bluuebunny/crossref_metadata_2025 huggingface dataset:
Stability of serum alanine aminotransferase activity
Authors: Williams K.M. , Williams A.E. , Kline L.M. , Dodd R.Y.
Published: March 2003

In this study the authors examine the effects of common storage and handling procedures on serum alanine aminotransferase (ALT) levels. Clotted blood samples from 14 subjects were centrifuged at 280 × g for 10 minutes. Serum was tested immediately for baseline ALT levels and aliquots were stored at 22, 4, −20, and −80 ° C. Additional serums were stored on the clot at 22 and 4 ° C. ALT quantitation was performed at intervals of 3, 6, 9, and 24 hours and on Days 2, 4, 6, and 8. Unseparated tubes were sampled both proximal and distal to the red cells to determine ALT leakage from red cells lysis. For all storage conditions, gradual loss of activity occurred over time. Mean activity loss in separated serum at 2 days was 6 percent at 4 ° C and 20 percent at 22 ° C. Mean loss in unseparated serum was 3 percent at 4 ° C and 12 percent at 22 ° C. Marked ALT loss averaging 46 percent by day 6 occurred with storage at −20 ° C, whereas storage at −80 ° C resulted in an 8 percent decrease for the same period. For storage of up to 1 week, it is recommended that serum be separated early and retained at 4 ° C. Frozen samples should be kept at −80 ° C. Storage of separated or unseparated blood for up to 24 hours at 22 or 4 ° C, as commonly found in blood centers, will marginally adversely affect the accuracy of ALT determination.
Comparison of autosurge versus surge protocols for discontinuous‐flow centrifugation plateletapheresis
Authors: Strauss R.G. , Halpern L.N. , Eckermann I.
Published: March 2003

Autosurge is a new, highly automated protocol for collecting platelets by centrifugation plateletapheresis. It was developed to allow optimal cell collections with less operator effort than was required with the earlier, standard Surge protocol. The authors compared the cellular content of 201 platelet concentrates prepared by Surge with that of 120 concentrates prepared by Autosurge by the same group of operators, using the same cell separator. Platelet yields were similar (p = 0.775) for both protocols (mean × 10(‐11) were 3.54 and 3.57 for Surge and Autosurge, respectively) and when subdivided according to preapheresis donor blood platelet counts, hematocrits, and leukocyte counts. Although platelet yields were comparable in concentrates prepared by either protocol, high donor hematocrit had less adverse effect on platelet yield when the Autosurge protocol was used. The composition of concentrates differed between protocols in that leukocytes contamination was significantly less (p less than 0.001) in units collected by Autosurge (3.4 × 10(8)) than in those collected by Surge (5.8 × 10(8)). Operator involvement can be less intense with Autosurge because the protocol includes automatic adjustment of cell separator settings for optimal plateletapheresis. The results of the direct comparison study were confirmed by data from 509 additional plateletapheresis procedures performed during routine blood center operation. Autosurge should replace Surge because the former easily produces platelet concentrates that contain fewer leukocytes without compromising platelet yields.
Combined plasma exchange and intravenous gammaglobulin in the treatment of patients with refractory immune thrombocytopenic purpura
Authors: Bussel J.B. , Saal S. , Gordon B.
Published: March 2003

Plasma exchange (PE) and intravenous gammaglobulin (IVGG) are potentially effective therapies in immune thrombocytopenic purpura (ITP). In this study, eight patients refractory to IVGG and to prednisone were treated with a protocol of combined PE and IVGG therapy using a single PE on each of 3 consecutive days, followed by 2 consecutive days of IVGG at 1 g per kg. Four of the eight patients responded to the combined therapy with a mean peak platelet count of 132,000 per microliter (range, 74,000 to 225,000/µliter). Responses lasted approximately 2 weeks. These four patients were among the five who had initially responded to IVGG before becoming refractory; none of the three patients without an initial response to IVGG responded to the combined therapy. Age, duration of disease, and splenectomy status did not appear to be related to response to the combined therapy. Two patients began maintenance treatment (1 PE followed by 1 g/kg IVGG on the same day), but both became unresponsive after three treatments. PE combined with IVGG may be a useful treatment for some patients with refractory ITP who have uncontrollable bleeding or require major surgery. The development of resistance to IVGG effect may be mediated by an increase in the level of antiplatelet antibodies. PE, by lowering antiplatelet antibody levels, may then allow IVGG infusion to be effective again in elevating the platelet count.
Five‐week red cell storage with preservation of 2,3 DPG
Authors: Carmen R.A. , Sohmer P.R. , Leng B.S. , Moore G.L. , Nelson E.J. , Simon T.L. , Myhre B.A. , Marcus C.S. , Moroff G. , Lewis L.M. , Chong C.
Published: March 2003

The 2,3 diphosphoglycerate (2,3 DPG) content of red cells stored in current anticoagulant‐preservative products decreases rapidly after the first few days of storage, and by 3 weeks the red cells are essentially depleted of 2,3 DPG. Because ascorbic acid and ascorbate‐2‐phosphate (A‐ 2‐P) are effective in maintaining erythrocyte 2,3 DPG during liquid preservation, ascorbate was stabilized through autoclaving and subsequent storage by adding it as the trisodium salt of A‐2‐P to a phosphate‐adenine‐saline solution at a pH of 8.5 to 9.0. Red cell concentrates prepared from blood drawn into citrate‐phosphate‐double‐ dextrose were supplemented with the A‐2‐P additive solution (AS‐4) and studied in vitro and in vivo. Mean 2,3 DPG values for 22 units were 147.6, 113.5, and 82.3 percent of initial value after storage for 3, 4, and 5 weeks, respectively. Maintenance of 2,3 DPG was at the expense of adenosine triphosphate (ATP), which fell to as low as 22.2 percent of initial value after 5 weeks. Despite the low ATP values, the 24 hour 51Cr‐labeled red cell recoveries averaged 80.8 and 74.1 percent after 4 and 5 weeks of storage, respectively. The AS‐4 system provides a red cell product with acceptable viability and improved oxygen off‐loading function.
Delayed immune hemolysis in a patient receiving cyclosporine after orthotopic liver transplantation
Authors: Hyma B.A. , Moore S.B. , Grande J.P. , Talmo J.J. , Reisner R.K. , Rakela J. , Krom R.A.
Published: March 2003

