bluuebunny/crossref_metadata_2025 huggingface dataset:
Infective, chronic carriers of Hepatitis C virus among blood donors with no history of clinical hepatitis
Authors: Larsen J. , Skaug K. , Maeland A. , Hetland G. , Stoervold G.
Published: April 2008

Summary. We investigated the infectivity of three hepatitis C virus antibody (anti‐HCV) positive blood donors with either hepatitis B core antibodies (anti‐HBc) (Nos 1 and 2) or raised alanine aminotransferase (ALT) (No. 3). The 57 recipients of blood products from these donors during the period 1971–1990 were identified and the living 23 were tested for anti‐HCV. Among these, 11 out of 14 (78%) recipients from Nos 1 and 2, and 1 out of 9 (11 %) recipients from No. 3 were anti‐HCV positive. The former donors had high titres of anti‐C 100‐3 and high rating scores in the HCV recombinant immunoblot assay (RIBA). They were evidently infective, chronic carriers of HCV but had no clinical signs or medical history of hepatitis. The latter donor had low titres of anti‐C100‐3 and a low RIBA rating score. She had clinical signs of chronic hepatitis and persistently elevated ALT, but only one of her recipients was anti‐HCV positive.
Semi‐quantitative assay of D antigen site density by flow cytometric analysis
Authors: Nicholson G. , Lawrence A. , Ala F. A. , Bird G. W. G.
Published: April 2008

Summary. This study describes the comparative measurement of D antigen site density using a fluorescent indirect antiglobulin test (FIAT) read by flow cytometry. The test results confirmed the continuum of D antigen strength from weakest D through to R2R2 and also allowed the majority of weak D samples to be adequately distinguished from D‐negative samples.
Post‐transfusion hepatitis C in Finland
Authors: Ebeling F. , Naukkarinen R. , Leikola J.
Published: April 2008

Summary. Six of 11 (55%) non‐A, non‐B hepatitis (NANBH) patients seroconverted to hepatitis C virus antibody (anti‐HCV) positivity 8–16 weeks after transfusions in a prospective post‐transfusion hepatitis study on 685 open‐heart surgery patients in Finland. Five of them had a seropositive donor, and two of the five non‐converted NANBH patients had received an anti‐HCV positive unit. Among 36 studied donors who were positive in the anti‐HCV ELISA, reactivity of both the antigen bands in a recombinant immunoblot assay (RIBA) for anti‐HCV was significantly associated with NANBH (P < 0·00005) in the recipient. In addition, infective anti‐HCV positive donors had raised ALT values more often than seropositive donors which caused no seroconversion or infection in the recipients (P= 0·0001).
Follow‐up study on 24 patients with nomifensine‐induced immune haemolytic anaemia
Authors: Giers G. , Salama A. , Mxteller‐Eckhardt C.
Published: April 2008

Summary. There is as yet only scarce information regarding the natural history and long‐term clinical sequelae of patients who survive the acute complications of severe drug‐related immune haemolysis, the effect of the mode of drug administration for sensitization and possible alterations of serological characteristics of drug‐dependent antibodies during the post‐sensitization period. We therefore followed 24 patients with nomifensine‐induced haemolytic anaemia for up to 6 years after the haemolytic attack. All patients had suffered from a severe haemolytic episode. None of the patients showed any abnormal findings upon reinvestigation (complete history and physical examination; extended biochemical and haematological laboratory status), particularly with respect to renal function. Drug‐dependent antibodies remained detectable in 19 of 21 sera, while drug‐independent autoantibodies, demonstrable in six patients during the acute phase of haemolysis, could no longer be detected. With regard to the mode of drug administration, the majority of patients (15 out of 24) had developed the haemolysis at the beginning (immediately after a single dose) or during a second course of drug therapy (n= 8 and 7, respectively). The immune response did not appear to be dose‐ or time‐dependent. This study confirms the benign long‐term prognosis of patients who survive life‐threatening complications in drug‐induced immune haemolytic anaemia. In addition, it indicates that drug‐dependent antibodies may remain detectable over long periods of time, and that irregular drug administration might be associated with a higher risk of drug sensitization.
A pilot study of antithrombin replacement in intensive care management: the effects on mortality, coagulation and renal function
Authors: Harper P. L. , Williamson L. , Park G. , Smith J. K. , Carrell R. W.
Published: April 2008

Summary. A prospective, randomized, controlled trial to examine the effects of antithrombin supplementation on mortality, coagulation and renal function has been carried out on 132 intensive care patients. Antithrombin activity was measured in all patients on admission to the intensive care unit (ICU). Patients with an antithrombin activity of less than 70% were randomized to either receive antithrombin replacement or to act as controls. Antithrombin activity was maintained above 70% in the treated patients throughout their stay on ICU. Ninety‐three patients had an antithrombin activity of less than 70% and 35 received replacement therapy. Patients with antithrombin activity below 70% remained on the ICU significantly longer and had a significantly higher mortality rate than patients with antithrombin activity above 70%. Antithrombin supplementation neither reduced mortality nor shortened the intensive care stay. Fifty patients with reduced antithrombin activity remained on the ICU for at least 4 days, 25 received antithrombin and 25 acted as controls; coagulation parameters and renal function have been monitored in these patients. Fibrinogen concentration and platelet count were unaffected by antithrombin replacement. Antithrombin supplementation did not appear to reduce the incidence of impaired renal function in sepsis, trauma and postoperative patients. The creatinine clearance fell below 20 ml/min in eight patients in the no‐treatment arm while by comparison only three patients in the treatment arm developed impaired renal function. Our study does not demonstrate a clear role for the use of antithrombin supplementation in intensive care, however the finding that antithrombin reduced renal impairment is encouraging and a larger study to confirm this finding is at present underway.
Evaluation of the ID‐gel test for antibody screening and identification
Authors: Bromilow I. M. , Adams K. E. , Hope J. , Eggington J. A. , Duguid J. K. M.
Published: April 2008

