bluuebunny/crossref_metadata_2025 huggingface dataset:
Six filters for the removal of white cells from red cell concentrates, evaluated at 4°C and/or at room temperature
Authors: van der Meer Pieter F. , Pietersz Ruby N.I. , Nelis Johanna T. , Hinloopen Boudewijn , Dekker Wilhelmina J.A. , Reesink Hendrik W.
Published: March 2003

BACKGROUND: Six filters were tested for their ability to remove white cells from buffy coat‐depleted red cell concentrates at various temperatures.

STUDY DESIGN AND METHODS: Cellselect FR, BPF4, and Sepacell filters were tested at both room temperature (RT) and 4°C. The Leucoflex filter was tested only at 4°C, while the Cellselect Optima Plus and Imugard filters were tested only at RT. Donor‐dependent differences were excluded by pooling and subsequently dividing 9 red cell concentrates; 12 sets of experiments were performed.

RESULTS: With all filters, red cell concentrates containing <5 × 106 white cells per unit were obtained. The lowest numbers of residual white cells were achieved with the Leucoflex (at 4°C, 0.15 ± 0.11 × 106), the Sepacell (at 4°C, 0.23 ± 0.14 × 106), the Imugard (at RT, 0.24 ± 0.14 × 106), and the BPF4 (at 4°C, 0.25 ± 0.24 × 106; differences not significant). With the Cellselect FR, filtration at 4°C resulted in 0.86 ± 0.37 × 106 white cells per unit, a level not significantly different from that obtained with the BPF4 and Sepacell filters at RT (1.16 ± 0.43 × 106 and 0.80 ± 0.36 × 106 white cells, respectively). Filtration at RT with the Cellselect FR and Cellselect Optima Plus resulted in red cell concentrates with 1.79 ± 0.69 × 106 and 2.29 ± 0.69 × 106 white cells, respectively (p<0.01).

CONCLUSION: All filters conformed to the current standards for white cell reduction; the process was less efficient at RT than at 4°C. For routine application, the composition of the red cell concentrate, the temperature, and logistic preferences should be taken into account in the final choice of filter; before implementation, the chosen filter must be validated under routine conditions.
Randomized trial assessing the feasibility and safety of biologic parents as RBC donors for their preterm infants
Authors: Strauss R.G. , Burmeister L.F. , Johnson K. , Cress G. , Cordle D.G.
Published: March 2003

BACKGROUND: Most very low birth weight (<1.0 kg) infants receive RBC transfusions. Several reports have demonstra‐ted that RBCs stored up to 42 days can be transfused safely in small volumes to preterm infants to decrease donor exposure without consequent hyperkalemia, acidosis, or other adverse effects. Although biologic parents are likely candidates as donors of blood for their neonates, it has been suggested that their blood may be serologically incompatible with that of their infants.

STUDY DESIGN AND METHODS: A two‐arm randomized study was conducted to compare the feasibility and immediate safety of two single‐donor programs for providing small‐volume RBC transfusions to preterm infants: in one arm, infants received RBCs collected from unrelated donors and stored up to 42 days, and in the other arm, RBCs were collected from one of the biologic parents and stored identically. All infants received compatible RBCs that were WBC reduced before storage, stored in AS‐3, and gamma‐radiated. All transfusions were given uniformly as 15 mL per kg of RBCs transfused over 5 hours, during which time the infants were closely observed for clinical reactions. In addition, laboratory studies were performed shortly before and after each transfusion.

RESULTS: A total of 40 preterm infants received 120 RBC transfusions. Biologic parents experienced several donor eligibility problems. However, once enrolled as donors, they were able to supply all RBCs needed by their infants. Significant differences in rates of clinical transfusion reactions and laboratory abnormalities were rare and had no apparent clinical importance, regardless of whether RBCs were donated by biologic parents or unrelated donors.

CONCLUSION: A single‐donor system, in which AS‐3 RBCs were collected either from unrelated blood donors or from biologic parents and then stored up to 42 days, was able to supply small‐volume RBC transfusions needed by individual preterm infants without immediate, adverse effects. Because the risk of infectious disease transmission is likely reduced by limiting donor exposure, it is logical to conclude that single‐donor programs should increase transfusion safety and that biologic parents should be considered as blood donors for their infants.
The low‐frequency MNS blood group antigens Nya (MNS18) and Osa (MNS38) are associated with GPA amino acid substitutions
Authors: Daniels G.L. , Bruce L.J. , Mawby W.J. , Green C.A. , Petty A. , Okubo Y. , Kornstad L. , Tanner M.J.A.
Published: March 2003

BACKGROUND: Antigens of the MNS blood group system are located on two sialoglycoproteins, GPA and GPB, encoded by GYPA and GYPB. The molecular backgrounds of the low‐frequency antigens Nya and Osa are not known.

STUDY DESIGN AND METHODS: Immunoblotting and a monoclonal antibody‐specific immobilization of erythrocyte antigens (MAIEA) assay were used to analyze Osa. PCR‐amplified products of the coding exons of GYPA were studied by single‐strand conformation polymorphism analysis, and exon 3 was sequenced. Synthetic peptides were used in hemagglutination‐inhibition tests.

RESULTS: Sequencing of GYPA exon 3 of two unrelated Ny(a+) persons revealed heterozygosity for a T194A base change encoding an Asp27Glu substitution. Immunoblotting with anti‐Osa and an MAIEA assay with MoAbs to GPA showed that Osa is on GPA. Sequencing exon 3 of an Os(a+) person from the only family with Osa revealed heterozygosity for a C273T base change encoding a Pro54Ser substitution. A synthetic peptide representing part of GPA with the Osa mutation (VRTVYPSEEETGE) completely inhibited anti‐Osa, whereas the control peptide (VRTVYPPEEETGE) did not inhibit anti‐Osa.

