage of platelet concentrates for 5 days in PL 732 containers on a 6‐rpm elliptical rotator is the least desirable method of storage; all other combinations gave acceptable and similar results.
Sterility and quality of blood dispensed in syringes for infants
Authors: Strauss R. G. , Crawford G. F. , Elbert C. , Floss A. M. , Liesch M.
Published: March 2003

A unit‐dose system was designed to dispense precise quantities of blood in a form ready for immediate transfusion into neonatal patients. The principles were similar to those used by pharmacies to dispense individual doses of drugs. In the blood center, the precise volume of blood ordered for a neonatal patient was aspirated through a microaggregate filter into a labeled plastic syringe for dispensing to the nursery in a correspondingly labeled zip‐lock plastic bag. In the nursery, the premeasured and prefiltered blood was ready for immediate infusion, and the syringe was attached directly to a mechanical infusion pump. Several experiments were performed to ensure sterility and quality of whole blood dispensed by this system. Over 300 aerobic and anaerobic cultures were performed, and it was concluded that the extra handling required to prepare syringes of blood did not lead to bacterial contamination. In addition, the quality of whole blood was maintained, for at least 6 hours, equally well in syringes as it was in blood bags stored under standard blood bank conditions when assessed by hematocrit, blood pH, and measurements of plasma potassium, glucose, lactic dehydrogenase, and free hemoglobin. Thus, unit dose dispensing offers a precise and convenient method to prepare small, accurately measured quantities of filtered, sterile, and quality blood products for neonatal patients.
Changes in adenosine triphosphate, 2,3 diphosphoglycerate, and P50 of dog blood following transfusion of autologous red cells pretreated with phosphoenolpyruvate in vitro
Authors: Yonenaga K. , Todoroki H. , Tokunaga K. , Hamasaki N.
Published: March 2003

Red cells treated with phosphoenolpyruvate (PEP) in vitro were reinfused into the donor dogs and were monitored for changes in adenosine triphosphate (ATP), 2,3 diphosphoglycerate (2,3 DPG), and P50. ATP and 2,3 DPG concentrations increased to 116 and 143 percent of control, respectively, when these cells were incubated with 60 mM PEP for 90 minutes at 37°C. The oxygen dissociation curve shifted to the right, and P50 increased from 24.5 to 30.6 torr as a result of the PEP treatment. When one‐half of the circulating red cell volume was treated with PEP and reinfused into the animal, the red cell 2,3 DPG increased to 120 percent of pretransfusion values. The 2,3 DPG level remained elevated during the following day and returned to near pretransfusion levels on the third day. The P50 of the circulating blood paralleled the variations in the red cell 2,3 DPG level, and the capacity for oxygen delivery was calculated to be raised by 13 to 38 percent for a period of 24 hours. In contrast, elevated red cell ATP returned to control values immediately after transfusion.

In vivo viability, i.e., 24‐hour survival and one‐half disappearance time, of the cells pretreated with PEP were determined by a single‐isotope technique using 51Cr. The results showed that PEP treatment did not injure the red cells. In addition, there was neither acute toxicity nor a deleterious hemodynamic effect when large amounts of PEP were administered intravenously.

These results suggest that PEP could be used clinically to improve the capacity of the circulating red cells to deliver oxygen to the tissues.
Sequestration of serotonin in stored platelets
Authors: Shimizu T. , Kato K.
Published: March 2003

A high‐pressure liquid chromatographic procedure was used for the determination of 5‐hydroxytryptamine (serotonin, 5HT) in platelets. The method, which is based on the separation on a reverse‐phase column and measurement of native fluorescence in an acidified mobile phase, had a detection limit of femtomol quantities of 5HT. The mean contents of 5HT extracted from the Triton X‐100‐lysed platelets in random‐donor platelet concentrates (PCs) were 0.39 ± 0.19 μmol per 1011 platelets (n=5), the value of which was almost equal to 0.40 ± 0.09 μmol per 1011 platelets (n=15) of platelets prepared by cytapheresis. The fate of platelet 5HT during storage of PCs at 22° C with agitation was investigated for 5 days. Nearly all amounts of 5HT were sequestered within platelets after 5‐day storage. No increased amounts of major metabolites of 5HT, 5‐hydroxytryptophol and 5‐hydroxy‐3‐indoleacetic acid, were detected in plasma. These data suggest that 5HT stored in dense granules of platelets is not metabolized during storage of PCs at 22°C for 5 days.
Evaluation of routine anti‐HBc screening of volunteer blood donors: a questionable surrogate test for non‐A, non‐B hepatitis
Authors: HANSON MARGRET R. , POLESKY HERBERT F.
Published: March 2003

