bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of white cell reduction on the resistance of blood components to bacterial multiplication
Authors: BUCHHOLZ D.H. , AUBUCHON J.P. , SNYDER E.L. , KANDLER R. , PISCITELLI V. , PICKARD C. , NAPYCHANK P. , EDBERG S.
Published: March 2003

BACKGROUND: While prestorage white cell (WBC) reduction by filtration may improve platelet and red cell quality, it also may remove an important anti‐bacterial defense mechanism, especially if blood is WBC‐ reduced shortly after collection. STUDY DESIGN AND METHODS: The question of whether WBC reduction of platelet concentrates and red cells altered bacterial proliferation kinetics in components prepared from deliberately contaminated, freshly collected blood was investigated. Two‐unit pools of whole blood were inoculated, at a concentration of approximately one colony‐forming unit per mL, with one of 17 bacterial species reported to have caused septicemia in transfusion recipients. Each pool was divided after inoculation, and components were prepared from the 2 units after a 7‐hour room‐ temperature holding period. One unit of each AS‐1 red cell or platelet pair was WBC‐reduced, and the pairs were then stored for 42 days at 4 degrees C (red cells) or for 10 days at 22 degrees C (platelets). Quantitative bacterial cultures were performed at periodic intervals. RESULTS: In red cells, clinically significant bacterial proliferation occurred in only one instance (Serratia marcescens), and growth was less rapid in the WBC‐reduced unit than in the control. Three patterns of growth were seen in platelet concentrates. In four cases, there was rapid proliferation in both test and control units, while on 13 occasions there was minimal replication in either pair. On six occasions, substantial growth was noted in control units, while few or no bacteria could be found in the WBC‐reduced units. There was no evidence in either red cells or platelets that bacteria proliferated more rapidly in units that had been WBC‐reduced before storage than they did in units in which WBCs were retained. CONCLUSION: Rather than increasing the risk of bacterial proliferation through removal of active phagocytic cells, WBC reduction by filtration before blood storage may act to reduce the likelihood of significant bacterial proliferation, possibly by removal of microorganisms along with WBCs.
Hematopoietic progenitor cells are resistant to dimethyl sulfoxide toxicity
Authors: BRANCH D.R. , CALDERWOOD S. , CECUITI M.A. , HERST R. , SOLH H.
Published: March 2003

BACKGROUND: A direct chemical toxicity of dimethyl sulfoxide (DMSO) to hematopoietic progenitor cells has been suggested. However, a recent study failed to corroborate these earlier findings. Thus, a series of experiments was undertaken to address this issue. STUDY DESIGN AND METHODS: Bone marrow was collected from 18 donors and cryopreserved with 10 percent (vol/vol) DMSO. Aliquots of frozen bone marrow were thawed, diluted with ACD‐A to 8 percent (vol/vol) DMSO, and allowed to remain in DMSO for up to 2 hours before mononuclear cells were plated for colony‐forming assays. After 14 days in culture, burst‐forming units‐erythroid, colony‐forming units–granulocyte/macrophage, and colony‐forming units–granulocyte/erythrocyte/macrophage/megakaryocyte colonies were enumerated. RESULTS: There was no significant difference (p > 0.5) seen in colony formation over the 2‐hour exposure to DMSO. CONCLUSION: These results support and extend a previous study that bone marrow hematopoietic progenitor cells, including burst‐forming units–erythroid, colony‐forming units–granulocyte/macrophage, and colony‐ forming units–granulocyte/erythrocyte/macrophage/megakaryocyte are resistant to any toxic effects of 8‐ to 10‐percent (vol/vol) DMSO during at least 2 hours of DMSO exposure.
Atypical reactions associated with use of angiotensin‐converting enzyme inhibitors and apheresis
Authors: OWEN H.G. , BRECHER M.E.
Published: March 2003

BACKGROUND: Anaphylactic or atypical reactions, characterized by flushing, hypotension, dyspnea, and bradycardia, have been reported in patients undergoing hemodialysis, low‐density lipoprotein apheresis, IgG affinity column apheresis, therapeutic plasma exchange, and desensitization immunotherapy while receiving angiotensin‐converting enzyme (ACE) inhibitor therapy. STUDY DESIGN AND METHODS: Records were reviewed of 299 consecutive patients undergoing therapeutic plasma exchange with colloid replacement at the University of North Carolina Hospitals from September 1981 through December 1993. Charts were selected for further analysis if atypical reactions (flushing or hypotension defined as a mean decrease in blood pressure of 20 torr or greater) occurred during apheresis or if there was concurrent administration of an ACE inhibitor. RESULTS: Fourteen (4.7%) of 299 patients were receiving ACE inhibitor therapy at the time of apheresis; all 14 experienced an atypical reaction. In contrast, 20 (7%) of 285 patients not receiving ACE inhibitors developed atypical reactions (p < 0.001). The 14 ACE inhibitor patients accounted for 41 percent (14/34) of all patients having atypical reactions during apheresis. CONCLUSION: Patients receiving ACE inhibitor therapy who are undergoing therapeutic plasma exchange with albumin replacement solutions are at high risk (100%) for atypical reactions. It is recommended that ACE inhibitors be withheld for at least 24 hours before that procedure.
Antenatal platelet antibody testing by flow cytometry—results of a pilot study
Authors: Marshall L. R. , Brogden F. E. , Roper T. S. , Barr A. L.
Published: March 2003

BACKGROUND: Maternal platelet antibodies can cause fetomaternal alloimmune thrombocytopenia (FMAT), which has significant mortality and morbidity even in a first pregnancy. Prenatal diagnosis of FMAT has not previously been possible in the first affected pregnancy.