CONCLUSION: Nya and Osa are low‐frequency antigens of the MNS blood group system that represent Asp27Glu and Pro54Ser substitutions in GPA, respectively.
Periodic alternating interface positioning to lower WBC contamination of apheresis platelet concentrates: a multicenter evaluation
Authors: Zeiler T. , Zingsem J. , Moog R. , Kretschmer V. , Eckstein R. , Müller N. , Eisenbeisz F.
Published: March 2003

BACKGROUND: A new software version of a cell separator (AS TEC 204, Fresenius) providing WBC‐reduced single‐donor plateletpheresis concentrates was tested.

STUDY DESIGN AND METHODS: Dual‐needle apheresis procedures (n = 621) were performed in three centers, using either fixed interface positioning (FIP) or periodic alternating interface positioning (PAIP). The other separation parameters (e.g., anticoagulant:whole‐blood ratio, and blood flow) were set individually. All platelet concentrates were evaluated for platelet yields and contaminating WBCs.

RESULTS: The introduction of the PAIP resulted in a significant (p<0.001) reduction in contaminating WBCs (median, 30,000) from the numbers seen with FIP (median, 2,300,000) while maintaining the separation efficacy (47%) and separation time. Ninety‐eight percent of all concentrates contained less than 5 × 106 WBCs per concentrate and 92 percent contained less than 1 × 106.

CONCLUSION: Plateletpheresis using the AS TEC 204 cell separator with PAIP is a valid alternative to WBC reduction by filtration. It may provide WBC‐reduced platelet concentrates without the additional cost of filters. However, the reliability of the WBC reduction is not yet advanced enough that PAIP can be employed without any monitoring of the end product.
Evaluation of pooled platelet concentrates using prestorage versus poststorage WBC reduction: impact of filtration timing
Authors: Ferrer F. , Rivera J. , Corral J. , Gonzalez‐Conejero R. , Lozano M.L. , Vicente V.
Published: March 2003

BACKGROUND: Concern for the undesirable consequences of transfusing passenger WBCs is leading to the general use of WBC‐reduced platelet concentrates (PCs). However, the impact of prestorage versus poststorage WBC reduction on the quality of platelet products has not been clearly defined.

STUDY DESIGN AND METHODS: Pooled PCs were WBC reduced before or after 5‐day storage, by use of a WBC filter (PXL‐8, Pall Corp.). Samples from pools were taken on days 1 and 5, before and after filtration, and on Day 9 of storage and assessed for cell counts, biochemical values, expression of platelet glycoproteins, thrombin generation, and content of IL‐6, IL‐8, TNFα, transforming growth factor β1 (TGFβ1), and anaphylatoxins C3a and C4a.

RESULTS: Filtration of fresh and 5‐day‐stored pooled PCs via a PXL‐8 filter was similarly efficient, rendering pools with low WBC counts (<1 × 106 cells) and high platelet recovery (>95%). No major changes were found in the metabolic behavior or the expression of platelet GPIb, GPIIb/IIIa, CD62, and CD63 in PCs filtered before or after storage. Filtration, either before or after storage, increased by less than 5 percent the proportion of CD62+ platelets. Moreover, no changes were found in the concentration of prothrombin fragments 1 and 2 and thrombin‐antithrombin complexes in the pooled PCs derived from the time of filtration. Finally, prestorage WBC reduction abrogated the accumulation of IL‐6 and IL‐8, but it did not prevent that of anaphylatoxins C3a and C4a nor of TGFβ1. However, filtration through a PXL‐8 filter significantly reduced (40‐90%) the amount of IL‐8, C3a, and C4a in the filtrate.

CONCLUSIONS: The timing of PXL‐8 filtration of PCs has little impact on the efficiency of WBC reduction and on platelet recovery, and it does not seem to affect the quality of platelets or the generation of thrombin in the PCs. As regards the goal of reducing the amount of bioactive products in PCs, it remains uncertain as to whether prestorage WBC reduction fully eliminates the need for poststorage filtration. Prestorage filtration leads to low levels of IL‐6 and IL‐8 in PCs, but it does not impair the poststorage content of TGFβ1 or anaphyla‐toxins. By contrast, poststorage PXL‐8 filtration removes significant amounts of C3a and C4a, and thus it might provide clinical benefits beyond those of prestorage WBC reduction.
An acute hemolytic transfusion reaction due to anti‐IH in a patient with sickle cell disease
Authors: Campbell S.A. , Shirey R.S. , King K.E. , Ness P.M.
Published: March 2003

BACKGROUND: A hemolytic transfusion reaction (HTR) due to anti‐IH is reported in a patient with sickle cell disease (SCD).

CASE REPORT: An 18‐year‐old woman with SCD and a complete phenotype on file had been identified as group B‐positive with negative antibody‐screening tests and had received 1 unit of packed RBCs. Ten days later, she was readmitted in painful crisis with a Hb of 4.2 g per dL. Antibody‐screening tests and panel cells were positive at all test phases with a negative autocontrol, which suggested alloantibodies. Phenotypically matched group O RBCs were issued emergently. After the transfusion of 100 mL, the patient had an HTR with chills, fever, and tachycardia and laboratory findings of hemoglobinemia, hemoglobinuria, and negative DATs. A high‐titer, IgM anti‐IH with a high thermal amplitude (reactive with group O, but not group B RBCs at 37°C) was identified. Autologous RBCs appeared to have normal I antigen expression, but less H antigen than pooled group B RBCs. She was given group B RBCs, uneventfully, by use of a blood warmer.

CONCLUSIONS: This is a rare case of anti‐IH as the cause of a HTR, as a serologic problem that may be seen in SCD, and as an autoantibody that may mimic an alloantibody. Ironically, this HTR resulted from the effort to provide phenotypically matched RBCs, which necessitated the selection of group O RBCs.
Cytokines in WBC‐reduced apheresis PCs during storage: a comparison of two WBC‐reduction methods
Authors: Wadhwa Meenu , Seghatchian M. Jerhard , Dilger Paula , Sands Dawn , Krailadisiri Pranee , Contreras Marcela , Thorpe Robin
Published: March 2003

BACKGROUND: Several studies have suggested that cytokine accumulation during storage of platelet concentrates (PCs) may mediate nonhemolytic febrile transfusion reactions and that a reduction in WBC numbers prevents the generation of cytokines. Despite efforts to minimize WBC contamination in apheresis PCs, high numbers of WBCs and increased cytokine levels may still occur, depending on the quality of the apheresis device employed.

