bluuebunny/crossref_metadata_2025 huggingface dataset:
Complement activation during storage of whole blood, red cells, plasma, and buffy coat
Authors: Hyllner M. , Arnestad J.P. , Bengtson J.P. , Rydberg L. , Bengtsson A.
Published: March 2003

BACKGROUND: The process of separating whole blood into components and the storage of blood components may cause the release of toxic metabolites from the complement cascade. The aim of this study was to determine whether the storage of blood components leads to the activation of the complement cascade and the release of anaphylatoxins.

STUDY DESIGN AND METHODS: Blood from 12 healthy volunteers was collected and stored either as whole blood or as components: red cells in saline‐adenine‐glucose‐mannitol solution, plasma, and buffy coat. The concentrations of anaphylatoxins and other complement proteins in the various blood components were intermittently analyzed during a 5‐week storage period.

RESULTS: Increasing levels of anaphylatoxins were demonstrated during the storage of whole blood and plasma. Elevated concentrations of the anaphylatoxins C3a and C5a were observed during the storage of whole blood. Increased C5a levels were observed after 7 days of storage. High concentrations of C3a were found in plasma after 14 days of storage. Low or non‐detectable levels of C3a, C5a, and other complement components were found in red cells stored in saline‐adenine‐glucose‐mannitol solution.

CONCLUSION: The study demonstrated activation of complement during the storage of whole blood and plasma but not in red cells in storage solution. The transfusion of larger volumes of stored whole blood or plasma may contribute to the risk of development of organ dysfunction. Therefore, it is advisable to use red cells in storage solution.
Infection with hepatitis G virus and its strain variant, the GB agent (GBV‐C), among blood donors in Japan
Authors: Yoshikawa A. , Fukuda S. , Itoh K. , Kosaki N. , Suzuki T. , Hirakawa K. , Nakao H. , Inoue T. , Fukuda M. , Okamoto H.
Published: March 2003

BACKGROUND: The purpose of the study was to survey the epidemiology of recently reported non‐A through ‐E hepatitis virus designated hepatitis G virus (HGV) and its strain variant, the GB agent (GBV‐C). STUDY DESIGN AND METHODS: Pilot samples from 2461 blood donors in Japan, randomly selected to form cohorts with different levels of alanine aminotransferase (ALT) and markers of hepatitis B virus or hepatitis C virus (HCV) infection, were tested for RNA of HGV/GBV‐C by reverse transcription‐polymerase chain reaction with nested primers deduced from the 5′‐noncoding region. RESULTS: HGV/GBV‐C RNA was detected in 23 (7.4%) of the 361 donors with anti‐HCV and HCV RNA. This detection is more frequent than that in donors without elevated ALT levels (< or = 45 U/L) or markers of HCV or hepatitis B virus infection (15/1303; 1.2%) (p < 0.001), donors with ALT values between 46 and 99 U per L (0/108) (p < 0.002), donors with ALT values > or = 100 U per L (5/361; 1.4%), and donors with anti‐HCV but without detectable HCV RNA (1/93; 1.1%) (p < 0.05). CONCLUSION: More than 1 percent of Japanese blood donors were infected with HGV/GBV‐C, and the prevalence was much higher in those with HCV RNA. Should persistent infection with HGV/GBV‐C induce any hepatotoxic sequelae, either alone or in concert with the other hepatitis viruses, screening of blood units for HGV/GBV‐C would deserve consideration.
Collection of peripheral blood progenitor cells after the administration of cyclophosphamide, etoposide, and granulocyte‐colony‐ stimulating factor: an analysis of 497 patients
Authors: Weaver C. H. , Schwartzberg L. S. , Birch R. , Greco F. A. , Hainsworth J. , Beeker T. , Price H. , Geier L. , Foster J. , West J. , Hazelton B. , Buckner C. D. , Rhinehart S.
Published: March 2003

BACKGROUND: There is great interpatient variability in the number of peripheral blood stem cells collected, as measured by CD34+ cell content, after the administration of chemotherapy and a growth factor. The ability to predict patients who fail to yield adequate quantities of CD34+ cells would be of value. However, very few reports include large numbers of patients treated in an identical fashion. STUDY DESIGN AND METHODS: Between 1991 and 1995, 497 consecutive patients with a variety of malignant diseases received cyclophosphamide (4 g/m2), etoposide (600 mg/m2), and granulocyte‐colony‐stimulating factor (6 micrograms/kg/day) for mobilization and collection of a target dose > or = 2.5 × 10(8) CD34+ cells per kg. Multivariate analyses were performed to determine the factors associated with failure to achieve this target harvest. RESULTS: A median of 14.71 × 10(6) CD34+ cells per kg (range, 0.08‐137.55) was harvested with a median of 2 (range, 1–11) apheresis procedures. Ninety‐one percent of patients yielded > or = 2.5 × 10(5) CD34+ cells per kg. Patients with Stage II‐III breast cancer, who had pretreatment platelet counts > or = 150 × 10(9) per L and patients who underwent < or = 1 prior chemotherapy regimen had improved CD34+ cell yields. However, most patients with adverse risk factors yielded > or = 2.5 × 10(6) CD34+ cells per kg. CONCLUSION: A regimen of cyclophosphamide, etoposide, and granulocyte‐colony‐stimulating factor led to the successful collection of adequate numbers of CD34+ cells in most patients without excessive toxicity. These observations confirm previous reports that intense prior therapy adversely affects the quantity of CD34+ cells harvested. Pretreatment and posttreatment variables did not predict with any certainty the small fraction of patients who fail to yield > or = 2.5 × 10(6) CD34+ cells per kg via multiple apheresis procedures.
Evaluation of changes in hemoglobin levels associated with ABO‐ incompatible plasma in apheresis platelets
Authors: B. Mair MD  , K Benson MD Director
Published: March 2003