Summary. A gel technique for the detection of red blood cell (rbc) antigen‐antibody reactions was evaluated for use in antenatal antibody screening and identification procedures. The evaluation was undertaken on 3,900 random antenatal samples. Results obtained in the gel test system were compared with those obtained from parallel testing using conventional serological methods. The ID gel system detected 148 (3·7%) red cell antibodies, compared with 95 (2·4%) using traditional techniques. The number of non‐specific antibodies and false‐positive screens were reduced using the gel test system. Antibody titres performed using the gel system were more sensitive than with our tube 1AT method. The gel system was easy to use and gave reliable, reproducible results. Antibody detection rates were enhanced compared with our existing routine techniques.
Evaluation of a solid phase red cell adherence technique for platelet antibody screening
Authors: Lown J. A. G. , Ivey J. G.
Published: April 2008

Summary. Solid‐phase red‐cell adherence (SPRCA) techniques in platelet serology are used mainly for crossmatching. A SPRCA method for general diagnostic application was evaluated in parallel with the platelet suspension immunofluorescence test (PIFT). Of 149 patient sera sent for investigation of thrombo‐cytopaenia, 76 were negative and 59 positive when studied by both methods, eight positive by PIFT only and six positive by SPRCA only. The reactivity observed for 24 sera containing HLA antibodies tested with chloroquine‐treated and untreated platelets was similar for both methods. All of 14 sera containing quinine‐associated antibodies reacted strongly to both techniques in the presence of added quinine. In comparison, however, whereas all sera were non‐reactive to SPRCA in the absence of added quinine, and with PIFT, seven of the sera reacted weakly. Titration studies with three examples of anti‐PlA1 and five sera containing HLA antibodies generally showed a one doubling dilution lower titre with the SPRCA procedure. End‐point interpretation, however, was more readily achieved with the SPRCA method. The SPRCA technique displays similar sensitivity and specificity to the PIFT and is recommended for use by routine hospital laboratories to screen platelet antibodies.
Promoting blood donation: a study of the social profile, attitudes, motivation and experience of donors*
Authors: Moore R. J.
Published: April 2008

Summary. This study investigated how to improve the recruitment of blood donors, their retention as active donors and their response to call‐up. A total sample of 9,000 non‐donors, lapsed donors and current donors was examined in three programmes to determine the sex, age and social profile of donors; the attitudes of the population to blood donation; the motivating forces prompting people to give blood; the de‐motivating forces preventing them; the image of the blood donor in society and the image of the National Blood Transfusion Service (NBTS). The profile of blood donors, with small variations, reflects that of the population. The experience of blood donation is widespread with 27% of the population either current or lapsed donors. The image of both blood donors and the NBTS was found to be very positive. The main force motivating donors is an awareness of patient need complemented by awareness that the need may one‐day be personal. NBTS strategy will concentrate on reinforcing the need for blood donors and enhancing the experience of donors at blood donor sessions.
Quantification of IgG on erythrocytes of patients and normals by a radio‐ligand‐binding assay
Authors: Giles C. M. , Davies K. A. , Loizou S. , Moulds J. J. , Walport M. J.
Published: April 2008

Summary. A monoclonal IgG anti‐human IgG, 1B12, was used in a radio‐ligand‐binding assay to quantify IgG on erythrocytes of patients and normals. The assay detected a range of 10–700 IgG molecules. Good correlation was achieved between the number of molecules and the strength of agglutination in antiglobulin tests performed in capillary tubes. The assay was capable of detecting subagglutinating immune bound IgG on erythrocytes from patients with systemic lupus erythematosus (SLE).
The preservative‐exchange method using a sextuple‐bag system for a 10‐week storage period of red blood cells
Authors: Ohkuma S. , Miyahara M. , Nishizaki T.
Published: April 2008

Summary. Prolonged storage of red blood cells in a liquid state was achieved by replacing the preservative using a sextuple‐bag system. The bag system consists of one primary bag containing citrate‐phosphate‐dextrose (CPD) solution, three satellite bags containing saline‐adenine‐glucose‐phosphate‐maltose (SAGP‐maltose) solution, and two empty satellite bags to remove plasma and buffy coat. Preservative can be exchanged three times in this closed system. The system is able to supply nutrients, such as glucose, and to remove harmful metabolites, such as lactic acid, by exchanging the preservative during storage. As a result, red cells stored by this method showed much higher levels of total adenylate and morphological score after the second preservative exchange, when compared with red cells stored by the conventional method (P < 0·01). Judging from these two in‐vitro parameters, red cells may tolerate storage for at least 10 weeks in a liquid state. This method might be useful for ‘predeposit autologous transfusion’, as it is more convenient and more cost effective than the freeze‐preservation method.
Lipolytic enzyme and phospholipid level changes in intraoperative salvaged blood
Authors: Langton S. R. , Sieunarine K. , Lawrence‐Brown M. M. D. , Goodman M. A. , Prendergast F. J. , Hellings M.
Published: April 2008