STUDY DESIGN AND METHODS: This study was undertaken to investigate whether PCs collected with WBC‐reduction devices (Spectra LRS, COBE;or MCS+ LDP, Haemonetics) were sufficiently depleted of WBCs to limit cytokine accumulation during storage. The study evaluated 1) the levels of cytokines of WBC and platelet origin in two types of apheresis PCs during storage and 2) the effects of prestorage filtration on cytokine levels in the Spectra LRS PCs.

RESULTS: In the Spectra LRS PCs, low levels of IL‐6, IL‐8, and monotype chemoattractant protein 1 (MCP‐1) were detected in Day 1 PCs, and they remained consistent during the shelf life. RANTES, platelet factor 4 (PF4), β‐thromboglobulin (β‐TG), and transforming growth factor (TGF)‐β1 were also detected in these PCs, and their levels increased significantly on storage. Prestorage filtration of Spectra LRS PCs did not further reduce the levels of IL‐6, IL‐8, MCP‐1, PF4, β‐TG, and TGF‐β1 in the filtered component. In the MCS+ LDP PCs, IL‐6 was detected on Day 1, and its level increased significantly on storage, whereas the levels in the Spectra PCs remained steady. IL‐8 levels were lower in MCS+ LDP PCs than in Spectra LRS PCs of the same age. MCP‐1 levels were similar in both products on Day 1 and marginally increased in stored MCS+ LDP PCs. Substantial amounts of RANTES, PF4, β‐TG, and TGF‐β1 occurred in Day 1 MCS+ LDP PCs, and, on storage, these levels rose significantly.

CONCLUSION: Despite a significant reduction in levels of WBC‐derived cytokines, platelet‐derived cytokines were present in different amounts in the two products.
Transfusion to blood group A and O patients of group B RBCs that have been enzymatically converted to group O
Authors: Kruskall Margot S. , AuBuchon James P. , Anthony Kathleen Y. , Herschel Louise , Pickard Connie , Biehl Ruth , Horowitz Marilyn , Brambilla Donald J. , Popovsky Mark A.
Published: March 2003

BACKGROUND: The transfusion of ABO‐incompatible RBCs is the leading cause of fatal transfusion reactions. Group O RBCs, lacking terminal immunodominant A and B sugars to which humans are immunized, are safe for transfusion to persons of any ABO blood group. With the use of a recombinant α‐galactosidase to remove terminal galactose from group B RBCs, the safety and efficacy of enzyme‐converted group‐B‐to‐group‐O (ECO) RBC components were studied in transfusion‐dependent patients.

STUDY DESIGN AND METHODS: Twenty‐four patients (blood groups A and O) were randomly assigned to receive transfusion(s) of either ECO or control group O RBCs. If a second transfusion was given, the other blood component was administered.

RESULTS: Twenty‐one patients were given ECO RBCs; 18 also underwent control transfusions. One patient received only a small aliquot for RBC survival studies, instead of a full‐unit transfusion, because his serum was incompatible with ECO RBCs. No adverse events occurred. Both ECO and control transfusions resulted in appropriate Hb increments and comparable 51Cr‐labeled RBC survival studies. One patient developed a transient, weak‐positive DAT, without hemolysis. Two weeks after transfusion, 5 of 19 evaluable ECO RBC recipients had increases in anti‐B titers.

CONCLUSION: ECO RBCs were comparable to group O cells for safety and efficacy in this study. The clinical significance of the increase in anti‐B and of occasional serologic incompatibilities with ECO RBCs is unclear. If strategies can be developed to remove A epitopes, enzymatic conversion could be used to create a universal (group O) donor blood supply.
First example of anti‐Kx in a person with the McLeod phenotype and without chronic granulomatous disease
Authors: Russo David C. , Øyen Ragnhild , Powell Vivien I. , Perry Sherry , Hitchcock Judith , Redman Colvin M. , Reid Marion E.
Published: March 2003

BACKGROUND: Kx is lacking in the RBCs of patients with the McLeod syndrome. This condition is sometimes associated with chronic granulomatous disease (CGD). If given allogeneic RBCs, CGD patients with the McLeod phenotype may produce anti‐Kx and anti‐Km, and only phenotypically matched McLeod blood would be compatible. McLeod phenotype persons without CGD have made anti‐Km but not anti‐Kx (2 examples), and thus both McLeod and KO blood would be compatible.

CASE REPORT: RBCs from a transfused patient with the McLeod phenotype but not with CGD (non‐CGD McLeod) were typed for the Kell blood group antigens, and the plasma was analyzed for the presence of antibody by agglutination. The molecular basis was determined by analyzing for XK protein on RBC membranes by Western immunoblotting, by sequencing the XK gene, and by RFLP.

RESULTS: The RBCs did not react with anti‐Kx + anti‐Km and showed weakening of Kell system antigens. The patient′s plasma reacted moderately (2+) with RBCs of common Kell type and strongly (4+) with KO RBCs and RBCs of common Kell type treated with dithiothreitol, and did not react with McLeod RBCs. XK protein was absent from the RBC membranes. The XK gene had a point mutation in the donor splice site of intron 1 (G>C).

