bluuebunny/crossref_metadata_2025 huggingface dataset:
Detection of drug‐dependent platelet antibodies using immobilized Staphylococcal protein A
Authors: Christie D.J. , Lennon S.S.
Published: March 2003

Serum samples from eight patients suspected of having drug‐induced immunologic thrombocytopenia provoked by a variety of medications were tested for drug‐dependent platelet antibodies with a newly developed assay that forms rosettes of antibody‐coated platelets around Staphylococcal protein A‐Sepharose beads. The same samples were then tested with immunofluorescence and 51Cr‐release assays. Seven of eight patients (87.5%) tested positive for drug‐dependent antibodies by the rosette assay. In contrast, two of eight (25.0%) and one of eight (12.5%) patients tested positive for drug‐dependent antibodies by immunofluorescence and 51Cr release, respectively. These results demonstrate that the new rosette method is significantly more sensitive and specific for the detection of drug‐dependent platelet antibodies than either immunofluorescence or 51Cr release.
Volunteer blood donors who fail the copper sulfate screening test
Authors: Lloyd H. , Collins A. , Walker W. , Fail B. , Hamilton P. J.
Published: March 2003

Volunteers attending blood donor sessions who fail the copper sulfate screening test merit an explanation of why they are considered ineligible to donate. During a 30‐month period, 0.24 percent of men and 2.8 percent of women attending blood donor sessions in the northern region of England failed this test. Their hematologic status was determined by performing complete blood counts on a venous blood specimen and measuring ferritin as an indication of iron stores in a representative sample of approximately 10 percent. Normal blood counts were found in some donors, while others had severe degrees of anemia, and such discrepancies could be clarified only by hemoglobin determinations. Iron deficiency was very common in deferred donors, including 36 of the 88 with normal blood counts in whom ferritin assays were performed. Microcytic blood cells, a hallmark of iron deficiency, were found to be a relatively insensitive measure of low iron stores, except at low levels of hemoglobin. By a check of a venous sample, the hematologic status of most volunteers failing the copper sulfate screening test can be ascertained, and appropriate review, investigation, and treatment can be undertaken.
Induction of lymphokine‐activated killer and natural killer cell activities from cryopreserved lymphocytes
Authors: Kawai H. , Komiyama A. , Katoh M. , Yabuhara A. , Miyagawa Y. , Akabane T.
Published: March 2003

Lymphokine‐activated killer (LAK) and natural killer (NK) cells were studied for their capacity to retain cytotoxicity after cryopreservation. LAK cells were generated by a 4‐day culture of lymphocytes with recombinant interleukin‐2 (rIL‐2). Cytotoxicity was measured by 51Cr‐release assay at effector:target ratios of 10:1 to 80:1. Cryopreserved LAK cells retained 58.8 to 87.4 percent of cytotoxicity, as compared with that in fresh control cells. Cryopreserved NK cell activity against K562 and Molt‐4 targets was 45.7 to 67.9 percent of the respective values of the fresh control cells. The responsiveness of NK cells to polyinosinic‐polycytidilic acid (poly I:C), interferon‐α (IFN‐α), or rIL‐2 remained intact. Activated NK cell activity after poly I:C or IFN‐α stimulation and that after rIL‐2 were, respectively, comparable to and higher than the endogenous NK cell activity of the fresh cells. The composition of lymphocyte subsets as determined by flow cytometry using monoclonal antibodies did not change after cryopreservation, indicating that cellular loss of the given subsets did not occur during the procedure. The retention of substantial levels of cytotoxicity in cryopreserved LAK and NK cells may make them promising candidates as cytotoxic effector cells.
A prospective study evaluating the lowering of hemoglobin standards for blood donors
Authors: ALI ANITA M. , GOLDSMITH CHARLES H. , McAVOY ANN T. , ALI MAHMOUD A.M. , BLAJCHMAN MORRIS A.
Published: March 2003

ABSTRACT: Strict regulations exist for the selection of blood donors. These include minimum hemoglobin (Hb) standards of 13.5 and 12.5 g/dL for males and females respectively. In Canada 2% of all blood donors, or approximately 25,000 individuals annually attempt to make a blood donation but are deferred because their Hb level does not meet these minimum accepted standards. In a previous study we provided a biostatistical approach to ascertain objectively the optimal minimum Hb standards for blood donors to best discriminate between iron deficient and non iron deficient individuals. The derived values were lower than the existing minimum Hb standards and because of concern that blood donors accepted using these lower Hb standards might have asymptomatic disease, the proposed new levels were not adopted. This present prospective study was undertaken to assess the impact on the blood donors of the new Hb standards. Over 26 months we evaluated 1,558 donors (695 males and 863 females). On entry into the study they were screened for a variety of medical conditions which could result in asymptomatic anemia and 6 months later they answered a health questionnaire. Blood donors were entered into 1 of 3 groups. Group I were donors accepted by the existing criteria. Group II were donors who did not meet the existing Hb criteria but satisfied the newly derived standards. Group III were donors deferred even by the new Hb standards. The results showed no difference in the prevalence of possible disease between the groups; nor was there a difference, as ascertained by the questionnaire, in the health of donors giving blood 6 months subsequent to their entry to the study. The majority of donors deferred by the current hemoglobin standards (83% of the males and 76% of females) were not iron deficient. ROC curves, to discriminate between iron deficient and non iron deficient donors, indicated that the optimal Hb levels for blood donors should be 12.5 g/dL for males and 11.5 g/dL for females.
A flow cytometric technique to accurately measure post‐filtration white blood cell counts
Authors: BODENSTEINER DAVID C.
Published: March 2003

