bluuebunny/crossref_metadata_2025 huggingface dataset:
Where does preoperative erythropoietin therapy count? A mathematical perspective
Authors: Brecher Mark E. , Goodnough Lawrence T. , Monk Terri
Published: March 2003

BACKGROUND: The administration of erythropoietin (EPO) can be used to increase a patient's hematocrit (Hct) in the preoperative period and thus possibly preclude the need for allogeneic red cells. However, the exact effect on the postoperative Hct of a given rise in Hct in the preoperative period (and on the avoidance of allogeneic blood) has not been thoroughly evaluated.

STUDY DESIGN AND METHODS: Equations were developed on the basis of previously described relationships that allowed the assessment of the impact of a given preoperative Hct increase on the postoperative Hct under a variety of clinical situations.

RESULTS: Equations were derived that related the change in preoperative Hct after the administration of EPO to the final Hct after a given blood loss. In a typical example (blood volume = 5000 mL, pre‐EPO Hct of 40%, post‐EPO Hct of 45% after blood losses of 1000, 2000, 3000, 4000, 5000, and 6000 mL), an additional 205, 168, 137, 112, 92, and 75 mL of red cells, respectively, would be present postoperatively over the volume in the same patient who did not receive EPO. For a smaller patient, such as a child (blood volume, 2500 mL), an additional 17 mL (5000‐mL blood loss) to 83 mL (1000‐mL blood loss) of red cells would be present postoperatively. Hemodilution and EPO act synergistically to yield additional postoperative red cell volume.

CONCLUSION: The use of preoperative EPO with a preoperative increase in Hct results in an increased postoperative Hct after a surgical blood loss. Such a postoperative increase is a function of the volume of blood lost and the patient's blood volume but is independent of the patient's initial Hct. The final postoperative red cell volume increase associated with a preoperative increase in Hct of 1 to 5 percent is limited, however (generally equivalent to a fraction of 1 unit of allogeneic blood). Much of the increase in the patient's Hct vanishes at higher blood losses, and this therapy is most effective with blood loss of >4000 mL. EPO therapy alone may be most effectively used in patients with mild anemia who are undergoing routine surgical procedures that commonly require blood transfusion.
Standardized units of RBCs:Is it time for implementation?
Authors: Högman C.F. , Knutson F.
Published: March 2003

BACKGROUND: Current practice for the preparation of RBCs from whole blood for transfusion results in poorly standardized contents of RBC Hb. The principle of apheresis, metering the anticoagulant into the collected blood, which is pumped into an empty container, allows variation in the collected volume according to properties of the donor.

STUDY DESIGN AND METHODS: The total Hb mass of each person in a representative group of Swedish blood donors was evaluated by using Hb concentration and blood volume (BV), with the latter calculated from each donor's weight and height. The number of blood units that could be collected without exceeding 13 percent of the BV was estimated at a standardized content of RBC Hb set at 40, 45, and 50 g.

RESULTS: With Hb standards of 45 and 50 g per unit of RBCs, it would be possible to collect 1 unit, but not more, from 93 female donors in the study; with 40 g of Hb as the standard, 2 units could be collected from 6 percent of the donors. Using a standard of 40 g of Hb, it would be possible to collect 2 units or more from 95 percent of 121 male donors. The corresponding figures at Hb standards of 45 and 50 g were 81 and 50 percent, respectively, of the male donors. The largest number of units that could be collected would thus be obtained at a 40‐g Hb standard. However, the greatest total mass of RBC Hb would have been obtained at 45 g. Even the yield of plasma would reach a maximum at this RBC Hb standard.

CONCLUSION: Depending on the donor's Hb and BV, it is possible to collect either 1 or 2 units of RBCs without exceeding 13 percent of any donor's BV, provided the collected volume of blood in each unit is less than the current standard. Such practice would allow better use of the donor population. Two‐unit blood collections may reduce donor exposure in transfusions. Applying a standard at 45 g of RBC Hb per unit was found to permit the collection of maximum RBC Hb and plasma in the evaluated population of Scandinavian donors. Perhaps it is time to discuss a change in current rules for the preparation of RBCs for transfusion.
Longitudinal monitoring of WBC subsets in packed RBC units after filtration: implications for transfusion transmission of infections
Authors: Roback J.D. , Bray R.A. , Hillyer C.D.
Published: March 2003

BACKGROUND: Specific subsets of peripheral blood WBCs are reservoirs for infectious agents, such as CMV and EBV, and can serve as vectors for transfusion transmission of these agents. While filter WBC reduction has been used to prevent transfusion transmission of infections, its effectiveness has not been documented for many infectious agents and in some instances may be difficult to demonstrate in clinical trials. Because the effectiveness of filtration depends on the number of infected WBCs remaining at transfusion, WBC subpopulations in packed RBC units were quantitated after filtration and storage.

STUDY DESIGN AND METHODS: Packed RBC units (n = 14) were filtered and stored at 4oC for 42 days or were stored without filtration. Serial samples were subjected to flow cytometric immunophenotyping of WBC subsets: neutrophils, monocytes, CD4+ and CD8+ T cells, B cells, and NK cells.

RESULTS: Filtration produced a mean reduction in total WBCs of 3.2 log. Monocytes, lymphocytes, and neutrophils were reduced by 4.1, 3.8, and 2.5 log, respectively. Lymphocyte subsets also demonstrated differential reduction with filtration. All WBC subsets showed ongoing loss during storage.

