bluuebunny/crossref_metadata_2025 huggingface dataset:
Current status of hemapheresis in the United States
Authors: Strauss Ronald G.
Published: February 2007

The face of automated hemapheresis in the United States is changing. No longer is it appropriate to view hemapheresis primarily in terms of therapeutic plasma exchange. For many centers, the bulk of day‐to‐day activities revolves around donor cytapheresis to satisfy the ever‐increasing need for units of platelet concentrates. Indications of therapeutic plasma exchange are becoming better focused, with neurological patients being among those most frequently managed. New and innovative applications of automated hemapheresis technology will continue to be developed. Current examples include the production of lymphocyte‐activated leukocytes for cancer therapy, use of extracorporeal photoactivation of leukocytes for immune modulation, and the collection of hematopoietic progenitors from peripheral blood for autologous transplantation. As we enter the 1990s, it is important to be aware of new technology and applications and to have the vision to apply them in innovative ways. However, it is also critical to demand rigorous scientific review before broadly adopting any new idea as a standard of practice.
Peripheral blood mononuclear cell collection from patients undergoing adoptive immunotherapy or peripheral blood‐derived stem cell transplantation and from healthy donors
Authors: Keilholz Ulrich , Klein Harvey G. , Körbling Martin , Brado Bernadett , Carter Charles S. , Cullis Herb , Galm Frank , Hunstein Werner
Published: February 2007

The demand for collection of mononuclear cells from the peripheral blood of patients for therapeutic purposes is rapidly increasing. Automated blood cell separators are usually designed for collection of blood components from healthy donors. We reviewed safety and efficiency of collection data of a new procedure for the Fenwal CS 3000 blood cell separator in 125 collections from normal donors and 101 collections from patients after IL‐2 pretreatment or chemotherapy. The new procedure set red blood cell spillovers to occur at 3.5 minute intervals, using procedure 1 with the interface detector set at 1,000 and the standard granulocyte and collection chambers.

Despite significant anemia and thrombocytopenia in a large number of patients no serious procedure‐related side effects occurred. The lymphocyte yield was 4.74 ± 1.6 × 109 per 5 liters of blood processed in normal donors and 24.2 ± 12.0 × 109 per 10 liters of blood processed after IL‐2 treatment. After chemotherapy the lymphocyte yield was 4.5 ± 3.1 × 109 per 10 liters of blood processed; the collection efficiency was found to be significantly lower in this group. The main problem was the platelet loss of 35.6 ± 12% of the initial count in normal donors, 40.3 ± 14.1% after IL‐2 treatment, and 42.1 ± 18.0% after chemotherapy. The platelet loss is, however, closely related to the preapheresis platelet count; patients with thrombocytopenia lose fewer platelets than normal donors. Therefore the procedure was found to be safe for patients with a platelet count as low as 20/nl.
Cyclosporin‐induced hypertriglyceridemia with prompt response to plasma exchange therapy
Authors: Valbonesi M. , Occhini D. , Frisoni R. , Malfanti L. , Capra C. , Gualandi F.
Published: February 2007

A case of severe cyclosporin‐induced hypertriglyceridemia that prompted plasma exchange therapy is reported. Hyperlipemic retinitis, headache, stupor, and peripheral paresthesias became apparent when the level of triglycerides exceeded the 1,500 mg/dL level. Two plasma exchanges were required to halt disease progression. This is the second time that plasma exchange was used in a bone marrow transplanted patient on cyclosporin‐A therapy. In both cases hypertriglyceridemia became apparent and symptomatic after approximately 7 months of therapy with cyclosporin.
Management of sickle cell anemia and pregnancy
Authors: Koshy Mabel , Chisum Darren , Burd Laurence , Orlina Armando , How Helen
Published: February 2007

There has been significant decrease in maternal morbidity and mortality of sickle cell disease patients during pregnancy due to better understanding of the pathophysiology of the disease and physiologic changes during pregnancy.

Prophylactic blood transfusion does not appear to reduce complications in patients with sickle cell anemia. Patients with sickle hemoglobin C disease and with Sβ thalassemia+ have fewer complications but still need close monitoring.

Blood transfusion therapy should be made available for medical and obstetrical complications to include increasing hypoxemia, progressive anemia, acut chest syndrome, twin pregnancy, splenic sequestration syndrome, preeclampsia, septicemia, or prior to general anesthesia and surgery. Blood transfusion therapy is associated with hepatitis, allergic reaction, alloimmunization, AIDS, and iron overload states. These aspects should be considered prior to using blood transfusion therapy.

Excellent prenatal monitoring and aggressive intervention should be instituted when problems arise for the successful management of the pregnant patient with sickle cell disease. Prenatal diagnosis and cord blood screening should be made available for the infant. Appropriate pediatric referral and prophylactic penicillin is recommended for the infant with sickle cell disease.
Ten years experience with therapeutic apheresis in a community hospital
Authors: Kornfeld Peter , Fox Sondra , Maier Karen , Mahjoub Mazen
Published: February 2007

A retrospective study was carried out on 2,500 therapeutic hemapheresis procedures performed at a community teaching hospital from 1980 to 1990. Seventy‐six percent of the procedures consisted of plasmapheresis (PE). The most frequently treated conditions were myasthenia gravis (MG), Guillain‐Barré syndrome (GB), hyperviscosity (HV), and thrombotic thrombocytopenia purpura (TTP). Therapeutic results and clinical implications for these four conditions are discussed. © 1992 Wiley‐Liss, Inc.
An unexpected complication following immunoadsorption with a staphylococcal protein a column
Authors: Huestis Douglas W. , Rifkin Robert M. , Durie Brian G. M. , Sibley William A. , Irani Mehraboon
Published: February 2007