Abstract: Leukocyte–depleted blood products are being used with increasing frequency in hopes of preventing or delaying platelet alloimmunization. However, accurately monitoring the efficiency of leukocyte (WBC) removal is a difficult problem because electronic cell counters are not accurate at very low WBC numbers and hemocytometer counts are tedious and time consuming. A simple flow cytometric technique was developed which accurately and rapidly measures extremely low WBC counts. Using a propidium iodide solution which causes DNA to fluoresce, the residual WBC count was measured in 42 units of blood products after leukocyte depletion using a commercial filter. There was a significant correlation with simultaneous hemocytometer counts, r = 0.672, but residual WBC could be identified in every unit using the flow cytometer, whereas in 19% of the units no WBC were seen using the hemocytometer. Extremely low counts, as low as a single WBC/4 μ1 could be reproducibly obtained. In addition, serial dilution studies yielded a correlation coefficient of 0.997. Because most clinical laboratories now have access to flow cytometers, this technique can be widely used.
Paroxysmal nocturnal hemoglobinuria and the transfusion of washed red cells. A myth revisited
Authors: Brecher M. E. , Taswell H. F.
Published: March 2003

Paroxysmal nocturnal hemoglobinuria (PNH) is an uncommon, acquired clonal stem cell disorder primarily affecting red cells that have an abnormal sensitivity to complement lysis. Since 1948, the use of saline‐washed red cells (WRBCs) has been advocated to minimize hemolysis after transfusion to patients with PNH. Thirty‐eight years of experience (1950 through 1987) with patients who had PNH were reviewed. Twenty‐three patients with a positive Ham's test had been transfused with 556 blood components, including 431 RBC products: 94 units of whole blood, 208 units of packed RBCs, 80 units of white cell‐poor RBCs, 38 units of WRBCs, 5 units of frozen RBCs, and 6 units of intraoperatively salvaged RBCs. Only one documented episode of posttransfusion hemolysis related to the underlying diagnosis of PNH was found, and it was associated with the transfusion of a unit of type O whole blood to an AB‐positive individual. This unit contained ABO‐incompatible plasma; this case was similar to one in an earlier report from which originated the recommendation for using WRBCs. The posttransfusion increment in hemoglobin concentration in patients receiving ABO‐identical packed RBCs was comparable to that in patients receiving frozen or washed RBCs. These findings indicate that the use of WRBCs is unnecessary and that patients with PNH should be transfused with group‐specific blood and blood products.
Accurate quantitation of the low number of white cells in white cell‐depleted blood components
Authors: Kao K.J. , Scornik J.C.
Published: March 2003

A simple method of accurate quantification of low concentrations of white cells (WBCs) in WBC‐depleted blood components was developed by using propidium iodide (PI) to stain the nuclei of WBCs. The method was validated by correlating the PI‐determined WBC concentrations with those determined with Coulter S‐plus IV counter in units of packed red cells (PRBCs) or random‐donor platelets (RDPs). The correlations were linear and had coefficients of 0.99. The sensitivity of PI staining permitted the detection of concentrations of WBCs as low as 1 cell per μL of RDPs or 11 cells per μL of PRBCs. Therefore, PI staining will be useful in investigating the role of transfused WBC‐depleted blood components in the prevention of primary alloimmunization to HLA antigens, as well in evaluating various new procedures with high efficiency in depleting WBCs from blood components.
Removal of white cells from red cells by transfusion through a new filter
Authors: Sirchia Girolamo , Wenz Barry , Rebulla Paolo , Parravicini Anna , Carnelli Vittorio , Bertolini Francesco
Published: March 2003

The effectiveness of a new filter (RC100) for the preparation of white cell‐depleted red cells (RBCs) at the bedside was evaluated in vitro and in vivo using three RBC products: standard RBC concentrate (CPDA units), RBCs suspended in saline‐adenine‐glucose‐mannitol additive solution after the removal of plasma (SAGM units), and RBCs suspended in SAGM after the removal of plasma and buffy coat (SAGM‐BC units). Median RBC recovery was at least 92 percent when 2 units were administered through one filter; median values for residual white cells and platelets were less than or equal to 20 × 10(6) and less than or equal to 2.5 × 10(9) per 2 units, respectively. The in vivo study was carried out in 80 multiply transfused patients with thalassemia, 35 of whom had experienced frequent nonhemolytic transfusion reactions when given standard or buffy coat‐free RBCs. During the 6‐month study, each patient was given two transfusions of each type of RBC product One febrile nonhemolytic transfusion reaction occurred in each of two patients receiving SAGM‐BC units, but in no other case. If the flow rate is not reduced, the median transfusion time is 35 minutes per CPDA unit and 15 minutes per SAGM and SAGM‐BC unit. It is concluded that the transfusion of RBCs through the RC100 is a simple and effective procedure to administer white cell‐depleted RBCs prepared at the bedside.
Prevention of iron deficiency with carbonyl iron in female blood donors
Authors: Gordeuk V.R. , Brittenham G.M. , Bravo J. , Hughes M.A. , Keating L.J.
Published: March 2003

The effectiveness of elemental, nontoxic carbonyl iron in replacing iron lost at blood donation was examined. In a randomized double‐blind design, 99 women, aged 18 to 40, were given placebo or low‐dose carbonyl iron (100 mg orally) at bedtime for 56 days after phlebotomy. Compliance was equivalent for the two regimens. Mild side effects were slightly greater with carbonyl iron. At Day 56, estimated net iron absorption from therapy or diet, or both, was sufficient to replace iron in 85 percent of those receiving carbonyl iron but in only 29 percent of those taking placebo (p< 0.001). The rates of deferral from repeat donation were 8 percent in the carbonyl iron group and 36 percent in the placebo group (p<0.01), and the positive predictive value of routine screening in identifying participants without iron deficiency was 83 versus 13 percent (p<0.01). It can be concluded that short‐term carbonyl iron supplementation in female blood donors can replace the iron lost at phlebotomy, protect the women against iron deficiency, and enhance their ability to give blood.
Modification of fresh‐frozen plasma transfusion practices through educational intervention
Authors: Barnette R.E. , Fish D.J. , Eisenstaedt R.S.
Published: March 2003

