bluuebunny/crossref_metadata_2025 huggingface dataset:
The response of an acquired Factor V inhibitor to activated Factor IX concentrate
Authors: Vickars L. M. , Coupland R. W. , Naiman S. C.
Published: March 2003

A 91‐year‐old man developed a severe bleeding diathesis postoperatively. Laboratory studies showed an inhibitor to factor V which was identified as IgG. The patient failed to respond to fresh‐ frozen plasma and platelet transfusions, but demonstrated both clinical and laboratory improvement after transfusion with an activated prothrombin complex concentrate (Autoplex). Patients with refractory inhibitors to factors VIII or IX have been managed successfully with this concentrate; however, this case demonstrates that is also may be of value in managing patients with refractory inhibitors to factor V.
Hemolysis following platelet transfusions from ABO‐incompatible donors
Authors: Pierce R. N. , Reich L. M. , Mayer K.
Published: March 2003

Two hemolytic transfusion reactions related to isoagglutinins present in group O platelet concentrates are reported. The first, a severe reaction in a group A 10‐kg patient, resulted from transfusion of 200 ml of plasma containing a hemolytic anti‐A, titer 16, and an IgG anti‐ A, titer of 32,000. In the second case, a group B adult received between 50 and 70 ml of O plasma with a titer (16,000) of anti‐B. This was followed by hemolysis of approximately 40 percent of the patient's red cell volume.
Inactivation of viruses in labile blood derivatives. I. Disruption of lipid‐enveloped viruses by tri(n‐butyl)phosphate detergent combinations
Authors: Horowitz B. , Wiebe M. E. , Lippin A. , Stryker M. H.
Published: March 2003

Use of the organic solvent, tri(n‐butyl)phosphate (TNBP), and detergents for the inactivation of viruses in labile blood derivatives was evaluated by addition of marker viruses (VSV, Sindbis, Sendai, EMC) to anti‐hemophilic factor (AHF) concentrates. The rate of virus inactivation obtained with TNBP plus Tween 80 was superior to that observed with ethyl ether plus Tween 80, a condition previously shown to inactivate greater than or equal to 10(6.9) CID50 of hepatitis B and greater than or equal to 10(4) CID50 of Hutchinson strain non‐A, non‐B hepatitis. The AHF recovery after TNBP/Tween treatment was greater than or equal to 90 percent. Following the reaction, TNBP could be removed from the protein by gel exclusion chromatography on Sephadex G25; however, because of its large micelle size, Tween 80 could not be removed from protein by this method. Attempts to remove Tween 80 by differential precipitation of protein were only partially successful. An alternate detergent, sodium cholate, when combined with TNBP, resulted in almost as efficient virus inactivation and an 80 percent recovery of AHF. Because sodium cholate forms small micelles, it could be removed by Sephadex G25 chromatography. Electrophoretic examination of TNBP/cholate‐treated AHF concentrates revealed few, if any, changes in protein mobility, except for plasma lipoprotein(s).
Binding of fluid phase C3b to nonsensitized bystander human red cells. A model for in vivo effects of complement activation on blood cells
Authors: Salama A. , Mueller‐Eckhardt C.
Published: March 2003

There is evidence that activated complement fragments (C3b) can bind to human red cells (RBCs) serving as adsorbing surfaces, but not as antigens. This evidence prompted the present in vitro experiments. Using the standard antiglobulin test (AGT), the radioimmune antiglobulin test (RIAT), and the immune adherence test, we found that C3 can indeed be attached to “bystander” human RBCs if complement is activated either through the classical pathway (anti‐A hemolysins plus blood group A1 RBCs) or the alternative pathway (activator surfaces, i.e., Escherichia coli bacteria, rabbit RBCs, or inulin). On Scatchard plot analysis, between 24,000 and 44,000 radiolabeled anti‐C3d molecules were bound per one adjacent “bystander” RBC, while untreated control RBCs, or RBCs preincubated with fresh compatible serum, bound only 200 to 300, and 600 to 800 molecules, respectively. Despite strong coating with C3 fragments, only “bystander” paroxysmal nocturnal hemoglobinuria, but not normal, RBCs were hemolyzed by complement activation, i.e., through E. coli at pH 8.0. RBCs were not coated with C3 when complement was activated in the fluid phase by heat‐aggregated IgG or a staphylococcal “decomplementation antigen.” We conclude that the findings of our in vitro experiments accurately mimic some old, but as yet insufficiently understood, in vivo effects of complement activation on circulating blood cells.
Why is fresh‐frozen plasma transfused?
Authors: Snyder A. J. , Gottschall J. L. , Menitove J. E.
Published: March 2003

A three‐part study to determine the reasons for fresh‐frozen plasma (FFP) transfusions at hospitals in southeastern Wisconsin was conducted. During a 1‐month period, hospital transfusion services reported that patients undergoing open‐heart surgery received 42 percent, medical patients 26 percent, noncardiac surgery patients 23 percent, neonatal patients 1 percent, and other patients 7 percent of the FFP transfused. In the second phase of the study, the records of 102 patients receiving FFP during a 1‐month period at two teaching hospitals were reviewed. Justification for the FFP transfusion was provided in the hospital chart for only 11 percent of the transfusion episodes, although abnormal results of coagulation studies or signs of hypovolemia were recorded for an additional 51 percent. Frequently, FFP and red cell (RBC) transfusions were given during the same transfusion episode. In the third phase of the study, clinicians completed a questionnaire specifying their “trigger” for prescribing FFP: bleeding (43% of episodes), abnormal coagulation studies (26%), signs/symptoms of hypovolemia (16%), and “other” (15%). They judged that the FFP transfusion was effective in 47 percent of transfusion episodes and ineffective in only 6 percent. These findings indicate that FFP is used mainly as a source of coagulation factor replacement in hospitals served by The Blood Center of Southeastern Wisconsin, that justification for FFP use rarely is provided in patient records, that both FFP and RBCs are frequently transfused together, and that clinicians believe FFP is beneficial for their patients. Educational efforts addressing appropriate use of FFP should be initiated.
The evaluation of a positive direct antiglobulin test (autocontrol) in pretransfusion testing revisited
Authors: Judd W. J. , Barnes B. A. , Steiner E. A. , Oberman H. A. , Averill D. B. , Butch S. H.
Published: March 2003

