bluuebunny/crossref_metadata_2025 huggingface dataset:
Dietary effects on growth, reproduction, body composition and stress resistance in the terrestrial isopodsOniscus asellusandPorcellio scaber
Authors: Lavy D. , Van Rijn M. J. , Zoomer H. R. , Verhoef H. A.
Published: September 2010

The effect of differences in food composition on growth, body composition and cold tolerance of the isopodsPorcellio scaber(Latreille) andOniscus asellus(L.) has been studied. The effect on reproduction ofP. scaberwas included. Total lipid and protein content remained the same inO. asellus, given food with a nitrogen content of 2.4, 2.5, 2.8 or 3.1% for 8 weeks. Those fed on 3.1% N gained significantly more weight than those fed on 2.4, 2.5 or 2.8% N. Cold tolerance after a period of low temperature acclimation could not be tested, due to high mortality at the subzero treatment. Haemolymph osmolality increased after the winter acclimation for all food treatments. JuvenileP. scaber, given food of 1.8, 2.5 or 3.1% N, showed no difference in growth over 18 weeks, nor in body composition over 14 weeks. Diet did not influence cold tolerance ability and haemolymph osmolality remained the same with changing cold tolerance of the animals. Gravid females ofP. scaberwere separated to examine the effect of diet on reproduction. Diet did not influence the number of juveniles, nor their weight. In all food treatments, a significant correlation was found between the weight of the female and the number and weight of her offspring.
Immunological evidence for FGLamide‐ and W2W9‐allatostatins in the ovary of Gryllus bimaculatus (Ensifera, Gryllidae)
Authors: Witek Günther , Hoffmann Klaus H.
Published: September 2010

Using polyclonal antisera to Gryllus bimaculatus allatostatin A1 (FGLamide) and B1 (W2W9‐amide), two sensitive and specific competitive enzyme‐linked immunosorbent assays (ELISAs) were developed, which allowed detection of A‐ and B‐allatostatin‐like immunoreactivity in extracts of ovaries and partially purified chromatography (HPLC) fractions. Immuno‐positive HPLC fractions inhibited biosynthesis of Juvenile Hormone in vitro in the rapid partition assay. Both antisera were also used to immunolocalize A‐ and B‐allatostatin epitopes in the ovary of larval and adult crickets. A‐ and B‐allatostatin immunoreactivity appeared in the cortical cytoplasm of the oocytes at the anterior cell poles. Controls treated with the pre‐immune sera or with antisera preadsorbed onto the respective peptides coupled to a solid phase support did not stain. There was no staining in any neural structures within the ovary.
The value of three cereal aphid species as food for a generalist predator
Authors: Bilde Trine , Toft Søren
Published: September 2010

The value of the cereal aphid speciesMetopolophium dirhodum(Wlk.), Sitobion avenae(F.) andRhopalosiphum padi(L.) as prey for the linyphiid spiderErigone atra(Bl.) was assessed. Fecundity of females was determined for spiders fed on eight experimental diets: three single‐species aphid diets, a mixed diet of all three aphid species, three mixed diets with each aphid species in combination with fruit fliesDrosophila melanogaster(Meig.), and pureD. melanogasteras a high quality comparison diet. The development and survival of first‐instar juveniles fed on three diets of single aphid species, and on a diet of Collembola were compared with those subjected to starvation. Prey value for adult females was assessed by egg production, hatching success and offspring size.

In pure diets all three aphid species were of low value to the spiders, causing a rapid decline in egg production and supporting no growth of significance of first‐instar juveniles. No difference in value of aphid species of single‐species aphid diets was found in the fecundity experiment, while a ranking of aphid species ofM. dirhodum> R. padi> S. avenaewas revealed in the survivorship experiment. A mixed‐aphid diet was not found to be advantageous compared with single‐species aphid diets, and no advantage of including aphids in mixed diets with fruit flies was found.Metopolophium dirhodumandR. padiwere neutral in mixed diets, while a diet ofS. avenaeand fruit flies caused reduced egg production compared with the pure diet of fruit flies, revealing a toxic effect ofS. avenaeon the spider. The value‐ranking of aphid species in mixed diets was similar to that of single‐species diets. A similar ranking of aphid species was found for different fitness parameters (fecundity of adult females and development of juveniles).

A ranking of aphids by offspring size of mothers on aphid‐only diets wasS. avenae> M. dirhodum> R. padi. All aphid‐fruit fly diets resulted in larger offspring than a diet of onlyD. melanogaster, with the overall largest offspring being produced on the diet ofM. dirhodumand fruit flies.
Daily patterns of locomotor and sugar‐feeding activity of the mosquito Culex annulirostris from geographically isolated populations
Authors: Williams Craig R. , Kokkinn Michael J.
Published: September 2010

Abstract.  The daily patterns of locomotor and sugar‐feeding activity of virgin female Culex annulirostris from three regions in Australia and a laboratory colony are studied using video techniques in the laboratory. Although all populations display a crepuscular/nocturnal locomotor pattern, significant variation exists between populations, with the pattern of those from southern Australia differing markedly from those in central and northern Australia. It is hypothesized that adaptation of populations to local climates is responsible. Sugar‐feeding (inferred from landing on a sugar source) is mostly crepuscular/nocturnal in all populations. The behavioural variation that exists within wide‐ranging mosquito species is highlighted, and indicates that significant behavioural differences exist between laboratory colonies and wild‐types.
Host adaptation of the fruit piercing moth, Eudocima fullonia
Authors: Reddy G. V. P. , Cruz Z. T. , Bamba J. , Muniappan R.
Published: September 2010

