bluuebunny/crossref_metadata_2025 huggingface dataset:
On willingness to be a bone marrow donor
Authors: Briggs N. C. , Piliavin J. A. , Lorentzen D. , Becker G. A.
Published: March 2003

The authors studied factors that may influence the willingness of apheresis donors to consider bone marrow donation to an unrelated recipient. Donors were sent questionnaires describing bone marrow transplantation and the role of the donor. The information about degree of risk to the donor was varied from low to high risk. Two other factors that might influence donor motivation also were presented: probability of actually being asked to participate (high or low), and “salience of responsibility,” which defines the stress to donate based on the number of persons being asked (large or small group). The degree of risk presented strongly affected willingness to volunteer, but the two motivation factors had no effect. The factor of risk negatively affected women more than men, and negatively affected those with family responsibilities more than single donors. Other findings were: 1) men were more willing then women to donate marrow; 2) those with few donations were among the most willing; and 3) those who knew others who had either needed or provided blood products were also among the most willing.
Use of an enzyme immunoassay for detection of antibody to human immunodeficiency virus in low risk populations
Authors: PEETOOM FRANS ,   THE COOPERATIVE STUDY GROUP
Published: March 2003

Abstract: Antibody to Human Immunodeficiency Virus (HIV) was detected by an enzyme immunoassay (Genetic Systems LAV EIA) in low risk populations from five geographically distinct sites. The assay used virus (LAV) grown in the T‐cell line CEM. In blood and plasma donor populations, 0.4 percent of the samples were initially reactive and 0.2 percent were repeatably reactive. Fourteen of the twenty‐one (67 percent) repeatably reactive specimens were confirmed by immuneprecipitation (RIP). The assay demonstrated 99.9 percent specificity compared to RIP and had a positive predictive value of 67 percent. The data suggest that this test generates a low proportion of false positive EIA results and is highly suitable to screen blood donors.
Detection of antibodies to human T‐lymphotropic virus type 1 (HTLV‐1)
Authors: Fang C.T. , Williams A.E. , Sandler S.G. , Slamon D.J. , Poiesz B.J.
Published: March 2003

Sera from 39,898 blood donors were tested for HTLV‐1 antibodies using two enzyme immunoassays (EIA). Sera testing initially reactive (IR) were retested in duplicate by both EIAs. Sera testing repeatedly reactive (RR) were further tested by two Western blots (WB) and by two radioimmunoprecipitation assays (RIPA). There were 176 (0.44%) EIA IR and 68 (0.17%) RR results. On WBs, 10 of the 68 EIA RR sera demonstrated reactivity to HTLV‐1 gag gene‐encoded core protein p24, with or without reactivity to other core proteins (p19, p28, p53/55). These ten sera were the only ones demonstrating reactivity on RIPAs to other HTLV‐1 gene products ‐ env gene‐encoded glycoproteins gp46, gp61/68, or tat gene‐encoded HTLV‐1 transcriptional activator p40x. These ten sera were interpreted as positive for HTLV‐1 antibodies. Of the remaining 58 EIA RR sera, 21 were negative by WBs and RIPAs, 37 sera demonstrated reactivity to various combinations of p19, p28, and p53/55, but not to p24 on WBs. These 37 sera were interpreted as “indeterminate”, because they were negative by RIPAs. We conclude that: 1) EIA testing and WB/RIPA verification identified 10 (0.025%) HTLV‐1 infected individuals among 39,898 low‐risk blood donors; 2) anti‐p24 may be a more sensitive and specific indicator of HTLV‐1 infection than antibodies to p19, p28, or p53/55; and 3) presently, both WB and RIPA are needed to verify HTLV‐1 EIA reactivity.
An undetectable source of technical error that could lead to false negative results in enzyme linked immunosorbent assay of antibodies to HIV‐1
Authors: WILTBANK T.B. , MCCARROLL D.R. , WARTICK M.G.
Published: March 2003

Since the institution of routine testing for antibodies to Human Immunodeficiency Virus (HIV) using the enzyme‐linked immunosorbent assay (ELISA), the specificity and sensitivity of this assay system has received significant scrutiny. During previous use of this methodology, we have quantified rates of false biological positive results using commercial kit assays in a normal donor population. In this study, we have identified a potential source for false negative results. Using multiple lots of two different commercial ELISA kits, the absorbance readings at the test end point could not differentiate between normal non‐reactive donor samples and blanks containing no sample. These results occur using normal donor samples, even though the assays could distinguish between blank wells and the manufacturers' “normal controls”, provided with the assay. Our findings suggest that a technical pipetting error is presently undetectable, either visually or by statistical methods, and could permit an untested, potentially HIV‐1 positive, unit to be released into the transfusable blood supply. A possible solution is suggested.
The gel test: a new way to detect red cell antigen‐antibody reactions
Authors: Lapierre Y. , Rigal D. , Adam J. , Josef D. , Meyer F. , Greber S. , Drot C.
Published: March 2003

