bluuebunny/crossref_metadata_2025 huggingface dataset:
The effect of oral iron supplementation on erythropoiesis in autologous blood donors
Authors: Biesma D.H. , Kraaijenhagen R.J. , Poortman J. , Marx J.J.M. , van de Wiel A.
Published: March 2003

The effect of oral iron supplementation on erythropoiesis was studied prospectively in 34 autologous blood donors. The subjects, all of whom were to undergo total hip surgery, had normal iron status at the start of the study. During the preoperative period, in which 4 units of blood were collected, 17 patients received oral iron supplementation with 287 mg of ferrous sulfate (105 mg of elemental iron/day), while 17 patients did not use any iron supplementation. Oral iron supplementation during the 4‐week preoperative period lessened the decrease in ferritin levels after two phlebotomies. Neither the decrease in hemoglobin nor the increase in erythropoietin levels was influenced by iron supplementation. In both iron‐supplemented and control patients, serum erythropoietin levels returned to initial values within a few days after surgery. In autologous blood donors with a normal iron status, the use of supplemental iron does not affect erythropoiesis and is insufficient to maintain iron stores.
Transmission of serologically silent hepatitis B virus along with hepatitis C virus in two cases of posttransfusion hepatitis
Authors: Baginski I. , Chemin I. , Hantz O. , Pichoud C. , Jullien A.M. , Chevre J.C. , Li J.S. , Vitvitski L. , Sninsky J.J. , Trepo C.
Published: March 2003

The polymerase chain reaction (PCR) was used to investigate the presence of hepatitis B virus (HBV)‐related DNA sequences in blood from three blood donors and two transfusion recipients who developed posttransfusion non‐A, non‐B hepatitis (NANBH). In the first case, the sole donor was positive for antibody to hepatitis B surface (HBs) and core (HBc) antigens and had elevated alanine aminotransferase (ALT) levels, while the recipient had no HBV serologic markers. Both the donor and the recipient had serologic markers of hepatitis C virus (HCV) and were found positive for HBV DNA and HCV RNA sequences by PCR. The second case involved two donors and one recipient. Serologic tests for conventional HBV markers were negative in all three individuals, but one of the donors had elevated ALT. HBV DNA sequences were detected by PCR in the serum of the recipient and of the donor with high ALT, but not in the serum of the donor with normal ALT. Anti‐HCV was detected in the serum of the recipient and of the suspect donor but not in that of the donor with normal ALT. The sequences amplified in the S region and determined after cloning of PCR products for both donor‐ recipient pairs were indistinguishable from each other and identical to the sequence of the major HBV subtype of adw in the first case and ayw in the second case. Furthermore, for the second case, an identical single‐point mutation was found in both the donor and the recipient. These data confirm the transmission of conserved HBV sequences together with HCV in posttransfusion NANBH. Several explanations for the absence of detectable conventional HBV markers in these patients are discussed.
Modulation of fibrinogen content in cryoprecipitate by temperature manipulation during plasma processing
Authors: FARRUGIA A. , GRASSO S. , DOUGLAS S. , HARRAP R. , OATES A. , YOUNG I. , JAMES J. , WHYTE G.
Published: March 2003

In routine blood bank production of single‐donation cryoprecipitate, the introduction of a 16‐hour hold at 4 degrees C, with the frozen plasma units packed into polystyrene containers, resulted in plasma prethaw temperatures of ‐4 degrees C to ‐8 degrees C. This in turn resulted in cryoprecipitate fibrinogen levels that were 214 percent of those obtained when units were thawed immediately after removal from ‐ 30 degrees C storage. In scale‐model production of factor VIII concentrate, plasma warmed from ‐30 to ‐10 to ‐15 degrees C over 18 hours before pooling and thawing yielded cryoprecipitate fibrinogen levels that were 66 percent of those found in plasma warmed to ‐2 to ‐5 degrees C over the same period. Processing ‐30 degrees C plasma without a warming period led to cryoprecipitate fibrinogen levels that were 40 percent of those obtained from plasma warmed to ‐2 to ‐5 degrees C. These differences were accentuated after purification of the cryoprecipitates to an intermediate‐purity factor VIII concentrate. These results suggest that simple modifications in production methods allow the fibrinogen content of cryoprecipitate to be tailored to specific uses.
Monocyte chemotaxis and chemotactic cytokine release after exposure to hydroxyethyl starch
Authors: EASTLUND D.T. , DOUGLAS M.S. , CHOPER J.Z.
Published: March 2003

Hydroxyethyl starch (HES) is commonly used in leukapheresis and infused as an alternative to blood components for the treatment of hypotension due to hemorrhage and trauma. Its prolonged intravascular persistence and retention in tissue raise concerns about possible effects on humoral and cell‐mediated immunity and white cell (WBC) locomotion, particularly in volunteer WBC donors or in severely burned individuals with immunologic depression and increased risk for infection. This study evaluated the effect of HES on human monocyte migration and chemotaxis and the production of antigen‐ and mitogen‐induced WBC‐ derived chemotactic cytokine. A bioassay was developed to quantitate the neutrophil chemotactic activity of a cytokine generated by mononuclear WBCs stimulated in vitro by phytohemagglutinin or tuberculin protein. The time‐ and dose‐dependent generation of the chemotactic cytokine was not affected by the presence of HES. HES by itself did not induce the generation of this cytokine, nor were human monocyte chemotaxis and spontaneous migration significantly changed by exposure to HES. These results, with those of other investigators, suggest that HES is a safe red cell‐sedimenting agent for leukapheresis and an alternative to the use of blood components in shock resuscitation.
Red cell collection by apheresis technology
Authors: Meyer D. , Bolgiano D.C. , Sayers M. , Price T. , Benson D. , Slichter S.J.
Published: March 2003