Abstract.  The fruit piercing moth, Eudocima fullonia (Clerck) (Lepidoptera: Noctuidae), whose larval host plants are vines of the family Menispermaceae in Asia, Africa and Australia, is thought to have adapted to Erythrina spp. in the Pacific and Papua New Guinea and has been designated as a separate biotype from the Australasian and African biotype. To test the hypothesis that the Pacific population of E. fullonia is a biotype, feeding trials with the host plants Tinospora homosepala Diels (Menispermaceae) and Erythrina variegata Linn. (Fabaceae) were conducted in Guam. The results indicate that the Guam population of E. fullonia is a biotype that has expanded its host range from its normal Menispermaceae plants to Erythrina species, possibly due to genetic changes and/or the presence of closely related alkaloids in both the species and paucity of menisperms.
Structural similarity and variety at the tips in a wide range of strike–slip faults: a review
Authors: Kim Young‐Seog , Sanderson David J.
Published: September 2010

Strike–slip faults are often accompanied by a variety of structures, particularly at their tips. The zones of additional fracturing are classified as tip‐damage zones. These zones can be subdivided into several different damage patterns based on the nature and orientation of faults and fractures developed. Damage zones at the ends of small strike–slip faults (mode II tips) develop wing cracks, horsetail splays, antithetic faults, synthetic branch faults and solution surfaces. Similar tip‐damage patterns are also commonly observed at larger (regional) scales, but with a dominance of faulting over tensile cracks and solution surfaces. Wing cracks and horsetail splays developed at small‐scale faults are replaced by normal faults in large‐scale faults. Antithetic faults and synthetic branch faults are observed at small and large scales. Thrust faults are developed at large scales, in a similar pattern to solution surfaces at a small scale. All these structures may show slightly different angular relationships to the master fault at small and large scale, but develop in response similar stress distribution and mechanics around the fault. Thus, mode II tip‐damage zones show similar patterns over a wide range of fault scales.
Focused subaerial erosion during ridge subduction: impact on the geomorphology in south‐central Peru
Authors: Wipf Martin , Zeilinger Gerold , Seward Diane , Schlunegger Fritz
Published: September 2010

Data obtained from low‐temperature thermochronometers such as apatite fission‐track and (U‐Th)/He are combined with morphometric information extracted from digital elevation models. This combination shows several geomorphological effects that are caused by the migration of the Nazca Ridge along the Peruvian Coastal margin. Offshore, the depth of the deep‐sea trench decreases by ∼1500 m where the Nazca Ridge collides with the continental South American Plate. Onshore the ridge causes an uplift of at least 800 m in the Coastal Cordillera. This uplift results in a westward shift of the coastline thereby focusing and increasing erosion in the uplifted areas. At the trailing edge, the shelf subsides and the coastline retreats eastwards, producing at least part of the indentation observed between Paita and Pisco. The Ridge acts therefore like a wave uplifting the Andean margin as it traverses inland and southwards leaving a clear fingerprint on the topographic evolution of the Peruvian coastal margin.
Relative fracture velocities based on fundamental characteristics of joint‐surface morphology
Authors: Weinberger Ram , Bahat Dov
Published: September 2010

Two different joint surface morphologies, plumes and rib marks, characterize joint surfaces, but the mechanical conditions that lead to the formation of either of the morphologies are not understood well. We studied two orthogonal joint sets that cut the same Santonian chalk beds in the Judea Desert, Israel. Joints of the J1 set are systematic, relatively long, characterized by almost exclusively by plumes and predate the shorter, non‐systematic joints of the J2 set that are characterized by rib marks. Joints of the J1 set formed at high stress during deformation of the Syrian Arc folding in the Late Senonian. Joints of the J2 set formed at lower stress that occurred because of stress relaxation after the formation of the J1 joints. A mechanical analysis indicates that the J1 joints propagated at subcritical velocities several orders of magnitude faster than the J2 joints. Based on previously published data of laboratory tests, the plumes and the rib marks are semi‐quantitatively placed on the subcritical part of the fracture velocity vs. stress‐intensity factor diagram.
Rh(D) Immunoglobulin – Where Does it Come From?
Authors: Davison Tanya , Wylie Brenton
Published: September 2010