Summary. Autotransfusion is becoming increasingly popular, mainly because it eliminates the risk of disease transmission. One of the techniques available is intra‐operative blood salvage and retransfusion with or without washing of the collected blood. The blood collected during this process is subjected to a variety of chemical and physical insults which can alter the normal composition of the plasma by activating plasma and cellular homeostatic mechanisms. In this study, we measured the plasma levels of total phospholipids, lysolecithin and non‐esterified fatty acids, and the lipolytic enzymes phospholipase A2 (PLA2) and lipase in the salvaged blood before and after washing. In the unwashed salvaged blood the mean levels of PLA2, non‐esterified fatty acids and lysophospholipids increased by 144, 96 and 149%, respectively, while those of total phospholipids and lipase did not change to any extent. All these substances were reduced to well below the patients circulating plasma levels by washing the collected blood. The changes indicate that the lipid profile of salvaged blood is significantly altered and that potentially dangerous substances such as PLA2and its metabolites, lysolecithin and non‐esterified fatty acids, are present in increased amounts. Washing the blood is recommended prior to reinfusion.
Is there a wastage of resources due to non‐specificity of anti‐HIV ELISAs?
Authors: Rodriguez M. A. , Runganga J. , Contreras M. , Ahya R. , Barbara J. A. J.
Published: April 2008

Summary. A library of anti‐HIV ELISA ‘grey‐area’ and repeatably reactive samples sent for confirmatory testing, were retested using a second technique, the modified (Fujirebio Gelatin Particle) agglutination test (MAT). On testing 224 grey‐area reactive samples, only four were found to be reactive with this second test. On retesting a further 259 ELISA repeatably reactive samples, of which only 33 were confirmed to be anti‐HIV‐1, only 45 were reactive by MAT; these included the 33 confirmed as positive samples, thereby reducing the false‐positives from 226 to 12. The introduction of this second technique supported our decision to cease the referral of grey‐area samples. It also demonstrated the high prevalence of non‐specificity of repeatable reactivity associated with some of the most specific ELISA kits currently available.
A new low‐frequency platelet alloantigen, Vaa, on glycoprotein IIbIIIa associated with neonatal alloimmune thrombocytopenia
Authors: Kekomäki R. , Raivio P. , Kero P.
Published: April 2008

SUMMARY. We describe platelet alloimmunization which caused severe thrombocytopenia in a neonate and could only be detected by testing the father's platelets. The platelet‐specific antibodies were identified by a monoclonal antibody‐immobilized platelet protein assay (MAIPA) using monoclonal antibodies against glycoprotein (GP) IIbIIIa complex (AP2 and 2G12). The previously described alloantigen systems on the GPIIbIIIa complex (HPA 1, HPA 3 or HPA 4) were not responsible for the reaction. In addition the newly described private platelet antigen Sra was not identical to the antigen. The antigen is therefore different from all known platelet alloantigens and was designated Vaa. The antigen was present on the platelets of the affected child. Family studies showed that the platelet antigen was transmitted as an autosomal dominant trait in three generations. No Va (a+) individuals were found in a population study of 250 blood donors, which indicates that the antigen is of low frequency in the Finnish population. The Va antigen was not detectable by immunoblot analysis, which suggests that the epitope may not be a linear peptide structure. The antigen was also destroyed by solubilization of platelets. Thrombin activation of platelets, known to increase the expression of GPIIbIIIa on platelets, did not increase the number of binding sites for anti‐Vaa antibodies to the extent observed with anti‐HPA la binding.
The use of the antiglobulin ‘gel‐test’ for antibody detection
Authors: Phillips P. K. , Whitton C. M. , Lavin F.
Published: April 2008

SUMMARY. Four antibodies used routinely in‐house for the assessment of antiglobulin reagents (anti‐Fyb, anti‐Jka, anti‐S) were tested in parallel using tube and antiglobulin ‘gel‐test’ low ionic strength antiglobulin techniques. In the latter the red cells are centrifuged following incubation through a dextran matrix incorporating an anti‐human globulin reagent. The results show that the antiglobulin ‘gel‐test’ was less sensitive than the tube technique in the detection of these difficult antibodies.
The A1 (B) phenomenon: a monoclonal anti‐B (BS‐85) demonstrates low levels of B determinants on A1 red cells
Authors: Voak D. , Sonneborn H. , Yates A.
Published: April 2008

SUMMARY. A monoclonal anti‐B (BS 85) that reacts strongly with red cells from weak B variants (B3, Bint and Bv) has demonstrated the presence of a trace of B on A1 red cells. The agglutination of group A1 red cells by an anti‐B antibody is called the A1 (B) phenomenon and is the converse of the B(A) phenomenon seen with certain monoclonal anti‐A antibodies.

Fragile A1 (B) agglutination is best seen by spin‐tube techniques and A1 red cells negative in saline tests are agglutinated by albumin and protease enzyme‐enhanced tests, but no reactions are seen with A2 red cells. The A1 (B) reaction is specifically inhibited by B substance, and D‐galactose and the galactose‐containing sugars melibiose and lactose. Red cells from B variants showed differential inhibition patterns with various sugars.

A1 transferase levels were normal even in the strongest A1 (B) reactive blood samples, although the plasma H transferase levels and H status of these red cells were elevated. This is in contrast to the B(A) phenomenon which is associated with elevated levels of B transferase. It is suggested that A1(B) overlapping specificity can occur because of a combination of higher H activity (and thus more H sites) together with normal levels of A transferase activity as they are 20% higher than normal levels of B transferase.

