bluuebunny/crossref_metadata_2025 huggingface dataset:
Human blood cells at microgravity: the NASA Initial Blood Storage Experiment
Authors: Surgenor D.M. , Kevy S.V. , Chao F.C. , Lionetti F.J. , Kenney D.M. , Jacobson M.S. , Kim B. , Ausprunk D.H. , Szymanski I.O. , Button L.N. , Curby W.A. , Luscinskas F.W. , Curran T.G. , Carter J.H. , Carr E. , Mozill D.R. , Blevins D.K. , Laird N.
Published: March 2003

The Initial Blood Storage Experiment (IBSE) probed the behavior of human red cells, white cells, and platelets during exposure to microgravity for 6 days and 2 hours on a National Aeronautics and Space Administration (NASA) shuttle mission, named STS 61‐C, which was launched on January 12, 1986. IBSE involved carefully controlled comparisons between two identical sets of blood cells, one exposed to microgravity and the other held on the ground. Specially designed and fabricated, electrically powered environmental chambers provided appropriate environmental temperatures and air flow to support cell metabolism throughout the experiment. To circumvent the need for constant agitation of platelets during storage, a new thin‐layer compression method for platelet preservation was developed. Blood cell samples were allocated to the two arms of the experiment, microgravity and earth gravity, by blind assignment. Moreover, to ensure unbiased assessment of the experiment's findings, postexperiment samples for measurement were identified by code. To optimize the chances of detecting possible gravitational effects, a wide array of measurements of cellular function, morphology, metabolism, and immunology were made. Analysis of variance was used in analyzing the data. The most striking finding was that platelets displayed markedly superior structural and functional integrity at microgravity. Granulocytes held on the ground were preserved slightly better than those that orbited in the shuttle, whereas red cells displayed few effects that were attributable to the gravitational variable. Polyvinylchloride‐di‐(2‐ethylhexyl)phthalate (PVC‐DEHP) was the plastic of choice for storage of red cells, while PVC‐trioctyltrimellitate (TOTM) was superior to PVC‐DEHP and polyolefin (PO) for platelets.
Differential reactions of HLA typing sera with cells homozygous for crossreacting antigens
Authors: Gantan Z.P. , Perkins H.A.
Published: March 2003

A large number of well‐characterized HLA typing sera were used in a standard cytotoxicity technique to evaluate the frequency with which homozygous cells reacted to antisera directed against a crossreacting specificity. Four of 15 anti‐HLA‐A1 sera reacted with cells homozygous for HLA‐A11 bet not with A11 heterozygotes. Similar dosage effects were noted with anti‐A3 sera and A11 cells, with anti‐A28 sera and A2 cells, with anti‐A23 sera and A24 cells, and with anti‐A24 sera and A23 cells. No dosage effects were seen with anti‐A1 sera and A3 cells, with anti‐ A3 sera and A1 cells, and with anti‐A11 sera and either A1 or A3 cells. Dosage effects were also not seen with anti‐B51 or ‐B35 sera and cells containing antigens of the B5 crossreacting group. Dosage is a property of the individual serum and does not occur with all samples sharing the same primary specificity. As noted by red cell serologists, sera demonstrating dosage effects are common with some specificities but absent with others. The reactions noted may be a quantitative effect of epitopes present on certain antigens. Caution should be observed when interpreting an HLA phenotype that appears to contain two crossreacting antigens at the same locus, unless the sera used have been shown not to manifest dosage effects.
Parentage analysis by endonuclease shattering of hypervariable DNA
Authors: Chiafari F.A. , Wenk R.E.
Published: March 2003

Single‐locus DNA probes for tandem repeat sequences are now used in conjunction with particular endonucleases to characterize heritable restriction fragment lengths in parentage tests. Southern blots of this type, however, demonstrate only two attributes of an allele: its length and the presence of nucleotide sequences that are complementary to the probe. Not all restriction fragments of the same apparent length that react with the same probe are identical. Differences between comigrating fragments can be detected by the selection of a restriction enzyme that recognizes sites in a subset of the repeat sequences, and the information content of these loci is therefore increased. This report describes a paternity case in which two brothers appeared, after DNA phenotyping using Hinf I, to be the father. A second phenotyping using Hae III excluded one of the brothers.
Physiologic observations of pregnant women undergoing prophylactic erythrocytapheresis for sickle cell disease
Authors: Lee W. , Werch J. , Rokey R. , Pivarnik J. , Miller J.
Published: March 2003

Five women in the second or early third trimester of pregnancy underwent prophylactic partial red cell exchange by automated erythrocytapheresis for sickle cell disease. The purpose of this pilot study was to characterize the hematologic, hemodynamic, and metabolic changes associated with this procedure. Pretransfusion hematocrit increased 49 percent by 3 to 5 days after the transfusion. Paired observations indicate a 14‐percent drop in maternal oxygen consumption. There was a slight tendency for reduced posttransfusion cardiac output that resulted primarily from changes in maternal heart rate and not from changes in stroke volume. Left ventricular contractility also tended to decrease after transfusion. Neither fetal bradycardia nor alteration in the umbilical circulation by Doppler ultrasound was observed during the transfusion procedures. Despite substantial hematologic alterations, this procedure is associated with small or negligible changes in maternal hemodynamic and metabolic function for minimally symptomatic pregnant patients with sickle cell disease.
Comparison of the effectiveness of potential marrow donors recruited from apheresis donors or whole blood donors and through appeals to the general public
Authors: Stroncek D. F. , Strand R. D. , Hofkes C. L. , McCullough J.
Published: March 2003

