bluuebunny/crossref_metadata_2025 huggingface dataset:
Increased detection of hepatitis C virus infection in commercial plasma donors by a third‐generation screening assay
Authors: Lee S.R. , Wood C.L. , Lane M.J. , Francis B. , Gust C. , Higgs C.M. , Nelles M.J. , Polito A. , DiNello R. , Achord D.
Published: March 2003

BACKGROUND: Routine screening of blood donations with second‐generation hepatitis hepatitis C virus (HCV) assays has substantially reduced the occurrence of posttransfusion hepatitis. However, following the development of third‐generation assays, several studies indicated that these assays may identify HCV‐infected individuals who are not identified by second‐generation assays.

STUDY DESIGN AND METHODS: The sensitivity of a third‐generation HCV enzyme‐linked immunosorbent assay (ELISA‐3) was compared with a second‐generation ELISA (ELISA‐2) in a side‐by‐side study of 9936 commercial blood donors. ELISA‐reactive specimens were subjected to supplemental analysis by third‐generation recombinant immunoblot assay and polymerase chain reaction.

RESULTS: ELISA‐3 demonstrated greater sensitivity than ELISA‐2, detecting 1 additional recombinant immunoblot assay‐positive specimen per 2000 tested. ELISA‐3 also detected 1 additional HCV‐infectious polymerase chain reaction‐positive unit among approximately 10,000 units screened.

CONCLUSION: The incremental sensitivity achieved with ELISA‐3 can be expected to eliminate approximately 20 infectious donations per week among those made by commercial donors in the United States. In accordance with previous studies, most of the improved sensitivity of ELISA‐3 derives from its increased detection of anti‐c33c (NS3), rather than from the inclusion of HCV antigen NS5.
Blood transfusion and septic complications after hip replacement surgery
Authors: Vamvakas E. C. , Moore S. B. , Cabanela M.
Published: March 2003

BACKGROUND: The purpose of this study was to address some methodologic issues that might help explain the disagreement between the findings of earlier reports on the presumed association between allogeneic blood transfusion and the increased postoperative infection rates seen in orthopedic surgery patients. STUDY DESIGN AND METHODS: A retrospective review of the incidence of postoperative septic complications in 367 patients from Olmsted County, Minnesota, who underwent 420 elective total hip arthroplasties between 1986 and 1993, was conducted. The infection rates in the exposed patients (those who had perioperatively received allogeneic blood components only or allogeneic and autologous blood components) were compared with those in the untransfused patients and patients who received only autologous blood. The study had sufficient statistical power to detect a deleterious effect of allogeneic blood transfusion equal to the 2.8‐fold effect observed in a recent randomized clinical trial of patients undergoing elective abdominal surgery. RESULTS: There was no association of allogeneic blood transfusion with postoperative infection (p = 0.226). Nineteen infections occurred in 201 exposed patients (9.5%), as compared to 14 infections in 219 unexposed patients (6.4%). CONCLUSION: Allogeneic blood transfusion does not increase the incidence of post‐operative septic complications in patients undergoing elective total hip arthroplasty, at least to the extent that the statistical power of this study allowed the determination.
Preparation of white cell‐reduced red cells by filtration: comparison of a bedside filter and two blood bank filter systems
Authors: Sprogøe‐Jakobsen U. , Saetre A. M. , Georgsen J.
Published: March 2003

BACKGROUND: Concern has been raised about the quality of white cell (WBC)‐reduced red cells (RBCs) obtained by bedside filtration. The bedside performance and workload of a routine bedside filter have been compared to the laboratory performance and workload of two blood bank filter systems.

STUDY DESIGN AND METHODS: Buffy coat‐depleted saline‐ adenine‐glucose‐mannitol (SAGM) RBCs (90 units) were prepared. Thirty units were filtered with each of the two blood bank filter systems, and 30 units were filtered (but not transfused) with the bedside filter in a clinical department after 8 to 24 days of storage. The RBCs lost and the postfiltration WBC content (Nageotte chamber) were determined for all filtered units, and the workload associated with filtration by each of the filter systems/filter was assessed. Units with a postfiltration content of > or = 2 × 10(6) WBCs were regarded as filtration failures.

RESULTS: Four (13%) of the 30 units filtered at the bedside were filtration failures, compared to no failures with either of the blood bank filter systems. In addition, the median WBC content (0.14 × 10(6)) of the units filtered at the bedside (2 units/filter) was significantly higher than that of the units filtered in the blood bank (0.05 × 10(6)). The RBC loss was significantly higher with the filter systems than with the bedside filter, provided 2 units per filter were processed with the latter. The timed workload of the filter systems was 45 to 75 minutes per 12 units, which was similar to the time required for bedside filtration.

CONCLUSION: Bedside filtration of 2 units of stored buffy coat‐depleted SAGM RBCs per filter resulted in a higher incidence of filtration failure and higher postfiltration WBC content than did laboratory filtration of 1 unit of fresh buffy coat‐depleted SAGM RBCs per filter with either of two blood bank filter systems.
Evidence that CDw108 membrane protein bears the JMH blood group antigen
Authors: Mudad R. , Rao N. , Angelisova P. , Horejsi V. , Telen M. J.
Published: March 2003

BACKGROUND: CDw108 is a cluster‐of‐differentiation antigen that resides on a glycosylphosphatidylinositol (GPI)‐linked protein; it has not previously been shown to be expressed on red cells. JMH is a high‐ frequency red cell blood group antigen that resides on a GPI‐linked protein of molecular weight similar to that bearing CDw108. The purpose of this study was to investigate whether CDw108 is expressed on red cells and whether it resides on the same membrane protein as does JMH.

STUDY DESIGN AND METHODS: Murine monoclonal antibodies to CDw108, MEM‐ 121 and MEM‐150, as well as a murine monoclonal antibody and human antibodies to JMH were used in radioimmunoassay, inhibition assay, Western blotting, and monoclonal antibody‐specific immobilization of erythrocyte antigen assay.