STUDY DESIGN AND METHODS: Using flow cytometry, a sensitive, inexpensive test for the detection of platelet antibodies has been developed. It was adapted for use as a possible antenatal screening test, and 600 pregnant women were tested in a pilot study.

RESULTS: In the study group, two women tested positive for platelet‐specific IgG antibodies, one for anti‐HPA‐ 1a and the other for anti‐HPA‐1a with anti‐HLA. In each case, the fetus was found to be affected in utero, and treatment was initiated before successful delivery. Another woman was shown to have a platelet‐ reactive autoantibody without IgG specificity, and her infant was unaffected. A total of 95 (15.8%) of the women tested had HLA antibodies alone, and the majority demonstrated IgG specificity. On follow‐up of 62 infants born to these women, none had thrombocytopenia; thus HLA antibodies were not shown to lead to FMAT in this study.

CONCLUSION: The flow cytometry‐based test for platelet antibodies can detect clinically significant maternal antibodies, and it may be that early diagnosis and treatment in utero can enhance outcome in FMAT. A population screening program is planned to determine the predictive power of this test, in addition to its sensitivity, specificity, and efficiency.
Clinical study of recovery and half‐life of vapor‐heated factor VII concentrate
Authors: Rivard G. E. , Kovac I. , Kunschak M. , Thöne P. M. ,   Factor VII Study Group
Published: March 2003

BACKGROUND: The in vivo recovery and half‐life of intermediate‐purity, vapor‐heated factor VII (FVII) concentrate were determined in patients having a congenital deficiency for FVII according to the 1991 guidelines of the International Society for Thrombosis and Haemostasis.

STUDY DESIGN AND METHODS: A total of 11 patients received a single infusion of the FVII concentrate. Blood was drawn before infusion and 15 and 30 minutes and 1, 2, 4, 8, 12, and 24 hours after. Recoveries were calculated from the highest FVII activity of the first four blood samples drawn after infusion. The two‐phase linear regression method was used to estimate the half‐life according to the two‐compartment model. In addition, a noncompartmental approach was applied.

RESULTS: The mean recovery value obtained for FVII concentrate, 110.53 percent (SD, ± 26.37), indicates rapid and efficient incorporation into the blood stream. Equivalent results were obtained with both pharmacokinetics methods and indicate a very short half‐life for FVII. A half‐life of 6.49 hours (SD, ± 2.42) was obtained with the compartmental method and a half‐life of 5.25 hours (SD, ± 2.42) with the noncompartmental method.

CONCLUSION: The half‐life and recovery reported here, along with the specificity of the replacement therapy, the earlier anecdotal cases of clinical efficacy, and the clinical safety of the concentrate with regard to viral infections, recommend vapor‐heated FVII concentrate for the treatment of patients with hereditary FVII deficiency.
The effect on the safety of intravenous immunoglobulin of testing plasma for antibody to hepatitis C
Authors: Biswas R.M. , Nedjar S. , Wilson L.T. , Mitchell F.D. , Snoy P.J. , Finlayson J.S. , Tankersley D.L.
Published: March 2003

Background: The safety of intravenous immunoglobulin (IGIV), manufactured from units testing negative for antibody to hepatitis C virus (anti‐HCV), was investigated.

Study Design and Methods: A study involving five chimpanzees was performed to determine whether the safety of IGIV would be compromised if units of plasma that reacted for anti‐HCV were withheld from pools from which IGIV is manufactured. In the first phase of the experiment, two chimpanzees were infused with 25 mL per kg of unprocessed, pooled plasma from 2887 donors who did not react for anti‐HCV in single‐antigen (c100‐3) enzyme‐linked immunosorbent assays. In the second phase, each of three chimpanzees was infused with 1000 mg per kg of IGIV manufactured from the same plasma units. The immunoglobulin was made by seven United States‐ licensed manufacturers, each using its own approved method. Each chimpanzee received an equal dose of each manufacturer's IGIV.

Results: The two chimpanzees that received anti‐c100‐3‐nonreactive, unprocessed pooled plasma became infected with HCV. The three chimpanzees infused with IGIV did not show any evidence of infection with HCV 15 months after inoculation. Two of these animals were challenged with human non‐ A,non‐B hepatitis‐infectious plasma, and both subsequently showed evidence of HCV infection.

Conclusion: These studies demonstrate that, as determined by infectivity for chimpanzees, 1) the withholding of plasma units that react for anti‐c100‐3 from pools from which plasma products are manufactured does not render the source material noninfectious, and 2) the safety of IGIV manufactured from such plasma pools is not compromised by withholding the units that react for anti‐ c100‐3.
Resolution of refractory, classic thrombotic thrombocytopenic purpura after staphylococcal protein A immunoadsorption
Authors: Drew M.J
Published: March 2003

Background: Multiple therapeutic interventions are available for treatment of thrombotic thrombocytopenic purpura. Resolution of thrombotic thrombocytopenic purpura may require use of several of these interventions.

Case Report: A patient presenting with classic (non‐ cancer chemotherapy‐associated) thrombotic thrombocytopenic purpura had an initial response to intensive, daily plasma exchange with fresh‐ frozen plasma and cryosupernatant. Multiple attempts over a period of 2 months to decrease the frequency of plasma exchange resulted in exacerbations of disease activity, indicated by increased schistocytosis, decreased hematocrit, increased serum lactate dehydrogenase, and decreased platelet counts. After a total of 39 plasma exchanges, the patient was begun on immunoadsorption therapy utilizing a staphylococcal protein A immunoadsorption treatment column. After six 2000‐mL protein A immunoadsorption treatments, the patient's platelet count, lactate dehydrogenase, and peripheral smear normalized, and they have remained normal over nearly 4 months of follow‐up.