Australian Rh(D) Immunoglobulin is produced by CSL Bioplasma using plasma containing anti‐D collected by the Australian Red Cross Blood Service (ARCBS) from Australian voluntary blood donors. The ARCBS Rh Project was established, initially in New South Wales in 1967, with an aim of providing an adequate supply of Australian derived Rh(D) Immunoglobulin. In 1999, the NHMRC ‘Guidelines on the prophylactic use of Rh(D) Immunoglobulin (Anti‐D) in obstetrics’ stated that universal prophylaxis with Rh(D) Immunoglobulin to RhD negative women with no preformed anti‐D antibodies at 28 and 34 weeks gestation is generally regarded as best practice. With the availablity of Rh(D) Immunoglobulin at that time, the NHMRC recommended a phased implementation commencing with all Rh(D) negative primigravidae with no preformed anti‐D antibodies (Phase 1). Phase 1 commenced in late 2002. The NHMRC recommemnded that full antenatal prophylaxis (phase 2) would be implemented when domestic supplies of Rh(D) Immunoglobulin increased sufficiently to cover the increased demand. The ARCBS plays an integral part in the implementation of universal antenatal prophylaxis by being the supplier of plasma containing anti‐D for production and as the distributor of the final Rh(D) Immunoglobulin product. In 1999, the ARCBS supplied an average of 15 × 106 IU of anti‐D per month to CSL Bioplasma. Implementation of phase 1 occurred following the introduction of two new products; the Australian derived Rh(D) Immunoglobulin 250 IU dose for first trimester indications and the temporary importation of WinRho SDFTM for postnatal use. Implementation of phase 2 and 3 requires the ARCBS to increase the amount of anti‐D collected to an average of 30 × 106 IU and 45 × 106 IU per month, respectively. Phase 3 of the program is full antenatal prophylaxis supported entirely by domestic product. In 2002, additional funding was allocated to the ARCBS Rh Project to implement strategies to ensure that the input targets for phase 2 and 3 are achieved. In mid 2004, following months of primary immunisation and boosting of both new and existing donors, input levels began to consistently meet or exceed 30 × 106 IU, and planning for phase 2, implementation began. This presentation will give an overview of the strategies used by the ARCBS to increase the volume of anti‐D collected from these donors.
Molecular Characterization of FUT1(H) Gene in the Bombay Phenotypes Detected in India
Authors: Vasantha K , Gorakshakar Ajit , Colah Roshan , Kulkarni Swati , Mohanty Dipika
Published: September 2010

Bombay phenotype, one of the rare blood group was discovered in India in 1952 by Bhende et al. The frequency of this in Western India is about 1 in 7600.

Aim  Our Institute gets referral samples from various hospitals and blood banks with problems in grouping and cross matching for identification of blood group and atypical antibodies. We have identified many Bombay phenotype cases out of these by serological procedures. We undertook molecular characterization of FUTI(H) gene on this large series of Bombay phenotypes to see whether the earlier reported mutations on Indian Bombay phenotypes from South Africa and Reunion Island are present in our population or not.

Method  Serological confirmations of Bombay phenotypes was done as per standard procedures. Thirty of these serologically confirmed samples were undertaken for molecular characterization of FUTI(H) gene. DNA extraction was done from these samples and FUTI(H) gene was amplified by performing nested PCR followed by digestion with restriction enzyme Nae 1 to screen for T 725 G mutation. The digested product was run on agarose gel electrophoresis and analysed.

Result  Out of these 30 samples 27 samples were homozygous for T 725 G mutation and one sample was heterozygous for T 725 G mutation which serologically had shown absence of H antigen on red cells and two samples did not show the presence of this mutation.

Conclusion  The T 725 G mutation of FUTI(H) gene appears to be the common mutation amongst the Bombay phenotypes detected in India.
The Quantitation of D Antigenic Sites in Partial D and Weak D Variants by Flowcytometry
Authors: Kulkarni Swati , Mohanty Dipika , Gupte Snehalata , Vasantha K , Joshi Sanmukh
Published: September 2010

Aim  The aim of the study is to quantitate D antigenic sites on RBC in weak D and partial D variants in Indian population by flowcytometric method.

Method  Dantigenic sites were estimated in 48 cases of partial D, eight cases of weak D (identified by serological methods) and normal Rh phenotypes subjects by flowcytometric technique. The indirect immunoflourescence method was employed using thirty epitope specific monoclonal anti‐D as primary antibody. The D antigenic sites were calculated using standard RBC with known D antigenic sites.

Result  The mean (±I S.D) D antigenic sites per RBC in weak D and partial D were 4503 ± 2067 and 6750 ± 3426 respectively. In R1R1 phenotype the range of D antigenic sites was 16500 ± 2500 and in R1r it was 10600 ± 2520. In four cases of weak D sites were in range of 1700 to 3500 and in other four it was 5000 to 7200 D sites/RBC. Among partial D variants DVI had minimum, and DVa had maximum number of D sites.

Conclusion  Flowcytometry is a very good tool for demonstrating minor differences in D antigen sites in partial D and weak D when serological methods are not conclusive.
Improving Hospital Transfusion Practice: Evaluation of Progress at Two Metropolitan Hospitals
Authors: Botting Karen , Boyce Neil , Aranda Sanchia , Topp Felicity
Published: September 2010

Aim  Blood Matters was a project funded by the Victorian Department of Human Services to introduce sustainable improvements in hospital transfusion practice. An evaluation was conducted at two metropolitan hospitals to review progress against stated aims and identify key elements leading to changes in transfusion practice and highlight any unintended consequences.