CONCLUSIONS: Monocyte and lymphocyte subsets are removed most effectively by prestorage filtration. Postfiltration storage leads to further significant reductions in WBC subsets. The implications of these findings for the mitigation of transfusion transmission of infection are discussed.
False‐negative testing errors in routine viral marker screening of blood donors
Authors: Busch M.P. , Watanabe K.K. , Smith J.W. , Hermansen S.W. , Thomson R.A. ,   for the Retrovirus Epidemiology Donor Study
Published: March 2003

BACKGROUND: The contribution of testing errors to the risk of virus transmission by transfusion depends on the rate of false‐negative testing errors and the prevalence of infected seropositive donations. Although the false‐negative testing error rate has been estimated at 0.1 to 1 percent on the basis of proficiency studies, it has not previously been measured in routine donor screening.

STUDY DESIGN AND METHODS: A 1991 to 1995 database containing 5,153,153 donations from 1.5 x 106 donors (including autologous donors) was searched to identify donors who tested seropositive for HIV, HCV, HTLV‐I or II and who attempted subsequent donations. The false‐negative rate in routinely screened follow‐up donations was determined, and false‐negative cases were investigated to identify the cause.

RESULTS: Subsequent donations (n = 2015) by 1224 donors with confirmed‐positive results were identified. Eleven (0.5%) of these donations did not react in EIA. Ten of the 11 false‐negative cases were attributable to borderline‐reactive donations. On subsequent donations, there were borderline‐nonreactive results on HTLV‐I (2 cases), first‐generation HCV (5 cases), and second‐generation HCV (3 cases) EIAs. The final case was strongly reactive for HCV in a second‐generation EIA on two donations (signal‐to‐cutoff [S:C] ratio >3.5), followed by a baseline nonreactive result on a third donation (S:C = 0.05).

CONCLUSION: False‐negative testing results occur infrequently during routine infectious‐disease donor screening. Although most false‐negative results occurred with borderline‐reactive HTLV‐II samples and/or early‐generation HCV EIAs, frank technical errors (e.g., sample mixup or failure to add sample to EIA well) also occur at a low rate (0.05%; 95% CI, 0‐1.5%). Process enhancements designed to reduce errors (e.g., enhanced automation of data management and testing systems and process controls for EIAs) are warranted to detect and prevent false‐negative results.
Verification of the drug history given by potential blood donors: results of drug screening that combines hair and urine analysis
Authors: Mahl M.A. , Hirsch M. , Sugg U.
Published: March 2003

BACKGROUND: Besides modern virus‐screening methods, the avoidance of transfusion transmission of viral diseases is based on the best possible selection of healthy donors. Unfortunately, most of the relevant behavior‐related risk factors are not accessible to objective verification. Drug screening can be used to validate a defined section of donor statements. It may be assumed that donors who conceal drug consumption may also conceal other relevant risk factors.

STUDY DESIGN AND METHODS: Hair and urine samples from 186 young potential donors who denied having consumed drugs were investigated by gas chromatography with mass selective detection and a urine fluorescence polarization immunoassay for cannabinoids, amphetamine and amphetamine derivatives, cocaine, and opiates.

RESULTS: Ten potential donors with 14 positive results on hair and urine analyses (6× cannabinoids, 4× cocaine, 1× opiates, 3× dihydrocodeine) could be identified in the population investigated.

CONCLUSIONS: The donor history is not adequate for identifying potential donors with risk factors. Deliberately false statements concerning risk factors are a clear breach of trust between the blood bank and potential donors. These unreliable donors represent an incalculable risk for the transfusion recipient. Therefore, it is appropriate to validate donor statements about drug consumption by random hair and urine analyses and to exclude from the donor pool all persons revealed as drug users.
Assessment of donor T‐cell function in cellular blood components by the CD69 induction assay: effects of storage, γ radiation, and photochemical treatment
Authors: Fiebig E. , Hirschkorn D.F. , Maino V.C. , Grass J.A. , Lin L. , Busch M.P.
Published: March 2003

BACKGROUND: Functional donor T‐lymphocytes in blood components may cause a variety of transfusion complications. A flow cytometric assay based on the measurement of induced CD69 expression may be an alternative to cell proliferation methods in determining the functional status of these cells in blood components.

STUDY DESIGN AND METHODS: Seven units of whole blood, RBCs, and platelet concentrates (PCs) were stored under blood bank conditions. Half of 3 PCs each were gamma‐radiated or treated with UVA+psoralen; the other half served as controls. Samples were analyzed for phorbolester‐induced expression of CD69 as an indicator of cell responsiveness and for exclusion of propidium iodide as a measure of cell membrane integrity and viability.

RESULTS: CD69 inducibility and propidium iodide exclusion decreased exponentially (half‐life, 3.3 and 8.1 days, respectively) during cold blood storage. Irradiation and UVA+psoralen treatment of PCs immediately reduced CD69 inducibility to 21 percent (controls, 82%; p = 0.004) and 12 percent (controls, 95%; p = 0.0008), respectively. The proportion of cells capable of propidium iodide exclusion was similar in treated samples and controls, but it declined faster in the treated samples during subsequent storage.

CONCLUSION: Flow cytometric measurement of CD69 induction can be adapted to provide quantitative assessment of T‐cell function in blood components. Results obtained by the CD69 assay are in general agreement with those previously reported by use of proliferation methods; the assay may be useful for special applications in transfusion medicine.
Transfusion‐related sepsis due to Serratia liquefaciens in the United States
Authors: Roth V.R. , Arduino M.J. , Nobiletti J. , Holt S.C. , Carson L.A. , Wolf C.F.W. , Lenes B.A. , Allison P.M. , Jarvis W.R.
Published: March 2003

BACKGROUND: Severe, often fatal, transfusion reactions due to bacterial contamination of blood components continue to occur. Serratia liquefaciens, an unusual human pathogen, is a recently recognized potential cause of transfusion‐related sepsis.