Marrow transplants with phenotypically HLA‐matched, unrelated donors have been used effectively to treat a number of diseases. Many blood centers have recruited HLA‐typed apheresis blood donors into marrow donor registries. However, to build larger registries so that more patients may be treated with unrelated donor marrow transplants, whole blood donors and people who do not donate blood have been added to the registries. The marrow donor program at our blood center had 2844 potential donors, of whom 1725 were also apheresis donors, 608 were whole blood donors, and 511 were recruited from the general public as a result of community appeals for marrow donors for a specific patient. Over a 9‐month period, 297 potential donors were asked to donate blood samples for HLA‐DR typing or mixed lymphocyte culture (MLC) testing or to participate in an informational session, undergo a medical evaluation, and sign a statement indicating an intention to donate marrow for a specific patient. Overall, these requests were successfully completed by 75.5 percent of apheresis donors, 87.2 percent of whole blood donors, and 78.1 percent of the potential donors recruited through community appeals. Furthermore, there was no difference among the three groups in the portion of people who donated blood samples for HLA‐DR typing or MLC testing. Fifteen of 18 apheresis donors who were found to match a specific donor signed a statement of intent to donate marrow, 2 apheresis donors were deferred for medical reasons, and 1 decided not to donate. Of those people signing a statement of intent to donate, 12 apheresis donors, 1 whole blood donor, and 2 community‐appeal potential donors donated marrow. Marrow donations by 3 apheresis donors and 1 whole blood donor were canceled because of changes in the potential recipient's clinical condition. In conclusion, most donors recruited from all three groups are committed to donating marrow. Potential marrow donors obtained by community appeal or whole blood donation should be added to marrow donor registries if they have been recruited properly and if funds can be provided for the cost of HLA typing.
White cell depletion of single‐donor platelet preparations by a new adsorption filter
Authors: Böck M. , Heim M. U. , Weindler R. , Bilas A. , Greither L. , Salat C. , Mempel W.
Published: March 2003

A newly developed adsorption filter has been evaluated for the removal of white cells (WBCs) from platelet concentrates. It consists of surface‐modified polyester fibers and can be used at the patient's bedside. WBC mean removal rate was 98.8 +/− 0.9 percent, and platelet recovery was 99.0 +/− 0.7 percent. The aggregation curves (ADP, collagen) and hypotonic shock response of platelets were not influenced by the filtration, and the plasma electrolyte and lactate dehydrogenase concentrations were unaffected. Transmission and scanning electron micrographs showed no difference in platelet ultrastructure before and after filtration. Determination of posttransfusion platelet recovery did not reveal any significant difference from that of nonfiltered platelets. The tested filter seems to be a suitable device for WBC depletion of single‐donor platelet concentrates at the bedside.
Serial immunoreactive erythropoietin levels in autologous blood donors
Authors: Lorentz A. , Jendrissek A. , Eckardt K.U. , Schipplick M. , Osswald P.M. , Kurtz A.
Published: March 2003

The variations in plasma erythropoietin (EPO) concentration during preoperative deposit of autologous blood were studied in 12 patients (8 men, 4 women). Four donations were scheduled at weekly intervals. A predonation hemoglobin concentration of 11 g per dL (110 g/L) was required. Hemoglobin concentration decreased from 14.3 ± 1.1 g per dL (143 ± 11 g/L) (mean ± SD) before the first donation to 11.7 ± 0.7 g per dL (117 ± 7 g/L) on Day 22 (p ≤ 0.0001). Reticulocyte counts increased from a median of 31,800 (range, 4900–95,000) per μsL (median, 32 × 109/L [range, 5–95 × 109/L]) to 93,800 (16,800‐194,900) per μL (median, 94 × 109/L [range, 17‐ 195 × 109/L]) on Day 28 (p ≤ 0.01). Plasma EPO concentration was 17.8 ± 5.1 mU per mL prior to the first donation and displayed a small and transient peak after each donation. A sustained elevation followed each peak. Although plasma EPO concentration differed significantly from the baseline value after the first donation, only the peak concentrations after the second (35.5 ± 15.5 mU/mL), third (38.0 ± 14.5 mU/mL), and fourth (36.1 ± 11.0 mU/mL) donations exceeded the normal range. The moderate, biphasic increase in plasma EPO concentration and the moderate increase in erythropoiesis suggest two strategies in autologous blood donation that should be investigated with respect to efficiency and safety: 1) more aggressive donation schemes, which reduce donation intervals and/or the minimum hemoglobin concentration and 2) the administration of recombinant human EPO.
Serologic distinction between human T‐lymphotropic virus (HTLV) type I and HTLV type II
Authors: Hjelle B , Cyrus S , Swenson S , Mills R
Published: March 2003