BACKGROUND: Hemolytic transfusion reaction is considered a rare complication of platelet transfusion. If minor ABO incompatibility exists (donor antibody directed against recipient's red cells [plasma‐ incompatible platelets]), however, the antibodies present in the plasma of platelets may cause acute hemolysis. A retrospective study was performed to identify possible hemolysis related to the transfusion of plasma‐incompatible apheresis platelets. STUDY DESIGN AND METHODS: Acute hemolysis due to low‐titer anti‐A present in group O apheresis platelets transfused to a group A patient is reported. Pretransfusion and posttransfusion hemoglobin levels were evaluated in 16 non‐group O autologous bone marrow transplant patients receiving apheresis platelets. All patients received, within 24 hours, both ABO‐identical and plasma‐incompatible platelet transfusions. No red cells were transfused during the time between the collection of the pretransfusion and posttransfusion hemoglobin samples. RESULTS: A total of 24 evaluable paired platelet transfusions in the 16 patients were compared. The mean change in hemoglobin following transfusion of the ABO‐identical and plasma‐incompatible platelets was ‐0.50 g per dL and ‐ 0.11 g per dL, respectively (p = 0.193). CONCLUSION: There was no significant change in the hemoglobin concentration associated with the transfusion of plasma‐incompatible apheresis platelets (minor ABO incompatibility) in our study group. The case reported here represents the only hemolytic transfusion reaction identified among 46,176 platelet transfusions performed at this hospital, despite approximately 21 percent of all platelet transfusions being plasma incompatible. The risk of such a reaction remains low.
Antibodies to hepatitis E virus among several populations in Greece: increased prevalence in an hemodialysis unit
Authors: Dalekos G. N. , Zervou E. , Elisaf M. , Germanos N. , Galanakis E. , Bourantas K. , Siamopoulos K. C. , Tsianos E. V.
Published: March 2003

BACKGROUND: Hepatitis E virus (HEV) has been found to be the causative agent of enterically transmitted non‐A, non‐B hepatitis in tropical and subtropical countries. Several investigators, however, have indicated that HEV could be endemic in Europe, albeit at a low prevalence.

STUDY DESIGN AND METHODS: The purpose of this study was to estimate the prevalence of anti‐HEV in various populations in northwestern Greece (Epirus region). Healthy blood donors (2636), refugees from southern Albania (350), children (165), injecting drug users (IDUs) (65), multiply transfused patients (62), patients with chronic viral hepatitis (75), and chronic hemodialysis patients (149) were investigated for anti‐HEV by enzyme immunoassay and confirmatory Western blot assay. In addition, 380 consecutive healthy blood donors and 62 hemodialysis patients from a neighboring area (Agrinion, Greece) were investigated.

RESULTS: A very low presence of anti‐HEV antibody was found among healthy blood donors from Epirus (0.23%) and Agrinion (0.53%). Anti‐HEV was not detected in children, IDUs, or multiply transfused patients. In contrast, a low but significant prevalence of anti‐HEV was found among refugees (4.85%), patients with chronic viral hepatitis (5.3%), and hemodialysis patients from Epirus (1.34%), as compared with healthy blood donors from Epirus: p < 0.0001, p < 0.00001, and p < 0.10, respectively. A high prevalence (9.7%) of anti‐ HEV was revealed in patients at the hemodialysis unit of the General Hospital of Agrinion (p < 0.00005, compared to healthy blood donors from Agrinion). No significant association was found between anti‐HEV positivity and the age or sex of donors, the duration of hemodialysis, positivity for hepatitis B or C virus infection markers, history of hepatitis, increased alanine aminotransferase, renal transplantation, a history of transfusion, or the number of units transfused.

CONCLUSION: This study demonstrated a high prevalence of anti‐HEV in a separate hemodialysis unit, without an association with the known routes of transmission of blood‐borne viruses. This observation suggests that a still‐undefined intra‐unit factor or other factors are associated with HEV transmission.
Changing transfusion practices in hip and knee arthroplasty
Authors: Warner D.O. , Warner M.A. , Schroeder D.R. , Offord KP. , Maxson P. , Santrach P.
Published: March 2003

BACKGROUND: This study was designed to examine changes in perioperative transfusion practices after the introduction of autologous blood conservation strategies into routine clinical practice.

STUDY DESIGN AND METHODS:The existing medical records of all patients undergoing total hip or knee arthroplasty at Mayo Clinic in Rochester, MN, who resided in Olmsted County, were reviewed over three periods: 1981–82 (232 procedures), 1987–88 (269 procedures), and 1993–94 (398 procedures).

RESULTS:The proportion of patients receiving any perioperative red cell (RBC) units significantly decreased (from 85% in 1981–82 to 65% in 1993–94). The timing of transfusion also changed; the proportion of RBC units transfused in the preoperative or intraoperative periods decreased from 68 percent in 1981–82 to 38 percent in 1993–94, with the balance of RBC units transfused in the postoperative period. Although the number of RBC units utilized per procedure in the intraoperative period significantly decreased, the number of RBC units transfused in the postoperative period significantly increased (from 0.6 +/− 1.0 to 1.1 +/− 1.4 units per procedure in 1981–82 and 1993–94, respectively, p < 0.05). CONCLUSION: Although blood conservation strategies have been successful in reducing RBC transfusion intraoperatively, avoidance of intraoperative transfusion may in some cases postpone, rather than prevent, transfusion.
Oral or intravenous iron as an adjuvant to autologous blood donation in elective surgery: a randomized, controlled study
Authors: Weisbach V. , Skoda P. , Rippel R. , Lauer G. , Glaser A. , Zingsem J. , Zimmermann R. , Eckstein R.
Published: March 2003

BACKGROUND: This study was performed to evaluate the capacity of oral and intravenous (IV) iron administration during autologous blood donation (ABD) to improve the efficacy of ABD and to prevent the need for allogeneic blood transfusion in patients without iron deficiency who are undergoing major elective surgery for which a minimum of 3 autologous units have been ordered.