To determine the feasibility of collecting 2 units (450 mL) of red cells per donation by apheresis technology, apheresis red cell collections were compared to whole‐blood donations. Forty blood donors were equally divided between the two study arms on the basis of gender and iron supplementation (650 mg ferrous gluconate/day vs. no supplementation). During the 1‐year study period, the apheresis participants donated 450 mL of red cells three times, and the whole‐ blood donors gave 225 mL of red cells (1 unit of blood) on six occasions. There were no reported side effects during the 102 whole‐ blood donations, whereas symptoms were noted in 83 percent of the 59 apheresis procedures. The most common symptoms were numbness and tingling, which were relieved by a decrease in the plasma‐return rate or by the administration of oral calcium supplements. Seven donors dropped out or were deferred during the study. Two whole‐blood donors left with medical problems unrelated to the study, one apheresis donor and one whole‐blood donor dropped out of the study because of excessive fatigue, and three non‐iron‐supplemented whole‐blood donors had unacceptably low hematocrit levels. By the end of the study, 70 percent of the apheresis donors considered the procedure acceptable, 15 percent were undecided, and 15 percent thought it was not acceptable. As measures of iron balance, the serum ferritin and the red cell zinc protoporphyrin:heme ratios were significantly more abnormal in the non‐ iron‐supplemented donors than in the iron‐supplemented donors. However, there were no differences in iron balance according to the donation method.
Use of a questionnaire to identify potential blood donors at risk for infection with Trypanosoma cruzi
Authors: Appleman M.D. , Shulman I.A. , Saxena S. , Kirchhoff L.V.
Published: March 2003

Trypanosoma cruzi is the protozoan parasite that causes American trypanosomiasis (Chagas' disease). Chagas' disease is endemic in Latin America. The infection is usually seen in poor people who live in rural areas in substandard housing, where they are bitten by infected reduviid bugs. Transmission also can occur by blood transfusion. Infected individuals who immigrate to the United States might donate blood if they are asymptomatic and unaware of their infection. This study evaluated the usefulness of a questionnaire for identifying T. cruzi‐infected individuals among prospective blood donors who met all American Association of Blood Banks, Food and Drug Administration, and State of California criteria for donor eligibility. Seventy‐two of 3492 otherwise eligible donors were disqualified because of their answers on the questionnaire. Forty‐five of these 72 agreed to be tested serologically, and 2 were positive for T. cruzi antibodies. One of six autologous blood donors tested also was positive for T. cruzi antibodies. We conclude that the questionnaire selected a subgroup of Latin Americans at high risk for T. cruzi infection. The deferral of these high‐risk individuals clearly reduced the risk of transmission of T. cruzi by transfusion, without intolerably decreasing the supply of donated blood.
Evaluation of laboratory assays for screening antibody to hepatitis C virus
Authors: Leon P. , Lopez J.A. , Domingo C. , Echevarria J.M.
Published: March 2003

An evaluation study, involving 11 screening methods for the detection of antibody to hepatitis C virus (anti‐HCV) and a panel of 500 serum samples, was performed. Samples were tested by all 11 methods, and those showing reactivity in at least one method were studied by a combination of supplemental assays (recombinant immunoblot assays, first and second generation; neutralization test for anti‐c100; synthetic peptide immunoblot assay; recombinant multi‐dot immunoassay) and classified as positive (110 samples), indeterminate (4 samples), or negative (386 samples) on the basis of the results obtained. Second‐ generation recombinant methods performed better on positive samples than first‐generation assays or synthetic peptide‐based methods (99.1‐ 100% correlation vs. 64.5–85.5% and 93.6–99.1%, respectively), whereas the latter showed higher correlations on negative samples than recombinant assays (97.4–99.7% vs. 82.4–93%). Further investigations, using broad panels of indeterminate samples from blood donors, should be done, however, before synthetic peptide‐based methods are recommended for blood bank screening. Reactivity of samples must be confirmed by one supplemental test in all cases before the donor is informed. In some cases, it may require the use of two or more different tests to obtain definite conclusions.
Recombinant immunoblot assay reaction patterns and hepatitis C virus RNA in blood donors and non‐A, non‐B hepatitis patients
Authors: Bresters D. , Zaaijer H.L. , Cuypers H.T.M. , Reesink H.W. , Winkel I.N. , van Exel‐Oehlers P.J. , van Drimmelen A.A.J. , Jansen P.L.M. , van der Poel C.L. , Lelie P.N.
Published: March 2003

To establish the value of the second‐generation recombinant immunoblot assay (RIBA‐2) and cDNA polymerase chain reaction (cDNA PCR) for confirmation of hepatitis C virus (HCV) infection, anti‐HCV reaction patterns and the presence of HCV RNA were examined in 610 blood donors and 255 non‐A, non‐B hepatitis patients who were positive or indeterminate in RIBA‐2. Of RIBA‐2‐positive donors (n = 191) and patients (n = 224), 75.4 and 89.7 percent, respectively, were HCV RNA positive. The most frequently observed anti‐HCV recognition patterns in HCV RNA‐positive donors and patients were c22, c33c, and c100 and/or 5‐1‐1 (67.3%, 57.7%) and c22, c33c (24.8%, 29.3%). Among subjects with a RIBA‐2‐indeterminate result, HCV RNA was detected more often in patients (n = 31) than in donors (n = 419): 67.7 and 2.1 percent, respectively. In viremic persons with single‐band reactivity in RIBA‐2, this reactivity was always directed against either c22 or c33c. HCV RNA was detected by cDNA PCR in none of 162 persons with only anti‐c100 and/or anti‐5‐1‐1 reactivity. Therefore, RIBA‐2 reactivity against c100 in combination with 5‐1‐1 should not be considered positive but indeterminate. In RIBA‐2‐indeterminate persons, HCV RNA detection is necessary for reliable confirmation of HCV infection.
A statistical model for estimating donor postdonation platelet counts after plateletpheresis
Authors: Cabezudo I. , Winegarden D.K. , Randels M.J. , Strauss R.G.
Published: March 2003