ABSTRACT: Routine antibody to hepatitis B core antigen (anti‐HBc) screening, recommended as a surrogate test to identify potential carriers of non‐ A, non‐B hepatitis, was evaluated on 22,346 blood donors using currently available enzyme immunoassay (EIA) reagents. Of the 2 percent found reactive, the majority had cutoff‐to‐sample absorbance ratios < 2.0 and < one‐half had anti‐HBc when tested by a radioimmunoassay (RIA) method. Only one of 2877 units donated previously by the reactive donors was implicated in a transfusion associated hepatitis case. These results raise questions about the use of currently available anti‐HBc reagents as a surrogate test for non‐A, non‐B hepatitis.
A Ge‐like autoantibody in the serum of a patient receiving gold therapy for rheumatoid arthritis
Authors: Beattie K.M. , Sigmund K.E.
Published: March 2003

A 61‐year‐old nulliparous woman who had never been transfused was admitted to the hospital because of severe anemia. She had been treated with gold salts for 4.5 years for rheumatoid arthritis. Because she had a negative direct antiglobulin test, an anti‐Ge found in her serum was believed to be an alloantibody. Subsequent testing of her initial serum sample with autologous red cells drawn 12 months later showed them to be strongly agglutinated, indicating that she had had a transient depression of her Ge antigen and that the anti‐Ge was an autoantibody. It was postulated that these transient effects may have been related to the gold therapy.
Two‐stage separation of immature and mature T lymphocytes from myeloerythroid clonogenic bone marrow cells by apheresis and elutriation centrifugation
Authors: Zucali J. R. , Weiner R. S. , Elfenbein G. J. , Ashkenazi Y. J. , Mason R. R. , Gross M. A. , Anderson L. A. , Barth K. C.
Published: March 2003

Because graft‐versus‐host disease remains a major complication in allogeneic bone marrow transplantation, a number of techniques capable of removing mature T lymphocytes from bone marrow cells have been attempted. The authors describe a simple two‐step procedure using counterflow centrifugation elutriation (CCE) that eliminated 95 to 98 percent of the mature T lymphocytes and greater than 97 percent of the T lymphocyte colony‐forming units (CFU‐T) while concentrating the bone marrow myeloid colony‐forming cells. Viability was greater than 98 percent, and 72 to 98 percent of the total cells separated were recovered. Lymphocyte depletion was substantiated by both morphologic and phenotypic criteria using monoclonal antibodies to T lymphocytes, as well as by responsiveness in mixed‐lymphocyte cultures and to mitogens. In addition, this technique separated the lymphoid colony‐ forming cells from the larger myeloid colony‐forming cells. It was concluded that this simple two‐step CCE procedure can be used to separate T lymphocytes and CFU‐T from myeloid colony‐forming cells and offers a means of purging T lymphocytes from large numbers of marrow cells that may be required for human allogeneic bone marrow transplantation.
Use of a pneumatic tube system for delivery of blood bank products and specimens
Authors: Tanley P. C. , Wallas C. H. , Abram M. C. , Richardson L. Douglas
Published: March 2003

This study evaluated the effect of pneumatic tube transport on blood bank specimens and products. No important differences were found between aliquots transported in the tube system and those stored in the laboratory as controls. ABO, Rh, antibody detection or identification, direct antiglobulin testing, and elution were studied. Further, no differences in plasma hemoglobin and potassium concentration were found between units of whole blood and packed cells handled in either manner. Platelet counts in platelet concentrates were not decreased and coagulation factor levels in units of fresh‐frozen plasma and cryoprecipitate did not decrease after pneumatic transport. The system tested is currently providing expeditious transport of specimens and blood between blood banks and patient care areas.
A review of recent events related to surrogate testing of blood to prevent non‐A, non‐B posttransfusion hepatitis
Authors: Zuck T. F. , SHERWOOD W. C. , BOVE J. R.
Published: March 2003

