bluuebunny/crossref_metadata_2025 huggingface dataset:
Radiolabeled red cell viability
Authors: Marcus C.S. , Myhre B.A. , Angulo M.C. , Salk R.D. , Essex C.E. , Demianew S.H.
Published: March 2003

The authors developed a double in vivo crossmatch method using 2 to 3 ml of potential donor blood labeled with either 400 microCi of 99mTc or 30 microCi of 111In‐oxine. Data are presented for 19 crossmatches on nine patients, using one blood specimen labeled with 99mTc or two specimens, one labeled with 99mTc and the other with 111In. Normal values are given for standardization purposes. This method appears to have advantages over earlier in vivo crossmatch techniques using 51Cr‐ labeled RBCs. These advantages include the rapidity with which the in vivo crossmatch may be repeated, the ready availability of 99mTc and 111In‐oxine, and the lower radiation absorbed doses with the shorter‐ lived radionuclides.
Hemolytic warm IgM autoagglutinins in autoimmune hemolytic anemia
Authors: Freedman J. , Wright J. , Lim F.C. , Garvey M.B.
Published: March 2003

The authors report a patient with fulminant autoimmune hemolytic anemia due to a rare warm IgM autoagglutinin more reactive at 37 degrees C than at lower temperatures and secondary to systemic lupus erythematosis. The patient's clinical course and the serologic and immunochemical characteristics of the antibody are described, including the possibility that transfusions of small amounts of incompatible red cells may have contributed to the hemolysis. The consequences of using the initial serologic test results as the basis for therapy are discussed.
Murine monoclonal antibodies associated with Rh17, Rh29, and Rh46 antigens
Authors: Rouger P. , Edelman L.
Published: March 2003

After immunization with native human red cells and red cells infected with Plasmodium falciparum, mouse splenocytes were fused with a myeloma cell line to obtain hybridomas. Among the antibodies specific for blood group antigens, four antibodies (iB3C4, F12, MR432, and iB4) directed against epitopes related to the Rh antigen were selected for characterization. It is suggested that two monoclonal antibodies (iB3C4 and F12) recognized an epitope associated with the Rh29 antigen. The specificity of the monoclonal antibody iB4 seemed related to the CcEe series of antigens. MR432 did not react with red cells of people who are homozygous for the R̄N gene, and seemed to identify an epitope associated with the Rh46 antigen (recently numbered).
A near‐fatal reaction during granulocyte transfusion of a neonate
Authors: O'Connor J.C. , Strauss R.G. , Goeken N.E. , Knox L.B.
Published: March 2003

Although reactions to granulocyte transfusions in neonates are rarely reported, we observed a near‐fatal pulmonary reaction, presumably due to white cell antibodies, in a neonate with Rh hemolytic disease. The hemolytic disease was being treated with exchange transfusions, and at 2 days after the infant's birth, bacterial sepsis was suspected and granulocyte transfusions were begun. The first granulocyte transfusion (Day 3) was uneventful. Five minutes after the beginning of the second granulocyte transfusion (Day 4), severe respiratory distress, hypotension, bradycardia, cyanosis, and acidosis suddenly occurred. The infant's serum obtained after the reaction contained granulocytotoxic and B‐lymphocytotoxic antibodies that reacted with leukocytes from the second granulocyte donor. Antibodies could not be detected either in the initial infant serum or in maternal serum. However, an antileukocyte antibody was present in the serum of a parous woman donor. We used plasma from this woman to prepare reconstituted whole blood for the exchange transfusion that we performed immediately preceding the second granulocyte transfusion. Despite the sequence of events, an irrefutable cause‐and‐effect mechanism could not be established because the properties of the donor and neonatal antibodies were similar, but not identical. However, this catastrophic event emphasizes both the potential for adverse effects of granulocyte transfusions in neonates and the need for caution when transfusing blood from parous women.
Histamine levels in stored platelet concentrates
Authors: Muylle L. , Laekeman G. , Herman A. G. , Peetermans M. E.
Published: March 2003

The histamine levels in samples from platelet concentrates (PC) were measured at various storage times by a radioenzymatic assay. Elevated histamine levels were detected in 5 of 14 PC after 3 days of storage (range, < 1 to 13.3 ng/ml) and in 9 of 14 PC after 5 days (range, < 1 to 22.2 ng/ml). A very good linear correlation (r = 0.913) was found between the initial white cell content of the PC and the histamine level at 5 days of storage. The rise in histamine content was not influenced by the type of plastic container. The results indicate a process of histamine release by the white cells during storage. Although histamine is metabolized rapidly in vivo, a critical histamine threshold could be reached in man by the rapid infusion of stored PC containing high levels of histamine. This could explain some unexpected transfusion reactions in patients receiving PC.
Preparation of white‐cell‐poor blood components using a quadruple bag system
Authors: Hirosue A. , Yamamoto K. , Shiraki H. , Kiyokawa H. , Maeda Y. , Yoshinari M.
Published: March 2003

