bluuebunny/crossref_metadata_2025 huggingface dataset:
Suitability of preadmission blood samples for pretransfusion testing in elective surgery
Authors: Marosszeky S. , McDonald S. , Sutherland J. , Haysom H. , Haeusler M. , Sellings C. , Metz J. , McGrath K.M.
Published: March 2003

BACKGROUND: North American transfusion guidelines do not stipulate a time limit between drawing the specimen for pretransfusion testing and giving the transfusion to patients who have not received a transfusion or been pregnant in the preceding 3 months. British guidelines suggest that separated plasma and serum can be stored at ‐30 degrees C for up to 6 months, but they draw attention to the paucity of evidence concerning the use of stored samples. In Australia, transfusion guidelines recommend a maximum of 10 days' validity for pretransfusion specimens, which requires the patient to present for pretransfusion testing within 10 days of admission or to undergo retesting after admission, which in turn necessitates additional time in the hospital before operation. The study was performed to document the safety of using for pretransfusion testing a blood sample collected more than 10 days before surgery. STUDY DESIGN AND METHODS: Samples from 500 patients scheduled for elective surgery who had not been pregnant or received a transfusion in the previous 3 months were separately tested in blood group and antibody screens at an interval from 11 to 335 days before admission and again on admission. RESULTS: No clinically significant change was detected in the red cell antibody status of the paired samples of any patient. CONCLUSION: For patients who have not been transfused or pregnant in the previous 3 months, it is safe to crossmatch blood for transfusion by using a sample collected well in advance of elective surgery and stored at ‐30 degrees C.
Clinical trial and local process evaluation of an apheresis system for preparation of white cell‐reduced platelet components
Authors: Adams M. R. , Dumont L. J. , McCall M. , Heaton W. A.
Published: March 2003

BACKGROUND: A new method for the consistent preparation of white cell (WBC)‐reduced plateletpheresis components, the Spectra Leukoreduction System (LRS), was evaluated by clinical trial and local process validation. The centrifuge‐based system was projected to decrease the WBC content of plateletpheresis components to a level below 1 × 10(6) per unit. Phase I and II clinical trials were performed. The manufacturer's claims were then tested at the local level with an ongoing quality assurance program.

STUDY DESIGN AND METHODS: In Phase I, a cross‐over analysis of five subjects compared LRS to standard plateletpheresis procedures in collection efficiency and component quality: a panel of in vitro measures was taken on Day 0 and Day 5. In Phase II, the LRS process was tested on a larger scale (n = 57; control = 58) with component transfusion. Finally, validation, determination of degree of conformance with standards, and ongoing quality control were performed locally on a newly installed instrument.

RESULTS: Phase I and II trials revealed no significant differences between LRS and control units in donor or recipient safety and comfort, platelet function and yield, or component volume. WBC per‐unit values were significantly different: the LRS median per unit was 3.2 × 10(4) WBCs, versus 81.4 × 10(4) for control units. Assessment of process capability gave an estimate of 99‐percent confidence that 99.5 percent of LRS units would be WBC reduced to < 1 × 10(6) WBCs. Local process validation and quality control revealed 90‐percent confidence that 99 percent of the units would be WBC reduced and 99.9‐percent confidence that 75 percent would exceed platelet yield standards; the process was stable over time.

CONCLUSIONS: The LRS is safe for apheresis and the component produced is safe for transfusion with platelet function and yield equivalent to controls and WBC reduction superior to controls. Local process evaluation confirmed that component quality meets the goals of the institution.
Assessment of motivations for return donation among deferred blood donors. American Red Cross ARCNET Study Group
Authors: Munsterman KA , Grindon AJ , Sullivan MT , Trouern‐Trend J , Blackmon MJ , Watkins J , Williams AE
Published: March 2003

BACKGROUND: The recent addition of a computerized donor deferral registry to American Red Cross blood donation procedures has enabled blood center staffs to identify, before donation, persons who attempt to donate despite previous deferral. The current study investigated reasons that deferred donors return to donate, despite having been notified that they are ineligible. STUDY DESIGN AND METHOD: Anonymous mail surveys requesting demographic information, details of last donation or attempted donation, and assessments of incentives for donating were sent to 311 donors presenting inappropriately at blood drives and 849 matched controls in three American Red Cross regions between April and July 1996. RESULTS: Responses were received from a total of 113 deferred donors and 388 matched controls. Analysis of the 49 permanently deferred donors indicated that they were more likely than controls to donate blood to receive test results or to be awarded community service credit. Responses also revealed that some deferred donors may return to donate blood because of a misunderstanding of the deferral message or erroneous recruitment by blood center staff. CONCLUSION: There is a need before donation for the provision of educational materials regarding the window period of infection and for careful consideration of the use of incentives to attract donors to blood centers. It is also important to provide to donors a clear and consistent message regarding their test results and deferral status.
A clinically applicable method for determining the three major alleles at the Duffy (FY) blood group locus using polymerase chain reaction with allele‐specific primers
Authors: Olsson M.L. , Hansson C. , Avent N.D. , Akesson I.E. , Green C.A. , Daniels G.L.
Published: March 2003

