bluuebunny/crossref_metadata_2025 huggingface dataset:
A search for hepatitis C virus polymerase chain reaction‐positive but seronegative subjects among blood donors with elevated alanine aminotransferase
Authors: Prince A.M. , Scheffel J. W. , Moore B.
Published: March 2003

BACKGROUND: Previous studies reported the existence of hepatitis C virus (HCV) polymerase chain reaction (PCR)‐positive but seronegative sera. This is not surprising in the case of window‐phase specimens, because PCR can detect HCV RNA many weeks before the appearance of antibody. To determine whether such sera can also be found in chronically infected subjects, a high‐risk population of blood donors with elevated alanine aminotransferase was studied. STUDY DESIGN AND METHODS: Freshly frozen plasma from 301 donors with alanine aminotransferase > 100 IU per L was tested with PCR assays that were rigidly controlled for specificity and contamination, and with current and newer versions of assays for anti‐HCV. Sera were classified as seropositive if positive in two screening assays and one supplemental assay or if positive in two screening assays and PCR. RESULTS: New versions of screening assays detected 100 percent of seropositive samples. A second‐generation immunoblot assay detected 98 percent of seropositive sera, a second‐generation recombinant immunoblot assay detected 96 percent, and an enzyme immunoassay for antibody to the envelope protein of HCV detected 98 percent. Fifty‐one of 54 seropositive sera were PCR positive. None of the 247 seronegative samples was reproducibly positive on PCR. CONCLUSION: No PCR‐positive but seronegative donors were found in this high‐risk donor population. The possible benefit of PCR screening of blood donors can be determined only by large‐scale comparative testing of donor populations and may be limited to the detection of window‐phase infections.
Growth of bacteria in platelet concentrates obtained from whole blood stored for 16 hours at 22°C before component preparation
Authors: Sanz C. , Pereira A. , Vila J. , Faundez A.‐I. , Gomez J. , Ordinas A.
Published: March 2003

BACKGROUND: Previous studies have shown that cooling whole blood to 22°C immediately after collection allows it to be held for up to 16 hours before component preparation (overnight‐hold method) without a significant decrease in the quality of components obtained. A study was designed to evaluate the effect of the overnight‐hold method on the growth of bacteria in experimentally contaminated blood units.

STUDY DESIGN AND METHODS: Twenty whole‐blood units were inoculated with Staphylococcus epidermidis (300 colony‐forming units [CFU]/mL; n = 10) or Escherichia coli (50 CFU/mL; n = 10) immediately after collection. Half the units of each group were fractionated 6 hours after collection and the other half after storage for 16 hours at 22°C. Twenty additional whole‐blood units were divided in two equal parts, one of which was white cell reduced before inoculation. These 40 half‐units were inoculated with S. epidermidis or E. coli and processed by the overnight‐hold method. The growth of bacteria was assessed in platelet concentrates on the second and fifth days of storage, in packed red cells on Day 35, and in fresh‐frozen plasma after 60 days.

RESULTS: No bacteria growth was detected in plasma or red cell units. On the second day of storage, both bacteria strains grew more slowly in platelet concentrates obtained from blood processed by the overnight‐hold method. This difference disappeared for S. epidermidis on the fifth day. When white cell‐reduced and non‐white cell‐reduced whole‐blood units were compared, platelet concentrates from the latter showed a delayed growth of both bacterial strains on the second and fifth days of storage.

CONCLUSION: Prolonged storage of whole‐blood units at 22°C before component preparation delays bacteria growth. This effect seems to be mediated by white cells.
Application of a computer program to exclude additional unexpected antibodies
Authors: Rondeel J.M.M. , van Opdorp A.H.B. , Dinkelaar R.B.
Published: March 2003

BACKGROUND: When a patient has produced red cell (RBC) antibodies in the past, he or she is at risk of producing additional antibodies after antigen challenge. The presence of these antibodies should be excluded before each transfusion. The following criteria are applied when using commercial test RBCs: RBCs should not express the antigen against which the previously documented antibody is directed. For other clinically significant antigens, at least one RBC sample should be from a donor who is homozygous for the encoding gene. The manual selection of such RBCs is tedious and requires experience.

STUDY DESIGN AND METHODS: A computer program has been developed that generates exclusion panels (EPs) by selecting a minimum number of RBCs from commercial test panels complying with current criteria. When RBCs from a donor who is homozygous for the encoding gene are absent, the program selects, as a second‐best option, RBCs from a donor who is heterozygous for that gene. The computer program developed for this study investigated the usefulness of commercially available panels from separate manufacturers in excluding the presence of additional antibodies. A list of 488 antibodies detected by a regional blood bank in 1994 was used as cases of antibodies documented in the past.

RESULTS: In 61 percent of the cases, successful EPs (i.e., those complying with the criteria), consisting of three to four different phenotypes, were selected. In the remaining 39 percent of cases, it was impossible to generate successful EPs: 1 to 2 additional antibodies could not be excluded or could be excluded only by using RBCs from heterozygotes. Commercial panels differed only slightly in their efficiency in providing suitable RBCs. None of the commercial panels could provide suitable RBCs to exclude all additional antibodies in the presence of anti‐c, anti‐e, or anti‐M. Increasing the number of RBCs from which to select EPs only slightly increased the percentage of success.