BACKGROUND: To avoid the need, in serial apheresis donors, either to delay plateletpheresis until a predonation platelet count is completed or to obtain a postdonation count after each procedure, a statistical model has been developed to predict the postdonation platelet count from the donor predonation platelet count, weight, and hematocrit. STUDY DESIGN AND METHODS: Predonation and postdonation platelet counts were measured in two groups of approximately 100 consecutive donors (Group A to test the model and Group B to validate it), and the postdonation counts were calculated with the model. Using stepwise multiple linear regression from donor data, estimated postdonation platelet counts were found to be comparable to the postdonation platelet counts actually measured. RESULTS: Estimated postdonation platelet counts × 10(9) per L (mean +/− SD) for each group, respectively, were Group A, 195 +/− 35, versus actual platelet counts of 195 +/− 39 (p = 0.43), and Group B, 183 +/− 36, versus actual platelet counts of 189 +/− 34 (p = 0.14). Sensitivity and specificity, respectively, were Group A, 57 and 99 percent and Group B, 62 and 99 percent. CONCLUSION: For most serial apheresis donors, application of this predictor model should preclude the need to obtain an extra postdonation platelet count.
Transfusion and second malignancy
Authors: Ford C.D. , Gillette J.W. , Handrahan D.L. , Koehler C.S.
Published: March 2003

BACKGROUND: Perioperative blood transfusion has been reported to cause a variety of immunosuppressive effects, including increased rates of malignancy recurrence. The effect of perioperative transfusion on second malignancy risk has not previously been investigated.

STUDY DESIGN AND METHODS: Second malignancy risk was evaluated in 1053 patients previously operated upon for colon cancer, and these findings are related to perioperative transfusion history.

RESULTS: Transfusion history did not relate to the probability of a patient's remaining free of second malignancy.

CONCLUSION: An increased risk of total or second malignancies (with the possible exception of lung cancer) was not associated with transfusion.
Declining efficacy of AIDS case list cross‐referencing in human immunodeficiency virus look‐back: 1981 through 1992
Authors: Samson SM. , Edmiston RK. , Busch MP. , Perkins HA.
Published: March 2003

Background: The impact of AIDS case list cross‐referencing in human immunodeficiency virus look‐back was assessed.

Study Design and Methods: Post‐1977 blood donations from former donors identified by 11 collaborating health departments as having developed AIDS have been traced at Irwin Memorial Blood Centers since 1983. To assess the changing efficacy of AIDS case list cross‐referencing in identifying infected donors and recipients, trends in cases reported through December 1992 were analyzed.

Results: Previous donors (n = 638) were identified from 21,917 AIDS case listings, for an overall match rate of 2.9 percent. The rate of detection of previous donors from listings of AIDS cases declined from a peak of 5.3 percent in 1985 to 1.6 percent in 1992. Overall, 86 percent (1824/2122) of donations by persons later reported on AIDS case lists were made prior to January 1983 when risk exclusion measures were initiated. Of the 212 known infected recipients linked to AIDS case list donors, 87 (41%) were previously identified by other look‐back approaches. The rate of identification of infected recipients detected exclusively through AIDS case listings declined from a mean of 21 per year from 1984 to 1987 to a mean of 3 per year from 1990 to 1992. No transmissions have been documented from donations prior to 1979.

Conclusion: These findings demonstrate the declining yield of AIDS case list cross‐referencing as a trigger for human immunodeficiency virus look‐back. Continued reevaluation of look‐back programs is essential so that their various components may be curtailed when justified.
Use of recombinant human erythropoietin to assist autologous blood donation by anemic rheumatoid arthritis patients undergoing major orthopedic surgery
Authors: Mercuriali F. , Gualtieri G. , Sinigaglia L. , Inghilleri G. , Biffi E. , Vinci A. , Colotti M.T. , Barosi G. , Deliliers G. Lambertengh
Published: March 2003

Background: In rheumatoid arthritis (RA) patients undergoing orthopedic surgery, anemia is the major factor in the use of allogeneic blood.

Study Design and Methods: To determine whether recombinant human erythropoietin (rHuEPO) could allow preoperative autologous blood procurement and reduce allogeneic blood exposure, 11 RA patients who were unable preoperatively to deposit blood for autologous use because of their anemia (baseline hematocrit < 34% [0.34]) and who were scheduled for primary total hip replacement or total knee replacement were treated intravenously with 300 U per kg of rHuEPO in combination with intravenous iron saccharate (100 mg), given twice weekly for 3 weeks. The transfusion treatment was compared with that in 12 control patients with comparable baseline hematologic values who underwent the same operation.

Results: Control patients could not preoperatively deposit any blood for autologous use, while all but one of the rHuEPO‐ treated patients deposited 2 or more units (mean, 2.6 ± 0.6; range, 2‐ 4) (p < 0.001). The control group received more allogeneic units (2.6 ± 1.6 vs. 0.8 ± 0.8) (p = 0.009). Moreover, 50 percent of the rHuEPO‐treated patients, as compared with 8 percent of controls, completely avoided allogeneic transfusion.

