bluuebunny/crossref_metadata_2025 huggingface dataset:
Viability and functional integrity of washed platelets
Authors: Pineda A. A. , Zylstra V. W. , Clare D. E. , Dewanjee M. K. , Forstrom L. A.
Published: March 2003

The viability and functional integrity of saline‐ and ACD‐saline‐washed platelets were compared with those of unwashed platelets. After template bleeding time (TBT) was measured, 15 healthy volunteers underwent plateletpheresis and ingested 600 mg of aspirin. Autologous 111In‐labeled platelets were transfused: unwashed (n = 5), washed with 0.9 percent saline solution (SS) (n = 5), and washed with a buffered 12.6 percent solution of ACD‐A in 0.9 percent saline solution (n = 5). After transfusion, we measured TBT at 1, 4, and 24 hours; platelet survival at 10 minutes and 1, 4, and 24 hours and daily for 6 days; and the percentage of uptake in liver and spleen by quantitative whole‐body radionuclide scintigraphy at 24 and 190 hours. We found that saline washing affected platelet recovery, 23.47 ± 12 percent (p<0.001) as compared to 52.43 ± 17 percent (p<0.002) for ACD‐saline and 73.17 ± 8 percent for control; that saline washing resulted in a greater liver uptake than control and ACD‐saline‐washed platelets (31.9 ± 8% [p<0.001] vs 17.7 ± 4.1 and 19.3 ± 2.1% [p>0.1], respectively); that, unlike control and ACD‐saline‐washed platelets, saline‐washed platelets did not shorten bleeding time; and that neither type of washing affected survival. Although ACD‐saline washing affects recovery, it also results in intact function, normal survival, higher recovery than SS platelets, and no significant liver uptake.
Alloimmunization to platelet‐specific antigens on glycoproteins IIb‐ IIIa and Ib/IX in multiply transfused thrombocytopenic patients
Authors: Kickler T. , Kennedy S.D. , Braine H.G.
Published: March 2003

The rate of alloimmunization to platelet‐specific antigens associated with platelet glycoproteins (GPs) IIb‐IIIa and Ib/IX was studied in 293 multiply transfused thrombocytopenic patients. Antibodies to platelet‐ specific antigens were measured with a solid‐phase assay using platelet GP IIb‐IIIa or Ib/IX as the antigenic targets. Nine patients were found to have antibodies to platelet GP IIb‐IIIa, and no patients had antibodies to platelet GP Ib/IX. In six of these nine patients, the specificity of the antibody was shown by using GP IIb‐IIIa from donors with different platelet‐specific antigen phenotypes. In the remaining three patients with antibodies to platelet GP IIb‐IIIa, no specificity could be identified. These patients had autoimmune thrombocytopenia in association with lymphoma. The alloimmunization rate to platelet‐ specific antigens associated with GP IIb‐IIIa was 2 percent, whereas the rate of alloimmunization to HLA antigens was 23 percent. Of the patients alloimmunized to HLA antigens, 9 percent also had antibodies to platelet‐specific antigens. A poor response to HLA‐identical platelet transfusions was observed only in those patients with positive assays in the solid‐phase test. These results suggest that the incidence of antibodies to platelet‐specific antigens carried on GP IIb‐ IIIa is low. Platelet‐specific antibodies may be found more frequently in patients alloimmunized to HLA antigens than in those not so alloimmunized.
The low‐incidence red cell antigen Wra: genetic studies
Authors: Lewis M. , Kaita H. , Philipps S. , McAlpine P. J.
Published: March 2003

Studies of 91 individuals in three families allowed a genetic‐linkage analysis of the gene governing the production of the low‐incidence red cell antigen Wra and provided evidence that Wra is not a member of the Scianna, Landsteiner‐Wiener, Chido/Rodgers, or XK blood group systems, and that the “WR” locus is excluded from autosomal sites or regions 1p34‐p22.1, 1p21‐q23, 1q32, 2p25, 3q21, 4q28‐q32, 6p24‐q12, 9q34.1‐ q34.2, 13q14.1‐q14.2, 14q24.3‐q32.1, 14q32.33, 16p13, 16q22.1, and 21q21‐q22.1. “WR” is also excluded from within specified genetic distances of chromosomes 8 (GPT), 18 (JK), 19 (C3), 20 (ADA), and 22 (P1) loci, which brings its exclusion to approximately 10 percent (320cM) of the total genetic map of the genome. The possibility that “WR” is pseudoautosomal is deemed to be highly unlikely.
A rational attitude toward serum alanine aminotransferase measurement by blood banks, based on a longitudinal study of a cohort of repeat blood donors
Authors: Driss F. , Costagliola D. , Marie B. , Ekindjian O. G. , Eme D. , Berthelot P. , Nalpas B.
Published: March 2003

A cohort of 879 blood donors was followed over a 3‐year period. Of the 3858 units of blood collected, 112 (2.9%), obtained from 64 donors, had an alanine aminotransferase (ALT) activity over 45 IU per L; of these, 39 had a single ALT elevation. The incidence of ALT increase was 2.01 per 100 units, or 5.1 per 100 donors, per year. The pattern of elevated ALT was followed in 72 donors, 54 of whom were from the 64 cited above. At the second blood donation (BD2), about 5 months later, 62.5 percent had a normal ALT value, and most (91%) retained those values at blood donation 3 (BD3). However, 19 (70.3%) of the 27 whose ALT levels had not returned to normal at BD2 had an increased value at BD3. These results led to the formulation of the following algorithm to improve the management of blood donors; at the first donation, the ALT assay is done after the blood collection, but, at the next donation, the ALT level is measured before donation if the preceding ALT activity had been abnormal. If ALT is elevated, blood is not collected. Three consecutive ALT elevations are a criterion for permanent exclusion of the donor.
The critical role of blood from HLA‐homozygous donors in fatal transfusion‐associated graft‐versus‐host disease in immunocompetent patients
Authors: Otsuka S. , Kunieda K. , Kitamura F. , Misawa K. , Sasaoka I. , Hirose M. , Kasuya S. , Saji S. , Noma A.
Published: March 2003

