bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors affecting the labor efficiency of hospital‐based blood bank laboratories
Authors: LAM H.C. , KOMINSKI G.F. , PETZ L.D. , SOFAER S.
Published: March 2003

BACKGROUND: A variety of financing mechanisms and managerial innovations have been developed in the past decade to control hospital costs. Some evidence suggests that those changes have not produced substantial improvements in labor efficiency among employees in the hospital's technical level, such as in the blood bank laboratories.

STUDY DESIGN AND METHODS: This study measured labor efficiency in 40 hospital‐based blood bank laboratories in Southern California during the year from July 1989 to June 1990 and explored the impact of financial, managerial, and operational factors on labor efficiency.

RESULTS: With standardized output measures used in all blood bank laboratories, a wide variation of labor efficiency was found. Multivariate analyses indicate that the labor efficiency of blood bank employees was not influenced by organizational financial incentives, but was affected by the managerial styles of blood bank managers.

CONCLUSION: Interpretation of the findings suggests that labor efficiency is affected by operational designs intended to improve responses to variable workloads and reduce slack time.
Cryopreservation of human platelets with dimethyl sulfoxide: changes in biochemistry and cell function
Authors: Bock M. , Schleuning M. , Heim M.U. , Mempel W.
Published: March 2003

BACKGROUND: The shelf life of liquid‐stored platelet concentrates is limited to 5 days. Therefore, much work has been carried out in an attempt to establish the optimum method for cryopreservation. Among the various cryoprotectants, dimethyl sulfoxide (DMSO) has been shown to be the most effective. However, DMSO‐frozen platelets are characterized by a number of cell lesions. This report describes metabolic and functional changes that should give rise to some concern about the functional integrity of these cells.

STUDY DESIGN AND METHODS: Single‐ donor platelet concentrates were frozen in liquid nitrogen by use of DMSO (5%). After thawing, the cells were washed and resuspended in autologous plasma. Before, during, and after the freezing process, samples for analysis of metabolic measures (e.g., pH; calcium, potassium, and lactate dehydrogenase concentrations; plasma complement factors) and functional measures (e.g., aggregometry, in vitro bleeding time, alpha‐granule membrane protein‐140 expression) were taken.

RESULTS: Mean platelet volume increases during the deep‐freezing process. Potassium, calcium, and lactate dehydrogenase are released from the intracellular space to the extracellular space. A strong activation of complement, which is mainly due to the addition of DMSO, is observed. Platelets become activated as indicated by the expression of alpha‐granule membrane protein‐140. Accordingly, decreased platelet function can be observed.

CONCLUSION: DMSO‐frozen platelets are characterized by several metabolic and functional changes. Although these cells have been shown to exert hemostatic effects in vivo, it is conceivable that those effects could be improved by further development of platelet‐freezing techniques.
Large‐volume leukapheresis for collection of mononuclear cells for hematopoietic rescue in Hodgkin's disease
Authors: Comenzo Raymond L. , Malachowski Marie E. , Miller Kenneth B. , Erban John K. , Schenkein David P. , Desforges Jane F. , Berkman Eugene M.
Published: March 2003

BACKGROUND: Peripheral blood mononuclear cells (MNCs) collected by leukapheresis contain hematopoietic stem and progenitor cells that provide autologous hematopoietic rescue after high‐dose chemotherapy, an approach that offers a significant benefit to patients with recurrent Hodgkin's disease. However, patients with low MNC counts may require 10 or more standard leukapheresis procedures for the collection of sufficient cells for hematopoietic rescue. STUDY DESIGN AND METHODS: The effectiveness of steady‐state large‐volume leukapheresis (LVL; 15‐ 35 L blood processed) was evaluated as a method for collecting MNCs for hematopoietic rescue in seven patients with recurrent Hodgkin's disease. LVL was performed on 2 consecutive days per week to collect 7 × 10(8) MNCs per kg. The circulating MNC counts on the first day of LVL and the total numbers of LVL, of MNCs collected, and of liters of blood processed were determined per patient. After high‐dose chemotherapy and MNC transfusion, days to granulocyte and platelet engraftment were recorded. RESULTS: On the first day of LVL, patients had median circulating MNCs of 1536 (range, 504–3950) × 10(6) per L. The median number of LVL procedures per patient was four (range, 1.25‐6), and the median L per kg of blood processed was 1.57 (range, 0.38‐4.03). Simple regression analysis plotting L per kg against initial MNCs gave a curve with the equation y = e(1.42‐(6.31 × 10E‐4)x) (correlation coefficient = ‐0.97, R2 = 0.95, exponential fit). Without posttransfusion growth‐ factor support, median days to granulocyte engraftment were 19 (range, 12–26) and those to platelet transfusion independence were 34.5 (range, 10–57). CONCLUSION: LVL provides a useful method of collecting MNCs for hematopoietic rescue in patients with Hodgkin's disease. The patient's baseline MNC count provides a useful estimate of the volume required for LVL.
Anomalous ABO inheritance explained by ovum transplantation
Authors: Freund Gregory G. , Finke Catherine A. , Kirkley Scott A.
Published: March 2003

BACKGROUND: Modern fertilization techniques can lead to unexpected ABO phenotypes in newborn infants and can raise questions as to maternity, paternity, and infant misidentification. Ovum transplantation can result in an infant with an ABO phenotype that is unexpected, given the birth mother's ABO type. STUDY DESIGN AND METHODS: A group AB, Rh‐ positive female infant was born to a group O, Rh‐positive woman as a result of ovum transplantation. The case report is provided. RESULTS: The birth mother typed group O, Rh‐positive both before and after delivery. The infant typed group AB, Rh‐positive on cord blood and heelstick specimens. CONCLUSION: Ovum transplantation can result in newborns whose ABO phenotypes are unexpected, in relation to the birth mother's ABO type. To ensure patient privacy, such fertilization techniques may not be clearly documented in the delivery room chart. A complete obstetric history helps prevent repeat phlebotomies, expensive and unnecessary typing studies, and concern of the clinical staff with possible sample or infant misidentification.
Cytokine generation in stored, white cell‐reduced, and bacterially contaminated units of red cells
Authors: Stack G. , Baril L. , Napychank P. , Snyder E. L.
Published: March 2003