Conclusion: Treatment by protein A immunoadsorption may be of benefit in patients with classic thrombotic thrombocytopenic purpura who are not achieving a sustained remission with conventional plasma exchange therapy.
Influence of Rh phenotype on the antigen density of C, c, and D: flow cytometric study using a frozen standard red cell
Authors: Wagner F.F.
Published: March 2003

BACKGROUND: Flow cytometry is increasingly being used for the comparison of antigen density. Indirect immune fluorescence is more sensitive than direct immune fluorescence and thus allows the study of red cells (RBCs) with a weak D antigen.

STUDY DESIGN AND METHODS: In indirect immune fluorescence, when the fluorescence is standardized by the use of aliquoted frozen standard RBCs, the coefficient of variation in fluorescence intensity was less than 5 percent, which allows accurate determination of minor variations of Rh antigen density. RESULTS: For D antigen, the well‐known suppressive effect of C, and the low antigen density of the weak D phenotype, was demonstrated. Use of epitope‐specific monoclonal antibodies yielded similar results and allowed the identification of a D category IV heterozygote; the relative antigen density measured with a monoclonal antibody that reacted with D(IV) was twice that measured with a monoclonal antibody that did not react with D(IV). RBCs from C and c homozygotes had significantly more antigen than those from heterozygotes. There was significant variation in antigen density, depending on Rh phenotype: for example, D+ RBCs had less C antigen than D‐ RBCs, and Rh:1,2,‐3,4,5 (CcDee) RBCs had more c antigen than Rh:1,2,3,4,5 (CcDEe) RBCs. There was no difference in D, C, and c antigen density in neonatal and adult RBCs. CONCLUSION: Flow cytometry is an excellent tool for the demonstration of minor differences in antigen density
Demonstration by the monoclonal antibody‐specific immobilization of erythrocyte antigens assay that a new red cell antigen belongs to the Kell blood group system
Authors: DANIELS G.L. , PETTY A.C. , REID M. , MOULDS M. , DEVENISH A. , HALIL O.
Published: March 2003

BACKGROUND: The Kell blood group system comprises 21 antigens residing on a red cell membrane glycoprotein of apparent M(r) 93,000.

STUDY DESIGN AND METHODS: Serologic techniques were used to identify a new red cell antigen. The monoclonal antibody‐specific immobilization of erythrocyte antigens (MAIEA) assay was used to identify the red cell membrane component carrying that antigen.

RESULTS: A new high‐frequency red cell antigen was identified and provisionally named RAZ. RAZ is absent from K.o red cells and from red cells treated with 2‐amino‐ ethylisothiouronium bromide and is expressed weakly on McLeod phenotype cells. It differs from all other Kell system antigens, and no depression of other Kell system antigens on RAZ+ red cells was noticed. The RAZ antigen was shown by the MAIEA assay to be located on the Kell glycoprotein.

CONCLUSION: RAZ is a new high‐frequency antigen located on the Kell glycoprotein. The MAIEA assay is a very effective method of demonstrating the membrane structure carrying a red cell antigen
Transfusion of donor buffy coat cells in the treatment of persistent or recurrent malignancy after allogeneic bone marrow transplantation
Authors: Collins R.H. , Pineiro L.A. , Nemunaitis J.J. , Jain V.K. , Waxman D. , Miller W.V. , Fay J.W.
Published: March 2003

BACKGROUND: Patients who experience relapse after allogeneic bone marrow transplantation have a poor prognosis. However, preclinical and clinical data have strongly suggested the existence of an immune‐ mediated anti‐tumor effect of allogeneic bone marrow transplantation. This effect, termed graft‐versus‐leukemia, may be harnessed purposefully in patients with posttransplant relapses by the administration of immune cells obtained by leukapheresis of the original bone marrow donor.

STUDY DESIGN AND METHODS: Thirteen patients with persistent or recurrent hematologic malignancy after HLA‐matched sibling‐donor allogeneic bone marrow transplantation were treated with transfusion of buffy coat cells collected from the original bone marrow donors. Mononuclear cell dose ranged from 1.18 to 4.28 × 10(8) per kg. Alpha‐interferon (1.5‐3 × 10(6) U/m2 3‐5x/week) was given to seven patients. Patients were observed for the development of graft‐versus‐ host disease and disease response.

RESULTS: Three of five patients with chronic myelogenous leukemia had complete remissions. One of five patients with active acute leukemia attained complete remission. A sixth acute leukemia patient treated with buffy coat transfusion after the induction of remission with chemotherapy relapsed 12 months later. One patient with myeloma had a complete but transient response. A patient with Hodgkin's disease did not respond. Four patients remain in remission 4, 16, 17, and 29 months after attaining complete remission. Graft‐versus‐host disease occurred in eight patients, including all of those with a complete response. One patient developed transient pancytopenia.