RESULTS: MEM‐121 and MEM‐150 were found to bind to red cells, and MEM‐150 blocked binding of human anti‐JMH to red cells. Anti‐CDw108 and anti‐JMH identified red cell membrane proteins that were of similar size and that were absent from JMH‐negative red cells on Western blotting. MEM‐150 and MEM‐121 also immobilized the same protein that reacted with human anti‐JMH.

CONCLUSION: CDw108 is expressed on red cells and resides on the same GPI‐linked membrane protein as does the JMH blood group antigen.
Hypotensive reactions: a previously uncharacterized complication of platelet transfusion?
Authors: Hume H.A. , Popovsky M.A. , Benson K. , Glassman A.B. , Hines D. , Oberman H.A. , Pisciotto P.T. , Anderson K.C.
Published: March 2003

Background: In 1993, the American Association of Blood Banks (AABB) received reports of severe hypotensive reactions associated with platelet transfusions. The question arose as to whether these reports were indicative of a previously uncharacterized platelet transfusion reaction.

Study Design and Methods: To further characterize these reactions, the AABB Transfusion Practices Committee developed a series of three questionnaires. The initial questionnaire was sent to all AABB institutional members; the two subsequent questionnaires were sent to those institutions reporting severe and/or unusual platelet transfusion reactions. This report focuses on the 24 responses to the third and most detailed questionnaire, which specifically addressed reactions that were characterized by hypotension and/or unexplained respiratory failure.

Results: Of the 24 detailed responses received, 4 were not considered to represent unusual reactions to platelet transfusion, 3 described reactions consistent with a (presumably unrecognized) diagnosis of transfusion‐related acute lung injury, and 17 described reactions that were primarily characterized by hypotension. The majority of the hypotensive reactions occurred within 1 hour of the beginning of the transfusion (88%), were associated with respiratory distress (82%), and resolved rapidly after cessation of the transfusion (82%). Eighty‐eight percent of implicated components had been white cell reduced by filtration.

Conclusion: The hypotensive platelet transfusion reactions that were described appear to represent a previously uncharacterized complication of platelet transfusion. However, the nature of the questionnaires used in this investigation does not allow the drawing of firm conclusions as to the frequency or the cause of these reactions.
Blood donation‐related neurologic needle injury: evaluation of 2 years' worth of data from a large blood center
Authors: Newman B.H. , Waxman D.A.
Published: March 2003

Background: There is little information in the medical literature on t he clinical spectrum of blood donation‐related neurologic needle injury and on its frequency in a blood donor population.

Study Design and Methods: Sixty‐six cases of blood donation‐related neurologic needle injury were identified from nursing reports made during a 2‐year collection period involving 419,000 whole blood donations. Telephone follow‐up was completed on 56 of the 66 cases to better define clinical symptoms, the donor's desire for physician consultation, recovery times, and residual effects.

Results: Symptoms in 66 donors included numbness or tingling (n = 54), excessive or radiating pain (n = 43), and loss of arm or hand strength (n = 8). Of the 56 donors with complete follow‐up, 17 (30%) consulted a physician one or more times. Recovery times in these 56 donors were <3 days (n = 22), 4 to 29 days (n = 17), 1 to 3 months (n = 13) 3 to 6 months (n = 2), and >6 months (n = 2). Fifty‐two of 56 donors achieved a full recovery, and 4 other donors had only a mild, localized, residual numbness. The incidence of blood donation‐related neurologic needle injury was 1 of every 6300 donations.

Conclusion: While donor recovery may in some cases require a great deal of time and/or physician consultation(s), total recovery appears to be the rule. The incidence of blood donation‐related neurologic needle injury is relatively low.
Chemokines in stored platelet concentrates
Authors: Bubel S. , Wilhelm D. , Entelmann M. , Kirchner H. , Kluter H.
Published: March 2003

BACKGROUND: Platelets contain several mediators, belonging to a family of proinflammatory cytokines named chemokines, that are stored in the organelles. Release and accumulation of these chemokines during storage of platelet concentrates (PCs) might be responsible for nonhemolytic transfusion reactions.

STUDY DESIGN AND METHODS: Analysis was done of pH and the levels of platelet factor 4, beta‐thromboglobulin, interleukin 8, RANTES, macrophage‐inflammatory protein‐1 alpha, lactate dehydrogenase, and serotonin in the supernatant of stored PCs on Days 1, 3, 5, and 8. PCs were prepared by apheresis or from pools of four buffy coats. Buffy coat PCs were filtered before storage.

RESULTS: Nonfiltered apheresis PCs, which had a higher white cell contamination (p < 0.01), contained significantly more platelets than did buffy coat PCs (p = 0.02). The pH decreased significantly in apheresis PCs (p = 0.01), whereas there was a significant increase in lactate dehydrogenase (p < 0.001). In buffy coat PCs, pH remained stable and lactate dehydrogenase increased moderately. Concentrations of platelet factor 4 and beta‐thromboglobulin increased steadily in both preparations over the storage period (p < 0.001). Macrophage‐ inflammatory protein‐1 alpha was hardly detectable in the supernatant of both PCs, while RANTES levels increased significantly with storage time (p < 0.001). Interleukin 8 was not found in the supernatant of any PCs, with the exception of one apheresis PC with high white cell contamination (> 10(9)/ L). Serotonin levels were higher in apheresis PCs (p = 0.01), but the levels did not correlate with storage time.