Extracorporeal immune adsorption with staphylococcal protein A (SPA) columns can remove immune complexes and immunoglobulins in the treatment of a variety of diseases. We present the case of an elderly man with neuropathy associated with monoclonal gammopathy, treated by 3 on‐line SPA procedures. At the completion of these treatments his neuropathy relapsed, progressing to near‐total paralysis. Return to a baseline clinical status required several months. The reason for this severe relapse is not clear. Possible explanations include SPA activation of T‐lymphocytes, with release of gamma interferon and increased antigen recognition, or removal of an anti‐idiotype control mechanism. We advise caution in the application of immunoadsorption to conditions in which it has not yet been evaluated. © 1992 Wiley‐Liss, Inc.
Backwashing procedure for on‐line reuse of a plasma fractionator in cryofiltration
Authors: Sawada Koji , Ohshima Tadashi , Zborowski Maciej , Malchesky Paul S. , Koo Anna P. , Skibinski Christine I.
Published: February 2007

During membrane plasma fractionation therapy there are reported incidences of membrane plugging requiring the corrective actions of either filter replacement or backwashing (BW) in order to continue the treatment. In this preliminary study, a simple BW procedure to allow for on‐line reuse of the filter (Asahi AP06M) during the treatment was evaluated to assess its efficacy and safety in cryofiltration (CF).

Evaluations were carried out on two patients treated for rheumatoid arthritis. Seven tests, each using 1 L or 2 L warmed saline as a BW solution were performed to evaluate the decrease of the transmembrane pressure (TMP) between just before and after backwashing and TMP change during cryofiltration procedures between before and after backwashing. Sieving coefficients of total protein, albumin, immunoglobulins (G, M, A), fibrinogen, and rheumatoid factor were also calculated at 1,000 ml plasma volume processed.

Results showed statistically significant decreases of TMP from 300 mm Hg to 70 mm Hg between just before and after both backwashing procedures, and that there were no significant changes in the TMP increase during the cryofiltration procedure between pre‐ and post‐BW. The protein sievings were not significantly affected by BW. The use of a second liter for rinsing did not reduce the inlet pressure further suggesting that 1 L BW was adequate. The accumulated solutes did not affect significantly the effective mean pore size. The BW procedure did not affect the overall patient safety during therapy.

In conclusion, this simple BW procedure using 1 L of normal saline and accomplished in approximately 11 minutes by a manual procedure proved reliable to rinse the filter and to prolong its clinical use. This procedure obviated the need for filter replacement.
Specificity of antibody responses affected by extracorporeal immunoadsorption of plasma over columns of protein A silica
Authors: Snyder Harry W. , Seawell Betty W. , Cochran Sharon K. , Balint Joseph P. , Jones Frank R.
Published: February 2007

A relationship is described between the interaction of circulating immune complexes (CIC) from plasma with staphylococcal protein A immunoadsorption treatment columns and modulation of antibody responses related to the specific CIC. Eluates from the initial immunoadsorption columns used to treat a series of patients with breast adenocarcinoma, cancer chemotherapy‐associated thrombotic thrombocytopenic purpura/hemolytic uremic syndrome (C‐TTP/HUS), or immune thrombocytopenic purpura (ITP) were evaluated for disease‐specific CIC containing Lex glycosphingolipid (Lex gl) adenocarcinoma‐associated antigens or platelet autoantibody (anti‐GPIIb/IIIa), together with the corresponding neutralizing antibody [anti‐F(ab′)2], and for nonspecific CIC containing cytomegalovirus (CMV) or herpes simplex virus type 1 (HSV‐1) antigens. In addition, the levels of antibodies directed against CMV, HSV‐1. Lex gl, and GPIIb/IIIa antigens, as well as anti‐F(ab′)2 antibodies, were compared in pretreatment and posttreatment serum samples.

Columns used to treat breast adenocarcinoma patients contained only Lex gl CIC, and the only immunologic change observed after treatment was significant increases in anti‐Lex gl antibodies in some patients. Columns used to treat C‐TTP/HUS patients contained anti‐GPIIb/IIIa‐anti‐F(ab′)2 CIC, in addition to Lex gl CIC. After treatment, significant increases in anti‐Lex gl and anti‐F(ab′)2 antibodies and significant decreases in anti‐GPIIb/IIIa antibodies were observed in some patients. Columns used to treat ITP patients only exhibited anti‐GPIIb/IIIa‐anti‐F(ab′)2 CIC, and after treatment only decreases in anti‐GPIIb/IIIa and increases in anti‐F(ab′)2 antibodies were observed in some patients. None of the treatment columns exhibited CIC with CMV or HSV‐1 antigens, and no effects on pretreatment levels of anti‐CMV or anti‐HSV‐1 antibodies were observed in any patients posttreatment. Immunologic responses were correlated closely with clinical responses in each group of patients. The study showed that neither stimulation nor depression of antibody responses occurred in the absence of an interaction of corresponding specific CIC with the matrix. The results suggest that nonspecific stimulation of a variety of antibody responses is not the usual mechanism by which clinical responses to protein A immunoadsorption treatment are obtained. © 1992 Wiley‐Liss, Inc.
Analysis of venous access for therapeutic plasma exchange in patients with neurological disease
Authors: Grishaber J. E. , Cunningham M. C. , Rohret P. A. , Strauss R. G.
Published: February 2007