BACKGROUND: Proinflammatory cytokines were measured in the supernatant portion of stored, bacterially contaminated, and/or white cell (WBC)‐ reduced units of red cells (RBCs). Previous studies from this laboratory and others have shown that cytokines are generated in platelet concentrates during storage. This earlier work has been expanded to the study of stored RBCs.

STUDY DESIGN AND METHODS: Units of AS‐1 RBCs (n ? 10 non‐WBC‐reduced; n ? 10 WBC‐reduced) were obtained from a regional blood center, and each was split on Day 3 of storage into three equal portions by sterile techniques. One portion was kept sterile (control), and the other two were inoculated with Yersinia enterocolitica and Staphylococcus aureus, respectively, at 1 to 3 colony‐forming units per mL. The RBCs were stored at 1 to 6 degrees C for 42 days. Sequential samples were taken during storage and assayed for interleukin 8 (IL‐8), interleukin 1 beta (IL‐1 beta), interleukin 6, WBC count, and bacteria count. For the WBC‐reduced group (n ? 10), WBC removal was done by filtration on Day 3 of storage, before bacterial inoculation.

RESULTS: IL‐8 was detected in the supernatant portion of all 42‐day‐old, non‐WBC‐reduced (mean WBCs ? 4760 ± 3870/μL) units of AS‐1 RBCs at levels ranging from 63 to 1610 pg per mL. By contrast, at 2 to 3 days of storage, lower levels of IL‐8 (range, 0‐280 pg/mL) were detected in the same units. IL‐8 levels increased progressively during storage in most (7/10) units. The highest mean levels of IL‐8 were reached by outdate at Day 42. Y. enterocolitica‐contaminated units had statistically higher levels of IL‐ 8, with a range of 170 to 2100 pg per mL, by 42 days of storage. S. aureus grew poorly in stored units of RBCs and failed to further stimulate cytokine production. No WBC‐reduced unit (mean WBCs ? 0.5 ± 0.6/μL), even when contaminated with bacteria, had more than 260 pg per mL of IL‐8. Although IL‐1 beta was not detected in any unit of RBCs at 3 days of storage, it increased to low levels (5‐13 pg/mL) in all units tested at 42 days. Interleukin 6 was not detected in any unit at any storage time.

CONCLUSION: IL‐8 and IL‐1 beta accumulated in the supernatants of stored RBCs despite cold storage conditions. IL‐8 reached levels > 1000 pg per mL in the supernatants of some RBC units. IL‐1 beta increased to significant but low levels (< 13 pg/mL). WBC filtration early in storage prevented the accumulation of IL‐8. The physiologic significance to transfusion recipients of IL‐8 in RBC supernatants is currently unknown and deserves further investigation.
A microtiter plate assay for measurement of serum alanine aminotransferase in blood donors
Authors: des Roziers N. Burin , Pouilles F. , Roche M. , Claret G.
Published: March 2003

BACKGROUND: Alanine aminotransferase (ALT) testing in blood donors is required in many countries as a surrogate test for viral hepatitis. Current automated ALT assays do not fulfill some operational requirements of blood banks. STUDY DESIGN AND METHODS: The standard ALT measurement method of the International Federation of Clinical Chemistry was adapted to the 96‐well microtiter plate to obtain optimal conditions. The method was compared with a reference biochemical method using an analyzer on 251 serum samples. RESULTS: The analytical variability was minimal (2.3% for an ALT level of 59 IU/L and 3.6% for an ALT level of 33 IU/L) after a total analysis time of 8 minutes and a time of 7 minutes before the first reading. With these measures, a linear standard curve was obtained in the range of 10 to 130 IU per L.A computerized validation procedure allowed rejection of samples with high ALT levels. Comparison with the analyzer gave a correlation coefficient, r = 0.935. The method proved to be efficient and time‐ saving in routine use over an 8‐month period. CONCLUSION: The microtiter plate ALT assay is helpful in allowing the simultaneous distribution of ALT and immunoenzymatic assays. It provides accurate results and a minimal risk of false‐negative results.
Transfusion practices in human immunodeficiency virus‐infected patients
Authors: Popovsky M. A. , Benson K. , Glassman A. B. , Hume H. , Oberman H. A. , Pisciotto P. T. , Anderson K. C.
Published: March 2003

BACKGROUND: The reported immunomodulatory effects of transfusion raise concern about the potential for virus activation and tumor growth in human immunodeficiency virus (HIV)‐infected patients. In the absence of “standards” of transfusion practice for such patients, a survey of transfusion policies among institutions specializing in the care of HIV‐ infected patients was performed to delineate current practices.

STUDY DESIGN AND METHODS: A survey developed by the Transfusion Practices Committee of the American Association of Blood Banks was sent to 47 AIDS clinical trial units and 14 regional hemophilia centers in North America.