Conclusion: Recombinant human erythropoietin is safe and effective in stimulating erythropoiesis, allowing preoperative donation of blood for autologous use, and reducing exposure to allogeneic blood for RA patients who are unable preoperatively to deposit blood because of anemia.
Effects of new brochures on blood donor recruitment and retention
Authors: Gimble J.G. , Kline L. , Makris N. , Muenz L.R. , Friedman L.I.
Published: March 2003

BACKGROUND: Currently, donors may arrive at blood collection sites without prior knowledge of eligibility and deferral criteria.

STUDY DESIGN AND METHODS: The effects of distributing newly developed recruitment brochures 2 weeks in advance of blood drives and the provision of brochures on temporary deferral at the taking of health history were examined in four southeastern regional blood collection centers. Twenty‐four similar pairs of worksites, with employee‐only recruitment, were randomly assigned to a control (C) or experimental (E) group. Information about sponsor recruitment strategies, worksite factors, and first‐time, repeat, and temporarily deferred donors was obtained at three collection drives per site over a 1‐year period. Drive 1 was used as a baseline. Two weeks before Drives 2 and 3, the recruitment brochures were distributed to all Group E employees, with temporary deferral brochures provided as needed when the health history was taken.

RESULTS: No significant differences between groups or drives were found in the total percentage of employees recruited or returning as a result of recruitment or deferral brochure distribution (Wilcoxon's signed rank test and t test). Substantiating previous observations by donor recruiters, the study results showed decreased donations during vacation periods and busier times at the workplace. Loudspeaker announcements led to decreased donations; increased donations followed special appeals in relation to a specific patient, an accident, or a natural disaster.

CONCLUSION: The brochures may have encouraged previous donors to return, but their use did not significantly increase the recruitment of new donors or the return of temporarily deferred donors.
Rare detection of hepatitis B and hepatitis C virus genomes by polymerase chain reaction in seronegative donors with elevated alanine aminotransferase
Authors: SANKARY T.M. , YANG G. , ROMEO J.M. , ULRICH P.P. , BUSCH M.P. , RAWAL B.D. , VYAS G.N.
Published: March 2003

Background: Since screening for antibody to hepatitis C virus (HCV) was introduced in 1990, posttransfusion hepatitis has been reduced to nearly background levels. This has led to reconsideration of the value of testing donated blood for elevated alanine aminotransferase (ALT). The contribution of ALT testing in detecting seronegative infection was evaluated by the performance of polymerase chain reaction (PCR) for hepatitis B virus (HBV) or HCV in plasma from ALT‐elevated blood units.

STUDY DESIGN AND METHODS: Testing was performed on 375 units of plasma, derived from an equivalent of 47,500 blood donations, with a highly sensitive hemi‐nested PCR procedure. Using a triplet of primers directed at the conserved regions of HBV DNA and 5′‐noncoding regions of HCV RNA, the hemi‐nested PCR assay can reliably amplify 10 viral molecules to levels detectable in ethidium bromide‐stained agarose gels. Pools of plasma from groups of four donors were screened with hemi‐nested PCR. For any reactive pools, the plasma from individual donors was retested twice on different aliquots.

RESULTS:Two of 375 units, both with midrange ALT elevation, were repeatedly reactive in hemi‐nested PCR (one each for HBV DNA and HCV RNA). However, samples from the two suspect donors tested 9 and 5 months later revealed no seroconversion, elevated ALT, or viral genomes in hemi‐nested PCR. CONCLUSION: The lack of confirmed HBV or HCV infection in this study representing an estimated 47,500 voluntary blood donations suggests that routine ALT testing for further prevention of posttransfusion hepatitis after exclusion of HBV‐ and/or HCV‐seropositive blood may be superfluous.
The routine use of Rh‐negative reagent red cells for the identification of anti‐D and the detection of non‐D red cell antibodies
Authors: SHULMAN I.A. , CALDERON C. , NELSON J.M. , NAKAYAMA R.
Published: March 2003

BACKGROUND: Before 1987, fewer than 50 patients per year at the authors' laboratory had a positive antibody detection test due to antepartum Rhesus immunoprophylaxis. However, after 1987, a marked increase was observed in the number of patients who had received Rh immune globulin (RhIG) during pregnancy as part of routine antepartum Rh immunoprophylaxis. In anticipation that an increased use of RhIG during pregnancy would increase the number of patients in whom anti‐D was detected by this laboratory, a protocol was developed to abbreviate the process required to identify anti‐D. Although this protocol was adopted primarily to address an anticipated increase in antenatal RhIG usage in women, it was also applied to alloimmunized Rh‐negative males.

STUDY DESIGN AND METHODS: When an Rh‐negative patient (male or female) had a reactive screening test for unexpected antibodies and met certain other criteria, the patient's serum was tested with a three‐vial set of Rh‐negative reagent red cells (Rh‐negative screening RBCs), instead of with panels of typed RBCs (panel RBCs), for the identification of anti‐ D or the detection of non‐D antibodies. If the serum under test did not agglutinate or hemolyze Rh‐negative screening RBCs, anti‐D was identified and no further testing was performed. If the serum agglutinated or hemolyzed Rh‐negative screening RBCs, conventional testing with panel RBCs was done to determine the antibody specificity.