CONCLUSION: Platelet factor 4, beta‐thromboglobulin, and RANTES were released from platelets during storage and accumulated over time in the PCs. These chemokines might play a causative role in nonhemolytic transfusion reactions because of their inflammatory potential, but the clinical effects of the transfusion of PCs with high chemokine contents remain to be investigated.
All medium starches are not the same: Influence of the degree of hydroxyethyl substitution of hydroxyethyl starch on plasma volume, hemorrheologic conditions, and coagulation
Authors: Treib J. , Haass A. , Pindur G. , Grauer M. T. , Wenzel E. , Schimrigk K.
Published: March 2003

BACKGROUND: After the application of high volumes of high‐molecular‐ weight starch (hetastarch), bleeding complications have repeatedly been observed. Later studies showed that the application of medium‐molecular‐ weight starch led to far fewer disturbances of the blood coagulation system. However, the relationships among the degree of hydroxyethyl substitution, the rate of degradation, and the average in vivo molecular weight have not been investigated.

STUDY DESIGN AND METHODS: A 10‐day hemodilution treatment (n = 20) was carried out using two medium‐molecular‐weight hydroxyethyl starches (HES) with a degree of hydroxyethyl substitution of 0.5 and 0.62, respectively (10% HES 200 was used for a substitution of 0.5 and 6% HES 200 for a substitution of 0.62). After a loading dose of 500 mL was administered, 1000 mL of HES was infused daily for 4 days, and then 500 mL was infused daily for 6 days.

RESULTS: The more highly substituted starch was broken down more slowly and eliminated renally. This resulted in a higher intravascular molecular weight than for the less highly substituted HES (120 vs. 84 kDa) and a greater increase in serum concentration (20.3 vs. 9.0 mg/mL). Initially, the more highly substituted 6‐percent HES had a lesser effect on plasma volume (p < 0.01). Because of HES accumulation, there was no longer a significant difference between the starches by the end of treatment, even though a higher dose of the 10‐percent low‐ substitution starch was infused. Six‐percent HES caused an increase in plasma viscosity (+9%, p < 0.01) that was due to an accumulation of macromolecules. Ten‐percent HES 200/0.5 had no effect on the coagulation system beyond the dilution effect. Six‐percent HES, on the other hand, led to an acquired von Willebrand syndrome during the course of the 10‐day therapy. Factor VIII function was reduced by 72.2 percent, von Willebrand ristocetin cofactor by 61.3 percent, and von Willebrand factor antigen by 64 percent (p < 0.01).

CONCLUSION: It is the intravascular and not the initial (in vitro) molecular weight that determines the properties of HES. Especially after repeated administration, a high degree of hydroxyethyl substitution leads to an accumulation of macromolecules that affect hemorrheologic measures and the coagulation system just as adversely as high‐molecular‐weight starch does. Depending on the degree of substitution, medium‐molecular‐ weight starches can have widely differing properties.
Studies of antibodies in the sera of patients who have made red cell autoantibodies
Authors: Issitt P. D. , Combs M. R. , Bumgarner D. J. , Allen J. , Kirkland A. , Melroy‐Carawan H.
Published: March 2003

BACKGROUND: In patients in whom autoantibodies of broad specificity (panagglutinins) are present in the serum, adsorption studies are often necessary to identify alloantibodies that are simultaneously present. STUDY DESIGN AND METHODS: Samples from 138 patients in whom the direct antiglobulin test was positive and antibody was present in the serum were studied. When antibody identification studies before or after initial adsorption suggested the presence of an alloantibody, additional alloadsorptions were performed. RESULTS: Among the samples from 138 patients, 71 contained only panagglutinating autoantibody, and another 19 contained either autoantibodies or alloantibodies that were not accompanied by panagglutinins. The remaining 48 samples contained both panagglutinins and a total of 62 antibodies that appeared to be alloimmune in nature. Alloadsorption with antigen‐negative red cells showed that 29 (47%) of the apparent alloantibodies were in fact partially adsorbed autoantibodies that mimicked alloantibodies by their reactions. CONCLUSION: Initial autoadsorption often left unadsorbed alloantibodies and autoantibodies with mimicking specificities. Initial alloadsorption more often left only true alloantibodies unadsorbed. From the screening tests, it appeared that 43 percent of the 138 patients were alloimmunized. Recognition of the mimicking nature of the partially adsorbed autoantibodies found that the real incidence of alloimmunization in the patients was 23 percent. Recognition of this phenomenon considerably simplifies the selection of blood for transfusion to these patients.
Quantitation of passively acquired human immunodeficiency virus (HIV) antibodies in AIDS patients transfused with a plasma that is rich in HIV antibodies
Authors: Lefrère J.‐J. , Roudot‐Thoraval F. , Vittecoq D. , Heshmati F. , Audat F. , Lerable J. , Reed D. , Petit J. C. , Burghoffer B. , Morand‐Joubert L.
Published: March 2003

BACKGROUND: Passive immunotherapy in human immunodeficiency virus (HIV) infection is based on transfusions of plasma that is rich in HIV antibodies. STUDY DESIGN AND METHODS: To verify whether the clearance of transfused antibodies will maintain an elevated titer of specific antibodies between biweekly transfusions of plasma, the titers of anti‐ HIV‐1 in plasma and in transfusion recipients were measured. Samples from 12 recipients were analyzed by automated scanning of Western blot, before transfusion and at Days 2, 7, and 14 after transfusion. RESULTS: The p24 antibody became detectable or higher than the baseline after transfusion and remained detectable until the second transfusion. Anti‐ p24 titers were variable and dependent on the antibody titer of the transfused plasma and the baseline p24 antigen titer. CONCLUSION: Biweekly transfusion of plasma with a high anti‐HIV titer maintains a high anti‐p24 titer between transfusions in AIDS patients treated with passive immunotherapy.
Prestorage inline filtration of whole blood for obtaining white cell‐ reduced blood components
Authors: Riggert J. , Schwartz D. W. , Wieding J. U. , Mayr W. R. , Kohler M.
Published: March 2003