RESULTS: Forty‐three percent of centers completed the survey. Most centers observed more than 200 HIV‐infected patients each. The key findings were that 1) 81 percent of centers used identical red cell transfusion criteria for HIV‐infected and noninfected patients; 2) 52 percent used recombinant human erythropoietin as initial treatment for zidovudine‐induced anemia, while 46 percent used recombinant human erythropoietin for anemia not associated with zidovudine; 3) 35 percent of centers used white cell‐reduced blood components in lieu of cytomegalovirus (CMV)‐seronegative components when administering transfusion(s) to CMV‐seronegative patients; 4) 27 percent gamma‐ radiated cellular components, but no case of graft‐versus‐host disease had been observed; 5) > 85 percent of centers used monoclonal factor VIII for pediatric and adult hemophiliacs infected with HIV; 6) approximately one‐third of centers routinely white cell‐reduced cellular components; and 7) the most common reasons for white cell reduction included reduction of febrile reactions and CMV risk, reduction of platelet alloimmunization, and delay of immunomodulatory consequences of transfusion.

CONCLUSION: There is marked heterogeneity in transfusion practice for HIV‐infected patients. Modification of cellular components to achieve different objectives is routine in many centers.
Human immunodeficiency virus type 1 activation after blood transfusion
Authors: Mudido P.M. , Georges D. , Dorazio D. , Yen‐Lieberman B. , Bae S. , O'Brien W.A. , Spritzler J. , Lederman M.M.
Published: March 2003

Background: Anemia and transfusion are predictors of disease progression in AIDS patients. This study was designed to examine the effects of blood transfusion on human immunodeficiency virus type 1 (HIV‐1) expression.

Study Design and Methods: Assays of plasma viral load were performed before and after transfusion in nine HIV‐1‐infected patients who required blood transfusion for refractory anemia.

Results: There was a modest rise in plasma HIV‐1 p24 antigen and plasma HIV‐1 RNA beginning 1 to 2 weeks after the blood transfusion. The mean change in plasma p24 antigen for all patients was 9.3 ± 5.1 (mean ± SE) pg per mL at Week 2 after transfusion and 18 ± 11.1 pg per mL at Week 4. Plasma HIV‐1 RNA levels were unchanged immediately after transfusion and exceeded pretransfusion levels with a mean rise of 84 ± 40 percent (SE) at Week 1, 70 ± 27 percent at Week 2, and 67 ± 38 percent at Week 4 (p equals; 0.006, exact permutation test). There was no increase in spontaneous or interleukin 2‐induced lymphocyte proliferation or p24 antigen production by patients' lymphocytes that were examined immediately after blood transfusion.

Conclusion: The transfusion of blood to persons with advanced HIV‐1 infection modestly increases plasma levels of HIV‐1. The activation of HIV‐1 expression by transfusion may help to explain the accelerated course of HIV‐1 disease in recipients of blood transfusion.
A novel system for providing compatible blood to patients during surgery: “self‐service” electronic blood banking by nursing staff
Authors: Cheng G. , Chiu D.S.M. , Chung A.S.M. , Wong H.F. , Chan M.W.K. , Lui Y.K. , Choy F.M.F. , Chan J.C.M. , Chan A.H.C. , Lam S.T. , Fan T.C.W.
Published: March 2003

Background: A good blood bank must be able to provide compatible blood units promptly to operating room patients with minimal wastage. A “self‐ service” by nursing staff blood banking system that is safe, efficient, and well‐accepted has been developed.

Study Design and Methods: Specific blood units are no longer assigned to surgical patients who have a negative pretransfusion antibody screen, irrespective of the type of surgery. A computer‐generated list of the serial numbers of all group‐identical blood units currently in the blood bank inventory is provided for each patient. The units themselves are not labeled with a patient's name. The group O list will be provided for group O patients, the group A list for group A patients, and so forth. Should the patient require transfusion during surgery, the operating room nurses go to the refrigerator, remove any group‐identical unit, and check the serial number of the unit against the serial numbers on the patient's list. If the serial number is on that list, the blood bank will accept responsibility for compatibility. The system was implemented in 1995.

Results: Since implementation, a total of 2154 patients have undergone operations at this hospital. Thirty‐two patients received more than 10 units of red cells each. There were no transfusion errors. The crossmatch‐to‐transfusion ratio was reduced from 1.67 to 1.12. Turnaround time for supplying additional or urgent units to patients in operating room was shortened from 33 to 2.5 minutes. There was no incidence of a blood unit's serial number not being on the list. Work by nurses and technical staff was reduced by nearly 50 percent.

Conclusion: The “self‐service” (by nursing staff) blood banking system described is safe and efficient. It saves staff time and can be easily set up.
Photosensitized inactivation of Plasmodium falciparum in human red cells by phthalocyanines
Authors: Lustigman S. , Ben‐Hur E.
Published: March 2003

BACKGROUND: Photodynamic treatment of red cell concentrate with phthalocyanines and red light inactivates lipid‐enveloped viruses such as vesicular stomatitis virus and human immunodeficiency virus. This procedure is evaluated for its ability to enhance the viral safety of red cell concentrate for transfusion. It is of interest to study whether photodynamic treatment could also inactivate parasites in blood (e.g., Plasmodium falciparum). STUDY DESIGN AND METHODS: Red cells parasitized by P. falciparum were treated with phthalocyanines and red light and then cultured in vitro for 48 hours. The percentage of parasitemia was then estimated by microscopic examination of the red cells. RESULTS: Of the phthalocyanines studied, the one that proved to be the most effective was HOSiPcOSi(CH3)2(CH2)3N(CH3)2 (Pc4). The extent of parasite inactivation increased with light dose and decreased with an increase in hematocrit. At a hematocrit of 60 percent and 2 microM Pc 4,>or= 3 log10 kill occurred at a light dose of 60 J per cm2. This is a lower dose than is required for>or= 6 log10 of vesicular stomatitis virus inactivation (90 J/cm2). CONCLUSION: Photodynamic treatment with Pc 4 could make red cell concentrate not only virally safe for transfusion but also safe with respect to transmitting malaria.
High frequency of HLA‐A*0207 subtype in Chinese population
Authors: Shieh D.‐C. , Lin D.‐T. , Yang B.‐S. , Kuan H.‐L. , Kao K.‐J.
Published: March 2003

Background: HLA‐A2 is the most polymorphic and most common HLA phenotype found in various ethnic populations. Seventeen HLA‐A2 subtypes have been reported and characterized by molecular techniques. Differences among these subtypes are limited to a few amino acids. Among them, HLA‐A*0201 is the predominant subtype among whites. The results of a recent study, however, suggest that the HLA‐A*0207 subtype may be present at a high frequency in the Chinese population.