CONCLUSION: Computer‐aided construction of EPs quickly shows whether strict criteria can be met or whether alternative techniques should be used. It leads to a significant reduction in the number of RBC suspensions necessary to exclude additional antibodies. Results with various commercial panels differed only slightly.
Shelf‐life of photodynamically sterilized red cell concentrates with various numbers of white cells
Authors: Moor A.C.E. , van der Veen A , Wagenaars‐van Gompel A.E. , Dubbelman T.M.A.R. , VanSteveninck J , Brand A
Published: March 2003

BACKGROUND: Phthalocyanines are useful sensitizers for the photodynamic sterilization of red cell concentrates. The use of the phthalocyanine Pc4 (HOSiPcOSi(CH3)2(CH2)3N(CH3)2) and red light is very efficient in killing various viruses. The addition of scavengers of Type I photodynamic reactions and the use of cremophor to deliver Pc4 give protection to the red cells. STUDY DESIGN AND METHODS: Various red cell components, either white cell‐enriched, buffy coat‐removed, or white cell‐reduced, have been used to study the effect of photodynamic treatment with Pc4 on hemoglobin and potassium leakage and on ATP and glucose levels after prolonged storage. RESULTS: After treatment, storage interval‐dependent damage to the red cells could be observed. In components with 26 × 10(9) white cells per L, virus inactivation was less efficient than that in components with no or 2 × 10(9) white cells per L. Similarly, red cells were less affected by the treatment in components with a large number of white cells. Pretreatment storage and use within 1 week after photodynamic treatment induce less damage to the red cells at the moment of transfusion. CONCLUSION: Various improvements in the treatment protocol may ultimately lead to the implementation of photodynamic treatment in transfusion practice. In this respect, the white cell content of the red cell concentrates should be taken into account.
Role of screening for hepatitis C virus in children with malignant disease and who undergo bone marrow transplantation
Authors: Tada K. , Tajiri H. , Kozaiwa K. , Sawada A. , Guo W. , Okada S.
Published: March 2003

BACKGROUND: Children with malignant disease who received multiple blood transfusions before the clinical definition of hepatitis C virus (HCV) require evaluation for HCV infection. STUDY DESIGN AND METHODS: The role of HCV infection in 54 children with primary malignant disease was evaluated in terms of the following aspects: prevalence of HCV infection, distribution of HCV subtype, the benefit of screening of blood donors, and the presence of chronic liver disease. The benefit of screening for HCV in a subset of patients who underwent bone marrow transplantation (BMT) was also evaluated. RESULTS: Seventeen patients (31.4%) of 54 tested were seropositive in a second‐generation HCV antibody test. Thirteen patients (24.0%) were also positive for circulating HCV RNA. HCV subtype 1b and HCV subtype 2b were found in six and two patients, respectively. Multiple HCV genotypes were present in two patients. One of these two patients had relatively progressive liver disease. Before the introduction of blood screening with a second‐ generation HCV antibody test, 15 of 35 patients seroconverted, whereas none of 7 patients seroconverted after the screening was used (p = 0.032). For patients who underwent BMT, the screening drastically decreased the seroconversion rate, from 7 of 11 patients to 0 of 6 (p = 0.016). CONCLUSION: A considerable number of children with primary malignant disease who received multiple blood transfusions became infected by HCV before HCV screening was used. Patients who underwent BMT were at high risk for HCV infection. Screening with a second‐ generation HCV antibody test has proven to be remarkably beneficial in preventing HCV infection in these children.
Prevalence of hepatitis G virus RNA in French blood donors and recipients
Authors: Loiseau P. , Mariotti M. , Corbi C. , Ravera N. , Girot R. , Thauvin M. , Portelette E. , Mariette X. , Roudot‐Thoraval F. , Benbunan M. , Lefrère J.‐J.
Published: March 2003

BACKGROUND: Recently, cases of chronic hepatitis were linked to the presence of genomic sequences of a newly described RNA virus termed hepatitis G virus (HGV) and belonging to the Flaviviridae family. STUDY DESIGN AND METHODS: The presence of HGV RNA was searched for by polymerase chain reaction in a population of blood donors and in patients who had received multiple blood component transfusions and/or intravenous immunoglobulin (IVIG) infusions. RESULTS: Twenty‐one (4.2%) of 500 donors were positive for HGV RNA as were 21 (10.7%) of 196 nonimmunosuppressed patients who had received multiple transfusions of packed red cells, 4 (8.7%) of 46 common variable immune deficiency (CVID) patients who had received only IVIG, and 22 (24.7%) of 89 bone marrow transplant (BMT) patients who had received IVIG and cellular components. The proportion of HGV‐positive individuals was significantly higher in the immunosuppressed recipients (CVID and BMT patients) than in the nonimmunosuppressed patients who were multiply transfused with packed red cells (p < 0.03). The proportion of HGV‐ positive individuals was significantly higher in the BMT patients who had received IVIG and cellular components than in the CVID patients who had received IVIG only (p < 0.03). Eight (17.0%) of the 47 HGV‐positive recipients and 48 (16.9%) of the 284 HGV‐negative recipients had a serum alanine aminotransferase level higher than the upper limit of normal (nonsignificant difference). The medical history of HGV‐positive donors failed to reveal a particular at‐risk event. The large majority of HGV‐infected patients had a normal serum alanine aminotransferase level, and the proportion of patients with elevated alanine aminotransferase was the same in HGV‐positive and in HGV‐negative recipients. CONCLUSION: The pathological significance of HGV infection remains unelucidated, and the classification of HGV as a new hepatitis virus was perhaps premature.
Retroviral transduction of peripheral blood leukocytes in a hollow‐ fiber bioreactor
Authors: Shankar Raji , Whitley Chester B. , Pan Dao , Burger Scott , McCullough Jeffrey , Stroncek David
Published: March 2003

