bluuebunny/crossref_metadata_2025 huggingface dataset:
Acute hemolysis and renal failure with rifampicin‐dependent antibodies after discontinuous administration
Authors: Tahan Steven R. , Diamond Jonathan R. , Blank Joyce M. , Horan Richard F.
Published: March 2003

Acute hemolysis as a reaction to rifampicin is extremely rare; case reports number less than 15. We recently evaluated a 65‐year‐old Cambodian refugee who self‐regulated the use of rifampicin and isoniazid for pulmonary tuberculosis. Fifteen minutes after a single discontinuous oral dose, he developed flank pain, chills, rigors, vomiting, diarrhea, fever, and brown turbid urine. Laboratory tests at presentation showed acute intravascular hemolysis. Nonoliguric renal failure ensured, and he was transferred to our institution 2 days later. The patient was group A, Rh (D) positive, P1 negative with a cold autoantibody and cold anti‐P1 alloantibody. The direct antiglobulin test was negative at the time of transfer. To evaluate the hemolysis, studies were done to test for rifampicin‐ or isoniazid‐ dependent antibodies. Rifampicin‐dependent antibodies were detected in the antiglobulin phase with broad spectrum anti‐human globulin, monospecific anti‐gamma chain, and anti‐complement antisera. Agglutination titers did not change after dithiothreitol reduction of the patient's serum. We conclude that this patient developed rifampicin‐ dependent IgG antibodies with complement‐fixing capability. The presence of rifampicin‐dependent antibodies should be suspected in a patient with hemolysis and/or renal failure taking rifampicin.
Posttransfusion purpura
Authors: Dunstan R. A. , Rosse W. F.
Published: March 2003

A case of posttransfusion purpura is reported in which the laboratory determination of the specificity of the causative antibody was initially confused by the presence in the patient's serum of HLA‐ directed antibodies. The patient was a multiparous 65‐year‐old woman with a previous history of blood transfusion. She developed the typical clinical features of posttransfusion purpura 8 days following the transfusion of 6 units of packed red cells. The patient was P1A1 negative, and her serum reacted strongly in a radiolabeled monoclonal antibody assay with both P1A1‐positive and ‐negative platelets. Radioimmunoprecipitation demonstrated that the patient's serum contained antibodies both of anti‐P1A1 and anti‐HLA specificity. Western blotting of normal platelets incubated with the patient's serum verified that the anti‐P1A1 antibody was directed against platelet membrane glycoprotein III.
Platelet storage in a plasma‐free medium
Authors: Rock G. , Swenson S. D. , Adams G. A.
Published: March 2003

Currently, platelet concentrates are stored in 50 to 60 ml of plasma. A major drawback to storage in plasma is the considerable loss of platelet function which occurs during storage. A modified Tyrodes medium has been developed for storage of platelets. A comparison between platelet concentrates stored in this medium and in plasma showed that platelet aggregation and release responses to synergistic pairs of stimuli were equivalent for both types of concentrates on the day of preparation and after 72 hours. Platelet aggregation and release responses to single stimuli, the content of membrane glycoproteins, and the pH declined during storage but were similar for both preparations. The data show that plasma is not required to maintain in vitro platelet function during storage of platelet concentrates, but in vivo functions remain to be determined. The use of an artificial medium has the advantages of decreasing patient exposure to plasma contaminants, generating additional plasma for fractionation, and controlling more exactly the storage environment.
A new test useful in identifying red cells with a (δ‐α) hybrid sialoglycoprotein
Authors: Vengelen‐Tyler V. , Mogck N.
Published: March 2003

St(a+) and Dantu+ red cells (RBCs), treated with 0.1 percent ficin solutions, reacted strongly with Vicia graminea lectin (anti‐Nvg). No other RBC sample tested gave these results. This test (ficin‐pretreated RBCs tested with anti‐Nvg [FT‐Nvg]) was used to screen the RBCs of 300 Oriental and 100 black donors. Three percent of the Oriental donor samples tested were FT‐Nvg+, whereas no FT‐Nvg+ RBCs were found in the black donor samples tested.

The FT‐Nvg test is easy to perform and gives selective reactions with antigens associated with (δ‐α) hybrid sialoglycoproteins, such as Sta and Dantu. This test can be used for mass screening of RBCs in a search for St(a+) or Dantu+ RBCs. Another application of the FT‐Nvg test would be to screen RBCs suspected of having a low‐incidence antigen before using scarce anti‐Sta and ‐Dantu reagents.
Efficacy of plasma exchange in severe idiopathic rapidly progressive glomerulonephritis. A report of ten cases
Authors: Burran W. P. , Avasthi P. , Smith K. J. , Simon T. L.
Published: March 2003

The vast majority of patients with idiopathic rapidly progressive glomerulonephritis (RPGN) develop irreversible renal failure within weeks to months. We report a retrospective study of 10 patients with idiopathic RPGN who were treated with plasma exchange in addition to steroids and immunosuppression. Renal biopsies were obtained in nine patients. RPGN without immune complexes was present in four, immune complex disease in four, and anti‐glomerular basement membrane disease in two. Renal function did not recover in those patients with anti‐glomerular basement membrane disease. In contrast, seven of eight patients without auto‐antibodies to basement membranes responded to therapy, and four did not need dialysis for two years or more. The sustained improvement in renal function in these seven patients suggests the need for evaluation of plasma exchange as an adjunct to steroids and immunosuppression in a prospective, controlled study in RPGN.
Carbonyl iron for short‐term supplementation in female blood donors
Authors: Gordeuk V.R. , Brittenham G.M. , Hughes M.A. , Keating L.J.
Published: March 2003