Fatal transfusion‐associated graft‐versus‐host disease developed in a 69‐year‐old woman with colon cancer who underwent elective hemicolectomy. During the perioperative period, she was transfused with 4 units of nonirradiated fresh whole blood less than 6 hours after the blood was donated by family members. She was immunocompetent and was not treated with any immunosuppressive agents such as corticosteroids, chemotherapy, or irradiation therapy. The implicated donor was thought to be her daughter, who was homozygous for an HLA haplotype that was shared with the recipient: A24, Bw52, CBL, DR2. This is the most common haplotype in the Japanese population. This case and others in the Japanese literature indicate that the transfusion of fresh, nonirradiated blood that contains immunocompetent lymphocytes and peripheral hematopoietic precursor cells from HLA‐homozygous donors can be lethal to the recipient.
Improving blood transfusion practice: role of a computerized hospital information system
Authors: Lepage E.F. , Gardner R.M. , Laub R.M. , Golubjatnikov O.K.
Published: March 2003

The recent focus on medical risk and financial cost has prompted a need for better guidelines for prescribing the transfusion of blood components. In 1987, to respond to the issues of quality transfusion practice and accurate evaluation, LDS Hospital (Salt Lake City, UT) began using a computerized, knowledge‐based blood‐ordering system. Each transfusion request was reviewed and flagged by the computer when it did not meet the criteria established by the medical staff. The study reviewed the use of red cells, platelets, and fresh‐frozen plasma in 13,082 transfusion orders for 5847 consecutive patients from July 1, 1988, through June 30, 1989. The evaluation assessed, first, the adherence of physicians to computerized criteria and, second, their adherence to the quality of transfusion practice. A high percentage of the blood units ordered met the established criteria: 91.2 percent for the red cell transfusions, 72.9 percent for platelets, and 81.7 percent for fresh‐frozen plasma. From the July 1, 1987, implementation date through June 1989, the mean hematocrit of persons being transfused dropped from 28.6 to 27.7 percent (0.29 = 0.28) (p less than 0.005) and the number of orders requiring review by the quality assurance department dropped from 100 to 14 percent; moreover, there was a true‐ exception rate of only 0.37 percent. The use of the computer system effected the implementation of the following measures: 1) identification of the indications and establishment of clear clinical and biologic parameters for every transfusion, and 2) measurement and improvement of institutional transfusion practice. These results demonstrated the efficacy of a computerized hospital information system in implementing continuous quality improvement for transfusion practice.(ABSTRACT TRUNCATED AT 250 WORDS)
Fatal immune hemolytic anemia due to cefotetan
Authors: Garratty G. , Nance S. , Lloyd M. , Domen R.
Published: March 2003

In the first death associated with immune hemolytic anemia due to cefotetan, the patient developed hemolytic anemia and renal failure, dying 12 days after the beginning of 1 week's cefotetan therapy. The patient's serum contained strong antibodies reacting with cefotetan‐ treated red cells (RBCs) and with uncoated RBCs in the presence of cefotetan; a much weaker, drug‐independent antibody was also detected. Three‐days before the patient's death, the antibody reacting with cefotetan‐coated RBCs rose to a titer of 262,144; the titer of the antibody to uncoated RBCs, in the presence of cefotetan, rose to 2048; the titer of the drug‐independent antibody remained at 4.
In vitro and in vivo evaluation of cotton wool filtration of platelet concentrates obtained by automated and manual apheresis
Authors: HOLME S. , SNYDER E. , HEATON A. , KEEGAN T. , NAPYCHANK P.
Published: March 2003

The effect of cotton wool filtration of apheresis platelet concentrates (PCs) on platelet viability and complement activation was evaluated by two laboratories. PCs were prepared by automated (Lab A, n = 5) or manual (Lab B, n = 5) apheresis. After storage for 1 day, the PC was filtered through cotton wool before transfusion on one occasion and, on the other occasion, filtered through a standard screen filter before transfusion to the same donor. Five paired studies were performed by each laboratory. Except for a small, but significant reduction in mean platelet size, from 7.3 +/− 1.1 to 6.6 +/− 0.9 microns 3, after cotton wool filtration, no effect of filtration on various tests of in vitro platelet function and morphologic integrity was found. As demonstrated by autologous radiolabeled studies, no effect of cotton wool filtration on platelet viability was found by Laboratory B, while Laboratory A found a slight increase in the percentage of recovery from 59 +/− 4 to 68 +/− 13 percent, and a small reduction in survival, from 8.2 +/− 0.9 to 7.7 +/− 0.5 days after cotton wool filtration (p less than 0.05). Cotton wool filtration was associated with a slight increase in C3a levels found in manual apheresis PCs. Neither laboratory found any effect of cotton wool filtration per se on the recipients' white cell (WBC) counts or C3a and C5a levels after transfusion. However, it was observed that the transfusion of automated PCs (whether filtered through cotton wool or not filtered) caused a small, but significant (p<0.05; F<0.05) drop of 13 percent i recipient WBC count after transfusion, which is indicative of some in vivo effect from the automated apheresis procedure. These studies show that WBC reduction by the cotton wool filtration of apheresis PCs does not cause any significant damage to the platelets or activate the recipient complement reaction, as measured by recipient posttransfusion levels of WBCs, C3a, or C5a.
The role of white cells in the transmission of Yersinia enterocolitica in blood components
Authors: Hogman C.F. , Gong J. , Hambraeus A. , Johansson C.S. , Eriksson L.
Published: March 2003