Immune hemolytic anemia in patients after organ transplantation has been reported generally to be graft‐cell‐derived due to elaboration by the donor's “passenger” lymphocytes of the antibodies directed against the recipient's red cell antigens. In contrast, this report presents a case that illustrates postoperative red cell alloantibody production by the recipient of an orthotopic liver transplant. Anti‐Jka, ‐c, and ‐S, detected in the recipient's serum 9 days after transplantation, resulted in significant hemolysis. These alloantibodies had not been present in the recipient's serum before transplantation or in the sera of the liver or blood donors. In addition, anti‐Jka and ‐c were eluted from posttransfusion red cells. The patient was transfused during surgery with crossmatch‐compatible blood, that carried the alloantigens Jka, c, and S. The liver donor's red cells also carried the Jka, c, and S antigens. The recipient's pretransplantation red cell phenotyping was Jk(a−), c−, S−. The recipient had received only one transfusion 10 years prior to this operation, after which time he was noted to have anti‐K. Immunosuppression initially consisted of cyclosporine, azathioprine, and prednisolone. This is believed to be the first report of delayed immune hemolysis due to non‐ABO antibodies in a liver transplant patient treated with cyclosporine.
Human red cell antigens
Authors: Telen M. J. , Green A. M.
Published: March 2003

The In(Lu) gene, which inhibits the expression of Lutheran blood group antigens by red cells (RBCs), also down‐regulates the expression of an 80‐kD glycoprotein, In(Lu)‐related p80, by both RBCs and a subset of white cells. This study examined the expression of multiple‐RBC p80 epitopes by autosomal and X‐linked recessive‐type Lu(a−b−) RBCs in order to explore the relationship, if any, between expression of In(Lu)‐ related p80 and Lutheran antigens. Both autosomal and X‐linked types of recessive Lu(a+b−) RBCs expressed near‐normal to increased amounts of p80 antigens, as measured by radioimmunoassay. P80 from both types of recessive Lu(a−b−) RBCs had apparently normal molecular weight in denaturing polyacrylamide gels and showed normal sensitivity to digestion by trypsin and chymotrypsin. Thus, the absence of Lutheran antigens on recessive‐type Lu(a−b−) RBCs is not associated with decreased or absent p80 antigens. Furthermore, the XS2 gene probably does not act via a mechanism similar to that of the In(Lu) gene, since the expression of p80 remains undiminished in X‐linked recessive‐type Lu(a−b−) RBCs.
Cisplatin‐induced nonimmunologic adsorption of immunoglobulin by red cells
Authors: Zeger G. , Smith L. , McQuiston D. , Goldfinger D.
Published: March 2003

Antibodies to cisplatin, an extensively used anticancer chemotherapeutic agent, have been implicated previously as a cause of immune hemolytic anemia. Investigation of a suspected case of cisplatin‐ induced hemolytic anemia in a 40‐year‐old man demonstrated that IgG could be adsorbed nonimmunologically by reagent red cells in vitro. This phenomenon was found to be a source of possible error in the interpretation of studies identifying specific cisplatin antibodies. Furthermore, cisplatin was found to be capable of producing a positive direct antiglobulin test (DAT), owing to the nonspecific adsorption of immunoglobulin and complement in vivo. Although this finding did not result in acute hemolysis, it may cause confusion in the investigation of DAT‐positive hemolytic anemias. We question whether previous reports of cisplatin‐induced hemolytic anemia are accurate in their assessment that such hemolysis was mediated immunologically. Future studies of suspected cases of hemolysis induced by this drug should include serologic investigation adequate to demonstrate the presence of specific cisplatin antibodies. A positive DAT in such patients should not be considered proof of drug‐induced immune hemolytic anemia.
Vancomycin‐induced red cell aggregation
Authors: Williams L. , Domen R. E.
Published: March 2003

Vancomycin, an antibiotic similar in structure to ristocetin, is used to treat staphylococcal infections. However, vancomycin‐induced hemagglutination complicated red cell (RBC) serologic testing in the blood bank. At concentrations >3.0 mg per ml, vancomycin caused spontaneous macroscopic red cell (RBC) aggregation; concentrations of 2.0 and 2.5 mg per ml were associated with weakly positive aggregation with anti‐IgG and polyspecific antiglobulin reagents negative with anti‐complement; and concentrations <1.5 mg per ml had no apparent effect. Ficin‐treated RBCs demonstrated negative reactions with the antiglobulin reagents. Vancomycin‐induced aggregation was reversed partially with 0.2 M trisodium citrate, and supernatant transfer studies showed that normal RBCs retained a significantly (p < 0.025) greater percentage of vancomycin than did ficin‐treated RBCs. Vancomycin causes the aggregation of RBCs, which can be a source of confusion in the blood bank. The mechanism(s) through which vancomycin enhances aggregation may be related to its polycationic properties and to its direct protein binding to the RBC membrane, although other nonimmunologic mechanisms may be operative.
Delineation of false‐positive HIV antibody response in patients with renal failure and history of multiple transfusions
Authors: Monos D. S. , Frank T. S. , Senior M. B. , Gadson M. , Zmijewski C. M. , Prystowsky M. B. , Goodman D. B. P.
Published: March 2003