STUDY DESIGN AND METHODS: One hundred twenty‐three patients were enrolled in an open‐labeled, randomized, controlled trial and assigned to three treatment groups: patients in Group 1 received 3 × 100 mg of Fe2+ per day given orally for 5 weeks before operation; patients in Group 2 received 200 mg of Fe3+ given intravenously after each donation combined with initial IV iron supplementation in patients with hemoglobin under 15 g per dL; and patients in Group 3 were in the control group that received no iron medication. A modest ABD program involving weekly phlebotomy and threshold hemoglobin values for donation of 11.5 g per dL in women and 12.0 g per dL in men was performed.

RESULTS: Ninety patients, 15 women and 15 men in each of the three groups, completed the study. The mean net red cell production during ABD was no higher (p>0.2) in the iron‐treated groups (Group 1: 473 ± 178 mL; Group 2: 436 ± 170 mL; Group 3 (controls): 397 ± 174 mL). The mean number of autologous units donated per patient did not differ (p>0.7) among the groups (Group 1: 3.1 ± 0.6; Group 2: 2.9 ± 0.7; Group 3: 3.0 ± 0.7). The proportion of patients who needed allogeneic blood transfusion showed no significant (p>0.4) advantage for iron treatment, (Group 1: 7%; Group 2: 20%; Group 3: 10%).

CONCLUSION: In non‐iron‐deficient patients undergoing modest ABD without erythropoietin therapy, neither oral nor IV application of iron during the preoperative period enhances the success of preoperative ABD.
An investigation into the possibility of transmission of tick‐borne pathogens via blood transfusion
Authors: Arguin P.M. , Singleton J. , Rotz L.D. , Marston E. , Treadwell T.A. , Slater K. , Chamberland M. , Schwartz A. , Tengelsen L. , Olson J.G. , Childs J.E. ,   the Transfusion‐Associated Tick‐Borne Illness Task Force
Published: March 2003

BACKGROUND: Tick‐borne illnesses were diagnosed in a group of National Guard members, including some who had donated blood a few days before the onset of symptoms. A voluntary recall of those blood components was issued and a multistate investigation was conducted to determine if transfusion‐transmitted illness had occurred.

STUDY DESIGN AND METHODS: Donors and recipients were asked to complete questionnaires regarding symptoms and risk factors for infection and to provide blood samples for laboratory analysis.

RESULTS: Among National Guard personnel who donated blood, 12 individuals were found to have a confirmed or probable case of Rocky Mountain spotted fever or ehrlichiosis. A total of 320 units (platelets or packed red cells) from 377 donors were transfused into 129 recipients. Although 10 recipients received units from National Guard personnel with confirmed or probable infection, none became ill.

CONCLUSION: Transfusion‐transmitted illness did not occur. Despite the awareness of the risk for tick‐borne diseases and the use of tick‐preventive measures, many National Guard personnel reported exposure to ticks. In addition to augmenting current tick‐preventive measures, scheduling blood drives before rather than after field exercises could further reduce the potential for transmission of tick‐borne pathogens.
Preparation of autologous platelets for the ophthalmologic treatment of macular holes
Authors: Gehring Svante , Hoerauf Hans , Laqua Horst , Kirchner Holger , Klüter Harald
Published: March 2003

BACKGROUND: Platelet concentrates were recently used for ophthalmologic treatment of macular holes. This strategy was investigated to define standardized blood bank components.

STUDY DESIGN AND METHODS: Two different, highly concentrated autologous platelet components, one from whole‐blood preparation and the other from plateletpheresis, were evaluated. In the first procedure, platelet‐rich plasma was obtained from 250 mL of whole blood. After storage for 20 hours, platelet‐rich plasma was concentrated In a second centrifugation step and adjusted to 10 × 109 platelets per mL. In the second procedure, platelets were collected by apheresis, stored overnight, centrifuged, and adjusted to 20 × 109 platelets per mL. The respective component was instilled during vitrectomy and gas tamponade in patients with stage II to IV macular holes. Patients were followed for 9 months.

RESULTS: With regard to the various preparation procedures and final concentrations of platelets in the components, no differences in wound healing were observed. An anatomic closure of the macular hole was achieved in 18 of 19 treated patients. Visual acuity improved in 14 patients.

CONCLUSION: Both types of highly concentrated platelet components were effective in achieving high closure rates of macular holes. These autologous platelet components possess the quality standard of blood bank components and could be of great benefit for initiating wound healing in other clinical settings.
Reducing the risk of transfusion‐transmitted rickettsial diseaseby WBC filtration, using Orientia tsutsugamushiin a model system
Authors: Mettille F.C. , Salata K.F. , Belanger K.J. , Casleton B.G. , Kelly D.J.
Published: March 2003

BACKGROUND: Careful donor screening and infectious disease marker testing have significantly reduced the incidence of transfusion‐transmitted diseases and improved the safety of the blood supply. However, transfusion‐transmitted diseases resulting from the use of asymptomatic yet infectious donors continue to put patients at risk. This study was undertaken to determine if third‐generation WBC filters could remove Orientia tsutsugamushi‐infected cells from contaminated blood.

STUDY DESIGN AND METHODS: Packed RBCs were inoculated with human MNCs infected with O. tsutsugamushi at levels estimated to occur in asymptomatic infectious donors. WBC reduction was accomplished with a third‐generation WBC filter. Prefiltration and postfiltration specimens were collected, serially diluted, and injected into mice to determine the infectivity of the samples.