The mechanism for the transmission of Yersinia enterocolitica in blood components has been studied experimentally. One hypothesis is that, during a Yersinia infection in the blood donor, bacteria are phagocytosed by white cells (WBCs), but are not killed. After collection of blood from such a donor and component production, the bacteria are present in WBCs for some time, during which the unit appears sterile. Later, when the WBCs disintegrate, the bacteria are released and multiply in the unit. Aliquots of whole blood and buffy coat were inoculated with 100 colony‐forming units (CFU) per mL of a Y. enterocolitica strain of type O:3 and left at room temperature for 5 hours. Some aliquots were then WBC‐reduced by filtration, while others retained their WBC contents. All aliquots were kept at 4 degrees C for 6 weeks. Meat extract broth culture medium was used as a control. Growth in the range of 2000 CFU per mL was obtained in the broth control by 24 hours, whereas the whole blood and buffy coat units appeared sterile for the first days of storage. After 1 week, a trace of bacteria and, after 4 weeks, massive growth were found in the WBC‐ containing units but not in the WBC‐reduced units. The likely explanation is that the bacteria had been phagocytosed by the WBCs and were thereby hidden and not available for bacterial culture during the first phase of storage. When the WBCs spontaneously disintegrated, bacteria were released and multiplied in the blood units. That the of filtration, the bacterial culture was negative. The results indicate that the hypothesis may be correct. This implies that routine WBC reduction will increase the safety of blood components with respect to bacteria transmission.
A randomized trial on the efficacy of an autologous blood drainage and transfusion device in patients undergoing elective knee arthroplasty
Authors: HEDDLE N.M. , BROX W.T. , KLAMA L.N. , DICKSON L.L. , LEVINE M.N.
Published: March 2003

The purpose of the study reported here was the determination of the efficacy of a postoperative autologous blood drainage and transfusion device in reducing allogeneic red cell requirements in patients undergoing elective knee arthroplasty. The study was a randomized controlled trial with adult patients undergoing unilateral elective arthroplastic knee surgery. Patients underwent suction drainage, attached to an autologous blood drainage and transfusion device, or standard suction drainage. Allogeneic red cells were given according to strict transfusion guidelines based on blood loss and postoperative hemoglobin values. Outcome measures included the mean number of allogeneic red cell concentrates required and the number of patients in each group who required no transfusion. Patients assigned to standard suction drainage had a mean allogeneic red cell utilization of 1.2 units (SD 1.0), as compared to a mean of 0.4 units (SD 0.8) in the group undergoing drainage with the autologous blood drainage and transfusion device (p = 0.0007). The percentage of patients not requiring allogeneic red cells was significantly higher in the latter group (74.3% vs. 32.5%; p = 0.002). The postoperative drainage and transfusion device was efficacious in reducing the amount of allogeneic red cells required by patients undergoing knee arthroplasty, and its use resulted in a 42 percent reduction in the number of patients requiring allogeneic transfusion.
Low‐temperature storage of bone marrow in nitrogen vapor‐phase refrigerators: decreased temperature gradients with an aluminum racking system
Authors: ROWLEY S.D. , BYRNE D.V.
Published: March 2003

Large temperature gradients may exist in nitrogen vapor‐phase refrigerators. Cryopreserved cells stored at higher levels may be considerably warmer than those stored closer to the liquid nitrogen reservoir. To decrease this temperature gradient, racking systems constructed of aluminum were placed in marrow storage refrigerators. The higher heat conductivity of aluminum resulted in a vapor‐phase temperature gradient of only 5.9 degrees C at 22.5 inches above the liquid, as compared to the gradient of 86 degrees C seen with steel frames in a similar refrigerator. Temperature fluxes were minimal with lid opening or nitrogen filling. The thicker frame size and loss of the lowest storage level resulted in a storage capacity 63 percent of that achievable with steel frames and liquid immersion. Consumption of nitrogen was estimated to be 174 to 220 percent of the static usage in this model of refrigerator with 6 inches of nitrogen, but comparable to the consumption expected with full immersion of the racking system, regardless of frame construction. These data demonstrate the feasibility of achieving very low, stable, cryogenic temperatures in a vapor‐phase refrigerator.
Transfusion‐associated Serratia marcescens infection: studies of the mechanism of action
Authors: Gong J. , Hogman C.F. , Hambraeus A. , Johansson C.S. , Eriksson L.
Published: March 2003