The effect of an educational program designed to address misconceptions about the perioperative transfusion of fresh‐frozen plasma (FFP) was examined. Results of a baseline audit of FFP use were compared to those of a study subsequent to the educational process. Statistical analysis of the data revealed that the decrease in the number of patients transfused with FFP, from 32 of 2077 operative cases in Group A (baseline) to 18 of 2540 operative cases in Group B (after education), was significant (p<0.01). Analysis of the justifications given for transfusion of FFP revealed that the increase in acceptable indications from 47 percent in Group A to 78 percent in Group B was also significant (p<0.05). There was no significant difference between the two groups in units of FFP transfused per patient (Group A, 3.66 ± 3.2, vs. Group B, 2.47 ± 1.7) or red cells (Group A, 2.84 ± 5.2, vs. Group B, 5.22 ± 4.4), and the patterns of platelet transfusion were similar in the two groups. There was a significant difference in the postoperative partial thromboplastin time (Group A, 38.2 ± 8.7 vs. Group B, 56.3 ± 24 seconds, p<0.01) but no significant difference in postoperative prothrombin time (Group A, 14.1 ± 2.6 vs. Group B, 15.4 ± 3.3 seconds). It can be concluded that an educational program designed to address misconceptions in transfusion practice can alter physician performance and thereby reduce the inappropriate use of FFP.
Ultraviolet irradiation of platelet concentrates: feasibility in transfusion practice
Authors: Andreu G. , Boccaccio C. , Lecrubier C. , Fretault J. , Coursaget J. , LeGuen J.P. , Oleggini M. , Fournel J.J. , Samama M.
Published: March 2003

Ultraviolet (UV)‐B irradiation abolishes lymphocyte functions (the ability to respond and to stimulate) in mixed lymphocyte culture (MLC). This effect may have practical application in the prevention or reduction of transfusion‐induced alloimmunization against HLA class I antigens. To study this, platelet concentrates (PCs) were obtained with a cell separator, suspended in autologous plasma in a final volume of 400 mL, and transferred into a large (22 times 30 cm) cell culture bag. This plastic showed a good transmittance of UV‐B rays at 310 nm (54%). PCs were placed between two quartz plates (surface of irradiation = 25 times 37 cm), and the two sides were irradiated simultaneously. Energy delivered to the surface of the plastic bag was automatically monitored. The ability to respond (in MLC and to phytohemagglutinin) and to stimulate allogeneic lymphocytes was completely abolished with energy of 0.75 J per cm2 (irradiation time less than 3 min). The temperature increase during irradiation was negligible. Platelet aggregation (collagen, adrenalin, ADP, arachidonic acid, ristocetin) was not impaired if UV‐B energy was below 3 J per cm2. Recovery and survival of autologous 111in‐labeled platelets were studied in four volunteers; no differences were found between UV‐B‐treated (1.5 J/cm2) platelets and untreated platelets. These results show that a large‐scale clinical trial using UV‐B‐irradiated PCs to prevent HLA alloimmunization is feasible.
Anti‐Sc1 in pregnancy
Authors: Kaye T. , Williams E.M. , Garner S.F. , Leak M.R. , Lumley H.
Published: March 2003

Anti‐Sc1 was detected in a gravida‐2 patient at 12 weeks' gestation. At 29 weeks, the antibody was found to be of the IgG3 subclass with a titer of 16, score 36, by the indirect antiglobulin test, and it produced 7 percent lysis by antibody‐dependent cellular cytotoxicity (ADCC) assay, a finding that suggested an unaffected fetus. The titer remained constant throughout the pregnancy, as did the IgG subclass and activity in the ADCC assay. At delivery of the full‐term infant, the cord hemoglobin was 13.5 g per dL and the direct antiglobulin test was positive (3 +) with anti‐IgG. The infant did not require transfusion. A sample taken 9 weeks after delivery showed 44 percent lysis in the ADCC assay. The anti‐Sc1 titer was 32, score 65.
The risk of transmitting cytomegalovirus infection by fresh frozen plasma
Authors: BOWDEN R. , SAYERS M.
Published: March 2003

ABSTRACT: In order to determine if cytomegalovirus seronegative patients are at risk of infection from fresh frozen plasma we reviewed our experience with 21 seronegative marrow transplant recipients who underwent plasma exchange with unscreened plasma. The mean (± SD) number of units of plasma required in the procedure was 47.6 (± 19.5). The majority of patients, 17 of 21, were followed for 100 days. No patients had evidence of cytomegaloviral infection. We conclude that fresh frozen plasma is not infectious for cytomegalovirus.
Red cell use during cesarean delivery
Authors: Camann W. R. , Datta S.
Published: March 2003