We retrospectively analyzed our 2‐year experience with venous access for 363 therapeutic plasma exchanges in 46 patients with neurological disease, including acute Guillain‐Barré syndrome (N = 20), myasthenia gravis (N = 17), and chronic inflammatory demyelinating polyneuropathy (N = 9). Twenty‐three patients (50%) completed the planned course of therapy using only peripheral venous access, and 28 central venous catheters were placed in the remaining 23 patients. Patients utilizing central venous access did not undergo a greater number of procedures, but they were more likely to have acute Guillain‐Barré syndrome (P < 0.02) or to be hospitalized in a medical intensive care unit (P < 0.01). Three types of central catheters were used, and although our experience was predominantly with 1 type, differences were noted. Only 3% of procedures (3 of 96) done with a Quinton‐Mahurkar catheter were associated with a catheter failure, compared to 27% (4 of 15, P < 0.01) with a Hickman catheter and 67% (2 of 3) with a triple‐lumen catheter. Life‐threatening complications occurred with 3 of 28 (11%) central catheters. To optimize the success of therapeutic plasma exchange using central access, it is critical that hemapheresis personnel advise each patient's primary physician regarding the type of central venous catheter required. Currently, we recommend use of a Quinton‐Mahurkar or other dual‐lumen hemodialysis catheter. © 1992 Wiley‐Liss, Inc.
Role of plasmapheresis in acute disseminated (postinfectious) encephalomyelitis
Authors: Stricker Raphael B. , Miller Robert G. , Kiprov Dobri D.
Published: February 2007

Acute disseminated encephalomyelitis (ADEM) is a demyelinating central nervous system disease that is associated with high morbidity and mortality. Although the recognition of ADEM may be facilitated by newer imaging techniques, the optimal treatment of this disease remains uncertain. We describe 4 patients with severe ADEM who responded to treatment that included intensive plasmapheresis. Two of the patients were in coma at the time that plasmapheresis was instituted, and all 4 patients made an excellent recovery. Immunologic studies revealed increased serum IgA levels, increased circulating immune complex levels as measured by the Raji cell assay, and decreased numbers of T and B cells prior to treatment of ADEM. These abnormalities improved following plasma exchange. Plasmapheresis appears to be effective in reversing the neuropathologic process in ADEM. The role of this treatment modality in ADEM requires further evaluation in controlled clinical trials. © 1992 Wiley‐Liss, Inc.
Subacute (acute, persistent) thrombotic microangiopathy
Authors: Taft Edwin G. , Carver Bala B.
Published: February 2007

Six patients with prolonged acute courses of thrombotic microangiopathy are reviewed. These patients had in common courses of acute disease requiring plasma support for more than 3 months, with subsequent complete remission. Plasma support requirements may be prodigious, and the acute course may require more than 100 plasma exchanges before a stable remission is achieved. These patients appear to represent a subset of thrombotic microangiopathy distinct from the more common acute T.T.P. course, which resolves in 3–6 weeks, and the chronic relapsing pattern, which may have a short or prolonged acute course. © 1992 Wiley‐Liss, Inc.
Therapeutic cytoreduction in a 7‐month‐old baby with acute leukemia
Authors: Huestis Douglas W. , Hutter John J. , James Peggy
Published: February 2007

A 7‐month‐old girl with acute biphenotypic leukemia [t(4;11)] had accompanying anemia, thrombocytopenia, and a white blood cell count of 535,000/μL with 98% blasts. Before instituting chemotherapy, therapeutic leukapheresis was done to reduce the threat of complications from leukostasis. Using a Cobe Spectra blood cell separator primed with modified blood, we processed 1,395 mL of her blood, removing 201 mL of the buffy coat containing 5.8 × 1010 white blood cells. This reduced the WBC count to 301,000/μL. Only a single procedure was done, without significant complications. The rationale of this preparatory cytoreduction is discussed critically. Subsequent chemotherapy resulted in a long‐lasting remission. © 1992 Wiley‐Liss, Inc.
Peripheral blood stem cell transplantation: Impact on procedure load and workload in an apheresis unit
Authors: Ghalie Richard , McLeod Bruce , Richman Carol , Valentino Leonard , Manson Sharon , Netols Carol , Kaizer Herbert
Published: February 2007

Peripheral blood stem cells (PBSC) reinfusion appears to hasten hematologic reconstitution following myeloablative therapy. While procurement of PBSC adds apheresis procedures, rapid engraftment could decrease the demand for platelet transfusions. To determine the impact of PBSC collection on workload in our apheresis unit, we studied 3 consecutive groups of patients with metastatic breast cancer given comparable high‐dose chemotherapy and autologous bone marrow transplant, with or without PBSC or granulocyte‐colony stimulating factor (G‐CSF). Forty‐one transplants were performed with bone marrow cells only: 31 patients (Group A) did not receive G‐CSF, while the following 10 patients (group B) received daily G‐CSF until neutrophil engraftment. Bone marrow cells and PBSC were used for the most recent 11 transplants (group C), followed by daily G‐CSF until engraftment. PBSC were mobilized with cyclophosphamide (4 g/m2) and etoposide (1 g/m2), followed by G‐CSF, 8 μg/kg/day. PBSC collection was carried out on a Fenwal CS3000 + cell collector, using modified procedure 1, to obtain a minimum of 5 × 108 mononuclear cells/kg. The times to neutrophil count over 500/μL, platelet count over 20,000/μL, and discharge from the hospital after transplant were significantly shorter for patients in group C (medians of 8, 8, and 21 days, respectively) compared to group A (medians of 14, 14, and 29 days; P = 0.001) or group B (medians of 11, 24, and 32 days; P < 0.001). The number of single‐donor platelet equivalents transfused (1 SDE = 1 unit of single‐donor platelets or 8 pooled random‐donor platelets) was significantly decreased in group C (median = 4) compared to group A (median = 19) and group B (median = 11; P = 0.001 for both comparisons). The total apheresis procedure load (the sum of SDE and PBSC collection for each transplant) was significantly decreased in group C (median = 6) compared to groups A and B combined (median = 14; P = 0.001). The apheresis unit workload assessing apheresis durations per patient, calculated as 2 × SDE + 4 × PBSC, was also significantly reduced in group C (median = 16) compared to groups A and B (median = 28; P = 0.002). Thus, PBSC were advantageous in terms of faster engraftment, reduced platelet transfusions, and shorter hospitalization, while decreasing both procedure load and net workload per patient in the apheresis unit. © 1992 Wiley‐Liss, Inc.
Comparative bioavailability of ferric polymaltose and ferrous sulphate in iron‐deficient blood donors
Authors: Jacobs Peter , Fransman Debbie , Coghlan Patrick
Published: February 2007