In November 1988, the Food and Drug Administration approved reagents for serologic screening for human T‐lymphotropic virus type I (HTLV‐I) infection in blood donors and patients suspected of having HTLV‐I‐ related illnesses. These reagents are able to detect HTLV type II (HTLV‐ II), a close relative of HTLV‐I with no known pathologic effect. The distinction between the two forms of HTLV is important to the donor and to any recipient of blood containing HTLV. The application to sera from 38 seropositive blood donors and 2 recipients (37 “confirmed” positive and 3 indeterminate by Western blot) of two methods (Western blot and peptide enzyme immunoassay) for serologic distinction between HTLV‐I and ‐II is described. These results were compared to those from polymerase chain reaction (PCR) analysis of HTLV proviral DNA obtained from donor peripheral blood mononuclear cells. The peptide enzyme immunoassay was found to be less sensitive than the Western blot, but completely concordant with PCR results when differential reactivity could be established. The Western blot pattern showed complete diagnostic concordance with the samples with confirmed‐positive serologic tests, but was incorrect in two HTLV‐II‐infected donors with indeterminate serologic tests. Thirty‐three (89%) of the 37 individuals from this predominantly Native American and Hispanic group of blood donors were found to have HTLV‐II. These findings confirm and extend previous reports that HTLV‐I infection may be less common, and HTLV‐II infection more common, than previously believed. The peptide enzyme immunoassay can provide most individuals who have positive results with the HTLV‐I/II screening test with serologic distinction between HTLV‐I and HTLV‐II.
The perioperative use of blood components during heart and heart‐lung transplantation
Authors: Hunt B. J. , Sack D. , Amin S. , Yacoub M. H.
Published: March 2003

Perioperative blood usage during 172 heart transplants (HTs) and 100 heart‐lung transplants (HTLs) performed at the same center during 1986 and 1989 was reviewed. In 1986, 79 HTs were performed with a median (interquartile range) blood component use of 12 (range, 8–20) units, of which 6 (range, 4–8) constituted red cell components. The use of blood components was significantly reduced (p < 0.05 by the Mann‐ Whitney U test) in 1989 to 10 (range, 8–20) units, of which red cell components constituted 5 (range, 3–7) units. Fifty HLTs in 1986 used a median (interquartile range) of 25.5 (range, 11.5–53) units of blood components. This use was significantly reduced (p < 0.05) to a median of 18 (range, 9–29) units in 1989, of which 8 (range, 5–11) were red cell components, 4 (range, 2–8) were units of fresh‐frozen plasma, and 5 (range, 0–10) were units of platelets. More blood components were used in patients who had previous cardiothoracic surgery and/or previous transplants; this reached significance in the 1986 HTs (p < 0.001). Fresh blood was used in only one HT but in 12 (24%) of 1086 HLTs and 4 (8%) of 1989 HLTs. As the indication for fresh blood was excessive bleeding, there was a significantly greater use of blood components in 1989 HLT patients receiving fresh blood than in those not receiving fresh blood (median [range] of 163.5 [62–251] units compared to 15.5 [3–126]). There was a trend for patients who had a large blood loss to have a reduced 1‐week postoperative survival, which reached significance (p<0.05) in the 1987 HLTs.
Low risk of viral infection after administration of vapor‐heated factor VIII concentrate
Authors: Mannucci P.M. , Schimpf K. , Abe T. , Aledort L.M. , Anderle K. , Brettler D.B. , Hilgartner M.W. , Kernoff P.B.A. , Kunschak M. , McMillan C.W. , Preston F.E. , Rivard G.E. ,   The International Investigator Group
Published: March 2003

A multicenter prospective study was carried out to evaluate whether a vapor‐heated factor VIII concentrate transmitted blood‐borne viral infections over a surveillance period of 15 months. Thirty‐five patients with hemophilia and von Willebrand disease who had never received any blood components were treated. Twenty‐eight were analyzed and found not to have non‐A,non‐B hepatitis. Sera from 20 of these 28 patients were also tested for the antibody to the hepatitis C virus. None had sero‐converted during the follow‐up period. None of the patients analyzed developed markers of the hepatitis B virus (n = 17) or the human immunodeficiency virus (n = 31). This vapor‐heated factor VIII concentrate carries a low risk of transmitting hepatitis and human immunodeficiency virus infection.
Storage and transfusion of platelets collected by an automated two‐ stage apheresis procedure
Authors: Simon T. , Lee E.J. , Heaton A. , Schiffer C.A. , Huestis D. , Schoendorfer D. , Hedberg S. , Buchholz D.
Published: March 2003

Platelets collected by using a two‐stage automated blood cell separator were evaluated after 5 days of storage. The procedure caused no unanticipated physiologic changes in donors and produced greater than 3 × 10(11) intact platelets in 200 mL of plasma, plus an additional 400 mL of plasma with intact coagulation factors. Posttransfusion recovery of autologous radiolabeled platelets was comparable to that seen in platelets prepared by manual centrifugation techniques. Corrected count increments in 14 patients showed results similar to those with control transfusions. This device, which involves a collection time of less than 90 minutes, provides an option for platelet‐pheresis in a variety of settings including blood mobiles.
Activation in stored platelet concentrates: correlation between membrane expression of P‐selectin, glycoprotein IIb/IIIa, and beta‐ thromboglobulin release
Authors: Rinder H.M. , Snyder E.L. , Bonan J.L. , Napychank P.A. , Malkus H. , Smith B.R.
Published: March 2003