Direct antiglobulin tests (DATs) using anti‐IgG were performed on 65,049 blood samples from prospective transfusion recipients; 3570 tests (5.49%) were positive. Using criteria published previously (primarily excluding patients not transfused within the preceding 14 days), 778 samples from other than neonatal patients were selected for further evaluation. Eluates that did not react were obtained on 518 (66.6%) of these samples. Warm‐reactive autoantibodies were apparent in 192 eluates, while 16 contained drug‐related antibodies, anti‐A or anti‐B from prior transfusion with ABO mismatched blood components, or anti‐D passively acquired from immune serum globulin. Fifty‐two eluates contained alloantibodies; however, in only six of these cases did the corresponding serum lack unexpected alloantibodies, as determined by routine pretransfusion studies. Three additional weakly reactive clinically significant alloantibodies were detected solely through additional serum tests performed on DAT‐positive samples.

On the basis of these findings, the DAT had a low predictive value when used to detect the early manifestations of an immune response to recently transfused red cells. Elimination of the autocontrol from routine pretransfusion testing, therefore, carries minimal risk to patients yet will undoubtedly contribute to the containment of health care costs. Moreover, the risk is lower than that associated with the elimination of the antiglobulin crossmatch.
Intracellular hemolysis and renal failure in a patient with T polyagglutination
Authors: Levene C. , Sela R. , Blat J. , Friedlaender M. , Manny N.
Published: March 2003

A patient with postoperative intravascular hemolysis aggravated by transfusion with fresh whole blood and fresh plasma products had acute renal failure. Screening with Arachis hypogaea and Glycine soja lectins showed that his red cells were T‐transformed. Only washed red cells were transfused subsequently, and no further fresh plasma products were given. All hemolysis ceased, the renal function returned to normal, and the T‐polyagglutination as measured by lectin tests disappeared 4 months after surgery. Early diagnosis of polyagglutination using lectin screening tests is simple to perform, and will facilitate the immediate choice of the correct transfusion therapy, which in this case may have been life‐saving.
Recruitment of unrelated persons as bone marrow donors. A preliminary experience
Authors: McElligott M. C. , Menitove J. E. , Aster R. H.
Published: March 2003

Seven hundred and sixty‐three blood donors previously typed for HLA‐A and B antigens were asked to consider donating bone marrow to unrelated patients for whom no HLA‐matched sibling was available. Eighty‐eight percent (668) indicated willingness to donate marrow, and of these, 615 (81%) participated in testing and 53 (7%) were unable to participate at the time of the request. Donors matched for HLA‐A, B, C, and DR antigens and compatible in the mixed‐leukocyte culture reaction were identified for 12 patients and eight transplants were performed. Engraftment was successful in all eight patients. In this article the factors considered in planning the program, the protocol eventually developed, the problems encountered, and critical issues of informed consent and donor confidentiality are reviewed.
Immunoreactivity of the Rho(D) antigen in cytoskeleton‐free vesicles
Authors: Victoria E.J. , Branks M.J. , Masouredis S.P.
Published: March 2003

Skeleton‐free microvesicles derived from D‐positive red cells immunospecifically bind anti‐D. Anti‐D saturation binding yielded an equilibrium constant value (K = 1–2 × 108 I mole−1) similar to intact red cells. The vesicles contained band 3, the major sialoglycoproteins and, at high protein loads, low‐molecular‐weight polypeptides. Anti‐D binding was referenced to total protein, phospholipid, and band 3 content to determine whether there was nonrandom segregation of the D antigen into vesicles. Selective segregation of the D antigen into vesicles could not be demonstrated unequivocally based on the methods and the assumptions of this study. The results, however, indicate that D reactivity does not require a membrane skeletal association.
K23: A low‐incidence antigen in the Kell blood group system identified by biochemical characterization
Authors: Marsh W.L. , Redman C.M. , Kessler L.A. , DiNapoli J. , Scarborough A.L. , Philipps A.G. , Mody K.M.
Published: March 2003

An antibody in the serum of a gravida 4, para 3 woman reacted with red cells from two of her children, her husband, and his mother, but with none of more than 2100 reference red cell samples and blood samples from donors. The reactive antigen was inactivated by 2‐ aminoethylisothiouronium bromide or dithiothreitol‐papain treatment. The antigen was immunoprecipitated from paternal red cells with maternal antibody and shown to migrate by sodium dodecylsulfate polyacrylamide gel electropheresis as a single protein of approximately 93,000 daltons. After transfer to nitrocellulose paper by Western blotting, the protein reacted with a rabbit antibody specific for Kell protein. The chemical inactivation and electrophoretic findings were characteristic of Kell group antigens. The reaction with the rabbit antibody establishes that the “new” low incidence antigen was an epitope on Kell group protein and must be coded for by the Kell gene. It has been designated K23.
Reduction of fresh‐frozen plasma use through a daily survey and education program
Authors: Shanberge J. N.
Published: March 2003