Method  During the project, each hospital chose to focus improvement efforts in key areas. Measurable, specific goals were developed. Using a case study approach, the evaluation was conducted by review of the aim‐specific data collected during the project and by semi‐structured interviews from which key themes (eg assumptions underpinning decisions) were identified. Interviews were conducted with at least 10 representative individuals from each organisation whose roles were considered necessary for change in their institution’s transfusion practice.

Result  Measurable improvements have been made (eg an 87 percent improvement in reduction of patient identification error) and the Transfusion Nurse position made operational at both sites. Examples of key success factors identified are: a committed transfusion team to direct improvements in the organisation; integration of transfusion data reporting into existing organisational quality/risk management structures to provide ongoing visibility for transfusion issues and; mentorship and support for the Transfusion Nurse role.

Conclusion  This project has, in the short term, successfully generated improvements in hospital transfusion practice and influenced hospital systems to enable changes to be sustainable in the longer term.
Recidivism in Transfusion Quality Improvement: Support for the Role of Transfusion Nurses
Authors: Quayle Sue , Crispin Philip , Crowe Bethany , McDonald Anne
Published: September 2010

Aim  To evaluate longer term outcomes of a quality improvement strategy in transfusion.

Method  A Clinical Health Improvement Program (CHIP) quality improvement project was conducted in a 290 bed acute general hospital, to decrease the rate of transfusions with high pre‐transfusion haemoglobins. Strategies for improvement included: formation of a Transfusion Committee; development of transfusion pathway; implementation of a Maximum Blood Order Schedule; educational strategies targeting clinical staff at all levels; promulgation of the NHRMC Clinical Practice Guidelines on the Use of Blood Components; and feedback to clinicians. The CHIP project was superseded by the ACT Haemovigilance Project, and an ACT wide concurrent transfusion audit was undertaken. There was no formal feedback on clinician performance during, or for 6 months prior to, the Haemovigilance audit. Red cell transfusion was assessed for compliance with the NHMRC Guidelines and compared with CHIP results.

Result  The CHIP project demonstrated successful implementation of the selected strategies, leading to a reduction in transfusions with pre‐transfusion haemoglobins greater than 90 g/L. Follow up auditing commencing six months later demonstrated a progressive, and statistically significant, increase in inappropriate transfusions over the following six months.

Conclusion  Although improvement in transfusion practice was demonstrated with a multi‐factorial approach to quality improvement, the improvement was not sustained in the medium term. Our results indicate the need for organisational commitment to long term quality improvement strategies in transfusion, and support the development of Transfusion Officers or Nurses to improve bedside clinical practice.
NSW Blood Transfusion Improvement Collaborative: Where to From Here
Authors: Thomson Amanda
Published: September 2010

The NSW Blood Transfusion Improvement Collaborative completed its project in mid 2003 and presented the final report in November 2003. The focus of the collaborative was on the appropriateness of red cell transfusion using the ‘breakthrough’ methodology of the Institute for Healthcare Improvement. Results showed that the goal of 50% reduction in inappropriate transfusion of red cells had been met. The largest improvements were seen at sites that used vetting of transfusion requests based upon a restrictive threshold as per the guideline parameters. This was most effective when combined with endorsement, distribution and education re the guidelines. There has been no further funding for BTIC. In NSW there are currently no systems in place for monitoring the safety and appropriateness of transfusion practice. It is essential that this is addressed particularly in view of the findings of the Collaborative and the NSW Coroner indicating that there are inappropriate transfusion practices and serious preventable adverse events associated with transfusion occurring. Necessary measures include improvement in the governance of transfusion practice in the clinical setting, establishment of measurement systems to provide data on the management and use of blood and improvement in education for the staff who prescribe and administer transfusions. Valuable transfusion practice improvement work is progressing in a number of other States and overseas. However, securing commitment for resources to allow these to proceed is an ongoing problem. With the restructuring of the state and national systems of management of blood and transfusion services, there is the opportunity to establish a coordinated approach to ensuring safe and appropriate transfusion practice.
Testing for Homologous Blood Transfusion in Elite Athletes – RPAH AT ATHENS 2004.
Authors: Brown Ross , Nelson Margaret , Cooper Simon , Ashenden Michael
Published: September 2010

Following the 2000 Sydney Olympics and the introduction of testing for erythropoietin in elite athletes, it became apparent that many athletes had reverted to blood doping using homologous and autologous transfusions. The Science and Industry Against Blood doping research consortium approached Dr Nelson at RPAH to determine if a test could be developed to detect recent blood transfusions. A grant was provided by the US Anti‐Doping Agency to develop a flow cytometric assay which detects the expression of a panel of minor blood group antigens. Most blood bank reagents are IgM and are not satisfactory as they cause aggregation. A series of IgG polyclonal antibodies were sourced and the optimal titre of each antibody to detect minor negative and positive red cell populations in in vitro mixtures was determined. The test was validated by four Sydney flow cytometry laboratories who tested unknown samples in a proficiency exercise. In April 2004, IOC, WADA and ATHOC agreed to introduce the test into the Athens laboratory in time for the 2004 Olympics with assistance from RPAH. From May till August, RPAH sourced suitable antibodies, performed antibody titrations, provided a standard operating procedure, consulted daily with both the Athens lab and the Anti‐doping lab in Lausanne and conducted a series of 3 Proficiency Testing exercises for both labs. No false positives were found in 254 antibody/sample test combinations. The Athens lab used a panel which included antibodies to C, c, E, Jka, Jkb, Fyb, Fyb, M, N and S. Reagents for anti s, K and e were also provided by RPAH. Two weeks before the Games, the lab personnel moved into the IOC Athens Testing lab. A total of 350 endurance athletes were tested. This included placegetters plus randomly selected competitors.
Stem Cell Collection in a Patient with Cold Agglutinins
Authors: Collins David , Antonenas Vicki
Published: September 2010