By using two distinct measurements of alpha‐degranulation (surface P‐ selectin [alpha‐granule membrane protein‐140] expression and beta‐ thromboglobulin [beta‐TG] release) and quantitation of glycoprotein (GP) IIb/IIIa surface density, stored platelet concentrates were evaluated to determine a) which method of measuring platelet alpha‐ granule release was more sensitive in detecting early platelet activation; b) whether Day 1 levels of activation predicted the extent of activation or cell lysis on Day 5 of storage; and c) whether changes in surface GPIIb/IIIa density were primarily dependent on platelet activation. By using samples from paired and unpaired units stored for 1, 3, and 5 days, four observations could be made. 1) A flow cytometric assay for the percentage of P‐selectin‐positive platelets was more sensitive for early detection of platelet activation than was measurement of beta‐TG release. This finding was most likely due to enhanced sensitivity in detecting platelets that had undergone partial alpha‐granule release. 2) Total P‐selectin expression correlated with beta‐TG release, which indicated that the extent of alpha‐granule membrane fusion with the external platelet membrane was proportional to the amount of alpha‐granule contents released into the supernatant. 3) All of the activation measurements on Day 1 predicted the activation values, but did not predict the degree of cell lysis (measured by lactate dehydrogenase discharge), on Day 5 of storage. 4) Surface GPIIb/IIIa density was increased on the subset of P‐selectin‐positive platelets as compared with the P‐selectin‐negative subset at all times during storage, but, within each subset, GPIIb/IIIa surface density did not significantly increase over the time of storage.
Blood donation and patterns of use in southeastern Nigeria
Authors: Emeribe A.O. , Ejele A.O. , Attai E.E. , Usanga E.A.
Published: March 2003

A retrospective study of donor blood availability and patterns of use from 1984 through 1988 was conducted in a 400‐bed university teaching hospital in Nigeria by extraction of data from the master registers for blood donors and recipients. Blood transfusion requests, number of persons who underwent phlebotomy, number of crossmatches performed, and blood use increased each year during the period of study. Average wastage rate and crossmatch‐to‐transfusion ratio were 3.5 percent and 1.61, respectively. Replacement blood donation constituted 98 percent of available donor blood. Obstetrics and gynecology and surgery patients used 70.4 percent of the donor blood. The donor blood units were used as whole blood (81%) because of a lack of infrastructure such as a refrigerated centrifuge. Less than 5 percent of the donors were females. It is concluded that the levels of voluntary blood donation and general blood supply are unacceptably low. The need for a functional National Blood Transfusion Service is highlighted.
Blood donation behavior of Hispanics in the lower Rio Grande Valley
Authors: Thompson W.W.
Published: March 2003

This study was designed to determine the blood donation behavior and attitudes of Hispanic residents of the Lower Rio Grande Valley for the purpose of developing promotional and educational approaches to enhance levels of donor participation. Personal interviews of 545 respondents were conducted in English and Spanish using quota sampling and standard intercept techniques at lower‐ and middle‐income supermarkets in five cities during a payday weekend. A number of research hypotheses were established to test for demographic, behavioral, and attitudinal differences that were observed in donors and nondonors using chi‐square analysis and multiple discriminant analysis. After analyzing the difference between Hispanics and non‐Hispanics for blood donation rates, all non‐Hispanics were eliminated from analysis, and the remaining 419 Hispanics were evaluated on the basis of their donor behavior. Donation among Hispanics was most likely to be by better‐ educated, English‐speaking, higher‐job‐status individuals who had participated in a blood donation drive. Donors tend to have parent(s) who were donors, and they were also more likely to carry an organ donor card. Donors were found to vary in their behaviors as well as their attitudes and beliefs. Perceptions of a lack of safety in donating, the risk of contracting acquired immune deficiency syndrome, and the financial motivation of donors were most pronounced among Hispanics, which indicated a need for improved education on these issues.
Quantitation of immunoglobulin classes and subclasses of autoantibodies bound to red cells in patients with and without hemolysis
Authors: Dubarry M. , Charron C. , Habibi B. , Bretagne Y. , Lambin P.
Published: March 2003

The concentration of IgG, IgA, and IgM, as well as IgG subclasses, was measured by an enzyme‐linked immunosorbent assay in autoantibodies eluted from red cells (RBCs); the number of molecules of each isotype per RBC was calculated. Three groups were analyzed: Group 1 included 23 patients with autoimmune hemolytic anemia (AIHA) associated with warm autoantibodies of IgG class; Group 2 included 11 patients without anemia but with a positive direct antiglobulin test (DAT); Group 3 included 10 healthy DAT‐negative subjects. The mean number of IgG molecules per RBC in Group 1 (920) was about three times that in Group 2 (306) and about 17 times that in Group 3 (54). The range of RBC‐bound IgG showed an overlap between the two groups of patients. The mean number of IgM and IgA molecules per RBC was low in the three groups. IgG1 predominated in all groups except in two patients with AIHA, in whom IgG3 made up at least 50 percent of total IgG. The mean number of IgG1, IgG2, and IgG4 molecules per RBC in Group 1 was about three times that in Group 2, whereas the mean number of IgG3 molecules per RBC was 10 times as high (p < 0.001). It follows that IgG3 was more common in patients of Group 1, but it was also detected in patients of Group 2.
The impact of blood transfusion on the occurrence of pneumonitis in primary cytomegalovirus infection after liver transplantation
Authors: Manez R. , Kusne S. , Martin M. , Linden P. , Irish W. , Torre‐Cisneros J. , Kramer D. , Ho M. , Starzl T.E.
Published: March 2003