A method for the preparation of white‐cell‐poor red cells from 400 ml of blood collected in a quadruple bag with one 80‐ml and two 300‐ml satellite bags is described. In this procedure, a platelet concentrate was prepared from the buffy coat fraction obtained by the first centrifugation of whole blood. After centrifugation of whole blood for 5 minutes at 3500 × g, the plasma was transferred into the 300‐ml bag until the interface of red cells and plasma reached a level 32 mm from the top of the bag; then approximately 70 g of plasma and buffy coat were collected into the 80‐ml bag. The buffy coat fraction was centrifuged further for 5 minutes at 170 × g, and the supernatant (concentrated platelets in plasma) was transferred into the second 300‐ml bag. In this blood processing, the recovery of red cells into the packed red cells and of platelets into the platelet concentrate was 93 ± 4 percent and 52 ± 13 percent, respectively, of the original value. White cells in the packed red cells were 70 ± 28 × 107 with recovery of 32 ± 9 percent of the original value, and the lymphocytes in the white cells were only 7 ± 5 × 107 (7 ± 4% of the original value). White cell contamination of platelet concentrate was below the threshold of white cell detection by the microcell counter (less than 300 cells per μl of concentrate).
Minimal expression of blood group A antigen on thrombocytes from A2 individuals
Authors: Skogen B. , Hansen B. Rossebo , Husebekk A. , Havnes T. , Hannestad K.
Published: March 2003

Two multiply transfused group O patients developed refractoriness to random‐donor platelet transfusions. Both had high‐titer IgG antibodies to group A and B antigens. Subsequent transfusions with ABO‐compatible platelets were successful, suggesting that the ABO blood group system is significant in the development of refractoriness to platelet transfusions. By indirect immunofluorescence, the patients' IgG anti‐A reacted with platelets from group A1 donors but not with those from group A2 donors. A2 platelets were at least 38 times less efficient at adsorbing a mouse monoclonal anti‐A; the difference between the adsorbence capacities of A2 and O platelets was minimal. Transfusion of A2 platelets, unlike that of A1 platelets, effected a good increment in the platelet counts of these two patients. The results indicate that the expression of A2 antigen on platelets from A2 subjects is minimal.
Effect of ABO mismatching on a radioimmunoassay for platelet compatibility
Authors: Ellinger P. J. , Morgan L. K. , Malecek A. C. , Chaplin H.
Published: March 2003

IgG and IgM anti‐A and/or ‐B agglutinin titers were determined on 17 serum samples (5 group 0, 7 group A, 5 group B) to range from 8 to 1024. The presence of hemolysins was also evaluated. Single adsorptions with solid‐state synthetic A and B substances greatly reduced or eliminated anti‐A and ‐B titers but did not adsorb known platelet antibodies. Unadsorbed and adsorbed serum samples were crossmatched with ABO‐compatible and ‐incompatible platelets by a radioimmunoassay employing 125l‐labeled monoclonal antibodies specific for human γ, μ, and C3d antigens. IgG and IgM crossmatch incompatibility was directly related to ABO alloantibody titers ≥64. The use of adsorbed serum in the crossmatch eliminated or greatly reduced incompatible results that were due to ABO alloagglutinins alone, thus allowing the reliable detection of platelet and/or HLA antibodies.
Polyethylene glycol improves the indirect antiglobulin test
Authors: Wenz B. , Apuzzo J.
Published: March 2003

PEG3350, a linear polymer of ethylene glycol, was evaluated as a potentiator of the indirect antiglobulin test (IAGT). The polymer enhances the avidity and affinity of clinically significant red cell alloantibodies than those obtained with bovine serum albumin (BSA). The sensitivity and specificity of the PEG‐mediated reactions were superior to those obtained with BSA. Subpopulations of red cells, such as those encountered with fetomaternal hemorrhages, were detected at lower concentrations with PEG than with BSA using the microscopic Du test. The superiority of the PEG reaction, its simplicity, and the reagent's relatively low cost make substitution of the polymer for BSA in the IAGT an attractive option.
Second fingerstick: a simple method to increase the blood supply
Authors: Bravo J. , Hsueh Y. , Gordeuk V. , Querin J. , Brittenham G. , Keating L.
Published: March 2003

ABSTRACT: Before blood donors are deferred because of a low hemoglobin determination by the copper sulfate procedure, they are routinely retested with a microhematocrit. The copper sulfate test and the microhematocrit usually are performed on blood samples taken from the same finger (or earlobe) puncture. We studied 201 male and female volunteer blood donors who failed the copper sulfate test to determine if more donors would be accepted for donation if blood from a second fingerpuncture, Instead of the original fingerstick, was used for the microhematocrit determination. Venous blood samples were obtained to evaluate complete blood count and measures of iron status. The results indicated that the deferral rate was reduced by 46% using a fresh fingerpuncture for the microhematocrit determination. The iron status of the additional donors accepted on the basis of the second puncture was not significantly different from that of the donors accepted by the original fingerstick. We conclude that using a second fresh fingerpuncture for the microhematocrit determination after failing the copper sulfate test decreases the number of hematocrit deferrals and does not compromise the iron status of the additional donors.
Efficacy and safety of vapor‐heated anti‐inhibitor coagulant complex in hemophilia patients. FEIBA Study Group
Authors: Hilgartner M. , Aledort L. , Andes A. , Gill J. ,   the members of the FEIBA Study Group
Published: March 2003

The study reported here was designed to measure the efficacy and safety of a vapor‐heated anti‐inhibitor coagulant complex (FEIBA‐VH) for the treatment of bleeding episodes in patients with hemophilia A who have inhibitors to factor VIII (FVIII). FEIBA‐VH, a second‐generation complex, is vapor‐heated for 10 hours at a temperature of 60°C and a pressure of 1190 millibar (mbar) and for 1 additional hour at 80°C and 1375 mbar. The current study was performed because of concern that this vapor‐heating process would reduce the efficacy of FEIBA‐VH as compared with non‐heat‐treated FEIBA (FEIBA). Forty‐one patients received FEIBA‐VH for 106 evaluable bleeding episodes. Ninety‐ three (88%) episodes were controlled, and 13 (12%) were not. Eighty‐ three (79%) episodes were controlled within 36 hours of the first infusion. No significant toxicity was seen. These results were compared with those of an earlier study with FEIBA. FEIBA‐VH was at least as effective as FEIBA in controlling bleeding episodes and can be compared favorably to any reported treatment of bleeding episodes in hemophiliacs with inhibitors to FVIII.
Platelet activation during preparation of platelet concentrates: a comparison of the platelet‐rich plasma and the buffy coat methods
Authors: Fijnheer R. , Pietersz R.N. , de Korte D. , Gouwerok C.W. , Dekker W.J. , Reesink H.W. , Roos D.
Published: March 2003