The production of anti‐B reagents free of the A1 (B) phenomenon with BS‐85 is achieved by suitable dilution using quality control tests with protease‐treated A1 red cells. BS 85 anti‐B supernatant binds so strongly to B cells that it elutes only weakly by heat methods and therefore the B antigen cannot be demonstrated by the elution technique.
Predictive markers for hepatitis C antibody ELISA specificity in Australian blood donors
Authors: Hyland C. A. , Kearns S. , Young I. F. , Battistutta D. , Morgan C. L.
Published: April 2008

SUMMARY. The hepatitis C antibody reactivity rate in 91,748 blood donors tested using the ORTHO HCV C‐100 ELISA system was 0.51%. Specificity of ELISA positive reactions was measured using a recombinant immunoblot assay (RIBA). The aim of this study was to identify markers in ELISA positive donors which were predictive of a RIBA positive result.

Samples from 430 ELISA positive donors were tested by the first generation RIBA, RIBA‐1, which incorporates two HCV peptides C‐100 and 5‐1–1. Fifty‐five per cent (236) were positive and 19% (83) indeterminate. Multivariate analysis of gender, age, HCV ELISA OD ratio, alanine aminotransferase (ALT) status and hepatitis B core antibody (anti‐HBc) status identified age, magnitude of HCV ELISA OD ratio and anti‐HBc status as the only independent predictors of a positive RIBA‐1 result. The relative odds of being RIBA‐1 positive were 4.6‐fold (95% CI 1.3–16.4) higher among donors aged 25–34 years compared with donors less than 25 or greater than 44; 6.1‐fold (2.1–17.9) higher if the donor was anti‐HBc positive and 273.4‐fold (30.9–2417) higher if the HCV ELISA OD ratio was greater than 5.98 compared to those with a ratio less than 1.77. Seventy‐eight of the 83 RIBA‐1 indeterminates were tested on the second generation RIBA, RIBA‐2, which includes two additional HCV peptides, C22 and C33c. Thirty‐one per cent (24) were positive and 41% (32) were negative. Multivariate analysis showed that the presence of an elevated ALT level and anti‐HBc were the only independent predictors of a RIBA‐1 indeterminate result resolving as positive on RIBA‐2.
A survey of cold‐growing Gram‐negative organisms isolated from the skin of prospective blood donors
Authors: Stenhouse M. A. E. , Milner L. V.
Published: April 2008

SUMMARY. The skin of the antecubital fossae of 90 subjects, chosen at random but eligible to be blood donors, was sampled using sterile swabs. This sampling was done prior to disinfection. The swabs were inoculated into a selective culture medium and ‘incubated’ at blood bank refrigerator temperature for a total of 6 weeks. The results show that there were a number of cold‐growing Gram‐negative bacilli (GNB) on the skin tested. One of the GNB carriers found was subjected to frequent testing both before and after skin disinfection. The routine skin disinfection regime for blood donors was used in an attempt to establish its effectiveness. Despite regularly being able to culture Pseudomonas fluorescens prior to swabbing, no swabs taken after disinfection showed growth. This volunteer was subjected to a skin biopsy to establish whether the skin disinfection might be simply superficial. No growth occurred in the medium into which biopsy tissue, after disinfection, was inoculated. We conclude that although GNB may be present on donors' skin, the disinfection procedure, as used by us prior to donation, was effective.
Specificity and sensitivity of first and second generation anti‐HCV ELISA in a low prevalence population
Authors: Kolho E.
Published: April 2008

SUMMARY. Specificity and sensitivity of the second generation enzyme immunosorbent assay for hepatitis C antibodies were calculated from data on 208,554 blood donors screened with either the first or the second generation tests (ELISA I, ELISA II) or both (4,639 donors). The second generation ELISA was no more specific than the first generation test in this low‐prevalence blood donor population (specificity 99.7% vs 99.6%). Most of the donors (93.5%) who were found to be reactive using ELISA II were negative or indeterminate according to a supplemental test, the second generation recombinant immunoblot assay (RIBA II). The second generation ELISA was found to be more sensitive than the first. It identified all 16 donors who were positive according to RIBA II during screening with ELISA I. The latter found only 13 out of 30 donors (43%) who were positive according to RIBA II during screening with ELISA II. If the number of RIBA II positive donors found during the first year of screening with ELISA I (74, 0.024%), and the number of RIBA II positive but ELISA I negative donors found during screening with ELISA II, are taken into consideration it can be estimated that the added sensitivity due to using ELISA II is about 40%.
Anti‐HPA‐4b (anti‐Yuka) neonatal alloimmune thrombocytopenia: first report in a Caucasian family
Authors: Morel‐Kopp M‐C. , Blanchard B. , Kiefel V. , Joly C. , Mueller‐Eckhardt C. , Kaplan C.
Published: April 2008

SUMMARY. Neonatal alloimmune thrombocytopenia (NAIT) is caused by platelet antigen incompatibility between the mother and fetus. NAIT is mainly due to alloimmunization; the frequency varying among ethnic groups. In Caucasians HPA‐la is the antigen most frequently implicated. In Japan, NAIT due to anti‐HPA‐4b antibody has already been described, but this is the first case to be reported in Caucasians.
Reactions to platelet transfusion: the effect of the storage time of the concentrate
Authors: Muylle L. , Wouters E. , De Bock R. , Peetermans M. E.
Published: April 2008