Study Design and Methods: To determine the exact frequency of the HLA‐A*0207 Sep s1996 Septype in the Chinese population, genomic DNA samples obtained from 54 HLA‐A2‐positive Chinese in Taiwan were studied by using sequence‐specific primers and polymerase chain reaction.

Results: HLA‐A*0207 was present in 56 percent of the studied subjects. The estimated gene frequency for HLA‐A*0207 is 17.8 percent in the Chinese population.

Conclusion: HLA‐A*0207 is the most common HLA‐A2 subtype among Chinese. The high frequency of the HLA‐A*0207 allele in this population offers a unique opportunity to study the ways in which different HLA‐A2 subtypes may influence the clinical outcome of allograft transplantation and the disease susceptibility of recipients.
Co‐presence of a point mutation and a deletion of exon 3 in the glycophorin C gene and concomitant production of a Gerbich‐related antibody
Authors: King M. J. , Kosanke J. , Reid M. E. , Poole J. , Banks J. , Hemming N. J. , Smythe J. , Martin P. G.
Published: March 2003

BACKGROUND: Antigens of the human blood group system Gerbich (Ge) are located on sialoglycoproteins glycophorin C (GPC) and glycophorin D (GPD). CASE REPORT: The Ge+ proposita (RW) produced an alloanti‐Ge after receiving 2 units of red cells (RBCs) during surgery. Further studies were carried out to characterize the antibody specificity, RBC GPC and/or GPD (GPC/GPD), and the glycophorin C gene (GYPC) from RW and her compatible siblings. RW's serum contained an alloanti‐Ge that did not react with RBCs from RW or four of her siblings or with RBCs with Ge‐negative phenotypes. An eluate of RW's antibody reacted weakly with GPC in Western blotting. RW's RBCs were positive with 20 alloanti‐Ge2, 1 autoanti‐Ge2, 4 alloanti‐Ge3, and 1 alloanti‐Ge4. Titrations revealed weak expression of these antigens on her RBCs and those of her compatible siblings as compared with controls. In contrast, titrations of mouse and rat monoclonal antibodies specific for GPC/GPD showed no differences. Western blotting of RBC membranes using GPC/GPD specific monoclonal antibodies showed a broad diffuse band corresponding to GPC.Ge in addition to GPC and GPD. Blotting of membranes from trypsin‐ treated RBCs from these individuals revealed an increase of 1500 in M(r) of membrane‐bound tryptic fragment over that in the membranes from typsin‐treated RBCs from persons with normal GPC/GPD. In RT‐PCR, two products were obtained for RW and her compatible siblings: one had a complete deletion of exon 3 and the other had a base change (A–>T) in nucleotide 173 in exon 3 (confirmed by genomic DNA sequencing of exon 3). This point mutation has resulted in the loss of restriction enzyme Tth111 I‐sensitive site in the mutant GYPC. CONCLUSION: The specificity of antibody in RW's serum was serologically anti‐Ge2. Two genetic events occurred in exon 3 in GYPC of RW and her compatible siblings. The exon 3 deletion confirmed a Ge:‐2,‐3,4 haplotype. The abnormal tryptic fragment obtained was due to the (A173–>T) base change in exon 3 that resulted in Asp58–>Val in the deduced amino acid sequence at the membrane boundary.
Molecular basis for the high‐incidence antigens of the Kell blood group system
Authors: Lee S. , Naime D.S. , Reid M.E. , Redman C.M.
Published: March 2003

BACKGROUND: The Kell blood group system is complex, containing at least 21 antigens. Some antigens are organized in five allelic sets; other, mostly high‐incidence antigens, may be independently expressed. In this study, the molecular basis of five high‐incidence antigens in the Kell system are described. STUDY DESIGN AND METHODS: Genomic DNA sequences from K:‐12 (KEL:‐12), K:‐18 (KEL:‐18), K:‐19 (KEL:‐19), K:‐22 (KEL:‐ 22), and TOU‐(KEL:‐26) persons were sequenced and compared to those from persons with a common Kell phenotype. RESULTS: The various Kell phenotypes are due to point mutations that encode amino acid substitutions. In KEL:‐18, two mutations in the same codon were noted. In the various phenotypes, the following KEL mutations were noted: in KEL:‐12: A1763G, His548Arg; in KEL:‐18: C508T and G509A, Arg130Trp and Arg130Gln; in KEL:‐19: G1595A, Arg492Gln; in KEL:‐22: C1085T, Ala322Val; and in TOU‐:G1337A, Arg406Gln. A son of one of the two people with the TOU‐phenotype was heterozygous, and he also had the G1337A mutation. CONCLUSION: The high‐incidence antigens of the Kell blood group system are characterized by point mutations leading to amino acid substitutions. The KEL:‐18 phenotype could be due to either of two point mutations in the same codon replacing arginine with tryptophan or glutamine. TOU was confirmed as a Kell system antigen, and the inheritance of the mutation was demonstrated.
Sexual transmission of hepatitis C virus to a repeat blood donor
Authors: Capelli C. , Prati D. , Bosoni P. , Zanuso F. , Pappalettera M. , Mozzi F. , De Mattei C. , Zanella A. , Sirchia G.
Published: March 2003