The activation of platelets during the preparation of platelet concentrates (PCs) by two methods was compared. To eliminate interdonor differences, 2 units of whole blood were pooled and subsequently divided into two batches. From one batch, the platelets were harvested as pelleted platelets from platelet‐rich plasma (PRP) and from the other as nonpelleted platelets from the buffy coat (BC). The activation of platelets in these PCs was studied immediately after preparation and during storage for up to 9 days at 22°C with gentle agitation. The binding of monoclonal antibodies (MoAbs) against the GP IIb/IIIa complex and against activation‐dependent antigens (GMP 140 from the alpha granules and a 53‐kDa glycoprotein from the lysosomal granules) was measured. β‐thromboglobulin (β‐TG) release was also determined. Disc‐to‐sphere transformation was quantitated by measuring on an aggregometer the difference in light transmission during stirring at different rates and also by light microscopy. Immediately after preparation, platelets derived from PRP had a more spheric morphology (p < 0.01), had a higher β‐TG release (p < 0.01), bound more MoAbs against GP IIb/IIIa (p < 0.01), and expressed more GMP 140 and 53‐kDa glycoprotein (p < 0.01) than did BC‐ derived platelets. However, these differences had disappeared after 2 days of storage. It was concluded that, immediately after preparation, PRP‐derived platelets are more activated than BC‐derived platelets. This is most likely a result of the pelleting that follows the second high‐speed centrifugation of the PRP.
Clinical significance of white cell antibodies in febrile nonhemolytic transfusion reactions
Authors: Brubaker D. B.
Published: March 2003

Febrile nonhemolytic transfusion reactions (FNHTRs) are associated with white cell (WBC) antibodies. The purposes of this study were to determine the frequency of WBC antibodies, to associate the severity of reactions with antibody specificity, and to distinguish FNHTRs from infection and postoperative fever. By using the granulocyte indirect immunofluorescence test in conjunction with lymphocytotoxicity testing, it was found that 70 percent of FNHTRs in 24 patients involved WBC antibodies. The remaining 30 percent of apparent FNHTRs were associated with infections and postoperative fever. Granulocyte‐specific antibodies were as prevalent as HLA antibodies and were associated with the severest reactions. Because FNHTRs occur with granulocyte‐specific antibodies, HLA antibodies, and possible monocyte‐specific antibodies (untested in this and other studies), these reactions could be grouped together as WBC‐associated reactions.
Inactivation of viruses in blood with aluminum phthalocyanine derivatives
Authors: Horowitz B. , Williams B. , Rywkin S. , Prince A. M. , Pascual D. , Geacintov N. , Valinsky J.
Published: March 2003

The inactivation of viruses added to whole blood and a red cell concentrate with aluminum phthalocyanine and its sulfonated derivatives was studied. A cell‐free form of vesicular stomatitis virus (VSV), used as a model, was completely inactivated (greater than 10(4) infectious units; TCID50) on treatment of whole blood with 10 microM (10 mumol/L) aluminum phthalocyanine chloride (AIPs) and visible light dosage of 88 to 176 J per cm2. At 44 J per cm2, complete VSV inactivation was achieved on raising the concentration of AIPc to 25 microM (25 mumol/L). Results at least as good were achieved on similar treatment of a red cell concentrate. Also inactivated were a cell‐associated form of VSV and both cell‐free and cell‐associated forms of human immunodeficiency virus; encephalomyocarditis virus, used as a model for non‐lipid‐enveloped viruses, was not inactivated by this procedure. This inactivation of cell‐free VSV suggests that a similar degree of inactivation could be achieved with a lower concentration of the sulfonated forms of aluminum phthalocyanine. Throughout the above studies, red cell integrity was well maintained, as judged by the absence of hemoglobin release (less than or equal to 2%) during the course of treatment or on subsequent storage. Red cell osmotic fragility was decreased on treatment of whole blood with AIPc. This study indicates that AIPc may be a promising method for the inactivation of viruses in cellular blood products.
Human immunodeficiency virus type 1 ‐infected blood donors:behavioral characteristics and reasons for donation
Authors: Doll L.S. , Petersen L.R. , White C.R. , Ward J.W.
Published: March 2003