CONCLUSION: The transfusion of donor buffy coat cells has significant anti‐tumor activity in patients with relapsed hematologic malignancy after allogeneic bone marrow transplantation. This effect is strongly associated with graft‐versus‐host disease.
Unusual kinetics of white cell clearance in transfused mice
Authors: Goodarzi M. O. , Lee T. ‐H. , Pallavicini M. G. , Donegan E. A. , Busch M. P.
Published: March 2003

BACKGROUND: Donor white cells (WBCs) in blood transfusions are responsible for complications in recipients, including alloimmunization, graft‐versus‐host disease (GVHD), and virus transmission and reactivation. The recent use of sequence‐specific polymerase chain reaction assays to monitor the kinetics of clearance of donor WBCs in transfused humans and dogs found transient recirculation of donor lymphocytes on Days 3 to 5 after transfusion; this presumably reflected an abortive GVHD reaction to major histocompatibility complex‐incompatible recipient cells, after which donor WBCs were cleared to undetectable levels. STUDY DESIGN AND METHODS: This study sought to develop a murine model to further characterize the kinetics and major histocompatibility complex restriction of donor WBC clearance. A sensitive murine Y chromosome‐ specific polymerase chain reaction assay was developed and applied to serial blood samples collected after transfusions of allogeneic blood to naive inbred, primed inbred, and outbred mice, as well as after transfusions of gamma‐radiated blood to naive inbred mice. RESULTS: In inbred mice, both naive and primed to the allogeneic blood donor, transfused WBCs were not cleared to undetectable levels for more than 1 month after transfusion. Transfused outbred mice also showed prolonged donor WBC survival, although at lower levels than inbred mice. There was no evidence of GVHD in either inbred or outbred mice, and gamma radiation had no significant impact on donor WBC persistence. CONCLUSION: These results contrast with the rapid clearance of donor WBCs observed in humans and dogs. The immunologic basis for this discrepancy remains unclear. Caution should be exercised in any extrapolation to humans of conclusions drawn from results in transfused mice.
Reduction in transmission of hepatitis C after the introduction of a heat‐treatment step in the production of C1‐inhibitor concentrate
Authors: Cicardi M. , Mannucci P. M. , Castelli R. , Rumi M. G. , Agostoni A.
Published: March 2003

BACKGROUND: The transmission of viral infections via protein concentrates made from a large pool of plasma depends on the selection of donors, fractionation process, and virucidal methods. To date, no data are available on the infectivity risk of plasma concentrates of the inhibitor of the first component of complement (C1‐INH). STUDY DESIGN AND METHODS: The prevalence of blood‐borne viral infections and levels of transaminases were evaluated in patients treated with a large‐ pool plasma concentrate of the inhibitor of C1‐INH before and after the introduction of virucidal methods. The study included 85 patients with hereditary angioedema and 4 with acquired angioedema. The patients were divided into three groups: 1) 48 untreated patients; 2) 22 patients treated with non‐virus‐inactivated C1‐INH concentrates; and 3) 19 patients treated with virus‐inactivated concentrates. Serum samples obtained at various times after the infusion of concentrate were assayed for alanine amino‐transferase and tested for hepatitis B surface antigen and antibodies to hepatitis C virus (anti‐HCV) and human immunodeficiency virus (anti‐HIV); anti‐HCV‐negative subjects exposed to the concentrate were also tested for HCV RNA. RESULTS: Prevalences of HCV infection and elevated alanine aminotransferase are significantly lower in patients treated with virus‐inactivated concentrates than in those exposed to non‐virus‐inactivated concentrates. No patients were anti‐HIV positive. CONCLUSION: This study suggests that C1‐INH concentrates transmitted HCV, but that the virucidal methods adopted are effective in reducing the infectivity.
Adverse reactions in blood donors with a history of seizures or epilepsy
Authors: Krumholz Allan , Ness Paul M. , Hauser W. Allen , Douglas Deborah K. , Gibble Joan W.
Published: March 2003

BACKGROUND: Individuals with epilepsy or seizure disorders are restricted from donating blood because of concern that they are prone to adverse donor reactions such as syncope and convulsions. A study evaluating whether that concern is warranted is reported. STUDY DESIGN AND METHODS: During a 2‐year period beginning in 1987, blood donors in Maryland with a history of seizures were actively recruited by the American Red Cross. Adverse donor reactions were classified as “slight”, indicating dizziness and nausea without loss of consciousness; “moderate,” denoting syncope; and “severe,” indicating convulsive syncope. RESULTS: There were 329,143 satisfactory blood donations; 613 individuals reporting a history of seizures donated blood a total of 723 times. Among donors with seizures, 186 (35.7%) were taking antiepileptic medication, and 61 (8.4%) had had one or more seizures in the preceding year. Individuals with seizures had a low incidence of adverse reactions (3.34%). Although this incidence was slightly higher than that in the entire population (2.24%), the difference was not significant. In particular, the risk of syncope with or without convulsive activity was low for people with seizures (0.21%) and not significantly greater than that in other donors (0.28%). CONCLUSION: Individuals with seizures or epilepsy are not at greater risk for adverse reactions after blood donation, and major restrictions on their participation as blood donors are not warranted.
Transfusion‐transmitted human parvovirus B19 infection in a thalassemic patient
Authors: Zanella A. , Rossi F. , Cesana C. , Foresti A. , Nador F. , Binda A.S. , Lunghi G. , Cappellini M.D. , Furione M. , Sirchia G.
Published: March 2003

BACKGROUND: Human parvovirus (HPV) B19 infection has been shown to be transmissible by clotting factor concentrates, most often resulting in asymptomatic seroconversion. So far, no case of B19 transmission due to single‐donor transfusion has been documented. CASE REPORT: A case of transfusion‐transmitted HPV B19 infection in a 22‐year‐old female thalassemia major patient is described. She presented with an aplastic crisis; this was followed 1 week later by transitory heart failure and acute tricuspid incompetence. The echocardiogram revealed a grade III tricuspid regurgitation and a floating vegetation on the atrial face of the tricuspid lateral leaflet. The tricuspid regurgitation and vegetation spontaneously disappeared within 15 days. Blood cultures for bacteria were repeatedly negative. IgM anti‐HPV B19 seroconversion was documented in the acute phase. B19 DNA was detected by polymerase chain reaction and remained detectable up to 4 months after diagnosis. High‐ titer IgM anti‐HPV and B19 DNA were also found in serum samples collected at the time of donation from one of the donors of the blood transfused before the onset of clinical symptoms.