BACKGROUND: Sexual transmission of hepatitis C virus (HCV) can occur, albeit inefficiently, and this represents a possible cause of community‐ acquired infections. This study describes a case of asymptomatic HCV infection acquired by a repeat blood donor from her sexual partner. CASE REPORT: A female repeat blood donor showed anti‐HCV seroconversion and a slight elevation in alanine aminotransferase. She had a normal physical examination and no clinical symptoms. She admitted a sexual partnership with a man with chronic HCV infection. Genotyping showed subtype 3a infection in both. Nucleotide sequence analysis of the hypervariable region of the viral envelope was performed on five clones obtained from the donor and the partner. Five blood donors with subtype 3a infection were analyzed as controls. The mean homology among clones was 99.3 percent (95% CI, 98.9–99.7) in the donor and 96.8 percent (95% CI, 94.4–99.2) in the partner, which suggests a more recent infection in the woman. The mean homology between donor and partner was 93.4 percent (95% CI, 93.1–93.8), which is different from that between donor and controls (76.2%; 95% CI, 73.3–79.1; difference between means, 17.2%; 95% CI, 16.0–18.4). This suggests that the infection was transmitted to the donor from her sexual partner. Sexual intercourse is the most probable route of transmission, because parenteral risk factors were absent. CONCLUSION: Heterosexual transmission of HCV can occur in the absence of a long‐lasting contact, and the infection can be asymptomatic. It remains to be determined whether the sexual partners of HCV‐infected subjects should be deferred from blood donation.
The presurgical management with erythrocytapheresis of a patient with a high‐oxygen‐affinity, unstable Hb variant (Hb Bryn Mawr)
Authors: Larson Peter J. , Friedman David F. , Reilly Michael P. , Kattamis Antonis C. , Asakura Toshio , Fortina Paolo , Cohen Alan R. , Kim Haewon C. , Manno Catherine S.
Published: March 2003

BACKGROUND: Hemoglobin (Hb) Bryn Mawr is an unstable Hb variant resulting in congenital hemolytic anemia. This variant Hb also has an increased affinity for oxygen. The perioperative transfusion management of this disorder is described, and the first genomic analysis of this Hb variant is given. CASE REPORT: An 11‐year‐old boy, heterozygous for Hb Bryn Mawr, was referred for cholecystectomy. Sequence analysis of genomic DNA confirmed that the patients was heterozygous for a T–>C transition in the codon for amino acid 85, causing a substitution of serine for phenylalanine in the beta‐globin chain. On the basis of whole‐blood O2 dissociation studies, projected tissue O2 delivery would have been suboptimal during general anesthesia; therefore, a partial red cell exchange transfusion was performed to lower variant Hb and prevent tissue hypoxia during surgery. The red cell mass to be exchanged (50%) was determined from the calculated increase in O2 delivery capacity required to maintain an O2 extraction of 4 to 5 mL of O2 per dL of whole blood. The p50 of whole blood from the patients immediately after the exchange transfusion was 16.0 torr. At the time of surgery, the p50 was normal (25.9 torr). The patient's whole blood 2,3 DPG levels were 4.70 mmol per mL of red cells (before transfusion) (normal range=4.8 +/− 0.3 mmol/mL red cells), 4.07 mmol per mL of red cells (immediately after transfusion), and 4.55 mmol per mL of red cells (48 hours after transfusion). CONCLUSION: This patient with Hb Bryn Mawr was prepared for surgery with a partial exchange transfusion to prevent tissue hypoxia during anesthesia. Decreased 2,3 DPG levels immediately after transfusion resulted in increased O2 affinity of whole blood; however, 48 hours after exchange transfusion, a normal p50 (due to both removal of variant Hb and regeneration of 2,3, DPG) was observed. Partial exchange transfusion is useful in the preoperative management of patients with Hb variants characterized by increased O2 affinity.
Flow cytometric analysis of platelet membrane antigens during and after continuous‐flow plateletpheresis
Authors: Gutensohn Kai , Bartsch Nancy , Kuehnl Peter
Published: March 2003

BACKGROUND: The influence, extent, and duration of changes in platelet antigen expression caused by blood‐biomaterial interaction in plateletpheresis were assessed. STUDY DESIGN AND METHODS: Twenty‐two apheresis donors were studied by using two automated continuous‐flow apheresis devices. Blood samples were taken before, during, and for 4 days after extracorporeal circulation. The platelet surface expression of glycoproteins CD41a, CD42b, CD62p, and CD63 was analyzed by flow cytometry. RESULTS: Over the course of plateletpheresis, there was a significant increase in mean channel fluorescence intensity (MCFI) of CD62p, from 25.1 +/− 7.9 (mean +/− SD) to 50.4 +/− 28.9, and of CD63, from 22.3 +/− 6.5 to 33.3 +/− 13.2. There was a significant decrease in CD41a expression as measured by the MCFI, from 1129.8 +/− 125.0 to 1066.6 +/− 102.2, and in CD42b MCFI, from 329.6 +/− 49.4 to 321.4 +/− 52.0. The two apheresis devices showed different platelet activation kinetics, but the overall MCFI of CD62p and CD63 did not significantly diverge after 60 minutes of apheresis. CD62p and CD63 expression as measured by the MCFI returned to preapheresis levels during the follow‐ up period in 25 and 25 of 44 procedures, respectively, within 24 hours; in 10 and 13 of 44 procedures after 48 hours; in 7 and 3 of 44 procedures after 72 hours; and in 2 and 3 of 44 procedures on Day 5. CONCLUSION: The varying kinetics of expression, as measured by the MCFI, of platelet antigens CD62p, CD63, CD41a, and CD42b during extracorporeal circulation may be useful for biocompatibility testing. Activated platelets continue to circulate in donors for several days after cytapheresis, which suggests that a sufficient interval between apheresis procedures is necessary to avoid the collection of activated platelets.
A pilot study of continuous ambulatory electrocardiography in patients donating blood for autologous use in elective coronary artery bypass grafting
Authors: Kasper Stefan M. , Baumann Marc , Radbruch Lukas , Harnischmacher Urs , Ohler Jürgen P. , Buzello Walter
Published: March 2003