Between May 1988 and September 1989, 829 human immunodeficiency virus type 1 (HIV‐1)‐seropositive donors were identified from 3,919,000 units of blood donated at 20 United States (US) blood centers. Of the 829,512 (62%) were interviewed to assess behavioral characteristics of the largest subgroup, men reporting sex with men, use of the confidential unit exclusion (CUE) and reasons for donation among all donors. Among 216 men reporting sex with men, 97 percent had male and 72 percent had female sexual contact since 1978. The majority identified themselves as bisexual (29%) or heterosexual (26%). Although 61 percent of 512 donors were aware of their risk behavior at donation, including 57 percent of those infected through heterosexual transmission, only 5 percent used the CUE. Reasons for donation included failure to read carefully (46%) or comprehend (15%) the deferral materials, pressure to donate (27%), a desire to be tested for HIV‐1 (15%), and a reliance on screening to identify infected blood (10%). Reasons given for a perception of being at low risk included no recent risk behaviors, infrequent risk behaviors, or modification of risk behaviors. To reach high‐risk donors, centers should assess whether referral materials provide necessary medical information and are clearly written for persons with diverse cultural and language backgrounds. Staff should be encouraged to avoid the use of culturally stigmatized terms and behaviors that may be perceived as high pressure.
An auto‐anti‐M causing hemolysis in vitro
Authors: Combs M.R. , O'Rourke M.M. , Issitt P.D. , Telen M.J.
Published: March 2003

A 64‐year‐old white man, who had never received a transfusion, was found to have anti‐M in his serum. The antibody agglutinated all M+ red cells in room‐temperature tests. When the ionic strength of the test milieu was reduced by use of an additive solution and the tests were incubated at 37 degrees C, the antibody hemolyzed M + N‐ but not M+N+ red cells. All M+ red cells reacted in indirect antiglobulin tests using polyspecific antiglobulin reagents when such tests followed an initial incubation at room temperature. When red cells and the patient's serum were warmed to 37 degrees C before being mixed, no antibody activity was demonstrable. The antibody was adsorbed to exhaustion onto M+N‐ and M+N+ red cells (including the patient's own), and its activity was destroyed by dithiothreitol. There was no evidence of in vivo red cell destruction by the autoantibody. No previously reported example of anti‐M has been shown to activate complement in conventional in vitro tests. This example was extraordinary in that it caused sufficient complement activation to present as an in vitro hemolysin.
Blood loss and replacement in total hip arthroplasty: a multicenter study. The Preoperative Autologous Blood Donation Study Group
Authors: Toy P.T.C.Y. , Kaplan E. B. , McVay P. A. , Lee S. J. , Strauss R. G. , Stehling L. C.
Published: March 2003

To determine blood loss, the number of transfusions, and the hemoglobin levels achieved in patients via transfusion in the course of total hip arthroplasty, 324 patient records from 1987 through 1989 were reviewed at three university and three community hospitals. Calculated blood loss was 3.2 ± 1.3 units in primary procedures and 4.0 ± 2.1 units in revision procedures (mean ± SD). Of 777 red cell units transfused, 455 (59%) were autologous units. Transfused patients received 2.0 ± 1.8 units for primary procedures and 2.9 ± 2.3 units for revision procedures (mean ± SD). The maximum number of units given to 95 percent of the transfused patients was 4 for primary procedures and 6 for revision procedures. The mean postoperative hemoglobin level after all transfusions was 103 to 110 g per L, regardless of patient age group of physical status, autologous donor status, or hospital. No difference in length of hospital stay was observed for patients < 65 years old with hemoglobin concentrations of 80 to 139 g per L at discharge.
Preoperative red cell production in patients undergoing aggressive autologous blood phlebotomy with and without erythropoietin therapy
Authors: Goodnough L.T. , Price T.H. , Rudnick S. , Soegiarso R.W.
Published: March 2003

Previous studies have demonstrated that autologous blood donors have a suboptimal endogenous erythropoietin response to the mild anemia induced by blood donation. Recent studies in baboons subjected to aggressive phlebotomy have shown an acceleration of erythropoiesis that may be beneficial perioperatively. To address the issue of accelerated erythropoiesis in autologous blood donors, red cell production during an aggressive preoperative autologous blood donation program was analyzed. The volume of red cells increased 568 mL (27% over baseline) and 911 mL (47% over baseline) for 23 placebo and 21 erythropoietin‐treated patients, respectively, by hospital admission (9 days after last drug administration and 26 days after beginning therapy). The mean rate of additional red cell production was 22 mL per day in the placebo group and 34 mL per day in the erythropoietin group (p<0.001), which represents a twofold and a 2.5‐fold increase over basal erythropoiesis, respectively. The major difference in red cell production in the placebo and erythropoietin groups occurred early in the collection period. It can be concluded that an aggressive autologous blood phlebotomy program results in clinically important increased erythropoiesis at the time of surgery. In patients unsuited for aggressive autologous phlebotomy, a more modest autologous blood procurement program, coupled with the administration of recombinant erythropoietin, may be a preferable approach.
Red cell transfusions in coronary artery bypass surgery (DRGs 106 and 107)
Authors: Surgenor D.M. , Wallace E.L. , Churchill W.H. , Hao S.H.S. , Chapman R.H. , Collins J.J.
Published: March 2003

To study red cell transfusion practice in 3216 coronary artery bypass graft (CABG) cases in 11 hospitals in 1988, abstracted patient records were stratified by diagnosis related group (DRG) (that is, DRG 106, coronary artery bypass without catheterization, or DRG 107, coronary artery bypass with catheterization) and International Classification of Diseases, 9th revision, Clinical Modification (ICD‐9‐CM) surgical procedure code. Means of units per transfused patient, age and length of stay, and in‐hospital mortality rates were significantly greater for patients in DRG 106 than DRG 107. Gender was a significant factor for transfusion outcomes; female patients were more likely to undergo transfusion, and, when transfused, they received more units of red cells than male patients. For a given DRG/ICD‐9‐CM surgical procedure class, significant differences were found between hospitals in the percentage of patients transfused, but not in mean units of red cells per transfused patient. However, within individual hospitals, the proportion of patients transfused and the number of units per transfused patient did not vary significantly across DRG/ICD‐9‐CM procedure classes. These results suggest that circumstances operating within a hospital, still to be identified, had more influence on transfusion decisions than the nature of the surgical intervention.
A report of 104 transfusion errors in New York State
Authors: Linden J.V. , Paul B. , Dressler K.P.
Published: March 2003