The transfusion of red cells (RBCs) was analyzed over a 4‐year period (1984–1987), during which 9596 cesarean deliveries were performed. A total of 336 patients were identified as receiving RBC transfusions during or after cesarean delivery; 747 units of RBCs were administered. The overall incidence of transfusion in this patient population declined from 6.2 to 3.2 percent during the study period (p less than 0.001). Slightly more than one‐half (54.4%) of all transfusions were given in the operating room or recovery room. The majority of patients (68.4%) received 2 units of RBCs, 11.6 percent received a 1‐unit transfusion, and 8.3 percent received 5 units or more. The most common obstetric diagnoses associated with RBC transfusion were disorders of placental implantation, preeclampsia, premature labor with tocolytic therapy, fetal distress, and augmentation of dysfunctional labor. In patients without risk factors for bleeding, there was no trend indicating increased transfusion requirements when general anesthesia was employed. In conclusion, this study documents a decline in the transfusion rate during cesarean delivery.
Storage of saline‐adenine‐glucose‐mannitol‐suspended red cells in a new plastic container: polyvinylchloride plasticized with butyryl‐n‐ trihexyl‐citrate
Authors: Högman C. F. , Eriksson L. , Ericson Å. , Reppucci A. J.
Published: March 2003

Blood collection and component preparation have been performed in integrally connected multiple plastic containers made with a new plastic. This polyvinylchloride (PVC) container plasticized with butyryl‐n‐trihexyl‐citrate (BTHC) is a new material for blood storage; it contains no di(2‐ethylhexyl)phthalate (DEHP). After removal of plasma and buffy coat, the red cells were suspended in saline‐adenine‐ glucose‐mannitol (SAGM) medium. After 42‐day refrigerator storage, the total adenine nucleotide concentration remained the same as the initial concentration in the red cells, whereas ATP levels had decreased to 61 percent of the initial value. The 2,3 DPG concentration was 62 percent of normal on Day 7 and 21 percent on Day 14. Glucose consumption, lactate production, potassium leakage from red cells, and pH levels were similar to those found after storage in DEHP‐plasticized containers under the same conditions. After 42 days, hemolysis levels were 0.56 ± 0.21 percent and 0.42 ± 0.17 percent in two series of units mixed weekly and 0.70 ± 0.27 percent in units stored unmixed. Although even higher levels of hemolysis were observed in the units stored unmixed and used for 24‐hour posttransfusion survival, the autologous red cell recovery results were excellent (83.2 ± 5.1%, n = 8). BTHC‐plasticized PVC is found to be a suitable material for 42‐day storage of red cells in SAGM solution.
Factors influencing 20‐hour increments after platelet transfusion
Authors: Bishop J. F. , Matthews J. P. , McGrath K. , Yuen K. , Wolf M. M. , Szer J.
Published: March 2003

The 20‐hour posttransfusion platelet count determines transfusion policy for patients requiring platelet support, and yet factors influencing the 20‐hour count have been poorly defined. The clinical factors influencing both the 1‐ and 20‐hour corrected count increment (CCI), were studied in 623 human leukocyte antigen (HLA)‐unmatched platelet transfusions in 108 patients. The 1‐ and 20‐hour CCIs were highly correlated (r = 0.67, p less than 0.001). On average, the 20‐ hour CCI was 64 percent of the 1‐hour CCI. Multiple linear regression analyses identified splenectomy, bone marrow transplantation, disseminated intravascular coagulation, administration of amphotericin B, palpable spleen, and HLA antibody grade as the major factors influencing the 20‐hour posttransfusion CCI. Platelet‐specific antibodies, number of concurrent antibiotics, clinical bleeding, and temperature did not significantly influence the 20‐hour posttransfusion CCI. The 1‐hour CCI was the only significant factor influencing the 20‐ hour CCI in a regression model containing the 1‐hour CCI and the above factors. Thus, the same clinical factors exert a major influence on the CCI at both 1 and 20 hours after platelet transfusion, with no evidence that any factor has more influence at 20 hours after transfusion than at 1 hour.
Antibodies to histo‐blood group substances A and B: agglutination titers, Ig class, and IgG subclasses in healthy persons of different age categories
Authors: Rieben R. , Bbuchs J.P. , Flückiger E. , Nydegger U.E.
Published: March 2003

Isotypes and IgG subclasses of ABO antibodies from sera of 235 healthy blood donors were determined by an enzyme‐linked immunosorbent assay (ELISA). Synthetic A and B trisaccharide‐bovine serum albumin glycoconjugates were used for coating and monoclonal antibodies for the detection of heavy chain isotypes. Hemagglutination titers were determined in addition. Blood donors were between 20 and 67 years old, and at least 10 sera per 10‐year age category and ABO blood group were included in this study. Antibody concentrations were expressed as a percentage of an internal standard, and sera with subclass‐restricted anti‐A and/or anti‐B (anti‐A/B) responses were used to normalize the ELISA values of IgG subclasses. A good correlation between the sum of the four subclasses and the total anti‐A/B IgG values (rs = 0.81 for anti‐A and 0.84 for anti‐B) was obtained. IgG1 and IgG2 were the most predominant subclasses, but were found in various proportions in different individuals. Donor‐to‐donor variation exceeded age‐related changes for all measured parameters. The correlation of anti‐A IgM, IgG, IgA, and their sum with the agglutination titers was significant and revealed rs values of 0.70, 0.65, 0.65, and 0.80, respectively. For anti‐B as well, the correlation of ELISA values with the agglutination titer was best when all three isotypes were added. We conclude that anti‐A/B IgA, together with IgM and IgG, substantially contributes to the agglutination reaction. Potentially autoreactive antibodies were detected in sera of blood groups A, B, and AB.
Preliminary studies of photoinactivation of human immunodeficiency virus in blood
Authors: Matthews J.L. , Sogandares‐Bernal F. , Judy M.M. , Marengo‐Rowe A.J. , Leveson J.E. , Skiles H. , Newman J.T. , Chanh T.C.
Published: March 2003