BACKGROUND: The clinically significant antigens of the Duffy (Fy [FY]) blood group system are expressed on the red cell form of the FY glycoprotein, a promiscuous chemokine receptor and also a receptor for malarial parasites. After the cloning of cDNA coding for FY glycoprotein, the molecular basis of the three major alleles (Fya/Fyb/Fy) has been established. Because of the mistyping of the silent Fy allele as Fyb, the error rate of current genotyping methods is high in black populations. STUDY DESIGN AND METHODS: Two hundred blood donors (European whites and African Blacks) and some amniotic DNA samples were investigated by a new allele‐specific primer polymerase chain reaction technique. Sense primers corresponding to normal and GATA‐1‐mutated FY gene promoter region sequences were combined with antisense primers discriminating the Fya/Fyb polymorphism. RESULTS: Complete correlation between FY phenotypes and genotypes was obtained in all samples studied, although, in two whites and one black, serology showed weak Fyb expression while polymerase chain reaction indicated a Fyb allele. Gene frequencies were calculated. CONCLUSION: This simple and rapid polymerase chain reaction method was shown to detect the three common alleles at the FY locus in two representative ethnic populations. Its future use as an independent technique in red cell FY investigations and for fetal genotyping in hemolytic disease of the newborn is predicted.
Comparison of the level of cytokine mRNA in buffy coat‐derived platelet concentrates prepared with or without white cell reduction by filtration
Authors: Christensen L.L. , Grunnet N. , Rudiger N.
Published: March 2003

BACKGROUND: The generation of proinflammatory cytokines in platelet concentrates (PCs) by white cells is thought to be implicated in febrile nonhemolytic reactions. Furthermore, other cytokines could be generated in the PCs as signs of white cell activation when PCs are prepared from a pool of buffy coats (BCs). The number of white cells in the PCs is crucial to cytokine generation. STUDY DESIGN AND METHODS: Each of the PCs (n = 12) was prepared from a pool of BCs from four donors. Before storage, half of the BC‐derived PCs (BC‐PCs) were white cell reduced by filtration. The BCs and the unfiltered and filtered BC‐ PCs were assayed for the presence of cytokine mRNA (i.e., interleukin [IL]‐1beta, IL‐6, tumor necrosis factor alpha [TNFalpha], IL‐8, IL‐2, and interferon gamma [IFN‐gamma]) by the use of competitive reverse transcription‐polymerase chain reaction. RESULTS: No mRNA of cytokines with pyrogenic activity, that is, IL‐1beta, IL‐6 and TNFalpha, was detected in either the filtered or the unfiltered BC‐PCs. Likewise, IL‐ 2 mRNA was not found in any of the BC‐PCs. IFN‐gamma mRNA, however, was detected in the unfiltered BC‐PCs but not in the filtered BC‐PCs. IL‐8 mRNA was found in both the unfiltered and the filtered BC‐PCs, but with a lower frequency in the filtered BC‐PCs. CONCLUSION: The unfiltered BC‐ PCs produced in the top‐and‐bottom bag system contain traces or undetectable levels of the investigated cytokine mRNA. The results can be used in defining consensus recommendations for the use of filtered and unfiltered blood components.
Prevalence and infectivity of hepatitis G virus and its strain variant, the GB agent, in volunteer blood donors in Taiwan
Authors: Wang J.T. , Chen P.J. , Liu D.P. , Sheu J.C. , Wang T.H. , Chen D.S.
Published: March 2003

BACKGROUND: The prevalence of hepatitis G virus (HGV) and its strain variant, the GB agent (GBV‐C) is high in non‐virus‐inactivated plasma products, but, persistent infection in recipients is relatively low. STUDY DESIGN AND METHODS: Stored samples from transfusion donors and recipients in a prospective study of posttransfusion hepatitis were tested for HGV RNA and antibody to the E2 protein (anti‐E2). RESULTS: Thirty‐two (2.1%) of the 1500 qualified donors were positive for HGV RNA. Twenty‐four persons had received a transfusion of blood from one of these 32 viremic donors. Of these 24 recipients, 3 were positive for HGV RNA before transfusion. Of the remaining 21 recipients, 8 became viremic after transfusion, while the other 13 were not infected. Four of the eight infected recipients were persistently positive for HGV RNA, while four became negative in 1 to 3 years. Three of the four patients with HGV clearance seroconverted to anti‐E2 positivity. Comparison of the viral titer, viral sequences at E2, storage period of blood donations, and clinical data in the infected and noninfected recipients revealed no significant differences. However, the noninfected recipients seemed to have a higher prevalence of anti‐E2 before transfusion. CONCLUSION: The prevalence of HGV viremia in volunteer blood donors in Taiwan is 2.1 percent, and blood from 0.6 percent of them actually causes HGV infection in the recipients. In half of infected recipients, clearance of HGV occurs. Anti‐E2 appears in most recipients whose viremia is cleared.
Effect of 24‐hour storage at 25°C on the in vitro storage characteristics of CPDA‐ 1 packed red cells
Authors: Ruddell J.P. , Lippert L.E. , Babcock J.G. , Hess J.R.
Published: March 2003

BACKGROUND: Packed red cells (RBCs) warmed above 10 degrees C are generally discarded. Few data exist on the degree of accelerated metabolism and increased hemolysis of packed RBCs allowed to warm.

STUDY DESIGN AND METHODS: Twenty‐four CPDA‐1 packed RBC units were combined in 3‐unit pools and subdivided into 2 test units and a control unit. One test unit from each pool was warmed to 25 degrees C for 24 hours on Day 6 and the other test unit was warmed on Day 20; control units were maintained at 1 to 6 degrees C. RBC and supernatant chemistries and RBC morphology were measured weekly (Days 0, 7, 14, 21, and 28) and on the day before warming (Days 6 and 20).

RESULTS: Warming CPDA‐1 packed RBCs accelerated the catabolism of glucose 10‐fold and produced concentrations of glucose, lactate, and ATP after 25 days of storage that were equivalent to those in unwarmed units at 35 days. Supernatant sodium and potassium concentrations were corrected partially with warming. RBC morphology transiently normalized with warming and without increased hemolysis; no bacteria growth was detected.