BACKGROUND: Peripheral blood white cells (leukocytes) (PBLs) have been used as effective targets for genetic manipulation by transduction with retroviruses in open systems. A semi‐closed hollow‐fiber bioreactor was tested for culturing and transducing lymphocytes. STUDY DESIGN AND METHODS: PBLs were isolated from five healthy donors, and 5 × 10(7) cells were cultured in hollow‐fiber bioreactors for 4 days after stimulation with anti‐CD3 in medium containing 200 units per mL of recombinant interleukin 2. Transduction with retroviral vector containing the gene for iduronate‐2‐sulfatase and G 418 resistance, L2SN, was performed daily on Days 4, 5, 6, and 7, and the cells were expanded for an additional 3 days. RESULTS: PBLs from three donors were harvested from the bioreactor after transduction and expansion, and 4.5 × 10(9), 7.0 × 10(9), and 2.9 × 10(9) cells were recovered, representing 90‐, 136‐, and 58‐fold expansions. The transduction frequency of L2SN was 10, 5, and 1 percent, respectively. For additional expansion of PBLs, in two cases the bioreactor was reinoculated with 5 × 10(7) cells, which were expanded again for 16 and 8 days, respectively, yielding 1.4 × 10(9) and 3.1 × 10(9) cells, which reflected an additional 28‐ and 62‐fold expansion of cells. PBLs from two other donors were transduced and expanded in the bioreactor, and then 0.8 mg per mL of G 418 was added to the medium in an attempt to enrich the transduced population. Although 2.5 and 10 percent of the cells were transduced, cell death and absence of expansion in the presence of G 418 resulted in final cell lots with viabilities of only 4 and 8 percent. In all cases, the harvested cells tested negative in bacterial and fungal cultures. CONCLUSION: Hollow‐fiber bioreactors are an efficient and effective system for the retroviral transduction and expansion of PBLs for clinical gene therapy.
Specific antibodies to Trypanosoma cruzi among blood donors in Los Angeles, California
Authors: Shulman Ira A. , Appleman Maria D. , Saxena Sunita , Hiti Alan L. , Kirchhoff Louis V.
Published: March 2003

BACKGROUND: Trypanosoma cruzi, the cause of Chagas' disease, is often transmitted by transfusion in Latin America. Previous studies showed that at least 1 in 1000 eligible blood donors at the Los Angeles County+University of Southern California (LAC+USC) Medical Center Blood Bank had specific antibodies to T. cruzi. In June 1993, serologic screening of prospective allogeneic donors at epidemiologic risk for T. cruzi infection was begun voluntarily. STUDY DESIGN AND METHODS: The risk of T. cruzi infection in all eligible donors was assessed by questionnaire. At‐risk donors were screened serologically for antibodies to T. cruzi with an enzyme immunoassay, and confirmatory testing was done with a radioimmunoprecipitation assay. RESULTS: During the 29‐month study period 1311 (39.5%) of 3320 donors were judged to be at risk for T. cruzi infection. Seven donors (1/475) were reactive by an enzyme immunoassay, and six of these seven (1/ 553) were positive in a radioimmunoprecipitation assay. All radioimmunoprecipitation assay‐ positive donors had been born in countries in which Chagas' disease is endemic. One person in this group had received a transfusion in his homeland. CONCLUSION: These results demonstrate that a substantive proportion of eligible blood donors at our institution have antibodies specific for T. cruzi and that a commercially available assay can be used to detect these antibodies. Our data suggest that the risk of transmission of T. cruzi by transfusion could be eliminated by serologic testing limited to persons born in or transfused in countries in which Chagas' disease is endemic.
Effects of gamma irradiation on red cells from donors with sickle cell trait
Authors: Jin Young Shik , Anderson Garth , Mintz Paul D.
Published: March 2003

BACKGROUND: Transfusion‐associated graft‐versus‐host disease can be prevented by gamma irradiation of blood components. Red cells (RBCs) from sickle cell disease patients may exhibit oxidative changes of RBC membranes due to the instability of hemoglobin (Hb) S. Persons with sickle cell trait are eligible to donate blood, and 35 to 45 percent of their total Hb is Hb S. The effect of gamma irradiation on RBCs from such persons is of interest. STUDY DESIGN AND METHODS: RBCs from 12 donors with sickle cell trait (Hb AS) and from 12 with normal Hb (Hb AA) were studied. Each of the 24 RBC units was divided equally into two transfer bags via a sterile connecting device. One bag from each RBC unit received a 2500‐cGy dose of gamma irradiation at its mid‐plane and was stored at 4 degrees C; the second set of bags was stored without irradiation. For RBCs from 6 donors with Hb AS and 6 donors with Hb AA, units were irradiated on Day 7 and studied on Day 35 of storage (Group 1). For the RBCs from the other 6 donors with Hb AS and the other 6 donors with Hb AA, units were irradiated on Day 28 and studied on Day 42 of storage (Group 2). RESULTS: For Group 1 and Group 2, plasma potassium and plasma Hb concentrations were significantly higher and RBC ATP concentrations were slightly lower in the irradiated units than in the nonirradiated units. In Group 1 and Group 2, there were no significant differences in the plasma potassium or RBC ATP concentrations in either the irradiated or the nonirradiated units of RBCs from donors with Hb AS and donors with Hb AA. Plasma Hb concentrations were consistently lower in the units from donors with Hb AS, whether or not they were irradiated. However, in both groups, proportionally similar changes in plasma Hb concentration were detected when the irradiated Hb AS and Hb AA units were compared to nonirradiated Hb AS and Hb AA units. CONCLUSION: Gamma irradiation of RBCs from donors with Hb AS or with Hb AA resulted in comparable changes in plasma potassium, RBC ATP, and plasma Hb concentrations, although donors with Hb AS had lower plasma Hb. RBCs from donors with Hb AS subjected to 2500 cGy of gamma irradiation did not evidence a storage lesion greater than that seen in RBCs from donors with Hb AA.
Blood transfusions downregulate hematopoiesis and subsequently downregulate the immune response
Authors: Grzelak I. , Zaleska M. , Olszewski W.L.
Published: March 2003