CASE REPORTS: Five episodes of transfusion‐related sepsis and endotoxic shock due to S. liquefaciens were reported to the CDC from July 1992 through January 1999. One episode has been described. The remaining four, all fatal, are described here: three associated with RBC transfusion and one associated with transfusion of platelets. In each instance, the source of contamination could not be found. The implicated units tended to be older (mean RBC age 28 days), and visual discoloration was noted in each RBC unit, although usually in retrospect.

CONCLUSION: S. liquefaciens is an increasingly recognized cause of transfusion‐related sepsis and is associated with a high mortality rate. S. liquefaciens can contaminate both RBCs and platelets, but the mechanism(s) of contamination remain unknown. Increased attention to pretransfusion visual inspection may avert the transfusion of some S. liquefaciens‐contaminated RBC units. However, more sensitive rapid diagnostic tests are needed to further reduce the risk of transfusion‐related sepsis and endotoxic shock.
Donor lymphocyte infusion to eradicate recurrent host hematopoiesis after allogeneic BMT for sickle cell disease
Authors: Baron Frederic , Dresse Marie‐Francoise , Beguin Yves
Published: March 2003

BACKGROUND: Donor lymphocyte infusion (DLI) is currently standard therapy for relapse of malignancies after allogeneic BMT. Several observations suggest that both normal and leukemic progenitor cells of host origin constitute effective target cells for donor‐derived lymphocytes. To prevent relapse of sickle cell disease (SCD), a child with evidence of decreasing mixed chimerism received DLIs 8 months after allogeneic BMT for SCD.

CASE REPORT: A 4‐year‐old child who was homozygous for SCD underwent a transplantation of bone marrow from his fully HLA‐matched sister. Routine detection of sex chromosomes in bone marrow cells evidenced decreasing mixed chimerism, which heralded a probably imminent recurrence of the disease. The patient received two DLIs in graded incremental doses on Days 234 and 267. One month later, he developed grade 2 acute GVHD that responded well to corticosteroids and cyclosporine.

RESULTS: DLI resulted in complete donor chimerism within 2 months of the second infusion. Now, 2 years after the second DLI, the patient is in excellent condition, with normal Hb and excellent growth and development.

CONCLUSION: This is the first report of successful use of DLI in a patient with probable imminent SCD recurrence after allogeneic BMT. It shows that DLI can displace residual host HPCs in case of recurrence of nonmalignant disease after allogeneic BMT.
Quantitative determination of anti‐K (KEL1) IgG and IgG subclasses in the serum of severely alloimmunized pregnant women by ELISA
Authors: Ahaded Abdellah , Brossard Yves , Debbia Martine , Lambin Patrick
Published: March 2003

BACKGROUND: Severe cases of HDN occur after the immunization of the mother with K (KEL1) antigen. To date, the only means of evaluating the concentration of anti‐K in maternal serum is by titration with an indirect antiglobulin test (IAT). A more accurate estimation of the serum anti‐K concentration is needed.

STUDY DESIGN AND METHODS: An ELISA technique was developed for the determination of the absolute concentration of anti‐K IgG and IgG subclasses in the sera of alloimmunized patients. In this technique, after absorption of anti‐K on K‐positive RBCs and subsequent elution at acid pH, the concentration of anti‐K in the eluate was measured with a sensitive and reproducible ELISA. This method was validated with monoclonal and polyclonal anti‐K. It was then used to assay the sera of eight pregnant women with anti‐K immunization, associated with early fetal anemia (Hct, 7‐17%) detected between the 20th and the 31st week of pregnancy. In addition, in most of these cases, the anemia was associated with fetal hydrops.

RESULTS: The anti‐K IgG concentration measured by ELISA in the sera of the eight women varied from 1.0 to 4.1 μg per mL (mean, 2.2 μg/mL). Therefore, severe and early forms of fetal anemia can be observed with a relatively low concentration of anti‐K (as compared to the concentration of anti‐D in similar cases of fetal anemia due to anti‐D). The mean proportion of each IgG subclass of anti‐K in these sera was IgG1, 95.9 percent; IgG2, 2.4 percent; IgG3, 1.3 percent; and IgG4, 0.4 percent.

CONCLUSION: A simple method for quantitative estimation of anti‐K in human serum has been developed. Low concentrations of anti‐K can cause fetal anemia relatively early in pregnancy. This method should lead to a better identification of pregnant women whose fetuses are at risk for severe fetal anemia due to anti‐K.
The effect of storage on the expression of platelet membrane phosphatidylserine and the subsequent impacton the coagulant function of stored platelets
Authors: Shapira Shirley , Friedman Ziva , Shapiro Hava , Presseizen Katya , Radnay Judith , Ellis Martin H.
Published: March 2003

BACKGROUND: Platelet concentrates (PCs) derived from whole blood and stored under standard blood bank conditions undergo changes that are referred to as the platelet storage lesion. This study assesses the effect of PC preparation and storage on the distribution of phosphatidylserine (PS) in the platelet membrane and the effect that this distribution may have on the thrombogenic potential of stored PCs.

STUDY DESIGN AND METHODS: Fresh platelets and PCs donated by healthy donors were obtained. PCs derived from platelet‐rich plasma were studied on Day 1, Day 3, and Day 6 of storage under blood bank conditions.