CONCLUSION: This is the first report describing the molecular alteration in a non‐CGD McLeod patient who has made anti‐Kx. The immune response of people with the McLeod phenotype can vary, and KO blood may not always be compatible.
Surveillance of HIV‐1 genetic subtypesand diversity in the US blood supply
Authors: De Oliveira C. Fernando , Diaz Ricardo S. , Machado Daisy M. , Sullivan Marian T. , Finlayson Teresa , Gwinn Marta , Lackritz Eve M. , Williams Alan E. , Kessler Debra , Operskalski Eva A. , Mosley James W. , Busch Michael P.
Published: March 2003

BACKGROUND: Recent reports of variant (non‐subtype B) HIV infections in US populations have raised concerns about the sensitivity of subtype B virus‐based donor screening and diagnostic assays. This study was designed to determine the prevalence and genetic diversity of HIV subtypes in US blood donors over the last two decades.

STUDY DESIGN AND METHODS: Three groups were studied: hemophiliacs infected by clotting factor concentrates in the early 1980s (n = 49), blood donors retrospectively identified as being seropositive in 1985 (n = 97), and blood donors identified as seropositive between 1993 and 1996 (n = 405). Subtype assignment was based primarily on heteroduplex mobility analysis (HMA) of HIV‐1 env, with DNA sequence confirmation of selected specimens. HIV peptide‐based EIA serotyping was used to rule out HIV‐2 and group O infections and to serotype HMA‐refractory specimens.

RESULTS: Of 551 specimens, 535 (97%) were assigned subtypes; 532 (99%) of these were subtype B. Three postscreening donations (1%) were assigned non‐B subtypes (2 A, 1 C). Two of these three donors were born in Africa; the third was born in the United States and reported no risk factors other than heterosexual activity. HMA distribution plots showed an increase in env diversity among HIV‐1 group B strains over time.

CONCLUSION: The results support the need for continued surveillance of HIV subtype diversity and ongoing validation of the sensitivity of HIV diagnostic assays to non‐B subtype infections.
Economic consequences of alterations in platelet transfusion dose: analysis of a prospective, randomized, double‐blind trial
Authors: Ackerman Stacey J. , Klumpp Thomas R. , Guzman Gladys I. , Herman Jay H. , Gaughan John P. , Bleecker Giselle C. , Mangan Kenneth F.
Published: March 2003

BACKGROUND : In recent years, decreasing financial resources led to the use of lower‐dose platelet components. However, the economic consequences of the use of such components have not been carefully studied.

STUDY DESIGN AND METHODS: A formal economic analysis was conducted of a recently reported, prospective, randomized, double‐blind study examining the platelet dose–response relationship in nonrefractory patients. The economic analysis used a decision analysis model, conducted from the hospital's perspective and based directly on the observed clinical data and on institutional cost structures.

RESULTS : The decision analysis model estimated that a 38‐percent reduction in mean platelet dose, within the commonly prescribed dose range, would result in the average patient's requiring approximately 60 percent more transfusions in the posttransplant period (8 vs. 5; p = 0.05), which would result in an estimated 60‐percent increase in the median cost to the hospital ($4486/patient vs. $2804/patient [in 1996 US dollars], p = 0.05).

CONCLUSION: Efforts to decrease costs by utilizing lower‐dose single‐donor platelet transfusions are predicted to result in a disproportionate increase in the number of transfusions per patient, with a corresponding increase in overall hospital transfusion costs.
The release of prion protein from platelets during storage of apheresis platelets
Authors: Bessos Hagop , Drummond Olive , Prowse Chris , Turner Marc , MacGregor Ian
Published: March 2003

BACKGROUND: Recent studies using a time‐resolved fluoroimmunoassay method (dissociation‐enhanced lanthanide fluoroimmunoassay) showed that platelets and plasma are the main reservoir of the normal isoform of cell‐associated prion protein (PrPc) in human blood. The aims of the present study were to monitor PrPc levels in various fractions of apheresis platelets during storage by using the DELFIA method and to assess the association of this release with alpha‐granule protein β‐thrombo‐globulin and cytoplasmic LDH.

STUDY DESIGN AND METHODS: Units of apheresis platelets (n = 6) were obtained from volunteer donors by the use of a cell separator and stored up to 10 days. Samples (7‐9 mL) were aseptically collected from each unit on storage Days 1, 2, 3, 4, 5, 8, and 10. Platelet‐poor plasma and apheresis platelets were prepared and the former split into two fractions, one centrifuged at 40,000 ×g for 2 hours at 4°C to remove microparticles. The spun microparticles, apheresis platelets and platelet samples, platelet‐poor plasma, and high‐spun plasma fractions were stored in a frozen state until they were tested.

RESULTS: The results showed that the mean overall levels of PrPc throughout storage remained within 15 percent of Day 1 levels. In contrast, the mean cellular levels in platelets significantly decreased to 46 percent of Day 1 levels by Day 10 of storage (p<0.01), while the corresponding levels in plasma significantly rose as much as 329 percent (p<0.01). Moreover, although microparticle‐bound PrPc was released during storage, it was increasingly superseded by soluble protein. PrPc and β‐thrombo‐globulin release exhibited very similar patterns (p<0.01). In contrast, LDH showed a significant increase in high‐spun plasma only toward the end of the storage period (p<0.01).

CONCLUSION: These results indicate that PrPc is released from platelets during the storage of apheresis platelets and that this release is probably due mainly to platelet activation and alpha‐granule release in the first few days of storage. Moreover, the released PrPc is increasingly composed of soluble proteins, as the storage period exceeds 5 days.
Development of non‐ABO RBC alloantibodies in patients undergoing allogeneic HPC transplantation. Is ABO incompatibility a predisposing factor?
Authors: De La Rubia Javier , Arriaga Francisco , Andreu Rafael , Sanz Guillermo , Jiménez Carmen , Vicente Ana , Carpio Nelly , Marty María L. , Sanz Miguel A.
Published: March 2003

BACKGROUND: Data from the appearance of RBC antibodies other than ABO in patients undergoing HPC transplantation are limited.

STUDY DESIGN AND METHODS: The incidence and specificity of non‐ABO RBC alloantibodies are described in a series of 217 patients undergoing allogeneic HPC transplantation because of various hematologic malignancies.