In New York State, significant incidents involving the collection, processing, or transfusion of blood must be reported. Incident reports received over a 22‐month period involving transfusion of blood to other than the intended recipient or release of blood of an incorrect group were analyzed. Among 1,784,600 transfusions of red cell components; there were 92 cases of erroneous transfusion that met study criteria (1/19,000). There were 54 ABO‐incompatible transfusions (1/33,000); three of these (1/600,000) were fatal. Correction for underreporting of ABO‐compatible errors resulted in an estimate of 1 per 12,000 as the true risk of transfusion error. National application of New York State data results in an estimate of 800 to 900 projected red cell‐associated errors in the United States annually. The majority of reported errors occurred outside of the blood bank (43% resulted solely from failure to identify the patient and/or unit prior to transfusion and 11% resulted from phlebotomist error), while the blood bank was responsible for 25 percent of errors and contributed, with another hospital service, to 17 percent. The risk of transfusion of ABO‐incompatible blood remains significant, and additional precautions to minimize the likelihood of such events should be considered.
Autologous and allogeneic red cell survival studies in the presence of autoanti‐AnWj
Authors: Whitsett C.F. , Hare V.W. , Oxendine S.M. , Pierce J.A.
Published: March 2003

Chromium survival studies were performed with AnWj‐positive allogeneic blood in a patient with autoanti‐AnWj. 99mTc‐labeled autologous RBCs that had depressed AnWj expression had normal survival (77% [94.7% 51Cr equivalent]) at 24 hours, whereas 51Cr‐labeled allogeneic AnWj‐positive cells had 76 percent survival at 24 hours and 55 percent survival at 7 days. These studies suggest that the specificity of the autoantibody may have implications for transfusion therapy when the development of such autoantibodies is associated with decreased antigen expression on the patient's cells.
Trends in transfusion‐associated acquired immune deficiency syndrome in the United States, 1982 through 1991
Authors: Selik R.M. , Ward J.W. , Buehler J.W.
Published: March 2003

To evaluate the efficacy of measures for preventing the transmission of human immunodeficiency virus (HIV) by blood transfusion, trends in transfusion‐associated cases of acquired immune deficiency syndrome (AIDS) reported through June 1992 were analyzed. By year of transfusion, cases rose from 56 in 1978 to 714 in 1984, dropped sharply to 288 in 1985 when screening of donated blood for HIV antibody began, and fell below 20 per year from 1986 through 1991. Reinvestigation of a sample of cases suggested that only one‐fourth of those attributed in the trends analysis to post‐1985 United States transfusions actually were due to that source. By year of AIDS diagnosis, cases climbed from 14 in 1982 to 824 in 1987 and subsequently remained relatively level. Of cases diagnosed in 1991 with known transfusion dates, almost all resulted from transfusions received before 1986. Cases in persons aged > or = 65 years at diagnosis fell steeply after 1987, while those in persons aged 45 to 64 years leveled and those in persons aged 25 to 44 years continued to increase; this caused the median age to decrease from 59 in 1986 to 47 in 1991. Thus, screening and other measures have almost completely prevented transmission, but, because of infections acquired before screening began, many cases continue to be diagnosed among increasingly younger persons.
Prolonged neutropenia resulting from antibodies to neutrophil‐specific antigen NB1 following marrow transplantation
Authors: Stroncek D. F. , Shapiro R. S. , Filipovich A. H. , Plachta L. B. , Clay M. E.
Published: March 2003

Marrow graft failure is a significant cause of morbidity following bone marrow transplantation. A case is reported of marrow graft failure due to neutrophil antibodies. A 13‐year‐old girl with a large granular lymphocytosis and chronic neutropenia was treated with granulocyte transfusions prior to undergoing a transplant with bone marrow from a partially matched, unrelated donor. Following the transplant, a bone marrow biopsy showed engraftment of donor myeloid cells, but the recipient remained neutropenic. Testing of the serum for neutrophil antibodies found that the recipient's serum had a high‐titer neutrophil antibody. Immunoprecipitation studies using the marrow recipient's serum and 125I surface‐labeled neutrophils showed that the antibody reacted to the neutrophil‐specific antigen NB1. Phenotyping of neutrophils from the marrow donor found that they expressed NB1 antigen, and, in a crossmatch assay, the recipient's serum reacted with donor neutrophils. Despite treatment with granulocyte‐macrophage– colony‐stimulating factor, the marrow transplant recipient remained neutropenic and died of polymicrobial sepsis and aspergillosis 38 days after the transplant. The presence of high‐titer antibodies to neutrophil‐specific antigen NB1 in this patient following transplant likely prevented the recovery of her peripheral blood neutrophils and contributed to her death.
Nosocomial epidemic of Serratia marcescens septicemia ascribed to contaminated blood transfusion bags
Authors: Heltberg O. , Skov F. , Gerner‐Smidt P. , Kolmos H.J. , Dybkjaer E. , Gutschik E. , Jerne D. , Jepsen O.B. , Weischer M. , Frederiksen W. , Sørensen H.
Published: March 2003