BACKGROUND: Blood transfusions are associated with numerous clinical phenomena attributable to reduced posttransfusion immunocompetency. The exact mechanism by which blood transfusions induce a state of reduced immune responsiveness remains unclear. STUDY DESIGN AND METHODS: The effect of a large‐volume blood transfusion on the frequency and responsiveness of immune cells in lymphoid compartments was examined in normovolemic rats. The effects of syngeneic and allogeneic blood transfusions were compared. RESULTS: The results in normovolemic rats were compared to those in nontransfused and saline‐infused animals. In the normovolemic rats, there was a significant decrease in cells of erythroid lineage in bone marrow, with a slight increase in the percentage of cells in the bone marrow myeloid and lymphoid lineages; a significant increase in the percentage of the OX7+ Thy1+ cell population in bone marrow cells (stem cells are contained in this population) and blood cells; a decrease in the bone marrow OX6+ cell population (HLA class II‐positive cells); a decrease in the responsiveness of blood, spleen, lymph node, and bone marrow cell populations to mitogens; and a downregulating effect of both syngeneic and allogeneic blood transfusions on hematopoiesis and cell responsiveness. CONCLUSION: Massive whole blood transfusion, either syngeneic or allogeneic, constitutes a strong downregulating signal for hematopoiesis, affecting the erythroid, myeloid, and lymphoid cell lineages. It leads also to an attenuation of the responsiveness of hematopoietic tissues to mitogenic stimuli.
Nationwide survey of home transfusion practices
Authors: Benson K , Popovsky MA , Hines D , Hume H , Oberman HA , Glassman AB , Pisciotto PT , Thurer RL , Stehling L , Anderson KC
Published: March 2003

BACKGROUND: Limited information exists on home transfusion practices. STUDY DESIGN AND METHODS: In 1995, a survey requesting data for 1994 was sent to 1273 American Association of Blood Banks (AABB) institutional members and 113 non‐AABB home health care agencies that provide out‐of‐hospital transfusions. RESULTS: Of 943 respondents, 102 provide blood to a home transfusion program, 37 provide blood and run a home transfusion program, and 13 run a home transfusion program only, for a total of 152 (16%) with some involvement in home blood transfusions. Most of the 50 respondents with a home transfusion program are licensed by their state and accredited by the Joint Commission on Accreditation of Healthcare Organizations. All respondents have written policies for home transfusion, and 90 percent require a signed informed‐consent document before initiating transfusions in the home. Most have policies requiring that there be a second adult and a telephone in the home, that the home be deemed safe for transfusion, that the patient's physician be readily available, and that the patient have had prior transfusions. The most common component issued by the blood providers was red cells, followed by platelets. White cell‐reduced components were always provided by 36 percent of respondents. The most common patient diagnosis was cancer. Home transfusions were provided primarily by registered nurses. Only 14 percent of respondents indicated that the medical director of the blood bank is responsible for approving a patient for home transfusion. A posttransfusion visit is performed by 46 percent of respondents. CONCLUSION: Although most facilities have policies for the administration of home transfusions, there remains marked heterogeneity among blood providers and transfusionists regarding home transfusion practices.
Identification and characterization of an HIV‐2 antibody‐positive blood donor in the United States
Authors: Sullivan M.T. , Guido E.A. , Metler R.P. , Schable C.A. , Williams A.E. , Stramer S.L.
Published: March 2003

BACKGROUND: As of June 1, 1992, the Food and Drug Administration recommended that all donated blood be screened for antibodies specific to HIV‐2. Despite broad serologic surveillance, only two cases of HIV‐2 infection had been detected among potential blood and plasma donors since the implementation of the test. CASE REPORT: The identification of a third HIV‐2 antibody‐positive blood donor is reported. The first‐ time donor was identified by routine screening procedures as anti‐HIV‐ 1/HIV‐2‐reactive, and that status was confirmed by licensed HIV‐1 Western blot. Concurrent whole‐virus lysate enzyme immunoassay and Western blot for HIV‐2 were strongly positive, but the possibility of HIV‐1 cross‐reactivity could not be eliminated. The donor was notified, counseled, and deferred from future donation. He subsequently enrolled in a Centers for Disease Control and Prevention‐sponsored epidemiologic study of HIV‐positive former donors. When it was revealed during the standardized interview that he was a native of an HIV‐2‐endemic region, follow‐up samples were submitted to the Centers for Disease Control and Prevention. Investigational HIV‐1 and HIV‐2 peptide enzyme immunoassays indicated that this infection was due to HIV‐2 only. CONCLUSION: Enzyme immunoassays for antibodies to synthetic peptides of HIV‐1 and HIV‐2 may be useful in differentiating the two viruses in individuals with ambiguous Western blot results and risk factors for HIV‐2 infection.
Collection and transfusion of blood and blood components in the United States, 1994
Authors: Wallace E.L. , Churchill W.H. , Surgenor D.M. , Cho G.S. , McGurk S.
Published: March 2003

BACKGROUND:Collections and transfusions of blood in the United States in 1994 were measured and compared with those in 1992.

STUDY DESIGN AND METHODS:Completed survey questionnaires were returned by all 147 regional blood centers, 1340 American Association of Blood Banks (AABB) member hospitals, and 523 non‐AABB hospitals. Statistical tests verified the representativeness of the sample.