CONCLUSION: One day of 25 degrees C storage of CPDA‐1 packed RBCs accelerates essential metabolite break‐down equivalent to 10 days of storage at 1 to 6 degrees C. It does not appear to matter whether the packed RBCs are warmed on Day 6 or Day 20. This information may be useful in determining the acceptability of blood allowed to warm above 10 ° C.
Expression of neutrophil antigens after 10 days of granulocyte‐colony‐stimulating factor
Authors: Stroncek D.F. , Jaszcz W. , Herr G.P. , Clay M.E. , McCullough J.
Published: March 2003

BACKGROUND:Granulocyte‐colony‐stimulating factor (G‐CSF) is becoming the standard agent for mobilizing granulocytes. Most granulocyte donors are given a single dose of G‐CSF, but in some cases they are given G‐ CSF for several days, and multiple granulocyte concentrates are collected. The administration of a single dose of G‐CSF induces several changes in the expression of neutrophil antigens, but the effects of multiple daily doses of G‐CSF are not known.

STUDY DESIGN AND METHODS:Seven healthy people received 5 microg per kg of G‐CSF for 10 days. Their expression of several neutrophil antigens before, during, and after the administration of G‐CSF was analyzed through the use of flow cytometry.

RESULTS:The expression of L‐selectin (CD62L), Fcgamma receptor (FcgammaR) III (FcgammaRIII, CD16), and the leukocyte function antigen (CD11a) decreased throughout the course of G‐CSF administration, while the expression of FgammaR I (FcgammaRI, CD64) and lipopolysaccharide‐binding protein receptor (CD14) increased. The expression of FcgammaR II (FcgammaRII, CD32) also increased, but not until the fourth day of G‐CSF administration. The expression of amino peptidase N (CD13), C3bi receptor (CD11b), and the neutrophil beta2 integrin unit (CD18) did not change during the administration of G‐CSF, but that of both CD13 and CD18 increased 3 days after the last dose. The expression of neutrophil‐specific antigen NB1 initially increased, returned to pre‐G‐CSF levels after 4 days, and then increased again after 10 days of G‐CSF administration. CONCLUSION: Changes in the expression of several neutrophil antigens occurred throughout a 10‐day course of G‐CSF Most of the changes occurred after one dose, but additional changes occurred later in the 10‐day course and after its completion. These changes may affect the function of G‐CSF‐mobilized granulocytes.
Surveillance for Creutzfeldt‐Jakob disease among persons with hemophilia
Authors: Evatt B. , Austin H. , Barnhart E. , Schonberger L. , Sharer L. , Jones R. , DeArmond S.
Published: March 2003

BACKGROUND: Although Creutzfeldt‐Jakob disease (CJD) has been shown to be transmissible through blood components in rodent models, no human blood‐to‐blood transmission has been documented. If blood transmission were possible in humans, persons with hemophilia in the United States would be at higher risk of contracting CJD, because they receive large numbers of blood components. Nearly one‐half of the hemophilia population contracted HIV in the 1980s, and many of these people have since died with neurologic complications. This study investigated whether some hemophilia patients with neurologic disorders may have died with CJD.

STUDY DESIGN AND METHODS: Hemophilia treatment Centers across the United States were invited to participate in this retrospective surveillance study. The centers were asked to send any available formalin‐fixed paraffin block brain samples from hemophilia decedents. Slides were prepared at the Centers for Disease Control and Prevention and reviewed by three expert neuropathologists. Two slides were stained for the prion protein at the request of one of the neuropathologists.

RESULTS: Specimens from 24 decedents with genetic bleeding disorders were collected and reviewed. The panel found no evidence of CJD in any of the specimens.

CONCLUSIONS: Although the study sample is small, these results support the growing evidence that CJD is not being transmitted in the nation's blood supply.
Cost‐effectiveness of transfusing virus‐inactivatedplasma instead of standard plasma
Authors: Pereira A.
Published: March 2003

BACKGROUND: Virus inactivation of plasma intended for transfusion avoids the transmission of hepatitis B virus, hepatitis C virus, and HIV. However, because most plasma recipients also receive other blood components concomitantly, the procedure reduces but cannot eliminate the risk of transfusion‐transmitted infection. As virus‐inactivated plasma has just been licensed in the United States and other countries, a cost‐effectiveness analysis is pertinent.

STUDY DESIGN AND METHODS: A Monte Carlo simulation of a Markov model representing the possible outcomes of plasma recipients was used to derive costs and utilities of transfusing virus‐inactivated plasma instead of standard plasma. Probability distributions for patients' age and sex and for the number of blood components transfused per case were determined in 924 plasma recipients in a tertiary‐care hospital. Other values were obtained from the medical literature. Results of the baseline and sensitivity analyses are the mean (± SD) of 10 simulations with 107 patients per simulation.

RESULTS: In the baseline analysis, transfusing virus‐inactivated plasma instead of standard plasma prolonged the quality‐adjusted survival by 1 hour and 11 minutes per patient, at a cost‐effectiveness ratio of $2,156,398 ± $257,587 per quality‐adjusted life year gained. Cost‐effectiveness was most sensitive to the patients' mean age, the incremental cost per unit of virus‐inactivated plasma, the HIV and hepatitis C virus transmission rates, and the short‐term mortality of plasma recipients due to their underlying diseases.