CONCLUSION: This case documents the transmission of HPV B19 by the transfusion of 1 red cell unit and the occurrence of possible transient cardiac involvement in this infectious complication.
Patterns of use of group O, Rh‐negative red cells in a large metropolitan area and an action plan to control utilization
Authors: Newman B.H. , Shafer A.W. , Saeed S.M.
Published: March 2003

Background: In southeastern Michigan, the group O, Rh‐negative (O‐) red cell supply was below emergency levels during one‐sixth of 1994, despite 43‐percent overcollection of O‐ red cell units relative to the size of the O‐ patient population. O‐ red cell units are overutilized because of their universal ABO and Rh compatibility. This study evaluated how hospitals in a large metropolitan area utilized O‐ red cell units, so that strategies could be devised to reduce O‐ usage.

Study Design and Methods: Through an O‐ red cell utilization survey, 56 hospitals were encouraged to collect three months' worth of transfusion data, either prospectively or retrospectively. O‐ usage was compared to total red cell usage and categorized into transfusions to O‐ patients, those to non‐O‐ patients, and the number of O‐ units that outdated.

Results: Of 40,616 units transfused in 38 hospitals, 3,535 (8.7%) were O‐; 71 percent of the O‐ units were transfused to O‐ patients, 28 percent were transfused to non‐O‐ patients, and 1 percent outdated. Hospital transfusions to O‐ patients appeared to correlate with the racial makeup of the patient population, while hospital transfusions to non‐O‐ patients appeared to correlate with hospital size and the hospital's transfusion practices.

Conclusion: O‐ red cell usage in a hospital is dependent on the racial and ethnic mix of the hospital's patient population, the amount of transfusion activity, and the hospital's transfusion practices. An understanding of the dynamics of O‐ usage allowed the development of strategies to decrease O‐ utilization.
Donation deferral criteria for human immunodeficiency virus positivity among blood donors in northern Thailand
Authors: Sawanpanyalert P. , Uthaivoravit W. , Yanai H. , Limpakarnjanarat K. , Mastro T.D. , Nelson K.E.
Published: March 2003

Background: The purpose of this study was to develop human immunodeficiency virus (HIV) infection donation deferral criteria for blood donors in an HIV‐epidemic area of northern Thailand, where the predominant means of transmission of HIV is through heterosexual contact.

Study Design and Methods: In a preliminary study, 2242 blood donors were interviewed, and their blood was tested for HIV antibodies between September 1993 and April 1994. The risk factors associated with HIV positivity were identified. Criteria to identify HIV‐positive persons on the basis of a logistic equation were developed and applied to another group of 5769 prospective blood donors.

Results: A multivariate analysis showed the following odds ratios (OR) for traits that were independently associated with HIV positivity: younger age (OR = 0.93 for each additional year of age), male gender (OR = 2.41), having no more than a primary school education (OR = 2.00), being in the military (OR = 1.78), being unsure of one's own blood safety (OR = 2.00), history of injecting drug use (OR = 5.36), diagnosis of syphilis or positive syphilis serologic test in the past 12 months (OR = 2.67), and genital ulcer in the past 12 months (OR = 4.56). On the basis of the model, with a limit of <10 percent loss of uninfected donors, predicted probabilities of HIV positivity alone or of markers of infection with HIV, hepatitis B virus, or Treponema pallidum were calculated. With a cutoff of 6.5‐percent estimated probability of HIV infection, derived from the logistic equation, the donor deferral criteria have 33.6‐percent sensitivity and 8.3‐percent positive predictive value for HIV positivity and 15.5‐percent sensitivity and 18.4‐percent positive predictive value for markers of infection with one of the three pathogens.

Conclusion: The proposed donor deferral system provides a more flexible, sensitive, and predictive tool for averting donation by those who, though HIV antibody‐negative, are at a higher risk of being infected with HIV.
Institutional variation in hemotherapy for solid organ transplantation
Authors: Danielson C.F. , Filo R.S. , O'Donnell J.A. , McCarthy L.J.
Published: March 2003

Background: Solid organ allograft recipients may require large amounts of blood components. The modification of components to make them safer for iatrogenically immunosuppressed transplant patients increases workload demands on blood banks and transfusion services.

Study Design and Methods: Institutions within the United States and Canada providing hemotherapy as support for transplant recipients were surveyed for their transfusion practices.

Results: Responses from 25 institutions provide the data for this report. In 1991, the mean intraoperative red cell requirements ranged from <1 unit for renal allograft recipients to 17.3 units for liver transplant recipients. The latter group also required the greatest amounts of platelets, fresh‐frozen plasma, and cryoprecipitate. More than 75 percent of responding institutions provided either cytomegalovirus‐seronegative or white cell‐reduced cellular components to pediatric recipients of liver allografts and to both adult and pediatric recipients of heart, lung, and heart‐lung allografts. The use of irradiated cellular blood components, although uncommon, was greatest in heart transplant recipients. The use of pretransplantation transfusions for immunomodulation was generally limited to patients awaiting a living‐donor renal transplant.