RESULTS: Mice receiving WBC‐reduced packed RBCs showed no signs of illness or markers of infectivity, which suggested that a reduction of as much as 105 infectious rickettsiae could be achieved by filtration.

CONCLUSION: The high‐efficiency, third‐generation, WBC‐reduction filters that were tested may provide protection against the transfusion transmission of scrub typhus rickettsiae by removing from contaminated blood cells that contain intracellular bacteria.
An immediate, allergic skin reaction to aprotinin after reexposure to fibrin sealant
Authors: Beierlein W. , Scheule A.M. , Antoniadis G. , Braun C. , Schosser R.
Published: March 2003

BACKGROUND: The safety of fibrin tissue adhesives has been a concern since they entered wide clinical application. Most commercially available kits contain the proteolytic inhibitor, aprotinin, to stabilize the fibrin clot. A bovine protein, this substance has an allergenic potency.

CASE REPORT: This case report presents a patient who had a generalized allergic skin reaction, probably triggered by aprotinin upon reexposure to fibrin sealant injected subgaleally to achieve closure of a liquor fistula after neurosurgical treatment. The serologic investigation revealed aprotinin‐specific IgE and IgG. From 1990 through 1998, reports of five allergic reactions following 1 million exposures to fibrin sealant were made to the manufacturer. The clinical relevance of allergic reactions to aprotinin contained in fibrin sealants and measures to avoid them are discussed.

CONCLUSION: These hypersensitivity reactions are extremely rare (incidence, 0.5/100,000 for all reactions and 0.3/100,000 for serious reactions), but they must be kept in mind as possible adverse events after repeated applications of fibrin sealants within a few weeks.
Infectious disease markers in young blood donors
Authors: Watanabe K.K. , Williams A.E. , Schreiber G.B. , Ownby H.E. ,   for the Retrovirus Epidemiology Donor Study
Published: March 2003

BACKGROUND: To evaluate whether the active recruitment of young donors of high school and college age could affect the safety of the blood supply, prevalence and incidence rates of infectious disease markers among donors aged 17 to 18 and 19 to 22 were compared to those in donors 23 years of age and older.

STUDY DESIGN AND METHODS: Over 15 percent of 4.97 million whole blood donations were collected from donors aged 17 to 18 and 19 to 22. Prevalence (per 100,000 first‐time donors) and incidence (per 100,000 person‐years) rates for confirmed infectious diseases were compared between age groups.

RESULTS: The prevalence estimates for HIV, HCV, HTLV‐I and ‐II, and serologic tests for syphilis (STS) were significantly lower among first‐time donors aged 17 to 18 and 19 to 22 than among those 23 to 44 years of age. HBsAg prevalence was higher in the first‐time donors in the younger groups than in first‐time donors in the older group because of higher prevalences among Asians and blacks. The incidence rates of HIV, HCV, and HTLV were similar in the younger groups and the older group. Donors 19 to 22 years of age had a higher incidence rate of estimated HBV than did donors aged 23 to 44 and 45+ (p<0.001), but the incidence rate of STS was lower in donors aged 17 to 18 and 19 to 22 than in donors 23 to 44 and 45+ years of age (p<0.001).

CONCLUSION: Aggressive recruitment of school‐age donors should not result in an increased risk of transmission‐transmitted infections, with the possible exception of HBV.
Public perception of the risk ofblood transfusion
Authors: Finucane M.L. , Slovic P. , Mertz C.K.
Published: March 2003

BACKGROUND: Health policymakers are concerned about the proportion of people who say they are unwilling to receive a blood transfusion. This article examines how social, cultural, and political factors affect the perceived risk of transfusions.

STUDY DESIGN AND METHODS: Data were collected as part of a large national telephone survey of 1204 people conducted in the United States in 1997 and 1998. The survey elicited images associated with blood transfusions and contained questions about the perceived risk of the blood supply, sensitivity to stigma, worldviews, trust, and demographics.

RESULTS: The results showed that a substantial proportion of people do not consider the US blood supply to be safe and say they would not accept blood if hospitalized. The images evoked most frequently by the stimulus phrase “blood transfusions” were related to AIDS or HIV. The people who tend to perceive the greatest personal and public risk from blood transfusions are female, nonwhite, and less educated, and they have not previously received a transfusion. Sensitivity to stigma, mistrust, one's perceived inability to control hazardous activities and technologies, and fatalistic and egalitarian worldviews tend to be associated with heightened concern about the risk of blood transfusions.

CONCLUSION: Risk perceptions need to be monitored to anticipate and deal with problems of public acceptance. Risk management strategies should be tailored to the specific characteristics of individuals that are important determinants of the perceived risk of transfusions.
Venipuncture‐induced causalgia: anatomic relations of upper extremity superficial veins and nerves, and clinical considerations
Authors: Horowitz Steven H.
Published: March 2003

BACKGROUND: In 1994, 11 patients with injury to upper extremity cutaneous nerves after routine venipuncture were reported. All developed causalgia (Complex Regional Pain Syndrome, Type 2). Nerve injury appeared secondary to direct trauma via “inappropriate” needle or bolused material entry into the plane of the nerves beneath the veins, or nerves overlying the veins. However, in 3 of 13 additional patients, the venipunctures were properly performed and atraumatic.

STUDY DESIGN AND METHODS: To explore the anatomic relationships of superficial veins and cutaneous nerves with regard to the role of direct nerve trauma during venipuncture in the development of causalgia, the 14 upper extremities of seven randomly chosen cadavers were dissected at three common venipuncture sites. In addition, the clinical features of all 24 patients are presented.

RESULTS: Major branches of cutaneous nerves were superficial to and overlay veins in six extremities. In multiple instances, nerves and veins were intertwined, requiring detailed dissection to separate them. In the classic situation, nerves were immediately as deep as veins, often with no fascial separation.