The use of autologous Bone Marrow Transplant (BMT) has increased in Non Hodgkin’s Lymphoma. A patient, who had a relapse of Non Hodgkin’s Lymphoma after a remission of 13 years, required an autologous stem cell transplant. However, he was found to have cold agglutinins. The problem was raised as to whether or not he could have stem cells collected and if they would survive following freezing and storage. A literature search was undertaken and very little information found on stem cell collection in patients with cold agglutinins. Some anecdotal information was reported by colleagues all of which seemed to point to less than favourable outcomes. It was decided to mobilize the patient for stem cell collection and devise a method of collection, storage and transplantation. This paper will give an account of the collection, treatment and progress of the patient, and discuss the procedures involved. It will demonstrate the collaboration between medical, nursing and laboratory staff to achieve a positive patient outcome.
What Has SHOT Told Us and What Are We Doing About It?
Authors: Williamson Lorna M
Published: September 2010

The UK haemovigilance scheme Serious Hazards of Transfusion (SHOT) has just issued its 7th report. Particpiation remains high, and is now actively encouraged by the Dept of Health. The main areas of concern over this period have been hospital errors, bacterial contamination, and more recently transfusion‐related acute lung injury (TRALI). Post‐transfusion purpura and transfusion‐associated graft‐versus‐host disease, which were already uncommon, have virtually disappeared since universal leucocyte depletion in 1999. To minimise hospital errors, new guidelines for blood administration have been issued, and hospitals are trialling bar code equipment from patient wrists bands and blood fridges, which presents implementation challenges. SHOT is working with the new National Patient Safety Agency on further measures to reduce errors. Bacterial reduction is being approached in a stepwise manner, with new 2‐stage donor arm cleansing being rolled out, and blood bag divert pouches now universal. Bacterial screening and pathogen reduction remain under consideration. Review of donors and components associated with TRALI cases showed a strong association between HLA‐ or HNA‐ positive female donors and ‘high plasma’ components (FFP and platelets). Therefore we are moving towards ‘male only’ FFP, and approach which requires neither donor testing or deferral. We have achieved 90% success so far, and some centres also use male plasma for suspension of buffy coat pools. Additional options for platelets including additive solution are being considered. Future haemovigilance data will assess the impact of these initiatives.
Ethics and Apheresis: What Choice is There?
Authors: Kerridge Ian
Published: September 2010

By comparison with many other procedures in medicine, apheresis for collection of haematopoietic progenitor cells (HPC) is a relatively innocuous process. The procedure itself is straightforward, serious adverse effects are rare and many donors experience real benefits. But the apparent simplicity of HPC harvest is misleading as apheresis raises substantial issues of consent, risk assessment and conflict of interest. G‐CSF primed apheresis is associated with a number of predictable shortterm risks and unpredictable long‐term risks, particularly in those who submit to a second or third donation. Donors are often coerced by the very nature of their relationship to the recipient and by expectations of altruism and are infrequently offered a true choice between bone marrow harvest and peripheral HPC harvest. And, as is the case in solid organ donation, HPC donors may consent to HPC collection for a number of different reasons, some of which may negatively impact upon their experience of apheresis and may give rise to concerns regarding late withdrawal from donation. While these issues are complex enough where competent adults are the donors, they are more difficult again where the ‘donor’ in not competent, is mentally ill or is a child. In this paper I will review the ethics of apheresis, critique the concept of informed consent and the disproportionate concern with unrelated donors, and consider whether current practices are ethically justifiable.
Improving Platelet Transfusion: The Impacts of Pathogen Reduction Technology and Increased Storage Periods
Authors: AuBuchon James P
Published: September 2010

Removing, inactivating or detecting pathogens in platelet units are panaceas that some expect to revolutionize transfusion support for patients. Opting for transfusion without concern for the presence of pathogens may not be such a simple decision, however. The effect of pathogen reduction treatment may reduce platelet number and/or function. Clinical trials have documented that treated platelets provide effective hemostatic support for thrombocytopenic patients. However, platelets may need to be transfused in greater quantity, and thus the treatment technique may create a greater demand for the production of platelets through the supply system. Toxicologic concerns about the treatments must be addressed to ensure that there is net benefit for patients. Testing reported to date suggests that any residual compounds are at concentrations far below that associated with detectable toxicity, but the concept of transfusing a component containing even minute amounts of toxic substances may be unsettling to some. Detecting bacteria may remove the largest remaining infectious threat in platelet units and would leave platelets undamaged to function normally. This opens the option for extending the storage period of platelet units, but any extension of storage would be expected to be associated with a decrease in recovery and survival. To avoid continuing decrements with each proposed change in processing or storage, a new standard for efficacy has been proposed that would compare the recovery and survival of the platelet component to fresh platelets from the same donor. This standard appears useful and applicable in ensuring safe and efficacious platelets for transfusion. The question remains: Which direction is best for platelet recipients?
Regulatory Oversight of Blood, Tissues and Emerging Biological Therapies in Australia and New Zealand
Authors: Pembrey Richard
Published: September 2010