In an attempt to reverse a tendency toward the inordinate use of fresh‐ frozen plasma (FFP), the Transfusion Committee in a large tertiary care hospital distributed guidelines based on those derived at a Consensus Development Conference at the National Institutes of Health in 1984. In addition, the use of FFP was surveyed daily and supplemented by a one‐ on‐one educational program for the attending and house staffs. In 2 years, these steps resulted in a 77 percent decrease in the number of units of FFP transfused.
The first example of autoanti‐Kx
Authors: Sullivan Carolyn M. , Kline William E. , Rabin Barbara I. , Johnson Carol L. , Marsh W. Laurence
Published: March 2003

An IgG autoantibody with Kx specificity was found in the blood of a 61‐ year‐old white man. The antibody did not cause hemolysis of his own or transfused Kx‐positive red cells. The patient is of common Kell blood type and does not exhibit any clinical or hematologic features of McLeod syndrome.
Transfusion‐acquired cytomegalovirus infection in neonates
Authors: Preiksaitis J.K. , Brown L. , McKenzie M.
Published: March 2003

The incidence of cytomegalovirus (CMV) infection was determined in 114 transfused neonates of any birthweight born to CMV antibody‐negative mothers. In a second phase of this study, an additional 28 transfused infants weighing less than 1250 g, born to both CMV antibody‐negative and antibody‐positive mothers, were followed. All infants underwent weekly virus culture and monthly serology during hospitalization and at 6 to 12 weeks after their last transfusion. Only one of 126 (0.8%) seronegative infants and one of 16 (6.3%) seropositive infants developed CMV infection. If the assumption is made that the CMV‐ infected infant received only 1 unit of infectious blood, the risk of transfusion‐acquired CMV infection to seronegative infants is 0.16 percent per cellular unit transfused or 0.37 percent per seropositive cellular unit transfused. Despite similarities in the prevalence of CMV antibody in the donor population, the age of blood products used, and the mean number of donor exposures, a significantly lower incidence of CMV infection was found in the seronegative transfused infants than that in two previously published studies (p < 0.01, p < 0.001). Because no mortality and very little morbidity could be attributed to transfusion‐acquired CMV infection in the nurseries, the authors can see no justification for the provision of specialized blood components for the prevention of CMV infection in this patient population.
Alloimmunization to D antigen and HLA in D‐negative immunosuppressed oncology patients
Authors: Baldwin M.L. , Ness P.M. , Scott D. , Braine H. , Kickler T.S.
Published: March 2003

D‐negative patients may be divided into responders and nonresponders when immunized with D‐positive red cells (RBC). Forty‐nine D‐negative oncology patients who received D‐positive RBCs via platelet and white cell transfusions were studied to determine if nonresponders to D were likely to form lymphocytotoxic antibody (LCA). Nine patients developed anti‐D in 16 to 390 days (x̄ = 112) after 2.6 to 481 ml (x̄ = 106) of D‐positive RBCs. Forty patients had no evidence of anti‐D after 0.8 to 535 ml (x̄ = 98) of D‐positive RBCs and were followed for 14 to 1275 days (x̄ = 192). The anti‐D group had no prior D‐positive RBC transfusions, and two of five women making anti‐D had previous pregnancies but no record of anti‐D. LCA was found in four of nine (44%) patients with anti‐D and in 12 of 40 (30%) patients without anti‐D (p < 0.50). Since both D and antigens HLA are considered highly immunogenic, it is of interest that the ability to form anti‐D or LCA does not correlate. In fact, more patients (16/49; 32%) made LCA than anti‐D (9/49; 18%). Of the 21 alloimmunized patients, 4 made both antibodies, while 17 had selective alloimmunization. It would thus appear that alloimmunization to D and HLA are not strongly linked and may indeed be unrelated.
Evaluation of atypical human immunodeficiency virus immunoblot reactivity in blood donors
Authors: Dock N. L. , Lamberson H. V. , O'Brien T. A. , Tribe D. E. , Alexander S. S. , Poiesz B. J.
Published: March 2003

Blood donors reactive by enzyme‐linked immunosorbent assay for antibody to the human immunodeficiency virus (HIV) who showed atypical patterns of viral core protein reactivity on Western blot were monitored for several months. Characterization of their antibodies was performed by 1) use of recombinant HIV proteins; 2) determination of cross‐ reactivity to HTLV‐I, HTLV‐II, and HTLV‐IV: 3) assessment of immune status; and 4) identification of potentially interfering autoantibodies. Nineteen of 20 donors maintained the same HIV antibody reactivity throughout the follow‐up period; the other donor became fully antibody‐positive. Eighteen of 20 donors' sera showed clear reactivity with HIV recombinant core proteins. Ten of 19 donor samples demonstrated cross‐reactivity to HTLV‐IV; 3 of these 10 also cross‐ reacted with HTLV‐I. The immune status of all donors was normal, although the medical histories and HLA antibody screens suggested possible autoimmune reactivity in 9 of 18 donors. During follow‐up interviews, three donors reported possible risk factors for HIV infection that had not been acknowledged at the time of blood donation. We conclude that exclusion of donors with these atypical serologic test results is warranted while further studies to determine significance are being conducted.
Evaluation of granulocyte‐releasing products and chemiluminescence during cytapheresis
Authors: LIndena J. , Sommerfeld U. , Burkhardt H. , Aulmann H. M.
Published: March 2003