CONCLUSIONS: Anatomical relationships between upper extremity superficial veins and cutaneous nerves are so intimate that needle–nerve contact during venipuncture is common. Because venipuncture‐induced nerve injuries are rare, factors other than direct nerve contact appear necessary for the chronic pain syndrome to occur.
Blood transfusion in a random sample of hospitals in France
Authors: Mathoulin‐Pélissier Simone , Salmi L. Rachid , Verret Catherine , Demoures Bruno ,   for the RECEPT investigators
Published: March 2003

BACKGROUND: Representative information on blood use is scarce. A large‐scale study of blood recipients and blood use in France was conducted.

STUDY DESIGN AND METHODS: Based on a random sampling, this study was carried out in teaching and other hospitals between March and December 1997. In each hospital, a patient was included if he or she received an allogeneic or an autologous transfusion during the observation period for that hospital. For each recipient, product and patient characteristics for 24 hours after inclusion were collected.

RESULTS: From the 175 hospitals that had given a transfusion to at least one patient during the observation period, 3206 patients were included. Most transfusion recipients (57%) were over 65 years old; 42 percent were in teaching hospitals and 53 percent in medical wards. Among the 3044 adults, 91 percent received an allogeneic transfusion. Fifty‐three percent of allogeneic units were WBC reduced. The indications most frequently reported for allogeneic transfusion were neoplasms (48%) and those for autologous transfusion were disorders of musculoskeletal (63%) or circulatory (15%) systems. The patients in nonteaching hospitals were more often transfused during surgery and were more likely to be aged and to have a musculoskeletal disorder than were patients in teaching hospitals.

CONCLUSION: General collection of such data, within a system of traceability, could provide relevant denominators from which to interpret adverse‐reaction data.
Selective protection of RBCs against photodynamic damage by the band 3 ligand dipyridamole
Authors: VanSteveninck John , Trannoy Laurence L. , Besselink Geert A.J. , Dubbelman Tom M.A.R. , Brand Anneke , De Korte Dirk , Verhoeven Arthur J. , Lagerberg Johan W.M.
Published: March 2003

BACKGROUND: All studied photosensitizers for virus inactivation impair RBCs. To reduce damage to the RBCs without affecting virucidal activity, selective protection of the RBCs is necessary. The ability of the band 3 ligand, dipyridamole, to react with singlet oxygen and to increase the selectivity of photosterilization was investigated.

STUDY DESIGN AND METHODS: Solutions of dipyridamole were illuminated in the presence of tetrasulfonated aluminum phthalocyanine (AlPcS4) and dimethylmethylene blue (DMMB). Solutions of amino acids, RBCs, and vesicular stomatitis virus (VSV) in RBC suspensions were photodynamically treated in the presence or absence of dipyridamole.

RESULTS: Illumination of a solution of dipyridamole in the presence of AlPcS4 or DMMB resulted in changes in the optical spectrum of dipyridamole. The photooxidation of dipyridamole was inhibited by azide and augmented by D2O, which suggests the involvement of singlet oxygen. Photooxidation of amino acids and photodamage to RBCs was strongly reduced in the presence of dipyridamole. In contrast, photoinactivation of VSV in RBC suspensions was only slightly affected by dipyridamole.

CONCLUSION: Dipyridamole can improve the specificity of photodynamic sterilization of RBC concentrates, thereby increasing the practical applicability of this photodecontamination method.
Cytokines and vascular cell adhesion molecule‐1 in the blood of patients undergoing HPC mobilization
Authors: Dosquet Christine , Chen Yolande , Makke Jaffar , Miclea Jean‐Michel , Coudert Marie‐Claude , Marolleau Jean‐Pierre , Fermand Jean‐Paul , Cottu Paul , Lotz Jean‐Pierre , Benbunan Marc
Published: March 2003

BACKGROUND: The mechanism of HPC mobilization in humans is unclear. In this study, the relationship between PBPC mobilization and blood levels of G‐CSF, endogenous cytokines (IL‐8, SCF, thrombopoietin [TPO]), and the vascular cell adhesion molecule‐1 (VCAM‐1) was analyzed in patients with malignancy who were undergoing a PBPC mobilization regimen.

STUDY DESIGN AND METHODS: Fifty‐four patients with multiple myeloma (MM) and 29 with breast cancer (BC) underwent a mobilization regimen combining conventional chemotherapy and G‐CSF up to the last day of PBPC collection. The CD34+ cell count was determined on each day when leukapheresis was scheduled. Venous blood samples (n = 117) were drawn before apheresis for CD34+ cell count (flow cytometry) and cytokine (G‐CSF, IL‐8, SCF, TPO) and VCAM‐1 measurements (ELISA).

RESULTS: In multiple regression analysis, SCF was a significant determinant of CD34+ cell levels in BC patients (R = 0.50, p = 0.03) and of VCAM‐1 levels in MM patients (R = 0.32, p = 0.02). SCF was negatively correlated with CD34+ cell count in patients with BC. SCF and VCAM‐1 blood levels were correlated in MM and BC patients.

CONCLUSION: SCF and VCAM‐1 could play a role in PBPC mobilization in patients and could be useful measures by which to study patients undergoing a mobilization regimen.
Quantitation of genomic DNA in plasma and serum samples: higher concentrations of genomic DNA found in serum than in plasma
Authors: Lee Tzong‐Hae , Montalvo Leilani , Chrebtow Vera , Busch Michael P.
Published: March 2003

BACKGROUND: Plasma and serum samples have been used to detect cell‐free genomic DNA in serum or plasma in certain pathologic conditions such as systemic lupus erythematosus, pulmonary embolism, and malignancies, as well as in fetal cell chimerisms in maternal serum and/or plasma. In this study, baseline concentrations of cell‐free DNA in serum and plasma samples were evaluated for the study of posttransfusion chimerism.