The regulation of blood, blood product, tissue and gene technology therapies are viewed as critical to protecting the health of Australians. In response to the growing community concerns regarding the ethics, quality and safety of tissue and biological therapy products, the Australian Health Ministers Council, in 2002, recommended the development and introduction of a regulatory framework for tissues and emerging biological therapies. The proposal for tissues and emerging biological therapies parallels the regulation of blood and blood components introduced by the TGA in 2000 following similar ministerial recommendations, policy development and consultation A comprehensive system for the regulation of cellular and tissue based therapies within a proposed trans Tasman framework will be characterised by the following principles:

• All therapeutic products definable as cellular and tissue therapies, including cell‐based gene therapy products, will be overseen by the system

• The level of regulation will be classified according to the risks posed by the therapies to the individual and the community.

• The classification system will align regulation of therapies to:

– standards

– standards and GMP

– standards, GMP and pre‐market evaluation according to the level of risk.

• All facilities responsible for the manufacture and supply of cellular and tissue based products will be required to register their organisation with the TGA.
Clinical Governance and Transfusion
Authors: Bartlett Jenny
Published: September 2010

Governance is the exercise of power consequent on the assumptions of responsibility. Clinical Governance is the process and framework through which Health Services achieve accountability for continuously improving the quality of their services and safeguard high standards of care by creating an environment in which excellence in clinical care can flourish in a patient centred environment. In terms of clinical governance as it pertains to safe and appropriate use of blood and blood products it is being rolled out in Victoria at two levels. At a hospital level, as part of clinical governance there is a requirement for organisations to have an active transfusion committee to provide oversight on the usage, appropriateness and adverse events related to blood and blood products. This committee should report through to the hospitals clinical risk/quality committee. Transfusion nurses have been funded to amongst other things resource this committee. At a state level Victoria has established a Better Safer Transfusion (BeST) practice program supported by a BeST advisory committee. The work will support hospital transfusion committees and advise on future work in the area.
Blood Transfusion Prescribing Patterns Across the Australian Capital Territory (ACT)
Authors: Crowe Bethany , Crispin Philip , Quayle Sue , McDonald Anne
Published: September 2010

Aim To identify the medical officers responsible for blood transfusion therapy across the ACT.

Method  Medical records of patients having transfusions were audited in one tertiary referral hospital, one general hospital and one associated private hospital as part of a quality improvement project. The clinical status patients, reasons for transfusion and laboratory data were extracted and the appropriateness of transfusion was assessed independently by two of the authors. Differences were resolved by consensus. The prescriber was also identified where possible, defined as the most senior clinician recorded in the medical record involved in the decision to transfuse.

Result  The prescriber could be determined in 78% of transfusion episodes. In the majority of cases the decision to transfuse was attributed to specialist staff, in all hospitals. Registrars at the tertiary hospital prescribed significantly fewer inappropriate transfusions (12%) than specialists (18.1%, p < 0.05). This was not found at the smaller public hospital. After hours resident and registrar staff prescribed significantly fewer inappropriate transfusions (3%) than other prescribers across the Territory (18.7%, p < 0.005).

Conclusion  Medical practitioners with varying levels of experience make medical decisions in hospitals. Who is responsible for these decisions has not been well studied. Our findings demonstrate specialist involvement in the majority of transfusion decisions. The results favour a ‘top down’ approach to quality improvement in transfusion, rather than targeting junior medical officers. The findings also have significant implications in understanding the dynamics of clinical decision making in the hospital setting and for the targeting of other quality improvement strategies.
Investigation of Intragam® P Haemolysis Adverse Events
Authors: Isbister James , Hogan Chris , Wood Erica , Wilson Fiona , Maher Darryl
Published: September 2010

Aim  To understand the underlying cause of a cluster of haemolysis‐type adverse event (AE) reports received by CSL/ARCBS in patients receiving Intragam® P.

Method  The cluster of AE reports were analysed with respect to patient factors (clinical indication, dose, blood group, concomitant medications and blood products, bone marrow reserve), product factors (batch results, production records) and changes in clinical practice (administration protocols, infusion kits). All Intragam P haemolysis related AEs from clinical trials and post‐marketing exposure were reviewed, as well as international literature on this subject.

Result Sixteen haemolysis type cases were reported to ARCBS/CSL over a 3 month period, ranging from abnormal laboratory test results (positive Coombs test) to clinical symptoms requiring transfusion. Ten of these reports were received in 4 days from 2 Victorian hospitals following the detection of 2 cases, which precipitated a retrospective review that identified additional similar cases. All patients received high dose (doses exceeding 400–600 mg/kg given every 3–4 weeks either in frequency or quantity) and all but one (where evidence suggested an underlying disorder) were of blood group A or AB. Eight patients were recipients of bone marrow transplants. No product or batch related factors or processes likely to have contributed to the haemolysis type AEs were identified. Anti‐A and Anti‐B titres of all Intragam P batches were investigated and confirmed to be within regulatory approved release specifications and pharmacopoeial limits.