RESULTS: Eight patients (3.7%) developed 10 antibodies after transplant. None of these patients had previously been immunized. Seven patients had one RBC antibody and one patient had three RBC antibodies. Antibody specificity were anti‐Jkb (2 patients), ‐Kell (2), ‐M (2), ‐Leb (1), and ‐D (1). Finally, two patients had a panagglutinin. The mean time between transplant and antibody detection was 23 days (range, 16‐672). The source of the HPCs, the conditioning regimen administered, and the type of GVHD prophylaxis administered did not influence the rate of antibody formation. On multivariate analysis, ABO blood group incompatibility (p = 0.005) and patient′s age (p = 0.02) were the only two variables significantly associated with the development of RBC alloantibodies.

CONCLUSION: Patients undergoing allogeneic HPC transplantation are at risk of developing RBC‐specific antibodies despite the immunosuppressive therapy administered. Antibody formation was more frequently observed in ABO‐mismatched cases, which suggests a potential role of this incompatibility in facilitating antibody production.
Dextran sedimentation in a semi‐closed system for the clinical banking of umbilical cord blood
Authors: Tsang Kam S. , Li Karen , Huang Dolly P. , Wong Angela P. , Leung Yonna , Lau Tai T. , Chang Allan M.Z. , Li Chi K. , Fok Tai F. , Yuen Patrick M.P.
Published: March 2003

BACKGROUND: The results of current processing procedures for reducing volume and recovering HPCs from umbilical cord blood (UCB) before cryopreservation vary.

STUDY DESIGN AND METHODS: Dextran was added to bags containing UCB, followed by sedimentation for 30 minutes. The processed UCB was then frozen. RBCs, nucleated cells, MNCs, CD34+ cells, CFUs and long‐term culture‐initiating cells (LTC‐ICs), viability, and sterility were evaluated. Fractionations in ficoll‐hypaque and hydroxyethyl starch (HES) were also run in parallel for comparison.

RESULTS: The nucleated cell (NC) recovery and RBC depletion were 86.1 percent and 94.3 percent, respectively (n = 50). Sedimentation with dextran also enabled the recovery of 80.7 percent MNCs and 82.6 percent CD34+ cells (n = 30). Postsedimentation samples displayed no impairment of CFU growth (n = 42, 108.7% CFU–C, 104.6% CFU–GEMM, 107% CFU–GM, and 95.7% BFU–E). Long‐term cultures on five paired samples before and after sedimentation generated similar numbers of CFU–C each week (p = 0.88). Limiting dilution analysis of 12 paired pre/postsedimentation samples showed comparable median proportions of LTC‐ICs (1/6494 vs. 1/5236; p = 0.18). The cell viability of 24 samples of thawed UCB after sedimentation was 90.3 percent (77.5‐96%) and the recovery of CFU–C, CFU–GEMM, CFU–GM, and BFU–E of 11 postsedimentation samples was 93.4 percent, 84.9 percent, 92.3 percent, and 83.4 percent, respectively. NC recovery was significantly higher after treatment with dextran than with ficoll‐hypaque (n = 30; 88.5% vs. 29.1%; p<0.005) and HES treatment (n = 21; 88.5% vs. 76.4%; p = 0.004). However, MNCs, CD34+ cells, CFUs, LTC‐ICs, and RBCs were comparable. Two cycles of dextran sedimentation recovered 93.9 percent of NCs with cell viability of 98.6 percent (96.5‐100%), whereas 11.7 percent of RBCs were retained (n = 20). The final yield volume was 33.5 (28‐41) mL.

CONCLUSION: In a semi‐closed system, dextran sedimentation enabled volume reduction of UCB without significant quantitative and qualitative losses of HPCs.
The first example of a paraben‐dependent antibody to an Rh protein
Authors: Judd W. John , Storry Jill R. , Annesley Thomas D. , Reid Marion E. , Bensette Michelle , Waddington Sherry , Dake LouAnn , Rohrkemper David , Valdez Ricardo
Published: March 2003

BACKGROUND: Parabens are added to a commercial LISS (C‐LISS) to retard microbial growth. Paraben‐dependent anti‐Jka has been detected by the use of C‐LISS.

CASE REPORT: Serum from a D+ woman reacted in antiglobulin tests with RBCs stored (2‐4 hours, 22‐25°C) in C‐LISS (Löw and Messeter formulation, Immucor). Freshly prepared C‐LISS‐suspended RBCs did not react; nor did RBCs stored in LISS‐additive reagents, PEG, saline, or homemade LISS.

RESULTS: Studies using C‐LISS‐stored RBCs revealed an antibody that reacted with D+ and rrV+ RBCs, but not with r′r, r′′r, or rrV‐VS‐ RBCs. All partial D RBC phenotypes tested reacted, as did D+LW‐, rGr, r′′Gr, ryr, r′srV+VS+, and r′srV‐VS+ RBCs. The active ingredient in C‐LISS was propylparaben. Other LISS ingredients were not required; saline solutions of propylparaben, ethylparaben, methyl salicylate, 2‐phenoxyethanol, and butylparaben were active. Methylparaben and methyl‐m‐hydroxybenzoate were inactive. Reactivity to C‐LISS‐stored RBCs could not be inhibited by propylparaben. Reactivity with D+V‐ and D‐V+VS+ RBCs was not separable by adsorption‐elution.

CONCLUSIONS: This antibody likely detects a neoantigen formed between active compounds and RBC membranes. Review of the structure of active compounds suggests that proximity between methyl and hydroxyl groups is important for binding with RBC membranes. The role of RhD is unclear; no single portion of RhD protein appears to be implicated.
Meta‐analysis of controlled clinical trials studying the efficacy of rHuEPO in reducing blood transfusions in the anemia of prematurity
Authors: Vamvakas Eleftherios C. , Strauss Ronald G.
Published: March 2003

BACKGROUND: Recombinant human EPO (rHuEPO) has not gained broad acceptance in the treatment of the anemia of prematurity, because its efficacy in diminishing RBC transfusions is questionable. Meta‐analysis was used to investigate the extent and reasons for variation in the results of published clinical trials.