The growth of two strains of Serratia marcescens in blood components was tested in this study. One of the strains had been implicated in the epidemic of transfusion‐associated sepsis experienced in Denmark and Sweden in 1991. In whole blood with a final concentration of 100 colony‐ forming units per mL of S. marcescens, there was an immediate reduction of more than 95 percent of colony‐forming units, but no reduction of the bacterial concentration if the blood had been white cell‐reduced before inoculation. This is interpreted as an effect due to phagocytosis by white cells and as a lack of bactericidal effect of the plasma. A reduction to 10 percent of the original concentration, observed if the blood had a nominal content of white cells, was most likely due to phagocytosis. White cell reduction by filtration after inoculation further reduced the bacterial concentration of one of the strains tested, but, after a 1‐week lag phase, growth accelerated to high concentrations by 6 weeks. In platelet‐rich plasma prepared from S. marcescens‐inoculated units, abundant growth was found after 24 hours, increasing to very high concentrations (10(12) colony‐forming units/mL) during 10‐day storage at 22 +/− 2 degrees C. Keeping the whole blood at ambient temperature for 20 hours before preparation of platelet‐rich plasma caused only temporary reduction of bacterial concentration in the S. marcescens experiments, but resulted in a complete absence of bacteria in the platelet‐rich plasma for 10 days in control experiments performed with Staphylococcus epidermidis. In another control experiment using Staphylococcus aureus, the initial growth pattern was similar to that of S. marcescens, but the final bacterial concentrations were not as high. Thus, the protection against bacterial growth was insufficient with respect to S. marcescens as well as to S. aureus. Growth of one of two strains of S. marcescens was inhibited in whole blood. This growth inhibition did not occur in white cell‐reduced units. The resistance of S. marcescens to antibacterial mechanisms in the blood shows that contamination, even with low numbers of these bacteria, may be dangerous.
A note on paternity computation in cases lacking a mother
Authors: Brenner C.H.
Published: March 2003

When the mother is unavailable for parentage testing, a calculation must usually be based on types determined for the child and the alleged father. Particularly in the case of DNA typing, the formula is easy to derive. The correct formula is apparently not widely known, however, and in fact, a formula that is obviously incorrect seems often to be used and quoted. The correct method of derivation is indicated, and formulae are given for the various possibilities for patterns of gene‐ sharing between child and alleged father. In most cases paternity = 1/4Pr(shared allele) is an adequate formula.
Routine quantitation of white cells as low as 0.001 per microL in platelet components
Authors: Sheckler V.L. , Loken M.R.
Published: March 2003

A method is described for routine quantitation of very low numbers of white cells (WBCs) in platelet components, using flow cytometry and dual nucleic acid stains. The WBC quantitation is based on the detection of nucleated cells labeled with propidium iodide and thiazole orange, with chicken red cells added as an internal counting standard. Platelet concentrates containing 0.001 to 1500 WBCs per microL (2 × 10(2)‐3 × 10(8) WBCs/component) and 600 to 2800 × 10(3) platelets per microL were analyzed for the number of contaminating WBCs. The method was found to be linear throughout the 7 log10 range and to have sufficient reproducibility and sensitivity for routine analysis of WBC‐ reduced platelet concentrates.
A flow cytometric method for counting very low levels of white cells in blood and blood components
Authors: Vachula M , Simpson S.J. , Martinson J.A. , Aono F.M. , Hutchcraft A.M. , Balma D.L. , Van Epps D.E.
Published: March 2003

Reduction of white cells (WBCs) in blood components may reduce the risk of virus transmission and HLA alloimmunization. Filtration provides a means by which to achieve high‐efficiency WBC reduction. A method has been developed using flow cytometry to quantitate the number of WBCs in WBC‐reduced packed red cells or platelet concentrates. This method uses a detergent and propidium iodide (PI) solution to label the WBC nuclei and incorporates a known amount of fluorescein isothiocyanate (FITC)‐ labeled chicken red cells (cRBCs) into the mixture as an indicator of the volume examined. The number of observed WBCs per mL is calculated as follows: Number of PI WBC nuclei events/Number of FITC cRBC events × Number of FITC cRBCs added to mixture/Volume of blood in mixture. The method may allow the detection of WBCs at a concentration as low as 0.01 per microliters (10/mL) in a blood sample. It is an efficient method of collecting data, as it requires less than 10 minutes per sample. This flow cytometric technique is suitable for research purposes and for quality control of WBC‐reduced blood components, because it is precise and can be used to quantitate WBCs in large or small numbers in a sample.
Refrigerated storage of lyophilized and rehydrated, lyophilized human red cells
Authors: Sowemimo‐Coker S.O. , Goodrich R.P. , Zerez C.R. , Tanaka K.R.
Published: March 2003

Human red cells (RBCs) were collected in CPDA‐1 and then freeze‐dried in lyoprotective solution. The lyophilized RBCs were then stored at ‐20 degrees C for 7 days. At the end of the storage period, the lyophilized RBCs were rehydrated and washed in dextrose saline. The washed, reconstituted, lyophilized RBCs were resuspended in final wash solutions of ADSOL, CPDA‐1, or a special additive solution containing glucose, citrate, phosphate, adenine, and mannitol, and then they were stored at 4 degrees C for an additional 7 days. The main purpose of this study was to determine whether human RBCs can be lyophilized in such a manner that normal metabolic, rheologic, and cellular properties are maintained during rehydration and subsequent storage in standard blood bank preservative solutions. Our results show that reconstituted, lyophilized RBCs maintained levels of ATP, 2,3 DPG, lactate, and cellular properties that are equal to or better than those in control nonlyophilized RBCs stored for a comparable period in CPDA‐1. Reconstituted, lyophilized RBCs stored at 4 degrees C after rehydration also show better maintenance of ATP, 2,3 DPG, and lactate than do control RBCs stored in the same preservative solutions for comparable periods.
Toxicities associated with cryopreserved and thawed peripheral blood stem cell autografts in children with active cancer
Authors: Okamoto Y. , Takaue Y. , Saito S. , Shimizu T. , Suzue T. , Abe T. , Sato J. , Hirao A. , Watanabe T. , Kawano Y. , Kuroda Y.
Published: March 2003