BACKGROUND: A pilot study was conducted to evaluate the impact of a single autologous blood donation on the presence or absence of myocardial ischemic episodes in patients with coronary artery disease. STUDY DESIGN AND METHODS: Fifty patients scheduled for elective coronary artery bypass grafting underwent two 24‐hour periods of ambulatory electrocardiogram monitoring, one before and one after their first autologous blood donation. The presence or absence and the number, duration, and integral area of episodes of ST segment depression for each 24‐hour monitoring period were determined. RESULTS: Forty‐two patients had legible electrocardiogram recordings for both monitoring periods. Of these, 36 patients (86%) had at least one episode of ST segment depression during any monitoring period. The number of patients who had at least one episode of ST segment depression before donation was not significantly different from the number of those who had at least one episode after donation (31 and 33 patients, respectively; p=0.73). CONCLUSION: Donating a unit of blood had no demonstrable effect on the presence or absence of myocardial ischemic episodes in this sample of 42 autologous blood donors with coronary artery disease. The results of this study should be validated in further trials.
Reduction of plasma volume after storage of platelets in CP2D
Authors: Rock G. , Haddad S.A. , Poon A.O. , Romans R.A. , Sparling C.R. , Louis P. , Berger R.
Published: March 2003

BACKGROUND: There has been concern that further deterioration might occur if stored platelets are centrifuged to reduce their volume. Although such centrifugation appears to have minimal effect on platelets in CPDA‐1 (osmolarity, 470 mOsm) there is no information on the situation with CP2D (580 mOsm). STUDY DESIGN AND METHODS: Platelet concentrates from CP2D packs were sampled at 1 and 5 days and after centrifugation was used to reduce the plasma volume to 10 mL. The aggregation, hypotonic shock response, morphology, pH, and lactate, glucose, pCO2 and pO2 levels were assessed, and values were compared to those seen with CPDA‐1. In addition, blood was collected from the same donors into both CP2D and standard sodium citrate anticoagulant in an anticoagulant‐to‐blood ratio of 1:8 and the aggregation response of the fresh platelets was measured. RESULTS: Collection of blood into CP2D results in an immediate reduction of the platelet aggregation response when compared to that found after collection of blood into sodium citrate or CPDA‐1. Aggregation is further decreased after storage; however, these changes and those for hypotonic shock, pH, lactate, glucose, and pCO2 are similar to those seen for CPDA‐1. Additional centrifugation did not cause further change. CONCLUSION: Platelets stored in CP2D have reduced in vitro function after 5 days of storage, but subsequent centrifugation to reduce the plasma volume does not further alter these platelets.
Quantitation of white cell subpopulations by polymerase chain reaction using frozen whole‐blood samples
Authors: Lee T.H. , Sakahara N.S. , Fiebig E.W. , Hirschkorn D.F. , Johnson D.K. , Busch M.P.
Published: March 2003

BACKGROUND: Previous methods for processing whole blood (WB) for nucleic acid analyses of white cells (WBCs) required fresh blood samples. A simple protocol that involves the freezing of WB for quantitative polymerase chain reaction (PCR) analyses was evaluated. STUDY DESIGN AND METHODS: Controlled studies were conducted in which paired fresh and frozen WB preparations were analyzed. The integrity of WBCs in the frozen WB samples was first assessed by flow cytometry using CD45 fluorescence, and calibration beads to quantitate recovery of WBC subsets. PCR of an HLA‐DQ‐A sequence was used to quantitate residual WBCs in a double‐filtered red cell (RBC) component spiked with serial dilutions of WBCs, as well as in 51 filtered RBCs and 19 filtered platelet concentrates. Y‐chromosome‐specific PCR was used to quantitate male WBCs in five female WB samples spiked with serial dilutions of male WBCs and in serially collected frozen WB samples from four females transfused with male blood components. RESULTS: By flow cytometry, all major WBC subpopulations in frozen‐thawed WB were quantitatively recovered and immunologically intact, although they were nonviable. HLA‐DQ‐A PCR quantitation of a dilution series from 8 to 16,700 per mL of WBCs spiked into double‐filtered RBCs showed linear correlation of the results with both fresh and frozen preparations of the expected WBC concentrations (r2 = 0.98, p<0.0001 for both), without significant difference between observed and expected values (p>0.05). Y‐ chromosome‐specific PCR results in female WB samples spiked with male WBCs were not significantly different in fresh and frozen preparations over a 3 log10 range of male cells. The results of WBC survival studies on frozen WB samples were consistent with previous observations in fresh blood samples. CONCLUSION: Direct freezing of WB enables subsequent recovery of WBCs for quantitative PCR analyses, with results comparable to those of fresh preparations. This protocol should facilitate wider implementation of nucleic acid‐based analyses for quality control of WBC‐reduced components, as well as for prospective clinical studies of microchimerism in transfusion and transplant recipients.
Cytomegalovirus DNA can be detected in peripheral blood mononuclear cells from all seropositive and most seronegative healthy blood donors over time
Authors: Larsson S. , Soderberg‐Naucler C. , Wang F.Z. , Moller E.
Published: March 2003