The transmission of human immunodeficiency virus (HIV) by blood or blood components is a major concern in blood banking. A photodynamic flow cell system was designed to inactivate cell‐free HIV mixed with blood from a healthy donor. Blood containing 4 × 103 infectious units of HIV was treated with 10 and 20 μg per mL of commercially available dihematoporphyrin ether (DHE) per mL. Aliquots of this mixture were then held in the dark or irradiated in a flow cell illuminated at a light energy density of 5 J per cm2 provided by a xenon light source equipped with a 630 ± 5 nm band‐pass interference filter; the aliquots were subsequently placed in A.301 cells. All infected cultures were assessed for reverse transcriptase (RT) activity for 17 days. RT activity for either concentration of dye was significantly reduced in irradiated samples as compared to that in samples held in the dark. Blood samples from volunteers also were assessed for the effects of the inactivation process on red cells at concentrations of DHE up to 200 micrograms per mL. No effects were observed on red cell 2,3 DPG or ATP, whole blood potassium concentrations, red cell osmotic fragility, or blood cell antigens.
Postfiltration factor VIII and fibrinogen levels in cryoprecipitate stored at room temperature and at 1 to 6 degrees C
Authors: SPIVEY M.A. , JETER E.K. , LAZARCHICK J. , KIZER J. , SPIVEY L.B.
Published: March 2003

The 13th edition of the standards of the American Association of Blood Banks specified storage at 1 to 6 degrees C for cryoprecipitated anti‐ hemophilic factor (Cryo) administered up to 6 hours after thawing if the Cryo is used for factor VIII (FVIII) content (Standard J4.210). Previous editions specified room‐temperature (RT) storage for up to 6 hours. Currently, the temperature specification has been deleted. There are few data addressing the optimal storage temperature and maximum storage time for FVIII and fibrinogen in thawed Cryo. Thirty bags of Cryo were assayed for FVIII and fibrinogen. Each bag was divided into two aliquots; one was stored at RT and the other at 1 to 6 degrees C. Assays were performed immediately after thawing (Base) and 6 and 24 hours after thawing, respectively. All samples were filtered through 200‐mu blood component infusion sets before assay. Three hundred analyses were performed, 150 each for FVIII and fibrinogen by conventional clotting technique. Data were analyzed by using a paired t test. Cryo stored at 1 to 6 degrees C for 6 and 24 hours showed an FVIII loss of 35 percent (p less than 0.0001) and 63 percent (p less than 0.0001), respectively. Cryo stored at RT for 6 and 24 hours had an FVIII loss of 8 percent (p greater than 0.05) and 20 percent (p less than 0.0001). Cryo stored at 1 to 6 degrees C for 6 and 24 hours had a fibrinogen loss of 20 percent (p less than 0.0001) and 43 percent (p less than 0.0001). Cryo stored at RT for 6 hours had no fibrinogen loss and a 2 percent loss at 24 hours (p greater than 0.05). These preliminary data show a significant loss of FVIII and fibrinogen activity in Cryo stored at 1 to 6 degrees C and filtered before assay. The FVIII and fibrinogen activity at RT is clearly maintained up to 6 hours after thawing.
Geographic risk factors for viral hepatitis and cytomegalovirus infection among United States Armed Forces blood donors
Authors: Hyams K.C , Cross E.R , Bianco M.A , Soyk‐Sarty D.R. , Roper C.M. , Dahut W.L , Holmberg J.A.
Published: March 2003

In an effort to determine whether residence in a foreign country increases the risk of hepatitis B and C and cytomegalovirus (CMV) infection in United States (US) Armed Forces blood donors, 5719 volunteer donors at four US Navy blood banks were evaluated. Most participants were repeat donors (68%) and were young (mean age, 25 years), male (88%), and white (80%), black (10%), or Hispanic (7%). Birth outside of the United States was reported by 6 percent of subjects, and 34 percent had lived in a foreign country for more than 3 months. Twenty (0.3%) subjects had hepatitis B surface antigen (HBsAg), and 100 (1.7%) had antibody to hepatitis B core antigen (anti‐HBc). Thirty‐four (0.6%) were repeatably reactive in enzyme‐linked immunosorbent assay for antibody to hepatitis C virus (anti‐HCV); 11 (0.2%) had anti‐HCV in immumoblot assay. Of the 3484 donors tested for anti‐CMV, 1117 (32.1%) were positive. When demographic characteristics were controlled for both anti‐HBc and anti‐CMV seropositivies were independently associated in male blood donors with residence in the Philippines. Geographic factors were not associated with HBsAg and anti‐ HCV positivity. These findings indicate that the prevalence of serologic markers for viral hepatitis is low in military blood donors, but that residence in the Western Pacific is a risk factor for hepatitis B and CMV infection.
Blood donation and transfusion practices: the 1990 American Association of Blood Banks Institutional Membership Questionnaire
Authors: Devine P. , Postoway N. , Hoffstadter L. , Surgenor D.M. , Linden J.V. , Hines D. , Chernoff A. , Ciavarella D. , Bove J.R.
Published: March 2003

Responses to the 1990 American Association of Blood Banks (AABB) Institutional Membership Questionnaire were submitted by 2126 regional blood centers, hospital‐based blood banks, and transfusion facilities. Data from 2117 of these facilities were considered to be valid. The questionnaire included information on blood donor demographics, number of units collected, and collection procedures; services performed; usage of blood components; and transfusion‐transmitted diseases reported during 1989. Institutional members collected 7.4 million whole blood units, of which 90.8 percent were donated for allogeneic use, 6.0 percent were donated for autologous use, and 3.2 percent were donated for directed use. Approximately 630,546 allogeneic and directed‐use blood donors were deferred, most often for low hemoglobin or hematocrit values. Approximately 225,205 full allogeneic and directed‐donor units were discarded, primarily for elevated alanine aminotransferase levels or the presence of hepatitis B core antibody. The 14.3 million transfused components included 56.7 percent red cell‐containing components, 27.4 percent platelets, 11 percent fresh‐frozen plasma, and 4.8 percent cryoprecipitate. Institutional members reported 1397 cases of transfusion‐associated hepatitis. In this group, 921 patients were tested for hepatitis B surface antigen after the transfusion; 339 (36.8%) were found to be hepatitis B surface antigen positive. The AABB Institutional Questionnaire results provide recent data on blood donor and transfusion‐related activities that are vital to the evaluation of current transfusion medicine practices.
A prospective study to identify the risk factors associated with acute reactions to platelet and red cell transfusions
Authors: Heddle NM. , Klama LN. , Griffith L. , Roberts R. , Shukla G. , Kelton JG.
Published: March 2003