Conclusion: Transfusion practices varied among the institutions, but the majority provide cytomegalovirus‐safe cellular blood components to heart and lung allograft recipients and to pediatric transplant patients. Gamma‐radiated cellular components are not routinely provided to patients undergoing solid organ transplantation. Liver allograft recipients require the greatest amount of hemotherapeutic support.
Circulating red cells usually remain of host origin after bone marrow transplantation for severe combined immunodeficiency
Authors: Brady K.A. , Cowan M.J. , Leavitt A.D.
Published: March 2003

Background: Patients with severe combined immunodeficiency (SCID) treated with allogeneic bone marrow transplantation often receive a milder conditioning regimen than patients who undergo transplantation for hematologic malignancy, and they regularly retain circulating white cells of host origin. The origin of circulating red cells following successful bone marrow transplantation to treat SCID is not known.

Study Design and Methods: Review of the medical records identified all patients with SCID who underwent ABO‐mismatched bone marrow transplantation at the University of California, San Francisco, between 1982 and 1994. The ABO and Rh phenotype at>6 months after transplantation was determined for all successful transplants by review of the medical record or the taking of a fresh blood sample for analysis. Patient‐conditioning and donor bone marrow‐preparative regimens were reviewed to assess their possible influence on the red cell phenotype after successful bone marrow transplantation.

Results: Nine of 35 SCID patients who underwent successful transplantation received marrow from ABO‐mismatched donors. Eight of the nine patients had only host red cells circulating at 6 to 84 months after transplantation, while one patient had only donor red cells circulating at 48 months after transplantation. None of the patients had circulating red cells of both host and donor origin. Conditioning regimens included cyclophosphamide and antithymocyte globulin for all nine patients; only three patients also received total body irradiation. Seven of the nine patients received related‐donor, HLA‐ mismatched bone marrow, and two patients received HLA‐identical bone marrow; eight patients received T‐cell‐depleted bone marrow. The one patient whose red cell phenotype converted to that of the donor received T‐cell‐depleted, haploidentical marrow, and the preparative regimen included chemotherapy and total body irradiation.

Conclusion: SCID patients successfully treated with allogeneic bone marrow transplantation typically fail to show circulating red cells of donor phenotype; this finding is in contrast to the universal presence of circulating donor red cells following successful bone marrow transplantation to treat hematologic malignancies and other diseases. The milder conditioning regimens typically given to patients with SCID, along with T‐cell depletion and HLA mismatching, may play a role in this different outcome. It is not known whether the inability to find circulating red cells of donor origin is due to a failure to engraft donor pluripotent stem cells or a failure of engrafted donor stem cells to differentiate along the erythroid lineage.
An unusual case of autoimmune hemolytic anemia with reticulocytopenia, erythroid dysplasia, and an IgG2 autoanti‐U
Authors: Roush G. R. , Rosenthal N. S. , Gerson S. L. , Toy E. M. , McCarthy P. , Hirschler N. V. , Yomtovian R.
Published: March 2003

BACKGROUND: Autoantibodies with anti‐U specificity, usually in combination with autoantibodies of other specificities, have occasionally been identified in association with autoimmune hemolytic anemia. A case of life‐threatening autoimmune hemolytic anemia, characterized by several atypical features, including apparent intravascular hemolysis associated with an IgG2 anti‐U, reticulocytopenia, and bone marrow dyserythropoiesis is described. CASE REPORT: A 36‐year‐old man with a severe case of acute‐onset autoimmune hemolytic anemia was admitted to another hospital; he had a hematocrit of 15 percent, elevated bilirubin and lactate dehydrogenase, and positive direct and indirect antiglobulin tests. He received 7 units of incompatible red cells without improvement in hematocrit, and he was transferred to University Hospitals of Cleveland (OH). He was jaundiced and became syncopal in the sitting position. His serum was reddish pink; he had a hematocrit of 11.8 percent and a reticulocyte count of 2.5 percent. No spherocytes were observed in the peripheral blood smear. Shortly after admission, the hematocrit fell to 6.9 percent. He was given 3 units of “least‐incompatible” red cells and was started on prednisone, with little improvement. An IgG2 autoanti‐U was detected in his serum. Seven units of U‐ red cells were transfused over the next 4 days. The hematocrit improved to 23 percent and continued to rise without further transfusion. A bone marrow examination, initially revealing erythroid hyperplasia accompanied by dyserythropoiesis, became morphologically normal. Drug studies failed to show evidence of drug‐related hemolysis. He remains well 2 years after discharge without evidence of recurrent hemolysis. CONCLUSION: Severe life‐threatening autoimmune hemolytic anemia, in this instance induced by an autoanti‐U, may be associated with IgG2 autoantibody and characterized by apparent intravascular hemolysis and bone marrow dyserythropoiesis. Early treatment with U‐ blood, in addition to steroids, may be beneficial.
New anti‐human immunodeficiency virus immunoblot assays resolve nonspecific western blot results
Authors: ZaaijerMD H.L. , van Rixel T. , van Exel‐Oehlers P. , Cuypers H.T.M. , Lelie P.N.
Published: March 2003

BACKGROUND: Two new anti‐human immunodeficiency virus type 1 and 2 (HIV‐ 1/2) immunoblot assays, which use recombinant and synthetic antigens for antibody detection have become available. These assays might be able to resolve indeterminate anti‐HIV Western blot results. STUDY DESIGN AND METHODS: The new anti‐HIV immunoblot assays were used to test 67 samples from 31 HIV infected and 24 noninfected persons showing various anti‐HIV Western blot patterns. RESULTS: The immunoblots correctly identified eight HIV‐2‐positive samples and five late‐stage HIV‐1‐positive samples. After 30 samples from 18 seroconverting persons were tested, the Western blot showed reactivity in 24 of 30 samples and the immunoblots showed reactivity in 21 of 30 samples (difference not significant). In 16 of 30 seroconversion samples, both immunoblot assays produced HIV‐1‐positive results. In accordance with various criteria for interpretation, the number of positive Western blot results was as follows: Centers for Disease Control and Prevention, 16 of 30 and World Health Organization, 13 of 30. When samples from non‐ HIV‐infected persons were tested, both immunoblot assays resolved 20 (83%) of 24 samples showing indeterminate Western blot reactivity. CONCLUSION: Although the sensitivity of the immunoblot assays should be validation in larger studies, the mere specificity of these assays makes them valuable for the exclusion of HIV infection in Western blot‐ indeterminate, HIV p24 antigen‐negative samples.
A point score system for predicting the likelihood of blood transfusion after hip or knee arthroplasty
Authors: Larocque B. J. , Gilbert K. , Brien W. F.
Published: March 2003