During the procedures of centrifugation leukapheresis and plateletpheresis, donors occasionally experience adverse clinical reactions. The possibility of whether the activation of granulocytes and the subsequent release reactions, which may have been triggered by this extracorporeal circuit, were responsible for these adverse effects was evaluated. Six blood samples were obtained at set intervals during cytapheresis. Of these samples, four were taken directly from the donor. The remaining two were drawn from the efferent lines, i.e., those which return blood from the cytapheresis machine to the donor. Reactive oxygen species produced by granulocytes were measured by chemiluminescence (CL) using microamounts of whole blood or isolated granulocytes. Furthermore, secreted granulocyte products such as neutral proteinase elastase, which is present in plasma in a complex with alpha‐1‐proteinase inhibitor (E‐alpha‐1‐PI), and lysosomal beta‐glucuronidase were examined. A complete blood cell count and the values of hemoglobin, hematocrit, lactate dehydrogenase, protein, albumin, and proteinase inhibitors such as alpha‐2‐macroglobulin and alpha‐1‐proteinase inhibitor were also determined. Clinical chemical and cytologic values, with the exception of those for E‐alpha‐1‐PI, were 10 to 17 percent lower than values before apheresis. These results can be attributed to inherent plasma volume expansion. Reduced CL was observed on the stimulation of phagocytes in the whole blood assay, as well as with stimulated granulocytes. Unstimulated granulocytes, on the other hand, showed an increased native CL. These data do not indicate a cytapheresis‐mediated activation of the oxydative metabolism of granulocytes, and the concomittant discharge of proteolytic enzymes remains, therefore, of no clinical importance.
Temporary suppression of Kidd system antigen expression accompanied by transient production of anti‐Jk3
Authors: Issitt Peter D. , Obarski Genevieve , Harnett Pauline L. , Wren Mary R. , Prewitt Patricia L.
Published: March 2003

This report describes an 85‐year‐old woman of Russian Jewish extraction whose red cell Kidd system phenotype changed during the 2 years in which her blood was studied. Certainly once, and perhaps twice, the patient's phenotype changed from Jk(a+b‐) to Jk(a‐b‐). On both occasions, it reverted to Jk(a+b‐). During the first episode of loss of Jka, she formed anti‐Jk3. Although this antibody was weak, it was capable of in vivo destruction of Jk(a+b‐) and Jk(a‐b+) red cells. A lack of details about the patient's clinical condition precludes speculation as to the cause of suppression of Jka expression. The phenomenon appeared to affect only the Kidd blood group system. This case should alert others that antigen loss can occur in the Kidd system as it has been shown to occur in, at least, the Rh, Kell, and Ge systems.
Evaluation of a blood warmer that utilizes a 40 degrees C heat exchanger
Authors: Kruskall Margot S. , Pacini Donna G. , Malynn Elizabeth R. , Button Larry N.
Published: March 2003

Most commercial blood warmers are unable to warm blood components to greater than 35 degrees C at rapid flow rates (greater than 100 mL/min) because of problems with inefficient heat transfer and resistance to the flow of blood through the instrument's tubing. A new blood warmer, using a closed‐flow 40 degrees C counter‐current water bath and large‐ bore tubing, is able to warm cold (10 degrees C) packed red cells to temperatures greater than 35 degrees C even at flow rates of 500 mL per minute. To evaluate the effects on red cells of prolonged exposure to the 40 degrees C heat exchanger, blood from five volunteers stored for 42 days in AS‐1 was run through the blood warmer using flow rates equivalent to the transfusion of a unit of blood over 4 hours. Compared with unwarmed blood, these blood units showed no significant changes in plasma hemoglobin, mean corpuscular hemoglobin concentration, potassium, ATP, pH, and osmotic fragility. In vivo survivals of chromium‐51‐labeled warmed autologous red cells were greater than 75 percent in four volunteers and 49.5 percent in the fifth volunteer, whose abnormally low unwarmed red cell ATP level suggested a storage problem. Thus, this blood warmer, which warms blood efficiently at high flow rates, causes no red cell damage, even with prolonged exposure of old red cells to the 40 degrees C heat exchanger.
Febrile reactions after platelet transfusion: the effect of single versus multiple donors
Authors: Chambers L.A. , Kruskall M.S. , Pacini D.G. , Donovan L.M.
Published: March 2003

Febrile reactions to platelet transfusions are a common problem. The platelet transfusion records from a 30‐month period were analyzed to determine 1) when reactions occur in a transfusion sequence; 2) how frequently they recur; and 3) whether the choice of multiple‐donor (pooled concentrates) or single‐donor components (unmatched apheresis and HLA‐compatible apheresis platelets) affected the reaction rate. Overall, 18.7 percent of all patients receiving platelets experienced reactions. A subset of 85 patients, who began platelet support with unmodified components during the study interval, were analyzed in detail. This group received 1204 unmodified transfusions (mean, 14.2/patient), which were associated with 171 reactions (per‐transfusion reaction rate, 14.2%). Despite a higher mean white cell content, the transfusion of 438 unmatched single‐donor platelets (10.84 times 108 white cells, 8.4% reaction rate) resulted in reactions significantly less often than did that of 583 pooled concentrates (8.53 times 108 white cells, 21.4% reaction rate)(p<0.001). The rate of reaction to HLA‐compatible platelets (9/183 transfusions, 4.9%) was not significantly different from that to unmatched single‐donor platelets. The use of platelet components from one donor, as opposed to multiple donors, may provide an effective means of reducing the incidence of febrile reactions.
Abnormal membrane physical properties of red cells in McLeod syndrome
Authors: Ballas S. K. , Bator S. M. , Aubuchon J. P. , Marsh W. L. , Sharp D. E. , Toy E. M.
Published: March 2003