RESULTS: Platelet aggregation after exposure to the platelet agonists ADP and epinephrine singly declined progressively, but, when ADP and epinephrine in combination and collagen and thrombin in combination were used as agonists, the decline in platelet aggregation was less marked. PS expression as measured by Annexin V binding (mean and SD) was 2.02 ± 0.93 percent in fresh platelet samples and increased to 5.39 ± 4.2 percent on Day 1, 22.1 ± 7.1 percent on Day 3, and 39.5 ± 12.1 percent on Day 6. Platelet prothrombinase activity (mean ± SD) as measured by thrombin generation increased from 1.49 ± 0.7 μ per mL in fresh platelet samples to 3.68 ± 1.1 μ per mL in Day 1 platelets (p<0.001), 5.15 ± 2.5 μ per mL in Day 3 platelets (p<0.001), and 4.65 ± 2.48 μ per mL in Day 6 platelets (p<0.001).

CONCLUSION: These results show that PS expression increases after preparation of PCs from platelet‐rich plasma and rises progressively during platelet storage under blood bank conditions. Furthermore, the greater PS expression is associated with increased platelet‐ dependent thrombin‐generating capacity.
The capacity of different infusion fluids to lower the prooxidant activity of plasma iron: an important factor in resuscitation?
Authors: Moison Ralf M.W. , Bloemhof Fimke E. , Geerdink Janneke A.M. , De Beaufort Arnout Jan , Berger Howard M.
Published: March 2003

BACKGROUND: Prooxidant activity of non‐protein‐bound iron (NPBI) is an important contributor to reactive oxygen species‐induced injury after the resuscitation of critically ill patients. Plasma NPBI occurs in critically ill adults, children, and newborn babies, who often require resuscitation. The ability of the resuscitation fluids to bind iron and lower the patients′ NPBI levels in vitro has not previously been studied.

STUDY DESIGN AND METHODS: In an in vitro model, highly iron‐saturated cord blood plasma from 10 preterm and 10 term babies was mixed with FFP, pasteurized plasma protein solution, and 0.9‐percent saline. Plasma from 10 healthy adult volunteers was used as a control. Before and after the mixing with any resuscitation fluid, NPBI levels and ceruloplasmin iron‐oxidizing and transferrin iron‐binding antioxidant capacities were measured.

RESULTS: After the in vitro mixing with FFP, the incidence and concentration of NPBI were markedly decreased and the iron‐binding antioxidant capacity was increased in the plasma of the preterm and term babies. Being mixed with pasteurized plasma protein solution and 0.9‐percent saline did not influence the iron‐binding antioxidant capacity of newborn babies′ plasma. In the control plasma, results were not changed after the mixing with any resuscitation fluid. In every group, the iron‐oxidizing antioxidant capacity was not changed after the mixing with any fluid.

CONCLUSION: Iron‐induced oxidative tissue damage may be influenced by resuscitation fluids. In the ongoing debate over the choice of crystalloid or colloid resuscitation fluids, the influence of each fluid on the patient′s antioxidant capacity warrants more attention.
PEG adsorption of autoantibodies and detection of alloantibodies in warm autoimmune hemolytic anemia
Authors: Cheng Chun‐Kwok , Wong Maria L. , Lee Ala W.
Published: March 2003

BACKGROUND: The purpose of this study was to evaluate the effectiveness of PEG in the adsorption of autoantibodies and the detection of alloantibodies in patients with warm autoimmune hemolytic anemia (WAIHA).

STUDY DESIGN AND METHODS: The study was divided into three parts. First, the effectiveness of antibody removal by a conventional adsorption procedure and that by the PEG adsorption method were compared by using commercial antisera adsorbed with antigen‐positive RBCs. Second, patients′ sera with known weak alloanti‐E were used to test against screening cells after allogeneic adsorption to show nonspecific coating of antibodies and the dilution effect on the PEG adsorption procedure. Third, conventional and PEG one‐cell sample allogeneic adsorptions of WAIHA patients′ sera with and without alloantibodies were performed and compared.

RESULTS: In the first part, seven of the eight polyclonal antisera gave a lower titer and score when tested against antigen‐positive RBCs in the indirect antiglobulin test; this indicated that PEG is more efficient in removing antibodies. In the second part, similar reaction patterns were observed in antibody screening tests on unadsorbed sera and on sera after the first, second, and third adsorptions, which indicated that there was no alloantibody loss, nonspecific antibody coating, or dilution effect when PEG was added in the allogeneic adsorption procedures. In the third part, a 40‐percent increase in efficiency in reducing the number of adsorptions and an 85‐percent decrease in completion time of the adsorption procedures were obtained when PEG was used for adsorbing sera from 16 patients with WAIHA. Both conventional and PEG procedures were capable of removing autoantibodies to identify the specificities of alloantibodies.

CONCLUSION: The PEG adsorption method is an effective, sensitive, and efficient method of enhancing auto‐ antibody adsorption and alloantibody detection. It can reduce the processing time and minimize the delay of urgent transfusions to patients with WAIHA and can indirectly enhance cost‐effectiveness and decrease the labor‐intensive testing required by these cases.
Counting of residual WBCs in WBC‐reduced blood components: a multicenter evaluation of a microvolume fluorimeter by the United Kingdom National Blood Service
Authors: Seghatchian Jerard , Krailadsiri Pranee , Scott Colin S.
Published: March 2003

BACKGROUND: Implementation of universal WBC reduction of blood components means that automated analytical methods may be the only satisfactory way for production laboratories to meet increased testing requirements.

STUDY DESIGN AND METHODS: A multicenter study on the performance of a microvolume fluorimeter (IMAGN 2000, Becton Dickinson) was undertaken on 519 RBC, 353 platelet, and 27 fresh plasma units.