It is generally assumed that febrile nonhemolytic transfusion reactions are an immunologically mediated reaction involving the recipient's plasma and the white cells in the donor unit. This has led to the use of white cell reduction and pretransfusion medication, to try to minimize these reactions. To better understand febrile transfusion reactions, a prospective study was performed in which all patients receiving platelet and red cell transfusions in a tertiary‐care medical center were interviewed before and after transfusion to obtain information about the typical presentation of the syndrome. It was found that transfusion reactions were much more frequently associated with platelet transfusion (30.8%) than with red cell transfusion (6.8%, p < 0.0005). The routine use of antipyretics prevented most episodes of fever but did not prevent the occurrence of other symptoms such as chills, cold, and discomfort. The application of logistic regression analysis revealed that the dominant factor determining the risk of a reaction was not white cell contamination, but the age of the component (p < 0.005). The significant relationship between reaction and the increasing age of the component suggests that cytokines released in the component during storage may be responsible for many reactions to blood components.
Antibodies to hydrocortisone in reagent red cells causing positive antibody screening tests
Authors: Umlas J. , Turner L.A.
Published: March 2003

When a patient's serum contains a temperature‐independent antibody reacting with all antibody screening and antibody identification panel cells but with few or no units of blood used for crossmatching, one should suspect an antibody against a constituent of the suspension medium of the reagent blood cells. This observation is confirmed by negative reactions with a) washed reagent cells or b) another manufacturer's cells that do not contain the same additives. Two patients are described with antibodies to hydrocortisone that are present in one manufacturer's antibody screening cells and identification panels. The hydrocortisone was added by the manufacturer to prevent hemolysis of the reagent red cells. The patient's antibodies were IgM, complement independent, and nonneutralizable by prior incubation with hydrocortisone. The addition of hydrocortisone to other manufacturers' reagents converted previously negative reactions to the same level of positivity as was seen with the reagent from the index manufacturer. Antibodies to reagent constituents can cause delays in finding compatible blood. It is suggested that manufacturers delete irrelevant additives or those of questionable necessity from their reagents.
Coagulation parameters of CPD fresh‐frozen plasma and CPD cryoprecipitate‐poor plasma after storage at 4°C for 28 days
Authors: Gregoor P.J. Smak , Harvey M.S. , Briët E. , Brand A.
Published: March 2003

A pilot study was performed on the storage of plasma and cryosupernatant plasma at 4 degrees C for up to 28 days. Eight bags, four of CPD fresh‐frozen plasma (FFP) and four of CPD cryosupernatant plasma (CSP, plasma without cryoprecipitate), were sampled during storage for assays of pH; factors V, VIII, IX, and XI; fibrinogen; prothrombin time; activated partial thromboplastin time (APTT); plasma protein electrophoresis; viscosity; and C1q binding. No changes were found in viscosity or the plasma protein electrophoretic pattern, and there was no detectable immune complex formation. The fibrinogen concentration remained constant, and the prothrombin time showed a gradual increase of 2.5 seconds for both groups of plasma. The labile coagulation factor V decreased gradually for FFP and CSP to 58 and 64 percent of its initial value, respectively (51 ± 8% and 54 ± 6% of the value of fresh pooled plasma). Factor VIII decreased to 36 percent of its initial value in FFP (48 ± 14% of fresh pooled plasma). In CSP, factor VIII decreased after 28 days to 7 percent of its initial value (7 ± 1% of fresh pooled plasma). The APTT increased for FFP from 28 to 35.8 ± 1.1 seconds and for CSP from 36 to 49.5 ± 4.9 seconds. The only chemical change observed for both plasmas was a rise in pH, from 7.27 to 7.56, after 28 days. The results of this pilot study indicate that FFP can be stored at 4 degrees C for 28 days with sufficient recovery of coagulation factors to maintain hemostasis. The prolongation of the APTT in CSP is due to factor VIII deficiency. In vascular surgery and intensive care patients who do not have prolonged APTT, CSP stored at 4°C for up to 28 days could be used, but in vivo studies are necessary for evaluation.
The effectiveness of the confidential unit exclusion option
Authors: PETERSEN L.R. , LACKRITZ E. , LEWIS W.F. , SMITH D.S. , HERRERA G. , RAIMONDI V. , ABERLE‐GRASSE J. , DODD R.Y.
Published: March 2003