BACKGROUND: A poor correlation between cytomegalovirus (CMV) seroreactivity and the risk of CMV transmission prompted an investigation of the presence of CMV DNA in peripheral blood mononuclear cells (PBMNCs) from seropositive and seronegative blood donors. Because latent CMV exists in monocytes, monocyte‐enriched cells were analyzed separately. STUDY DESIGN AND METHODS: Samples from 270 blood donors were tested with a sensitive polymerase chain reaction (PCR) test that detects two CMV genes, and the results were correlated to CMV serology. Cross‐reactivity with other herpesvirus genes was not recorded. RESULTS: PCR testing demonstrated that 71 percent of seropositive donors harbor CMV in PBMNCs. Thus, not all seropositive donors were CMV DNA positive when individual samples were tested. Tests repeated over a period of time showed that all seropositive individuals were positive. Increased sensitivity was obtained with enriched monocytes. Among seronegative donors, 55 percent harbored CMV DNA in monocyte‐enriched PBMNCs, while 14 percent had CMV DNA in PBMNCs. CONCLUSION: All seropositive donors harbored latently infected PBMNCs, as demonstrated by the testing of samples collected over time. In addition, a substantial proportion of seronegative individuals are CMV carriers and might transfer infection. The findings concur with clinical evidence of CMV transmission by blood components from seronegative individuals and with in vitro reactivation of CMV in PBMNCs from seronegative donors.
Mathematical modeling of platelet survival with implications for optimal transfusion practice in the chronically platelet transfusion‐dependent patient
Authors: Hersh J.K , Horn E.G. , Brecher M.E.
Published: March 2003

BACKGROUND:It is known that in vivo platelet survival varies as the platelet count changes. Previous attempts at curve fitting fail to predict the decreased platelet survival in thrombocythemia. Therefore, mathematical relations that more closely approximate platelet survival were derived and used in models of platelet transfusion practice.

STUDY DESIGN AND METHODS:A differential equation for platelet loss was derived that included a constant (constant homeostatic loss), a first‐ order term (senescent loss), and a second‐order term (one proportional to the square of the platelet concentration and whose contribution is expected to be significant only at higher platelet concentrations). Data derived from this model was compared to platelet survival data in normal, thrombocytopenic, and thrombocythemic patients and to the platelet decay after high‐dose chemotherapy. To provide further validation of this model, predicted and actual platelet requirements were calculated or obtained (chart review) in bone marrow patients with uncomplicated thrombocytopenia after ablation and at two platelet‐ transfusion thresholds (20 and 10 × 10(9)/L).

RESULTS:The equations accurately modeled normal, thrombocytopenic, and thrombocythemic platelet survival. Chart review demonstrated a 12.5 percent reduction in platelet transfusion requirements when the transfusion threshold was reduced from 20 to 10 × 10(9) per L. The model predicted a reduction of 14.0 percent. For 100 days of uncomplicated thrombocytopenia and a transfusion threshold of 10 × 10(9) per L, transfusion of 3 units of platelet concentrates compared to a 6‐unit pool of platelet concentrates, resulted in a 22‐percent savings of platelet units. CONCLUSION: Platelet survival as a function of platelet concentration can be modeled by use of a differential equation. This model challenges current dogma regarding platelet destruction and predicts decreased platelet survival in thrombocythemic patients. The model illustrates that large doses of platelets would result in greater time between transfusions, however, more units of platelets are used. Consideration should be given to the more frequent use of smaller doses of platelets in patients who chronically require platelet transfusion support.
Lowering the hemoglobin cutoff for female plateletpheresis donors
Authors: Fraser J. L. , Whatmough A. , Uhl L. , Kruskall M. S.
Published: March 2003

BACKGROUND: The standards of the American Association of Blood Banks describe a minimum hemoglobin level of 12.5 g per dL for apheresis donors. Until 1995, the authors' institution accepted occasional platelet donors with a lower minimum hemoglobin (11.5 g/dL), if accompanied by medical director approval.

STUDY DESIGN: All donation records from a 6‐month period before 1995 were retrospectively reviewed to determine whether this lower hemoglobin cutoff adversely affected either the safety of the platelet donation process or donors' subsequent hemoglobin levels.

RESULTS: Of 450 donations, 56 (12%, Group 1) were from donors with hemoglobin concentrations between 11.5 and 12.4 g per dL (2 donations from 1 man; 54 donations from 45 women). The remaining 394 donations (88%, Group 2) came from donors with hemoglobin concentrations > or = 12.5 g per dL (216 donations from 118 men; 178 donations from 119 women). The frequency of donor reactions was acceptable (Group 1, 11%; Group 2, 6%); 2 percent of donations by Group 1 donors and 1 percent by Group 2 donors were terminated because of these reactions. Of 46 donors in Group 1, 30 returned to donate platelets again at a later time; at least once, 23 (77%) had a hemoglobin > or = 12.5 g per dL. Ten donors in Group 1 returned for additional donations within 56 days; no meaningful decrease in hemoglobin levels occurred. A hemoglobin cutoff of 12.5 g per dL during the study period would have excluded 1 percent of platelet donations by men and 23 percent by women.

CONCLUSION: The data demonstrate that the lower hemoglobin cutoff of 11.5 g per dL is a safe and relevant threshold for accepting female plateletpheresis donors and would allow more participation by women in blood donor programs.
Infection by an unenveloped DNA virus associated with non‐A to ‐G hepatitis in Japanese blood donors with or without elevated ALT levels
Authors: Itoh K. , Hirakawa K. , Okamoto H. , Ukita M. , Tanaka H. , Sawada N. , Tsuda F. , Miyakawa Y. , Mayumi M.
Published: March 2003

BACKGROUND: An unenveloped, single‐stranded DNA virus named TT virus has been found in association with elevated alanine aminotransferase (ALT) levels in recipients of transfusions and has been detected frequently in patients with acute or chronic hepatitis of non‐A to ‐G etiology in Japan. DNA of the TT virus was searched for in blood donors with or without elevated ALT levels.