STUDY DESIGN AND METHODS: DNA was extracted from fresh or stored (4°C for 1‐6 days) normal donor serum or plasma samples (ACD; EDTA) by using reagents from an HIV assay kit. After incubation and washing of samples, purified DNA was amplified with HLA DQ‐α primers (GH26 and 27) or human Y‐chromosome primers (SA and SD) to quantitate the concentration of genomic DNA.

RESULTS: Fresh serum samples had concentrations of cell‐free DNA that were about 20‐fold higher than the concentrations in fresh plasma samples. The concentration of cell‐free genomic DNA in serum samples increased daily, to a level more than 100 times baseline after clotted blood tubes were stored at 4°C for 4 to 5 days. There was a small increase in cell‐free plasma DNA in stored ACD whole blood samples. Male WBCs, spiked into fresh nonanticoagulated female blood, were lysed during the process of clotting, with male DNA liberated into the serum samples.

CONCLUSION: Most cell‐free DNA in serum samples is generated during the process of clotting in the original collection tube. The concentration of cell‐free genomic DNA in fresh plasma is probably the same as that in circulation. Consequently, while serum samples should not be used to monitor the concentration of cell‐free DNA in a patient's circulation, serum collected from sample tubes containing clots (i.e., without anticoagulant), 3 to 5 days after the date of phlebotomy, could be useful as a source of DNA with which to screen for posttransfusion microchimerism.
WBC reduction in RBC concentrates by prestorage filtration: multicenter experience
Authors: Yomtovian Roslyn , Gernsheimer Terry , Assmann Susan F. , Mohandas Kala , Lee Tzong‐Hae , Kalish Leslie A. , Busch Michael P. ,   for the Viral Activation Transfusion Study Group
Published: March 2003

BACKGROUND: As universal leukocyte (WBC) reduction (ULR) is being considered as a new standard, few data are available on the performance of WBC‐reduction filtration in routine practice. The performance of WBC‐reduction in RBCs, using varied filtration practices, in meeting the current FDA requirement (<5 × 106), Council of Europe (EC) recommendation, the proposed FDA requirement (<1 × 106), and a more stringent proposal (<5 × 105) for residual WBCs per RBC unit was assessed and compared.

STUDY DESIGN AND METHODS: Participating facilities were the 11 sites of the Viral Activation Transfusion Study (VATS), a prospective study of the impact of transfusion with and without WBC‐reduction on survival and HIV viral load in HIV‐1‐infected patients. Patients randomly assigned to undergo WBC reduction were required to receive RBCs ≤14 days old that had undergone prestorage (within 72 hours of collection) WBC‐reduction filtration by a method devised to achieve a postfiltration WBC count of <5 × 106. Residual WBC quantitation was performed by PCR in the central VATS laboratory by using frozen WBC‐reduced RBC samples obtained at issue for transfusion.

RESULTS: A total of 1869 WBC‐reduced RBC units were studied. Filtration practices varied within and between sites. There were significant differences in mean residual WBC counts at the 11 sites (p<0.001). Among the WBC‐reduced RBC units, 0.8 percent exceeded 5 × 106 WBCs per unit, 8.3 percent exceeded 1 × 106 WBCs per unit, and 14.3 percent exceeded 5 × 105 WBCs per unit.

CONCLUSION: Residual WBCs in WBC‐reduced RBC units vary within and between sites. WBC reduction was successful, in that over 99 percent and 91 percent of VATS WBC‐reduced RBC units met US and EC thresholds, respectively. However, the small but measurable failure rate indicates that not every unit will meet these guidelines.
AnAQP1null allele in an Indian woman with Co(a–b–) phenotype and high‐titer anti‐Co3 associated with mild HDN
Authors: Joshi Sanmukh R. , Wagner Franz F. , Vasantha K , Panjwani Sangeeta R. , Flegel Willy A.
Published: March 2003

BACKGROUND:The Colton blood group system (CO, ISBT 015) is composed of three antigens, of which Co3 (ISBT 015.003) is carried by almost all persons, except those of the extremely rare Co(a–b–) phenotype. The Colton blood group antigens are expressed by the water channel aquaporin 1 (aqp1; also known as channel‐forming integral protein, CHIP‐28), which is a highly conserved RBC integral membrane protein. The two most frequent alleles,CO1andCO2, encode the antigens Coaand Cob, respectively. Four null alleles have been described for theAQP1gene to date.

CASE REPORT:An Indian woman had an alloimmune antibody to an high‐frequency antigen associated with mild HDN. Her RBCs were typed Co(a–‐b–), and the antibody was an anti‐Co3. She typedCO1‐positive andCO2‐negative in a new genotyping method, using PCR with sequence‐specific priming, forCO1andCO2.A method for nucleotide sequencing of the fourAQP1exons from genomic DNA was developed. The patient was shown to be homozygous for a nonfunctional alleleAQP1(232delG)that also carried theCO1‐specific polymorphism.

CONCLUSION:The kindred presented a fifth example of anAQP1null allele, which was caused by a single nucleotide deletion leading to a shift in the reading frame beyond codon 78. A method of genotypingCOfor Coaand Cobantigen phenotype prediction was presented.
Posttransplant immune‐mediated hemolysis
Authors: Sokol Robert J. , Stamps Robert , Booker David J. , Scott Fiona M. , Laidlaw Stuart T. , Vandenberghe Elisabeth A. , Barker Helen F.
Published: March 2003

BACKGROUND:Immune‐mediated hemolysis is a well‐recognized complication of transplantation, but few reports have drawn together the different mechanisms that could be involved.

STUDY DESIGN AND METHODS:The clinical and laboratory records of three patients are used to illustrate different types and complexities of posttransplant immune‐mediated RBC destruction.