Four patients with a history of multiple blood transfusions who awaited renal transplantation were tested for human immunodeficiency virus (HIV) infection and found to be positive on enzyme immunoassay (EIA) and negative on Western blot. None of these patients had any clinical evidence of HIV infection. Absorption of these patients' sera with B‐lymphoblastoid cell lines (B‐LCL) positive for the serologic specificities DR3, DR4 (Dw4, Dw10, Dw14), and DR5 resulted in EIAs that were negative for HIV. Treatment of the B‐LCL with an anti‐DR monoclonal antibody (L243) interfered with the absorption of the serum sample by B‐LCL. This indicates that the initial false‐positive EIA results may be due to HLA antibodies. Furthermore, it was shown that these HLA antibodies are not limited in specificity to the HLA type of the host cell used in the preparation of the EIA reagents, but can consist of other DR specificities.
Stability of platelet and plasma HLA concentrations in healthy adults or random‐donor platelet concentrates
Authors: Kao K. J.
Published: March 2003

The quantitative differences between the platelet HLA antigens of different individuals are potentially significant in determining the survival of transfused platelets in allosensitized patients. To learn whether platelet HLA concentration is sufficiently stable to be documented for each donor and used for donor selection, platelet and plasma HLA concentrations in five healthy adults were measured monthly for 5 consecutive months. HLA concentrations were measured by using a competitive enzyme‐linked immunoassay. The results showed that both platelet and plasma HLA concentrations varied within ± 20 percent of the mean values in each individual. Changes in plasma and platelet HLA concentrations were also studied in 5 units of random‐donor platelets during in vitro storage. HLA concentrations were determined every other day over a 5‐day period. There was no significant quantitative change in the platelet and plasma HLA concentrations during the 5 days of in vitro storage. Thus, platelet HLA concentrations in healthy individuals are stable and may be quantitatively documented for donor selection.
Longitudinal follow‐up of blood donors found to be reactive for antibody to human immunodeficiency virus (anti‐HIV) by enzyme‐linked immunoassay (EIA+) but negative by western blot (WBμ)
Authors: NUSBACHER JACOB , NAIMAN RENEE
Published: March 2003

Abstract: A cohort of 467 volunteer blood donors who were found to be EIA+/WB‐ was studied longitudinally for up to two years. EIA screening for anti‐HIV and WB testing, regardless of the EIA result, was performed on all 769 subsequent donation events of this cohort to ascertain the consistency of test results over time. The following results were obtained: 1) 8.8% of subsequent donation events were EIA+; 2) Most donors who returned were found to be EIA‐/WB‐; 3) EIA‐/WB? (indeterminate) was 14.5 times more common than EIA+/WB?; 4) EIA and WB results were generally inconsistent from donation to donation; 5) No donor was found to be WB+. These results suggest that, in a volunteer donor population, an EIA+/WB‐ result may have little value in predicting anti‐HIV test results and AIDS infectivity in a future donation. The current practice of not using blood donated subsequently by EIA+/WB‐ donors unless a re‐entry testing scheme is satisfactorily completed should be reconsidered.
Granulocyte transfusion therapy in a child with chronic granulomatous disease and multiple red cell alloantibodies
Authors: Depalma L. , Leitman S. F. , Carter C. S. , Gallin J. I.
Published: March 2003

A 7‐year‐old, 17‐kg child with chronic granulomatous disease and nocardial pneumonia and osteomyelitis did not respond to antibiotic therapy and developed multiple red cell (RBC) alloantibodies (anti‐c, –E, and –Jka). To provide daily granulocyte concentrates, a method was devised to reduce the number of incompatible RBCs per transfusion. Leukapheresis was done with hydroxyethyl starch, and the apheresis product was allowed to sediment by gravity in a plasma expressor for 90 minutes. The leukocyte‐rich plasma was separated from the sedimented RBCs by transfer to a satellite bag, and the volume of the product was reduced by centrifugation to approximately 80 ml. RBC content was reduced from 29 ± 7 to 2.5 ± 1.0 ml (n = 22, p<0.01) and was accompanied by a 70 percent recovery of white cells (range, 49–90%). The final product contained 1.6 ± 1.0 × 1010 granulocytes. There were no clinical or laboratory signs of hemolysis during the course of 46 granulocyte transfusions, 37 of which were derived from c‐, E‐, or Jka‐positive donors. The size of most apheresis donor pools is insufficient to provide phenotypically matched granulocyte concentrates daily for patients with RBC alloimmunization. The rapid, simple method described here may allow daily therapy with mismatched concentrates to be administered safely to such patients.
Comparison of human and chimpanzee Kell blood group systems
Authors: Redman C. M. , Lee S. , Huinink D. Ten Bokkel , Rabin B. I. , Johnson C. L. , Oyen R. , Marsh W. L.
Published: March 2003