STUDY DESIGN AND METHODS: A total of 861 blood donors without previous transfusions and who were negative for markers of hepatitis B or C virus infection were tested. DNA of the TT virus was detected by polymerize chain reaction with hemi‐nested primers.

RESULTS: TT virus DNA was detected in 62 of 280 (22.1% [95% CI: 18.1‐26.6]) donors with elevated ALT levels (mean ± SD, 89.3 ± 36.4 U/L; range, 61‐301 U/L), which is significantly more frequently (p<0.02) than its detection in 91 of 581 (15.7% [95% CI: 13.2‐18.4]) donors with normal ALT (<45 U/L). The frequency of TT virus DNA increased with age, in donors with and without elevated ALT.

CONCLUSION: The detection of TT virus DNA, at a frequency higher in donors with elevated ALT than in those without, strengthens the association of TT virus with non‐A to ‐G hepatitis.
Factor VIII/von Willebrand factor complex in methylene blue‐treated fresh plasma
Authors: Aznar J.A. , Molina R. , Montoro J.M.
Published: March 2003

BACKGROUND: The effect of virus inactivation of fresh plasma with methylene blue has been studied on the factor VIII/von Willebrand factor molecular complex (FVIII/vWF), factor XIII, and fibrinogen.

STUDY DESIGN AND METHODS: FVIII function or activity, vWF activity, vWF antigen, vWF:Ag, vWF multimeric structure, fibrinogen, and factor XIII were analyzed in paired samples of control fresh plasma (untreated) and the same fresh plasma treated with methylene blue. Treated plasma was filtered (0.8‐1.2 μm), mixed with a methylene blue solution (300 μg/L), and illuminated at 50,000 lux for 30 minutes on both sides.

RESULTS: Average loss of biologic activity of coagulation factors studied was 25 percent (FVIII function, 29%; fibrinogen, 39%; factor XIII, 16%; and vWF activity, 18%). Reduction in vWF activity was significantly lower than that in FVIII function (p<0.05), and the vWF multimeric structure did not show alterations.

CONCLUSION: Methylene blue‐treated plasma and the cryoprecipitates obtained from it may be effective for replacement therapy in cases of von Willebrand disease and deficiencies of factor XIII and fibrinogen, but the clinical studies are needed to verify that possibility.
Transfusion‐related acute lung injury due to granulocyte‐agglutinating antibody in a patient with paroxysmal nocturnal hemoglobinuria
Authors: Żupańska B. , Uhrynowska M. , Konopka L.
Published: March 2003

BACKGROUND: Transfusion‐related acute lung injury (TRALI) is usually reported after the transfusion of blood components from donors with white cell (WBC) antibodies, but only very rarely if the patient has these antibodies. The pathogenesis of TRALI is not fully understood. Not all transfusion recipients develop TRALI, even though WBC antibodies are present in the donor or the recipient.

CASE REPORT: A patient with paroxysmal nocturnal hemoglobinuria (PNH) who developed TRALI after the transfusion of non‐WBC‐reduced red cells is described. Granulocyte‐agglutinating anti‐5b was detected in his serum, and the crossmatch with the donor granulocytes was positive. The patient also developed a severe exacerbation of hemolysis with renal failure; serologic results excluded an immune hemolytic posttransfusion reaction. The patient recovered from both events after about 1 week.

CONCLUSION: Granulocyte‐agglutinating antibodies present in the recipient play an important role in TRALI, and also other factors may contribute to its pathogenesis. The reaction between the PNH patient's antibody (anti‐5b) and transfused WBCs was found not only to be responsible for the respiratory distress but also to have triggered, through the innocent‐bystander mechanism of complement activation, an intensive hemolysis, which was very likely a contributing factor in the development of TRALI.
Quality and clinical response to transfusion of prestorage white cell‐reduced apheresis platelets prepared by use of an in‐line white cell‐reduction system
Authors: Elfath M. , Tahhan H. , Mintz P. , Dumont L. , Whitley P. , Sawyer S. , McNeil D.
Published: March 2003

BACKGROUND: This study evaluated the quality and clinical effectiveness of white cell (WBC)‐reduced apheresis platelets collected by the use of a new technology, fluidized particle‐bed separation.

STUDY DESIGN AND METHODS: In phase I, six suitable donors underwent two separate plateletpheresis procedures on one occasion, each separated by less than 10 minutes. In random order, a control unit was collected with the COBE Spectra and a test unit with the Spectra Leukocyte‐Reduction System (LRS). The quality of apheresis platelet components was assessed by an in vitro test panel, and residual WBCs were counted by Nageotte chamber and flow cytometric methods. For the in vivo studies, the test and control units were randomly labeled with either 51Cr or 111In at the end of storage and transfused simultaneously to the donor. Samples were taken for calculation of platelet survival and recovery. In phase II, 109 thrombocytopenic patients were given platelets collected by use of the Spectra LRS.

RESULTS: Test platelets had significantly fewer residual WBCs (median 7.6 × 104) than control platelets (median 3.9 × 105), with equivalent in vitro function values. Test and control platelets had similar recovery and survival. Transfused platelets collected by use of the LRS achieved a mean 1‐hour corrected‐count increment of 19.3.

CONCLUSION: The LRS collects platelet components with significantly lower WBC contamination without adverse effects on the function or in vivo survival of the platelets.