SUMMARY. Random platelet concentrates were pooled and depleted of leucocytes by centrifugation immediately prior to transfusion. The incidence and severity of reactions to 570 leucocyte‐poor platelet transfusions in 74 patients were studied. An overall transfusion reaction rate of 13.7% was observed. The reaction rate to platelets stored for less than 3 days (8.7%) was significantly different from the reaction rate to platelets stored for 3 days or more (17.6%). Minor reactions as well as moderate and severe reactions were more frequent in the latter group. As most of the white blood cells were removed prior to transfusion, it is suggested that the reactions result from the transfusion of pyrogenic and/or vasoactive substances accumulated in the plasma of the concentrate during storage.
Impact of aprotinin on blood transfusion requirements in liver transplantation
Authors: Smith O. , Hazlehurst G. , Brozovic B. , Rolles K. , Burroughs A. , Mallett S. , Dawson K. , Mehta A.
Published: April 2008

Summary. A retrospective study was carried out to ascertain the blood bank provision required to support a liver transplant programme and to assess the effect of intraoperative aprotinin on blood product requirements in liver transplant recipients with cirrhosis. Sixty patients with end‐stage liver disease underwent 62 consecutive orthotopic liver transplants between October 1988 and January 1991. The total and intraoperative requirements of red cells, platelets and fresh frozen plasma (FFP) were analysed for three groups of liver transplant recipients, those without cirrhosis (n= 15), those with cirrhosis (n= 25) and those with cirrhosis who received intraoperative aprotinin (n= 20). Fifteen without cirrhosis had mean total requirements of 15 units of red cells, 18 units of platelets and 16 units of FFP. Twenty patients with cirrhosis who received intraoperative aprotinin had broadly similar requirements. However, blood product requirements for 25 patients with cirrhosis were significantly greater (46 units of red cells, 41 units of platelets, 43 units of FFP, excluding the seven patients with primary biliary cirrhosis). We conclude that a liver transplant programme can be supported by a teaching hospital blood bank. The use of intraoperative aprotinin significantly reduces blood product requirements.
BCSH‐NIBSC anti‐D reference reagent for antiglobulin tests: the in‐house assessment of red cell washing centrifuges and of operator variability in the detection of weak, macroscopic agglutination
Authors: Phillips P. K. , Voak D. , Whitton C. M. , Downie D. M. , Bebbington C. , Oampbell J.
Published: April 2008

Summary. A batch of an anti‐D preparation, reference 91/608, has been prepared for the preparation of red cells weakly sensitized with IgG that can reveal inhibition of the antiglobulin test by one volume of human serum, diluted 1:1000. The preparation provides an objective assessment of red cell washer efficacy and the confidential, in‐house assessment of operator variability in detecting weak but definite macroscopic agglutination by blind, replicate tests.

Red cell washer efficacy and poor operator reading procedures causing disruption of weak agglutination are two major causes of false‐negative antiglobulin tests; neither are adequately detected by the common quality‐control procedure of adding strongly IgG‐sensitized red cells (‘Coombs control cells’) to apparently negative antiglobulin tests. However, weakly IgG‐sensitized red cells do offer a valuable control function that can detect some degree of cell washer inefficiency and reading errors although such cells are not a substitute for the more sensitive replicate testing.

Test protocols are provided to assess the efficacy of cell washing machines and operator skills in the detection of weak but definite macroscopic agglutination.
Study of viral safety of Scottish National Blood Transfusion Service factor VIII/IX concentrate
Authors: Bennett B. , Dawson A. A. , Gibson B. S. , Hepplestone A. , Lowe G. D. O. , Ludlam C. A. , Mayne E. E. , Taylor T.
Published: April 2008

Summary. To assess the viral safety of the Scottish National Blood Transfusion Service (SNBTS) intermediate purity factor VIII and IX concentrates, the liver function and viral status were assessed prospectively in 13 recipients. None developed hepatitis or seroconverted to HIV or HCV. This study provides additional evidence for the efficacy of dry heat treatment at 80°C for 72 h in preventing virus transmission by coagulation factor concentrates.
Stablization of von Willebrand factor in banked blood by leucocyte depletion
Authors: Farrugia A. , Street A. , Douglas S. , Raines G. , Aumann H. , Whyte G. , Sykes S. , Oates A.
Published: April 2008

Summary: The von Willebrand factor (vWf) activity, as measured by the ristocetin co‐factor (vWf:RCo) and collagen binding (vWf:CBA) assays, declined progressively in standard blood units stored at 4°C after a 2‐day storage period. This loss of activity was accompanied by a loss and degradation of high molecular weight (HMW) vWf multimers. In studies using a paired design, filtration of blood with a high efficiency leucocyte‐removal filter, prior to storage at 4°C, led to significantly improved maintenance of vWf:RCo and vWf:CBA compared with unfiltered units (P, < 0·01 after 8 days). Loss and degradation of HMW vWf decreased when blood was filtered prior to 4°C storage. Filtration had no effect on vWf‐associated activities when blood was stored at 22°C for 10 days.