Kelt antigens on chimpanzee (Pan troglodyte) red cells were determined using specific human alloimmune and murine monoclonal antibodies. After avoidance of interspecies reactions, chimpanzee red cells were found to react with most Kell system antibodies. The chimpanzees had phenotypes similar to those of humans. The main difference was that all of 27 chimpanzee red cell samples tested were of the K:6, −7, phenotype, while in humans most are K:−6, 7. The most common chimpanzee Kell blood group phenotype was K:−1, 2, −3, 4, 5, 6, −7, 11, 12, 13, 14, 15, 18, 19, 22. Murine monoclonal anti‐K2 and ‐K14 immunoprecipitated a 97‐kD protein from chimpanzee red cells and a 93‐kD protein from human red cells. Enzymatic deglycosylation yielded proteins of about 79 kD for humans and 77 kD for chimpanzees. Both human and chimpanzee Kell proteins reacted equally well on Western blots with polyclonal rabbit antibody to human Kell protein, which indicated close homology.
Inactivation of the human immunodeficiency viruses (HIV‐1 and HIV‐2) during the manufacturing of placental albumin and gammaglobulins
Authors: Grandgeorge M. , Pelloquin F.
Published: March 2003

A laboratory study was undertaken to verify the elimination and/or inactivation of the human immunodeficiency viruses HIV‐1 and HIV‐2 during the manufacture of placental albumin and the gammaglobulins Gamma 16 and Veinoglobuline. Nine steps of the process were selected for study. Samples of current production batches were taken at these different stages and a known quantity of virus was added. Each sample was then processed according to the production schedule for the corresponding step, and the residual viral activity was measured. In eight of nine steps, a complete viral clearance was achieved. Estimation of the cumulative infectivity reduction due to these nine steps is in the following range: >12 to 16 log10 HIV‐1 and >17 to 19 log10 HIV‐2 for Gamma 16, >9 to 13 log10 HIV‐1 and >13 to 15 log10 HIV‐2 for Veinoglobuline, and >19.7 log10 HIV‐1 and >24 log10 HIV‐2 for albumin. As many other purification steps were not included in this study, the real infectivity reduction capacity for the whole process probably exceeds these values. Nevertheless, the levels of inactivation measured clearly document a rigorous fractionation process that has a high assurance of killing or eliminating all contaminating virus. TRANSFUSION 1989;29:629–634.
Needlestick injuries in blood collection staff
Authors: McGuff J. , Popovsky M. A.
Published: March 2003

Health care workers, including blood collection staff, are increasingly concerned about occupational hazards, particularly infection with human immunodeficiency virus (HIV) and hepatitis B virus. For individuals involved with volunteer blood donors, the most frequent route of parenteral exposure is needlestick injury with the phlebotomy needle. To assess the level of risk and possible avenues for prevention, 117 needlestick injury reports involving 72 employees were reviewed over a 2‐year period (March 1983–March 1985) at a large blood center. Some 708,824 units of blood were collected over this period by more than 200 collection staff members. The incidence of needlestick injury for the study period was 0.0165 percent (1 in approximately 6000 collections). The activities most frequently associated with injury were the filling of the pilot tubes, removal of the needle from the pilot tubes, and performance of the hemoglobin fingerstick. As needlestick is a rare event and as the prevalence of infection is low among volunteer donors, the risk of acquiring HIV or hepatitis B is extremely small among blood collection staff. This information should serve to reassure employees who perform venipuncture.
Frequency of platelet‐specific antigens among Koreans determined by a simplified immunofluorescence test
Authors: Han K. S. , Cho H. I. , Kim S. I.
Published: March 2003

The frequencies of platelet‐specific antigens among Oriental populations have not been well studied. This article reports the determination of the frequency of five major platelet‐specific antigens among Korean blood donors. Both the PlA1 (Zwa) and Yukb antigens were positive in all of the 126 Koreans tested. Baka and Yuka antigens were positive in 110 (87.3%) and 2 (1.6%) of the 126 subjects, respectively. Ten (11.5%) of 87 Koreans had PlA2 (Zwb) antigens. A simplified immunofluorescence test, the adhesion slide immunofluorescence test, was devised for platelet antigen typing.
Preparation of white cell‐depleted blood. Comparison of two bedside filter systems
Authors: Böck Markus , Wagner Marianne , Knüppel Wolfgang , Riedner Carola , Pachmann Ulrich , Heim Marcel U. , Mempel Wolfgang
Published: March 2003

Numerous techniques have been established for preparing white cell‐poor blood, such as centrifugation, sedimentation, freezing, and filtration. All of these methods have disadvantages that restrict their practical use: they are time‐consuming, they require the facilities of a blood bank, and the white cell‐poor units cannot be stored. Therefore tests have been performed on two filter systems that make possible the depletion of white cells directly at the bedside. Both filters have a high white cell‐removal rate. The number of residual white cells in 1 unit of packed red cells was calculated as 1.08 +/‐ 0.53 × 10(7) in one system and 1.54 +/‐ 0.71 × 10(7) in the other. The filters do not affect the filtered red cells. Pressure filtration is performed without significant loss of efficiency. One of the systems can filter 2 units via one filter; however, handling the filters is tedious, and both filters are characterized by a low red cell recovery. Despite these disadvantages, the tested filter systems provide an effective device for preparing white cell‐poor blood at the bedside. They are a suitable alternative to the conventional methods.
Testing in the years ahead: new pressures and new concerns
Authors: Bove Joseph R.
Published: March 2003

In the past, testing by blood banks was intended primarily to ensure product quality or donor safety or to meet existing regulations. As a result of recent pressures, especially the AIDS epidemic, additional reasons to test have become evident. Although some of these reasons are not easy to accept, it is appropriate to review them and to evaluate a new approach to reaching blood bank decisions that have public policy implications. It is suggested that The Institute of Medicine of the National Academy of Sciences sponsor a new and permanent structure for this purpose.
Decreasing seroprevalence of human immunodeficiency virus type 1 in a regional blood donor population
Authors: Ness P.M. , Douglas D. , Koziol D. , Harper M. , Munoz A. , Polk B. F.
Published: March 2003