Absolute iron deficiency is treated by correcting the causative lesion and then, traditionally, administering sufficient amounts of ferrous salt to return the haemoglobin level to normal and replenish body stores. The bioavailability of ferric compounds has been questioned and accordingly their therapeutic role remains controversial. A special problem is posed by regular blood donation, where the frequency of phlebotomy is limited by the haemoglobin level, which, in turn, requires maintenance of an adequate supply of iron from dietary sources. Since this latter situation may not always occur, it would be of practical benefit to have a form of supplementation that is effective and can be taken without side effects. These issues were prospectively examined in a consecutive series of otherwise healthy blood donors who developed absolute iron deficiency anaemia and were then randomly allocated to receive 60 mg of this metal as ferrous sulphate twice a day (Group 1: n = 51), 100 mg as chewable ferric polymaltose daily (Group 2: n = 53), or the latter product twice a day (Group 3: n = 55). Serial studies showed that 80% of patients in Groups 1 and 3 had reached normal haemoglobin levels by 12 weeks, but this figure was only 50% in Group 2. Similarly, the proportion of patients improving their percentage saturation of transferrin to within the normal range was significantly better in Groups 1 and 3 than in Group 2 (P < .01). However, body iron stores, reflected in serum ferritin level, was significantly better in Group 1 (P < .01); there was no difference in this respect between Groups 2 and 3. Toxicity was more severe in those receiving ferrous sulphate, with 20% having to discontinue participation owing to nausea and vomiting, whereas this was mild in those receiving ferric polymaltose and none withdrew from the trial for this reason. It can be concluded that the two forms of iron are equally bioavailable for hemoglobin regeneration, but at 12 weeks of study ferrous sulphate was superior in reconstituting stores, as reflected in the serum ferritin level. Since the ferric iron complex is associated with only minimal side effects, it may be useful in selected populations and, in the context of blood donors, valuable as a means of maintaining positive balance, thereby diminishing the number of donors rejected because of their having developed phlebotomy‐iron deficiency anaemia. © 1993 Wiley‐Liss, Inc.
Safety of the blood supply
Authors: Perkins Herbert A.
Published: February 2007

This is a review of events when the medical community realized that AIDS was an infectious disease which might be transmitted by blood transfusions and the response by the various organizations and agencies to curb the potential spread of HIV via blood products. It became possible through a number of approaches to make the blood supply safe so that today the likelihood of transmission of HIV by blood transfusion is extremely unlikely. © 1993 Wiley‐Liss, Inc.
Infection of hemophiliacs with HIV
Authors: Aronson David L.
Published: February 2007

HIV was introduced into the blood supply at least 4 years before there was any clinical illness in hemophiliacs. While viral removal and inactivation techniques of plasma products have improved, contamination with a very stable virus is still a possibility. © 1993 Wiley‐Liss, Inc.
HIV inactivation in plasma products
Authors: Mozen Milton M.
Published: February 2007

This is a review of therapeutic plasma products viz., coagulation factor concentrates, immunoglobulins, volume expanders, and protease inhibitors, and the progress made in rendering them free from transmitting infectious virus. Problems associated with the development of plasma products and the risks associated with their use are addressed. The recent technical advances designed to inactivate the hepatitis virus which led to the inactivation of HIV while preserving most of the biologic activity are reviewed. Today manufactured plasma products are essentially free from transmitting viral diseases of any significant clinical consequences. © 1993 Wiley‐Liss, Inc.
What does the future hold for patients infected with HIV?
Authors: Fields Mimi
Published: February 2007

Remarks are offered on the future of the HIV‐infected individual, the system's ability to care for more HIV‐infected individuals, and our global ability to maintain our efforts to fight this disease. © 1993 Wiley‐Liss, Inc.
Role of extracorporeal photopheresis in the treatment of cutaneous t‐cell lymphoma, autoimmune disease, and allograft rejection
Authors: Rook Alain H. , Wolfe Jonathan T.
Published: February 2007