A randomized, double‐blind trial of iron replacement after repeated blood donation was conducted in 75 menstruating women; 51 completed the study. Volunteers were assigned randomly to one of three treatment groups: 1) carbonyl iron (nontoxic elemental iron powder), 600 mg; 2) ferrous sulfate, 300 mg (60 mg Fe++); or 3) placebo, each given three times daily for 1 week immediately after blood donation. Blood samples obtained initially and 56 days later were tested for hemoglobin, mean corpuscular volume (MCV), free erythrocyte protoporphyrin, serum ferritin, serum iron, total iron binding capacity (TIBC), and percent saturation of TIBC. The prevalence of gastrointestinal side effects was similar in both groups taking iron. At the end of the study there was no laboratory evidence of change in iron status in women who received carbonyl iron (n = 15). In those treated with ferrous sulfate (n = 17) the mean TIBC increased (p < 0.001), and in the placebo group (n = 19) there were decreases in mean MCV (p < 0.01), serum ferritin (p < 0.001), and percent saturation (p = 0.027) with an increase in mean TIBC (p = 0.004). Carbonyl iron seems to be effective for short‐term iron replacement in repeat blood donors and may have the advantage of decreased or absent risk of poisoning if accidentally ingested by children.
Quantitative studies on the Rh‐antigen D
Authors: Araszkiewicz P. , Szymanski I.O.
Published: March 2003

Using an automated antiglobulin consumption test and Scatchard's analysis, the authors measured the number of D antigen epitopes on each of 46 samples of washed red cells (RBC) that represented six different Rh phenotypes. A clear D dosage effect was observed only when C was missing from the Rh genome, which confirmed the previously recognized suppressive effect of C. Thus, RBC of the Rh phenotype R2R2 had almost twice as many D epitopes (mean, 30,300/cell) as RBC of the Rh phenotypes R2r and R0r (means, 17,200 and 16,500 respectively). The data indicated that C in trans and cis suppressed similar amounts of D epitopes.
Photodynamic therapy of viral contaminants with potential for blood banking applications
Authors: Matthews J.L. , Newman J.T. , Sogandares‐Bernal F. , Judy M.M. , Skiles H. , Leveson J.E. , Marengo‐Rowe A.J. , Chanh T.C.
Published: March 2003

A photodynamic method has been evaluated as a means of eradicating viral contaminants with the potential for rendering blood safe for transfusion. Herpes simplex virus type 1 (HSV‐1) was tested under flowing conditions in culture media or in blood supplemented with the virus. Hematoporphyrin derivative was used as the sensitizer and was photoactivated with visible light at 630 nm and 5 J/cm2. HSV‐1 in suspension both in culture medium as well as in blood was shown to be killed. The human immunodeficiency virus was also found to be photoinactivated in flowing cell culture medium and, thus, potentially may be inactivated in blood. These findings extend our previous studies which demonstrated that enveloped viruses can be photoinactivated with hematoporphyrin derivative in a static fluid system. Analysis of blood cell number, red cell lysis, plasma proteins, and other standard hematological tests showed no significant change. The possibility that transfusion‐associated acquired immunodeficiency syndrome (AIDS) may result from a blood unit infected with human immunodeficiency virus that tested negative makes it imperative that a safe and effective means of viral killing be developed. The system reported here offers promise as an effective approach to this problem.
Storage of human platelet concentrates in an artificial medium without dextrose
Authors: Adams G. A. , Rock G.
Published: March 2003

It was shown previously that human blood platelets stored in an artificial medium (PCD) for up to 5 days remain functional in vitro and have normal survival and recovery in vivo. This report demonstrates that the medium can be simplified further by the removal of dextrose, leaving for study a medium consisting simply of balanced salts and citrate anticoagulant (PC). Some dextrose, 3.2 mM, was present in the fresh PC platelet concentrates due to plasma carryover in the production of platelet concentrates, but this dextrose concentration was considerably less than the 22.6 to 25.5 mM present in platelet concentrates in PCD or plasma. Platelet count, pH, PCO2, and PO2, as well as platelet aggregation and release responses to stimulation, in vitro, were as well preserved in the PCD or PC media as in the plasma controls. In the PC medium, platelets consumed 2.5 mM dextrose over 5 days and left 0.7 mM dextrose. The same consumption of dextrose was noted in PCD platelet concentrates, while platelets in plasma metabolized twice as much dextrose and formed twice as much lactate. Thus, the rate of glycolysis in platelet concentrates was independent of the dextrose concentration in the medium, and the platelet functions were well preserved.
An autologous fibrinogen‐based adhesive for use in otologic surgery
Authors: Silberstein L.E. , Williams L.J. , Hughlett M.A. , Magee D.A. , Weisman R.A.
Published: March 2003

Successful middle ear surgery requires the availability of a safe, effective bonding material. Side effects caused by synthetic materials have led to the use of biologic adhesives; however, they carry the risk of transmission of infectious disease if they are prepared from pooled human blood. A procedure for the production of an autologous fibrinogen‐based adhesive using polyethylene glycol to precipitate the fibrinogen‐factor XIII component from plasma is described. This procedure requires 40 ml of whole blood and approximately 3 hours' preparation time, and it can be performed in any blood bank with the facilities for sterile techniques. This adhesive has been used successfully for otologic surgery in 12 patients, and further study of the use of this biologic adhesive for other microsurgical techniques should be undertaken.
Serum ALT levels
Authors: Briere Russell O.
Published: March 2003