CONCLUSIONS: Compared to most accepted medical procedures, the transfusion of virus‐inactivated plasma produces little health benefit at a very high cost. This poor cost‐effectiveness ratio is due to the low current risk of infection with transfusion‐transmitted viruses and to the greater age and poor short‐term prognosis of most plasma recipients.
Evaluation by enzyme‐linked immunosorbent assay of IgG anti‐D and IgG subclass concentrations in immunoglobulin preparations
Authors: Ahaded A. , Debbia M. , Beolet M. , Le Pennec P.Y. , Lambin P.
Published: March 2003

BACKGROUND: Anti‐D immunoglobulin preparations are injected to prevent hemolytic disease of the newborn. The concentration of IgG anti‐D in these preparations is usually determined by an automated hemagglutination technique using as a reference a calibrated preparation of anti‐D, but the method requires special equipment and cannot be routinely applied to measure the IgG subclasses of anti‐D in these preparations.

STUDY DESIGN AND METHODS: Taking advantage of a recently described enzyme‐linked immunosorbent assay (ELISA) for the determination of the anti‐D concentration in sera of alloimmunized pregnant women, IgG anti‐D and IgG subclass concentrations were measured in the international reference preparation (IRP) coded 68/419, 10 anti‐D immunoglobulin preparations, and sera of 15 D‐immunized volunteers.

RESULTS: An IgG anti‐D concentration of 61.5 ± 4.8 μg per ampoule (mean ± SD) was found by ELISA in IRP 68/419. This result was in agreement with previous determinations obtained by radioimmunoassay (60 μg/ampoule). The IgG subclass concentration of anti‐D in this preparation was 48.4 μg of IgG1 (78.6%), 3.0 μg of IgG2 (4.8%), 9.7 μg of IgG3 (15.8%), and 0.4 μg of IgG4 (0.7%) . The mean proportion of IgG subclasses of anti‐D in 10 immunoglobulin preparations was similar (81.7% for IgG1, 5.0% for IgG2, 12.7% for IgG3, and 0.6% for IgG4). In the sera of 15 immunized volunteers, the IgG anti‐D concentration varied from 3.1 to 68.4 μg per mL. The mean IgG subclass composition of anti‐D was 79.3 percent for IgG1, 2.2 percent for IgG2, 18.1 percent for IgG3, and 0.4 percent for IgG4. The proportions of IgG3 anti‐D in these sera were found to range between 1 percent and 87 percent, as in the sera of D‐alloimmunized pregnant women.

CONCLUSION: ELISA provides an alternative to the radioimmunoassay and the automated hemagglutination technique. In addition, it allows the evaluation of the absolute concentration of each IgG subclass of anti‐D in immunoglobulin preparations and necessitates only the conventional equipment required for an immunoenzymatic assay.
Biocompatibility of a new cell separator studied by flow cytometry: analyses of platelet antigens during apheresis and storage
Authors: Gutensohn K. , Alisch A. , Crespeigne N. , Eifrig B. , Kuehnl P.
Published: March 2003

BACKGROUND: Alterations of platelet antigens are known to occur during cytapheresis and storage. These changes have been shown to be dependent on the biomaterials, techniques, and devices used. In this study, the influence of a new cell separator (AMICUS) and storage container (PL‐2410) on platelet glycoproteins was analyzed.

STUDY DESIGN AND METHODS: During plateletpheresis and storage, the levels of platelet glycoproteins and binding of fibrinogen were determined by flow cytometry.

RESULTS: During apheresis, mean channel fluorescence intensity of CD41a did not change significantly (p = 0.06). A small increase was evident in CD42b mean channel fluorescence intensity, which rose from a baseline level of 178.6 ± 68.3 to 231.5 ± 97.9 at the end of the procedure (p<0.05); in CD62p‐positive platelets, which increased from 2.0 ± 0.9 percent to 9.9 ± 3.9 percent (p<0.05); in CD63‐positive platelets, which increased from 1.7 ± 0.7 percent to 7.9 ± 2.6 percent (p<0.05); and in the binding of fibrinogen, which increased from 1.9 ± 0.8 percent positive platelets to 10.5 ± 2.6 percent (p<0.05). During storage, the mean channel fluorescence intensity of CD41a and CD42b, the percentage of CD62p‐ and CD63‐positive platelets, and the binding of fibrinogen to platelets showed no significant change.

CONCLUSION: These studies show that alterations in platelet antigens and platelet activation occur to a small degree during apheresis and storage. These findings demonstrate generally good biocompatibility of this new cell separator.
Platelet concentrates prepared and stored under currently optimal conditions: minor impact on platelet adhesive and cohesive functions after storage
Authors: Lozano M. , Estebanell E. , Cid J. , Diaz‐Ricart M. , Mazzara R. , Ordinas A. , Escolar G.
Published: March 2003

BACKGROUND: The effect on platelets of two standard methods of platelet concentrate (PC) preparation was studied by flow cytometry. The findings were correlated with those obtained in an experimental in vitro perfusion model.

STUDY DESIGN AND METHODS: PCs were prepared from whole blood by the platelet‐rich plasma (PRP) or buffy coat (BC) method and placed on a flatbed platelet agitator at 22°C for up to 5 days. Platelet glycoproteins (GP)Ibα, GPIIb/IIIa, and GPIV, p‐selectin and lysosomal integral membrane protein, and the binding of von Willebrand factor, fibrinogen, fibronectin, and coagulation factor Va were measured with the corresponding specific conjugated antibodies. Perfusions were carried out in an annular chamber with citrated blood depleted of platelets and white cells by filtration, to which samples from PCs were added.