BACKGROUND: The confidential unit exclusion (CUE) option is intended to reduce human immunodeficiency virus (HIV) transmission by excluding donors newly infected with HIV who have not yet developed HIV antibody (window‐period donors); however, its efficacy in excluding window‐ period donors has not been evaluated. STUDY DESIGN AND METHODS: The use of the CUE option was studied among the donors of 3.7 million units at 18 American Red Cross blood services regions during 1991 and 1992 and among 322 previously HIV‐1‐seronegative donors who subsequently donated a seropositive unit between 1987 and 1990 at 40 United States blood centers. These seroconverting donors had previously been shown to be highly likely to donate during their window period. RESULTS: On the basis of data from these two populations, it was estimated that only 3 to 5 percent of units donated by window‐period donors were not transfused because of the CUE option, that 0.4 percent of all donations were from donors who confidentially excluded their blood from transfusion, and that donors who confidentially excluded their blood were 21 times more likely to be HIV antibody‐positive than donors who did not use the CUE option. It is estimated that, if all US blood centers used the CUE option, a total of 2 to 17 otherwise acceptable units donated by window‐period donors would not be transfused annually. CONCLUSION: Although donors who confidentially exclude their blood from transfusion are 21 times more likely to have HIV antibody, the rarity of window‐period donors and the infrequency of confidential exclusion by window‐period donors cause the CUE option to have minimal impact on transfusion safety
Characteristics of white cell‐reduced red cells stored in tri‐(2‐ ethylhexyl)trimellitate plastic
Authors: DAVEY R.J. , HEATON W.A.L. , SWEAT L.T. , STEC N.M. , NELSON E.J. , HOLME S.
Published: March 2003

BACKGROUND: Standard blood storage containers contain extractable plasticizers that accumulate in blood during storage and are an unintended transfusion product. However, extractable plasticizers have a protective effect on the red cell membrane and improve red cell storage variables. Prestorage white cell reduction also improves selected red cell storage variables. STUDY DESIGN AND METHODS: The study evaluated whether the beneficial effect of prestorage white cell reduction would offset the negative effect of the absence of extractable plasticizer in red cells stored in AS‐3 for 42 days at 4 degrees C. Filtered red cells stored in polyvinylchloride containers with the nonextracting plasticizer, tri‐(2‐ethylhexyl)trimellitate (TEHTM), were compared to unfiltered red cells stored in polyvinylchloride containers with the extractable plasticizer di‐(2‐ ethylhexyl)phthalate (DEHP). RESULTS: Poststorage supernatant potassium and red cell osmotic fragility were significantly higher in white cell‐ reduced TEHTM units than in unfiltered DEHP units. The mean 24‐hour recovery of the filtered TEHTM red cells was significantly lower than that of the unfiltered DEHP red cells (69.1 +/− 7.4% vs. 77.1 +/− 5.1%, p < 0.05, n = 8). CONCLUSION: These data demonstrate that white cell reduction before 42‐day storage in TEHTM containers with currently approved preservatives does not yield an acceptable red cell component.
Reappraisal of optimal hemoglobin standards for female blood donors in Canada
Authors: Pi D.W. , Krikler S.H. , Sparling T.G. , Carter C.J. , Wadsworth LD
Published: March 2003

BACKGROUND: A hemoglobin (Hb) standard of 115 g per L on the copper sulfate test has been in use by the Canadian Red Cross Society Blood Services for female blood donor predonation screening since 1989.

STUDY DESIGN AND METHODS: To determine if this lowered Hb standard results in increased iron deficiency in repeat blood donors, a study was conducted to evaluate the performance of the copper sulfate test and predonation capillary and venous Hb assays in a population of female blood donors most at risk of developing iron deficiency.

RESULTS: Of the 174 donors who were of childbearing age, who were not taking iron supplements, and who had made at least three blood donations per year, 45 (25.9%) were iron deficient, and 64 (36.8%) had reduced iron stores; only 65 (37.3%) had normal iron stores. This study showed that capillary blood is more likely to have a higher Hb concentration (3.2 +/− 7.8 g/L) than venous blood samples, which could affect the performance of predonation screening assays that are based on capillary blood samples at a given discriminating value. With an Hb standard of 115 g per L, both the copper sulfate and capillary Hb assays were not sensitive enough to screen for iron deficiency (sensitivity, 27% and 33%; specificity, 96% and 93%, respectively) and were comparable only to the performance of a venous Hb assay with a cutoff value of 110 g per L (sensitivity, 27%; specificity, 99%). In contrast, an Hb standard of 125 g per L in the copper sulfate test could achieve a more optimal sensitivity of 79 percent and specificity of 78 percent.

CONCLUSION: This study supports the use of a higher Hb cutoff value of 125 g per L for female blood donors in the predonation fingerstick copper sulfate test.
Red cell autoantibody production in utero: a case report
Authors: Erler B.S. , Smith L. , McQuiston D. , Pepkowitz S.H. , Goldfinger D.
Published: March 2003

BACKGROUND: Autoantibody production by the fetus is thought to be extremely unlikely. Only one possible case of in utero autoantibody production against red cells by the fetus has previously been described.

STUDY DESIGN AND METHODS: A case of apparent red cell IgG autoantibody production in utero is reported.

RESULTS: This was established by a positive direct antiglobulin test in a newborn infant without evidence of maternal alloantibodies or autoantibodies. There was no evidence of clinically significant hemolysis at the infant's birth. After 6 weeks, his direct antiglobulin test remained strongly positive. The infant thrived without evidence of hemolysis, and after 6 months the direct antiglobulin test was negative.

CONCLUSION: The production of autoantibodies to red cells in utero is possible, though rare. This did not result in apparent hemolysis in this patient.
Hepatitis C viral markers in patients who received blood that was positive for hepatitis C virus core antibody, with genetic evidence of hepatitis C virus transmission
Authors: Watanabe M. , Ohkoshi S. , Tawaraya H. , Miyajima T. , Shimotohno K. , Kamimura T. , Asakuar H.
Published: March 2003

Background: Despite the use of the anti‐c100‐3 assay for blood donor screening, posttransfusion non‐A,non‐B hepatitis still occurred. A more sensitive assay should be developed to prevent this.