These results indicate that part of the storage lesion of vWf in banked blood is due to leucocyte‐mediated removal and degradation of HMW vWf. This has implications when specifying plasma for the production of vWF concentrates and may also play a role in the haemostatic lesion associated with massive transfusion of stored blood.
Protein levels and plasmapheresis intensity
Authors: Ciszewski T. S. , Ralston S. , Acteson D. , Wasi S. , Strong S. J.
Published: April 2008

Summary: In order to evaluate the influence of intensity of plasmapheresis on donor serum total protein and immunoglobulin concentrations, these parameters were measured monthly in two groups of plasma donors over a period of 6 months. Donors in group one donated 500–600 ml of plasma at weekly intervals and those in the other groups at intervals of 14 days or longer. Regular whole blood donors were used as a control group. The average concentrations of total protein and IgG immunoglobulin fraction in group one were significantly lower (P < 0·002) than those of the other two groups but they always remained well within the normal ranges. Although the mean total protein level of this group of donors fell significantly during the first 3 months, their values returned to almost baseline levels at the end of the study. No statistically significant difference from the initial concentrations was observed during monthly measurements of IgG, IgA and IgM levels among any of the groups studied. We conclude that removal of 500–600 ml of plasma at weekly intervals involves little, if any, risk of total protein or immunoglobulin depletion in donors who satisfy current criteria. This study also suggests that the frequency of IgG and IgM evaluations may be safely lowered and that IgA determinations may be limited to first time plasma donors.
Platelet alloantigen frequencies in Caucasians: a serological study
Authors: Kiefel V. , Kroll H. , Bonnert J. , Unkelbach K. , Katzmann B. , Nebenführer Z. , Santoso S. , Mueller‐Eckhardt C.
Published: April 2008

Summary. Alloimmunization against platelet antigens is related to neonatal alloimmune thrombocytopenia and post‐transfusion purpura. Moreover, platelet‐specific alloantibodies, in addition to HLA‐specific antibodies, play a role in the state of refractoriness to platelet transfusions. Most platelet‐specific alloantigens have been assigned to platelet glycoproteins IIb/IIIa, Ib/IX and Ia/IIa. Data on antigen frequencies were first reported for Caucasians, but since then platelet glycoprotein polymorphisms have been reported for other populations, e.g. the Yuk alloantigens in Japanese. As information on the distribution of the recently described alloantigens is incomplete in Caucasians, this study was undertaken to provide reliable data on the PIA, Ko, Bak, Yuk and Br (HPA 1–5) alloantigens, of the ‘low‐frequency’ Sra and Vaa antigens and of the Naka isoantigen. In contrast to the frequencies determined in Oriental populations, all 964 individuals tested in this study were Yuka‐negative and all persons tested (n= 382) had Naka‐isoantigen‐positive platelets. A comparison of typing results shows that the recently described Siba‐alloantigen is identical with the Koa antigen.
A simplified method for large‐scale HPA‐la phenotyping for antenatal screening
Authors: Metcalfe P. , Doughty H. A. , Murphy M. F. , Waters A. H.
Published: April 2008

SUMMARY. A simplified method for large‐scale HPA‐la phenotyping of platelets was developed for use in an antenatal screening programme for fetomaternal alloimmune thrombocytopenia (FMAIT). The test was based on the MAIPA assay, which was modified for antigen‐typing with a well‐characterized anti HPA‐la reagent. The resulting assay gave reliable results, was inexpensive and allowed testing of large batches using semiautomated equipment.
The expression of IgG Fc receptors on circulating leucocytes in the fetus and new‐born**
Authors: Mawas F. , Wiener E. , Ryan G. , Soothill P. W. , Rodeck C. H.
Published: April 2008

SUMMARY. The expression of Fc‐gamma‐R (FcR) classes on circulating leucocyte lineages (lymphocytes, monocytes, granulocytes) was determined by flow cytometry in 46 fetuses at 18–35 weeks of gestation and in 11 full‐term neonates, and compared to that in 20 adults. Classes of FcR present on adult leucocytes could be detected on the corresponding fetal cells as early as 18 weeks of pregnancy. Generally, in the fetus, FcR expression was lower than in the adult while in the neonate it approached values found later in life. However, percentages of Fc‐gamma‐RIII‐positive fetal/new‐born monocytes, and those of FcR‐positive new‐born granulocytes were considerably raised above adult levels. The modified pattern of FcR expression on fetal/new‐born leucocytes is likely to influence their IgG‐mediated effector activities towards targets such as red cells and platelets.
Can mandatory pretransfusion approval programmes be improved?
Authors: Hawkins T. E. , Carter J. M. , Hunter P. M.
Published: April 2008

SUMMARY. To improve the appropriateness of blood‐component prescribing, a mandatory haematologist pretransfusion approval programme of all non‐red‐cell components was instituted. This was associated with a 33% decrease in the units of fresh frozen plasma (FFP) transfused. Platelet transfusions increased but utilization of both platelets and FFP are now the lowest of the six comparable blood transfusion regions in New Zealand.

A subsequent concurrent audit, using preset criteria, of FFP, cryoprecipitate and platelet usage over a 3‐month period showed that further reductions in blood component usage could still be achieved, despite the continuing pretransfusion approval policy. This audit showed that 33% of FFP and 30% of cryoprecipitate units transfused were inappropriately given, despite prior haematologist approval.

Hospital transfusion practices can be improved by mandatory blood‐component pretransfusion approval but concurrent auditing of this programme is required to identify and correct continuing inappropriate blood‐component prescribing. Haematologists need to agree on blood‐component indications prior to instituting a pretransfusion approval programme in order to provide optimal management.
Hepatitis C (HCV)‐positive blood donors in South‐West England: a case control study
Authors: Goodrick M. J. , Gray S. F. , Rouse A. M. , Waters A. J. , Anderson N. A.
Published: April 2008

SUMMARY. The aim of this study was to compare the socio‐demographic characteristics and risk factors in anti‐HCV positive blood donors with those of matched controls. The participants were 50 hepatitis C antibody (HCV) positive blood donors and 50 matched blood donors with no evidence of HCV infection, who gave blood to the South Western Transfusion Centre between November 1991 and July 1992. A confidential structured interview was conducted to collect socio‐demographic data and to elicit information on risk factors for HCV. Measurements were made of the prevalence of risk factors and socio‐demographic characteristics in cases and controls.