McLeod red cells (RBCs) lack Kx antigens and have weak expression of the Kell antigens. Individuals who carry the McLeod phenotype have acanthocytic RBCs and a compensated hemolytic state. To elucidate the role of the protein on which the Kx antigens reside in maintaining membrane deformability, the rheologic properties of McLeod RBCs were determined by ektacytometry. RBCs were obtained from normal individuals and from four patients with McLeod syndrome. Osmotic gradient deformability profiles of McLeod RBCs showed decreased whole cell deformability. Resealed ghosts from McLeod RBCs also showed decreased deformability, partly because of the decreased cell surface area and partly because of an intrinsic membrane stiffness in this syndrome. For the measurement of membrane mechanical stability, resealed ghosts were subjected to constant high shear stress in the ektacytomer, and deformability was recorded continuously as the deformable ghosts fragmented into rigid spherical vesicles. Membranes from McLeod RBCs showed a noticeable increase in mechanical stability. Acquired causes of acanthocytosis, such as liver disease, did not cause the rheologic abnormalities observed in McLeod cells. Other abnormalities noted in McLeod RBCs were decreased RBC potassium content and an increased number of dense RBCs, as determined by centrifugation on a discontinuous density gradient. The data indicate that McLeod RBCs are rigid and have decreased surface area and that their membranes are intrinsically rigid with increased mechanical stability. These abnormalities may account for the reduced RBC survival observed in McLeod syndrome. The protein that carries the Kx surface antigen seems to be required for the maintenance of the normal physical function of RBC skeletal proteins.
Viral infections in transfusion‐dependent patients with beta‐ thalassemia major: the predominant role of cytomegalovirus
Authors: Nigro Giovanni , Lionetti P. , Digilio G. , Multari G. , Vania A. , Midulla M.
Published: March 2003

For 9 months, 38 transfusion‐dependent patients with beta‐thalassemia, ranging in age from 3.4 to 19.1 years, were observed for serologic evidence of viral infections, by the collection of serial serum samples. Seventy‐six age‐matched healthy subjects, two for each patient, were followed as controls. Samples taken at the beginning, middle, and end of the study were tested against 18 viral antigens by complement fixation (CF). In addition, tests for antibodies to HIV, Epstein‐Barr virus, hepatitis A virus, and markers for hepatitis B virus were performed. When changes in the antibody titer on CF tests (greater than or equal to 2‐fold increase or decrease) or persistently high titers (greater than or equal to 64) were revealed, specific enzyme immunoassays (EIAs) for IgM and IgA antibodies were performed concomitant with CF tests in all sera. When symptomatic infections occurred, viral cultures and/or direct detection of antigens were carried out by immunofluorescence methods, EIA, or latex agglutination tests. Thalassemic patients and controls had similar (p greater than 0.05) overall rates of serologically confirmed viral infections (53 versus 132), but the former group had a higher (p less than 0.01) incidence of cytomegalovirus (CMV) infections (9 versus 4). CMV infections were associated in the thalassemic patients with hepatitis (2 cases), lymphadenitis (2 cases), and upper respiratory tract infection (1 case), while the remaining cases of CMV had a subclinical course. Moreover, the thalassemic patients had a lower (p less than 0.01) incidence of symptomatic infections (27 versus 110) than controls. Therefore, this study showed that both symptomatic and subclinical CMV infections may occur often in thalassemic patients, who otherwise have subclinical viral infections at an overall rate similar to that in healthy subjects.
Platelet storage in synthetic media lacking glucose and bicarbonate
Authors: Murphy S. , Kagen L. , Holme S. , Gottlieb B. , Heaton W. , Grode G. , Davisson W. , Buchholz D.
Published: March 2003

The goal of these studies was to develop a cost‐effective medium for the storage at 22 +/− 2 degrees C of platelets for transfusion. Platelet concentrates were prepared from platelet‐rich plasma in a standard fashion and resuspended in 55 mL of medium. Residual plasma was 14.4 +/− 4.3 percent of the final suspending solution. The use of a simple solution containing electrolytes and citrate, but no glucose or bicarbonate, was associated with a drop in pH to the range of 6.0 to 6.6, as a result of the production of lactic acid from the platelet glycogen and glucose present in residual plasma. When 25 mM (25 mmol/L) sodium phosphate was included as a buffer, the drop in pH was retarded, but the range throughout storage was still 6.5 to 6.8. Nonetheless, platelets stored for 5 days in this phosphate‐containing medium showed satisfactory maintenance of many in vitro variables. However, there was a 10 to 35 percent reduction of in vivo recovery after isotopic labeling. There was no significant reduction in subsequent mean cell life. Because of the in vivo abnormalities, these media are not recommended for use at the present time. However, the results are encouraging and suggest that further research may lead to a satisfactory, cost‐effective medium.
Risk of human immunodeficiency virus (HIV) transmission by blood transfusions before the implementation of HIV‐1 antibody screening
Authors: Busch M.P. , Young M.J. , Samson S.M. , Mosley J.W. , Ward J.W. , Perkins H.A. ,   The Transfusion Safety Study Group
Published: March 2003

Little information is available regarding the risk of human immunodeficiency virus type 1 (HIV‐1) infection for patients transfused before routine anti‐HIV‐1 screening of blood donors was instituted in March 1985. A model was developed for estimating both the proportion and the number of transfusion recipients in the San Francisco Bay area who were infected by HIV‐1 during each of the 7 years preceding routine donor screening for anti‐HIV‐1. The model is based on analysis of 1) donation histories of HIV‐1‐infected donors identified at the regional blood center; 2) HIV‐1 seroprevalence estimates for homosexual and bisexual men in San Francisco; and 3) HIV‐1 infection and survival rates for recipients traced by the Transfusion Safety Study and Irwin Memorial Blood Centers’ Look Back Program. The incidence of transfusion‐ associated HIV‐1 infection is estimated to have risen rapidly from the first occurrence in 1978 to a peak in late 1982 of approximately 1.1 percent per transfused unit. The decrease after 1982 coincided with the implementation of high‐risk donor deferral measures. It is estimated that, overall, approximately 2135 transfusion recipients were infected with HIV‐1 in the San Francisco region alone. This number suggests a higher prevalence of transfusion‐associated HIV‐1 infection than has been generally recognized and indicates the need for continued tracing of potentially exposed recipients. The data also strongly support the effectiveness of early donor education and self‐exclusion measures and emphasize the importance of continued research and development in this area.
Lack of increased bleeding after paracentesis and thoracentesis in patients with mild coagulation abnormalities
Authors: McVay P. A. , Toy P.T.C.Y.
Published: March 2003