Study Design and Methods: Stored serum specimens from 2020 healthy blood donors who were negative for c100‐3 antibody to hepatitis C virus (HCV) were retrospectively screened for the presence of antibodies against a core protein of HCV using an enzyme‐linked immunosorbent assay and Western blot analysis as part of a study on posttransfusion non‐A,non‐B hepatitis.

Results: Eight (0.4%) of the 2020 donors were positive for HCV core antibody. Posttransfusion non‐A,non‐B hepatitis occurred in 5 of five patients known to have received blood that was positive for HCV core antibody and 1 of 141 patients transfused with blood that was negative for HCV core antibody. The total incidence of posttransfusion non‐A,non‐B hepatitis was 4.1 percent (6/146). The nucleotide sequence of the nonstructural 5 region of the HCV genome obtained from two donors and corresponding recipients was also analyzed. The HCV genome sequences were identical for one donor‐recipient pair, and there was 99.4‐percent homology for a second pair.

Conclusion: Anti‐core‐positive blood proved to be highly infectious for HCV, and this validated the use of the second‐generation anti‐HCV assay for blood donor screening.
A survey of the incidence of Miltenberger antibodies among Hong Kong Chinese blood donors
Authors: Mak K.H. , Banks J.A. , Lubenko A. , Chua K.M. , de Jardine A.L. Torres , Yan K.F.
Published: March 2003

Background: The ready availability of red cells of the Miltenberger (Mi) class III phenotype (6.28%) prompted the study of Mi antibodies among Chinese blood donors in Hong Kong, 98 percent of whom are descended from inhabitants of Guangdong Province in southern China.

Study Design and Methods: Red cells of the Mi class III phenotype were used to conduct a survey of the frequency of Miltenberger antibodies in 56,161 random Chinese blood donors, over a period of 12 months, using a microplate technique.

Results: Sera from 32 donors (0.057%) were found to contain Mi antibodies: sera from 22 contained anti‐Mur + Hut; sera from 4 contained anti‐Vw + Mur + Hut; sera from 4 had monospecific anti‐ Mur; and sera from 2 had monospecific anti‐Hil. The immunoglobulin isotypes of 24 sera were mixtures of IgM and IgG, 4 were pure IgM, and 4 were pure IgG.

Conclusion: The majority of Mi antibodies detected were naturally occurring. This survey proved useful for mass screening of random donors for the procurement of valuable Mi antisera.
Effect of freezing on the in vivo recovery of irradiated red cells
Authors: MIRAGLIA C.C. , ANDERSON G. , MINTZ P.D.
Published: March 2003

BACKGROUND: Transfusion‐associated graft‐versus‐host disease can be prevented by gamma radiation of blood components. The increased use of blood components donated for patients by their family members has resulted in an increased demand for the storage and handling of irradiated units, and the ability to freeze the cells would allow storage beyond their current expiration date.

STUDY DESIGN AND METHODS: To assess the effect of freezing and deglycerolization on irradiated red cells, studies of autologous radiolabeled red cell recovery were performed using normal volunteers. Each unit of CPDA‐1 red cells was immediately divided into two equal volumes. Further handling of each half was identical except that one was irradiated (3500 cGy). The units were grouped under three protocols: I, irradiated on Day 0 and frozen on Day 5 (n = 4); II, irradiated on Day 7, rejuvenated, and frozen on Day 14 (n = 5); and III, irradiated on Day 14, rejuvenated, and frozen on Day 18 (n = 3). All cells were frozen for 3 to 10 months at −80 degrees C.

RESULTS: Irradiated and control units showed no significant differences in supernatant potassium or hemoglobin. Autologous 24‐hour posttransfusion recoveries (mean +/− SD) for the three groups were: I, 89.7 +/− 5.6 percent (control, 90.6 +/− 3.2%); II, 85.3 +/− 5.7 percent (control, 83.7 +/− 3.0%); and III, 79.5 +/− 1.4 percent (control, 82.6 +/− 5.2%). CONCLUSION: Irradiated red cells can be frozen after being stored under various conditions and can still meet established guidelines requiring 75‐percent recovery 24 hours after transfusion.
Collection and transfusion of blood and blood components in the United States, 1992
Authors: Wallace E.L. , Churchill W.H. , Surgenor D.M. , An J. , Cho G. , McGurk S. , Murphy L.
Published: March 2003

BACKGROUND: Studies were conducted to measure the state of the United States' national blood resource in 1992 and changes therein from 1989.

STUDY DESIGN AND METHODS: With data supplied by the American Red Cross and the American Association of Blood Banks, as well as data from a stratified random‐sample survey of 3350 non‐American Association of Blood Banks hospitals, statistical methods were applied to estimate national blood activities in 1992.

RESULTS: The total US blood supply in 1992 was 13,794,000 units, a decrease of 3.1 percent from 1989. Some 11,307,000 red cell units were transfused to 3,772,000 patients, an average of 3.0 units per transfused patient. Preoperative autologous blood deposits totaled 1,117,000 units, a 70‐percent increase over 1989. Of this number, 566,000 units (50.7%) were transfused, 5,000 (4.4%) transferred to the allogeneic supply, and 546,000 (48.9%) discarded. Of 436,000 directed‐donation units, 136,000 (31.2%) were transfused, 57,000 (13.1%) transferred to allogeneic supply, and 243,000 (55.7%) discarded. The total allogeneic blood supply, including imports, decreased by 7.4 percent from 1989, and allogeneic blood transfusions, including those to children, decreased by 8.6 percent. Over 8,300,000 platelet units were transfused; of these, some 3,600,000 were apheresis platelets. In addition, 2,255,000 units of plasma and 939,000 units of cryoprecipitate were transfused.

CONCLUSION: While the US blood supply was adequate for transfusion needs in 1992, blood collections and red cell transfusions had decreased substantially since 1989.