BACKGROUND: Preliminary studies have indicated that the inline filtration of whole blood is a feasible method of obtaining white cell (WBC)‐reduced packaged red cells (RBCs) and WBC‐reduced fresh‐frozen plasma (FFP) while using only one filter. STUDY DESIGN AND METHODS: An inline WBC‐reduction filter, specially designed for this purpose and integrated in a “top‐top” system, was used in the preparation of 24 units of WBC‐reduced RBCs (RBC‐F) and FFP (FFP‐F) in each of two transfusion centers (Vienna and Gottingen). Twelve conventionally prepared units of RBCs (RBC‐C) and FFP (FFP‐C) served as controls. WBC contamination was assessed in each unit with the Nageotte chamber. Several coagulation measures were evaluated by using standardized test systems. RESULTS: The median WBC contamination in RBC‐F was 27,000 per unit in Vienna and 50,000 in Gottingen. In FFP‐F, the median WBC contamination was 13,000 (Vienna) and 31,000 (Gottingen) per unit. Coagulation factors I, V, VIII, and XI in FFP‐F were not different from those in FFP‐C. In addition, markers for the activation of coagulation and fibrinolysis–that is, factor XIIa, prothrombin fragments, thrombin‐ antithrombin complexes and fibrinogen degradation products–were not greater in FFP‐F. CONCLUSION: Blood components prepared from inline‐ filtered whole blood meet the standards for WBC‐reduced RBCs and FFP. The protein profile of FFP‐F is not altered, and markers for the activation of coagulation and fibrinolysis show no increase.
The sickle cell hemolytic transfusion reaction syndrome
Authors: Petz L. D. , Calhoun L. , Shulman I. A. , Johnson C. , Herron R. M.
Published: March 2003

BACKGROUND: Patients with sickle cell anemia may develop serious, life‐ threatening hemolytic transfusion reactions (HTRs). More severe anemia may develop after the HTR than was present before transfusion, which suggests the possibility of an increased rate of hemolysis of autologous red cells. STUDY DESIGN AND METHODS: The signs and symptoms occurring during eight severe HTRs that occurred in five patients with sickle cell anemia were reviewed, as were published reports by other investigators. Calculations of red cell production and destruction incorporating known correction factors for reticulocyte maturation were performed to determine the most probable mechanism for the striking drop in hematocrit observed in several instances. RESULTS: A characteristic constellation of findings was recognized in some severe HTRs in patients with sickle cell anemia. Calculations of daily red cell production and senescence indicated that a marked drop in hematocrit occurs when erythropoiesis is suppressed in a patient with a short red cell life span and that this could account for severe posttransfusion anemia when donor red cells are hemolyzed during an HTR. CONCLUSION: A sickle cell HTR syndrome was defined. A rapid increase in the severity of anemia occurs in patients with sickle cell anemia when all donor red cells are hemolyzed during an HTR and when there is suppression of erythropoiesis, as commonly occurs as a result of transfusion or concomitant illness. Although an increased rate of hemolysis of autologous red cells may also occur, more definitive data are required to document that in these patients.
Reliability of the pretransfusion bedside compatibility test: association with transfusion practice and training
Authors: Ingrand P. , Surer‐Pierres N. , Houssay D. , Salmi L. R.
Published: March 2003

BACKGROUND: The utility of a pretransfusion bedside blood compatibility protocol to decrease immunohemolytic accidents has been questioned for years. STUDY DESIGN AND METHODS: The reliability of a standard bedside ABO compatibility test was evaluated with a stratified random sample of 48 nurses who performed agglutination testing by using Bristol cards, interpreted compatibility, and decided whether to transfuse red cells for 12 randomly and blindly selected donor‐and‐recipient blood sample pairs. An expert judged technical performance and the interpretation of each card. RESULTS: Erroneous decisions occurred in 18.2 percent of 576 tests, including 12 decisions to transfuse incompatible blood. Errors involved both testing protocols and the interpretation of compatibility. Anti‐A and anti‐B were detected with 92.8‐percent sensitivity and 95.9‐percent specificity. The expert judged 17.7 percent of tests to be technically inadequate, most often because of the application of excess blood to the card and a lack of rotation of the card. Testing errors (16.1% of tests) were significantly linked to infrequent transfusion activity by the nursing service, inexperience, and insufficient training. Compatibility misinterpretation occurred in 14.6 percent of the tests and was significantly linked to the nurses' infrequent transfusion activity, inexperience, insufficient training, lack of practical experience, and confusion regarding the use of ABO‐ compatible but not identical blood. CONCLUSION: Bedside pretransfusion compatibility determination should not be considered a reliable supplemental safety procedure in the hands of inexperienced and insufficiently trained operators.
Use of the gel agglutination technique for determination of fetomaternal hemorrhage
Authors: MD A. Salamam , David M. , Wittmann G. , Stelzer A. , Dudenhausen J.W.
Published: March 2003