To evaluate the safety of cryopreserved and thawed peripheral blood stem cell (PBSC) autografts in children with active cancer, a toxicity assessment was made of 54 PBSC transfusions to 52 children (aged 1–16 years; median, 9 years). Patients were conditioned with high‐dose chemotherapy without total body irradiation. The volume of PBSCs transfused varied from 46 to 500 mL (219.6 +/− 118.4 mL, mean +/− SD), with a mean of 0.91 g per kg of dimethyl sulfoxide. Insignificant and transient toxicities included hemoglobinuria in 40 patients (74%), headache in 38 (70%), nausea in 37 (69%), and vomiting in 25 patients (46%). Significant shock developed in 8 patients (15%), but they recovered quickly, whether they had supportive therapy or not. Vomiting and hyperbilirubinemia were the only toxicities that showed a correlation with the amount of PBSCs transfused. The data suggest that transient toxicity associated with PBSC autografts is rather common in children, and close observation of patients for possible serious morbidity is required.
Filtration through a polyester white cell‐reduction filter of plasma‐ poor platelet concentrates prepared with an acetate‐containing additive solution
Authors: Shimizu T. , Mizuno S. , Yamaguchi H. , Kamiya T. , Kokubo Y.
Published: March 2003

It is of practical importance to known whether the adsorption of platelets and contaminating white cells (WBCs) by the WBC‐reduction filter is altered when platelet concentrates (PCs) are prepared in a plasma‐poor condition with an acetate‐containing additive solution (Seto sol). Plasma‐poor PCs with 11‐percent residual plasma were prepared from apheresis platelet‐rich plasma by using a sterile docking device with steam‐sterilized Seto sol. Seto sol contains 115 mM (115 mmol/L) NaCl, 4 mM (4 mmol/L) KCl, 3 mM (3 mmol/L) MgCl2, 10 mM (10 mmol/L) Na3PO4, 15 mM (15 mmol/L) acetate, 3 mM (3 mmol/L) Na3 citrate, and 10 mM (10 mmol/L) glucose (pH 7.1). The solution was steam‐ sterilized under nitrogen gas. On Days 1 and 5, pooled Seto sol PCs (2.4 × 10(11) platelets) were filtered with a polyester filter at a flow rate of 10 mL per minute. The WBC‐removal rate was over 99.9 percent with a platelet recovery of 88 percent following Day 1 filtration. These values were very similar to those of plasma PCs, and 84‐percent recovery was achieved following Day 5 filtration. However, when 1 unit of Seto sol PCs with half the number of platelets was filtered with the polyester filter, platelet recovery was about 16 to 17 percent less than that of plasma PCs. Platelet quality was maintained if pooled Seto sol PCs were filtered on Day 1 and stored for over 4 days. Filtration did not alter platelet function in 1‐day‐old or 5‐day‐old Seto sol PCs. were filtered on Day 1 and stored for over 4 days. Filtration did not alter platelet function in 1‐day‐old or 5‐day‐old Seto sol PCs. It is concluded that the adsorption of WBCs and platelets b the filter was not changed when they were stored in a plasma‐poor condition with seto sol. Therefore, the present composition of Seto sol is adequate for maintaining in vitro adsorption of WBCs as well as the functional quality of stored platelets.
Subcutaneous administration of recombinant human erythropoietin before cardiac surgery: a double‐blind, multicenter trial in Japan
Authors: Hayashi J. , Kumon K. , Takanashi S. , Kawashima Y. , Eguchi S. , Takaku F. , Yamamura H.
Published: March 2003

Background: Dose and injection times have not previously been determined for subcutaneously administered recombinant human erythropoietin that would allow sufficient deposition of blood for autologous use in cardiac surgery.

Study Design and Methods: A double‐ blind, multicenter trial of placebo (Group 1) and recombinant human erythropoietin at 12,000 IU (Group 2) and at 24,000 IU (Group 3) was performed on 114 patients at 26 institutions to determine the dosage that would permit an 800‐g preoperative deposit of blood for autologous use. The test drug was administered subcutaneously on Days 21, 14, and 7 prior to operation, and oral iron preparations at 200 mg per day were given for 21 days. There were 28 patients in Group 1, 28 in Group 2, and 30 in Group 3, with 28 excluded for a violation of the protocol.

Results: Blood was safely drawn 14 and 7 days before operation from 22 patients in Group 1 (78.6%), from 26 in Group 2 (92.9%), and from all patients in Group 3 (p = 0.018). The hemoglobin level on the day before operation decreased by 1.1 ± 1.1 g per dL (11 ± 11 g/L) in Group 1 and by 0.9 ± 0.9 g per dL (9 ± 9 g/L) in Group 2 and rose by 0.1 ± 0.8 g per dL (1 ± 8 g/L) in Group 3, compared to initial levels. Allogeneic blood transfusion could be avoided in 62, 89, and 90 percent of Group 1, 2, and 3 patients, respectively (p = 0.013).