RESULTS: WBC counts for the RBC samples ranged from 0.02 to 6.94 × 106 per unit (mean, 0.57) as determined by FC and from 0.02 to 5.53 × 106 per unit (mean, 0.40) as determined by MVF with a mean FC bias of +0.15 × 106 WBCs per unit, and discrepancies outside the 95% limits of agreement were mainly associated with higher FC counts. The series of platelet samples showed means of 0.90 (range, 0.06‐19.45) and 0.66 (range, 0.01‐18.95) × 106 WBCs per unit for FC and MVF methods, respectively. FC and MVF results were in good agreement at low counts, although significant discrepancies were noted at higher counts. Overall, for the platelet units, there was a mean FC bias of +0.34 × 106 WBCs per unit. The intermethod agreement exceeded 99 percent for both types of blood component when the single (both UK and United States) decision point of 5.0 × 106 WBCs per unit was applied. The mean WBC counts for the 27 analyzed fresh plasma units were 61.8, 56.0, and 46.0 per μL by Nageotte hemocytometry, FC, and MVF, respectively.

CONCLUSIONS: This evaluation found that the level of intersite consistency for FC was relatively poor compared to that for MVF. The results nevertheless validated the broad equivalence of FC and MVF results for the current Council of Europe and UK/US decision points of <1.0 and <5.0 × 106 WBCs per unit.
Transfusion‐related acute lung injury after the infusion of IVIG
Authors: Rizk André , Gorson Kenneth C. , Kenney Lawrence , Weinstein Robert
Published: March 2003

BACKGROUND: Transfusion‐related acute lung injury (TRALI) is a well‐characterized, serious complication of blood component therapy in hospitalized patients. The signs and symptoms are often attributed to other clinical aspects of a patient's condition, and therefore TRALI may go unrecognized. IVIG is a pooled plasma derivative commonly used in the outpatient setting. Respiratory complications of IVIG infusion have typically been attributed to volume overload or allergic and vasomotor reactions. TRALI has never been documented to occur after IVIG infusion.

CASE REPORT: A 23‐year‐old man with multifocal motor neuropathy developed noncardiogenic pulmonary edema 6 hours after receiving 90 g of IVIG by a rapid‐infusion protocol. He fully recovered in 5 days with nasal oxygen and bed rest. Granulocyte‐associated IgG was detected in his blood 14 and 27 weeks after the event. The lots of IVIG that he received were found to contain a low‐titer, panreactive, granulocyte antibody, mostly IgG.

CONCLUSION: This is the first documented case of TRALI after IVIG infusion. An autoimmune syndrome, including autoantibody‐coated granulocytes, may have been a priming stimulus for granulocyte interaction with pulmonary capillary endothelium. Rapid infusion of a large quantity of granulocyte antibody may have precipitated TRALI. A pooled plasma product or derivative may result in TRALI.
Donor‐derived alloantibodies and passenger lymphocyte syndrome in two of four patients who received different organs from the same donor
Authors: Seltsam Axel , Hell Anette , Heymann Guido , Salama Abdulgabar
Published: March 2003

BACKGROUND:Reported here is the occurrence of RBC alloimmunization in two of four patients who received different organs from an immunized donor.

STUDY DESIGN AND METHODS:The donor, a 58‐year‐old woman, was group O D+, K−, and Fy(a−). Initially, her serum contained only a K antibody. After blood transfusion, a second antibody (anti‐Fya) could also be identified. The liver was given to a group O D+, K−, Fy(a+) patient; the pancreas and one kidney to a group O D+, K−, Fy(a+) patient; the heart to a group A D+, K−, Fy(a−) patient; and the other kidney to a group B D+, K−, Fy(a+) patient. RBC grouping and antibody screening were performed by standard techniques. Lymphoid microchimerism in the peripheral blood of the recipients was analyzed by flow cytometry and nested PCR.

RESULTS:None of the recipients had irregular RBC alloantibodies at the time of transplantation. After the transplant, anti‐K became detectable in the serum of the liver recipient, and anti‐Fyacould be eluted from the RBCs of the liver recipient and the pancreas‐kidney recipient. The latter patient also developed mild hemolysis, and his Hb dropped to 8 g per dL on posttransplant Day 9. Donor‐derived lymphocytes were detectable by flow cytometry in the peripheral blood of the liver recipient and the pancreas‐kidney recipient until Days 8 and 63, respectively, whereas no lymphoid chimerism could be demonstrated in the heart recipient. PCR chimerism analyses were positive in all three recipients over the whole observation period of 97 postoperative days.

CONCLUSION:The amount of cotransplanted lymphoid tissue may correlate with the extent of peripheral lymphoid microchimerism and the antibody‐formation capacity in solid organ transplantation.
Serial granulocytapheresisunder daily administration of rHuG–CSF: effects on peripheral blood counts, collection efficiency, and yield
Authors: Worel Nina , Kurz Martin , Peters Christina , Höcker Paul
Published: March 2003

BACKGROUND: An option for treatment of severe infections in neutropenic patients is the transfusion of granulocytes from donors stimulated with rHuG–CSF. The schedule of rHuG–CSF‐stimulated granulocyte donations and the quality of the components remain controversial. This study was done with the intention of ensuring daily granulocyte support with therapeutic cell numbers, while keeping the patients' allogeneic exposure as low as possible.

STUDY DESIGN AND METHODS: Granulocyte collection with multiple consecutive leukapheresis procedures under daily rHuG–CSF administration and with hydroxyethyl starch as sedimenting agent were prospectively studied. Complete blood counts of the donors, collection yield, and efficiency were analyzed.

RESULTS: Products (n = 259) from 76 donors were examined. The median peripheral blood WBC and neutrophil counts were 28.1 g per L and 24.1 g per L, respectively, and they were significantly higher on Day 5 of collections than on Days 1 to 3. Platelet counts and Hb levels decreased steadily. Collection yields increased over time from 4.9 to 6.7 × 1010 neutrophils. Side effects of cytokines and aphereses did not exceed World Health Organization grade II status.