Photopheresis is a pheresis‐based therapy that is currently available at approximately 70 medical centers worldwide. Recent evidence indicates that extracorporeal photopheresis can significantly prolong life, as well as induce a 60–75% response rate among individuals with advanced cutaneous T‐cell lymphoma (CTCL). Moreover, a 10–15% cure rate, in response to photopheresis alone, or in combination with interferon alfa, has been obtained at our institution. These complete responses have been characterized by the complete disappearance of morphologically atypical cells from the skin and blood. Southern blot analysis of peripheral blood specimens have also confirmed the indefinite disappearance of the malignant T‐cell clone from the blood of patients with complete responses. Current immunological data obtained from in vitro human studies and from animal models suggest that the basis for the responses of CTCL patients are related to activation of treated macrophages resulting in release of cytokines, including substantial levels of TNF alfa, and, perhaps, to the induction of anti‐clonotypic immunity directed against pathogenic clones of T‐lymphocytes. In addition to the treatment of CTCL, a potential role for photopheresis in the therapy of autoimmune disease has been suggested by recent pilot studies of pemphigus vulgaris, rheumatoid arthritis, and systemic lupus erythematosus. Furthermore, a randomized, single‐blinded trial involving 79 patients with early onset, aggressive systemic sclerosis suggested that photopheresis could beneficially effect the course of the cutaneous thickening in this form of the disease. Lastly, two independent pilot studies of cardiac transplantation have indicated that photopheresis can reverse acute cardiac allograft rejection and potentially suppress ongoing chronic rejection. Randomized, controlled trials for these new indications for photopheresis therapy are currently in the early stages of implementation. © 1994 Wiley‐Liss, Inc.
Collection of peripheral blood stem cells on spectra
Authors: James Peggy
Published: February 2007

The collection of peripheral blood stem cells by apheresis is a procedure used with increasing frequency in bone marrow transplant. The Spectra Apheresis System is an automated machine allowing the procedure to be tailored to every patient for optimal safety and comfort. The ability to constantly view the products allows the operator flexibility to control the results for an optimal result. © 1994 Wiley‐Liss, Inc.
PLT‐30: An improvement for platelet collection on the baxter CS‐3000 plus
Authors: Nussbaumer W. , Plattner R. , Schoppel W. , Ruth N. , Schönitzer D. , Kurz M. , Kollar I. , Jungling G. , Wagner A. , Höcker P.
Published: February 2007

The CS‐3000 is a well‐established blood cell separator. To increase the efficiency of platelet collection, Baxter developed a new separation chamber, the TNX‐6, for the follow‐up model of the CS‐3000, the CS‐3000 Plus. To reduce the occurrence of platelet aggregates and to increase platelet yield and efficiency the collection chamber A‐35 has been replaced by a new, volume‐reduced chamber called PLT‐30. We analyzed on the basis of 201 platelet separation procedures with the CS‐3000 Plus fitted with both new chambers the efficiency of platelet collection. The platelet yield per unit (mean ± SE) was 4.55 × 1011 M‐1 0.07 × 1011 and the efficiency was 50.79 ± 0.76%; only 3.98% of the platelet concentrates were below 3 × 10. To compare our data with results from the A‐35 we enrolled 33 random donors (17 in Innsbruck, 16 in Vienna) in a controlled study. Using both chambers in a randomly selected sequence within a period of 1 month on each chamber, we evaluated platelet yield, efficiency, and the contamination with white blood cells (WBCs). We found a platelet yield per unit (mean ± SE) of 3.74 × 10n ±0.11 × 1011 using the A‐35 and of 4.4 × 1011 ±0.21 × 1011 with the new PLT‐30 (P = .0001). The efficiency of the collecting process (mean ± SE) was higher with the PLT‐30 (47.76 ±2.11 %)than with the A‐35 (40.68 ± 1.29%). The difference is statistically significant (P= .0001). Comparing the contamination of the platelet concentrates with WBCs no significant differences could be found (P= .35). Our results demonstrate that the use of the new collection chamber PLT‐30 in combination with the separation chamber TNX‐6 significantly increases platelet yield and efficiency per unit, while no decrease of the contaminating WBCs could be obtained.
Peripheral blood stem cell collection with reduced platelet loss to the patient/donor
Authors: Orlina Armando R. , Dechristopher Phillip J. , Conant James C. , Catchatourian Rosalind , Cano Pedro
Published: February 2007

Apheresis procedures that optimize peripheral blood stem cell (PBSC) harvesting also result in a significant loss of platelets to the patient/donor because of their similar densities. We compared the percent drop in platelet count and hemoglobin concentration in the patients before and after PBSC collection using two different collection chambers with the CS‐3000TM. A modified plateletpheresis procedure was utilized. Seven patients underwent 38 PBSC collections during steady state hematopoiesis using the standard A‐35 collection chamber. At the end of the procedure, a second low‐speed centrifugation of the PBSC concentrate was performed in the manual mode, with siphoning out and return of the PRP to the patient through a transfer pack. For 14 patients who underwent 113 PBSC collections, a small volume collection chamber (SVCC) was substituted for the A‐35 chamber and the second centrifugation step was omitted. These patients were also primed with 4 g/m2 of cyclophosphamide. The percent drop in platelet count in the patients after the collection procedures was significantly less in the SVCC group (20.4 ± 9.1 vs. 36.0 ± 12.3, P = 0.000), even after correction for the difference in the volume of blood processed between the two groups (3.2 ± 1.4 vs. 3.9 ± 1.3, P = 0.006). The percent drop in hemoglobin concentration was also less with the SVCC both before (5.4 ± 3.8 vs. 11.7 ± 3.0, P = 0.000) and after (0.8 ± 0.6 vs. 1.3 ± 0.3, P = 0.000) correction for the difference in the volume of blood processed. The cellular contents of the PBSC concentrates were similar in both groups although mononuclear cell (MNC) purity was slightly higher in the A‐35 group (95.6 ± 5.9% vs. 91.0 ± 13.0%, P = 0.037). The MNC extraction efficiency was similar with both collection chambers (60.2 ± 17.4% for the SV and 64.6 ± 18.5% for the A‐35). The advantages of the SVCC and the possible reasons for the observed differences are discussed.
Effects of whole blood flow rates on mononuclear cell yields during peripheral blood stem cell collection using fenwal CS 3000 plus
Authors: Lin Jeong‐Shi , Burgstaler Edwin A. , Pineda Alvaro A. , Gertz Morie A.
Published: February 2007