ABSTRACT: Alanine aminotransferase (ALT) measurements in blood donors has been advocated as a surrogate test for non‐A, non‐B hepatitis. Use of the recommended single cutoff value for all donors resulted in disqualifying four times as many males as females in a group of 4712 donors. Separate cutoff values were calculated for male and female donors. The use of these separate cutoff values resulted in disqualifying equal numbers of males and females.
Evaluation of a new, more oxygen‐permeable, polyvinylchloride container
Authors: Holme S. , Heaton A. , Momoda G.
Published: March 2003

A new container made of polyvinylchloride (PVC) with diethylhexyl phthalate (DEHP) used as the plasticizer was subjected to in vitro and in vivo evaluation for prolonged platelet storage. As compared with the original PVC bag, this bag has increased gas permeability by its reduced film thickness, larger surface area (400 ml capacity), and more porous label. The oxygen permeability coefficient, K(O2), of the new container was measured to be 655 nmol per min per atm. On the basis of previous studies relating the K(O2) to the maximal platelet count, it was predicted that this maximal count would be in the range of 7.9 to 8.9 × 1010 platelets. This prediction was confirmed by carrying out 58 studies measuring pH, pO2, and platelet count on platelet concentrates (PCs) stored for up to 7 days. After 5 days of storage all PCs with counts above 8.0 × 1010 had pH ≤ 7.0, whereas those with counts below 8.0 × 1010 had pH ≥ 7.0. Six units (10%) with counts above 9.0 × 1010 had pH levels of 6.5 or below. Thirteen of the PCs underwent extensive in vitro testing of platelet function during 7 days of storage. No significant differences were found in pH, ATP content, and decrease in platelet count, as compared with studies (n = 22) using PCs stored in polyolefin containers. A marked reduction in the hypotonic shock response was found: 38 percent ± 16 as compared to 70 percent ± 13 for the polyolefin bag at 5 days of storage; this finding confirmed previous studies by others about the effect of DEHP on hypotonic shock. However, the reduced hypotonic shock response was not related to any loss of in vivo viability. In eight studies using autologous Indium‐111‐oxine labeling, percentage recoveries averaged 48 ± 6 percent, and survival averaged 155 ± 33 hours with 5 days of storage as determined by the multiple‐hit gamma model.
Formation of a cryogel during processing of cell‐free plasma
Authors: Rock G. , Palmer D. , Tittley P. , McCombie N. , Schoendorfer D. , Drago J.
Published: March 2003

Automated plasmapheresis devices are being integrated into many modern plasma procurement programs. Owing to the use of a different concentration and type of anticoagulant, the recovered plasma differs in pH and citrate levels from that obtained by manual plasmapheresis or whole blood donation. Recently, fractionators noted the recovery of a sticky, gelatinous fraction (cryogel) during thawing of cell‐free (CF) plasma, along with reduced recovery of factor VIII:C (FVIII:C) in the cryoprecipitate fraction. Following their manufacturing procedures, it was established that the cryogel fraction of CF plasma is enriched in FVIII:C, fibrinogen, and fibronectin, as compared to cryoprecipitate from CPDA‐1 plasma. Cryogel formation was not significantly affected by pH or citrate adjustment of the recovered plasma, by the use of polycarbonate or nylon filter membranes, or by the filter wetting agent polyvinylpyrrolidone (PVP). Furthermore, passage of CPDA‐1 plasma through the polycarbonate filter did not alter cryoprecipitate quality. However, cryogel formation from CF plasma was reduced significantly by 1) slow thawing at 4°C rather than quick thawing at 20 and 0 or 20 and 4°C, 2) the use of 1:16.6 sodium citrate rather than 1:12.5 ACD‐A, or 3) the addition of intact platelets, platelet lysate, membranes, or cytosol to CF plasma before freezing. The data suggest an important and, indeed, essential role of platelet constituents in the formation of both cryoprecipitate and cryogel during the low‐temperature purification of plasma proteins.
Posttransfusion survival of red cells frozen for 8 weeks after 42‐day liquid storage in AS‐3
Authors: Rathbun E. J. , Nelson E. J. , Davey R. J.
Published: March 2003

Current standards recommend that red cells (RBCs) should be frozen within 6 days of donation. There are situations, however, in which it is desirable to freeze RBCs that are older than 6 days, such as for the salvage of rare or autologous units. To determine the therapeutic efficacy of RBCs frozen after prolonged liquid storage, standard units were drawn from nine normal donors and stored at 4° C for 42 days in a nutrient‐additive solution, AS‐3. 51 Cr RBC survival assays were performed (24‐hour survival: 78.2 ± 12.4%; n = 8) and the units were frozen at −8° C in glycerol for 8 weeks. After deglycerolization, the mean RBC recovery was 81.0 ± 4.1 percent and the mean 24‐hour51 Cr survival was 78.0 ± 9.1 percent. The index of therapeutic effectiveness (ITE) was determined by multiplying the postdeglycerolization 24‐hour51 Cr survival by the mean RBC recovery (63.3 ± 9.2). ITE values >60 percent (75% 51 Cr survival X 80% RBC recovery) were considered acceptable. Mean adenosine triphosphate levels declined from an initial 3.81 ± 0.56 μmol per g of hemoglobin to 2.33 ± 0.55 μmol per g after frozen storage. These findings show that an acceptable percentage of RBCs survives frozen storage after maximum liquid storage (mean ITE >60%). If necessary, RBCs stored in AS‐3 can be frozen at any time before 42 days.
Absence of HIV‐1 infection in antibody‐negative sexual partners of HIV‐1 infected hemophiliacs
Authors: Jackson J. Brooks , Kwok Shirley Y. , Hopsicker Jocelyn S. , Sannerud Kim J. , Sninsky John J. , Edson J. Roger , Balfour Henry H.
Published: March 2003