CONCLUSION: Repetitive daily rHuG–CSF administration—even under daily leukapheresis procedures—results in a continuing increase in WBC and neutrophil levels and thus leads to increased collection yields. Side effects are tolerable, although Hb and platelet levels should be monitored closely.
Repeat whole‐blood and plateletpheresis donors:unreported deferrable risks, reactive screening tests, andresponse to incentive programs
Authors: Glynn Simone A. , Smith James W. , Schreiber George B. , Kleinman Steven H. , Nass Catharie C. , Bethel James , Biswas Bipasa , Thomson Ruth A. , Williams Alan E. ,   for the Retrovirus Epidemiology Donor Study
Published: March 2003

BACKGROUND: Evaluating plateletpheresis (PPH) and repeat community whole‐blood (RWB) donors' responses to donation incentive programs is essential for developing effective donor retention programs.

STUDY DESIGN AND METHODS: Using data from a 1998 anonymous questionnaire sent to 92,581 US blood donors, the prevalence of unreported deferrable risks, screening test reactivity, and response to incentives were compared in RWB and PPH donors by the use of weighted chi‐square tests and logistic regression analyses.

RESULTS: From 52,650 respondents, 38,884 RWB and 2,028 PPH donors were identified. Levels of screening test reactivity (1%) and unreported deferrable risks (UDRs, 2‐3%) were similar in RWB and PPH donors. RWB and PPH donors were strongly encouraged or discouraged by similar incentives. Of the incentives that would encourage a higher proportion of UDR‐free RWB donors to return, cholesterol screening and earning a blood credit appealed to >50 percent. Similar results were obtained for cholesterol screening in PPH donors. Community service or education credits, premarital screening, and cash had limited appeal for PPH and RWB donors, respectively, and would be more likely to differentially encourage donors with a UDR to return.

CONCLUSION: Incentives that were associated with the greatest donor appeal and that minimized the potential recruitment of more risky donors were identified.
Number of RBC units and rate of transfusionto anemic HIV‐positive patients assigned to receiveWBC‐reduced or non‐WBC‐reduced RBCs: the Viral Activation Transfusion Study experience
Authors: Brecher Mark E. , Triulzi Darrell J. , Assmann Susan F. ,   for the Viral Activation Transfusion Study
Published: March 2003

BACKGROUND: It is known that the use of filtration to reduce WBCs in RBC units is associated with a 6‐ to 15‐percent loss of RBCs. It is not known if the use of such WBC‐reduced RBCs results in an increased need for RBC units or in the transfusion of more units per year to patients with anemia.

STUDY DESIGN AND METHODS: In the multicenter Viral Activation Transfusion Study (VATS), anemic HIV‐positive patients were randomly assigned to receive either WBC‐reduced or non‐WBC‐reduced RBCs. The number of RBC units transfused per patient and the rate of RBC use were studied. All RBC units given after the enrollment transfusion were counted, until the end of follow‐up or the occurrence of bleeding (receiving >5 RBCs within 2 consecutive days).

RESULTS: As expected, the WBC‐reduced RBC units in VATS were lighter in weight than the non‐WBC‐reduced units (median weight: WBC‐reduced, 300 g; non‐WBC‐reduced, 330 g; p<0.0001). After the enrollment transfusion, 258 WBC‐reduced arm patients received 1279 units of RBCs (average, 5.0 units/patient, median, 2 units) while 262 patients in the non‐WBC‐reduced arm received 1111 RBCs (4.2 units/patient; median, 2 units). The number of units transfused for anemia was slightly greater in the WBC‐reduced arm, but the difference was not significant (p = 0.41). Similarly, the rate of RBC use was somewhat higher in the WBC‐reduced arm, but the difference was not significant (p = 0.14). The median was 2.3 units per patient per year of follow‐up in the WBC‐reduced arm; the median in the non‐WBC‐reduced arm was 1.2 units.

CONCLUSION: This study confirms that WBC‐reduced RBC units are significantly lighter in weight than non‐WBC‐reduced RBCs. However, in the setting of a large, randomized, blinded study of transfusion for anemia, the smaller size of the WBC‐reduced RBC units had no significant effect on the number of RBC units transfused or on the rate at which RBC units were used. In this study, the frequency of blood transfusion may have had a greater relationship to the frequency of routine, scheduled appointments or transfusion orders for a specified Hb trigger than to the actual Hb content of the unit.
Prestorage universal WBC reduction of RBC units does not affect the incidence of transfusion reactions
Authors: Uhlmann Erik J. , Isgriggs Elizabeth , Wallhermfechtel Mary , Goodnough Lawrence T.
Published: March 2003

BACKGROUND: Febrile nonhemolytic transfusion reaction (FNHTR) has been identified as a pivotal reason for prestorage universal WBC reduction. A regional blood center implemented universal prestorage WBC reduction for RBCs on January 1, 2000. Whether prestorage universal WBC reduction of RBC units will affect FNHTR is not known.

STUDY DESIGN AND METHODS: All reports of RBC transfusion reactions at Barnes‐Jewish Hospital submitted for evaluation to the blood bank, before and after the implementation of WBC reduction of RBCs, were retrospectively evaluated.