RESULTS: PRP‐PC production provoked intense platelet activation. In contrast, in BC‐derived PCs, platelet activation was milder, and only a significant increase in bound fibrinogen was seen. After 1 day of storage, differences between the methods that had been observed immediately after separation had almost disappeared. During the remaining storage period, increases in activation‐dependent antigens and in procoagulant activity were measured. Of the studied platelet GPs, only GPIIb/IIIa decreased by 25 percent in PRP‐PCs. Differences in covered surface were not significant in perfusion studies performed on Day 0 and after 5 days of storage in PRP‐PCs (26.8 ± 6.9 vs. 20.5 ± 5.8) or BC‐PCs (23.8 ± 11 vs. 24.8 ± 10.2).

CONCLUSION: Platelet activation occurred during the separation and storage of PCs prepared by both methods, and it was higher in PRP‐PCs only in samples obtained immediately after preparation. Despite these changes, platelet adhesive and cohesive functions were similar in both types of PCs and remained basically unchanged after storage.
Granulocyte storage and antigen stability
Authors: Chun H. , Cipolone K. , Procter J. , Stroncek D.F.
Published: March 2003

BACKGROUND: Current methods for the detection of granulocyte antibodies require panels of freshly isolated cells. This makes these assays time‐consuming, costly, and technically difficult.

STUDY DESIGN AND METHODS: The immunofluorescence method of detecting the binding of antibodies to granulocytes was modified for use with a flow cytometer, and methods were tested to store granulocytes for use in that assay. Granulocytes were stored at 4°C for 7 days under three conditions: 1‐percent formaldehyde‐fixed cells were stored in Hanks' balanced salt solution (HBSS); untreated cells were stored in tissue culture medium (RPMI‐1640); and cells were fixed and stored with a commercial white cell‐storage solution (Cyto‐Chex Reagent). Antigen stability was evaluated by using monoclonal antibodies (MoAbs) and alloantibodies. Serologic studies were done by an indirect immunofluorescence assay and assessed by flow cytometric analysis.

RESULTS: On Day 2, only 2 to 7 percent of granulocytes stored in RPMI‐1640 remained. On Day 7, 67 to 76 percent of granulocytes fixed in formaldehyde and stored in HBSS remained, and 47 to 87 percent of granulocytes stored in a white cell‐storage solution remained. All antigens were detectable by the MoAbs and alloantisera on Day 7. However, nonspecific staining by the fluorescein isothiocyanate (FITC)‐conjugated secondary antibody hindered interpretation of test results on Day 4. Nonspecific staining occurred over time and was associated with increased cell permeability during storage. Two sources of nonspecific staining were identified. The first source was the FITC‐conjugated secondary antibody; it was eliminated by switching to a phycoerythrin conjugate. The second source was factors in human serum; it was resolved by examining only viable, impermeable cells identified by using 7‐aminoactinomycin‐D.

CONCLUSION: Granulocytes and their antigens can be preserved for at least 7 days, but evaluation of antibody reactions was possible for only 4 days as a result of nonspecific staining due to enhanced membrane permeability of dying cells.
Serology of antibodies to second‐ and third‐generation cephalosporins associated with immune hemolytic anemia and/or positive direct antiglobulin tests
Authors: Arndt P.A. , Leger R.M. , Garratty G.
Published: March 2003

BACKGROUND: First‐generation cephalosporins rarely caused immune hemolytic anemia (IHA). Second‐ and third‐generation cephalosporins, especially cefotetan and ceftriaxone, are increasingly associated with severe, sometimes fatal IHA.

STUDY DESIGN AND METHODS: Samples from 53 patients with drug‐induced IHA and/or positive direct antiglobulin test (DAT) were tested. Patients' sera were tested against drug‐treated red cells (RBCs) and untreated or enzyme‐treated RBCs, with and without the addition of drug solution. Eluates from patients' RBCs were tested against drug‐treated and untreated RBCs.

RESULTS: Forty‐three patients had antibodies to cefotetan, 8 to ceftriaxone, 1 to cefoxitin, and 1 to cefotaxime. All patients had a positive DAT; only anti‐cefoxitin and anti‐cefotetan were demonstrable in RBC eluates. Sera containing anti‐cefoxitin, anti‐cefotaxime, and anti‐cefotetan reacted with drug‐treated RBCs (100%) and untreated or enzyme‐treated RBCs in the presence of drug (98% or 100%, respectively). All of the ceftriaxone antibodies reacted with untreated or enzyme‐treated RBCs in the presence of drug, but those tested did not react with ceftriaxone‐treated RBCs. In addition to cefotetan‐dependent antibodies, 19 (44%) and 14 (33%) of 43 sera contained drug‐independent antibodies when tested with and without the presence of a polyethylene glycol potentiator, respectively.

CONCLUSION: Cefotetan is by far the most common cause of drug‐induced IHA. All cefotetan antibodies and the single examples of cefoxitin and cefotaxime antibodies reacted with drug‐coated RBCs, and most, in contrast to the reactions of antibodies to first‐generation cephalosporins (e.g., cephalothin), also reacted with RBCs (not treated with drug) in the presence of the drug. Ceftriaxone antibodies reacted only by the latter mechanism. Drug‐independent antibodies (i.e., those reacting without any drug being present) were detected in 33 to 44 percent of patients' sera containing cefotetan antibodies, depending on the sensitivity of the method used.
Lack of difference in cytomegalovirus transmission via the transfusion of filtered‐irradiated and nonfiltered‐irradiated blood to newborn infants in an endemic area
Authors: Ohto Hitoshi , Ujiie N. , Hirai K.
Published: March 2003

BACKGROUND: It is accepted that white cells contained in blood components are the most significant source of cytomegalovirus (CMV) infection in immunocompromised and immunodeficient recipients.