The influence of blood transfusion, and particularly the transfusion of blood from cytomegalovirus (CMV)‐seropositive donors, on the incidence of primary CMV infection following liver transplantation was studied prospectively in 29 consecutive CMV‐seronegative adult liver transplant recipients. Fourteen patients received a liver graft from a CMV‐ seropositive donor (Group A), whereas for 15 patients, the donor was CMV seronegative (Group B). Eleven patients (79%) in Group A but only two (13%) in Group B developed CMV infection (odds ratio, 23.8; 95% confidence interval, 3.5–169.4). In five Group A patients, primary CMV infection resulted in pneumonitis. There was no statistical difference in the total number of blood units and the number of units of CMV‐ seropositive blood given to patients who did or did not develop CMV infection in both Groups A and B (odds ratio for unit of CMV‐ seropositive blood transfused, 1.07; 95% confidence interval, 0.96‐ 1.19). However, Group A patients who developed CMV pneumonitis received a higher total number of blood units (median, 44) and of CMV‐ seropositive blood units (median, 18) than did patients who developed other CMV infections (asymptomatic CMV, CMV syndrome, or CMV hepatitis), who received a median of 9 total units of blood and 5 units of CMV‐seropositive blood (p = 0.004). It is concluded that the total number of blood units and of CMV‐seropositive blood units transfused does not have an effect on the incidence of primary CMV infection after liver transplantation, but it does have an impact on the severity of the infection in recipients of a CMV‐seropositive allograft.
Cost‐effectiveness of white cell‐reduction filters in treatment of adult acute myelogenous leukemia
Authors: Balducci L. , Benson K. , Lyman G.H. , Sanderson R. , Fields K. , Ballester O.F. , Elfenbein G.J.
Published: March 2003

The objective of this study was to compare the cost and cost‐effectiveness of three transfusion strategies in the treatment of acute myelogenous leukemia: 1) the use of unfiltered pooled platelets until alloimmunization developed and of crossmatch‐compatible single‐donor platelets thereafter; 2) the use of filtered blood components until alloimmunization occurred and of crossmatch‐compatible single‐donor platelets thereafter; and 3) the use of single‐donor platelets from the beginning. The data sources were English language articles on transfusion medicine in acute leukemia and the management of acute leukemia and review of the transfusion experience at the H. Lee Moffitt Cancer Center. The method was decision analysis with a software program for cost‐effectiveness, sensitivity analysis, threshold evaluation, and Monte Carlo sensitivity analysis. In the basic models, the total costs of the first, second, and third strategies are, respectively, $12,557.14, $11,406.17, and $13,016.16 without bone marrow transplant and $14,002.72, $12,281.89, and $13,727.48 with bone marrow transplant. The threshold between the first and second strategies in regard to risk of refractoriness to filtered blood components and pooled platelets was 0.30 and 0.27, respectively, without bone marrow transplant and 0.28 and 0.40 with bone marrow transplant. According to a Monte Carlo sensitivity analysis of 500 samples, the second strategy is more cost‐effective than the first in 76 percent of cases. It is concluded that the use of filtered blood components is unlikely to increase the cost of treatment.
The effect of sterilization on transforming growth factor β isolated from demineralized human bone
Authors: Puolakkainen P.A. , Ranchalis J.E. , Strong D.M. , Twardzik D.R.
Published: March 2003

Growth factors have been identified as the primary cause of osteoinduction in bone healing. Transforming growth factor β (TGF‐β) has been shown to promote bone formation and is present in bone in high quantities. The aims of the present study were to isolate TGF‐β from human bone, demonstrate its biologic activity, and analyze the effects of conventional sterilization techniques on activity. Bone, obtained from femoral heads of five patients (mean age, 70 years) was ground, demineralized, and freeze‐dried, and samples from each patient were divided into three groups: no treatment, sterilization with 1.60 to 1.94 Mrad of 60Co irradiation, and sterilization with ethylene oxide (ETO). Carrier‐free recombinant TGF‐β control was also treated and was totally inactivated by ETO but not by irradiation (p < 0.01). TGF‐β activity in demineralized bone was not significantly diminished (p > 0.1) by either sterilization procedure, and substantial amounts of active TGF‐β were recovered in all bone samples: 1.04 ± 0.77 ng per mg of protein in irradiated samples, 0.67 ± 0.26 ng per mg in ETO‐treated samples, and 1.04 ± 0.33 in untreated samples, respectively (mean ± SD). Although a recent report demonstrated that the osteoinductive activity of bone morphogenetic protein in bone powder is diminished considerably by ETO and by 2.5 Mrad of irradiation sterilization of bone powder, these data demonstrate that TGF‐β activity, with its osteoinductive properties, was not destroyed in more coarsely ground, demineralized bone by ETO or by lower doses of irradiation. These findings support the use of human bone allografts in clinical instances involving impaired bone formation.
The necessary and the unnecessary transfusion: a critical review of reported appropriateness rates and criteria for red cell transfusions
Authors: Hasley P.B. , Lave J.R. , Kapoor W.N.
Published: March 2003

Background: The purpose of this study was to evaluate the criteria for assessing the appropriateness of red cell transfusions. The data were obtained by a computer search of all English‐language literature from 1966 to October 1992.

Study Design and Methods: Nine studies were selected, which dated from 1986 to 1989 and employed explicit criteria evaluating the appropriateness of red cell transfusion in adults. The following data were abstracted from all studies: study design, timing, location, criteria for evaluating appropriateness, and rate of appropriate or inappropriate transfusions.

Results: Five studies evaluated transfusion appropriateness. Appropriateness rates ranged from 88 to 99 percent in three studies, and inappropriateness rates ranged from 0.3 to 57.3 percent in two studies. Four studies evaluated transfusion inappropriateness and reported inappropriateness rates of 18 to 55 percent. Substantial variation was found in the criteria for an appropriate or an inappropriate transfusion. Appropriateness rates did not depend upon characteristics of the study design, location, or timing of data collection. Restrictiveness in the criteria used to determine appropriateness and the use of additional implicit evaluation after an initial explicit review affected appropriateness rates.