It is generally assumed that using high whole blood flow rates (WBFR), 80 ml/min, during peripheral blood stem cell (PBSC) collection on the Fenwal CS 3000 Plus blood cell processor will result in higher yields of mononuclear cells (MNC) than using lower WBFR (50 ml/min). To test this assumption, we retrospectively studied 129 PBSC procedures on 17 patients in a multiple myeloma protocol comparing MNC yield, as well as red blood cell (RBC), granulocyte, and platelet (Plt) content, of four average WBFR groups. Standard PBSC procedures were performed using modified procedure 1, interface offset 100, anticoagulant (AC) ratio of 11:1, small volume collection chamber, and a processing time of 4 hours. After correcting for AC volume used, the volume processed was divided by 240 minutes to obtain the average WBFR. WBFRs were separated into 4 groups of 40–49, 50–59, 60–69, and 70–79 ml/min.

When compared to the highest flow rate group (70–79 ml/min), the three lower flow rate groups had significantly higher MNC yields of 16.2 ± 6.9, 13.1 ± 5.1, and 11.5 ± 4.7 × 109, respectively, as compared to 8.9 ± 6.1 ± 109 MNC for the 70–79 ml/min group. There was no significant difference in granulocyte yield which ranged from 1.6 ± 2.1 to 4.5 ± 4.8 × 109.

There were also significantly more RBC in the 70–79 ml/min group with 21.1 ± 2.2 ml than all three other groups with 16.2 ± 4.3, 16.6 ± 4.0, and 17.9 ± 4.2 ml, respectively, but high average WBFR collected significantly less platelets (0.6 ± 0.7 × 1011 versus 1.9 ± 1.0, 1.5 ± 0.9, and 1.2 ± 0.9, respectively). Incidence of citrate reactions increased as flow rates increased, 6%, 18%, 30%, and 33%, respectively. We conclude that using a lower average WBFR during PBSC collection actually produced significantly more MNC, with equivalent granulocytes, less RBC, but more platelets than the high average WBFR.
Optimal growth of human blood hematopoietic progenitor cells collected by apheresis for autografts
Authors: Hirao Atsushi , Takaue Yoichi , Kawano Yoshifumi , Sato Junko , Makimoto Atsushi , Kawahito Masami , Okamoto Yasuhiro , Saito Shin‐Ichi , Suzue Takeshi , Abe Takanori , Kuroda Yasuhiro
Published: February 2007

For safe autografts with peripheral blood hematopoietic cells (PBSCT), better methods for determining the kinetics of stem cell populations and predicting engraftment speed after PBSCT need to be established. Current methods include culture in semi‐solid medium and measurement of CD34 cell surface antigen. In this study with only partially purified blood cells obtained from children with cancer in remission, we compared the effects of phytohemagglutinin‐stimulated lymphocyte‐conditioned medium (PHA‐LCM) and recombinant human cytokines on the growth of progenitor cells in a methylcellulose culture system. Interleukin‐3 (IL‐3) alone supported more progenitor growth than standard PHA‐LCM by a factor of 1.54 for colony‐forming unit granulocyte/macrophages (CFU‐GM) and by a factor of 1.84 for burst‐forming unit/erythroids (BFU‐E). No significant change, in terms of the number of growing colonies, was observed by adding granulocyte/macrophage colony‐stimulating factor (GM‐CSF), granulocyte‐CSF (G‐CSF), or IL‐1 to IL‐3. However, the addition of G‐CSF resulted in increased colony size. A further increase in CFU‐GM growth was observed by the addition of IFN‐γ to the combination of cytokines. No significant effect was observed when stem cell factor (SCF) was added to the combination of cytokines containing IL‐3, G‐CSF, and IFN‐γ. This analysis suggests that the combination of IL‐3, G‐CSF, and IFN‐γ may provide sufficient stimulation for the growth of human blood cells. The effects of different oxygen tensions on progenitor growth in the presence of IL‐3, G‐CSF, and IFN‐γ were also evaluated. Both CFU‐GM and BFU‐E formation were increased when the culture was grown at 5% O2, as compared with an ambient 20% O2 tension. A small number of infused cells were grown in culture incorporating either IL‐3, G‐CSF, and IFN‐γ at 5% O2 or PHA‐LCM at 20% O2, and the number of infused cells was correlated to the speed of hematopoietic recovery after PBSCT. Although a significant negative correlation was observed between the number of infused CFU‐GM per kilogram of the patient's body weight and the recovery of hematopoiesis under both culture conditions, a better correlation was found when the former method was applied (P lt; .001 vs. P lt; .05). These findings suggest that a culture containing IL‐3. G‐CSF, and IFN‐γ at low O2 tension provides satisfactory conditions for the proliferation of blood progenitors, and that this mixture of recombinant cytokines may enable a standardized hematopoietic progenitor assay for PBSCT.
Lipid apheresis: An in vivo application of plasma delipidation with organic solvents resulting in acute transient reduction of circulating plasma lipids in animals
Authors: Cham Bill E. , Kostner Karam M. , Dwivedy Ash K. , Shafey Tarek M. , Fang Ning Xia , Mahon Michelle G. , Lannuzzi Cecilia I. , Colquhoun David M. , Smith Jeffery L.
Published: February 2007