A new process for the detection of red cell (RBC) antigen antibody reactions is described. It is applicable to most of the tests performed in blood group serology. The procedures are standardized and easy, and they provide clear and stable reactions that improve the interpretation of results. The process uses special microtubes filled with a mixture of gel, buffer, and reagent. Depending on the test to be carried out, the test uses a neutral gel containing no reagents (reagents are added to top of gel) or a specific gel containing reagents (e.g., antiglobulin serum or anti‐A, ‐B, ‐D, etc.). A suspension of RBCs (for typing or the direct antiglobulin test) or a mixture of RBCs and serum (for reverse ABO typing or antibody characterization) is centrifuged through the gel under precise conditions. In negative reactions, the RBCs pass through the gel and pellet in the bottom of the tube, whereas, in positive reactions, they are trapped in the gel and the reaction may be read for hours afterwards. The test is easy to perform, sensitive, and reproducible. The antiglobulin tests can be performed without washing of the RBCs. There should be a reduction of risk from biohazardous materials.
Development of a model to demonstrate photosensitizer‐mediated viral inactivation in blood
Authors: Neyndorff H.C. , Bartel D.L. , Tufaro F. , Levy J.G.
Published: March 2003

A model has been developed to demonstrate the use of photodynamic treatment (PDT) to eradicate viral contaminants from donated blood and blood products. Whole blood, spiked with vesicular stomatitis virus (VSV), was treated with the photosensitizer benzoporphyrin derivative‐monoacid ring A (BPD‐MA). After light activation of BPD‐MA, a neutral red dye uptake assay was carried out to determine virus inactivation. Various drug incubation times and light intensities were tested as well as red cell lysis and distribution of VSV in blood. At BPD‐MA concentrations between 2 and 4 μg per mL in whole blood, up to 107 VSV were inactivated. Several photosensitizers were also tested with this model to determine their relative efficacy in viral inactivation.
A study of confidential unit exclusion
Authors: Kean C. A. , Hsueh Y. , Querin J. J. , Keating L. J. , Allensworth D. D.
Published: March 2003

The effectiveness of the confidential unit exclusion (CUE) procedure recommended by the Food and Drug Administration has been questioned by the blood banking community. The purpose of this study was to determine whether donors were informing the blood center correctly regarding the disposition (transfuse or do not transfuse) of their donated blood. A letter explaining the confidential study and requesting permission to send the participant a questionnaire noting his or her self‐exclusion choice was mailed to 230 donors who had chosen transfuse and 276 donors who had chosen do not transfuse. After consent was obtained, participants were sent a second packet and asked to indicate whether they had chosen correctly and, if not, to identify reasons for that incorrect choice. A seven‐word terminology quiz made up of words from the CUE form was also enclosed. All participants who had chosen transfuse indicated that this was the correct choice. Approximately 50 percent of those who had chosen do not transfuse indicated that this was an incorrect choice; the most common reason was that “I was not paying attention.” The most frequently misunderstood term was “confidential.” Donors who chose do not transfuse had a significantly higher rate of error on the terminology quiz (p less than 0.01) than did those who chose transfuse.
Commentary on the safety of red cells preserved in extended‐storage media for neonatal transfusions
Authors: Luban N. L. , Strauss R. G. , Hume H. A.
Published: March 2003

Red cells preserved in extended‐storage media are the standard product dispensed by many regional blood centers. When the red cells are intended for neonatal transfusion, concern exists about the safety of the relatively high quantities of additives present in these media. Definitive studies to address these concerns are not available. Therefore, to estimate the effects of additives and to delineate circumstances in which they might be harmful, the quantities transfused in defined clinical settings were calculated, and the following recommendations are offered for transfusing infants less than 4 months of age. First, red cells preserved in extended‐storage media should present no substantive risks when used for small‐volume (approximately 10 mL/kg) transfusions of premature infants and can be used without additional processing. Second, the risks of the most premature neonatal patients or those with severe renal and/or hepatic insufficiency cannot be defined clearly, and, because data are not available to ensure safety for these infants, removal of the additive medium and resuspension of the red cells in saline or albumin solution immediately before transfusion are recommended. Third, following a similar rationale, it seems prudent to avoid using entire units of red cells preserved in extended‐storage media in massive transfusion settings (e.g., exchange transfusion, cardiac surgery, and extracorporeal membrane oxygenation). In these settings, the preservative medium should be removed and the red cells resuspended in the fluid that is most appropriate for the procedure that is planned. It must be emphasized that these recommendations are based on calculations and hypothetical settings, not actual data. Accordingly, they are tentative and should be altered as definitive information becomes available.
Red cell transfusions in total knee and total hip replacement surgery
Authors: Surgenor DM , Wallace EL , Churchill WH , Hao SH , Chapman RH , Poss R
Published: March 2003