Conclusion: In the 1980s, high rates of inappropriate transfusion and low rates of appropriate transfusion were still reported. Appropriateness rates varied widely, in part because of marked variation in the criteria for an appropriate transfusion. Newly derived standards for an appropriate red cell transfusion, published in 1992, appear to provide a simple and objective means of evaluating the appropriateness of a transfusion. Appropriateness rates resulting from the application of these new standards have not yet been determined.
Screening of blood donors for idiopathic CD4+ T‐lymphocytopenia
Authors: Busch M.P. , Valinsky J.E. , Paglieroni T. , Prince H.E. , Crutcher G.J. , Gjerset G.F. , Operskalski E.A. , Charlebois E. , Bianco C. , Holland P.V. , Petersen L.R. , Hollingsworth C.G. , Mosley J.W.
Published: March 2003

Background: The recent recognition of idiopathic CD4+ T‐lymphocytopenia (ICL) had led to concern that an unknown immunodeficiency virus may be transmissible by transfusion.

Study Design and Methods: To evaluate the prevalence and significance of low CD4+ values among blood donors, CD4+ data on 2030 blood donors who were negative for antibody to human immunodeficiency virus type 1 (HIV‐1) were compiled. Those with CD4+ values below ICL cutoffs (< 300 CD4+ T cells/μL, or < 20% CD4+ T cells) were recalled for follow‐up investigations. Serial CD4+ data on 55 homosexual men who seroconverted during prospective follow‐up and data on 139 anti‐HIV‐1‐positive blood donors initially evaluated in 1986 were reviewed as well.

Results: Five seronegative donors (0.25%) had absolute CD4+ counts < 300 cells per μL and/or < 20 percent. On follow‐up, all five donors had immunologic findings within normal ranges, lacked HIV risk factors, and tested negative for HIV types 1 and 2 and human T‐lymphotropic virus type I and II infections by antibody and polymerase chain reaction assays. Four of five donors reported transient illness shortly after their low CD4+ count donations. The median interval from HIV‐1 seroconversion to an initial CD4+ value below ICL CD4+ cutoffs was 63 months for infected homosexual men. Of 139 HIV‐1‐infected blood donors studied 1 to 2 years after seropositive donations, 34 (24%) had CD4+ counts < 300 cells per μL and/or < 20 percent.

Conclusion: Low CD4+ counts are rare among anti‐ HIV‐1‐negative volunteer blood donors and are generally associated with transient illnesses. If any unknown virus progresses similarly to HIV‐ 1, CD4+ count donor screening would be a poor surrogate for its detection.
Effect of amphotericin B and fluconazole on platelet membrane glycoproteins
Authors: Sloand E.M. , Kumar P. , Yu M. , Klein H.G.
Published: March 2003

BACKGROUND: Fever, chills, and reduced platelet recovery may result when platelets are transfused simultaneously with amphotericin B. Amphotericin B reportedly increases the pitting of membranes in stored platelets.

STUDY DESIGN AND METHODS: The effects of amphotericin B and another antifungal agent, fluconazole, on platelet membrane glycoproteins (GP) were examined by the incubation of split aliquots of fresh and stored platelet concentrates (PCs) with these drugs for 3 days in storage bags. To determine the effect of storage, PCs were stored for 5 days, and aliquots removed on Days 1 through 5 were placed in platelet storage bags with 4 micrograms per mL of amphotericin B for 2 to 6 hours. Membrane glycoprotein expression was assessed by flow cytometry with fluorescein isothiocyanate‐labeled monoclonal antibodies (MoAbs) directed against the following antigens: GPIb (CD42b), CD63 (an activation protein), P‐selectin (CD62), and GPIIb/IIIa (CD41a).

RESULTS: Amphotericin B produced a concentration‐dependent decrease in the surface binding of CD42b MoAb with no consistent changes in the binding of CD41a, CD63, or CD62 MoAbs after a 3‐day exposure. Stored but not fresh PCs showed decreased binding of MoAb CD42b after a 6‐hour exposure to amphotericin B (4 micrograms/mL). Fluconazole produced no changes. When the binding of MoAb CD42b to permeabilized platelets was used to measure total platelet content, amphotericin B (4 micrograms/mL) decreased MoAb CD42b binding to a similar degree in fresh and stored platelets. Inhibition of aggregation to ADP and collagen and ADP and epinephrine was seen in stored but not fresh PCs.

CONCLUSION: Therapeutic levels of amphotericin B resulted in partial loss of total platelet GPIb in fresh and stored PCs, but decreased surface expression of platelet membrane GPIb only in stored platelets. This difference between fresh and stored platelets may be related to the limited reservoir of GPIb available for redistribution to the membrane in the previously stored PCs and may account for the decreased recovery of transfused platelets observed in some patients receiving amphotericin B.
Epidemiology of blood transfusion
Authors: Vamvakas E.C. , Taswell H.F.
Published: March 2003

Background: Earlier investigations of the epidemiologic attributes of blood transfusion were not based on total community populations. To calculate incidence rates of the transfusion of blood and blood components in the general population and in age‐ and gender‐specific groups, all residents of a United States county who received transfusion(s) from 1989 through 1992 were studied.

Study Design and Methods: The study was a prevalence survey (cross‐sectional study) of a well‐defined population at a specified time.

Results: There was no significant change in blood and blood component utilization from the beginning of 1989 through 1992. The incidence of red cell transfusion was 42.88 units per 1000 population per year in both men and women and varied from 12.08 units per 1000 population per year in those less than 41 years old to 245.24 units per 1000 population per year in the group aged more than 65. A random resident's probability of receiving transfusion(s) in any year was 0.89 percent (0.83% for men and 0.94% for women) and varied from 0.26 to 5.17 percent among the three age groups. The incidence of platelet and fresh‐frozen plasma transfusion was 21.24 units per 1000 population per year and 8.64 units per 1000 population per year, respectively.