The main results were that 45 of the 50 cases could have been exposed to HCV by previous intravenous drug abuse (IVDA), blood transfusion or medical employment. Cases were significantly more likely to have a history of IVDA, tattooing or of medical employment than matched controls. Cases with no history of IVDA were significantly more likely to have had a blood transfusion.

The key conclusions to emerge are that current policies are ineffective at excluding those with a history of IVDA from the donor pool. Consideration should be given to the introduction of a policy of direct confidential questioning about risk factors for all donors, or, at a minimum, the use of a questionnaire.
Molecular basis of glycophorin C variants and their associated blood group antigens
Authors: Reid M. E. , Spring F. A.
Published: April 2008

SUMMARY. The normal and variant forms of GPC and GPD molecules carry antigens of the Gerbich blood group system. This blood group system comprises three high‐incidence antigens (Ge2, Ge3 and Ge4) and four low‐incidence antigens (Wb, Lsa, Dha and Ana). Erythrocytes of the Ge and Yus phenotypes lack normal GPC and GPD molecules but express variant molecules (denoted GPC.Ge, GPC.Yus, respectively) that functionally substitute for normal GPC and GPD in the membrane. Leach phenotype cells lack GPC and GPD molecules and are elliptocytic in shape with a membrane that is less deformable than that of normal cells. The Lsa antigen is expressed on higher molecular‐weight variants of GPC (GPC.Lsa) and GPD (GPD.L3a). Wb, Dha and Ana antigens arise from point mutations in the GYPC gene and are expressed on GPC.Wb, GPC.Dha and GPD.Ana, respectively. The structure of each of the variant GPC and GPD molecules and the location of the Gerbich blood group system antigens is discussed. The GYPC gene, located on chromosome 2q14‐q21, is 13.5 kb long and comprises four exons. Exons 1,2 and most of exon 3 encode the N‐terminal extracellular domain while the remainder of exon 3 and exon 4 encode transmembrane and cytoplasmic domains of GPC. Exons 2 and 3 are highly homologous, with less than 5% nucleotide divergence. The molecular basis of generation of variation GPC and GPD molecules, and the structure of the GYPC gene from different Leach phenotype individuals, is discussed.
Guidelines for the collection, processing and storage of human bone marrow and peripheral stem cells for transplantation
Authors:   BCSH Blood Transfusion Task Force, Voak D. , Cann R. , Finney R. D. , Foreman K. , Knowles S. M. , Mitchell R. , Napier J. A. F. , Phillips P. K. , Rejman A. J. , Waters A. H. , Wood J. K. , Hutchinson R. M. , Bell A. J. , Duguid J. K. M. , Hows J. M. , Jestice K. , Pegg D. E. , Testa N. G.
Published: April 2008

SUMMARY. There are no current U.K. or international guidelines or regulations covering the production, processing and storage of haemopoietic cells such as to allow their engraftment following myeloablative therapy. This paper seeks to provide such guidelines. It enumerates how quality control and assurance can be applied to this area of transfusion medicine; procedural steps relating to bone marrow harvest on peripheral blood stem cell collection are outlined and recommended doses of nucleated cells suggested for both procedures. General specifications for identification, storage and transportation of bone marrow and peripheral blood stem cells are included and specific laboratory procedures related to the provision of haemopoietic cells for engraftment are outlined. Umbilical cord blood transplants and long‐term bone marrow culture are alluded to but these are still in a research phase.
Maternal intravenous immunoglobulin treatment does not prevent intracranial haemorrhage in fetal alloimmune thrombocytopenia
Authors: Kroll H. , Kiefel V. , Giers G. , Bald R. , Hoch J. , Hanfland P. , Hansmann M. , Mueller‐Eckhardt C.
Published: April 2008

SUMMARY. In fetal alloimmune thrombocytopenia (FAIT) the fetus is threatened by intracranial haemorrhage (ICH); therefore early diagnostic and therapeutic intervention is required. We followed the clinical course of a 30‐year‐old woman during her fifth pregnancy after she had given birth to a child with alloimmune thrombocytopenia due to anti‐Zwa. The fetus was monitored by 13 fetal blood samplings (FBS) always followed by transfusion of either maternal or compatible donor platelets. Intravenous immunoglobulin (ivIg) treatment of the mother was begun at 20 weeks of gestation when the fetal platelet count was 36 times 109/1. The fetal platelets were typed Zwa positive by DNA analysis. Despite 11 weeks of maternal ivIg treatment fetal platelet counts progressively declined to 6 times 10/1 and ICH occurred. Subsequently, the fetus was successfully managed by intrauterine platelet transfusions at shorter intervals (3–5 days) and elective Cesarean section was carried out at 35 weeks of gestation. We conclude that maternal ivIg treatment does not prevent ICH in FAIT. The treatment of choice for severely affected cases is serial FBS combined with transfusion of compatible platelets.
Pilot trials of PDF symbology as a means of transfering data on blood units between transfusion centres
Authors: Fisher M. M. , Hitchins L. , McDougall D. , Sherriff G. , Brown J. , Blakeman A. , Bowell P. , Strange J. , Gunson H. H.
Published: April 2008