Two cases of transfusion‐related Serratia marcescens bacteremia prompted extensive epidemiologic investigations in three independent hospitals. Test tubes and plasma from donors whose blood was drawn into bags from a single production batch were cultured. Analysis of the ribotype of S. marcescens isolates was performed. For comparison, a strain from the production plant and eight other, unrelated bacteremia isolates were examined. In addition, a retrospective national survey was carried out. S. marcescens was cultured from 11 (0.73%) of 1515 blood units, and an additional (third) bacteremic patient was identified. The clinical isolates from three patients, the three units of blood transfused, and the plant‐derived strain shared a unique ribotype. The incident is interpreted as a sporadic, bacterial contamination of blood bags with the S. marcescens epidemic strain, occurring during the manufacturing or packaging. A similar incident has not previously been reported. Attention is drawn to the possibility of significant contamination during the complex production of multiple‐bag blood collection systems. Guidelines for improved registration and handling of transfusion complications in wards are suggested. Manufacturers should be encouraged to provide blood packs with sterile exteriors, in appropriate, single, outer packages.
Blood donation leads to a decrease in natural killer cell activity: a study in normal blood donors and cancer patients
Authors: Marquet R.L. , van Papendrecht M.A. Hoynck , Busch O.R. , Jeekel J.
Published: March 2003

Transfusion‐induced immunosuppression has long been known to be beneficial for organ transplantation patients, but recent retrospective studies suggest that blood transfusions may be detrimental for patients with cancer. If autologous blood is used to avoid immunosuppression, the assumption is that the procedure, involving blood donation, is immunologically neutral. In the present study, this assumption was evaluated by monitoring 33 normal blood donors and 16 colorectal cancer patients before and after donation of 1 (500 mL) and 2 units of blood, respectively. The cancer patients belonged to the autologous arm of a randomized trial in which the effects of allogeneic versus autologous blood on cancer prognosis were studied. The patients donated 2 units of blood with an interval of 3 to 4 days between donations. Flow cytometric analysis revealed that blood donation by normal donors and cancer patients had no effect on the proportion of B, T, and natural killer (NK) cells. Only the total number of lymphocytes was significantly decreased in the normal donors on Day 12 after donation. Blood donation had no significant effect on T‐cell function assessed by phytohemagglutinin stimulation in normal donors or in cancer patients donating 2 units of blood. A significant depression of NK cell function (88% and 74% of predonation levels) was observed in normal donors on Days 2 and 5 after donation; on Day 12, the activity was again normal. Colorectal cancer patients had a significantly depressed NK cell activity (54% of predonation activity) on Day 12 after the first donation. Before donation, the NK cell activities of blood donors and cancer patients were similar (45.6 ± 4.3% and 41.4 ± 3.6%, respectively, at the 50:1 ratio). Before donation, the number of NK cells correlated significantly with NK cell activity, but, after donation, such a correlation was lacking. This study indicates that blood donation, especially the donation of 2 units, leads to a depressed NK cell activity. If confirmed in a larger study, this finding may have important implications for cancer patients undergoing surgery.
Influence of a 12‐hour, 22°C holding period for buffy coats on the preparation of platelet concentrates stored in plasma
Authors: BOERI N. , SALEUN S. , PELISSIER E. , SALEUN J.P. , AIACH M. , RENDU F.
Published: March 2003

BACKGROUND: The preparation of platelet concentrates (PCs) from buffy coats (BCs) stored at room temperature is controversial, because of the strong metabolic activity of cells in BCs and the possible detrimental effect of neutrophil enzymes on platelets when the holding time before separation is prolonged. Despite good in vitro and in vivo behavior of BC‐PCs stored in synthetic solution, little is known of the quality of BC‐PCs stored in plasma. STUDY DESIGN AND METHODS: Comparison was made of PCs prepared from BCs held at 22 degrees C for 3 hours (3‐hour BC‐ PCs) or overnight (12‐hour BC‐PCs) and stored in plasma. Platelet and white cell counts, pH, response to osmotic shock, and morphologic scores were determined on 20 PCs of each type. The decrease in dense granule and alpha granule content, a marker of platelet activation, were estimated by mepacrine counting and beta‐thromboglobulin measurement, respectively (n = 8–10). Platelet function was studied in terms of aggregation and thromboxane production in response to various concentrations of collagen and thrombin (n = 8–17). PCs prepared from unstored BCs (n = 15) and from BCs held for 90 minutes (n = 15) were used as controls. RESULTS: Platelet yield was increased from 53 +/− 10 percent of donated platelets to 73 +/− 4 percent by increasing the BC holding time from 0 to 90 minutes to 3 hours (p < 0.001). Similar yields (7.8 +/− 1.8 vs. 7.9 +/− 2 × 10(10) platelets) and white cell contamination (0.9 +/− 0.8 vs. 1.0 +/− 0.9 × 10(7)) were obtained with 3‐hour and 12‐hour BC‐PCs. At the end of the storage period (Day 5), all variables known to correlate with platelet survival in vivo were well maintained in both 3‐hour and 12‐hour BC‐PCs: pH > or = 6.9, response to osmotic shock > or = 70 percent, and morphology scores always > or = 240. During storage, the dense granule content decreased moderately (30% after 5 days), whatever the conditions. By contrast, the total platelet beta‐thromboglobulin content was better preserved in 12‐hour BC‐PCs than in 3‐hour BC‐PCs (p < 0.04). No significant differences were observed in collagen‐induced aggregation and thromboxane production in the two PC preparations. However, aggregation responses to thrombin were higher in 12‐hour BC‐PCs on Day 5 of storage (p < 0.01). CONCLUSION: BCs can be held at 22 degrees C for up to 12 hours, with no detrimental effect on the quality of PCs stored for up to 5 days in plasma. Such a holding time might help overcome logistic problems in blood banks
Yersinia enterocolitica septicemia in autologous blood transfusion
Authors: HADITSCH M. , BINDER L. , GABRIEL C. , MÜLLER‐URI P. , WATSCHINGER R. , MITCERMAYER H.
Published: March 2003