ABSTRACT: In order to confirm the presence and determine the frequency of human immunodeficiency virus, type I (HIV‐1) infection prior to antibody production, 23 healthy women with histories of repeated unprotected sexual exposure to HIV‐1 infected hemophiliacs were tested for evidence of HIV‐1 infection. Female subjects were tested for HIV‐1 antibody (enzyme immunoassay [EIA] and Western blot), HIV‐1 serum antigen, HIV‐1 DNA gag sequences by the polymerase chain reaction, and HIV‐1 virus isolation from peripheral mononuclear cells. Twenty‐two of 23 (96%) women were negative by all HIV‐1 assays. One woman was positive by all the HIV‐1 assays including an EIA screening test for HIV‐1 antibody. These preliminary results suggest that the frequency of HIV‐1 infection in antibody‐negative sexual partners of HIV‐1‐infected individuals is probably very low.
Response to platelet‐activating factor in human platelets stored and aged in plasma. Decrease in aggregation, phosphoinositide turnover, and receptor affinity
Authors: Shukla S. D. , Morrison W. J. , Klachko D. M.
Published: March 2003

Human platelet concentrates were stored in polyolefin bags at 22 to 24° C on a horizontal shaker for up to 8 days. At different intervals, aliquots of platelet‐rich plasma (PRP) were removed aseptically and five variables, i.e., platelet counts, morphology, platelet‐activating factor (PAF)‐stimulated aggregation, phosphoinositide turnover, and [3H]PAF binding to platelet receptors, were studied. The number of platelets did not change during the 8 days of storage. Scanning electron microscopy of the platelets revealed a gradual morphologic change from biconcave flat discs to irregular, crenated forms. The PAF‐induced aggregation of platelets declined with time of storage. A decrease to 50 percent of the Day 1 aggregatory response to PAF was evident on Day 2, and there was a further decline to about 20 percent by Day 6. Similarly, PAF receptor‐coupled phosphoinositide turnover, as monitored by 32P incorporation into individual phosphoinositides, decreased dramatically with storage. After 2 to 3 days of storage, the phosphoinositide turnover was reduced to 50 percent of the original response, and it continued to decline to about 25 percent of original response by Day 5 or 6. The binding of [3H]PAF to washed human platelets indicated subtle changes between Days 2 and 4, which became more noticeable by Day 6. These results have raised the possibility of changes in the number of the receptors and/or their affinity for the ligand during storage. We conclude that although the number of platelets was maintained during storage for 8 days, a general deterioration of their responses to PAF occurred at the levels of cell surface receptor, transmembrane signaling (phosphoinositide turnover), and response (aggregation).
Lyme disease—another transfusion risk?
Authors: Aoki S. K. , Holland P. V.
Published: March 2003

Lyme disease (or Lyme borreliosis) is caused by a spirochetal bacteria, Borrelia burgdorferi. Increased recognition of the disease and increased exposure to the vector (ticks) capable of spreading B. burgdorferi from animal hosts have resulted in a rise in the number of cases of Lyme borreliosis reported in the United States. There are three stages of the clinical course of Lyme borreliosis; however, not all those infected will have typical manifestations of each stage, such as the arthritis of the third stage. Routine blood cultures will rarely document bacteremia and serologic testing is not yet reliable. Early treatment can prevent later stages of Lyme borreliosis. There is evidence that transmission of B. burgdorferi by blood transfusion is possible, but, to date, there has been no documentation of transfusion‐associated Lyme borreliosis. Thus, no new recommendations for screening donors to identify possible carriers of B. burgdorferi are suggested at this time.
Properties of platelet concentrates prepared after extended whole blood holding time
Authors: Holme S. , Moroff G. , Whitley P. , Hallinen D. , Heaton A.
Published: March 2003

Extension of the maximum holding time for whole blood collected into a CPD‐ADSOL system from 6 to 8 hours at ambient temperature under conditions that cause the temperature of the blood to decrease to 20 to 24° C would facilitate the preparation of platelet concentrates (PCs). In this study, the properties of CPD‐PCs prepared and stored for 5 days in PL‐732 containers after various initial holding periods were assessed in two laboratories, designated Laboratory A and Laboratory B. Laboratory A found higher platelet‐rich plasma (PRP) volumes (276 ± 25 vs. 249 ± 19 mL) and platelet yields (76 ± 18 vs. 66 ± 18 × 109 platelets) with 8‐hour holds (n = 10) than with 1‐ to 2‐hour holds (n = 10), although only the difference in PRP volumes was significant (p < 0.05). No significant difference was observed in autologous in vivo recovery (54 ± 11 vs. 47 ± 9%) or survival (167 ± 37 vs. 170 ± 25 hrs), as calculated by gamma function using 111In as radiolabel. Laboratory B also found higher PRP volumes (304 ± 31 vs. 279 ± 37 mL) and platelet yields with 8‐hour holds (n = 12) than with a 6‐hour holds (n = 10) (88 ± 26 vs. 77 ± 27 × 109 platelets). No significant differences were found in morphology score, the extent of release of β‐thromboglobulin, the discharge of lactate dehydrogenase, or hypotonic shock response. These studies showed that an 8‐hour preprocessing hold period did not significantly affect in vitro and in vivo properties of PCs after 5 days of storage.
Studies with nonradioisotopic sodium chromate
Authors: Heaton W. A. L. , Keegan T. , Hanbury C. M. , Holme S. , Pleban P.
Published: March 2003