RESULTS: Rh‐negative patients (n = 1174) who had reactive screening tests for unexpected antibodies were tested with Rh‐negative screening RBCs; 1079 were found to have anti‐D as a single antibody. Seven of these patients subsequently developed a non‐D alloantibody, after transfusion or pregnancy, and one patient had anti‐C that escaped detection at the time of initial testing with Rh‐negative RBCs (a false‐ negative result). Ninety‐two patients had anti‐D in combination with a non‐D antibody, and three patients had a non‐D antibody but not anti‐D. Use of the anti‐D identification protocol actually reduced the laboratory workload by 176 College of American Pathologists workload units per month, in spite of a marked increase in the number of patients in whom anti‐D was detected. No hemolytic transfusion reaction was attributed to the abbreviation of anti‐D identification. CONCLUSION: The identification of anti‐D may be abbreviated without jeopardizing patient safety. Such a protocol can reduce laboratory workload and might be particularly appealing to health care facilities that perform antibody detection testing on large numbers of Rh‐negative pregnant women, especially if antepartum RhIG is administered routinely.
Comparison of bacteria growth in single and pooled platelet concentrates after deliberate inoculation and storage
Authors: Wagner S. J. , Moroff G. , Katz A. J. , Friedman L. I.
Published: March 2003

BACKGROUND: The ability to store pools of platelet concentrates (PCs) for extended periods would provide logistical flexibility. However, reports of severe adverse reactions due to the transfusion of contaminated PCs led to an examination of whether the total bacteria levels after storage of pools containing a deliberately inoculated platelet unit would be significantly different than the levels in paired unpooled concentrates. STUDY DESIGN AND METHODS: A single PC was deliberately inoculated on Day 0 with one of three bacterial species (0.1–8.0 colony‐forming units/mL). On Day 1, the deliberately inoculated PC was divided into three equal parts and either 1) pooled with 5 half‐volume, ABO‐ and Rh‐identical PCs; 2) similarly pooled and white cell reduced; or 3) kept as a control. Sterile connections were used during pooling; modified storage containers were used to ensure the correct surface‐to‐volume ratio of the single unit. RESULTS: Between Day 2 and Day 5 of storage, in 26 of 36 paired samples, nonfiltered pools containing Escherichia coli had greater total numbers of bacteria than did the paired single PCs. Day 2 pools had total bacteria levels approximately five times higher (colony‐forming units/mL × container volume) than those in single units (p < 0.05). There was rapid growth of Staphylococcus aureus by Day 2 in pooled and unpooled PCs; by Day 3, total bacteria levels were approximately five times higher in pools than in single units (p < 0.05). Between Days 3 and 5 of storage, in 23 of 27 paired samples, nonfiltered pools containing S. aureus had greater total bacteria levels than the single PCs. By Day 5, 15 of 16 non‐white‐cell reduced pools had total levels of Staphylococcus epidermidis bacteria approximately five times those in the paired single PCs. Greater total bacteria levels in pooled units than in single units generally occurred when bacteria in pools reached the stationary phase of growth (when bacteria concentration became constant), and they were well correlated with the sixfold volume of pooled units. White cell reduction did not substantially affect the time required to attain stationary phase. CONCLUSION: The potential during storage for greater total bacteria levels in pools than in single PCs is a consequence of the greater volume of the pool.
Sterility of plastic tubing welds in components stored at room temperature
Authors: AuBuchon J. P. , Pickard C. , Herschel L.
Published: March 2003

BACKGROUND: The ability of a sterile connecting device to maintain sterility when being used to weld tubing of a blood component to be stored at room temperature, such as a platelet unit, has not been adequately documented, nor has it been determined when the tubing to be welded is filled with liquid. STUDY DESIGN AND METHODS: The sterility of sterile connecting device welds of polyvinylchloride tubing were challenged after intentional contamination of the exterior of the tubing with both gram‐positive and gram‐negative organisms (4 × 10(4) to 3 × 10(6) colony‐forming units/mL). Welding (n = 244) was performed with the contaminated area either being wet or having been allowed to dry. At the time of the welding, the tubing segments were either empty or filled with liquid (either aliquots of white cell‐reduced apheresis platelets or bacteriologic growth medium). After the welding, the liquid was passed across the weld and held in the attached transfer pack for 5 to 7 days at room temperature. RESULTS: Two welds were found to be incomplete and leaky, and both of the units involved had positive cultures. One transfer pack had inadvertently been contaminated at the time of its initial, postweld culture by a bacterium other than the one used in the experiment. Aside from these three nonevaluable units, all of the welds were sterile when cultured after the packs were held for 5 to 7 days. CONCLUSION: This study documents the ability of the sterile connecting device to maintain a closed system in the welding of blood component units to be maintained at room temperature. All welds should be closely inspected at the time of completion to detect leaks that may lead to contamination.
Virus inactivation in red cell concentrates by photosensitization with phthalocyanines: protection of red cells but not of vesicular stomatitis virus with a water‐soluble analogue of vitamin E
Authors: Ben‐Hur E. , Rywkin S. , Rosenthal I. , Geacintov N. E. , Horowitz B.
Published: March 2003

BACKGROUND: Photodynamic treatment of red cells (RBCs) with phthalocyanines and red light inactivates lipid‐enveloped viruses, such as vesicular stomatitis virus (VSV) and human immunodeficiency virus. To protect RBCs from photodynamic damage, type I free radical quenchers, such as mannitol, which did not affect virus inactivation, were added.

STUDY DESIGN AND METHODS: Aluminum phthalocyanine tetrasulfonate (AIPcS4) was found to inactivate VSV at a rate one‐ fourth that of the silicon phthalocyanines (Pc 4 and Pc 5). However, the latter also caused more RBC damage. To protect RBCs against this photodynamic damage, Trolox, a water‐soluble vitamin E analogue, was used. RBC damage was measured as potassium leakage or hemolysis during storage after treatment. In addition, reduction in negative surface charge on RBCs was measured immediately after treatment, and the effect of Trolox on VSV inactivation in RBCs was evaluated.