To explore how red cell transfusions were used to support patients who underwent primary and revision hip and knee replacements classified within diagnosis‐related group (DRG) 209 (major joint and limb reattachment procedures), we studied abstracted patient discharge records from 151 United States hospitals in 1986. A total of 9684 units of whole blood and/or separated red cells was used to support 6472 patients. The transfusion use varied by surgical procedure, with patient gender as an influencing factor. Large proportions of patients underwent surgery without requiring transfusion. Among transfused patients, the majority received 1 to 3 units of red cells; however, a minority of patients required multiple transfusions, thereby utilizing a disproportionate share of the blood resource. Comparison of transfusion practice within the seven most active hospitals revealed significant differences (p less than or equal to 0.01) in the percentage of patients actually transfused, but not in the mean number of units of red cell components transfused per transfused patient. Similar findings emerged from comparison of transfusion practice when all hospitals were segregated into five hospital classes on the basis of orthopedic surgical service activity. These effects were seen for both total knee and total hip replacement procedures. It can be concluded that the lack of clearly defined criteria for transfusion contributed to the variations observed.
A prospective study of blood donations in healthy elderly persons
Authors: GARRY P.J. , VANDERJAGT D.J. , WAYNE S.J. , KOEHLER K.H. , RHYNE R.L. , SIMON T.L.
Published: March 2003

Iron stores were observed in 57 healthy elderly volunteers, between 63 and 77 years of age, who donated 5 units of blood over approximately 1 year. An equal number of nondonors who contributed approximately 7 mL of blood at each visit for iron status measurements only were seen at the same frequency as the donor population. At entrance to the study, iron stores in women and men averaged 724 and 875 mg, respectively. After five donations, mean iron stores dropped to 67 mg in women (n = 27) and 362 mg in men (n = 30); four women (15%) became iron deficient, while two (7%) developed iron deficiency anemia. Three men (10%) developed iron deficiency, but none were found to be anemic. Mean intakes of iron were 23.3 and 22.5 mg per day, respectively, for women and men. Iron intakes were adequate to meet iron requirements of nondonors, but they were not sufficient to halt the steady decrease in iron stores among the donor population, in whom iron absorption increased from approximately 5 percent at entrance to 14 percent at the time of the fifth donation. In summary, healthy elderly persons may contribute to the national blood resource; however, donations should probably be limited to less than five per year or donors should regularly take an iron supplement to preserve reasonable amounts of iron reserves.
Postoperative infections following autologous and homologous blood transfusions
Authors: Mezrow C. K. , Bergstein I. , Tartter P. I.
Published: March 2003

Perioperative homologous blood transfusion has been linked to immune suppression and increased risk of postoperative infection. Autologous blood transfusion may not be associated with increased risk of infection because it presumably is not immunosuppressive. Fifty recipients of preoperatively donated autologous blood were matched to 50 recipients of homologous blood who underwent the same procedure, and the hospital course was reviewed for evidence of postoperative infection in both groups. Postoperative leukocytosis and febrile episodes were more common in homologous blood recipients (17 and 6 vs. 12 and 4, respectively). Sixteen percent of the 50 homologous blood recipients had positive cultures, as compared to 4 percent of the 50 autologous blood recipients (p < 0.05). This study suggests that the association of blood transfusion with infection may be partially abrogated by the use of autologous blood.
Blood transfusion and postoperative infection in orthopedic patients
Authors: Fernandez M.C. , Gottlieb M. , Menitove J.E.
Published: March 2003