BACKGROUND: Adequate administration of Rh immune globulin requires an accurate determination of the number of D‐positive cells in the circulation of D‐negative women. Although several tests have been described for the detection of fetomaternal hemorrhage, there is still a need for a rapid, simple, and clinically relevant screening test. STUDY DESIGN AND METHODS: Serial dilutions of a monoclonal anti‐D were incubated with stock solutions (0.2 mL) of adult D‐negative red cells in the absence or presence of various amounts of fetal D‐positive cells (0.1, 0.2, 0.3, 0.4, and 0.5%). After incubation, the supernatants were tested against D‐positive red cells by using the new, gel agglutination technique (GAT). After the GAT was adapted to detect D‐positive cells at concentrations of > or = 0.2 percent, unselected postpartum samples from D‐negative women (n = 420) who delivered D‐positive infants were analyzed by both the new test and the Kleihauer‐Betke test (KBT). RESULTS: Three of a total of 420 postpartum samples were positive (> or = 0.4% fetal cells), and 406 were negative in both tests. One had 0.5‐ percent fetal cells in the KBT and gave negative results in the GAT. The latter test was, however, performed after administration of Rh immune globulin. The KBT gave false‐positive results in two cases, because of hereditary persistence of hemoglobin F, and the GAT gave a false‐positive reaction in one case because of a maternal weak D variant. In the remaining seven cases, the KBT results were only weakly positive (0.2%) and could not be attributed solely to D positive red cells. CONCLUSION: The GAT is suited for routine screening. It provides rapid and specific detection of D‐positive red cells at clinically relevant concentrations. The test may (rarely) yield false‐negative results due to insufficient administration of Rh immune globulin before testing.
Hematopoietic recovery in cancer patients after transplantation of autologous peripheral blood CD34+ cells or unmanipulated peripheral blood stem and progenitor cells
Authors: Beguin Y. , Baudoux E. , Sautois B. , Fraipont V. , Schaaf‐Lafontaine N. , Pereira M. , Paulus J.M. , Sondag D. , Fillet G.
Published: March 2003

BACKGROUND: A study of CD34+ cell selection and transplantation was carried out with particular emphasis on characteristics of short‐ and long‐term hematopoietic recovery. STUDY DESIGN AND METHODS: Peripheral blood stem and progenitor cells (PBPCs) were collected from 32 patients, and 17 CD34+ cell‐selection procedures were carried out in 15 of the 32. One patient in whom two procedures failed to provide 1 × 10(6) CD34+ cells per kg was excluded from further analysis. After conditioning, patients received CD34+ cells (n = 10, CD34 group) or unmanipulated (n = 17, PBPC group) PBPCs containing equivalent amounts of CD34+ cells or progenitors. RESULTS: The yield of CD34+ cells was 53 percent (18–100) with a purity of 63 percent (49–82). The CD34+ fraction contained 66 percent of colony‐forming units‐granulocyte‐ macrophage (CFU‐GM) and 58 percent of CFU of mixed lineages, but only 33 percent of burst‐forming units‐erythroid (BFU‐E) (p < 0.05). Early recovery of neutrophils and reticulocytes was identical in the two groups, although a slight delay in platelet recovery may be seen with CD34+ cell selection. Late hematopoietic reconstitution, up to 1.5 years after transplant, was also similar. The two groups were thus combined for analyses of dose effects. A dose of 40 × 10(4) CFU‐GM per kg ensured recovery of neutrophils to a level of 1 × 10(9) per L within 11 days, 15 × 10(4) CFU of mixed lineages per kg was associated with platelet independence within 11 days, and 100 × 10(4) BFU‐E per kg predicted red cell independence within 13 days. However, a continuous effect of cell dose well beyond these thresholds was apparent, at least for neutrophil recovery. CONCLUSION: CD34+ cell selection, despite lower efficiency in collecting BFU‐E, provides a suitable graft with hematopoietic capacity comparable to that of unmanipulated PBPCs. In both groups, all patients will eventually show hematopoietic recovery of all three lineages with 1 × 10(6) CD34+ cells per kg or 5 × 10(4) CFU‐GM per kg, but a dose of 5 × 10(6) CD34+ cells or 40 × 10(4) CFU‐GM per kg is critical to ensure rapid recovery.
An acute hemolytic transfusion reaction caused by an anti‐P1 that reacted at 37°C
Authors: Arndt P. A. , Garratty G. , Marfoe R. A. , Zeger G. D.
Published: March 2003

BACKGROUND: Hemolytic transfusion reactions (HTRs) due to anti‐P1 have rarely been reported. There is only one report (from 1945) of an acute HTR due to anti‐P1.

CASE REPORT: A 74‐year‐old woman with anti‐P1 was given blood that had been found to be compatible by the use of prewarmed serum and saline‐suspended red cells (RBCs) and of an antiglobulin test with anti‐IgG. The test mixtures were not centrifuged or inspected for agglutination after the 37°C incubation phase. After transfusion of 50 mL of P1 + blood, the patient had an acute HTR (hemoglobinemia, hemoglobinuria, and increased blood pressure, temperature, and respiration).

RESULTS: When studied by a reference laboratory, the anti‐P1 was shown to be easily detectable (3+ agglutination) by a prewarming technique (saline or low‐ionic‐strength saline [LISS]), which included centrifugation at 37°C, but only weak reactions were observed when centrifugation after 37°C incubation was omitted. The indirect antiglobulin test was weakly positive (1+) with anti‐IgG, but polyspecific anti‐human globulin reacted 2+. The anti‐P1 agglutinin was IgM, and its titer was 16 at 37°C (prewarmed) and 256 at 23°C; it caused hemolysis of RBCs at 37°C under conditions known to enhance hemolysis. An indirect monocyte monolayer assay gave results of 11.2 and 22 percent in testing of P1 + RBCs incubated with the patient's serum alone and with patient's serum plus fresh normal serum (as a source of complement), respectively (normal ≤3%).

CONCLUSION: An acute HTR was caused by a hemolytic anti‐P1 that reacted at 37°C. This antibody was not detected by the hospital in a prewarmed crossmatch that omitted 1) the addition of LISS, 2) the reading for agglutination after the 37°C incubation, and 3) the use of antiglobulin sera containing anti‐complement.
Hepatitis C virus and GB virus C/hepatitis G virus viremia in Swedish blood donors with different alanine aminotransferase levels
Authors: Björkman P. , Sundström G. , Widell A.
Published: March 2003

BACKGROUND: Hepatitis C virus (HCV) is a known blood‐borne hepatotropic virus for which antibody screening of blood donors is universally practiced. The newly identified GB virus C (GBV‐C) and its strain variant hepatitis G virus (HGV) are of unknown pathogenic significance, and screening of blood donors for this agent has not yet been implemented. Polymerase chain reaction (PCR) is the most sensitive method for detecting HCV viremia and is the only method presently available for the diagnosis of GBV‐C/HGV infection.