STUDY DESIGN AND METHODS: Prospective controlled trials published from 1990 through 1999 were retrieved; 21 met the criteria for meta‐analysis. Calculated across these studies were the summary OR of RBC transfusion in treated neonates as compared with controls and the summary mean difference between controls and treated neonates in the volume of RBCs transfused and the number of RBC transfusions per infant. Twelve study descriptors were examined as possible reasons for the variation in results.

RESULTS: Results of 21 eligible studies varied widely (p<0.001 for the Q test statistic), and this variation persisted in most analyses when studies were stratified by individual study descriptors. When the difference in volume of RBCs transfused was the outcome measure, variation was modest across the four studies with highly desired characteristics (i.e., high blindness and design quality scores, “conservative” transfusion criteria, and the majority of neonates weighing <1 kg at birth), and treatment with rHuEPO reduced RBC transfusions by an average of 11.0 mL per kg (p<0.001).

CONCLUSION: Benefit from rHuEPO is detected across high‐quality studies using conservative RBC transfusion criteria. However, there is extreme variation overall in the findings of available trials, and—until this variation is accounted for—it is premature to recommend rHuEPO as standard treatment for the anemia of prematurity.
Blood transfusion costs by diagnosis‐related groupsin 60 university hospitals in 1995
Authors: Jefferies Leigh C. , Sachais Bruce S. , Young Donald S.
Published: March 2003

BACKGROUND: Transfusion services are frequently challenged to initiate efforts to reduce blood transfusion costs. One approach is to analyze blood transfusion costs for individual medical and surgical Diagnosis‐Related Groups (DRGs). Rank ordering of DRGs by transfusion costs and interinstitutional comparisons of these costs may lead to the selection of DRGs for further analysis of the process of blood transfusion.

STUDY DESIGN AND METHODS: Common DRGs (n = 486) that were related to discharges in 1995 were analyzed from 60 university hospital members of the University HealthSystems Consortium (UHC). Cost data were tabulated by using cost‐to‐charge ratios reflecting all aspects of blood transfusion‐related costs of participating institutions.

RESULTS: Of these 486 DRGs, 471 had identifiable mean blood costs, and 34 had median blood costs, mostly for surgical conditions. Transfusion costs represented a small proportion (≤1%) of total hospitalization costs for most DRGs. Nonetheless, millions of dollars were spent on blood transfusion, and for the most expensive DRGs, the costs ranged from 5.0 to 8.6 percent of total hospitalization costs. Transfusion costs are more variable for the DRGs with the lowest transfusion costs than for those with the highest transfusion costs.

CONCLUSION: Members of the UHC may utilize such analyses to identify surgical or medical diagnoses with transfusion costs at variance with the group norm. These DRGs could then be targeted for further evaluation of components contributing to high costs, for possible alterations in physician or clinical laboratory practices. Considering those conditions with the highest cumulative transfusion costs (e.g., BMT, liver transplant, acute leukemia, and cardiothoracic procedures), changes in transfusion practices that affect these particular patient categories may have a significant impact on global blood transfusion costs.
A novel microplate agglutination method for blood grouping and reverse typing without the need for centrifugation
Authors: Spindler Jorg H. , Klüter Harald , Kerowgan Mohammad
Published: March 2003

BACKGROUND: Current agglutination tests and solid‐phase adherence methods, employed as the techniques for RBC typing and antibody screening, require centrifugation and washing steps. This report describes a novel agglutination method for forward and reverse grouping that is based on the formation of an RBC monolayer on a microplate without the need for centrifugation and washing.

STUDY DESIGN AND METHODS: In a comparative study, 2225 samples from healthy regular blood donors were tested for ABO, Rh (D, C, c, E, and e), K, and reverse grouping, in parallel, by the new microplate agglutination method and a commercially available blood testing system, which served as a reference method.

RESULTS: In the case of forward grouping, 0.37 percent of samples tested were false negative in the new method and 1.35 percent tested false negative in the reference blood testing system. In addition, the reverse grouping reference method showed 0.4 percent false‐positive and 2.6 percent false‐negative results. In contrast, the new method gave false‐positive results in only 0.09 percent and false‐negative results in 0.67 percent of the cases tested.

CONCLUSION: These results, as well as the possibility of adapting this method to a fully automated system, suggest that our novel agglutination method could be an important contribution to the field of immunohematology.
Platelet‐specific antibodies in HLA‐immunized patients receiving chronic platelet support
Authors: Sanz Cristina , Freire Carolina , Alcorta Inaki , Ordinas Antonio , Pereira Arturo
Published: March 2003

BACKGROUND : In HLA‐alloimmunized patients, the unexpected failure of HLA‐matched platelet transfusions usually raises the suspicion about concomitant platelet‐specific antibodies. As the reported frequency of platelet‐specific antibodies in multitransfused patients varies widely, the aim of this study was to determine the prevalence of such antibodies in a population of chronic thrombocytopenic patients with HLA antibodies.

STUDY DESIGN AND METHODS : From 1985 to 1997, 11,777 determinations of HLA antibodies were performed in 1330 hematologic patients receiving chronic platelet support. Fifty‐two patients with HLA alloimmu‐nization that lasted more than 1 month were selected. The search for platelet‐specific antibodies was performed by using a monoclonal antibody immobilization of platelet antigens assay, thus allowing the identification of platelet‐specific antibodies directed against the platelet glycoproteins (GP) Ib/IX, GPIIb/IIIa, and GPIa/IIa. Specificity of the platelet‐specific antibodies was further investigated by using a solid‐phase assay with chloroquine‐treated platelets.