A workshop sponsored by the Food and Drug Administration was held recently during which available data were reviewed concerning surrogate testing of blood donated for transfusion in order to reduce the risks of posttransfusion non‐A, non‐B hepatitis. Clinical studies from which the efficacy of testing for alanine aminotransferase and antibody to hepatitis B core antigen (anti‐HBc) could be predicted indicated such testing would be useful, although several studies using tests for anti‐ HBc developed recently questioned their effectiveness. Different approaches to establishing the cut‐off values for the screening tests were presented and difficulties regarding test standardization were discussed. The legal, ethical, and medical implications for donors of surrogate screening programs in the United States also were considered. A meeting sponsored by the private sector that included representatives of the major blood banking organizations and was convened to discuss the workshop proceedings and nationwide screening of the blood supply also is summarized.
Alterations in glutathione during storage of human platelet concentrates
Authors: Burch P.T. , Burch J W.
Published: March 2003

Glutathione and glutathione disulfide decline rapidly and progressively in human platelet concentrates stored for up to 7 days at 22 degrees C. Total glutathione declines progressively throughout the storage period, with an estimated half‐disappearance time of 2 days. Glutathione disulfide remains constant during the first 2 days of storage but declines progressively thereafter, with an estimated half‐disappearance time of 3.2 days. Based on measurements of glutathione disulfide in freshly collected platelets, the authors postulate that glutathione disulfide is elevated during the production of platelet concentrates or during the first 2 days of storage, accounting for the lag in its decay curve. Since total glutathione decreases more rapidly than glutathione disulfide, the fraction of glutathione present in the oxidized form increases throughout the storage period. Glutathione‐dependent mechanisms maintain essential cell proteins in the appropriate redox states and provide avenues for the detoxification of potentially noxious compounds generated by the cell or within its environment. Changes in platelet glutathione and glutathione disulfide during storage may be responsible for storage‐dependent alterations in in vitro functions and may also affect subsequent in vivo recovery and survival upon reinfusion.
Selecting the optimal dose of low‐molecular‐weight hydroxyethyl starch (Pentastarch) for granulocyte collection
Authors: Strauss R.G. , Villhauer P.J. , Imig K.M. , Eckermann I. , Gupta S.D. , Thomson D.S.
Published: March 2003

A new, rapidly excreted, low‐molecular‐weight form of hydroxyethyl starch (Pentastarch), is effective and safe in centrifugation leukapheresis. To define the optimal dose of Pentastarch, 12 subjects donated granulocytes by continuous‐flow, centrifugation leukapheresis on three occasions at 3‐week intervals. Each subject received approximately 250,500, or 1000 ml of Pentastarch according to a random sequence during procedures in which 81 of donor blood was consistently processed. Plasma Pentastarch concentrations (mean mg/ml) measured immediately after leukapheresis were 3.1, 6.7, and 12.7 for the 250, 500‐, and 1000‐ml doses, respectively. Total leukocyte and neutrophil yields with the 500‐ or the 1000‐ml doses of Pentastarch were similar, and both were significantly greater (p < 0.05) than those with the 250‐ml dose. Neutrophil yields per concentrate (mean × 10(‐10) were 0.74, 1.72, and 1.73 for the 250‐, 500‐, and 1000‐ml doses, respectively. Pentastarch dose had little effect on lymphocyte and platelet yields. No serious adverse effects were evident for any dose of Pentastarch during 12 weeks of observation. In particular, the 1000‐ ml dose did not produce increased toxicity. Thus, a single 500‐ml bottle of 10 percent Pentastarch produced maximal yields; efficacy was not improved by doubling the dose.
A solid‐phase antiglobulin test
Authors: Douglas R. , Schneider J.V. , Wilkie D. , Harden P.A.
Published: March 2003

A solid‐phase test (SPT), a machine‐readable adaptation of the indirect anti‐human globulin test (IAHG), is described. The SPT level of sensitivity was comparable to that of the manual IAHG test for the detection of IgG antibodies and was compared with manual pretransfusion compatibility tests. The average difference from the mean of duplicate SPT results was 5.94 percent of the optical density value. The data also demonstrated a linear and overlapping relationship between the scores of manual IAHG tests and SPT optical density values. The accuracy of the SPT declined slightly as the concentration of red cell samples increased; the optimum concentration of immunoglobulin used in the preparation of the solid phase was about 275 mg per l. The 97.5th percentile of negative tests occurred at the same optical density (0.13) when serums from either healthy donors or hospitalized patients were tested. Compatibility tests completed on 1304 blood samples from donors and 437 serum samples from hospitalized patients showed that 1.38 percent of results were SPT‐positive and manual IAHG‐negative, and 5.37 percent were SPT‐negative and manual IAHG‐positive. The lowest possible score in the manual test was allocated to 97.14 percent of the latter group, indicating good correlation between the two techniques.