Conclusion: The present study shows that subcutaneously administered recombinant human erythropoietin at a dose of 24,000 IU per week for 3 weeks is effective and sufficient to allow the safe deposition of 800 g of blood for autologous use in cardiac surgery.
Epidemiologic comparison of human T‐lymphotropic virus type I‐infected blood donors from endemic and nonendemic regions over a 3‐year period
Authors: Massari V. , Elghouzzi M.H. , Agis F. , Rannou C. , Gordien E. , Costagliola D. , Lefrère J.J.
Published: March 2003

Background: Screening for human T‐lymphotropic virus type I (HTLV‐I) infection became systematic in 1989 in the French West Indies for blood from all donors and in France for blood from natives of endemic areas; in 1990, it was extended to blood from donors with at‐risk sex partners and in July 1991 to blood from all donors.

Study Design and Methods: The epidemiologic characteristics of individuals found through the screening of donated blood to be HTLV‐I infected were compared for an endemic region (Guadeloupe, French West Indies) and a nonendemic region (Paris area) over a 3‐year period (1989 through 1991).

Results: In Guadeloupe, 131 HTLV‐I‐infected individuals were detected in the screening of 28,801 units; in the Paris area, 38 HTLV‐I‐infected donors were detected in the screening of 109,824 units. All Guadeloupean HTLV‐ I‐infected donors were natives of endemic areas. Among the 38 Parisian HTLV‐I‐infected donors, 21 were natives of endemic areas, 10 were natives of endemic areas and had received transfusions, 2 were whites who had received transfusions, and 5 were whites who had had heterosexual contact with natives of endemic areas. The percentage of HTLV‐I‐infected individuals whose blood would have been excluded because of positivity for one or more markers for other viruses did not significantly change over the study period and did not significantly differ between regions (41%). Among the eight Parisian HTLV‐I‐infected blood donors detected after July 1991, six would not have been detected without the biologic screening.

Conclusion: The generalization of biologic screening of HTLV‐I‐infected donated blood in France was useful for the prevention of HTLV‐I and HTLV type II infections through transfusion.
A review of transfusion‐associated AIDS litigation: 1984 through 1993
Authors: Kern J.M. , Croy B.B.
Published: March 2003

Background: Since 1984, hundreds of lawsuits have been filed against health care providers in the United States, alleging transmission of human immunodeficiency virus by transfusion. While anecdotal reports of jury verdicts have been published, no quantitative study to identify trends in transfusion‐associated AIDS litigation has been undertaken.

Study Design and Methods: To identify trends in lawsuits filed against health care providers alleging human immunodeficiency virus infection transmitted via transfusion, 163 legal actions were analyzed. Included were those for which the authors provided legal defense or consultation (n = 79) and cases reported nationally (n = 84). Cases were analyzed as to characteristics of defendant(s), date of transfusion and case filing, liability theories, and verdict, if applicable.

Results: Defendants were blood centers (74% of cases), hospitals (58%), and physicians (53%). Of physicians, surgeons were named in 78 percent of cases; 42 percent of these surgeons were cardiothoracic surgeons. Nationally, 14 cases have resulted in plaintiff awards totalling $75,420,798. Physicians have been liable for 41 percent of that sum, blood banks 31 percent, and hospitals 26 percent. Of the 10 liability theories raised, the most frequent were claims of medical negligence (46% of cases), failure to identify high‐risk donors (45%), lack of informed consent (39%), and failure to conduct surrogate testing (39%). Twenty‐six trial results favorable to health care providers were noted nationally, 17 occurring in the San Francisco Bay Area, where case filings peaked before 1990 (40/56) and where new case filings decreased (1990, 5; 1991, 3; 1992, 1; 1993, 0) as verdicts favoring health care providers were reported.

Conclusion: Transfusion‐associated AIDS litigation began with verdicts against blood banks, but has expanded to suits against physicians and hospitals that are based on theories of medical negligence and informed consent. Despite widely publicized verdicts for plaintiffs, health care professionals have successfully defended these lawsuits, and in one center of early litigation, a sharp decrease in new case filings has been observed.
New polymorphism on platelet glycoprotein IIIa gene recognized by endonuclease Msp I: implications for PlA typing by allele‐specific restriction analysis
Authors: Unkelbach K. , Kalb R. , Breitfeld C. , Santoso S. , Kiefel V. , Mueller‐Eckhardt C.
Published: March 2003

BACKGROUND: Five human platelet alloantigen systems have been shown to result from single base pair substitutions in encoding regions of platelet glycoprotein genes IIIa, Ib, IIb, and Ia. For each of the diallelic systems, at least one restriction enzyme is known to cut only one of the two haplotypes. In the PlA system, restriction endonucleases Nci I and Msp I both recognize the PlA2 allele.

STUDY DESIGN AND METHODS: A causal observation of an unexpected Msp I restriction pattern of a PlA2/PlA2 individual was made. Samples from 261 blood donors were then typed for antigens of the PlA system by restriction fragment length polymorphism analysis using the Nci I and Msp I restriction enzymes.

RESULTS: Applying both enzymes, concordant restriction patterns were found in 258 of 261 blood donors. Three donors had a base pair mutation on the PlA2 allele, which creates an additional restriction site for Msp I 20 base pairs downstream from the PlA polymorphic site. Nucleotide sequence analysis revealed a CT217–>CG217G base exchange resulting in a Leu40–>Arg40 polymorphism of glycoprotein IIIa.

CONCLUSION: Presuming that the mutation is not a singular phenomenon and also occurs with the PlA1 haplotype, it could lead to false interpretations of restriction analysis with Msp I. To exclude that possibility, Nci I is preferred for restriction fragment length polymorphism typing in the PlA system.
Effect of cold storage on platelet glycoprotein Ib and vesiculation
Authors: BODE A.P. , KNUPP C.L.
Published: March 2003

BACKGROUND: During storage of platelet concentrates at 22 degrees C, changes occur in surface glycoproteins, and membranous vesicles appear in the supernatant plasma. The extent of these changes during refrigerated storage is not known.