RESULTS : Only 2 (3.8%) of the 52 patients had platelet‐specific antibodies. One antibody reacted with an epitope of the GPIIb/IIIa that was present in all the panel platelets, and that probably was an autoantibody. The other was an anti‐HPA‐5b.

CONCLUSIONS : The prevalence of platelet‐specific antibodies in patients with HLA alloimmunization is very small. The search for concomitant platelet‐specific antibodies would be indicated only when other causes of refractoriness to HLA‐matched platelets are ruled out.
WBC‐reduced blood transfusions and clinical outcome in children with acute lymphoid leukemia
Authors: Rios Jorge A. , Korones David N. , Heal Joanna M. , Blumberg Neil
Published: March 2003

BACKGROUND: WBC reduction offers a variety of benefits to patients requiring multiple transfusions during induction therapy for childhood acute lymphoid leukemia (ALL), including reductions in febrile transfusion reactions, HLA alloimmunization, and CMV transmission. One potential benefit is a reduction in the deleterious effects of transfusion immunomodulation. In the surgical setting, transfusion immunomodulation has been linked to increases in postoperative infections and decreases in host cellular immunity that are mitigated by WBC reduction of transfused blood.

STUDY DESIGN AND METHODS: A retrospective review was conducted of the medical records of 68 consecutive children undergoing induction therapy for newly diagnosed ALL from 1988 through 1995, a period whose midpoint is 1991, the year WBC reduction was introduced in this hospital.

RESULTS: WBC reduction of platelet and RBC transfusions was associated with fewer days with fever (mean, 5.7 days [no WBC reduction] and 2.1 days [WBC reduction]; p = 0.012) and days with positive microbial cultures (mean, 1.5 [no WBC reduction] and 0.71 [WBC reduction]; p = 0.0055). There were more high‐risk ALL patients in the group receiving WBC‐reduced transfusions.

CONCLUSION: Allogeneic WBCs in transfused blood may cause impairment of host defenses against microbial infection during induction therapy for childhood ALL.
Repopulating activities of human cord blood cells separated by a stem cell collection filter in NOD/SCID mice:a comparative study of filter method and HES method
Authors: Tokushima Yasuo , Sasayama Norihisa , Takahashi Tsuneo A.
Published: March 2003

BACKGROUND: Volume reduction and removal of RBCs are essential for cost‐efficient cord blood (CB) banking. It has previously been shown that a newly developed device, a stem cell‐collection filter (SCCF), can reduce the CB volume and remove RBCs efficiently, giving high recovery rates for CD34+ cells, colony‐forming cells, and long‐term culture‐initiating cells with short operation time. The aim of this study was to compare the quality of CB cells separated by SCCF and HES by analyzing repopulation in NOD/SCID mice.

STUDY DESIGN AND METHODS: A total of 1 × 106 or 5 × 106 nucleated cells derived from SCCF‐ or HES‐separated, cryopreserved, thawed, and washed CB were transplanted into NOD/SCID mice. Eight weeks after transplantation, bone marrow cells of the recipient mice were examined by flow cytometry and hematopoietic progenitor assay for the engraftment of human cells.

RESULTS: Mice given human CB cells, separated by SCCF, showed degrees of engraftment similar to those in mice given HES‐separated CB cells. There was no significant difference in the lymphohematopoietic reconstitution pattern in the two groups of mice.

CONCLUSION: SCCF processing does not appear to reduce the number of repopulating cells in NOD/SCID mice or alter the number of HPCs. It is now shown that these cells can be captured by SCCF and removed, and that they will engraft.
The role of electrolytes and pH in RBC ASs
Authors: Hess John R. , Rugg Neeta , Knapp Amy D. , Gormas Jennifer F. , Hill Heather R. , Oliver Cindy K. , Lippert Lloyd E. , Greenwalt Tibor J.
Published: March 2003

BACKGROUND: Experimental additive solutions (EASs) containing saline, adenine, glucose, mannitol and disodium phosphate can support RBCs for 9 or 10 weeks if used in 200‐ or 300‐mL volumes. The effects of variations in the electrolyte composition and volume of EASs were explored.

STUDY DESIGN AND METHODS: In three four‐arm studies, 24 RBC units were pooled in groups of 4 and realiquoted as test units to ensure that all donors were equally represented in each study arm. In Study 1, units were stored for 11 weeks in EAS containing 0, 10, 20, or 30 mmol per L of sodium bicarbonate. In Study 2, units were stored for 9 weeks in EAS containing 26, 50, 100, or 150 mmol per L of sodium chloride. In Study 3, units were stored in 100 or 200 mL of AS‐3 or EAS‐61. RBC ATP concentrations and hemolysis were measured weekly.

RESULTS: Increasing the sodium bicarbonate content of EASs increased the pH throughout storage and increased RBC ATP concentrations in the later phases of storage, but it had no effect on hemolysis. Increased sodium chloride content of EASs led to lower RBC ATP concentrations and increased hemolysis. In EAS‐61, RBC ATP concentrations were increased throughout storage, and hemolysis was lower than that of RBCs stored in AS‐3.

CONCLUSION: RBC ATP synthesis is highly dependent on the pH of the AS. Hemolysis is affected by the salt content and volume of the AS.
Generation of reticulated platelets in responseto whole blood donation or plateletpheresis
Authors: Gyongyossy‐Issa Maria I.C. , Miranda Jorge , Devine Dana V.
Published: March 2003

BACKGROUND: There are few reports about throm‐bopoietic responses in whole blood (WB) and platelet‐pheresis donors. This study compares the thrombo‐poietic responses of such donors and their platelet values.

STUDY DESIGN AND METHODS: The effect of WB donation or selective platelet loss (plateletpheresis) was evaluated prospectively. WB and platelet donor samples before donation and for 7 days thereafter were assessed for platelet count, mean platelet volume, and platelet reticulocytes.