Conclusion: Incidence rates of blood transfusion for “causal” planning of blood collections are presented here for the first time. The probability of receiving a transfusion of RBCs in any year rises by 20‐fold from the rate in those less than 40 years old to that in those more than 65 years old, who receive 53.3 percent of the red cell units transfused.
Plasma proteins and lymphocyte phenotypes in long‐term plasma donors
Authors: Lewis S.L. , Kutvirt S.G. , Bonner P.N. , Simon T.L.
Published: March 2003

BACKGROUND: The possible effects of long‐term plasma donation remain unknown, but it is important to investigate them so that donor safety is ensured. The purpose of this study was to determine if long‐term plasma donation alters plasma proteins or lymphocyte phenotypes.

STUDY DESIGN AND METHODS: Two groups of long‐term plasma donors, source plasma donors (n = 20) and Rh immune globulin plasma donors (n = 26), were compared with whole blood donors (n = 29) and nondonor controls (n = 30). Blood samples were obtained prior to donation. Serum protein, albumin, globulin, and immunoglobulin levels were determined. In an assay using whole blood, lymphocyte phenotypes were characterized with a panel of single‐ and dual‐labeled monoclonal antibodies and subsequent analysis by flow cytometry.

RESULTS: As compared to the nondonor controls and/or whole blood donors, the mean values for serum protein, globulin, and IgG levels were lower in both plasma donor groups, with a significant negative correlation between donation frequency and serum protein values for the source plasma donors. Albumin levels were within normal ranges for both groups of plasma donors. No significant differences existed among the donor groups in total white cell counts, the percentage or absolute number of lymphocytes, T (CD3) cells, or helper T (CD4) cells. However, there were increased percentages of B (CD19) cells and decreased percentages of suppressor T (CD8+/CD11b+) cells and natural killer cells in both groups of plasma donors as compared to nondonor controls.

CONCLUSION: Many plasma donors have low levels of serum protein, globulin, and IgG. In addition, they have increased percentages of B cells and decreased percentages of suppressor T and natural killer cells. The clinical significance of these findings warrants further investigation.
Low‐oxygen‐affinity red cells produced in a large‐volume, continuous‐ flow electroporation system
Authors: Bruggemann Ulrich , Roux Eric C. , Hannig Jürgen , Nicolau Claude
Published: March 2003

BACKGROUND: Human red cells containing inositol hexaphosphate (IHP) have a lowered O2 affinity, though they are able to bind and carry about the same amount of oxygen as native cells. These modified cells therefore deliver oxygen more efficiently to the tissues, which is a property of potential clinical utility. Investigators set out to devise a system and procedure by which large volumes of IHP‐containing red cells, suitable for transfusion, could be produced quickly and efficiently. STUDY DESIGN AND METHODS: The encapsulation of IHP into human red cells by use of several variations of static electroporation was performed to define the conditions necessary for optimal IHP incorporation and cell survival. These conditions were used as a starting point for optimization of a flow electroporation system. RESULTS: When fresh human red cells in a 35 mM IHP solution are subjected to three exponential pulses of field strength of 2.98 +/− 0.064 kV per cm per pulse and pulse length of 2.0 +/− 0.2 msec per pulse while flowing through a cooled electroporation chamber, the condition of the resultant cells, according to the criteria used here, is optimized. After storage for 24 hours in plasma at 37 degrees C, the cells show more than 85‐percent survival (in vitro) and hematologic indices nearly identical to those of unpulsed control cells. The p50 value of these cells, however, has doubled to 50.4 +/− 2.0 torr. The processing time for 1 unit of blood is 90 minutes. CONCLUSION: These data indicate that the system described here can efficiently produce low‐oxygen‐affinity red cells in volumes that are useful in clinical applications.
Acute normovolemic hemodilution is a cost‐effective alternative to preoperative autologous blood donation by patients undergoing radical retropubic prostatectomy
Authors: Monk T. G. , Goodnough L. T. , Birkmeyer J. D. , Brecher M. E. , Catalona W. J.
Published: March 2003

BACKGROUND: Preoperative autologous blood donation is accepted as a standard of care for radical prostatectomy. Acute normovolemic hemodilution (ANH) is an alternative method for obtaining autologous blood. The cost and benefits of these two autologous blood‐collection techniques are compared.

STUDY DESIGN AND METHODS: Thirty consecutive patients scheduled for radical prostatectomy underwent ANH to a target hematocrit level of 28 percent. Blood was transfused in the perioperative period to maintain the hematocrit level > 25 percent. Hematocrit levels, transfusion outcomes and costs, and postoperative outcomes for these patients (hemodilution group) were compared with a matched patient cohort who preoperatively donated 3 units of blood for autologous use in prostatectomy surgery (nonhemodilution group, n = 30).

RESULTS: Thirty patients underwent ANH to a hematocrit level of 28.7 +/− 1.7 percent, and 1740 +/− 346 mL (3.5 +/− 0.7 units) of blood were collected. Three (10%) of the patients in each cohort had allogeneic blood exposure. Transfusion costs were 73 percent higher for the nonhemodilution group patients than for the hemodilution group patients ($330 +/− $100 vs. $191 +/− $55, p < 0.001). No differences were found in postoperative outcomes.