Blood banks have intensified their efforts to discourage donations from individuals at risk for the human immunodeficiency virus (HIV‐1). Since the onset of HIV‐1 donor screening in April 1985, a marked reduction in seroprevalence has been seen at the authors' institutions: from 51 cases per 100,000 donors in 1985 to 13 per 100,000 in the first 6 months of 1988. Data from 3.5 years have been analyzed for temporal trends in the association of HIV‐1 seroprevalence with donation site (urban vs. non‐urban) and donor gender. The association of HIV‐1 seropositivity with an urban donation site decreased through 1987 as the urban‐to‐nonurban donation odds ratio declined from 6.48 in 1985 to 2.54 in 1987. Despite this decrease, both men and women who donated in urban areas had a significantly higher seroprevalence than those in nonurban areas. Male donors had a higher overall HIV‐1 seroprevalence than female donors. However, the male‐to‐female odds ratio declined from 2.94 in 1985 to 1.96 in 1988, and male gender was no longer significantly associated with HIV‐1 seropositivity. This change in the donor profile appears to reflect declining numbers of seropositive men who acknowledge risk factors and greater numbers of women with no identified risks for HIV‐1. This study documents a dramatic decrease in HIV‐1‐seropositive donors and suggests that the deferral of high‐risk individuals has become increasingly successful.
Autoimmune hemolytic anemia caused by a cold agglutinin with a new specificity (anti‐Ju)
Authors: Göttsche B. , Salama A. , Mueller‐Eckhardt C.
Published: March 2003

A cold autoantibody detected in the serum of a patient with chronic idiopathic cold agglutinin disease and hemolytic anemia is described. The antibody reacted with adult as well as with cord red cells, and its reactivity was strongly diminished by treatment of the cells with neuraminidase and to a lesser degree by treatment with protease. Thus, the specificity of the antibody is distinct from those of all cold antibodies yet described.
Cefotaxime‐induced immune hemolytic anemia due to antibodies reacting in vitro by more than one mechanism
Authors: Shulman I.A. , Arndt P.A. , McGehee W. , Garratty G.
Published: March 2003

Until recently, all cephalosporin‐induced immune hemolytic anemias appeared to react by a “penicillin‐type” drug adsorption mechanism, and hemolysis was extra‐vascular. In 1987 and 1988, the first two cases of cephalosporin‐induced immune hemolytic anemia with intravascular hemolysis associated with a so‐called immune complex mechanism were reported. This report describes a case of extravascular hemolysis due to a third‐generation cephalosporin, cefotaxime, which, to the authors' knowledge, is the first to show in vitro characteristics of both the drug adsorption and the so‐called immune complex mechanisms.
A comparison of results obtained by two different chromium‐51 methods of determining platelet survival and recovery
Authors: Rock G. , Tittley P.
Published: March 2003

A number of different methods exist that use chromium‐51 to determine platelet survival and recovery. A 1986 article in TRANSFUSION described the recommended methods for conducting such studies in the hope of standardizing methodology and permitting interlaboratory comparison of results. The results obtained with the recommended method have been compared with those of our previous method. With the new method, recovery of fresh random‐donor platelets prepared in polyolefin bags was 76 ± 6 percent with a survival of 9.3 ± 2.8 days (n = 4). After 5 days of storage, these values were 67 ± 8 percent and 7.8 ± 1.9 days. Similar values were obtained for fresh and stored platelets collected on automated cell separators. However, when our previous (pre‐1986) method of evaluation was used, recovery of fresh platelets in the polyolefin bags was 56 ± 11 percent, and survival was 8.6 ± 1.3 days. The 5‐day values were 36 ± 5 percent and 6.9 ± 2.7 days. These values are significantly lower (p<0.05) than those obtained with the newer method, but they are in agreement with those previously reported for other techniques. Thus, the new method consistently gives higher values, possibly as a result of a less harmful labeling procedure.
The relative utility of the autologous control and the antiglobulin test phase of the crossmatch
Authors: Perkins J.T. , Arruza M. , Fong K. , Sosler S.D. , Saporito C.
Published: March 2003

A retrospective study of pretransfusion testing records compared the utility of the antiglobulin test (AGT) phase of the crossmatch and the autologous control (auto‐control) for detecting clinically significant alloimmunization to red cells (RBCs). Of 110,780 consecutive crossmatches, 141 were positive after a negative antibody screening test; only 4 of these were due to alloantibodies of potential clinical significance, for a predictive value of a positive AGT crossmatch, after a negative antibody screen, of 2.8 percent (4/141). The frequency of potentially shortened RBC survival was 1 in 27,685 units crossmatched. During a similar period, 56,090 autocontrols were performed with the antibody screen. The autocontrol was positive on 902 samples in which the antibody screen was negative. Antibody identification performed in 684 cases generally yielded only cold or warm autoagglutinins. In 96 cases, some form of alloantibody was detected, but only 25 had potential clinical significance by our criteria. Eight of these alloantibodies had concurrently caused in vivo sensitization of RBCs and were classified as delayed hemolytic transfusion reactions. The predictive value of the autocontrol, calculated as the number of significant alloantibodies detected in autocontrol‐positive, antibody‐screen‐negative samples, was 3.6 percent (25/684). Inspection of these cases revealed 11 in which shortened RBC survival might have resulted if the serologic abnormality had not been detected. Thus, the autocontrol had a slightly greater yield of clinically significant findings than the AGT crossmatch. On the basis of these data, the AGT phase of the crossmatch was discontinued after a negative antibody screen with no record of alloimmunization and the autologous control was continued, but a decision was made to limit the indications for antibody identification when a positive autocontrol was the only serologic abnormality present in the initial pretransfusion tests.
HLA class I and II antigen phenotypes of North American Indians from Minnesota: implications for marrow transplants using unrelated donors
Authors: Stronger D.F. , Strand R.D. , Nworeen H.J. , Kline W.E. , McGlave P.B. , Bartsch G.E. , McCullough J.
Published: March 2003