Despite primary and secondary prevention of coronary disease with lowering plasma cholesterol by diet and drug therapy, coronary heart disease remains the major cause of death in Western countries. Low density lipoprotein apheresis had the potential to make a significant impact as it acutely leads to a marked reduction in plasma cholesterol. However, recent preliminary results suggest that low density lipoprotein apheresis may not be more effective in preventing progression of coronary disease than current drug therapy. We have devised a new technique, termed lipid apheresis, which removes cholesterol and triglycerides from plasma but retains the apolipoproteins. This procedure shows great promise in stimulating regression beyond current therapy. Lipid apheresis, a new extracorporeal procedure based on plasma delipidation with the organic solvent mixture butanol‐diisopropyl ether, was applied to hypercholesterolemic and normocholesterolemic roosters. Approximately 25% of the calculated blood volume was removed from the animals. The plasma was separated from the blood cells. The plasma was delipidated for 20 min with the organic solvent mixture. The delipidated plasma containing all proteins, including the apolipoproteins and other ionic constituents, was remixed with the blood cells and infused back into the identical donor animals. Analyses of serial blood samples collected from lipid apheresed and sham treated animals up to 16 h after infusion revealed that lipid apheresis caused acute, marked reductions in plasma lipids. The pattern and extent of the plasma levels of cholesterol were different in the hypercholesterolemic animals when compared with normocholesterolemic animals, indicating that a readily extraplasma cholesterol pool in the hypercholesterolemic animals was rapidly mobilized into the plasma pool. Haematological and biochemical parameters in the blood of the treated animals were unaffected. These observations may have important implications for the management of human atherosclerosis.
Effectiveness of cascade filtration plasmapheresis in two patients affected by familial hypercholesterolemia
Authors: Barbagallo C. M. , Averna M. R. , Dimarco T. , Spano L. , Scafidi V. , Marino G. , Rao Camemi A. , Notarbartolo A.
Published: February 2007

Hypercholesterolemia has been recognised as a primary risk factor for coronary heart disease. Reduction of plasma levels of total and LDL cholesterol has been shown to decrease coronary atherosclerosis. Plasmapheresis represents an useful non‐pharmacological tool to treat severe hypercholesterolemias. We have evaluated the effectiveness of a system of plasmapheresis using a cascade filtration method in two young male subjects (aged 16 and 26 years) with homozygous familial hypercholesterolemia. Both showed severe coronary atherosclerosis as determined by angiography. Procedures were performed at intervals of 7 days in each case. We observed a mean reduction of plasma levels of total cholesterol of 59.5% (range 31.0–75.5%); LDL‐cholesterol, 61.6% (range 32.6–77.1%); triglycerides, 48.1%; HDL‐cholesterol, 31.1%; apo A‐I, 30.8%; and apo B, 57.6%. We also noted a reduction of other parameters, such as fibrinogen (49.9%) and Lp(a) (59.9%). At the end of each procedure about 8 g of cholesterol was removed from the total body pool. A decrease of total proteins (26.9%) and albumin (19.6%) was also observed, but this was completely restored before the next apheresis (1 week). These data show the effectiveness of the removal of LDL in a cascade filtration system, which obtains results not very different from other more selective methods. The lack of selectivity is not much of a problem, since it also reduces other risk factors such as Lp(a) and fibrinogen.
Blood center perspective of granulocyte transfusions: Future applications
Authors: Price Thomas H.
Published: February 2007

The role of the blood bank in provision of an optimal granulocyte concentrate is discussed. The importance of the granulocyte dose is emphasized, and recent developments permitting the collection of larger numbers of cells are reviewed. In particular, the administration of granulocyte colony‐stimulating factor to normal donors has been reported to result in dramatically increased neutrophil yields. Recent data has also suggested that increased efficiencies of collection can be realized by the use of hetastarch as the red cell sedimenting agent.
Collection and transfusion of granulocyte concentrates from donors primed with granulocyte stimulating factor and response of myelosuppressed patients with established infection
Authors: Hester Jeane P. , Dignani Maria C. , Anaissie Elias J. , Kantarjian Hagop M. , O'brien Susan , Freireich Emil J
Published: February 2007

Fifteen patients with prolonged neutropenia (a median of 23 days with granulocyte [PMN] ≤ 500/μl) and established fungal infections that had not responded to adequate antifungal therapy were transfused with PMN concentrates collected from 35 cytokine‐primed granulocyte colony‐stimulating factor (GCSF) donors. Patients received a median of six transfusions. Leukocytosis and granulocytosis were observed within 24 hours of the first GCSF injection, which yielded concentrates averaging 55 × 109 white blood cells and 41 × 109 PMN. Data analysis suggested that response might be related to the duration of neutropenia and known infection, as patients given PMN tx earlier in the infectious course tended to have a better response. No significant toxicity was observed in donors.
Immunologic rebound
Authors: Dau Peter C.
Published: February 2007

Evidence for accelerated specific antibody (Ab) rebound or overshoot after single or multiple therapeutic plasmapheresis (TP) is fragmentary but suggested by both clinical and experimental evidence. In vitro studies showing increased peripheral blood lymphocyte turnover and total immunoglobulin production after a series of TP without immunosup‐pression may signify a generalized immunostimulation through removal of regulatory molecules by TP. It is known that IgG class Ab can down regulate B cells by cross linkage of their Ag and Fc receptors. Cyclophosphamide and other cytotoxic immunosuppressive agents effectively delete proliferating lymphocytes. TP could particularly foster deletion of lymphocytes actively mediating autoimmunity, since they would be more readily stimulated to proliferation by removal of Ab or other inhibitory factors than the generally resting normal immune system. This is supported by a relatively greater reduction of autoantibody levels than total immunoglobulin after treatment with TP and cytotoxic immunosuppressives.
An appraisal perspective of justice, structure, and job control as antecedents of psychological distress
Authors: Spell Chester S. , Arnold Todd
Published: February 2007