STUDY DESIGN AND METHODS: To determine whether white cell filtration of blood would be effective in preventing infection among newborn transfusion recipients in a hyperendemic area, a randomized study was performed. All donor blood units were irradiated before issue to prevent posttransfusion graft‐versus‐host disease. Recipients were monitored for CMV infection by seroconversion (development of IgM anti‐CMV) and CMV‐DNA isolation.

RESULTS: Three (9%) of 33 infants who received filtered blood and 1 (5%) of 19 infants given nonfiltered blood were infected with CMV, as determined by the presence of IgM anti‐CMV and/or CMV DNA isolation. There was no significant difference in the rate of CMV infection in the two groups.

CONCLUSION: The CMV infection observed in the study may come from other routes such as breastfeeding, rather than from transfusion. Our findings suggest that the routine use of white cell‐reduction filtration to reduce the risk of transmitting CMV is unwarranted for neonates in endemic regions.
An analysis of errors in blood component transfusion records with regard to quality improvement of data acquisition and to the performance of lookback and traceback procedures
Authors: Zimmermann Robert Zimmermann , Linhardt Christian , Weisbach Volker , Büscher Marcus , Zingsem Jürgen , Eckstein Reinhold
Published: March 2003

BACKGROUND: Quality assurance of blood transfusion covers institutions, personnel, and procedures involved in preparing, issuing, and using blood components. The accuracy of data related to blood component transfusions is a tool for quality control in the transfusion service.

STUDY DESIGN AND METHODS: A study of the accuracy of data records of the transfusion service at the University Hospital of Erlangen, Germany, between June 1994 and May 1996 was carried out. All returned blood component transfusion report forms were examined for discrepancies between primary data records and clinical transfusion reports.

RESULSTS: Blood components (n = 49,224) from allogeneic and autologous donations, packed red cells, fresh‐frozen plasma, and platelet components that had been issued for transfusion were included in this evaluation. For 27.3 percent of all components issued, no transfusion report was returned to the blood bank. For the remaining 35,786 units, errors were found in 3.8 percent of the records. For 1.24 percent of all components, discrepant information related to the recipient's identity or the component's status was found; this affected the feasibility of lookback or traceback searches.

CONCLUSION: A remarkably high frequency of discrepancies exists between computerized blood bank records and the information recorded on returned blood transfusion forms. The processes of data acquisition and entry must be included in quality assurance efforts in transfusion medicine.
Successful mobilization of peripheral blood HPCs with G–CSF alone in patients failing to achieve sufficient numbers of CD34+ cells and/or CFU–GM with chemotherapy and G–CSF
Authors: Fraipont V. , Sautois B. , Baudoux E. , Pereira M. , Fassotte M.‐F. , Hermanne J.‐P. , Jérusalem G. , Longrée L. , Schaaf‐Lafontaine N. , Fillet G. , Beguin Y.
Published: March 2003

BACKGROUND: Mobilization with chemotherapy and G–CSF may result in poor peripheral blood HPC collection, yielding <2 × 106 CD34+ cells per kg or <10 × 104 CFU–GM per kg in leukapheresis procedures. The best mobilization strategy for oncology patients remains unclear.

STUDY DESIGN AND METHODS: In 27 patients who met either the CD34 (n = 3) or CFU–GM (n = 2) criteria or both (n = 22), the results obtained with two successive strategies—that is, chemotherapy and G–CSF at 10 μg per kg (Group 1, n = 7) and G–CSF at 10 μg per kg alone (Group 2, n = 20) used for a second mobilization course—were retrospectively analyzed. The patients had non‐Hodgkin's lymphoma (5), Hodgkin's disease (3), multiple myeloma (5), chronic myeloid leukemia (1), acute myeloid leukemia (1), breast cancer (6), or other solid tumors (6). Previous therapy consisted of 10 (1‐31) cycles of chemotherapy with additional chlorambucil (n = 3), interferon (n = 3), and radiotherapy (n = 7).

RESULTS: The second collection was undertaken a median of 35 days after the first one. In Group 1, the results of the two mobilizations were identical. In Group 2, the number of CD34+ cells per kg per apheresis (0.17 [0.02‐0.45] vs. 0.44 [0.11‐0.45], p = 0.00002), as well as the number of CFU–GM (0.88 [0.00‐13.37] vs. 4.19 [0.96‐21.61], p = 0.00003), BFU–E (0.83 [0.00‐12.72] vs. 8.81 [1.38‐32.51], p = 0.00001), and CFU‐MIX (0.10 [0.00‐1.70] vs. 0.56 [0.00‐2.64], p = 0.001134) were significantly higher in the second peripheral blood HPC collection. However, yields per apheresis during the second collection did not significantly differ in the two groups. Six patients in Group 1 and 18 in Group 2 underwent transplantation, and all but one achieved engraftment, with a median of 15 versus 12 days to 1,000 neutrophils (NS), 22 versus 16 days to 1 percent reticulocytes (NS), and 26 versus 26 days to 20,000 platelets (NS), respectively. However, platelet engraftment was particularly delayed in many patients.

CONCLUSION: G–CSF at 10 μg per kg alone may constitute a valid alternative to chemotherapy and G–CSF to obtain adequate numbers of peripheral blood HPCs in patients who previously failed to achieve mobilization with chemotherapy and G–CSF. This strategy should be tested in prospective randomized trials.
Transfusion errors in New York State: an analysis of 10 years' experience
Authors: Linden Jeanne V. , Wagner Kathleen , Voytovich Anthony E. , Sheehan Joseph
Published: March 2003

BACKGROUND: While public focus is on the risk of infectious disease from the blood supply, transfusion errors also contribute significantly to adverse outcomes. This study characterizes such errors.