To determine whether untreated mild coagulopathy in patients with no evidence of clinical bleeding is associated with an increased risk of hemorrhage after paracentesis or thoracentesis, retrospective examination was conducted of 608 consecutive procedures for which prothrombin time (PT), partial thromboplastin time (PTT), platelet (Plt) counts, and preprocedure and postprocedure hemoglobin concentrations were available. There was no increased bleeding in patients with mild to moderate coagulopathy (defined as PT or PTT up to twice the midpoint normal range or pit count of 50 to 99 × 10(3) per microL [50–99 × 109/L]). However, patients with markedly elevated serum creatinine levels (6.0 to 14.0 mg/dL [530–1240 mumol/L]) had a significantly greater average hemoglobin loss (−0.82 ± 1.3 g/dL [−8 +/− 13 g/L], n = 11) than patients with normal serum creatinine levels (−0.12 ± 0.88 g/dL [−1 ± 9 g/L], n = 450) (p = 0.011). Overall, the frequency of bleeding complications requiring red cell transfusions was very low: 0.2 percent of events. The most common diagnosis for patients who had paracentesis was alcoholic liver disease (72%); for those having thoracentesis, it was infection (37%). It can be concluded that, for these patients, prophylactic plasma or platelet transfusions are not necessary. Patients with markedly elevated serum creatinine deserve close postprocedure observation.
A fatal case of ceftriaxone (Rocephin)‐induced hemolytic anemia associated with intravascular immune hemolysis
Authors: Garratty G. , Postoway N. , Schwellenbach J. , McMahill P. C.
Published: March 2003

Fatal hemolytic anemia developed in a 52‐year‐old woman who was treated with a cephalosporin, ceftriaxone. The patient's red cells (RBCs) were coated with C3, but no RBC‐bound IgG, IgA, or IgM was detected. Her serum contained an antibody that did not react with cephalosporin‐ coated RBCs but reacted strongly with RBCs in vitro when her serum was added to drug and RBCs. This is the first case of immune hemolytic anemia associated with ceftriaxone, the first case of fatal cephalosporin‐induced hemolytic anemia, and the second case in which a cephalosporin antibody showed in vitro and in vivo characteristics usually thought to be associated with the so‐called immune complex mechanism.
Increase in circulating colony‐forming units‐granulocyte‐macrophage during large‐volume leukapheresis: evaluation of a new cell separator
Authors: Hillyer C. D. , Tiegerman K. O. , Berkman E. M.
Published: March 2003

Peripheral blood stem cell (PBSC) collection was evaluated in two groups of normal donors who underwent large‐volume leukapheresis on a blood cell separator. In Group A (n = 10), a 3‐hour leukapheresis was performed. An average of 11.8 L of blood was processed with a mean flow rate of 66 mL per minute and a collection rate of 3 mL per minute. The PBSC product contained a mean 1.4 × 10(10) mononuclear cells (MNCs) (lymphocytes and monocytes), 1.27 × 10(6) colony‐forming units‐ granulocyte‐macrophage (CFUs‐GM), and an average hematocrit of 4 percent (0.04). Postapheresis blood counts showed significant reductions in MNCs (19%) and platelets (45%) (p < 0.005). Twenty‐four hours later, the MNCs had returned to preapheresis levels. The platelet count returned to baseline only after 7 days. Circulating CFUs‐GM remained stable for 3 days after apheresis but were increased twofold by Day 7 after apheresis (p = 0.025). Varying the product hematocrit from 1 percent (0.01) to 13.3 percent (0.13) did not change the number of CFUs‐GM collected per MNC. In Group B (n = 4), an average of 18.5 L of blood was processed with a mean flow rate of 94 mL per minute and a collection rate of 3 mL per minute. The PBSC product was collected as four sequential samples and assayed for MNCs and CFUs‐GM. Total MNCs averaged 1.7 × 10(10) (an increase of 21% relative to Group A) and CFUs‐GM averaged 3.08 × 10(6) (an increase of 143%). Mean MNCs did not vary significantly among the four samples. However, CFUs‐GM collected per minute (relative to the first sample) did show 1.26‐fold (p = 0.001), 1.86‐fold (p = 0.011), and 2.52‐fold (p = 0.04) increases in the second, third, and fourth samples. These data suggest that MNCs and committed progenitor cells are recruited during large‐volume leukapheresis. Moreover, there is a twofold increase in circulating CFUs‐GM 1 week after apheresis.
Prevention of alloimmunization in patients with acute leukemia by use of white cell‐reduced blood components—a randomized trial
Authors: Oksanen K. , Kekomäki R. , Ruutu T. , Koskimies S. , Myllylä G.
Published: March 2003