RESULTS:Patient 1 received bone marrow from an HLA‐matched, unrelated donor. At 7 months after transplant, his Hb level fell to 50 g per L. The serum contained warm autoantibodies, and the DAT was strongly positive for IgG, IgM, and C3d; an eluate yielded IgG and IgM autoantibodies. Autoimmune hemolytic anemia was diagnosed. Patient 2, blood group A, experienced severe hemolysis 14 days after receiving a lung from a group O donor. The DAT was positive for IgG. Serum and RBC eluate contained anti‐A produced by immunocompetent B cells in the transplanted lung‐this was the passenger lymphocyte syndrome. Patient 3 experienced posttransplant hemolysis caused by two different immune mechanisms. Originally group A, D‐ with anti‐C, ‐D, ‐E, she received a peripheral blood progenitor cell (PBPC) transplant from her HLA‐identical group A, D+ son. Six months later, chimerism was evident; the remaining recipient marrow was still producing antibodies that destroyed D+ RBCs made by the transplant. Later, autoimmune hemolytic anemia also developed; the DAT became positive for IgG, and warm autoantibodies were eluted from D‐ RBCs.

CONCLUSION:An understanding of the causes and circumstances under which posttransplant immune hemolysis arises is required for proper management. As more patients become long‐term survivors of unrelated bone marrow and/or PBPC transplants, chimerism and complex serologic problems will become more common.
Transfusion of ABO‐nonidentical platelets is not associated with adverse clinical outcomes in cardiovascular surgery patients
Authors: Lin Yulia , Callum Jeannie L. , Coovadia Ahmed S. , Murphy Patricia M.
Published: March 2003

BACKGROUND: Current blood transfusion standards in Canada and the United States permit transfusion of ABO‐nonidentical platelets when ABO‐identical platelets are not available. This practice increases the availability of platelets, a component in chronic shortage in Ontario, Canada because of the 5‐day shelf‐life. The impact of transfusing ABO‐nonidentical platelets on patient outcomes is unknown.

STUDY DESIGN AND METHODS: A retrospective review of 1721 patients who had cardiovascular surgery between November 1989 and December 1999 and who had also received a platelet transfusion perioperatively was conducted. The impact of platelet and plasma incompatibility on clinical outcomes was analyzed.

RESULTS: The analysis included 1691 patients who were divided into two groups according to the compatibility of the first platelet transfusion received: ABO‐identical platelet transfusion (n = 1008) and ABO‐nonidentical platelet transfusion (n = 683). The only difference in baseline characteristics between the two groups was that there were more urgent cases in the ABO‐identical platelet transfusion group (p = 0.04). There were no significant differences in mortality at 30 days (10% for both groups, p = NS) or in postoperative length of stay (median, 7.0 days for both groups, p = NS). No significant differences were found with respect to the use of blood components, indices of bleeding, incidence of infection, or platelet CCIs.

CONCLUSION: Transfusion of ABO‐nonidentical platelets in patients undergoing cardiovascular surgery is not associated with an adverse impact on patient outcome.
Novel 3′Rhesus boxsequences confoundRHDzygosity assignment
Authors: Matheson Kimberly A. , Denomme Gregory A.
Published: March 2003

BACKGROUND: PaternalRHDzygosity is required for genetic counseling and management of HDN caused by anti‐D. The most common D− haplotype is due to the deletion ofRHD,which results in the formation of a hybridRhesus box,theoretically through the recombination of 5′ and 3′Rhesus boxes.

STUDY DESIGN AND METHODS: The validity ofRhesus box PstI analysis was assessed to determineRHDzygosity by correlating D phenotype, most probable genotype, andRhesus boxPCR‐RFLP.RHDexons were examined, and a 501‐bpRhesus boxfragment was sequenced that flanked the polymorphicPstI site.

RESULTS:Rhesus boxanalysis and the most probable genotype differed for 60 of 200 of the samples (30%). The incorrect zygosity assignment by the most probable genotype method is the likely reason for the difference. However, 8 of 328 samples showedRhesus boxcopy numbers that were inconsistent with the D phenotype. Two D− samples with one hybridRhesus boxhad a nonfunctionalRHD.Six D+ samples appeared to have two copies of the hybridRhesus boxdue to novel 3′Rhesus boxesthat contained nucleotide polymorphisms previously assigned to the 5′ and hybridRhesus boxes. All eight samples were from people of black decent, as determined by the GATA‐1 silencing mutation at theFYlocus.

CONCLUSION:Rhesus boxPCR‐RFLP analysis forRHDzygosity assignment is confounded by the presence of nonfunctionalRHD+ (2.3% of D−) and novel, low frequency (0.9% of all alleles) 3′Rhesus boxsequences.
Current prevalence and incidence of infectious disease markers and estimated window‐period risk in the American Red Cross blood donor population
Authors: Dodd R.Y. , Notari E.P. , Stramer S.L.
Published: March 2003

BACKGROUND : There has been continuing prog‐ ress in measures to reduce the risk of transfusion‐ transmitted infection, including introduction of serologic tests of increased sensitivity and the recent implementation of investigational NAT in small pools of samples.

STUDY DESIGN AND METHODS : Data relating to all blood donations to the American Red Cross have been consolidated into a single database. The prevalence of confirmed‐positive test results for HBsAg, HCV, HIV, and HTLV were evaluated for each year for first‐time donors from 1995 through 2001. Incidence rates for these infections were evaluated among repeat donors having at least two donations in a 2‐year period. The frequencies of HIV‐1 RNA‐ and HCV RNA‐positive, seronegative donations were assessed for first‐time and repeat donations. The relationship risk = (window period) × (incidence) was used to assess residual risk among repeat donations and to evaluate the incidence of HCV and HIV infection among first‐time donors.