STUDY DESIGN AND METHODS: The New York State Department of Health mandates the reporting of transfusion errors by the approximately 256 transfusion services licensed to operate in the state. Each incident from 1990 through 1998 that resulted in administration of blood to other than the intended patient or the issuance of blood of incorrect ABO or Rh group for transfusion was analyzed.

RESULTS: Erroneous administration was observed for 1 of 19,000 RBC units administered. Half of these events occurred outside the blood bank (administration to the wrong recipient, 38%; phlebotomy errors, 13%). Isolated blood bank errors, including testing of the wrong specimen, transcription errors, and issuance of the wrong unit, were responsible for 29 percent of events. Many events (15%) involved multiple errors; the most common was failure to detect at the bedside that an incorrect unit had been issued.

CONCLUSION: Transfusion error continues to be a significant risk. Most errors result from human actions and thus may be preventable. The majority of events occur outside the blood bank, which suggests that hospitalwide efforts at prevention may be required.
Preoperative predictors of the need for allogeneic blood transfusion in lung cancer surgery
Authors: Cirasino Lorenzo , Barosi Giovanni , Torre Massimo , Crespi Stefano , Colombo Paola , Belloni Pier Angelo
Published: March 2003

BACKGROUND: The use of blood‐saving techniques in elective surgery can produce a favorable cost‐benefit ratio only when there is a reasonable likelihood that transfusion will be required. To apply a targeted blood‐sparing technique in lung cancer surgery, the patient's preoperative characteristics that predict the use of allogeneic blood transfusion (ABT) in this practice were investigated.

STUDY DESIGN AND METHODS: One hundred seventy‐three consecutive patients who underwent primary lung cancer surgery were included in this retrospective study. Clinical and epidemiologic variables, lung tumor extension (TNM staging), and surgery type were analyzed by logistic regression to discover the preoperative predictors of ABT.

RESULTS: Thirty patients, 17.3 percent of all who underwent surgery and 19.9 percent of those who underwent resolvent surgery, received ABT. Excluding a patient who needed 18 units of RBCs, the number of ABT units required by transfused patients was 1.93 ± 0.88 (mean ± SD). Extensive surgery, patient's age (≤64 years), and elevated erythrocyte sedimentation rate (>45 mm/hour) were the preoperative variables that influenced the need for ABT. The definitive predictive model was able to recognize 82.3 percent of patients who received ABT and 95.6 percent of those who did not.

CONCLUSION: A predictive model can preoperatively identify patients at risk for needing ABT in lung cancer surgery. The model could be utilized to tailor blood‐sparing intervention programs.
Completely converting a blood service region to the use of safer plasma
Authors: McCarthy Leo J. , Danielson Constance F.M. , Rothenberger Sandra S. , Parker Carol , Weidner John , Miraglia Charles , Matus Deborah , Waxman Dan
Published: March 2003

BACKGROUND: Three types of plasma are widely available for transfusion. Two plasma components, FFP donor retested (FFP‐DR), and solvent/detergent‐treated plasma (SDP), are now considered to be safer from infectious complications than FFP.

STUDY DESIGN AND METHODS: A large regional blood center attempted to provide FFP‐DR exclusively to all its 42 hospitals. Significant planning, increases in computer capabilities, and expansion of component storage areas were completed before initiation of this program.

RESULTS: During the first 6 months of the FFP‐DR program, the blood center was not able to supply the entire region exclusively with FFP‐DR. Consequently, SDP was utilized to supplement the program and to successfully and completely convert the region's 42 hospitals to the use of safer plasma.

CONCLUSION: Two new plasma components were utilized to completely convert a blood service region to the use of safer plasma.
Donor neutrophil function after plateletpheresis
Authors: Western Karoline H. , Videm Vibeke
Published: March 2003

BACKGROUND: Neutrophils are important mediators of inflammation and may be activated by foreign surfaces in apheresis systems. Because most of the WBCs are returned to the donor, it was investigated whether artificial activation leads to altered donor neutrophil function.

STUDY DESIGN AND METHODS: Three apheresis systems (Amicus, Autopheresis‐C, and CS‐3000; all: Baxter Fenwal) were investigated. Preapheresis and postapheresis blood samples were drawn from 10 volunteer donors, with all three apheresis systems used in random order for each donor. Changes in neutrophil phagocytic ability, oxidative burst, and expression of l‐selectin and CD11b were measured by flow cytometry, and plasma concentrations of myeloperoxidase and lactoferrin were measured by EIA. Complement activation was evaluated by quantification of C3bc and the terminal complement complex by EIA.

RESULTS: Neutrophil expression of l‐selectin increased after apheresis (p = 0.02), and the production of oxygen radicals was reduced (p = 0.01). This effect was possibly a result of priming. Complement was not activated. There were no significant differences in neutrophil function after apheresis with any of the three apheresis systems.

CONCLUSIONS: Neutrophil function was altered after apheresis, although to a very small extent, and contact between neutrophils and the foreign surface in the apheresis systems is found to be a biotolerant procedure.
Detecting failed WBC‐reduction processes:a quality assurance program introduced in a blood center
Authors: Adams Melanie R. , Hirschler Nora V. , Papenfus Linda , Heaton William A.
Published: March 2003

BACKGROUND: Pragmatic yet statistically valid quality assurance (QA) programs are necessary so that blood centers can select, validate, and monitor their WBC‐reduction processes. A QA system for WBC‐reduction processes based on the practical application of statistical theory within a large blood center was developed. The system identifies parameters for procedure and component evaluation and provides sample size and formatting suggestions.