STUDY DESIGN AND METHODS: RNA extracts of sera from 577 anti‐HCV‐negative blood donors (393 with elevated alanine aminotransferase [ALT] levels, 184 with normal ALT levels) were tested with nested PCR for HCV and GBV‐C/HGV directed at the 5′‐noncoding regions of the two viruses.

RESULTS: One donor with elevated ALT was HCV PCR positive. This donor was anti‐HCV negative when recruited to the study but subsequently developed anti‐ HCV. Of the 19 donors with GBV‐C/HGV viremia in the series as a whole, 16 belonged to the group with elevated ALT levels and 3 to the group with normal ALT levels; the group difference in prevalence was nonsignificant (4.1% [16/393] vs. 1.6% [3/184; p = 0.20]). Phylogenetic analysis showed 16 of the GBV‐C/HGV isolates to be classifiable as subtype 2a and three as subtype 2b. At follow‐up 3 to 5 years later, 11 of 18 donors were still viremic.

CONCLUSION: There was no significant difference in GBV‐C/HGV viremia in the group with elevated ALT levels and the group with normal ALT levels. The frequency and subtype distribution in the present series were similar to those in other Western countries.
Neutrophil transfusions: kinetics and functions of neutrophils mobilized with granulocyte‐colony‐stimulating factor and dexamethasone
Authors: Dale D.C. , Liles W.C. , Llewellyn C. , Rodger E. , Price T.H.
Published: March 2003

BACKGROUND: The collection of adequate numbers of neutrophils (polymorphonuclear leukocytes, PMNs) from normal donors has long hampered the development of neutrophil transfusion therapy. The stimulation of donors with granulocyte‐colony‐stimulating factor (G‐ CSF) plus dexamethasone is a promising way of improving PMN collections.

STUDY DESIGN AND METHODS:Sixteen normal subjects received G‐CSF (600 micrograms subcutaneously) and dexamethasone (8 mg by mouth) 12 hours before leukapheresis. Measurements included PMN morphology, immunophenotype analysis, chemiluminescence, bactericidal activity, in vivo kinetics, and adverse effects.

RESULTS:A mean of 77.4 +/− 6.4 × 10(9) PMNs was collected with each leukapheresis; 14 percent were bands. PMNs had increased surface expression of CD11b, CD18, CD14, CD32, and CD64. Bactericidal capacity against Staphylococcus aureus was normal. Inducible respiratory burst was maintained, although the responses to some agonists were diminished. Returned leukapheresis cells labeled with 3H‐diisopropylfluorophosphate had a modestly decreased percentage of recovery and circulated with a prolonged half‐ life. Migration of these cells to skin chambers was approximately equal to that of the subjects' own blood PMNs. Adverse effects included transient bone pain, headache, hunger, and insomnia.

CONCLUSIONS:Precollection treatment of leukapheresis donors with G‐CSF plus dexamethasone is an effective way to enhance the collection of PMNs with normal or near‐normal functional properties for PMN transfusion therapy.
Photodynamic sterilization of red cells and its effect on contaminating white cells: viability and mechanism of cell death
Authors: Moor A.C.E. , Van Der Veen A. , Dubbelman T.M.A.R. , VanSteveninck J. , Brand A.
Published: March 2003

BACKGROUND: Phthalocyanines are useful sensitizers for photodynamic sterilization of red cell concentrates. Various lipid‐enveloped viruses can be inactivated with only limited red cell damage. Because white cells are involved in the immunomodulatory effects of blood transfusions, the study of the effect of photodynamic treatment on these cells is imperative.

STUDY DESIGN AND METHODS: White cell‐enriched red cell suspensions were photodynamically treated with either the hydrophobic Pc4 (HOSiPcOSi‐(CH3)2(CH2)3N(CH3)2) or water‐soluble aluminum phthalocyanine tetrasulfonate (AlPCS4) under virucidal conditions. Viability of white cell subpopulations on Days 0, 1, and 4 after treatment was determined by fluorescence‐activated cell sorting by flow cytometric analysis of propidium iodide uptake. Apoptosis induction was studied by DNA ladder formation and staining for an early marker of apoptosis (annexin V).

RESULTS: Treatment with Pc4 causes a significant decrease in cell viability of all white cells, as shown by prodidium iodide uptake. Monocytes and granulocytes are the most sensitive, and lymphocytes are relatively more resistant. Some of the cells die by apoptosis, which is induced within 30 minutes after treatment. Treatment with AlPCS4 damages only monocytes; other cell populations are not affected.

CONCLUSIONS: Physicochemical properties of the photosensitizers partly determine their effect on white cells. Differences in intracellular localization are likely to be responsible for the effects observed.
Clinical consequences of alterations in platelet transfusion dose: a prospective, randomized, double‐blind trial
Authors: Klumpp T.R. , Herman J.H. , Gaughan J.P. , Russo R.R. , Christman R.A. , Goldberg S.L. , Ackerman S.J. , Bleecker G.C. , Mangan K.F.
Published: March 2003

BACKGROUND: The dose‐response relationship for platelet transfusion has become increasingly important as the use of platelet transfusion has grown.

STUDY DESIGN AND METHODS: One hundred fifty‐eight prophylactic apheresis platelet transfusions were administered to 46 patients undergoing high‐dose therapy followed by hematopoietic progenitor cell transplantation in a prospective, randomized, double‐blind, multiple‐crossover study. Transfusions were administered in pairs, differing only in platelet content. Each pair consisted of a lower‐dose platelet component (LDP) and a higher‐dose platelet component (HDP) administered in random order to the same patient. LDPs contained a mean of 3.1 × 1011 platelets (range, 2.3‐3.5 × 1011), and HDPs contained a mean of 5.0 × 1011 platelets (range, 4.5‐6.1 × 1011). Patients with active bleeding and those who were refractory to platelet transfusions were excluded.