BACKGROUND: Given the high cost of autologous blood donation for elective surgery, it would be desirable to predict which patients are most likely to benefit from the procedure. The purpose of this study was to develop a point score system for predicting the likelihood of blood transfusion in hip and knee arthroplasty.

STUDY DESIGN AND METHODS: A database of 599 patients undergoing elective surgery at a teaching hospital was used for the analysis. Variables were analyzed to determine their univariate association with postoperative blood transfusion. Significant factors were entered into a multiple logistic regression model, and a point score system was developed on the basis of the regression coefficients. Four strata of transfusion risk were constructed.

RESULTS: Factors independently associated with blood transfusion included preoperative hemoglobin, type of arthroplasty, primary versus revision surgery, autologous donor status, and patient weight. Four factors were used to create a point score system with four strata. The likelihood of blood transfusion for patients in the four risk strata was 1.7, 11.0, 40.0, and 78.3 percent. The calculated area under the receiver operating characteristic curve was 0.86.

CONCLUSION: The likelihood of a postoperative blood transfusion can be predicted by using this simple point score system. Autologous blood donation can subsequently be targeted to the high‐risk patients.
Preparations of synthetic phospholipids promote procoagulant activity on damaged vessels: studies under flow conditions
Authors: Galán A.M. , Hernández M. R. , Bozzo J. , Reverter J. C. , Estelrich J. , Roy T. , Mazzara R. , Ordinas A. , Escolar G.
Published: March 2003

BACKGROUND: The possibility of developing synthetic platelet substitutes that could promote hemostasis with prolonged shelf‐life and increased safety is an appealing one. STUDY DESIGN AND METHODS: Preparations containing synthetic phospholipids were incorporated into blood samples (1.15 mg/mL) in which platelets and white cell counts had been experimentally reduced by a filtration procedure. Vesicles containing phosphatidylcholine (PC), phosphatidylethanolamine (PE), phosphatidylserine (PS), phosphatidylinositol (PI), or combinations of PC and PE and of PC and PS were tested in this system. Blood was recirculated (10 min; shear rate, 250/sec) through a perfusion chamber containing vascular segments. The ability of the various phospholipid preparations to promote fibrin formation on the damaged subendothelium was evaluated morphometrically and expressed as the percentage of fibrin coverage. Generation of thrombin in the system was monitored through the measurement of prothrombin fragments 1 and 2. RESULTS: Vesicles containing PC, PI, PE:PC (1:1), or PS:PC (1:3) increased fibrin deposition on the subendothelium (64.5 +/− 9.8%, 32.7 +/− 6.3%, 58.3 +/− 6.5%, and 46.6 +/− 15.2%, respectively; p < 0.01 vs. 11.5 +/− 1.2% in thrombocytopenic blood). Vesicles containing PE, PS, or PS:PC (3:1) did not show procoagulant effect. CONCLUSION: Synthetic phospholipid preparations promote a local procoagulant activity at sites of vascular damage when they are incorporated into thrombocytopenic blood maintained under flow conditions.
Use of IgM monoclonal reagents licensed for tube tests in column agglutination technology
Authors: Morelati F. , Burlini A. , Reis K.J. , Drago F. , Revelli N. , Villa M. A. , Guffanti A. , Italiano Z. , Parravicini A. , Rebulla P. , Sirchia G.
Published: March 2003

BACKGROUND: Red cell (RBC) phenotyping using column agglutination technology (CAT) is currently limited by the reagents formulated in the system. To overcome this limitation, it was investigated whether monoclonal IgM reagents licensed for use with tube tests produced valid results with CAT. STUDY DESIGN AND METHODS: Commercial CAT, does not contain antisera, was used to evaluate Procedures A (40 microL of reagent and 10 microL of 4% RBCs) and B (50 microL of reagent and 50 microL of 0.8% RBCs) with or without incubation at room temperature. In Study 1, reagents were tested to determine whether potentiators inhibit the passage of antigen‐negative RBCs through the column. In Study 2, CAT sensitivity was measured by the use of potency titrations to define a procedure for each reagent that matched or exceeded that of the tube method. In Study 3, the specificity of each reagent was determined in parallel with the CAT and tube tests. Typing of 1644 samples was performed. RESULTS: Study 1: Free passage was obtained with all reagents. Study 2: Immediate‐spin methods using CAT produced the same results as the tube method. Study 3: With 8048 comparisons made, discrepant results were found in 32 transfused patients and in 6 cord blood samples, mainly with Lewis reagents. With comparison of CAT and the standard tube method, complete agreement was obtained with Kell reagents, 99.9‐percent agreement with Kidd reagents, and 98.9‐percent and 99.4‐percent agreement with Lewis reagents. CONCLUSION: Most examined reagents seem suitable for use with CAT.
Pediatric peripheral blood progenitor cell collection: haemonetics MCS 3P versus COBE Spectra versus Fresenius AS104
Authors: Bambi F , Faulkner LB , Azzari C , Gelli AM , Tamburini A , Tintori V , Lippi AA , Tucci F , Bernini G , Genovese F
Published: March 2003