RESULTS: For the 36,303 allogeneic RBC transfusions administered in 1999, 85 reactions (0.23%) were reported. These reactions were classified as FNHTR in 43 cases, allergic in 13, delayed hemolytic in 19, and miscellaneous in 10. For the 31,543 non‐WBC‐reduced RBC transfusions performed in 1999, 78 reactions (0.25%) were reported. These reactions were classified as FNHTR in 39 cases, allergic in 13, delayed hemolytic in 19, and miscellaneous in 7. In the first half of 2000, 32 reactions (0.20%) were reported for 16,093 prestorage WBC‐reduced RBC transfusions (p = 0.41). There were 13 FNHTRs and 10 allergic, 7 delayed hemolytic, and 2 miscellaneous reactions. The use of prestorage WBC‐reduced RBCs did not significantly affect the rate of reactions classified as allergic (0.04% in 1999; 0.06% in 2000; p = 0.43) or as FNHTR (0.12% in 1999; 0.08% in 2000; p = 0.33). For all patients, universal WBC reduction in 2000 did not reduce the rate of FNHTR from the rate seen with selective bedside WBC reduction, the practice used in 1999 (0.12% in 1999; 0.08% in 2000; p = 0.36).

CONCLUSION: No significant difference was found in the incidence of transfusion reactions in patients receiving prestorage WBC‐reduced RBCs and non‐WBC‐reduced RBCs. In addition, no difference was found in transfusion reaction rates when periods of prestorage universal WBC reduction were compared to those of selective WBC reduction.
A DV‐like phenotype is obliteratedby A226P in the partial D DBS
Authors: Wagner Franz F. , Ernst Manfred , Sonneborn Hans‐H. , Flegel Willy A.
Published: March 2003

BACKGROUND:In D category V types, theRHDexon 5 or parts thereof are replaced by the correspondingRHCEDNA segments. In D category V types I and II, the amino acid at position 226 is alanine, which is typical of the prevalentRHDallele and is observed in allRHCEalleles encoding the antigen e. A proline at position 226 inRHCEencodes the antigen E.

STUDY DESIGN AND METHODS:A blood sample of ccDEe phenotype was referred as suspected D category VI. TheRHDnucleotide sequence and the D epitope pattern were determined.

RESULTS:A new partial D, DBS, encoded by anRHD‐RHcE(5)‐RHDhybrid allele, was found. Although it differed from DVatype II by an A226P substitution only, it lacked epitopes epD4, epD12, epD17, epD18, and epD22 that were present in DVa. The 5′ breakpoint region was located between the deletion inRHDintron 4 and the first polymorphic nucleotide of DBS exon 5.

CONCLUSION:The phenotypes ofRHDalleles with gene conversions limited to exon 5 depended critically on the amino acid at position 226. If alanine was present at this position, gene conversions involving E233Q led to a DVa‐like phenotype. If proline was present, many additional epitopes were lost, and the phenotype became reminiscent of DFR. The 5′ breakpoint region is shared by 10 alleles and may represent the most active “hot spot” for gene conversions known inRH.
Detection of Chlamydia pneumoniae antigenin PBMNCs of healthy blood donors
Authors: Haranaga Shusaku , Yamaguchi Hiroyuki , Leparc German F. , Friedman Herman , Yamamoto Yoshimasa
Published: March 2003

BACKGROUND: Because it has been increasingly recognized that Chlamydia pneumoniae may be linked to some chronic inflammatory diseases, including atherosclerosis, detection of this pathogen in blood from patients may be valuable in the diagnosis of such diseases. However, the prevalence of chlamydia in the blood of healthy donors has not yet been extensively studied.

STUDY DESIGN AND METHODS: The presence of C. pneumoniae in PBMNCs obtained from healthy persons who donated blood for blood transfusion was assessed by a PCR that was specific for the C. pneumoniae 16S rRNA gene and by the use of staining with FITC‐conjugated chlamydia MoAb.

RESULTS: Twenty‐one (8.9%) of 237 blood samples tested showed the presence of C. pneumoniae DNA and antigen in the PBMNCs. There was no significant difference in the presence of chlamydia in blood according to sex or to age between 20 and 59 years of age. However, a possible seasonal variation in the presence of chlamydia in blood from healthy donors was suggested by the results obtained.

CONCLUSION: A significant percentage of healthy donors carry C. pneumoniae, which may be a risk factor for some chronic diseases.
TT virus genotype changes frequently in multiply transfused patients with hemophilia but rarely in patients with chronic hepatitis C and in healthy subjects
Authors: Toyoda Hidenori , Fukuda Yoshihide , Nakano Isao , Katano Yoshiaki , Yokozaki Shoichi , Hayashi Kazuhiko , Ito Yoshinori , Suzuki Koji , Nakano Hiroshi , Saito Hidehiko , Takamatsu Junki
Published: March 2003

BACKGROUND: TT virus (TTV), a novel DNA virus, was originally thought to be transmitted by transfusion. However, nonparenteral transmission is recently suspected to be a major mode of transmission. To investigate the possibility of reinfection with TTV in multiply transfused patients and to evaluate the significance of transfusion transmission of TTV in patients with hemophilia, serial changes in TTV genotype were investigated in three groups.

STUDY DESIGN AND METHODS: Serial changes in TTV genotype were investigated in 16 multiply transfused patients with hemophilia, 16 age‐matched patients with chronic hepatitis C, and 16 age‐matched healthy subjects.

RESULTS: Mixed infection with multiple TTV genotypes was common in all groups. However, changes in TTV genotype were frequent in patients with hemophilia (15/16; 93.8%) but rare in patients with chronic hepatitis C and in healthy subjects (each group: 1/16; 6.3%).

CONCLUSION: Changes in TTV genotype were frequently observed in multiply transfused patients with hemophilia but not in patients with chronic hepatitis or in healthy subjects without risk of transfusion transmission. This difference may suggest that exposure to TTV or even reinfection occurs frequently in patients with hemophilia, which could be evidence of transfusion transmission of TTV in this population.
Extracorporeal photochemotherapy for treatmentof acute and chronic GVHD in childhood
Authors: Salvaneschi Laura , Perotti Cesare , Zecca Marco , Bernuzzi Stefano , Viarengo Gianluca , Giorgiani Giovanna , Del Fante Claudia , Bergamaschi Paola , Maccario Rita , Pession Andrea , Locatelli Franco
Published: March 2003

BACKGROUND: Extracorporeal photochemotherapy (EPC) has recently been proposed for the treatment of adults with either acute or chronic GVHD. However, data on children given this therapy are scarce. A Phase I‐II study was carried out on EPC in children experiencing GVHD after allogeneic transplantation of HPCs.