A recently developed nonradioisotopic 52Cr technique was used to measure either red cell volume or posttransfusion recovery of stored red cells. The experimental method uses Zeeman electrothermal atomic absorption spectrophotometry to measure red cell chromium. Results from the 52Cr method were compared with those from 51Cr single‐label and 125I‐albumin/51Cr double‐label procedures using 49‐day AS‐1 red cell concentrates drawn and prepared according to standard procedures. In the first group of five donors, red cell volume was estimated concurrently with both 52Cr‐labeled fresh red cells and 125I‐albumin. The latter measured plasma volume from which red cell volume was estimated on the basis of the hematocrit (125I red cell volume). 51Cr‐labeled stored red cells were transfused to measure posttransfusion recoveries. The correlation between 52Cr and 125I red cell volumes was significant (r = 0.68, p < 0.01), and, in this group, the differences were not significant (p > 0.05). Twenty‐four‐hour posttransfusion recoveries of 51Cr‐labeled stored red cells averaged 66 ± 5 percent when measured with the 125I/51Cr technique and 69 ± 8 percent when measured with the 52Cr/51Cr method. In the second group of five donors, red cell volume was estimated by the 125I‐albumin technique, and the posttransfusion recovery of stored red cells was quantitated by 51Cr‐ and 52Cr‐labeled stored cells simultaneously. In this group, posttransfusion recoveries with 125I/51Cr averaged 73 ± 7 percent; with 125I/52Cr, they averaged 75 ± 10 percent. Using the single‐label method of calculation, recoveries averaged 76 ± 7 and 75 ± 10 percent for the 51Cr and 52Cr methods, respectively. Calculated mean posttransfusion recoveries for the total group (n = 10) showed a small but significantly lower (p < 0.05) posttransfusion recovery with the double‐label 125I/51Cr technique (69 ± 7%) than that with the single‐label 51Cr method (74 ± 7%). The nonradioisotopic 52Cr technique provided an acceptable measure of posttransfusion recovery when used in a double‐label method, either for the determination of red cell volume concurrent with 51Cr‐labeled stored cells or for the labeling of stored cells with an independent measure of red cell volume.
The first‐year costs of establishing an unrelated bone marrow donor registry
Authors: Larson E.B. , Chestnut T.M. , Beatty P.G. , Slighter S.
Published: March 2003

The cost of therapies like bone marrow transplantation has been an important consideration for several decades. Bone marrow transplantation is becoming increasingly accepted as an effective treatment for hematologic disorders, including acute non‐lymphocytic leukemia. To find suitable donors, bone marrow donor registries are being developed. The first‐year costs of establishing an unrelated bone marrow donor registry are reported here. First‐year costs are largely due to personnel costs and HLA typing charges. The cost per registrant decreases over time, but further decreases due to economies of scale are limited by the continued fixed requirement for HLA typing. Data are presented by separating costs into six unique categories, thereby allowing other blood centers to estimate start‐up costs based on our experience.
Hemolysis after intravenous immune globulin therapy: relation to IgG subclasses of red cell antibody
Authors: Okubo S. , Ishida T. , Yasunaga K.
Published: March 2003

A patient with chronic idiopathic thrombocytopenic purpura (ITP), a 28‐year‐old group A, Rh‐positive woman, also had hemolytic anemia. At that time, her red cells typed as group A, but the serum typed as group O. This typing followed intravenous high‐dose immune globulin therapy, (400 mg/kg for 5 successive days) and was attributable to A antibody of the IgG type, composed of IgG1, IgG2, IgG3, and IgG4, in the immune globulin preparation, which had been given for treatment of ITP. All lots of commercial human plasma preparation products (heat‐treated human plasma protein, albumin, factor VIII or IX products, and immune globulin) examined were found to contain A and/or B antibodies of the IgM or IgG type, with titers of 1 to 1024. Twelve of the 20 lots of immune globulin contained RBC antibodies of the IgG type. Subclass IgG1 was found in all 12 of these lots, and all four subclasses, including IgG3, were detected in 8 lots. All 8 showed antibody titers higher than 64.
Incidence of red cell antibodies after multiple blood transfusion
Authors: Fluit C.R.M.G. , Kunst V.A.J.M. , Drenthe‐Schonk A.M.
Published: March 2003

A retrospective study was performed to estimate the frequency of alloimmunization against red cell (RBC) antigens in a multiply transfused group. Patients (n = 186) were studied who had received at least six blood transfusions during a period of at least 3 months. Some 6944 units of blood were transfused. One hundred forty patients had hematologic disorders. The patients' sera were investigated every 3 months with indirect antiglobulin tests and enzyme‐treated RBCs. Twenty‐two patients (11.8%) made 33 antibodies. Seven patients made more than one antibody. Eight of the 22 patients (36.4%) made their first antibody before or at the 10th transfusion. The risk of immunization increased with the number of transfusions. Influence of gender and age was not demonstrable. Nor was a relationship demonstrated between blood transfusion reactions and RBC antibody formation; no delayed hemolytic transfusion reactions occurred. Anti‐E was demonstrated in 12 patients and anti‐K in 15. When the gene frequencies were taken into account, it appeared that anti‐E was made by 11.5 percent of E‐negative patients, most of whom were immunized after an estimated three transfusions with E‐positive blood. Anti‐K was made by 8.7 percent of the K‐negative patients, after an estimated 2.1 units of K‐positive blood. It might be desirable to match red cell units for the E and K antigens in patients at relatively high risk. These are primarily patients who have already formed an antibody and are going to receive many transfusions and women of childbearing age who are to receive more than 4 units of blood.
Experience with a transfusion recipient education program about hepatitis C
Authors: ZUCK T. F. , ROSE G. A. , DUMASWALA U. J. , GEER N. J.
Published: March 2003