RESULTS: The mean posttransfusion platelet count increment with LDP was 17,010 per μL, and that with HDP was 31,057 per μL (p<0.0001). Only 37 percent of LDPs resulted in platelet count increments of at least 20,000 per μL, whereas 81 percent of HDPs resulted in increments above this level (p<0.0001). The mean transfusion‐free interval with LDP was 2.16 days, whereas that with HDP was 3.03 days (p<0.01). Administration of LDPs was associated with a 39 to 82 percent increase in the relative risk (per day) of requiring subsequent platelet transfusions (p<0.0001).

CONCLUSION: As compared to the administration of HDPs, the administration of LDPs for prophylactic transfusion in hematopoietic progenitor cell transplant patients results in a lower platelet count increment, a lower likelihood of obtaining a posttransfusion platelet increment >20,000 per μL, a shorter transfusion‐free interval, and a greater relative risk per day of requiring additional transfusions.
Cost‐effectiveness of a limited‐donorblood program for neonatal red cell transfusions
Authors: Hilsenrath P. , Nemechek J. , Widness J.A. , Cordle D.G. , Strauss R.G.
Published: March 2003

BACKGROUND: Very‐low‐birthweight infants have typically been given fresh red cells (RBCs), a practice in which aliquots of RBCs for several infants were issued each day from a single unit. Recently, to limit donor exposures, large volumes of RBCs are reserved for the long‐term transfusion support of individual infants.

STUDY DESIGN AND METHODS: Medical records were examined retrospectively to assess the costs of a limited‐donor program for providing RBC transfusions to very‐low‐birthweight infants. Costs of multiple‐ and limited‐donor programs were compared by using two samples of 30 consecutive infants treated at The University of Iowa Hospitals and Clinics in 1993 and 1997. Effectiveness was evaluated with respect to the number of donor exposures per infant.

RESULTS: The cost, in 1997 dollars, of preparing each small‐volume transfusion in the multiple‐donor program was $27.86 per transfusion, while that in the limited‐donor program was $34.83. This difference was largely attributable to use of white cell reduction in association with the limited‐donor program in 1997. Eliminating the costs associated with white cell reduction rendered the costs of the limited‐ and multiple‐donor transfusions comparable. The limited‐donor program had donor exposures of 2.0 per infant, while the multiple‐donor program had 3.6 exposures per infant (p<0.002).

CONCLUSION: The limited‐donor blood program reduces donor exposure without adversely affecting costs.
Hepatitis C virus genotypes in hemophiliacs in the state of Minas Gerais, Brazil
Authors: Oliveira G.C. , Carmo R.A. , Rocha M.O.C. , Silva M.O. , Lima A.T. , Guimarães M.D.C. , Corrêa‐Oliveira R.
Published: March 2003

BACKGROUND: Hepatitis C virus (HCV) is a positive‐strand RNA virus composed of at least 10 genotypes and dozens of subtypes. Six major genotypes can be distinguished by restriction fragment length polymorphism (RFLP) analysis of the amplified 5′ noncoding region (NCR) of the genome. The genotypes are unequally distributed throughout the world. Types 1 and 3 are most common in Europe and the United States. Although fewer studies have been performed in Brazil, the pattern seems to mirror that in the other areas. HCV infection is highly prevalent among hemophiliacs and is a major cause of chronic liver disease.

STUDY DESIGN AND METHODS: This study investigated a sample of the hemophiliac population in the state of Minas Gerais, Brazil, by RFLP analysis of the 5′ NCR.

RESULTS: It was observed that 84.1 percent were of genotype 1 and 13.6 percent of genotype 3. Sequence analysis of nine isolates confirmed the RFLP results and determined that all of the type 1 isolates belonged to subtype 1a. Phylogenetic analysis by parsimony and distance revealed that lineages of genotypes 1, 2, and 3, and 4 could be separated. The isolates of type 3 from this study were distinct from published sequences, which possibly indicated their different geographical origin.

CONCLUSION: Although the frequency of genotypes observed (types 1 and 3) among hemophiliacs in the state of Minas Gerais was higher than that in the southern part of the country, these frequencies were not different from those in other groups of patients in Brazil and other countries studied. Further investigation is needed of the evidence that the type 3 isolates observed in these studies are significantly different from other isolates previously characterized by sequence analysis.
Evaluation of methods for detecting alloantibodies underlying warm autoantibodies
Authors: Leger Regina M. , Garratty George
Published: March 2003

BACKGROUND: In pretransfusion testing of patients whose sera contain autoantibodies reacting optimally at 37°C, it must be determined whether alloantibodies are also present. Two approaches, testing a 1 ‐in‐5 dilution of patients' sera and the adsorption of sera in the presence of polyethylene glycol (PEG), have been proposed as alternatives to the time‐consuming approach of adsorbing sera with ficin‐ or ZZAP‐treated red cells (RBCs). The three approaches were compared.

STUDY DESIGN AND METHODS: Patients' sera containing warm autoantibodies, with and without alloantibodies, were retested 1) after dilution (1‐in‐5) and 2) after adsorption with allogeneic RBCs in the presence of PEG. Results were compared to those after adsorption with ZZAP‐treated allogeneic RBCs.