SUMMARY. PDF 417, a two‐dimensional barcode, was used as a portable data file to transfer key information on blood units and delivery documentation between two Regional Blood Transfusion Centres. Multiple Codabar messages currently displayed on blood packs, as well as other useful information, i.e. microbiology conformance, were encoded in a 45‐character single PDF barcode. The delivery note which accompanied each consignment of blood consisted of a series of PDF barcodes, each representing 20 blood units. Computer validation showed 100% reconciliation of PDF data with Codabar data. Readability of the code was excellent with a greater than 98% first‐pass read rate. The delivery note PDF barcode identified eight operator errors which would have been undetected by the present manual system. We conclude that PDF 417 is an effective, secure and space efficient means of transfering data associated with the transfer of blood.
Feasibility and usefulness of an efficient anti‐HBc screening programme in blood donors
Authors: Allain J.‐P. , Reeves I. , Kitchen A. D. , Wenham D. , Williamson L. M.
Published: April 2008

SUMMARY. Post‐transfusion hepatitis B remains a risk for recipients of hepatitis B surface antigen (HBsAg) screened blood. Anti‐hepatitis B core antibody (anti‐HBc) screening may help reduce this risk. To evaluate its usefulness, 9,238 East Anglian blood donors were screened for anti‐HBc. Those with isolated anti‐HBc were identified with two confirmatory anti‐HBc and anti‐HB surface antibody (anti‐HBs) assays. The prevalence of anti‐HBc reactions in screening and confirmatory assays was 1.29% and 0.35%, respectively. The level of reactivity was significantly higher when two anti‐HBc assays gave concordant results or, being concordant, were anti‐HBs positive. All isolated anti‐HBc‐positive units (0.04%) were negative for additional HBV markers including DNA tested with nested polymerase chain reaction (PCR).

A 0.31% prevalence of past HBV infection was found in this population, all carrying both anti‐HBc and anti‐HBs antibody, most above the protective level (0.IU/ml).

The proposed screening schemes would limit the number of deferred donors and discarded units and keep the testing time within the remit of routine blood banking practices for an additional cost of approximately £1 per unit. However, no evidence was found in this donor population to suggest that anti‐HBc screening would significantly reduce the incidence of post‐transfusion hepatitis B.
Determination of the number of Epstein—Barr virus genomes in whole blood and red cell concentrates
Authors: Wagner H. J. , Klüter H. , Kruse A. , Bucsky P. , Hornef M. , Kirchner H.
Published: April 2008

SUMMARY. The risk of Epstein—Barr virus (EBV) infection after blood transfusion has been controversially discussed. Little is known about EBV transmission via buffy‐coat‐depleted red cell concentrates (RCC). In this study, we determined the number of EBV genomes in RCC of EBV‐seropositive donors in comparison to whole blood. RCC were prepared from whole blood donations by using the ‘top and bottom system’. Leucocyte content was significantly reduced in RCC in comparison to whole blood (0.47 times 109 vs. 2.3 times 109 per unit; P < 0.001). As B cells are expected to harbour EBV genomes, we analysed the number of B lymphocytes in both types of blood products. There was a significant reduction of B cell content from a median value of 90 times 106 in whole blood to 0.2 times 106 in RCCs (P < 0.001). The number of EBV genomes was estimated at a median value of seven from 106 B cells in the peripheral blood of healthy, EBV‐seropositive blood donors by means of a polymerase chain reaction (PCR) assay. By calculation, one unit of RCC may contain an average of one to two EBV genomes, in contrast to a whole blood unit, which is likely to harbour an average of 600 to 700 EBV genomes. It is concluded that the use of leucocyte depletion systems significantly reduces the number of EBV genomes in erythrocyte concentrates. Thus, leucocyte reduced blood products appear to minimize the risk of EBV infection.
Characterization of antibodies directed against platelet cryptantigens detected during the immunological study of 356 consecutive patients with presumed autoimmune thrombocytopenia (AITP)
Authors: Muñiz‐Diaz E. , Madoz P. , Pujol‐Moix N. , Pastoret C. , Arilla M. , Ibañez M. , Guanyabens C. , Domingo‐Albós A.
Published: April 2008

SUMMARY. Cryptic antigens are detected by anti‐bodies present in a wide spectrum of patients with or without thrombocytopenia, and even in healthy individuals. They are produced for unknown reasons and do not react with antigens of native platelets, but only with altered platelets. Cryptantigen antibodies may not only result in spuriously low platelet counts, but also in ‘falsely’ positive tests for platelet antibodies. We report our experience in the characterization of the different types of antibodies directed against cryptantigens of platelets: EDTA‐dependent antibodies, PFA‐dependent antibodies, EDTA‐PFA‐dependent antibodies and cold agglutinins. These antibodies were detected in the course of the serological study of 37 patients from a group of 356 (10%) whose blood was sent to our laboratory for platelet antibody testing. Pseudothrombocytopenia was diagnosed in 24 cases. Twenty‐one of these showed EDTA‐dependent or EDTA‐PFA‐dependent platelet agglutination and three were due to the presence of cold agglutinins. In 13 patients the thrombocytopenia was genuine. Eleven of these presented EDTA‐dependent or EDTA‐PFA‐dependent antibodies in their serum and in the two remaining cases PFA‐dependent antibodies were found. Cryptantigen antibodies were also detected in 9 out of 228 (4%) blood donors who were used as healthy controls in the platelet immunofluorescence test. In the light of the results obtained we put forward some guidelines to detect the presence of these antibodies and establish an accurate serological and clinical diagnosis of the autoimmune thrombocytopenias.