CONCLUSION: An integrated blood conservation program utilizing hemodilution and a defined transfusion trigger can decrease the requirement for preoperative donation of blood for autologous use in radical prostatectomy. Point‐of‐care autologous blood procurement is more cost‐effective than preadmission donation of autologous blood units.
Platelet concentrates promote procoagulant activity: evidence from experimental studies using a perfusion technique
Authors: Hernandez M.R. , Bozzo J. , Mazzara R. , Ordinas A. , Escolar G.
Published: March 2003

BACKGROUND: Evaluation of the hemostatic effectiveness of platelet transfusions is difficult. Perfusion methods have been employed to test the quality and function of platelet concentrates, allowing differentiation between platelet‐platelet and platelet‐surface interactions.

STUDY DESIGN AND METHODS: A study was performed to investigate platelet adhesive and cohesive properties as well as the formation of fibrin when aliquots of platelet concentrates were added to thrombocytopenic blood. Blood previously anticoagulated with low‐ molecular‐weight heparin (20 U/mL) underwent platelet and white cell reduction by filtration. Perfusates were prepared by adding to filtered blood platelets obtained from standard concentrates (stored for 1, 3, and 5 days). The final platelet count in these perfusates was standardized at 80,000 per microL. After perfusions, platelet‐ subendothelium interaction and fibrin formation were analyzed morphometrically. Results were always compared with those obtained in unfiltered blood (> 150,000 platelets/microL).

RESULTS: A slight impairment in the ability of stored platelets to interact with the subendothelium was noticed during the storage period. However, the presence of fibrin was significantly greater than that observed in studies with unfiltered blood (Day 1 = 23.48 +/− 9.43%*; Day 3 = 26.99 +/− 6.74%*; Day 5 = 17.95 +/− 9.06% vs. unfiltered blood = 12.60 +/− 3.08%; *p < 0.05). The lower platelet counts (80,000/microL) in the perfusates containing platelets from concentrates could account for the reduced platelet‐subendothelium interactions, but they cannot explain the increments in fibrin formation.

CONCLUSION: While the preparation and storage of platelets have a detrimental effect on platelet adhesiveness, such procedures can positively influence the platelet procoagulant activity necessary to platelet hemostasis.
Cost‐effectiveness of blood transfusion and white cell reduction in elective colorectal surgery
Authors: Jensen L.S. , Grunnet N. , Hanberg‐Sorensen F. , Jorgensen J.
Published: March 2003

BACKGROUND: The use of white cell (WBC)‐reduced blood in elective colorectal surgery appears to reduce the frequency of postoperative infection. The question to be addressed is whether the cost:benefit ratio justifies the recommendation that WBC‐reduced blood should be used for all colorectal surgery.

STUDY DESIGN AND METHODS: Patients admitted for elective colorectal surgery (n = 197) were randomly assigned to receive transfusion consisting of whole blood or WBC‐ reduced whole blood. Postoperative complications, postoperative stay, and hospital charges were compared.

RESULTS: Forty‐eight patients received WBC‐reduced whole blood, 56 received unfiltered whole blood, and 93 received no transfusion. Postoperative infections were significantly higher (p < 0.001) in the group that received unfiltered whole blood. That group also had longer hospital stays: 17 days as compared to stays of 10 and 11 days for the group receiving no transfusion and the group receiving filtered whole blood transfusions, respectively (p < 0.01). The total hospital cost per patient receiving unfiltered whole blood was $12,347, as compared to $7,867 for those who received WBC‐reduced whole blood and $7,030 for those who received no transfusion.

CONCLUSION: The use of WBC‐reduced whole blood transfusions in elective colorectal surgery significantly reduces the frequency of postoperative infection, the length of hospital stay, and the total hospital charges for patients needing blood transfusion.
Perioperative blood transfusion and cancer recurrence: meta‐analysis for explanation
Authors: Vamvakas E.C.
Published: March 2003

BACKGROUND: Meta‐analysis was used to explain disagreements across observational studies in regard to the association between perioperative transfusion and cancer recurrence.

STUDY DESIGN AND METHODS: Observational studies published in English from 1982 through 1994 were retrieved. Five or more articles published in complete form were identified for each of six cancer sites: colorectum, breast, head and neck, lung, prostate, and stomach. Necessary information for building a 2 × 2 contingency table could be extracted from 60 studies. Summary relative risks (RR) reflecting the “average” adverse transfusion effect were computed for each cancer site by the random‐ effects method. Seven study characteristics were examined as potential explanations for the disagreements among the published studies.

RESULTS: Before any adjustment for the effect of confounding, computed crude summary RRs suggested a significant (p < 0.05) deleterious transfusion effect in all cancer sites, except for breast. The RR of an adverse outcome was 1.49 in colorectal cancer (95% CI, 1.23‐1.79) and ranged from 1.06 in breast cancers to 3.62 in head and neck cancers. The disagreements among published studies were most marked in the case of colorectal and gastric cancers. These discrepancies could be explained, in part, by study design, because prospective investigations had not produced a significant unadjusted transfusion effect (RR = 1.18; 95% CI, 0.93‐1.51 in the case of colorectal cancer).

CONCLUSION: A reduction in the size of the computed unadjusted transfusion effect (of an appropriate magnitude to adjust for the effect of confounding) might eliminate the significance of the average adverse effect in most studied cancer sites. Whether the entire unadjusted transfusion effect should be ascribed to the effect of confounding or whether a true, deleterious transfusion effect also exists can be resolved only by randomized controlled trials.