Platelet refractoriness arising from HLA alloimmunization is a serious complication of transfusion therapy. In a prospective randomized trial, white cell (WBC)‐reduced blood components were compared to standard platelet and red cell concentrates with respect to alloimmunization, refractoriness, and platelet increments after transfusion. Sixteen of 31 adult acute leukemia patients received only WBC‐reduced platelet concentrates (PCs) and red cells (RBCs), with fewer than 106 WBCs per unit. Fifteen control patients received standard blood components with a mean of 0.1 × 109 (PCs) and 1 × 109 (RBCs) WBCs per unit. Platelet loss during cotton‐wool filtration averaged 14 percent (range, 3–32%) from fresh PCs and 24 percent (range, 9–62%) from stored PCs. Filtration did not change corrected increments (CI) measured after transfusion of fresh PCs. The Cl 1 hour after filtration of stored PCs diminished by 27 percent, but the difference was smaller after 18 hours, which suggests better survival of WBC‐reduced platelets. The number of platelet units transfused did not differ in the two groups. No patient in the WBC‐reduced group developed permanent platelet refractoriness; transient HLA antibodies of low titer developed in two patients. In the control group, one patient became refractory because of immunization and two developed transient HLA antibodies. It can be concluded that the reduction of WBCs in blood components can effectively prevent alloimmunization.
The neonatal immune response to washed and irradiated red cells: lack of evidence of lymphocyte activation
Authors: DePalma L. , Duncan B. , Chan M.M. , Luban N.L.
Published: March 2003

A total of 21 neonatal infants (11 males and 10 females) were evaluated for lymphocyte subpopulation changes and cellular activation following the receipt of washed and gamma‐irradiated red cells. The mean donor exposure was 2 ±/− 1.5 donors, and the mean white cell concentration of each 10‐mL‐per‐kg transfusion was 2 × 10(7) cells. A total of 2800 rad (28 Gy) was delivered to each red cell unit prior to washing. The lymphocyte subsets CD3±, CD4±, CD8±, CD19±, CD3±/CD25±, CD3±/HLA‐DR, CD4±/CD45RA, CD4±/CDw29, and CD4±/ICHL‐1 were analyzed, as were plasma gamma‐interferon and neopterin levels, before and after blood transfusion. Posttransfusion samples were obtained from 3 to 12 days after the last blood transfusion. There were no posttransfusion changes in the percentage of lymphocyte subsets analyzed. Furthermore, overlay‐ histogram analysis of pretransfusion and posttransfusion CD45RA‐, CDw29‐, and UCHL‐1‐positive helper T cells failed to reveal a shift in mean channel fluorescence intensity, which is indicative of a lack of cellular activation. Gamma‐interferon levels remained unchanged after transfusion (range, 90 ±/− 5.9 to 95.5 ±/− 5.3 pg/mL), as did neopterin levels (range, 3.7 ±/− 1.5 to 4.6 ±/− 1.5 ng/mL). This study could not find any evidence, by either cellular or humoral markers, of the activation of neonatal lymphocytes by transfusion. It is hypothesized that this failure to observe lymphocyte activation is due to the low number of donor white cells present in washed, irradiated red cells and/or to a lack of recipient recognition of transfused, allogeneic, donor white cells.
Role of acetate during platelet storage in a synthetic medium
Authors: Bertolini F. , Murphy S. , Rebulla P. , Sirchia G.
Published: March 2003

It has previously been shown that buffy coat platelet concentrates (BC‐PCs) stored in a medium made up of approximately 70 percent platelet storage medium (Plasma‐Lyte A, PL) and 30 percent plasma (BC‐PC‐P) are effective in vivo after 9 to 12 days of storage. In addition to sodium, potassium, magnesium, and chloride, PL contains 27 m/W (27 mmol/L) sodium acetate and 23 m/W (23 mmol/L) sodium gluconate. This study investigated the effect of acetate and gluconate on platelet metabolism. Identical BC‐PCs were stored at 22 ± 2°C in PL (BC‐PC‐P); PL with gluconate but without acetate, termed PL‐A (BC‐PC‐A); or PL with acetate but without gluconate, termed PL‐G (BC‐PC‐G). On Day 1 of storage, no significant differences were seen between the three groups of BC‐PCs. In both BC‐PC‐P and BC‐PC‐G, pH and bicarbonate were stable at 7.0 ± 0.03 and 8.4 ± 0.9 mEq per L throughout 10 days of storage, whereas in BC‐PC‐A, they fell to 6.7 ± 0.05 and 5.5 ± 0.8 mEq per L on Day 5 (p<0.01 vs. Day 1) and to 6.1 ± 0.1 and 1.2 ± 0.4 mEq per L, respectively, on Day 10. The buffering capacities of 70 percent PL, PL‐A, or PL‐G and 30 percent plasma were similar in a platelet‐free setting when incremental additions of lactic acid were made. The role of acetate was further studied by adding 14C‐ or 3H‐labeled acetate to BC‐PC‐P. On Day 7 of storage, radioactivity decreased to 79 ± 1 percent of baseline in 14C‐labeled BC‐PC‐P (p = 0.02), while it was unchanged in 3H‐labeled BC‐PC‐P and in control samples in which 14C‐ and 3H‐acetate were added to platelet‐free plasma or PL. These studies indicate that platelets metabolize acetate to CO2 during storage and that acetate metabolism plays a major role in pH control during storage of BC‐PCs.
The effect of prestorage white cell reduction on the function and viability of stored platelet concentrates
Authors: DZIK W. H. , CUSACK W. F. , SHERBURNE B. , KICKLER T.
Published: March 2003

The role of residual donor white cells (WBCs) in producing the storage lesion of platelets used for transfusion was studied. The effect of prestorage WBC reduction on in vitro and in vivo measurements of the quality of stored platelet concentrates (PCs) was examined by using a newly developed WBC‐reduction filter capable of preparing PCs with a mean residual WBC concentration of less than 1 per microL. For in vitro studies, a triplet study design was used, in which WBC‐reduced PCs were matched to standard PCs and to WBC‐enriched PCs obtained from the same donor at the same phlebotomy. Twelve donors were studied. Prestorage WBC reduction resulted in a higher pH and pO2 and a lower pCO2 than in standard PCs. In accord with previous in vitro studies, a significant rise in plasma glycocalicin and lactate dehydrogenase was measured during storage, but the levels were not significantly different in WBC‐ reduced PCs and standard PCs. Platelet aggregation and ATP release in response to graded doses of thrombin was similar in WBC‐reduced and standard PCs. In vivo recovery and survival studies were comparable in WBC‐reduced and standard PCs. Although the residual donor WBC content of PCs has a significant impact on storage pH, pO2, and pCO2, prestorage WBC reduction does not affect platelet structure, function, or viability as assessed by in vitro or in vivo measurements.
The extension of 4 degrees C storage time of frozen‐thawed red cells
Authors: MYHRE B.A. , MARCUS C.S.
Published: March 2003