Conclusion  Haemolysis type adverse events are a recognised consequence of IVIG administration and are widely discussed in the literature. This investigation has confirmed the association of high dose IVIG in recipients of blood group A or AB and increased risk of haemolysis type adverse events. It also highlighted the possibility of accentuating any consequent anaemia in patients with diminished bone marrow reserve (eg post bone marrow transplant patients). Pre‐infusion ABO blood groups should be determined in patients receiving high dose IVIG and their haemoglobin levels monitored in the days following therapy.
Acquired Factor XIII Deficiency Secondary to an Inhibitor: Effect of Factor XIII Replacement and Rituximab Therapy
Authors: Abdallah Alhossain , Duncan Elizabeth , Casey Chirely , Davis Ken , Hui Chi‐Hung
Published: September 2010

Factor XIII (FXIII) is the last enzyme in the clotting cascade. Its main function is to convert the loose fibrin polymer into a firm, cross‐linked structure. FXIII inhibitor is a rare condition, in which three different types of inhibitors have been described usually due to IgG antibodies. We describe two male patients with acquired FXIII deficiency (age; 73 and 69 years), who had a history of significant bleeding. Functional assay using the acetic acid/urea clot solubility test showed residual FXIII levels between 1–2%. Molecular studies by PCR and DNA sequencing excluded an inherited FXIII deficiency. In addition, we demonstrated an inhibitor pattern for FXIII by in vitro mixing studies with both purified FXIII (Fibrogammin, Aventis Behring) and cryoprecipitates as sources of FXIII. Transglutaminase assay of FXIII (Dade Behring) was normal for both patients, consistent with a type III FXIII inhibitor, which believed to be directed against the activated FXIII‐fibrin complex. Both patients showed transient correction of clot solubility to normal after infusion of high doses of Fibrogammin. In view of previous reports describing FXIII inhibitors of the IgG class, we attempted a novel treatment with rituximab (chimeric monoclonal anti‐CD20 antibody, Roche) to interfere with production of the inhibitor. However, neither patient showed correction of FXIII activity as measured by clot solubility tests during and up to 2 weeks after therapy. Preliminary results suggest that high dose Fibrogammin is required to correct FXIII deficiency due to an acquired type III inhibitor. The role of rituximab or other immunosuppressive therapy requires further investigation.
The Western Australian Experience with a Register of Atypical Antibodies.
Authors: Lariat Susan , Fisher Brian
Published: September 2010

Since 1980 a register of all blood donors and patients in Western Australia (WA) with clinically significant red cell and platelet antibodies has been maintained by the Blood Group Reference Laboratory, Australian Red Cross Blood Service (ARCBS)‐Enterprise. The register is updated by ARCBS daily, and prior to 1999 a microfiche version was sent each month to WA transfusion laboratories. In 1999 ARCBS‐Enterprise and the Health Department of WA (HDWA) explored the option of transfusion laboratories in public hospitals obtaining immediate electronic access to the register. A secure telnet radio‐link was established between a dedicated stand‐alone ARCBS server and the HDWA computer network which allowed password protected enquiry‐only access to the database by hospital end‐users. All end‐users are required to sign an agreement to guarantee proper use of the register. The use of this comprehensive database has been successfully incorporated into the pre‐transfusion testing protocols of all transfusion laboratories in WA. The benefits of this system include:

• Reduced delay in obtaining phenotyped units for patients with known antibodies.

• Reduced chance of delayed transfusion reactions in patients whose antibody level has fallen below detectable levels.

• A mechanism for ante‐natal monitoring and predicting severity of haemolytic disease of the newborn when patients move between care providers during the pregnancy.

ARCBS‐Enterprise and end‐users are passionate about the continuation of this extremely important resource in the future.
Refrigeration Failures – Bringing the Problem in from the Cold
Authors: Waters Neil , Wood Erica , Forsyth Malcolm
Published: September 2010

Aim  Review of four failures of refrigeration facilities in Victorian institutional blood banks reported to ARCBS in the first 4 months of 2004. These incidents at both public and private institutions, in metropolitan and regional settings, resulted in loss of 148 units of red cells, 7 vials of RhD Ig and 2 bottles of Albumex. Incidents were investigated and root causes identified by initial phone interview and visits to blood bank storage facilities.

Result  Case 1: Temperature fell below 0 °C at remote site, alarm was activated at monitoring centre (main lab) but without response. Case 2: Power failure resulted in rise in temperature. Alarm did not activate until power was restored. Alarms were set outside required storage temperatures. Case 3: Circuit failure resulted in loss of power. Alarm was activated, but then switched off and no further action taken. Case 4: Compressor failure resulted in alarm activation. Alarm and monitoring devices were deactivated while repairs carried out. Product was not moved to other storage facilities. These cases all highlight the importance of procedures, training, equipment and maintenance.