RESULTS:The United States domestic blood supply in 1994 (13,340,000 units) was 3.3 percent less than in 1992. It included allogeneic blood (11,773,000 units), autologous blood (1,013,000 units), and directed donations (334,000 units). Of these, 432,000 units were rejected on testing, 11,107,000 units were transfused to 3,398,000 patients, and 1,801,000 units were discarded or unaccounted for. Platelet transfusions amounted to 7,866,000 units. Compared with the totals for 1992, transfusions of single‐donor platelets (714,000 packs or 4,284,000 units) increased by 17.6 percent, while transfusions of platelet concentrates (3,582,000 units) fell by 23.6 percent. Fresh‐frozen plasma transfusions (2,621,000 units) increased by 16.2 percent over the number for 1992.

CONCLUSIONS:The US blood collection rate in 1994 was 74.6 units per 1000 population of donor age, the lowest recorded level since 1971. The US RBC transfusion rate in 1994 was 42.8 units per 1000 population, about the same as 1979. Transfusions of single‐donor platelets, 16.5 units per 1000 population, exceeded transfusions of platelet concentrate (13.8/1000) for the first time. Plasma transfusions were 10.1 units per 1000 population. The US blood supply in 1994 was adequate to meet patient demands.
Validation of a new immunoblot assay (LiaTek HIV III) for confirmation of human immunodeficiency virus infection
Authors: Zaaijer H.L. , van Rixel G.A.C.M. , Kromosoeto J.N.R. , Balgobind‐Ramdas D.R. , Cuypers H.T.M. , Lelie P.N.
Published: March 2003

BACKGROUND: Used as a supplemental assay, new anti‐human immunodeficiency virus (HIV) immunoblots, employing recombinant and synthetic antigens, appeared to resolve the majority of samples with false‐reactive Western blot results. Would it be possible to completely replace the Western blot by an immunoblot for confirmation and exclusion of HIV infection?

STUDY DESIGN AND METHODS:The sensitivity of the new LiaTek HIV III immunoblot assay (Organon Teknika, Turnhout, Belgium) was tested on 416 Western‐blot positive samples (386 HIV‐1, 22 HIV‐2, 1 HIV‐1/2, and 7 HIV‐O) and on 45 HIV‐1 seroconversion samples. The specificity was tested on 146 samples from noninfected donors with false‐positive results on a HIV screening test.

RESULTS:All Western‐ blot‐positive samples tested positive in the immunoblot (sensitivity: 100%). The immunoblot could not discriminate between HIV‐1 and HIV‐2 infection in 22 of 416 (5%) samples. The LiaTek assay showed reactivity in 28 of 45 seroconversion samples, whereas the Western blot reacted in 30 of 45 seroconversion samples. With false‐positive donor samples, the immunoblot was indeterminate in 10 of 146 samples (specificity: 93%), and the Western blot was indeterminate in 44 of 146 samples (specificity: 70%). CONCLUSION: Like the Western blot, the immunoblot runs the risk of missing samples that are reactive by enzyme immunoassay during the early stage of HIV infection. Nevertheless, considering its superior specificity on false‐positive donor samples, it appears that the immunoblot offers a cost‐effective alternative to the Western blot assay for confirmation and exclusion of HIV infection.
Human T‐lymphotropic virus type I among blood donors from Guadeloupe: donation, demographic, and biologic characteristics
Authors: Rouet F. , Foucher C. , Rabier M. , Gawronski I. , Taverne D. , Chancerel B. , Casman O. , Strobel M.
Published: March 2003

BACKGROUND: Epidemiologic data on human T‐lymphotropic virus type I (HTLV‐I) in Guadeloupe (French West Indies) are scant.

STUDY DESIGN AND METHODS: From January 1989 to December 1996, 59,426 blood donors were screened by enzyme immunoassay for antibodies to HTLV‐I. All repeatedly reactive samples were confirmed by Western blot. Temporal trends in HTLV‐I seropositivity rates were examined during the study period. A multivariate analysis of donation, demographic, and biologic characteristics was performed.

RESULTS: Of the screened blood donors, 195 were confirmed as seropositive, for an overall prevalence of 0.33 percent (95% CI 0.28‐0.38). A marked decrease in overall HTLV‐I prevalence with time (from 0.47% in 1989 to 0.13% in 1996) was observed, which can be explained mainly by the decreasing percentage of recruited new donors during the study period. Four independent risk factors for HTLV‐I were identified: new donor status (odds ratio [OR] 12.5), female sex (OR 1.7), increasing age (30‐39 years: OR, 2.4; 40‐49 years: OR, 3.7; >50 years: OR 6.6), and positive antibodies to hepatitis B virus core antigen (OR, 1.7). Selection of specific locations for blood collection was inversely associated with HTLV‐I (OR 0.5).

CONCLUSION: New donor status, advancing age, female sex, and positivity for hepatitis B virus core antibodies were the major factors associated with HTLV‐I infection in Guadeloupe.
A survey of phlebotomy among persons with hemochromatosis
Authors: McDonnell S.M. , Grindon A.J. , Preston B.L. , Barton J.C. , Edwards C.Q. , Adams P.C.
Published: March 2003

BACKGROUND: One in 10 whites in the United States is a carrier for hemochromatosis and an estimated 1 in 200 is clinically affected. Early treatment with therapeutic phlebotomy to remove excess iron can prevent associated chronic diseases. However, little information is available on the amount of blood withdrawn or the rates of withdrawal from hemochromatosis patients. The patterns of therapeutic phlebotomy and the magnitude of charges in persons with hemochromatosis were surveyed.

STUDY DESIGN AND METHODS: Surveys were mailed to persons with hemochromatosis identified by health care providers, blood centers, patient advocacy groups, and the Internet. There were 2362 respondents to the survey from the United States.