RESULTS: Dilution (1‐in‐5): Twenty‐seven of 119 sera (7/26 [27%] with and 20/93 [22%] without alloantibodies) did not react; one example each of alloanti‐D, ‐E, ‐e, ‐Fya, and ‐Jka, and two examples of anti‐Jkb were not detected at a dilution of 1 in 5. Alloantibodies were identified in 5 (19%) of 26 1‐in‐5 diluted sera containing alloantibodies; 87 (73%) of 119 sera still reacted with all cells and would have required further workup. PEG adsorption: Thirty‐nine sera were tested after parallel PEG and ZZAP adsorptions. The PEG adsorptions required a total of 55 aliquots of adsorbing cells and 13.75 hours, whereas ZZAP adsorptions required 61 aliquots and 30.5 hours. All alloantibodies (anti‐D [3], ‐C [2], ‐c [1], ‐E [4], ‐K [2], ‐Fya [1], ‐Jka[2], ‐Jkb[1]) reacted in the adsorbed serum‐PEG mixtures at a strength equal to or greater than that in the ZZAP‐adsorbed sera.

CONCLUSION: Although the 1‐in‐5 dilution approach is convenient, only 22 percent of warm autoantibodies without alloantibodies were nonreactive, and 27 percent of alloantibodies of potential clinical significance were not detected. PEG adsorption appears to give similar results to those of ZZAP adsorption, but it has the advantages of eliminating the cost and time of prior treatment of the allogeneic adsorbing cells and of a reduction of at least a 50 percent in adsorption time.
Mobilization of blood‐derived stem and progenitor cells in normal subjects by granulocyte‐macrophage‐ and granulocyte‐colony‐stimulating factors
Authors: Lane Thomas A. , Ho Anthony D. , Bashey Asad , Peterson Sandra , Young Dennis , Law Ping
Published: March 2003

BACKGROUND: It was previously reported that the combination of granulocyte‐macrophage‐colony‐stimulating factor (GM–CSF) and granulocyte‐CSF (G–CSF) for 4 days mobilized more primitive CD34+ subsets than did either G–CSF or GM–CSF alone.

STUDY DESIGN AND METHODS: The studies determine the optimal number of days of growth factor dosing for mobilization and collection of peripheral blood progenitor cells, by increasing the days of administration of GM–CSF and/or G–CSF or employing the sequential administration of GM–CSF followed by G–CSF. Sixty normal subjects were given injections of G–CSF or GM–CSF alone; GM–CSF and G–CSF concurrently for 4, 5, or 6 days; or a sequential regimen of GM–CSF for 3 or 4 days followed by G–CSF for 2 or 3 days. A 10‐L apheresis was performed 24 hours after the last dose.

RESULTS: The three most efficacious mobilization regimens consisted of sequential GM–CSF for 3 days followed by G–CSF for either 2 or 3 days and G–CSF alone for 5 days. Each of these regimens resulted in the collection of significantly greater numbers of CD34+ cells by apheresis than any of the 4‐day dosing regimens with G–CSF and/or GM–CSF (sequential GM–CSF/G–CSF: 3 days/2 days = 3.58 ± 0.53 × 106 CD34+ cells/kg; GM–CSF/G–CSF: 3 days/3 days = 4.45 ± 1.08 × 106 CD34+ cells/kg; G–CSF: 5 days = 3.58 ± 0.97 × 106 CD34+ cells/kg; all p < 0.05 vs. G–CSF and/or GM–CSF for 4 days). Clonogenic assays generally paralleled the level of CD34+ cells. Regimens containing GM–CSF resulted in a higher percentage of the cells from primitive CD34+/CD38–/HLA‐DR+ subset than G–CSF alone.

CONCLUSION: Compared with 4‐day dosing regimens with G–CSF and/or GM–CSF, mobilization of CD34+ cells in normal subjects using sequential GM–CSF for 3 days followed by G–CSF for 2 or 3 days or using G–CSF alone for 5 days increased the number CD34+ cells that can be collected by a single 10‐L apheresis 24 hours after the last dose of cytokine.
Viability and in vitro properties of AS‐1 red cells after gamma irradiation
Authors: Moroff Gary , Holme Stein , AuBuchon James P. , Heaton W. Andrew , Sweeney Joseph D. , Friedman Leonard I.
Published: March 2003

BACKGROUND: Irradiation has been shown to adversely affect both in vivo 24‐hour recovery (recovery [%]) and in vitro properties of stored red cells (RBCs). There is uncertainty as to how these changes are related to the day of irradiation and the length of storage after irradiation.

STUDY DESIGN AND METHODS: Four protocols used day of irradiation and storage time after irradiation as the independent variables. At the conclusion of the storage period, viability was measured with radiolabeled RBCs as the recovery and the long‐term survival time for RBCs that were circulating beyond 24 hours. In addition, in vitro values including RBC ATP, hemolysis level, and supernatant potassium were measured. Each subject donated 2 units of whole blood (CPD) and received autologous irradiated and untreated control RBCs (AS‐1) on two separate occasions.

RESULTS: Reduced recovery in irradiated units was noted when compared to that in control units, and the reduction was most apparent with long periods of storage after irradiation, irrespective of the day of irradiation. With irradiation on Day 1 of storage and a total storage period of 28 days, mean ± SD recovery (single label) was 84.2 ± 5.1 percent for control RBCs and 78.6 ± 5.9 percent for irradiated RBCs (n=16; p<0.01). With irradiation on Day 14 and storage through Day 42, the recoveries were 76.3 ± 7.0 percent for control RBCs and 69.5 ± 8.6 percent for irradiated RBCs (n = 16; p<0.01). Less reduction in recovery was observed with shortening of the posrtrradiation storage time. When the total storage period was reduced to 28 days after Day 14 irradiation, the recoveries were not significantly different. With an additional 2‐day storage period after irradiation on Day 26, the recoveries were also comparable. Long‐term survival times for control and irradiated RBCs were not significantly different in any of the four protocols. RBC ATP levels and hemolysis were minimally, but significantly influenced by irradiation. Supernatant potassium levels, however, were substantially increased after irradiation in each of the four protocols.

CONCLUSION: Irradiation has only a small effect on the properties of RBCs treated and stored according to the utilized protocols. Longer storage times after irradiation resulted in progressively reduced recovery while long‐term survival remained unaffected.