As a result of an appeal for a bone marrow donor for a North American Indian (Native American) patient, 261 Native Americans from our community were typed for HLA‐A,B,DR antigens, and 51 were typed for HLA‐A,B antigens only. The HLA antigen frequencies of the Native Americans were compared with those of 12,881 white bone marrow donors and were found to differ markedly. To investigate the implications these differences in HLA antigen frequencies would have for the location of unrelated bone marrow donors, the HLA types of 12 Native American bone marrow transplant patients from our institution were used to search among 5389 HLA‐A,B,DR‐typed white donors in the National Marrow Donor Program file and the file of 261 HLA‐A,B,DR‐typed Native American donors. In the white donor file, at least two donors were found that matched at all HLA‐A,B,DR antigen loci of one Native American patient (8%). Using the Native American donor file, which was less than one‐twentieth the size of the white donor file, an HLA‐A,B,DR‐matched donor was also found for one (8%) of the patients. These results suggest that although donors for nonwhites can be identified in a file of HLA‐typed white volunteers, the probability of finding a suitably matched donor for such individuals is enhanced if donors representing racial or ethnic minorities are included in unrelated donor registries.
Adenylate kinase as a marker for platelet lysis
Authors: Gulliksson H.
Published: March 2003

The level of extracellular lactate dehydrogenase (LDH) activity is often used as an indicator for the leakage of cytosolic platelet contents. The objective of this investigation was to study the possibility of using a different enzyme, adenylate kinase (AK), as a substitute for LDH. A bioluminescent assay was used, and three different platelet storage containers were studied. In a comparative study of AK and LDH activities during platelet storage, similar results were obtained, but some differences were also observed. Because more AK (in percentages) than LDH is contained in platelets, the initial levels of AK are lower than those of LDH. The release of AK activity from damaged platelets is delayed or is somewhat lower than that of LDH. The amount of AK activity released per platelet is correlated with the volume of the platelet units. A smaller volume entails increased AK activity. This observation applies to all storage conditions investigated, and the results in one of the containers indicate that this is also true for LDH. The results of the investigation demonstrate that similar information is obtained with LDH and AK. AK can be used as an alternative to LDH for studies of lytic processes during platelet storage.
Correlation between in vivo hemolysis and the amount of red cell‐bound IgG measured by flow cytometry
Authors: Garratty G. , Nance S.J.
Published: March 2003

A flow cytometry method was used to compare the amount of red cell (RBC)‐bound IgG in 73 patients with and without immune hemolytic anemia (IHA). The positive results in 10 of the direct antiglobulin tests (DATs) were idiopathic, and those in 25 were due to methyldopa therapy; 38 of the 73 DAT‐positive patients were babies born to women with IgG alloantibodies of potential clinical significance. Normal blood donors with (n = 30) and without (n = 121) positive DATs were also tested. RBCs that had been strongly sensitized (4+ indirect antiglobulin test) in vitro with different quantities of IgG anti‐D, but that had similar antiglobulin test (AGT) titration scores, could easily be differentiated by flow cytometry. The mean percent fluorescence of RBCs, incubated with fluorescein‐labeled anti‐IgG, from neonatal patients with IHA was higher than that of RBCs from those without IHA, but there was no statistical difference in the other groups. There was considerable overlap in the respective ranges of percent fluorescence of RBCs from patients with and without IHA in all groups. It was not possible to define a clear quantitative threshold differentiating patients with IHA from those without. Although flow cytometry was more precise and reproducible than standard serology (e.g., AGT titration scores), correlations of the amount of RBC‐bound IgG and in vivo hemolysis were similar.
Return of autologous blood donors as homologous blood donors
Authors: McVay P. A. , Fung H. C. , Toy P.T.C.Y.
Published: March 2003

Autologous blood donors (ABDs) have been reported to have favorable attitudes toward returning as homologous blood donors (HBDs), but the frequency of return has not been well documented. ABDs eligible by history to be HBDs were followed at one blood center: 255 donating for elective surgery and 234 donating during pregnancy were followed for an average of 18 months and 20 months, respectively, from time of eligibility after surgery or postpartum. Male ABDs had a higher rate of return as HBDs, as 34 percent (21/62) returned to donate an average of 3 units, whereas 13 percent (56/427) of female ABDs returned as HBDs to donate an average of 2 units. Although a history of donation was associated with a higher rate of return (30%, 34/113), 11 percent (43/376) of ABDs with no history as HBDs returned to donate homologous units, despite having been recruited less frequently than prior HBDs. Overall, all male ABDs and female ABDs with an HBD history returned most frequently. The extra effort required for an autologous donor program may result in the recruitment of new donors into the HBD pool.
Prospective evaluation of posttransfusion hepatitis
Authors: Sirchia G. , Giovanetti A. M. , Parravicini A. , Bellobuono A. , Mozzi F. , Pizzi M. N. , Almini D.
Published: March 2003