ABSTRACT: Shortly after test kits for antibodies to the hepatitis C virus (HCV) were licensed in May of 1990, our medical community undertook a public education program encouraging previous transfusion recipients to see their physicians about the wisdom of being tested for anti‐HCV. In response, 1034 samples were received for testing. All samples repeatably reactive (RR) with anti‐HCV enzyme‐linked immunoassay (EIA) were tested further with a research recombinant immunoblot assay (RIBA). Overall, 76 of the 1034 (7.4%) recipient samples were RR and 64 of these (84.2%) were reactive with RIBA. Recipients transfused prior to surrogate testing (alanine aminotransferase [ALT] and anti‐hepatitis B core [anti‐HBc]) in 1986 showed a 8.6 percent reactivity with RIBA and those transfused after surrogate testing showed a 4.8 percent reactivity, a 44 percent reduction. Of the 57 recipient samples reactive with RIBA and suitable for assay, 11 (19.3%) had an elevated ALT. Among 76 randomly selected blood donors with RR EIAs studied for comparison with recipients, 20 (26.3%) were reactive with RIBA, 9 of which had an abnormal surrogate test that would have disqualified them. ALT concentrations were abnormal in 6 (30%) of the donors who were reactive on RIBA.

We conclude that an education program that encourages previous transfusion recipients to seek medical advice about anti‐HCV testing is practical from the standpoint of the blood center. We believe more widespread implementation of similar programs should be considered. The findings also suggest that, when available, supplemental testing should be offered to blood donors with RR EIAs before they are counseled about permanent deferral because of anti‐HCV testing and to transfusion recipients identified by programs such as the one described.
Histologic and immunohistochemical studies on the preparation of white cell‐poor red cell concentrates: the filtration process using three different polyester filters
Authors: Steneker I. , Biewenga J.
Published: March 2003

Three third‐generation white cell (WBC)‐depletion filters based on polyester layers with decreasing pore size were investigated. In the coarse layers, unaggregated granulocytes, monocytes, and platelets and aggregates of these cells were captured in close contact with the fibers. This indicates that the depletion of granulocytes, monocytes, and platelets in the coarse layers of the filters is due in part to activation and adhesion with the formation of cell clusters on the fibers. In Filter I and Filter II platelets were not found in the fine layers, whereas in Filter III, 70 percent of the platelets were detected as unaggregated platelets on the fibers of the fine layers. More than 95 percent of the lymphocytes captured in the three filters occurred as single cells in the fine layers, and over 60 percent of these could be recovered. This suggests that the depletion of lymphocytes depended on trapping of the cells in the fiber network. All three filters captured HLA‐DR‐positive lymphocytes in the top layers, a finding that supports earlier reports that the transfusion of filtered red cell concentrates reduces HLA alloimmunization. More lymphocytes and granulocytes were found in the last layer of Filters II and III than of Filter I. Therefore, the risk of white cell leakage is probably lowest for Filter I. Red cells were found as red cell aggregates in the fine layers of Filters I and II, whereas almost no red cells were detected in Filter III. It was shown that the three filters studied were similar in their removal of WBCs, but differed in their mechanisms of removal.
Methods for measuring a 6 log10 white cell depletion in red cells
Authors: Sadoff B. J. , Dooley D. C. , Kapoor V. , Law P. , Friedman L. I. , Stromberg R. R.
Published: March 2003

Methodology is presented for enumerating very low concentrations of white cells (WBCs) in red cells (RBCs) by two separate measurement techniques. Both techniques rely on the method of harvesting WBCs from a 300‐ to 350‐mL unit of RBCs and concentrating them to a volume of approximately 0.5 to 1.0 mL, which is equivalent to a WBC concentration of approximately 550 to 1. The WBC separation and concentration steps require less than 3 hours to complete, and multiple RBC units can be processed in parallel. Cell counting is carried out in a fluorescence hemocytometer or by a modified cytospin technique. As few as 1000 WBCs in a unit of RBCs, which corresponds to a more than 6 log10 WBC depletion, can be measured without reaching the sensitivity limit of either technique (800 and 200 WBC/unit, respectively). The harvesting method and counting techniques are relatively simple and inexpensive.
Screening blood donors for gastrointestinal illness: a strategy to eliminate carriers of Yersinia enterocolitica
Authors: Grossman BJ , Kollins P , Lau PM , Perreten JL , Bowman RJ , Malcolm S , Palko WM
Published: March 2003

Recent reports of fatal transfusion‐associated Yersinia enterocolitica sepsis prompted a study of the feasibility of adding a question to the routine donor health history as a method of reducing this risk. In three American Red Cross blood centers, 11,323 donors were asked one of two questions about gastrointestinal symptoms during their health history screenings. Affirmative responses were obtained from 0.6 or 4.0 percent of the donors, depending on how the question was asked. In one center, more than 6 percent of donors gave affirmative answers. The efficacy of asking a relatively simple question about gastrointestinal symptoms as a way of preventing Y. enterocolitica should be evaluated further, because relatively large numbers of donors may respond affirmatively. Other methods of reducing the risk of transfusion‐ associated Y. enterocolitica infection should be pursued.
Design and preliminary evaluation of an expert system for platelet request evaluation
Authors: Sielaff B.H. , Scott E.P. , Connelly D.O.
Published: March 2003