Blood was drawn from volunteer donors and frozen using the high glycerin, mechanical freezing procedure accepted by the United States Navy. Subsequently, the units of blood were thawed and washed. Various anticoagulants were added, and the red cells were stored in a refrigerator at 4 degrees C for periods of up to 28 days. Chemical analyses were performed periodically. These showed that the addition of the anticoagulants ACD, CPD and CPDA‐1 caused the red cells to be preserved better than the currently accepted 0.9‐percent NaCl, 0.2‐ percent glucose solution. In vivo 51Cr viability studies performed on blood stored with CPDA‐1 for 14 days showed a 24‐hour viability of 78.8 +/− 8.4 percent. In a subsequent study, the blood was stored for 21 days prior to freezing and then was rejuvenated and frozen. The cells were thawed, washed, and stored at 4 degrees C with CPDA‐1 for an additional 14 days. The 24‐hour viability of these cells was determined to be 74.0 +/− 5.1 percent. These findings show that the postthaw storage time of red cells can be increased greatly over the now‐ accepted 24 hours, if bacterial sterility can be assured.
Electronmicroscopic examination of white cell reduction by four white cell‐reduction filters
Authors: Steneker I. , van Luyn M.J.A. , van Wachem P.B. , Biewenga J.
Published: March 2003

The mechanisms of white cell (WBC) reduction in 16‐hour‐old CPDA‐1 red cell (RBC) concentrates by filtration on a column filter and on three different flatbed filters were studied by electron microscopy, with special emphasis on cell‐to‐cell interaction, cell damage, and interaction of blood cells with the material. Generally, lymphocytes were removed by mechanical sieving and monocytes by adherence and mechanical sieving. Granulocyte depletion occurred by mechanical sieving, direct adhesion to the fibers, and indirect adhesion to activated and spread platelets. In the column filter, most granulocytes were captured by adhesion. In the coarse layers of two of the flatbed filters, indirect adhesion was most prominent, whereas direct adhesion was most prominent in the other flatbed filter. For the most part, granulocytes were captured by direct adhesion in the fine layers, but in one flatbed filter, capture apparently occurred by mechanical sieving. The results of this study suggest that the efficiency and the mechanism of WBC reduction depend on the physicochemical characteristics of the non‐woven materials in the filters as well as the cellular composition of the RBC concentrates.
Immunohematologic complications of ABO‐unmatched liver transplants
Authors: TRIULZI D.J. , SHIREY R.S. , NESS P.M. , KLEIN A.S.
Published: March 2003

Transplantation of ABO‐unmatched livers has been associated with the development of donor‐derived antibody (DDAb) and hemolysis. Nine (22%) of 41 consecutive patients undergoing liver transplantation at our institution received 10 ABO‐unmatched livers. Five (56%) of nine patients developed DDAbs and hemolysis. All five patients were group A1 and received group O livers. DDAbs appeared a mean of 9.2 +/− 2.8 (1 SD) days after surgery and persisted for 15.2 +/− 10.3 days. All patients with DDAbs developed hemolysis. During the period when DDAbs were demonstrable, the hemoglobin dropped by a mean of 4.8 g per dL (48 g/L), and the patients were transfused with a mean of 7.8 +/− 2.3 units of group O red cells. One patient with hemolysis underwent exchange transfusion for acute renal failure. Patients with hemolysis required significantly more red cells postoperatively (15.0 vs. 6.9 units, p = 0.04) than did ABO‐matched patients. None of the parameters examined (age, recipient or donor gender, secretor status, rejection, or donor isoagglutinin titers) were predictive of DDAb or hemolysis, although hemolysis occurred in three of four cases in which donor serum IgG anti‐ A titers were > or = 128, as opposed to one of four cases in which titers were < 128. Because recipients of ABO‐unmatched livers are at high risk for transiently developing DDAb and hemolysis with associated morbidity, the prophylactic use of donor‐type red cells for surgery and after operation is justified.
Development of a colorimetric dosimeter for quality control of blood units and irradiators
Authors: Hillyer C.D. , Hall J.M. , Lackey D.A. , Wazer D.E.
Published: March 2003

The development is reported of a reproducible colorimetric irradiation dosimeter that is easy to prepare as well as to interpret. Optimal chloroform, dithizone, and paraffin concentrations to produce a distinctive color change at > 1500 cGy (optimized for 3000 cGy) were determined by combining various concentrations of each component at 65 degrees C. The melted dosimetric material was poured into molds, allowed to solidify, and irradiated with doses ranging from 0 to 3000 cGy. Color change was evaluated visually and spectrophotometrically to determine reproducibility. Twenty‐percent chloroform (wt/wt) and a dithizone concentration of 5.0 × 10(‐5) M combined in paraffin (TP‐2) produced optimal color change from pink to green after > 1500 cGy. The change was reproducible, and 50 individuals were able to distinguish between irradiated and nonirradiated dosimeters. Additionally, five of five of these individuals correctly ranked five dosimeters in order of increasing irradiation from 0 to 3000 cGy, in increments of 750 cGy. This dosimeter is easy to make and easy to read and may allow blood banks to show unit‐by‐unit quality assurance for irradiated blood components and quality control of the irradiator itself.