RESULTS: Trolox at a concentration of 5 mM was found to reduce potassium leakage during storage after Pc 4 and AIPcS4 photodynamic treatment of RBCs. Hemolysis during storage of RBC concentrates treated with Pc 4 or Pc 5 was drastically reduced by the addition of 5 mM Trolox prior to light exposure. At the same concentration, Trolox inhibited the reduction of negative surface charges on RBCs following Pc 4 and Pc 5 photodynamic treatment. Under these conditions, VSV inactivation by photodynamic treatment with all phthalocyanines was not affected by Trolox. In aqueous solution, Trolox formed a complex with AIPcS4, thus quenching the excited triplet state of AIPcS4 at a constant rate of 8.8 × 10(6) per M per second.

CONCLUSION: These findings indicate that Trolox protects RBCs from phthalocyanine‐photosensitized damage without affecting virus kill. The addition of Trolox would be beneficial for improving the quality of RBCs subjected to photodynamic treatment.
Evaluation of swirling, pH, and glucose tests for the detection of bacterial contamination in platelet concentrates
Authors: Wagner S. J. , Robinette D.
Published: March 2003

BACKGROUND: Although infrequent, episodes of transfusion‐associated bacterial sepsis may lead to serious outcomes or death and therefore are of concern. This study evaluates the sensitivity of three surrogate tests for the presence of bacteria in platelet concentrates: cessation of swirling, low extracellular pH, and low plasma glucose levels. STUDY DESIGN AND METHODS: Day 0 platelet concentrates were inoculated with low levels of one of seven bacterial strains and stored with agitation at 20 to 24 degrees C for up to 5 days. In the morning and afternoon of each day of storage, bacterial levels were ascertained by quantitative plate culture, and platelet concentrates were tested for platelet pH, plasma glucose, and swirling. Quantitative and semiquantitative dipstick techniques were used to determine pH and glucose levels. RESULTS: Platelet concentrates had attained stationary phase growth of Streptococcus pyogenes, Staphylococcus aureus, Escherichia coli, Bacillus cereus, Enterobacter cloacae, Streptococcus mitis, or Staphylococcus epidermidis (> or = 10(7) ‐10(8) colony‐forming units [CFU]/mL) before either the swirling or dipstick methods suggested the presence of bacteria. The sensitivity of swirling and glucose tests for detecting bacterial contamination in platelet concentrates was generally comparable. Although the sensitivity of the pH test was generally similar to that of swirling and glucose tests for most bacteria, platelet concentrates contaminated with E. cloacae had normal pH despite the presence of high levels of bacteria (> or = 10(7)‐10(8) CFU/mL). CONCLUSION: The sensitivity in detection of bacteria in platelet concentrates by the swirling technique or by measuring extracellular pH or plasma glucose is less than the sensitivity reported for microscopy with Gram stain (10(5)‐10(6) CFU/mL), fluorescence microscopy with acridine orange stain (10(4)‐10(5) CFU/mL), chemiluminescence detection of ribosomal RNA (10(3)‐10(4) CFU/mL), and automated bacterial culture (1 CFU/sample volume).
False‐positive human immunodeficiency virus type 1 western blot tests in noninfected blood donors
Authors: Sayre Keith R. , Dodd Roger Y. , Tegtmeier Gary , Layug Lynne , Alexander Steve S. , Busch Michael P.
Published: March 2003

Background: The manufacturers' criteria for a positive human immunodeficiency virus type 1 (HIV‐1) Western blot (WB) test were recently revised to require reactivity to only two of the following bands: p24, gp41, and gp120/160. In a recent report, low‐risk blood donors were identified in whom nonspecific reactivity to multiple env antigens in WB testing resulted in apparently false‐positive WBs by these criteria. The present study was conducted to verify the existence of false‐positive WBs among noninfected donors and to assess the extent of this problem.

Study Design and Methods: Four donors classified as WB‐ positive on the basis of env‐only (3 cases) or p24/env‐only (1 case) patterns were investigated. Index and/or follow‐up specimens were tested by polymerase chain reaction (PCR), by overlapping recombinant env antigens and synthetic peptides in enzyme immunoassays, and by deglycosylated and denatured antigen WBs. WB records from American Red Cross blood centers were reviewed to determine the frequency of env‐ only and p24/env‐only patterns, relative to all positive WBs, from 1988 through 1993.

Results: The four index‐case donors denied risk and had stable WB reactivity during follow‐up. HIV PCR was negative in all. Env reactivity was restricted to nonglycosylated gp41 epitopes; no gp120‐ specific reactivity was detected. For three of the four donors, env reactivity was mapped to a 20‐amino acid N‐terminal epitope of gp41. The rate of detecting WBs with these false‐positive patterns increased from 0.6 percent of all positive WBs from 1988 to 1990 (4/776) to 8 percent in 1991 and 1992 (52/683), and then it declined to 6 percent in 1992 and 1993 (47/783). Env‐only patterns predominated in 1991 and 1992, whereas p24/env‐only patterns were more frequent following implementation of combined anti‐HIV‐1/HIV type 2 enzyme immunoassays in 1992.