In spite of growing awareness of the potential risks associated with transfusion, the number of platelet units transfused in the United States continues to increase each year. There is a growing interest in ensuring that all transfusions are administered for appropriate reasons. Prospective review of requests for transfusions has been used to accomplish this goal. Although successful in reducing the number of inappropriate transfusions, this review method requires great time commitments by blood bank personnel and physicians. A knowledge‐based system (ESPRE) that aids hospital blood bank personnel in the review of requests for platelet transfusions has been developed. The system automatically obtains most of the required patient data via a direct link to the hospital's main laboratory computers. The system generates a printed report that includes a list of patient‐specific data, a list of the conditions for which a transfusion would be appropriate for the particular patient (given the clinical condition), and the conclusions drawn by the system. During a preliminary clinical evaluation of ESPRE, 73 randomly selected platelet transfusion requests were evaluated for approval by laboratory personnel and ESPRE. Overall, ESPRE would have approved 71 of the requests and laboratory staff would have approved 72. Forty‐four percent of the requests would have been approved for the same reasons given by the staff. There were only three disagreements on final approval between ESPRE and blood bank personnel. This computerized expert system is a promising approach to the prospective review of all platelet transfusions.
Effect of blood transfusion on survival in a mouse bacterial peritonitis model
Authors: Goldman M. , Frame B. , Singal D.P. , Blajchman M.A.
Published: March 2003

Allogeneic blood transfusions can result in alloimmunization or immunosuppression. A previous study demonstrated a deleterious effect of allogeneic blood transfusion on tumor growth in mice that was dependent, in part, on the dose of tumor cells with which the host animal was inoculated. The current study examined the effect of a similar allogeneic blood transfusion protocol on survival in a mouse bacterial peritonitis model. C57Bl/6J mice were transfused with 0.2 mL of heparinized fresh whole blood from C57Bl/6J (syngeneic) or Balb/c (allogeneic) mice. Transfusions were given on Days ‐10 and ‐7. On Day 0, mice were injected intraperitoneally with 10(7) Escherichia coli. Survival at Day 7 was 61 percent in the allogeneic blood transfusion group and 55 percent in the syngeneic blood transfusion group (p = 0.52). Experiments using different strains of mice, different transfusion protocols, and different doses of bacteria also failed to demonstrate an effect of allogeneic blood transfusion on survival. The results demonstrate that blood transfusion does not influence survival after a septic challenge with bacteria. The data obtained in the present study, together with those obtained in the tumor model, suggest that the mechanisms by which the allogeneic blood transfusion impedes host defense against bacterial infections is different from the mechanisms involved in tumor growth.
Effects of blood transfusion on the immune responsiveness and survival of cancer patients: a prospective study
Authors: Quintiliani L. , Buzzonetti A. , DiGirolamo M. , Iudicone P. , Guglielmetti M. , Martini F. , Scocchera R. , Terlizzi F. , Lapponi P. , Giuliani E.
Published: March 2003

To evaluate whether blood transfusion exerts an adverse influence on cancer evolution, a prospective clinical and immunologic investigation was carried out on 58 surgical patients with gastric or colorectal adenocarcinoma. None had had previous transfusion; 35 received perioperative transfusion. Among preoperative variables, only red cell count and hemoglobin concentration were significantly reduced in the patients transfused at operation. Other clinical characteristics and immunologic functions (except interferon‐gamma release) did not differ significantly from those of untransfused patients. The survival rate of transfused patients, although shorter, was not significantly different from that of untransfused patients. Immunologic tests done after surgery on 30 patients (17 transfused and 13 untransfused) did not show significant differences in the two groups. Significant increases in interleukin‐2‐stimulated production and immunoglobulin M synthesis were observed in transfused patients after surgery. Patients transfused perioperatively with more than 3 units of blood had some evidence of decreased immune function, but differences were not significant. While shorter survival and some immunologic changes may correlate with the number of transfusions, more patients must be studied to determine whether this relationship will be confirmed.
Reducing white cells in platelet units
Authors: Marx G , Blankenfeld A , Gorodetsky R , BarShany S
Published: March 2003

White cells (WBCs) constitute a significant contaminant of platelet concentrates (PCs). Various technologies, including apheresis and filtration, are currently being developed to minimize the carryover of WBCs into platelets. The aim is to reduce contamination of< 10(8) WBCs per platelet unit. As part of quality control monitoring of the blood bank operations, the centrifugation protocols employed in the preparation of platelet‐rich plasma (PRP) have been evaluated for their impact on the WBC content of the PCs. The WBC content, which is expressed throughout the PRP volume as well as in the PC, reflects the degree of braking. For example, after centrifugation (2500 rpm, 4 min) of whole blood into packed red cells (RBCs) and PRP, braking‐induced mixing increases the WBC content of the expressed PRP. Variations in the braking rates of the centrifuges used also correlate with the WBC carryover into packed platelets. An alternative centrifugation protocol to minimize WBC carryover is suggested. Whole blood is centrifuged at 2500 rpm for 1.5 minutes (rather than 4 min) and allowed to stop with no braking. This procedure adds some 3 minutes to the total centrifugation time, but the relative integral of this centrifugation program is approximately 50 percent smaller than that of the normally employed centrifugation protocol (with braking). It was observed that the WBC content throughout the expressed PRP, or in the entire PC, is reduced by about 75 percent. These results show that an effective method of significantly decreasing the WBC content of platelet units is simply to prepare PRP with reduced centrifugation time and with the braking programs disengaged.
The use of a recombinant immunoblot assay in the interpretation of anti‐ hepatitis C virus reactivity among prospectively followed patients, implicated donors, and random donors
Authors: Alter H.J. , Tegtmeier G.E. , Jett B.W. , Quan S. , Shih J.W. , Bayer W.L. , Polito A.
Published: March 2003