STUDY DESIGN AND METHODS: Nine patients with steroid‐resistant, grade II‐IV acute GVHD and 14 with chronic GVHD, all of whom had been refractory to at least one line of treatment, were enrolled in this study and analyzed. The median age was 10.3 years (range, 5.4‐18.1), and the median body weight was 35 kg (range, 17‐89).

RESULTS: Seven of the nine patients with acute GVHD showed a response to EPC, whereas the disease progressed in the remaining two children (both with skin, gastrointestinal, and liver GVHD), and they died of grade IV acute GVHD. Among the seven children who responded to EPC, it was possible to completely discontinue immunosuppressive treatment in three. In the 14 children with chronic GVHD, 4 and 5 patients experienced complete and partial response to EPC, respectively, whereas the remaining 5 patients, all with extensive chronic GVHD, had stable disease or disease that progressed during EPC. Among these latter 5 patients, 3 died. In 6 of the 9 patients with chronic GVHD responding to EPC, immunosuppressive therapy was discontinued.

CONCLUSION: EPC is safe, feasible, and effective in children with either acute or chronic GVHD occurring after an allograft.
Cataracts in neutrophil donors stimulated with adrenal corticosteroids
Authors: Ghodsi Zuleika , Strauss Ronald G.
Published: March 2003

BACKGROUND:A relatively young man (43 years old) was found to have a cataract after receiving prednisone before each of 35 neutrophil (PMN) donations over several years. Because corticosteroids are known to induce posterior subcapsular cataracts (PSCs), additional repeat PMN donors were examined ophthalmologically.

STUDY DESIGN AND METHODS:A controlled, blinded study was performed in 11 PMN donors who received prednisone with or without G–CSF before 17 to 46 leukapheresis donations over an average of 8.5 years. Control subjects were nine plateletpheresis donors of comparable age and donation experience, but they had never donated PMNs. A complete eye examination was performed by an ophthalmologist who was unaware of the donor's status (PMN vs. platelet).

RESULTS:Mild PSCs were found in 36 percent (4/11) of PMN donors versus 0 of 9 platelet donors (p = 0.068). Five of the 22 PMN donor eyes involved versus 0 of the 18 platelet donor eyes involved exhibited PSCs (p = 0.040). Cortical and nuclear cataracts were found similarly in both groups of donors (82% PMN vs. 56% platelet donors; p = 0.217); this indicated that lifestyle factors, independent of corticosteroids, that might predispose to cataract formation probably were comparable.

CONCLUSION:Corticosteroids given before PMN donations by leukapheresis might increase the risk of PSCs. Because of widespread renewed interest in PMN transfusions, this potential risk factor—if confirmed by studies of additional PMN donors—is of great international importance. Other centers are urged to perform ophthalmologic examinations on repeat PMN donors to clarify this issue.
Comparison of intermittent‐ and continuous‐flow cell separators for the collection of autologous peripheral blood progenitor cells in patients with hematologic malignancies
Authors: Hitzler Walter E. , Wolf Sieglinde , Runkel Stefan , Kunz‐Kostomanolakis Marika
Published: March 2003

BACKGROUND: The transplantation of autologous peripheral blood progenitor cells (PBPCs) after high‐dose chemotherapy is a valuable therapy for patients with hematologic and solid malignancies. Several methods are used for harvesting PBPCs. The efficiency of intermittent‐ and continuous‐flow blood cell separators in collecting progenitor cells from the blood of patients undergoing myeloablative treatment for cancer was compared.

STUDY DESIGN AND METHODS: PBPC components (n = 133) were obtained from 72 patients by leukapheresis with continuous‐flow machines (Spectra, COBE; CS 3000 Plus, Baxter) and with an intermittent‐flow machine (MCS 3P, Haemonetics). The data were analyzed retrospectively. Blood samples obtained from the patients before leukapheresis and samples of the leukapheresis components themselves were analyzed for their content of RBCs, WBCs, platelets, and CD34+ cells.

RESULTS: The Spectra processed more than twice the blood volume in the shortest time (15 L in 178 min), whereas the Baxter CS 3000 Plus (10 L in 185 min) and the MCS 3P (4.8 L in 239 min) processed significantly smaller volumes in a longer time. The mean ACD consumption was 403 mL with the MCS 3P, 900 mL with the CS 3000 Plus, and 1000 mL with the Spectra. The product volumes were 50 mL (CS 3000 Plus), 69 mL (MCS 3P), and 166 mL (Spectra). In all groups, differences in the preapheresis hemograms were not significant, but the Spectra group had fewer CD34+ cells than the other groups. Despite this, the differences in the number of CD34+ cells in the leukapheresis components of all groups were without statistical significance. In the Spectra group, the collection of MNCs of 104 percent and CD34+ cells of 154 percent was significantly more efficient than that in the MCS 3P group (42.2% and 56%, respectively) or the CS 3000 Plus group (50.8% and 47.15%) as related to the patients' blood volume.

CONCLUSION: PBPC collection can be performed successfully with continuous‐flow and intermittent‐flow blood cell separators. The Spectra had the best recovery of CD34+ cells within the shortest time. Leukapheresis with the MCS 3P is indicated if only a single venous access is available.