Conclusion  Losses of precious blood components and products through refrigeration failures are preventable. Vital improvements should include commissioning refrigeration equipment that meets AS 3864, protocol development and staff training in use of procedures to be followed when out of temperature events occur, and performance of regular preventative maintenance, calibration and testing of storage and monitoring equipment. ARCBS can work with institutional blood banks to improve storage and management of blood.
New Transport System for Maintaining Temperature of Blood Products in Emergency Situations
Authors: Haeusler Michael , Hogan Chris , Juneja Surender , Bartlett Jane , Suter A
Published: September 2010

The RMH is a large, tertiary teaching hospital that is now a designated level 1 trauma centre. Facilities include a helipad and upgraded Emergency Department and Operating Theatre areas. In many cases it is not possible to provide group specific and crossmatched Red Cell Concentrates (RCC) for individuals requiring urgent and lifesaving treatment. In this situation, scarce O Negative RCC must be used. Previously, the Blood Bank at the RMH issued blood and blood products to the Emergency Department in plastic bags or foam eskies. Once issued these RCC could not be returned to the hospital Blood Bank inventory, as the product transportation and storing conditions to and in the Emergency Department were uncontrolled. Baxter Healthcare ½ recently has made available an innovative and validated system of transport for blood and blood products. This ‘Blood‐In‐Motion’(BiM) system consists of moulded plastic elements that are filled with a patented Phase Change Material (PCM). Following our adoption of the BiM we found it an easy to use, validated system for the safe temperature controlled transport of RCC in an emergency situation. We have further utilised the BiM system as a ‘Massive Exsanguination Pack’(MEP) used in response to a time‐critical call from Emergency. The MEP transports 4 units O Neg RCC, 4 units thawed AB FFP & 1 pool Rh Neg platelets. This BiM/MEP system allows the storage of RCC and plasma products under controlled temperature for up to 6 hours. This solution has enabled the RMH to conserve a scarce and valuable resource, and to supply emergency blood products in a timely and controlled manner.
A Proteomic Approach for Identifying Proteins that Accumulate During Storage of Red Cell Products
Authors: Glenister Kristen M , Anniss Angela M , Killian Jessica J , Sparrow Rosemary L
Published: September 2010

The aim of this project was to identify potential protein mediators of adverse transfusion reactions in stored red cell concentrates. Previously, research into protein mediators of adverse transfusion reactions has focussed on specific proteins, such as cytokines. In this study, a global approach was taken which involved two‐dimensional electrophoresis based Proteomics, which has the potential to uncover previously unrecognised mediators or novel proteins. Red cell products with and without pre‐storage leukoreduction (each n = 6) were prepared and stored according to standard blood bank procedures. Supernatant samples were taken at several time points until product expiry. Proteins were separated by two‐dimensional electrophoresis and those that accumulated in the supernatant were selected for identification by mass spectrometry. The protein profile of supernatant from leukoreduced red cell products was less complex compared to non‐leukoreduced products (from 4.4 fold fewer proteins at day 1 to 1.6 fold fewer at day 43). Several proteins were observed to be predominantly present in leukoreduced products which may potentially be beneficial to red cell survival. These proteins were identified as being involved in the maintenance of a stable extracellular environment. Conversely, a number of proteins, which may have detrimental effects, were predominantly expressed in non‐leukoreduced products. These proteins included a neutrophil chemoattractant (activator) and a potential acute‐phase reactant. A number of proteins identified by mass spectrometry were matched to theoretical proteins of unknown function. The findings confirm the usefulness of Proteomics to investigate storage effects on blood products. The clinical relevance of these proteins is the focus of our future investigations.
Microbial Contamination in Cord Blood (CB): A Retrospective Analysis of Three Test Protocols
Authors: Mison Leigh , Goodear April , Vowels Marcus
Published: September 2010

Aim  Since 1995, the SCBB has used three protocols to screen CB for contaminating microbes. The protocols differed in the number of culture bottles inoculated and sample volume used. The aim of this study was to compare microbial detection rates for each method.

Method  CB units (n = 9,618) were tested for microbial contamination using BacT/ALERT blood culture bottles (BioMerieux). Of these, 6,836 had 20 ml plasma waste fraction inoculated into adult anaerobic and aerobic bottles (Group A), 365 had 1 ml final stem cell product into an aerobic paediatric bottle (Group B), and 2,417 had 1 ml final product into a paediatric bottle and 10 ml plasma waste fraction into an adult anaerobic bottle (Group C). All bottles were incubated for a minimum of 5 days. Detection rates for microbe contamination were calculated for each group.

Result  Microbe detection rates were: Group A –345/6836 (5.0%), Group B – 3/365 (0.8%) and Group C – 66/2417 (2.7%)(p < 0.0001). Organisms detected by A but not by B (and to a lesser extent C) included Streptococcus, Staphylococcus, Bacteroides and Proprionibacterium.

Conclusion  Contamination detection rates differ significantly, depending upon the sample volume and type of culture bottle used. A protocol that uses the recommended sample volume and both anaerobic and anaerobic test bottles is likely to detect the highest number of contaminated units. Testing of a small sample from the final product using only a single paediatric aerobic bottle is likely to miss detection of the majority of anaerobic and some aerobic organisms. Prospective studies to define a standardised method for microbial detection for CB are required.