RESULTS: Thirty‐seven percent of respondents reported being voluntary blood donors prior to diagnosis. The mean rate of therapeutic phlebotomy for iron depletion was 2.6 units per month (mean duration, 13 months). The mean rate of maintenance phlebotomy was 0.5 units per month. Therapeutic phlebotomy rates varied by sex, age, reason for diagnosis, and severity of symptoms. Seventy‐six percent of respondents reported full or partial insurance coverage of therapeutic phlebotomy charges. Seventy‐six percent received therapeutic phlebotomy services in a hospital or physician's office and 30 percent in a blood center. Charges for therapeutic phlebotomy varied by site, with a mean cost of $90 in hospitals and $52 in blood centers. Fifty‐four percent of respondents attempted to donate blood after their diagnosis but were excluded.

CONCLUSION: The amount of blood withdrawn from persons with hemochromatosis is substantial. The location where patients received phlebotomy services appears to be influenced by charges and time since diagnosis.
A study of an educational intervention to decrease inappropriate preoperative autologous blood donation: its effectiveness and the effect on subsequent transfusion rates in elective hysterectomy
Authors: Kanter M.H. , Van Maanen D. , Anders K.H. , Castro F. , Mya W. Win , Clark K.
Published: March 2003

BACKGROUND: Decreasing the overcollection of preoperative autologous blood is difficult to achieve. The purpose of this study was to determine whether an educational intervention designed to outline the risks of preoperative autologous collection can decrease such donations and, if so, to determine how this decrease will affect subsequent transfusion rates.

STUDY DESIGN AND METHODS: An educational intervention consisting of a didactic presentation to the Department of Gynecology staff about the risks and benefits of autologous blood was implemented. Written material with similar information was given to patients. Subsequently, the percentage of patients donating autologous blood, the number of autologous units donated, and the rates of transfusion in patients eligible for autologous donation who were admitted for elective abdominal or vaginal hysterectomy were measured. These rates were compared to those in similar patients admitted in the 2 years before the educational intervention.

RESULTS: After an educational intervention, the proportion of patients donating autologous blood decreased from 53 percent to 26 percent (p<0.01), and the number of units collected per patient decreased from 0.86 to 0.31 (p<0.01); this resulted in a savings of 80 autologous donations per year. Despite no difference in estimated blood loss (p = 0.46), the overall transfusion rate decreased from 10 percent to 3.7 percent (p = 0.03), while the allogeneic transfusion rate demonstrated no significant change (1.1% vs. 2.2%; p = 0.40).

CONCLUSIONS: Unnecessary preoperative autologous donations by elective hysterectomy patients can be decreased by educating physicians and patients about the risks of preoperative autologous blood donation. Decreasing such unnecessary donations can decrease the subsequent autologous transfusion rate, with its attendant risks, without increasing the risk of allogeneic transfusion.
Antibodies provoked by the transfusion of biotin‐labeled red cells
Authors: Cordle D.G. , Strauss R.G. , Lankford G. , Mock D.M.
Published: March 2003

BACKGROUND: Biotin‐labeled (biotinylated) red cells (B‐RBCs) offer a technique by which to study RBC volume and circulating kinetics without in vivo radiation. The immunogenicity of B‐RBCs is undefined.

STUDY DESIGN AND METHODS: To determine if biotinylation renders RBCs immunogenic, autologous B‐RBCs were transfused to 20 healthy subjects, and plasma samples were obtained before transfusion and serially for up to 6 months after transfusion. These serial samples, plus plasma from 20 normal control subjects not given B‐RBCs, were screened for antibodies to B‐RBCs by use of an antiglobulin technique against aliquots of group O RBCs from a single donor—one aliquot biotinylated and one aliquot not biotinylated (i.e., test and control RBCs). Posttransfusion recovery and survival of B‐RBCs were also determined.

RESULTS: Plasma from none of 20 normal nontransfused subjects reacted with B‐RBCs. Similarly, none of the 20 subjects given autologous B‐RBC transfusions exhibited antibodies before transfusion. However, 3 of the 20 subjects transiently produced antibodies to B‐RBCs after transfusion. Antibodies disappeared within 6 months in 2 of these 3 subjects and within 12 months in the third. Antibody reactivity was not reduced by dithiothreitol, but in 2 of the 3 subjects, B‐RBC antibodies were neutralized by incubation with biotin solution. Circulating RBC kinetics were not altered in the 3 subjects with antibody. The significance of these observations is unclear, because antibodies were just beginning to emerge during the studies.

CONCLUSIONS: Biotinylation does not render RBCs reactive with normal human plasma (i.e., presumably does not evoke neoantigens). Transfused B‐RBCs occasionally provoke IgG antibodies in healthy subjects. Because the biologic effects of B‐RBC antibodies currently are unknown, testing for them is recommended when multiple B‐RBC transfusions are given to study RBC volume or circulating kinetics.
Collection of peripheral blood progenitor cells with an automated leukapheresis system
Authors: Rowley S.D. , Prather K. , Bui K.T. , Appel M. , Felt T. , Bensinger W.I.
Published: March 2003

BACKGROUND: Apheresis devices designed for the collection of mature blood elements are being used for the collection of peripheral blood progenitor cells (PBPCs). The collection of PBPCs differs from that of other cells in the rarity of the target cell and in the fact that donors may undergo several days of collection. A consequence of this process may be a depletion of blood cells such as platelets from the blood. The disposable set and operating software for an apheresis device (Spectra, COBE BCT) was modified by the manufacturer to automate the collection of PBPCs and reduce the collection of unwanted blood cells.

STUDY DESIGN AND METHODS: A study was initiated to compare the collection of PBPCs with the new device, the AutoPBSC (version [V]6.0 with AutoPBSC tubing set), and that with the MNC (mononuclear cell) procedure (V4.7 with white cell tubing set), for patients and healthy donors.