The incidence of posttransfusion hepatitis (PTH) was determined prospectively at our institution. An active surveillance program of transfused surgical patients was set up; alanine aminotransferase (ALT) levels were determined before transfusion and at monthly intervals for 6 months after transfusion. Patients with confirmed ALT values > 2.5 times the upper reference values were referred to the out‐ patient clinics for diagnosis. Of 4051 surgical patients who underwent transfusion between January 1986 and December 1989, 2459 (60.7%) were enrolled in the surveillance program, and 1018 (25.1%) completed the follow‐up; 238 patients received autologous blood only and were used as controls. No PTH was observed in the control patients, and the incidence of the disease in patients receiving homologous blood was 10.97 percent in 1986, 6.58 percent in 1987, 5.55 percent in 1988, and 4.29 percent in 1989; the decreasing trend is significant (p = 0.018).
Detecting fetomaternal hemorrhage: a comparison of five methods
Authors: Bayliss K. M. , Kueck B. D. , Johnson S. T. , Fueger J. T. , McFadden P. W. , Mikulski D. , Gottschall J. L.
Published: March 2003

Appropriate postpartum administration of Rh immune globulin relies on sensitive detection and accurate quantitation of fetomaternal hemorrhage (FMH). Recently, the microscopic Du test (micro Du) enhanced with polyethylene glycol (PEG Du) and flow cytometry (FC) have been advocated for this purpose. Three qualitative methods (micro Du, rosette test, and PEG Du) and two quantitative methods (acid elution and FC) for assessing FMH were evaluated with particular attention given to PEG Du and FC. In vitro studies comprised 10 series of dilutions of D+ cord cells in D− adult cells to yield D+ cell concentrations of 0.06, 0.12, 0.25, 0.50, 0.75, 1.0, and 2.0 percent. Additionally, 26 postpartum samples were tested. Of the qualitative techniques, the micro Du test was the least sensitive with 20 percent false‐negative results occurring at 0.5 percent fetal cells. The PEG Du test was only slightly more sensitive and offered no clinical advantage. The rosette test was the most sensitive, consistently detecting fetal cells at concentrations of 0.25 percent or greater. FC and acid elution showed similar results, with good correlation obtained between measured and expected quantities of fetal cells (r = 0.99 and 0.96, respectively). One of 26 postpartum samples was positive by all screening techniques; acid elution and FC detected 0.3‐percent concentrations of fetal cells and 0.17‐percent concentrations of D+ cells, respectively. Although acid elution is a more commonly used method for quantitating FMH, FC offers an acceptable alternative that is capable of analyzing large numbers of cells with objectivity and reproducibility.
A stable perfluorochemical blood substitute
Authors: Mukherji B. , Sloviter H. A.
Published: March 2003

A stable emulsion of perfluorodecalin, made up of 34 percent (vol/vol) perfluorodecalin dispersed by sonication in isotonic Tyrode's buffer (pH 7.4) containing egg yolk lecithin, has been developed. The viscosity of the emulsion is the same as that of human blood, and the particle size is 0.2 microns in diameter. On storage at 5 degrees C, there was no change in viscosity for up to 60 weeks. At 21 degrees C, viscosity increased after 20 weeks of storage; this increase was considerably diminished by the presence of tocopherol in the emulsion. The accumulation of malondialdehyde indicated that there was continuous slow oxidation of the lecithin on storage of the emulsion at either 5 or 21 degrees C; this oxidation was markedly reduced by the presence of tocopherol.
The detection of platelet alloantibodies by flow cytometry
Authors: Worfolk L. A. , MacPherson B. R.
Published: March 2003

A flow cytometric procedure was investigated for its ability to detect antibodies directed against blood group A, HLA, and PlA1 (HPA‐1a) antigens. When type O sera were tested against platelets from blood group A donors, only 9 of 14 positive reactions were observed. Furthermore, the expression of blood group A varied more than 100‐fold on platelets derived from individual donors. When anti‐HLA‐A2 and ‐B7 were evaluated, 11 of 11 individuals with HLA‐A2 and ‐B7 antigens reacted. In contrast, when platelets from donors whose HLA antigens included HLA‐B8 or ‐B12 were tested with anti‐HLA‐B8 or ‐HLA‐B12, respectively, positive reactions were observed in only 3 of 7 instances, despite the fact that the lymphocytes reacted strongly. Platelets from 10 HLA‐A2‐positive donors, which had been stored for up to 20 months at −70 degrees C, were studied. In all cases, frozen‐ stored platelets reacted well with an anti‐HLA‐A2. Limited testing with an anti‐PlA1 (anti‐HPA‐1a) showed equal reactivity with fresh and frozen platelets. Finally, the method was compared to a visual immunofluorescence assay using sera from patients who were refractory to platelet transfusions. The results agreed in 30 of 37 comparisons, and most discrepancies were resolved in favor of flow cytometry. It is concluded that flow cytometry is useful for detecting platelet alloantibodies and possibly for prospective platelet crossmatching, as HLA‐ and platelet‐specific antibodies can be identified by using platelets stored frozen for several months.
A cryoglobulin with cold agglutinin and erythroid stem cell suppressant properties
Authors: Umlas J. , Kaufman M. , MacQueston C. , Sorba S. , Dainiak N.
Published: March 2003