STUDY DESIGN AND METHODS: Membranous microparticles and changes in surface or total glycoprotein Ib (GPIb) were studied in platelet concentrates divided into aliquots stored at either 4 degrees C or 22 degrees C for 5 days.

RESULTS: The refrigerated platelets showed greater loss of total GPIb, slightly less binding of monoclonal antibodies to surface GPIb, and reduced aggregation response to ristocetin relative to the paired platelet controls at 22 degrees C. Moreover, the platelets stored at 4 degrees C produced 45‐percent more microparticles and 64‐percent more platelet factor 3 activity in the supernatant plasma than were produced by the controls. These differences were augmented by warming both 4 degrees C‐ and 22 degrees C‐stored platelets at 37 degrees C for 1 to 4 hours.

CONCLUSION: Storage of platelets at 4 degrees C causes increased membrane vesiculation and accelerated loss of GPIb. The magnitude of these differences was small, but it may contribute to marked reductions in platelet survival in circulation
Removal of maternal antibodies from a woman with repeated fetal loss due to P blood group incompatibility
Authors: YOSHIDA H. , ITO K. , KUSAKARI T. , IDA K. , IHARA Y. , MORI T. , MATSUMURA M.
Published: March 2003

BACKGROUND: Plasmapheresis is intended to lower plasma antibody levels in women with blood group incompatible pregnancies.

CASE REPORT: Therapeutic specific antibody removal by using antigen‐positive red cells was applied to a blood group p pregnant women who had a high titer (128) of IgG anti‐PP1Pk and had lost all six previous fetuses in blood group P‐incompatible pregnancies. Plasma was taken from the patient with an intermittent‐flow cell separator, mixed with a volume of washed and packed P‐positive red cells equivalent to one‐fifth of the volume of plasma, and incubated for 10 minutes in an ice water bath. The PP1Pk antibodies were removed, and the autologous plasma was transfused. Treatment by specific antibody removal was started in the seventh week of gestation, and performed one to three times a week for a total of 56 times up to the 34th week. The volume of plasma treated was 2.4 L per procedure on average and totaled 135 L. After each treatment, the antibody titer in the patient's plasma usually decreased by 1 log2, and no deleterious effect on the women was noted. The titers of IgG anti‐P and anti‐Pk were kept between 4 and 16 after the ninth week of gestation. At the end of the 34th week of gestation, a male infant was delivered by cesarean section. The infant did not require an exchange transfusion and is now a healthy 2‐year‐old boy.

CONCLUSION:s This therapeutic method is very useful in the management of fetomaternal P‐incompatibility.
Multi‐gallon blood donors: who are they?
Authors: Royse D. , Doochin K.E.
Published: March 2003

BACKGROUND: Although vital to the nation's blood centers, multi‐gallon blood donors have never been the focus of investigation.

STUDY DESIGN AND METHODS: In the fall of 1994, questionnaires were sent to 500 individuals who had donated 5 gallons or more and to 500 randomly selected donors.

RESULTS: Multi‐gallon donors reported that they received little recognition or support for their efforts and were not pressured by friends or family. One‐third were not allowed time off from work to donate. One in five reported having a “bad experience” while donating. Donors who had family members or friends who had received blood donated a greater number of units than those who were not as close to blood recipients.

CONCLUSION: Women and minorities are underrepresented among long‐term donors. Further research is needed to learn what “captures” donors and helps them to develop the psychological commitment to continue to give, as well as why few multi‐ gallon donors talk about blood donation.
White cell reduction in platelet concentrates and packed red cells by filtration: a multicenter clinical trial. The Trap Study Group
Authors: Kao K.J. , Mickel Mary , Braine Hayden G. , Davis Kathryn , Enright Helen , Gernsheimer Terry , Gillespie Mary Jo , Kickler Thomas S. , Lee Edward J. , McCullough Jeffrey , McFarland Janice G. , Nemo George J. , Noyes Ward D. , Schiffer Charles A. , Sell Kenneth , Slichter Sherrill J. , Woodson Robert D.
Published: March 2003

BACKGROUND: Most previous studies on white cell (WBC) reduction by filtration have been small‐scale studies conducted under tightly controlled laboratory conditions. Their results would be the ideal, rather than what might be expected during routine operation. STUDY DESIGN AND METHODS: To obtain information on routine filtration of blood components, data have been collected from a large‐scale, ongoing, multicenter clinical trial designed to determine the effectiveness of WBC reduction in or ultraviolet B radiation of platelet concentrates before transfusion in preventing platelet alloimmunization and platelet transfusion refractoriness. The WBC content of blood components both before and after filtration was determined by automated cell counters and a manual propidium iodide‐staining method, respectively. Platelet and red cell losses during filtration were measured. RESULTS: The average platelet losses after filtration were 24 +/− 15 percent and 20 +/− 9 percent for apheresis platelets and pooled platelets, respectively. The frequencies at which filtered platelet concentrates contained high levels of residual WBCs (> 5 × 10(6)) were 7 percent and 5 percent for apheresis platelets and pooled platelets, respectively. Further analysis of the platelet filtration data showed that greater numbers of total initial WBCs in the pooled platelets were associated with increased percentages of filtration failure (> 5 × 10(6) residual WBCs). For packed red cells, the average losses during filtration were 23 +/− 4 percent and 15 +/− 3 percent for CPDA‐1 units and Adsol units, respectively. The frequencies at which filtered red cells contained > 5 × 10(6) residual WBCs were 2.7 percent for one type of filter and 0.3 percent for another type of filter. CONCLUSION: There were significant losses of platelets during filtration, which could add to the costs of WBC reduction and lead to possible increases in donor exposures. Filtration failures still occurred, despite careful observation of the standard filtration procedures. The number of total WBCs in pooled platelets before filtration has been identified as an important factor in determining the success of WBC reduction.
Detection of antibodies to Trypanosoma cruzi among blood donors in the southwestern and western United States. I. Evaluation of the sensitivity and specificity of an enzyme immunoassay for detecting antibodies to T. cruzi
Authors: Brashear R. J. , Winkler M. A. , Schur J. D. , Lee H. , Burczak J. D. , Hall H. J. , Pan A. A.
Published: March 2003