RESULTS : During the study period, prevalence rates for all markers declined significantly over time: in 2001, the rates per 100,000 were 75.6 for HBsAg, 299 for HCV, 9.7 for HIV, and 9.6 for HTLV; the corresponding incidence rates (/100,000 person‐years) were 1.267, 1.889, 1.554, and 0.239, respectively. Estimates of residual risk in donations from repeat donors (after NAT) for HCV and HIV were 1 per 1,935,000 and 1 per 2,135,000, respectively. However, incidence rates for these agents are approximately two times greater among first‐time donors. For both HCV and HIV, NAT yield was concordant with that predicted by current window‐period models.

CONCLUSION : These data cover about half of all the whole blood collected in the United States. They suggest increasing improvement in transfusion safety and clearly define the benefit of pooled NAT.
Vasovagal reactions in apheresis donors
Authors: Tomita Tadao , Takayanagi Miyuki , Kiwada Kimie , Mieda Akemi , Takahashi Chiyoko , Hata Tadayoshi
Published: March 2003

BACKGROUND : The incidence rate of vasovagal reactions (VVRs) in apheresis is known to be higher in women than in men donors. VVRs in women apheresis donors were therefore analyzed to find out possible factors for their high incidence.

STUDY DESIGN AND METHODS : VVR incidence was compared between whole blood (WB) and apheresis donation in relation mainly to age and circulatory blood volume (CBV). In addition, blood pressure and pulse rate were measured during apheresis.

RESULTS : In WB donors, the VVR incidence was 0.83 and 1.25 percent, while in apheresis donors it was 0.99 and 4.17 percent in men and women, respectively. The VVR incidence decreased with age in WB donors, but age dependence was very weak in apheresis donors. In elderly women, the incidence increased with repeating cycle of apheresis. There were three different patterns of pulse fluctuation during apheresis, that is, stable (type A), increased rate during blood withdrawal (type B), and irregular pattern (type C). Elderly women donors and donors who suffered from VVRs mostly showed type B fluctuation. There was no particular fluctuation in blood pressure in relation to apheresis cycles.

CONCLUSION : The VVR incidence rate was particularly high in women apheresis donors over 45 years old and increased with repeating cycles of apheresis. Smaller CBV, high sensitivity of low‐pressure baroreceptors, and citrate effects on cardiovascular reflex might be major factors involved in the high incidence of VVRs.
In utero or ex utero cord blood collection: which is better?
Authors: Lasky Larry C. , Lane Thomas A. , Miller John P. , Lindgren Bruce , Patterson Heidi A. , Haley N. Rebecca , Ballen Karen
Published: March 2003

BACKGROUND : The relative nucleated cell count of umbilical cord blood (CB) correlates with improved engraftment and survival. This study compares two collection methods to assess CB content, including cell numbers.

STUDY DESIGN AND METHODS : The Massachusetts CB bank used trained obstetricians and midwives to collect CB in utero before the delivery of the placenta. The banks in California, Ohio, Oregon, and Minnesota used trained American Red Cross (ARC) personnel who collected CB ex utero after the delivery of the placenta. All banks processed CB by RBC sedimentation and volume reduction.

RESULTS : The volume and total nucleated cell count of collected CB before processing, as well as after processing CFU‐GM and CD34+ cells, showed no advantage of either method. In utero collections resulted in more rejections of collected units (due to labeling problems, bacterial contamination, clotting, and delay between collection and processing) than ex utero collections. There were fewer medical exclusions after in utero collection.

CONCLUSION : CB can be collected successfully using either the in utero or ex utero methods; both methods produce comparable nucleated cell, MNC, CD34+, and CFU‐GM numbers. Bacterial contamination, low volume, clotting, and delay until processing are generally higher with in utero collection.
Leukapheresis after high‐dose chemotherapy and autologous peripheral blood progenitor cell transplantation: a novel approach to harvest a second autograft
Authors: Schwella Nimrod , Braun Andrea , Ahrens Norbert , Rick Oliver , Salama Abdulgabar
Published: March 2003

BACKGROUND : Autologous peripheral blood progenitor cells (PBPCs) are usually collected after the administration of conventional‐dose chemotherapy (CDCT) and growth factors. However, there are no data available concerning the collection of PBPCs after high‐dose chemotherapy (HDCT) and autologous hematopoietic transplantation in a larger series.

STUDY DESIGN AND METHODS : Patients (n = 30) underwent leukapheresis for PBPC harvest after CDCT. After HDCT and autografting, the collection of a second PBPC autograft was attempted.

RESULTS
: Leukapheresis was performed after CDCT in all cases at a median of 118 CD34+ cells per μL (range, 18‐589) and resulted in 6.4 × 10
6
CD34+ cells per kg (range, 1.7‐29.0). After HDCT and autografting, 24 patients (80%) underwent secondary leukapheresis, although they had a significantly lower median of peripheral blood (PB) CD34+ cells (30/μL; range, 10‐171; p < 0.001). In these patients a median of 3.6 × 10
6
CD34+ cells per kg (range, 1.6‐10.1) was collected in the post‐transplantation course. In the remaining six patients (20%) with PB CD34+ cells < 10 per μL, no PBPC harvesting was performed. These so‐called poor mobilizers had received significantly less CD34+ cells for autologous transplantation than patients with successful post‐HDCT mobilization (median, 2.5 × 10
6
/kg [range, 1.7‐3.0] vs. 6.5 × 10
6
/kg [range, 3.2‐19.6];
p < 0.001).

CONCLUSION : Collection of PBPCs is possible in most patients during the recovery phase of hematopoiesis after HDCT plus autografting, and the number of circulating PBPCs may be related to the CD34+ cell dose transfused by the preceding autograft.