BACKGROUND: An increasing number of apheresis machines are becoming available for peripheral blood progenitor cell (PBPC) collection in children. STUDY DESIGN AND METHODS: At the Children's Hospital of Florence (Italy), three apheresis machines were evaluated: MCS 3P (Haemonetics) (10 procedures in 4 patients, aged 10–12 years, weight 23.5‐64 kg), Spectra, (COBE) (8 procedures in 3 patients, aged 4–17 years, weight 19–59 kg), and AS104 (Fresenius) (24 procedures in 9 patients, aged 2–16 years, weight 13.6‐60 kg). For PBPC quantitative analysis, CD34 cytofluorimetry was employed. Relevant variables analyzed included efficiency of CD34+ cell extraction and enrichment, mononuclear cell purity and red cell contamination of the apheresis components, and platelet count decreases after leukapheresis. RESULTS: No significant differences in CD34+ cell‐extraction abilities were found. However, the AS104 provided consistently purer leukapheresis components in terms of mononuclear cell and CD34+ cell enrichment (441 +/− 59%, vs. 240 +/− 35% and 290 +/− 42% for MCS 3P and Spectra, respectively). Postapheresis platelet counts dropped the least with the AS104. The smallest patient who underwent apheresis with MCS 3P (the only machine working on discontinuous flow and hence with greater volume shifts) weighed 23.5 kg and tolerated the procedure well, with no signs of hemodynamic instability. No significant complications were observed. CONCLUSION: All machines seem to have comparable PBPC extraction efficiency, but the AS104 seems to give the component with the greatest PBPC enrichment. This feature might be relevant for further ex vivo cell processing (CD34+ cell selection, expansion, and so on).
Transmission of hepatitis G virus in patients with angioedema treated with steam‐heated plasma concentrates of C1 inhibitor
Authors: De Filippi F. , Castelli R. , Cicardi M. , Soffredini R. , Rumi M.G. , Silini E. , Mannucci P.M. , Colombo M.
Published: March 2003

BACKGROUND: Hepatitis G virus (HGV) is a blood‐borne flavivirus that may cause acute and chronic transfusion‐transmitted infections. Patients with complement component 1 (C1) inhibitor (C1‐INH) deficiency may acquire blood‐borne infections through infusion of plasma concentrates. STUDY DESIGN AND METHODS: Serum samples from 84 patients with C1‐INH deficiency (19 who received unmodified C1‐INH concentrates, 23 who received steam‐heated concentrates, and 42 untreated patients) were tested for HGV RNA and hepatitis C virus (HCV) RNA by a nested polymerase chain reaction (PCR). The samples were also tested for antibodies to the E2 envelope protein of HGV (anti‐HGV) and to HCV with enzyme‐linked immunosorbent assays. RESULTS: Nine (11%) patients had serum HGV RNA; that is, 7 (17%) of 42 patients previously treated with C1‐INH concentrates and 2 of 42 previously untreated patients. HGV RNA was as common in the 19 patients treated with unmodified concentrates as in the 23 given steam‐heated concentrates (16 vs. 17%, p = 0.60). Anti‐HGV was more common among the recipients of unmodified concentrates than among those given steam‐heated concentrates (26 vs. 0%, p = 0.014). HCV RNA was more frequently detected in treated patients than in untreated patients (33 vs. 7%, p = 0.005) and in the 19 recipients of unmodified concentrates than in the 23 treated with steam‐heated concentrates (58 vs. 16%, p = 0.003). Only one HGV RNA‐ seropositive patient had elevated serum aminotransferase activity, compared to 11 with HCV RNA. CONCLUSION: HGV was transmitted by both unmodified and steam‐heated concentrates, but it caused persistent viremia in a minority of the cases and was rarely associated with liver disease.
Increase in endogenous thrombopoietin in healthy donors after automated plateletpheresis
Authors: Dettke M. , Hlousek M. , Kurz M. , Leitner G. , Rosskopf K. , Stiegler G. , Stohlawetz P. , Worel N. , Hocker P. , Panzer S.
Published: March 2003

BACKGROUND: Thrombopoietin (TPO) is a key cytokine involved in the regulation of megakaryocytopoiesis and platelet production. The aim of the present study was to test whether platelet donation is associated with changes in the serum TPO levels in healthy donors undergoing plateletpheresis.

STUDY DESIGN AND METHODS: The study group consisted of 23 healthy donors undergoing single‐donor plateletpheresis for the first time. Serum TPO levels and platelet counts were determined before platelet collection, at the end of apheresis, and for 4 days thereafter. Serum TPO levels were determined by a TPO‐specific enzyme‐ linked immunosorbent assay.

RESULTS: In relationship to platelet donation, serum TPO levels showed a temporary increase from baseline levels of 69.2 +/− 7.1 pg per mL to 117 +/− 6.8 pg per mL 2 days after plateletpheresis (p < 0.05). Further evaluation revealed a decline in serum TPO levels as platelet counts increased. Female donors showed a delayed normalization of circulating platelet numbers and serum TPO levels as compared to male donors. There was no significant correlation between serum TPO levels and the absolute platelet number during normalization of the donors' platelet counts after plateletpheresis.

CONCLUSION: Single‐donor plateletpheresis results in a temporary increase in serum TPO levels in healthy platelet donors, which may be part of a compensatory response‐boosting megakaryocytopoiesis after platelet collection.