Conclusion: Low‐risk blood donors can have false‐positive results on WB tests. Increased detection of env‐only and p24/env‐only WBs appears related to the enhanced sensitivity of newer enzyme immunoassays to gp41 and p24 antibodies. Donors with these patterns should undergo follow‐up testing to document the presence or absence of HIV infection.
Relationship between antibody to hepatitis B core antigen and retroviral infections in blood from volunteer donors
Authors: Korelitz J.J. , Busch M.P. , Kleinman S.H. , Williams A.E. , Zuck T.F. , Gilcher R.O. , Ownby H.E. , Chien H. Co , Nemo G.J.
Published: March 2003

Background: The value of the test for antibody to hepatitis B core antigen (anti‐HBc) as a surrogate screening assay in the time before sensitive, virus‐specific screening tests were available has been well established. There is significant debate, however about the residual value of anti‐HBc screening after the implementation of human immunodeficiency virus (HIV)‐, human T‐lymphotrophic virus (HTLV)‐, and hepatitis C virus (HCV)‐specific assays and, in particular, about its utility as a lifestyle marker to identify persons at risk for retrovirus infections.

Study Design and Methods: Screening tests for antibodies to HIV, HTLV, and HBc, as well as confirmatory or supplemental test results for anti‐HIV and anti‐HTLV, were obtained from approximately 2.8 million donations collected from 1991 through 1993 by five blood centers within the United States. The sensitivity, positive predictive value, and relative prevalence of anti‐HBc for each retrovirus were calculated and compared among demographic subgroups.

Results: The overall relationship between anti‐HBc and anti‐HIV was similar to that between anti‐HBc and anti‐HTLV. When calculated from the measured endpoint of the prevalence of anti‐HIV‐positive and anti‐ HTLV‐positive donations, the sensitivities were 31.1 and 26.2 percent, the positive predictive values were 0.18 and 0.21 percent, and the relative prevalences were 30.1 and 23.8, respectively. Among 27 anti‐ HIV‐seroconverting donors and 9 anti‐HTLV‐seroconverting donors, the sensitivities were 7.4 percent (95% CI: 0.9–24.3%) and 0 percent (95% CI: 0.0–28.3%), respectively. It was estimated that for each HIV‐ infected window‐period donation detected by anti‐HBc, from 19,000 to 81,000 HIV‐noninfected donations are discarded. Similarly, more than 33,000 HTLV‐noninfected donations are likely to be discarded for each HTLV‐infected donation detected by anti‐HBc.

Conclusion: Although anti‐ HBc‐reactive donations are more likely to be seropositive for a retrovirus than are anti‐HBc‐nonreactive donations, the low positive predictive value limits the test's effectiveness. If the anti‐HBc test is retained in the blood donor setting, efforts should be focused on reducing the number of false‐positive results.
Surveillance for human immunodeficiency virus type 1 group O infections in the United States
Authors: Pau C. P. , Hu D. J. , Spruill C. , Schable C. , Lackritz E. , Kai M. , GEORGEM J.R. , Rayfield M. A. , Dondero T. J. , Williams A. E. , Busch M. P. , Brown A. E. , McCutchan F. E. , Schochetman G.
Published: March 2003

BACKGROUND: Reports that the human immunodeficiency virus type 1 (HIV‐ 1) group O variants are not reliably detected by some commercial diagnostic tests have raised concerns about the sensitivity of existing screening tests, especially with regard to blood safety. Although it is unlikely that these divergent strains are prevalent in North America, systematic, continuous surveillance is needed to monitor the potential spread of HIV variants into that region.

STUDY DESIGN AND METHODS: Stored serum samples (n = 1072) from both high‐ and low‐risk population groups at several sites in the United States and Puerto Rico were tested by peptide enzyme immunoassays specific for the prototypic HIV‐1 group O strains, MVP5180 and ANT70. RESULTS: None of the 1072 samples examined had peptide reactivity that was consistent with HIV‐1 group O infection.

CONCLUSION: While no evidence of specific HIV‐1 group O (MVP5180 or ANT70) infection was found in this study, the sensitivity of current tests has not been fully evaluated against the wide range of genetic variation of HIV. Therefore, it is important to continue active surveillance for HIV‐1 and HIV type 2 strains, to characterize any divergent strains, and to judiciously modify tests to correct for any deficiencies in sensitivity.
Monitoring for undertransfusion
Authors: Mair B. , Agosti S. J. , Foulis P. R. , Hamilton R. A. , Benson K.
Published: March 2003

BACKGROUND: Most published reviews and audits of blood and blood component transfusion have focused on the issue of overtransfusion and on the inappropriate use of red cell components. There is growing concern that efforts to curb unnecessary transfusions may result in a trend toward undertransfusion of patients. There is little published information that addresses this issue or the magnitude of this practice. STUDY DESIGN AND METHODS: Undertransfusion was evaluated by examining the transfusion records from a 3‐month period for 55 patients who met the study criteria of having either a hemoglobin level < 7 g per dL or a platelet count of < 10 × 10(9) per L. If the identified patient did not receive a transfusion within 24 hours of the reported hemoglobin level or platelet count, the medical record was reviewed by a resident physician. RESULTS: A total of 213 individual hemoglobin levels and platelet counts, representing the 55 patients, met our transfusion criteria. All except 8 of the identified patients received red cells and/or platelet transfusions. Reasons for not transfusing red cells included the patient's response to nutritional support and iron supplementation, refusal of blood, and noncompliance. Reasons for not transfusing platelets included falsely low platelet count because of platelet clumping in vitro, contraindication based on clinical diagnosis (e.g., immune thrombocytopenic purpura), and the patient's death before transfusion. CONCLUSION: Red cell and platelet transfusions were appropriately ordered for all patients who met the transfusion criteria. Undertransfusion is not a problem at this institution according to the criteria established. It is recommended that other institutions expand their blood utilization audits to include investigation for evidence of undertransfusion. Further research regarding the issue of undertransfusion is warranted and could be expanded to include other components.
A sequence‐specific polymerase chain reaction assay for mitochondrial DNA polymorphisms in human platelets and white cells
Authors: Garritsen H. S. , Szuflad P. , Sibrowski W. , Dzik W. H.
Published: March 2003