BACKGROUND: Increasingly, autologous blood transfusions are used in elective surgical procedures to avoid the risk of infection due to allogeneic blood transfusion. CASE REPORT: A 64‐year‐old patient had to undergo the implantation of a total right hip endoprosthesis. During the transfusion of 1 unit of autologous packed red cells, the patient experienced high temperature and shock, which necessitated his observation in the intensive care unit for several days. Yersinia enterocolitica (type O:9) was isolated from the packed red cells, from the unit of fresh‐frozen plasma separated from the same donation, and from one blood culture drawn from the patient. With appropriate therapy, the patient recovered without sequelae. CONCLUSION: Although autologous blood transfusions are safe with respect to transmission of human immunodeficiency virus or hepatitis B and C infections, the risk of bacterial septicemia remains
Rapid determination of platelet alloantigen genotypes by polymerase chain reaction using allele‐specific primers
Authors: Skogen B. , Bellissimo D. , Hessner M. J. , Santoso S. , Aster R. H. , Newman P. J. , McFarland J. G.
Published: March 2003

BACKGROUND: The technique of allele‐specific polymerase chain reaction (PCR) amplification has been adapted for DNA‐based human platelet alloantigen typing.

STUDY DESIGN AND METHODS: Sequence‐specific primers were used to discriminate between the alleles encoding the six major human platelet alloantigens in a series of patients and normal blood donors.

RESULTS: This technique allows the direct determination of platelet antigen genotypes from genomic DNA after PCR amplification and agarose gel electrophoresis. It offers significant advantages over previously described techniques for alloantigen identification, as the additional analytical steps of restriction enzyme digestion or dot blot hybridization are not required. The results obtained with this technique correlated precisely with those derived from serologic typing and allele‐specific oligonucleotide hybridization. CONCLUSION: The use of allele‐specific PCR for platelet alloantigen typing should facilitate the development of DNA‐based typing in other regional blood centers and clinical laboratories.
Cytokine generation in stored platelet concentrates
Authors: Stack G , Snyder EL
Published: March 2003

BACKGROUND: Cytokines, because of the nature of their immunoinflammatory actions, are potential mediators of the symptom complex of nonhemolytic transfusion reactions. One possible source of cytokines in the transfusion setting is the stored blood component itself.

STUDY DESIGN AND METHODS: To test this possibility, the plasma portion of stored platelet concentrates (PCs) was assayed for the presence of interleukins 1 beta (IL‐1 beta), 6 (IL‐6), and 8 (IL‐8) and tumor necrosis factor alpha (TNF‐alpha). Samples were taken from PCs obtained from the inventory of a regional blood center (n = 120; 30 each of 2‐, 3‐, 4‐, and 5‐day‐old units).

RESULTS: Detectable levels of IL‐8 were measured in 59 percent of the PCs sampled, ranging from 30 percent of the 2‐day‐old units to 83 percent of the 5‐day‐old units. The median IL‐8 concentration ranged from undetectable levels in 2‐day‐ old units up to 1100 pg per mL in 5‐day‐old units. The mean IL‐8 concentration in 5‐day‐old units, 11,600 pg per mL, was 100 times the mean for 2‐day‐old units, which was 116 pg per mL (p < 0.0001). The highest levels of IL‐8, 50,000 to 200,000 pg per mL, in general were found in units with the longest storage times and highest white cell counts. Sequential sampling of 17 individual PCs over 7 days of storage confirmed that IL‐8 increases progressively with increasing storage time. Parallel, but smaller, increases in IL‐1 beta were observed in those units with high IL‐8 concentrations. TNF‐alpha was detected in 3 (10%) of 30 five‐day‐old PCs, but never exceeded 55 pg per mL in any unit tested. IL‐6 at levels of 740 and 508 pg per mL was detected in two 5‐day‐old units with high white cell counts of 9500 and 14,800 per microL, respectively, but not in 21 additional units tested with white cells < or = 9200 per microL or storage time of < or = 2 days. White cell reduction by third‐generation filters on Day 1 of platelet storage prevented the generation of IL‐8 and IL‐1 beta to Day 5 of storage.

CONCLUSION: Although IL‐8 achieved levels in some units of PCs that appear capable of causing physiologic changes, the potential adverse effect on transfusion recipients of the infusion of cytokines in PCs remains to be investigated.
Evaluation of indeterminate c22‐3 reactivity in volunteer blood donors
Authors: Tobler L.H. , Busch M.P. , Wilber J. , Dinello R. , Quan S. , Polito A. , Kochesky R. , Bahl C. , Nelles M. , Lee S.R.
Published: March 2003

Background: Approximately 25 percent of blood donor sera that are repeatably reactive for hepatitis C virus (HCV) on second‐generation enzyme immunoassay (EIA 2.0) are indeterminate on second‐generation recombinant immunoblot assay (RIBA 2.0), and over 76 percent of these results are due to single reactivity to the HCV recombinant antigen c22‐ 3.

Study Design and Methods: Data are presented on 46 volunteer allogeneic blood donors who were reactive on EIA2.0 and c22‐3 indeterminate in RIBA 2.0. Index and follow‐up samples were evaluated by using a panel of five synthetic peptide EIAs, a prototype strip immunoblot assay that uses synthetic peptides in addition to recombinant protein (RIBA 3.0), and polymerase chain reaction (PCR) for HCV RNA.