RESULTS: Reticulated platelets appeared in the circulation of plateletpheresis donors by 24 hours. The proportion of reticulated platelets was highest on Day 2, and above‐normal levels of reticulated platelets persisted until Day 7. The mean platelet volume was high on Days 2 and 3, which corresponded with the appearance of reticulated platelets. After plateletpheresis, platelet counts were higher than could be accounted for by new platelets, which suggested the release of sequestered platelets. WB donors manifested no changes in platelet counts but had a peak of circulating platelet reticulocytes 2 days after the donation.

CONCLUSION: The thrombopoietic peak in WB and plateletpheresis donors occurs 2 days after donation, and the response level is related to the amount of platelets lost. The impact of platelet loss on the number of circulating platelets is modulated by the release of platelets from the spleen.
Polymorphism and distribution of the Secretor α(1,2)‐fucosyltransferase gene in various Taiwanese populations
Authors: Yu Lung‐Chih , Chu Chen‐Chung , Chan Yung‐Syu , Chang Ching‐Yi , Twu Yuh‐Ching , Lee Hui‐Lin , Lin Marie
Published: March 2003

BACKGROUND: The Secretor gene (Se or FUT2), which produces α(1,2)‐fucosyltransferase, exhibits extensive polymorphism. Six Se genes, including the weak Se (Sew or Se385) and three nonsecretor alleles (se571, se685, and se849) have been detected in various populations of Taiwan. The distribution of various Lewis phenotypes among the Taiwanese population groups has been shown to vary considerably.

STUDY DESIGN AND METHODS: A PCR‐RFLP analysis system, which was based on the nucleotide polymorphism variation of the different Se alleles and which can reveal the Se genotype of an individual easily and accurately, was developed. The distribution of the Se alleles among Taiwanese population groups, including the two major populations, Minnan and Hakka Taiwanese, and 11 indigenous groups, was analyzed by the method.

RESULTS: Frequencies of the Se alleles among the Taiwanese populations were revealed. The distribution of the nonsecretor alleles, especially se849, showed a marked variation. A good correlation was observed between a person's Se genotype and Lewis phenotype.

CONCLUSION: The Se genes have a polymorphic distribution among various Taiwanese populations, and this agrees with previous results for Lewis phenotype distributions. The Sew allele and the three se alleles are responsible for the Le(a+b+) and Le(a+b–) phenotypes, respectively.
Identification of Yersinia‐infected blood donors by anti‐Yop IgA immunoassay
Authors: Kendrick Chris J. , Baker Bartrum , Morris Arthur J. , O'Toole Paul W.
Published: March 2003

BACKGROUND: From 1991 through 1996, nine transfusion‐related cases of septicemia and endotoxemia occurred in New Zealand, a rate approximately 80 times that in the United States. Eight cases involved the transfusion of Yersinia enterocolitica‐infected blood and one involved Serratia liquefaciens‐infected blood. Six of the recipients died. Donor exclusion by recent gastrointestinal illness failed to prevent the four most recent such infections, and it has led to an estimated 3‐ to 5‐percent rate of donor deferral.

STUDY DESIGN AND METHODS: An antigen preparation containing the released proteins (Yops) of Y. enterocolitica was used to establish an EIA to detect IgA directed against these proteins in donated blood. The assay was tested with serum from donors in transfusion‐related endotoxemia cases, subjects who were stool culture‐positive for Y. enterocolitica, and 495 healthy volunteer blood donors.

RESULTS: The assay detected anti‐Yop IgA in the donors of all 6 infected units tested. Ninety‐six percent of culture‐positive subjects tested positive, whereas there was 70‐percent positivity with a commercial immunoassay based on lipopolysaccharide. Five percent of random donors tested positive; only one of these had Y. enterocolitica present in a stool sample, and none were bacteremic.

CONCLUSION: The anti‐Yop immunoassay used in this study could be applied to reduce the risk of posttransfusion endotoxic shock caused by Y. enterocolitica.
In vivo and in vitro characteristics of double units of RBCs collected by apheresis with a single in‐line WBC‐reduction filter
Authors: Bandarenko Nicholas , Rose Michael , Kowalsky Richard J. , Baston Robert K. , Brecher Mark E. , Elfath Mahoud D. , Whitley Pam , Heminway Meritt , Holme Stein
Published: March 2003

BACKGROUND: A novel apheresis procedure for a blood separator (MCS+, Haemonetics) enables the collection of 2 WBC‐reduced RBC units in a single donation by using one disposable set with one in‐line WBC‐reduction filter (RC2H, Pall Corp.). The objective of this study was to evaluate the filtration performance in connection with different prefiltration RBC storage conditions and with the in vitro and in vivo storage quality of the filtered units.

STUDY DESIGN AND METHODS: Sixty‐six 2‐unit RBC collection and gravity‐filtration procedures were completed at three sites, resulting in 132 RBC units. Filtration of the double RBC units was performed at room temperature (RT) within 8 hours of collection (n = 36) and under refrigeration (1‐6°C) for up to 24 hours (n = 10) and 72 hours (n = 20) before filtration. RBC quality was compared to that of nonfiltered apheresis RBC units (n = 10).

RESULTS : Median filtration time was 6.5 and 14 minutes for units stored at RT and under refrigeration, respectively. All 132 RBC units had residual WBC counts <0.4 × 106. The refrigerated units showed a greater mean log reduction in WBCs: 5.06 ± 0.16 (24 hour) and 4.74 ± 0.48 (72 hour), respectively, than did RT units: 4.47 ± 0.28 (p<0.05). RBC loss was less than 12 percent in all cases (mean, 7.8 ± 1.8%). Minimal differences in volume were observed between the paired RBC units. In vitro RBC storage characteristics of the filtered units were as expected and similar to those of the nonfiltered units. For RBC units held at RT (n = 24), the mean in vivo 24‐hour recovery was 81.8 ± 8.4 percent (double‐label).

CONCLUSION: Satisfactory filter performance in terms of WBC removal and RBC loss was observed with all 66 procedures, irrespective of storage conditions before filtration.