BACKGROUND: Because mitochondria are abundant in white cells and are also present in platelets, polymorphic sequences in mitochondrial DNA (mtDNA) represent a unique target for polymerase chain reaction (PCR)‐ based detection of donor material. STUDY DESIGN AND METHODS: A PCR assay was developed that uses sequence‐specific primers (SSP) focused on two continent‐specific mtDNA polymorphisms. Results were validated by the use of informative restriction endonucleases. Three commercially available methods to extract mtDNA from white cell‐reduced human platelets was compared. In preparation for in vivo studies, in vitro mixing studies designed to mimic transfusion were conducted to investigate the performance of the SSP‐PCR assay. RESULTS: The gene sequences of two representative examples of amplicons obtained with the new SSP‐PCR matched the sequence expected from the published genetic code. Fifteen individuals were classified as either positive (n = 6) or negative (n = 9) for the Asian polymorphism by the use of published primers known to flank the polymorphic site followed by digestion with appropriate restriction enzymes. Results with SSP‐PCR were nearly perfectly concordant with those of restriction enzyme analysis. Although the use of three DNA extraction methods allowed the preparation of mtDNA that was suitable for PCR, large and consistent differences (ranging from 10‐ to 1000‐fold) in endpoint sensitivity were found. In vitro mixing studies reproducibly documented that the SSP‐PCR assay could detect as little as 1 percent of donor platelets mixed with recipient blood. CONCLUSION: PCR‐SSP can be reliably used to identify human mtDNA polymorphisms. By optimization of the method of mtDNA extraction, the sensitivity of PCR‐SSP assay was greatly increased. This assay should prove useful in investigations of allogeneic platelet transfusions without cell labeling. It may also be applied to studies of the donor cell microchimerism that follows transfusion or transplantation.
The effect of transfusion on cardiac function in patients with chronic anemia
Authors: Ho C. H.
Published: March 2003

BACKGROUND: The deteriorating cardiac function of patients with chronic anemia may be improved with transfusion. The effect of transfusion on cardiac function was evaluated in patients with chronic anemia. STUDY DESIGN AND METHODS: In a prospective study, ejection fraction (EF) was determined before and after transfusion in 41 patients with chronic anemia. The results were compared and analyzed. RESULTS: The volume of red cells transfused and the levels of pretransfusion hemoglobin, hematocrit, and red cell, white cell, and platelet counts did not affect the posttransfusion EF, whereas the pretransfusion EF of the right or left ventricle inversely affected the posttransfusion change in EF in the respective ventricle (p < 0.001 and r = ‐0.5022; p = 0.01 and ‐0.3917, respectively). There was no significant difference in the change in EF in the right and left ventricles. CONCLUSION: Transfusion produced little immediate effect on cardiac function, but did change the EF to an extent that aided cardiac function in chronic anemia patients. The pretransfusion EF itself, but not the degree of anemia or volume of red cells transfused, affected the posttransfusion change in EF.
A comparative trial of granulocyte‐colony‐stimulating factor and dexamethasone, separately and in combination, for the mobilization of neutrophils in the peripheral blood of normal volunteers
Authors: Liles W.C. , Huang J.E. , Llewellyn C. , SenGupta D. , Price T.H. , Dale D.C.
Published: March 2003

BACKGROUND: The clinical utility of polymorphonuclear neutrophil (PMN) transfusion therapy has been compromised, in part, by the inability to obtain sufficient quantities of functional neutrophils from donors. To define the optimal conditions for mobilization of PMNs in granulocyte donors, the effects of granulocyte‐colony‐stimulating factor (G‐CSF) and dexamethasone, separately and in combination, on PMN counts in normal volunteers were compared. STUDY DESIGN AND METHODS: Five normal subjects were randomly assigned to each of the following single‐dose regimens in 5 consecutive weeks: 1) G‐CSF, 300 micrograms given subcutaneously; 2) G‐CSF, 600 micrograms subcutaneously: 3) dexamethasone, 8 mg given orally; 4) G‐CSF, 300 micrograms subcutaneously, plus dexamethasone, 8 mg orally; and 5) G‐CSF, 600 micrograms subcutaneously, plus dexamethasone 8 mg orally. Venous blood was collected at 0, 6, 12, and 24 hours after drug administration for the determination of absolute neutrophil counts (ANCs). RESULTS: Maximal ANC was achieved at 12 hours after each regimen, except dexamethasone alone (maximum, 24 hours). Dexamethasone significantly increased the maximal ANC induced by either dose of G‐CSF alone (p < 0.05). The greatest mobilization of PMNs occurred after the administration of G‐CSF (600 micrograms) and dexamethasone (8 mg); the ANC increased from a mean baseline value of 3,594 per microL to 43,017 per microL at 12 hours. All of the drug regimens were well tolerated. CONCLUSION: Dexamethasone significantly increases the level of neutrophilia induced in normal subjects by G‐CSF. The combination of dexamethasone and G‐CSF (at the dosages used in this study) is a convenient, well‐tolerated regimen for the mobilization of PMNs in the peripheral blood of granulocyte donors. Moreover, the optimal quantitative yield of PMNs is likely to be achieved by leukapheresis 12 hours after drug administration.