STUDY DESIGN AND METHODS: Analyses of both procedure and component performance were undertaken during the purchase, validation, and control of filtration and apheresis WBC‐reduction processes at Blood Centers of the Pacific from 1997 through 1999. QA analysis was categorized on the basis of whether the process was new to the organization or was a modification of a previously validated system. The numbers of samples necessary to consistently detect failure in platelet yield, unit volume, pH, and WBC count was statistically determined by parametric and nonparametric techniques.

RESULTS: Parametric analysis (power analysis) of the mean ± SD of smaller numbers of samples was highly sensitive to shifted distributions, but only if the shift was normally distributed. Nonparametric analysis, necessary when the nature of the underlying distribution is unknown, suggested a minimal sample of 40 was required to achieve high confidence that significant bimodal failure (a secondary population with WBCs 5% above the cutoff) would be detected.

CONCLUSION: A QA system, developed for the evaluation of new or revised WBC‐reduction processes, was based on statistical analysis of normally and non‐normally distributed process failure. The number of samples was determined that allowed the achievement of confidence and tolerance levels considered appropriate within the blood center. Suggestions for outlier evaluation and a format for performance documentation have also been developed. To better define blood center quality goals, further research is necessary on donor and component biologic variability and the most significant modes of WBC‐reduction process failure.
Autoimmune hemolytic anemia caused by IgG λ‐monotypic cold agglutinins of anti‐Pr specificity after rubella infection
Authors: König Andreas L. , Schabel Angela , Sugg Udo , Brand Ulrich , Roelcke Dieter
Published: March 2003

BACKGROUND: In postinfection cold agglutinin (CA) disease, a relation between CA specificity and the underlying infectious agent has been observed. The induction of anti‐I by Mycoplasma pneumoniae and that of anti‐i by EBV are well‐established examples.

CASE REPORT: A 5‐year‐old boy developed severe hemolytic anemia after serologically ascertained rubella infection. Hemolysis was caused by high‐titer CAs, which were analyzed by absorption and elution with sialidase‐treated RBCs and hemagglutination‐inhibition experiments.

RESULTS: After elimination of normal anti‐I and anti‐T, the predominant CA was found to be an IgGλ autoantibody with anti‐Pr1 specificity.

CONCLUSION: This case seems to be of interest because it is the first report of severe CA‐induced hemolysis after rubella infection, it is the first description of an IgGλ‐monotypic CA, and, along with previous case reports (three established and three suspected cases), it indicates a relationship between rubella infection and the CA specificity anti‐Pr.
Comprehensive analysis of citrate effects during plateletpheresis in normal donors
Authors: Bolan Charles D. , Greer Sarah E. , Cecco Stacey A. , Oblitas Jaime M. , Rehak Nadja N. , Leitman Susan F.
Published: March 2003

BACKGROUND: Although plateletpheresis procedures are generally well tolerated, the clinical and metabolic consequences associated with rapid infusion of up to 10 g of citrate are underappreciated, and a comprehensive description of these events is not available.

STUDY DESIGN AND METHODS: Clinical and laboratory changes were studied in seven healthy donors undergoing three 90‐minute plateletpheresis procedures each, at continuous, fixed citrate infusion rates of 1.1, 1.4, and 1.6 mg per kg per minute.

RESULTS: Serum citrate levels increased markedly with increasing citrate infusion rates and did not achieve a stable plateau. As citrate infusion rates increased, the total volume processed and platelet yields also increased, but donor symptoms became more severe. Ionized calcium (iCa) and ionized magnesium (iMg) concentrations decreased markedly, by 33 and 39 percent below baseline, respectively, at a citrate rate of 1.6 mg per kg per minute. Intact parathyroid hormone levels were higher at 30 minutes than at later time points, despite progressive decreases in iCa and iMg. Urine citrate, calcium, magnesium, sodium, and potassium concentrations and urine pH values increased markedly during all procedures.

CONCLUSION: Marked, progressive increases in serum citrate levels occur during plateletpheresis, accompanied by symptomatic decreases in iCa and iMg, with significantly increased renal excretion of calcium, magnesium, and citrate.
Confidence in the safety of blood for transfusion: the effect of message framing
Authors: Farrell Kathleen , Ferguson Eamonn , James Virge , Lowe Kenneth C.
Published: March 2003

BACKGROUND: Blood transfusion is a universally used, life‐saving medical intervention. However, there are increasing concerns among patients about blood safety. This study investigates the effect of message framing, a means of presenting information, on confidence in blood transfusion safety.

STUDY DESIGN AND METHODS: The same factual information regarding the safety of blood for transfusion was presented to a sample of 254 adult students (donors and nondonors) as either a gain frame (lives saved), a loss frame (lives lost), or a combined frame (a loss frame expressed in a positive context). This provided a basic two‐way, between‐subjects design with 1) blood donation history (donors vs. nondonors) and 2) message frame (gain, loss, and combined) functioning as the between‐groups factors. It was hypothesized that participants would consider blood safer if information was presented as a gain frame. The role of stress appraisals as potential mediators of the framing effect was also explored.

RESULTS: As predicted, participants receiving the gain‐frame information were significantly more confident of the safety of blood for transfusion than those receiving loss‐frame information or both. This was unaffected by donation history or appraisals of stress associated with transfusion. The extent to which blood was considered safe was negatively associated, independently of framing effects, with perceptions that transfusion was threatening.

CONCLUSION: Information about transfusion should be conveyed to patients in a form focusing on the positive, rather than the negative, known facts about the safety of blood.