Through the application of cognitive appraisal theory, this study unifies the emergent themes of studying justice in relation to organizational context, as well as justice in relation to employee feelings of psychological distress. A sample of 677 employees from 72 organizations was used to test hypotheses related to justice, job control, mechanistic structure, and employee feelings of anxiety and depression. We found procedural justice, within a primary appraisal role, to be a highly effective tool for minimizing psychological distress. In combination with both distributive justice as well as a mechanistic structure, procedural justice can help to minimize feelings of anxiety and depression, but in different manners for each variable. Further, a strong influence of job control upon both procedural justice and, ultimately, depression and anxiety highlighted its role as a perceived means for avoiding or minimizing the harm of a potential stressor. Copyright © 2007 John Wiley & Sons, Ltd.
Surviving Radicals: Promises of a Microwave Effect on Miniemulsion Polymerization for Technical Processes
Authors: Holtze Christian , Tauer Klaus
Published: February 2007

Rapid heating in a microwave oven has unexpected effects on free radical miniemulsion polymerization: After a temperature pulse of less than 20 s, ultra‐high molecular weight polystyrene was yielded at a conversion larger than 40%. These results may be explained with the model of “surviving radicals” according to which single radicals remain active inside the confined reaction space of latex particles even after the emulsion has left the microwave oven. In the pure environment of a 100 nm droplet, they cannot terminate and will polymerize all the monomer within a droplet. In this contribution, we summarize the concept of “surviving radical polymerization” and present recent results on the effects of radical‐active additives and the development of a tube reactor for continuous microwave‐assisted processing. These investigations highlight the potential of this method for industrial applications.

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Synthesis of Polytriarylamines via Microwave‐Assisted Palladium‐Catalysed Amination
Authors: Shen I‐Wen , McCairn Mark C. , Morrison John J. , Turner Michael L.
Published: February 2007

A new synthetic route to polytriarylamines by microwave‐assisted palladium‐catalysed amination between 2,4‐dimethylaniline and 4,4′‐dibromobiphenyl is reported. The use of microwave heating significantly reduces the polymerisation time from days to around five minutes when conducted at 100 °C. However, prolonged microwave irradiation (20 min) can cause chain degradation of these polymers. Reactive amino and bromo end‐groups can be removed by sequential reaction with 4‐bromoanisole and diethylamine to generate polytriarylamines that are suitable for the fabrication of organic electronic devices.

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Microwave‐Assisted Polymer Synthesis: Recent Developments in a Rapidly Expanding Field of Research
Authors: Hoogenboom Richard , Schubert Ulrich S.
Published: February 2007

The use of microwave irradiation has become a common heat source in organic chemistry. Inspired by this enormous success, the use of microwave irradiation is also increasingly studied for polymerization reactions. The present review discusses developments in this rapidly growing field of research. The main areas in which the use of microwave irradiation has been explored in the recent years are step‐growth polymerizations, ring‐opening polymerizations as well as radical polymerizations. These different areas will be addressed in detail, whereby special attention will be given to observed improvements resulting from the use of microwave irradiation as well as the occurrence of non‐thermal effects.

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Microwave‐Assisted Preparation of Semiconducting Polymers
Authors: Galbrecht Frank , Bünnagel Torsten W. , Scherf Ullrich , Farrell Tony
Published: February 2007

Polymeric semiconducting materials are being utilized as components in a new generation of electronic devices. The generation of high quality polymeric semiconductors often involves transition metal‐catalyzed cross‐coupling reactions, which require long reaction times. Microwave heating can be very efficient in reducing reaction times and consequently leads to increased reaction yields and concomitantly reduces the amount of side products. This microreview aims to summarize the use of microwave heating to prepare conjugated polymers, which are specifically tailored towards applications in optoelectronic and electronic devices. Moreover, microwave heating is a valuable investigative tool for the screening towards novel materials, especially when optimizing the backbone arrangement of unsaturated building blocks.

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Single‐Mode Microwave‐Assisted Atom Transfer Radical Polymerization Catalyzed by [RuCl2(p‐cymene)(PCy3)]
Authors: Delfosse Sébastien , Borguet Yannick , Delaude Lionel , Demonceau Albert
Published: February 2007

In the atom transfer radical polymerization (ATRP) of methyl methacrylate in the presence of [RuCl2(p‐cymene)(PCy3)] (p‐cymene = 4‐isopropyltoluene, PCy3 = tricyclohexylphosphine), a microwave effect is noted which strikingly depends on both the temperature and the method used (conventional microwave synthesis (CMS, i.e., without simultaneous cooling) or enhanced microwave synthesis (EMS, with simultaneous cooling)). Thus, between 85 and 120 °C under CMS conditions, microwave‐assisted polymerizations take place in a controlled fashion, and at 120 °C the microwave‐assisted polymerization is three times faster than the conventionally heated protocol. However, from 130 °C, microwave irradiation has a deleterious effect and the polymerizations are no longer controlled. Likewise, using the EMS method in the temperature range of 85–120 °C results in uncontrolled processes, as indicated by the unsuccessful resumption of the polymerizations. These failures might be attributed to a significantly high concentration of radical species, which results in enhanced propagation and termination ‐ mostly disproportionation ‐ rates.

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