Results: All 46 donations had normal alanine aminotransferase values; only 2 (4.3%) reacted for antibody to hepatitis B core antigen. With a panel of 12 synthetic peptides spanning the entire sequence of the c22‐3 recombinant antigen, 33 plasmas (72%) reacted to one peptide or none, including 19 plasmas with reactivity restricted entirely to the N‐terminal peptide (1–15 amino acids) of c22‐3. With RIBA 3.0, 28 donations (61%) were nonreactive, including 25 that reacted with one peptide or none in EIA. Of these 25 plasmas, 18 reacted with the N‐ terminal sequence only. All 46 index donations were tested by PCR; the single PCR‐positive unit reacted with four HCV peptides, was positive by RIBA 3.0, and reacted for antibody to hepatitis B core antigen. Twenty‐six index donors were successfully recalled 3 to 7 months after their index donation. None seroconverted to positivity in RIBA 2.0, 1 was nonreactive, and 25 remained positive for c22‐3 only. The restricted epitope reactivity in peptide EIA and RIBA 3.0 was maintained over time in all cases. All 26 of the follow‐up samples tested negative by PCR.

Conclusion: On the basis of the restricted peptide reactivity and PCR negativity of index and follow‐up samples, it is concluded that the majority of c22‐3 RIBA 2.0‐indeterminate results are due to nonspecific cross‐reactivity to restricted (principally, N‐terminal) regions of HCV core antigen.
A flow cytometric method for phenotyping recipient red cells following transfusion
Authors: Griffin G.D. , Lippert L.E. , Dow N.S. , Berger T.A. , Hickman M.R. , Salata K.F.
Published: March 2003

Background: Reticulocyte phenotyping is used for transfused patients, who have red cell antibodies, to match blood for subsequent transfusion. Current methods are labor‐intensive and require a significant amount of sample.

Study Design and Methods: A simple dual‐ color flow cytometry method developed for antigen typing of reticulocytes in mixed red cell populations is reported. Antigens were labeled by an indirect immunofluorescence technique using undiluted reagent sera as the primary label, biotinylated goat anti‐human IgG as the secondary label, and avidin‐phycoerythrin as the fluorescent stain. Reticulocytes were labeled with a thiazole orange fluorescent stain. Reticulocyte identification and antigen typing were performed on 319 samples to establish the validity of the procedure. Mixed red cells were prepared in all possible c antigen combinations to simulate transfusion concentrations of 25, 50, and 75 percent.

Results: The anti‐ c flow cytometry profiles readily distinguished between antigen‐ positive and antigen‐negative populations and allowed the detection of reticulocytes at all simulated transfusion concentrations. Similar results were obtained in experiments using C, K, s, Fya, Fyb, Jka, or Jkb sera against equal volumes of antigen‐positive and ‐negative cells. Anti‐S gave inconsistent results. The in vitro results were confirmed in 19 transfused patients who had received red cells antigenically different from their own as well as cells from 1 chimera blood donor.

Conclusion: This method provides a simpler, safer, less labor‐ intensive, and less subjective technique requiring far less sample volume than current methods for antigen typing of reticulocytes in mixed red cell samples from recently transfused patients.
Evaluation of monoclonal anti‐glycophorin B as an unusual anti‐S
Authors: Hemming N.J. , Reid M.E.
Published: March 2003

Background: Monoclonal antibody 148 is a murine monoclonal anti‐ glycophorin B that preferentially reacts with S+ human red cells.

Study Design and Methods: Serologic and immunochemical studies were performed using red cells with various phenotypes.

Results: These studies reveal that this monoclonal antibody is unusual in that it fails to agglutinate S+ TSEN+ red cells and agglutinates S‐ St(a+) and S‐ Dantu+ red cells.

Conclusion: These results allow the prediction of the glycophorin composition of GP.Hop (Mi.IV) red cells.
Polyethylene glycol versus low‐ionic‐strength solution in pretransfusion testing: a blinded comparison study
Authors: Shirey R.S. , Boyd J.S. , Ness P.M.
Published: March 2003

BACKGROUND: Polyethylene glycol (PEG) has been shown to potentiate antigen‐antibody reactions.

STUDY DESIGN AND METHODS: To investigate the utility of PEG in pretransfusion testing, a blinded comparison study of PEG and a low‐ionic‐strength additive solution (LISS) was conducted. A total of 500 patient samples were tested in parallel with reagent antibody‐detection cells using blind‐coded PEG and LISS potentiators.

RESULTS: In 34 (34%) of 100 samples with known antibodies in the Rh, Kell, Duffy, Kidd, and MNS systems, PEG antiglobulin reactions were stronger (total score, 382) than LISS antiglobulin reactions (total score, 216), and in 66 cases (66%), they were equal to those of LISS. Of 400 samples without detectable antibodies, 384 were negative with PEG and LISS, and 16 were positive in PEG tests and negative in LISS. Seven of the 16 were clinically important antibodies (D, 1; E, 3; Fya, 1; Jka; 1; Jkb, 1), and four were clinically benign antibodies (Le(a), 2; McCc, 1; Sda, 1). Five of the 16 demonstrated inconclusive PEG reactions, for a false‐positive rate of 5 in 400 (1.3%). Of the 500 samples, none was negative in PEG tests and positive in LISS (0% false‐negative rate).

CONCLUSION: Although PEG demonstrates a relatively high false‐positive rate, PEG is more sensitive than LISS in detecting clinically significant antibodies.