ABSTRACT: Samples from prospectively followed recipients, their respective donors, and a cohort of random donors were used to evaluate the specificity and efficacy of a recombinant immunoblot assay (RIBA) as an adjunct to anti‐hepatitis C virus (HCV) testing by enzyme immunoassay (EIA). RIBA reacted (RIBA+) in 100 percent of patients who developed hepatitis associated with anti‐HCV seroconversion documented by EIA and in 100 percent of the EIA‐positive (EIA+) donors implicated in these cases. In contrast, RIBA reacted in none of 10 recipients who were EIA+ but did not develop hepatitis, in none of 7 EIA+ patients with hepatitis B or cytomegalovirus infection, in 33 percent of EIA+ donors who were not implicated in hepatitis transmission, and in 37 percent of EIA+ random donors. Hence, the vast majority of EIA+ individuals who have ancillary evidence of HCV infection react on RIBA, whereas the majority of EIA+ individuals in low‐risk settings do not react (RIBA− negative, or RIBA−). There was a strong association between RIBA reactivity and the presence of a surrogate marker (elevated alanine aminotransferase [ALT] and/or antibody to hepatitis B core antigen); 43 percent of RIBA+ implicated donors had a surrogate marker as compared to none of 14 EIA+, RIBA− donors. Among EIA+ random donors, 77 percent of those with a surrogate marker were RIBA+, as compared with 29 percent of those without a surrogate marker. In addition, in EIA+ donors, RIBA reactivity correlated with the extent of ALT elevation; 86 percent of those with an ALT > 135 IU per L were RIBA+ compared with 18 percent of those with an ALT < 30 IU per L. Among recipients of an EIAt, RIBAt blood unit, 73 percent developed hepatitisC and an additional 6 percent developed hepatitis, but were not positive for anti‐HCV. None o f 13 recipients of an E I A t, RIBA‐ unit developed hepatitis (p<0.00l). By using linked donor‐recipient sets, a RIBAt donor was found i n association with 75 percent of hepatitisC cases, which implies that these cases could have been prevented if anti‐HCV screening had been available at the time of the prospective study. Although considered supplemental rather than a confirmatory assay, RIBA correlates well with HCV infectivity and with surrogate markers of viral hepatitis. It sability to distinguish probable true‐positive E I A reactions from probable false‐positive reactions makes it a valuable adjunct t o blood donor noti fication, and it should be used prior to such notification whenever possible.
A flow cytometric method for determination of white cell subpopulations in filtered red cells
Authors: Al E.J. , Visser S.C. , Prins H.K. , Pietersz R.N. , Reesink H.W. , Huisman J.G
Published: March 2003

A flow cytometric method for the detection of low amounts of lymphocytes, monocytes, and granulocytes in filtered red cells (RBCs) was evaluated. In this procedure, the RBCs in the samples were lysed by ammonium chloride treatment and the white cells (WBCs) were detected by flow cytometry according to their specific light‐scattering properties. The identity of the WBC subpopulations was confirmed by immunofluorescence with monoclonal antibodies specific for each cell type. Flow cytometric determination of WBCs in filtered RBCs correlated with numbers obtained by both a hemocytometer (r = 0.76) and a radioimmunoassay (r = 0.79). Total numbers of WBCs in RBCs measured by flow cytometry were 59 +/− 13 percent (n = 7) of those measured by electronic particle counting, 32 +/− 6 percent (n = 25) by hemocytometer, and 48 +/− 11 percent (n = 29) by radioimmunoassay. Lymphocytes added to filtered RBCs in a concentration of 1.37 cells per microL were detected at an average of 0.56 +/− 0.22 cells per microL (n = 3). Results with monoclonal antibodies indicated an altered expression of membrane markers on granulocytes after RBC filtration, as seen with cell activation. The inefficiency of the flow cytometric method to detect the total number of WBCs calculated by other methods may reflect filtration‐induced changes in light‐scattering properties of the WBCs. Although the method described does not accurately quantitate the total numbers of WBCs present in filtered RBCs, it may provide useful information on qualitative aspects of WBC subpopulations.
Absence of human immunodeficiency virus (HIV) proviral sequences in seronegative hemophilic men and sexual partners of HIV‐seropositive hemophiliacs
Authors: Bailly E. , Kleim J.P. , Schneweis K.E. , van Loo B. , Hammerstein U. , Brackmann H.H.
Published: March 2003

To detect latent infection with human immunodeficiency virus (HIV), specimens of peripheral blood leukocytes from HIV‐seronegative hemophiliacs and from sexual partners of HIV‐seropositive hemophiliacs were examined by polymerase chain reaction (PCR). The primer pair SK 38/39 derived from the gag region and/or the primer pair SK 68/69 corresponding to a conserved region of the env gene were used. Whereas HIV proviral DNA was detected by PCR in samples from 86 (97%) of 89 HIV‐seropositive hemophiliacs, no HIV‐DNA was found in blood samples of 198 HIV‐seronegative hemophiliacs at risk. Of 40 HIV‐seronegative sexual partners of HIV‐infected hemophiliacs, none was PCR positive. Thus, PCR is proving to be a sensitive method by which to confirm infection in seropositive hemophiliacs, while the negative results in HIV‐seronegative hemophiliacs and HIV‐seronegative sexual partners of HIV‐seropositive hemophiliacs suggest that a prolonged seronegative period of latent HIV infection is the exception.