A 93‐year‐old woman presented with profound anemia (hematocrit 23% [0.23]); there was clumping of her red cells in test tubes and on peripheral blood smears. There was also a marked decrease in erythroid precursors in the bone marrow and reticulocytopenia in the peripheral blood. An IgM kappa monoclonal gammopathy was found in low concentration (approximately 1%) in her serum, and the cold agglutinins had a titer of 2560. However, the cold agglutinin titer of the supernatant after cryoglobulin precipitation was 40. Redissolving the cryoglobulin in the supernatant resulted in a cold agglutinin titer of 1280. Moreover, the addition of the patient's whole serum inhibited erythroid colony formation in culture. The inhibition was removed by cryoprecipitation of the cryoglobulin. The patient was given steroid therapy, to which she responded with reticulocytosis and an elevation of hematocrit. By 3 months, the cold agglutinin titer had fallen to 10. She remained well 4 years later. Whereas reports of cryoprecipitable cold agglutinins are rare, this case is unique because there have been no previous reports that these cold active proteins also have erythroid stem cell‐suppressant properties.
When is a unit of blood transfused relative to its date of expiration?
Authors: Judd W. J. , Butch S. H.
Published: March 2003

ABSTRACT: Analysis of computer‐generated data from 42,902 transfusions of red cells or whole blood reveales that 30 percent of Rh‐positive and 46.5 percent of Rh‐negative units of blood will be lost from inventory if the permissible storage time for blood is immediately reduced to 25 days. These data indicate that, should such a reduction be adopted as a means of preventing transfusion‐transmitted Yersinia infection, the blood banking industry will have serious difficulties in maintaining an adequate blood supply.
Reassessment of blood donor selection criteria for United States travelers to malarious areas
Authors: Nahlen B.L. , Lobel H.O. , Cannon S.E. , Campbell C.C.
Published: March 2003

In the United States (US), travelers who have had malaria or who have taken antimalarial chemoprophylaxis are deferred as blood donors for 3 years to prevent transfusion‐transmitted malaria. To assess the impact of shortening this 3‐year exclusion period, national malaria surveillance data from 1972 to 1988 were reviewed. The average annual rate of transfusion‐transmitted malaria is 0.25 cases per million units of blood collected. Of 45 reported cases, 38 percent were caused by Plasmodium malariae, 29 percent by P. falciparum, 24 percent by P. vivax, and 9 percent by P. ovale. Thirty‐two donors were implicated in 34 cases of transfusion‐transmitted malaria. Of 30 implicated donors whose native country was identified, 23 (77%) were foreign nationals and 7 (23%) were from the US. In a review of all imported malaria cases by species and by interval between date of entry and onset of illness, 98 percent of P. falciparum, 86 percent of P. malariae, 76 percent of P. vivax, and 74 percent of P. ovale infections became symptomatic within 6 months of the patient's arrival in the US, regardless of the use of prophylaxis. Shortening to 6 months the donor exclusion period for US travelers to malarious areas would result in a minimum of 70,000 additional blood donors' being made available, with a maximum annual increase of 0.03 additional cases of transfusion‐transmitted malaria. The potential benefit of bringing healthy travelers back into the donor pool after a shorter period of exclusion merits consideration by the blood banking industry
Reduced membrane protein methylation in red cells of the McLeod blood group phenotype
Authors: Wainfan E. , Kilkenny M. , Johnson C. , Marsh W.L.
Published: March 2003

Red cells (RBCs) contain an abundance of protein methylase II, which catalyzes the transfer of methyl groups from S‐adenosylmethionine to carboxyl groups of aspartyl and glutamyl residues in proteins. Enzyme‐ catalyzed transfer of methyl groups, labeled with 14C or 3H, from S‐ adenosylmethionine to membrane proteins of McLeod, Ko, and control RBCs was assayed by determining the acceptance of labeled methyl groups under standardized conditions. Membranes of control cells and Ko cells showed about 50 percent greater uptake than did those of McLeod cells. However, when ovalbumin was used as a methyl‐accepting substrate, the levels of protein carboxymethyltransferase activity in all three types of cells were found not to differ significantly. In addition, no significant qualitative differences were apparent when methyl‐labeled polypeptides from control and McLeod cells were separated by slab gel electrophoresis. The mechanisms responsible for changes in membrane protein methylation of McLeod cells remain unclear. However, these observations provide further evidence of the pleiotropic biochemical lesion associated with the acanthocytic morphology that characterizes McLeod RBCs.
Probable reasons that autologous blood was not donated by patients having surgery for which crossmatched blood was ordered
Authors: McVay P.A. , Strauss R.G. , Stehling L.C. , Toy P.T
Published: March 2003

Preoperative autologous blood donation is used by only a small percentage of surgery patients for whom crossmatched blood is ordered. To document the reasons the patients failed to donate, the medical records of surgical patients at three university and three community hospitals were studied. All procedures for which crossmatched blood was ordered, but for which autologous blood was not available, were included (n = 8121). Probable reasons for nondonation were found in 72 percent of university hospital patients and 65 percent of community hospital patients (n = 6064 and n = 2057, respectively). The most frequent reasons for nondonation among university hospital patients were emergency surgery (27%) and age < 12 years (17%), and those among community hospital patients were emergency surgery (42%) and American Society of Anesthesiologists physical status ≥to 4 (20%). Surprisingly, anemia (hemoglobin < 11 g/dL [< 110 g/L]) as the only limitation to donation was rarely found: this was the sole reason in only 3.3 percent of university hospital and 4.5 percent of community hospital patients. Overall, of 8121 patients who failed to donate autologous blood, 5731 (71%) had legitimate medical reasons. The remaining 2390 (29%) had no identifiable reason for nondonation, and recruitment efforts should be focused on them and their surgeons.