BACKGROUND: Chagas' disease or American trypanosomiasis, caused by infection with Trypanosoma cruzi, is a significant health problem in Latin America. In the United States, transfusions of T. cruzi‐ contaminated blood from Latin American immigrants may represent the major source of Chagas' disease. STUDY DESIGN AND METHODS: A new enzyme immunoassay (EIA) for the detection of antibody to T. cruzi was evaluated in the sera of blood donors from the southwestern and western regions of the United States. Serum samples had been screened and were negative for all tests required. Specimens that were repeatedly reactive in the Chagas antibody EIA were analyzed for seroreactivity by a confirmatory EIA and by radioimmunoprecipitation assay. RESULTS: Fourteen of the 13,309 donor samples (0.105%) were confirmed as being positive for antibody to T. cruzi. The Chagas antibody EIA showed improved sensitivity over the Chagas IgG enzyme‐linked immunosorbent assay and two indirect hemagglutination assays. The Chagas antibody EIA had a specificity of 99.98 percent with negative samples. The sensitivity of the Chagas antibody EIA was 100 percent (80/80) in xenodiagnosed specimens and 100 percent (50/50) in specimens positive by consensus (i.e., reactive in EIA, indirect hemagglutination assay, and immunofluorescence assays). CONCLUSION: This Chagas antibody EIA meets the need for accurate and rapid identification of seroreactive samples in low‐prevalence or endemic populations.
Detection of antibodies to Trypanosoma cruzi among blood donors in the southwestern and western United States. II. Evaluation of a supplemental enzyme immunoassay and radioimmunoprecipitation assay for confirmation of seroreactivity
Authors: Winkler M. A. , Brashear R. J. , Hall H. J. , Schur J. D. , Pan A. A.
Published: March 2003

BACKGROUND: Chagas' disease, caused by the protozoan parasite Trypanosoma cruzi, is endemic to Latin America and may be transmitted in the United States via blood donated by infected immigrants. Blood‐ borne pathogens such as T. cruzi require supplemental testing for confirmation of seroreactivity. STUDY DESIGN AND METHODS: A study was undertaken to determine an optimal scheme for confirmation of seroreactivity in repeatedly reactive samples identified by the Chagas antibody enzyme immunoassay (EIA). The procedure for initial confirmation involves three purified antigens coated onto three separate polystyrene beads and uses an EIA format. If the sample is reactive with two of three or three of three antigens, it is confirmed as seroreactive. If none or one of three beads is reactive, the sample is indeterminate and subjected to a radioimmunoprecipitation assay (RIPA). The RIPA must demonstrate characteristic bands at 32, 34, and 90 kDa. RESULTS: When tested with sera from persons with potentially cross‐reactive diseases (n = 39) or against a presumed negative population from southeast Wisconsin (n = 289), the confirmatory EIA had a specificity of 100 percent. Sensitivity was 100 percent (28/28) with xenodiagnosis‐positive sera and 97.6 percent (80/82) with chagasic sera from Latin America. The RIPA showed a specificity of 100 percent in EIA‐ nonreactive samples (n = 100) and a sensitivity of 100 percent with both xenodiagnosis‐positive (28/28) and chagasic (82/82) sera. CONCLUSION: The confirmatory EIA and the RIPA together provide a highly specific and sensitive means of confirming seroreactivity for antibodies to T. cruzi.
Transfusion requirements, risks, and costs for patients with malignancy
Authors: Mohandas K. , Aledort L. M.
Published: March 2003

BACKGROUND: Patients with cancer often develop significant anemia, which traditionally has been successfully managed by transfusion. Although substantially safer than in the past, transfusions continue to carry a variety of risks. The recent licensing of erythropoietin now provides a second treatment option, which indicates a need to reassess the use of transfusion to manage anemia in these patients.

STUDY DESIGN AND METHODS: A 12‐month retrospective chart review of all patients receiving outpatient transfusions at a large institution was used to identify patients with solid tumors (including lymphoma) requiring transfusions for any cause. Transfusions were considered as aberrations if they necessitated unusual laboratory monitoring or resulted in clinical evidence of a transfusion reaction. Patient charges proximately related to the transfusion were calculated.

RESULTS: A total of 219 patients requiring transfusions were identified, with 483 transfusion episodes and the use of 812 units of red cells to manage anemia (mean, 3.71 units/patient). A total of 100 aberrations were recorded. Twenty‐two (10%) of 219 patients had a positive antibody screen that required further work‐up; transfusion reactions occurred in 19 patients (8.7%).

CONCLUSION: Careful assessment by hematologists and oncologists of the risk:benefit ratio of erythropoietin and transfusion in patients with cancer is urged.