RESULTS: Patients whose blood was processed by either the V6.0 or V4.7 procedure achieved the target dose of 5 × 106 CD34+ cells per kg of patient weight in similar numbers of procedures, even though the calculated collection efficiency for CD34+ cells using the automated V6.0 procedure was significantly less than that with the V4.7 procedure for both allogeneic donors and patients donating PBPCs. The collection efficiency for platelets was lower with the V6.0 procedure, and components collected in this manner contained fewer platelets. Apheresis by the V6.0 procedure required 30 to 60 more minutes per procedure than apheresis by the V4.7 procedure. Review of engraftment kinetics after transplantation did not reveal any effect of the collection procedure on recipients of either allogeneic or autologous transplants.

CONCLUSION: The collection efficiencies of the V6.0 procedure for both CD34+ cells and mature blood cells are lower than those of the V4.7 procedure. The lower collection efficiency for platelets results in a smaller drop in peripheral blood platelet count after the procedure. The automated features of the V6.0 procedure may simplify PBPC collection, but this procedure requires a longer apheresis.
Evidence for a separate genetic origin of the partial D phenotype DBT in a Japanese family
Authors: Huang C.H. , Chen Y. , Reid M.E. , Okubo Y.
Published: March 2003

BACKGROUND: In a Moroccan family, the partial D phenotype DBT is defined by an RHD‐CE‐D gene in which exons 5 to 7 of RHD were replaced by those of RHCE. In this study, the molecular basis and inheritance of DBT in a Japanese family are described.

STUDY DESIGN AND METHODS: A Japanese proposita exhibiting the DBT phenotype was analyzed by serologic methods and molecular techniques. The RH transcripts of the proposita were sequenced and compared with those of normal donors. The inheritance and structure of the RH genes in the family were determined by Southern blot analysis and exon‐specific polymerase chain reaction.

RESULTS: The proposita typed weak D and C+c+E+e+Rh:32. Family data indicated a cotransmission of Rh32 with DBT and a linkage of C and e with DBT. Southern blot testing of the proposita's genomic DNA indicated a partial and a total absence of RHD on the respective homologous chromosomes. Sequencing of her cDNA showed expression of Ce, cE, and RHD‐CE‐D transcripts but not D. The RHD‐CE‐D hybrid was characterized by a conversion of five RHD exons into RHCE exons (exons 5‐9). The 5′ and 3′ breakpoints in the fusion gene were localized to the intron 4/exon 5 region and intron 9.

CONCLUSION: The new RHD‐CE‐D gene defines a separate genetic origin of DBT in the Japanese family. The proximal sequence encoded by RHD exon 4 and RHCE exon 5, together with the distal RHCE sequence, may involve the cotransmission of Rh32 and DBT, which behave as codominant and recessive characters, respectively.
Improved collection of mobilized CD34+ hematopoietic progenitor cells by a novel automated leukapheresis system
Authors: Ravagnani Fernando , Siena Salvatore , De Reys Stefan , Di Nicola Massimo , Notti Paola , Giardini Roberto , Bregni Marco , Matteucci Paola , Gianni Alessandro M. , Pellegris Giuseppe
Published: March 2003

BACKGROUND: For simplification of blood cell transplantation, an automated apheresis system that exploits a dual‐stage channel device for mononuclear cell (MNC) collection (Au‐toPBSC, designed for the COBE Spectra) was studied.

STUDY DESIGN AND METHODS: The automated default software (AutoPBSC‐Default) and three software modifications of the harvest frequency during leukapheresis, referred to as Au‐toPBSC‐1.25, AutoPBSC‐1.75, and AutoPBSC‐2.75, were evaluated in comparison with the semiautomated Version 4.7 (V4.7) apheresis system in 119 leukapheresis procedures performed in 90 cancer patients treated with chemotherapy plus granulocyte–colony‐stimulating factor. CD34+ cell and platelet collection efficiency (CE); volume and cell composition of the leukapheresis components; and patient platelet and red cell (RBC) loss during leukapheresis were measured.

RESULTS: The majority of collection measures evaluated with the AutoPBSC compared favorably to those obtained with the V4.7. CD34+ cell CE increased from 55 percent with V4.7 to 68 percent with the AutoPBSC‐Default (p = 0.05). The AutoPBSC provided lower platelet contamination in the collected component (1.18 × 1011 vs. 2.26 × 10′′ with the V4.7;p< 0.001). The volume of the AutoPBSC‐Default component was significantly lower (67 vs. 180 mL with the V4.7; p<0.001). The MNC purity of the AutoPBSC component was greater (52 vs. 28% with the V4.7; p<0.001), and the RBC contamination lower (AutoPBSC, 0.53 × 1011 vs. 1.04 × 1011 with the V4.7; p<0.001). Modifications of the AutoPBSC to increase the harvest frequency by 1.25‐, 1.75‐, and 2.75‐fold resulted in increased CD34+ cell CE (77%, 75%, and 83%, respectively; p<0.001 in all cases), but also in reduced numbers of circulating platelets, higher platelet contamination of the component, and lower MNC purity than were seen with the AutoPBSC‐Default.

CONCLUSION: The AutoPBSC offers the following advantages over the V4.7 system: a) better CE of CD34+ cells; b) reduced collection of platelets; c) reduced contamination of the leukapheresis component with granulocytes, platelets, and RBCs; d) reduced component volume; and e) automation.
Long‐term storage at −80°C of hematopoietic progenitor cells with 5‐percent dimethyl sulfoxide as the sole cryoprotectant
Authors: Galmés Antonio , Besalduch Judy , Bargay Judy , Novo Andres , Morey Miguel , Guerra José M. , Duran Maria A.
Published: March 2003

BACKGROUND: Hematopoietic progenitor cells (HPCs) can be cryopreserved and stored below −120°C in liquid nitrogen or at −80°C in mechanical freezers.

STUDY DESIGN AND METHODS: The feasibility of long‐term storage of HPCs at −80°C was investigated. The studies included a comparison of 5‐ and 10‐percent dimethyl sulfoxide (DMSO) as cryoprotectant at various lengths of storage time. Mononuclear cell (MNC) recovery and viability and colony‐forming unit‐granulocytemacrophage (CFU–GM) and burst‐forming unit–erythroid (BFU‐E) recovery assays were performed. The peripheral blood HPCs of 24 consecutive patients included in the program of autologous transplantation were studied.

RESULTS: The MNC viability decreased progressively with the length of time from cryopreservation, reaching 32 percent after 31 months of storage. The recovery rates of CFU–GM and BFU–E also decreased progressively with the duration of frozen storage, to 50 and 43.5 percent, respectively, after 12 months and to 0 percent (both) after 24 months. At 6 months of storage, MNC viability was 80 percent, and CFU–GM and BFU–E recovery was 63.5 and 80.5 percent, respectively. There were no differences between MNCs cryopreserved with 5‐ or 10‐percent DMSO in terms of cell viability. There were no differences between CFU–GM recovery or BFU–E recovery from HPCs cryopreserved in 5‐ or 10‐percent DMSO. Patients given HPCs stored in these conditions for periods ranging between 123 and 202 days showed a complete and rapid hematologic recovery.

CONCLUSION: HPCs can be cryopreserved at −80°C with 5‐percent DMSO and stored at −80°C no longer than 6 months. A 5‐percent DMSO concentration is comparable to a with 10‐percent concentration in terms of recovery and MNC viability.
Elimination of cytokine production in stored platelet concentrate aliquots by photochemical treatment with psoralen plus ultraviolet A light
Authors: Hei Derek J. , Grass Joshua A. , Lin Lily , Corash Laurence , Cimino George D.
Published: March 2003

BACKGROUND: Cytokines generated in platelet concentrates (PCs) during storage have been implicated as possible mediators of febrile nonhemolytic transfusion reactions. Two potential methods of white cell inactivation were compared for their ability to reduce cytokine synthesis in pooled random‐donor PC aliquots: treatment with γ‐radiation and photochemical treatment (PCT) using psoralens and ultraviolet A light.

STUDY DESIGN AND METHODS: ABO‐matched PC aliquots were pooled and divided into separate aliquots. Aliquots (20 mL) were taken from each pool to serve as an untreated control and to undergo γ‐radiation. Aliquots were treated by using either γ‐radiation (2500 or 5000 cGy) or virucidal PCT. PCT with the psoralens 8‐methoxypsoralen (8‐MOP), aminomethyltrimethyl psoralen (AMT), and S‐59 was investigated. PC aliquots were stored for 7 days and analyzed for levels of interleukin 8 by use of an enzyme‐linked immunosorbent assay. Levels of DNA adduct formation were determined by using 3H‐labeled psoralens.

RESULTS: Levels of interleukin 8 in the untreated random‐donor PC aliquots increased with increasing white cell counts, but they were not affected by pooling. The untreated control aliquots and the aliquots treated with γ‐radiation had significant increases in levels of interleukin 8 after 5 to 7 days of storage (p<0.05). PCT with S‐59 resulted in a significant reduction in cytokine synthesis (p<0.05). Day 5 to 7 levels of interleukin 8 did not differ significantly from Day 0 levels. Inhibition of interleukin 8 production by PCT increased with increasing levels of DNA modification (S‐59 > AMT > 8‐MOP).

CONCLUSION: PCT that utilizes S‐59 has been developed to inactivate potential viral and bacterial pathogens in PC aliquots while maintaining in vitro platelet function. These data demonstrate that PCT of aliquots of pooled PC aliquots before storage also prevents white cell cytokine synthesis during storage. PCT may therefore offer the potential for reducing cytokine‐associated febrile nonhemolytic transfusion reactions.
Trypanosoma cruzi in a low‐ to moderate‐risk blood donor population: seroprevalence and possible congenital transmission
Authors: Leiby David A. , Fucci Mei‐Chien Huang , Stumpf Robert J.
Published: March 2003

BACKGROUND: Several recent studies documented the seroprevalence of Trypanosoma cruzi in blood donors at high risk for infection, but little information is available regarding donors with lower levels of risk. Thus, the present study was designed to measure the seroprevalence of T. cruzi in a donor population with a low to moderate risk for infection.

STUDY DESIGN AND METHODS: During a 10‐month period, donations from all allogeneic blood donors in the American Red Cross Southwest Region were tested for T. cruzi antibodies by enzyme immunoassay, and results were confirmed by radioimmunoprecipitation. Confirmed‐seropositive donors were counseled and lookback investigations were initiated for those who were repeat donors.

RESULTS: A total of 100,089 donations were tested: 150 were repeatably reactive, and 3 (0.003%) were confirmed as positive for T. cruzi antibodies. All three seropositive donors were from the Waco, TX, area, where the estimated seroprevalence rate was 1 in 7700. Two of these three donors reported no risk factors; both were born in the United States and had not traveled to an endemic area. Both had extensive familial histories of cardiac disease and complications.

CONCLUSION: Blood donors seropositive for T. cruzi are present in populations with low to moderate risk, albeit at lower rates. The presence of seropositive blood donors without the usual identifiable risk factors argues against the use of a geographic screening question and also suggests that other routes of transmission, including the congenital route, should be considered in efforts to increase blood safety.