Adverse effects of the transfusion of homologous blood on tumor recurrence and resistance to bacterial infection have been reported previously, but the findings are inconclusive. A retrospective review of patients undergoing orthopedic surgery was conducted, and the rate of the postoperative infectious complications was compared among those receiving homologous blood, autologous blood, both types, or no transfusion support. An overall postoperative infection rate of 6.1 percent was observed: 6.9 percent among persons receiving homologous blood, 5.0 percent among those receiving autologous blood, 11.9 percent among those receiving both homologous and autologous blood, and 4.9 percent among those not receiving transfusions (p = 0.37). Among patients receiving homologous blood, a subset of 15 patients received homologous whole blood and had an infection rate of 20 percent. Significant predictors of postoperative infection included increasing age, spinal surgery, high admission hematocrit, and greater time in surgery. Of factors relating to transfusion, only the use of homologous whole blood was a significant predictor of postoperative infection, which suggests a detrimental effect of homologous plasma. It can be concluded that, in this group of patients undergoing relatively nontraumatic surgery, several variables that are not related to transfusion, as well as the use of homologous whole blood, were significant predictors of postoperative infection.
Direct identification of Yersinia enterocolitica in blood by polymerase chain reaction amplification
Authors: FENG P. , KEASLER S.P. , HILL W.E.
Published: March 2003

Primers based on the nucleotide sequence of the virF gene in the pYV plasmid and the chromosomal ail gene were used in polymerase chain reaction (PCR) amplifications to directly identify Yersinia enterocolitica in blood. Approximately 500 bacteria seeded into 100 microL of blood can be extracted and amplified by PCR to yield positive results. PCR analyses of seven Y. enterocolitica isolates previously implicated in blood contaminations showed that only one isolate harbored the plasmid‐borne virF gene; however, all seven isolates were identified effectively by the PCR product amplified from the chromosomal gene. The PCR assay has the potential for use in the identification of Y. enterocolitica contamination in stored units of blood or in the rapid diagnosis of transfusion‐related bacteremia caused by Y.
Removal by white cell‐reduction filters of activated platelets expressing CD62
Authors: Pedigo M. , Wun T. , Paglieroni T.
Published: March 2003

White cell (WBC)‐reduction filters that remove more than 99 percent of the WBCs from platelet concentrates are rapidly being introduced into routine use. Using activation‐dependent monoclonal antibodies and flow cytometry, platelet activation was evaluated before and after WBC reduction in 10 platelet concentrates prepared manually from whole blood obtained from five male and five female regular volunteer blood donors. In general no significant increases were found in platelet activation markers after WBC reduction using filters. However, if platelets were activated during preparation, increased numbers of platelets were found expressing the activation marker CD62, and this correlated with the decrease in the platelet count after WBC reduction. These observations may explain increased platelet loss following WBC reduction in some platelet components.
Transfusion transmission of human T‐lymphotropic virus types I and II: serologic and polymerase chain reaction results in recipients identified through look‐back investigations
Authors: Kleinman S. , Swanson P. , Allain J.P. , Lee H.
Published: March 2003

To determine the transmissibility of human T‐lymphotropic virus types I and II (HTLV‐I and HTLV‐II) via transfusion, persons who, from 1983 to 1989, received blood components donated by persons who subsequently tested anti‐HTLV‐I‐positive were evaluated. It was found that 16 (30%) of 54 evaluable recipients of transfused cellular components became infected with one of the HTLVs: 8 had HTLV‐I and 8 had HTLV‐II. Forty percent of platelet recipients and 28 percent of red cell recipients acquired infection. The rate of transmission of HTLV‐I and HTLV‐II was significantly correlated with storage age of red cell units prior to transfusion: 47 percent for red cells stored < or = 14 days and 0 for red cells stored > 14 days (p < 0.01). Multiple confirmatory serologic tests performed in 46 anti‐HTLV‐I enzyme immunoassay‐negative recipients revealed that HTLV infection could not be excluded in 3 recipients of blood components from HTLV‐II‐infected donors. Polymerase chain reaction established HTLV‐II infection in one recipient, and the other two recipients could not be classified with respect to HTLV infection status. It appears that some HTLV‐II‐infected transfusion recipients will not be detected by existing HTLV‐I antigen‐based reagents. If it is deemed necessary to initiate or continue look‐back programs to detect transfusion transmission of HTLV‐II infection, it is suggested that the current testing algorithm be modified in selected cases.
Early transfusion and length of survival in acquired immune deficiency syndrome: experience with a population receiving medical care at a public hospital
Authors: Vamvakas E. C. , Kaplan H. S.
Published: March 2003

An extensive body of literature has attributed an immunosuppressive, and potentially deleterious, effect to blood transfusion. The possibility of a deleterious effect of transfusion on the subsequent survival of acquired immune deficiency syndrome (AIDS) patients was investigated in a public hospital‐based cohort of 569 AIDS patients not treated with zidovudine and followed in a retrospective cohort study. With controls for the effects of baseline anemia, mode of initial disease manifestation of AIDS, most prevalent cause of death, and several other morbidities, a highly significant (p < 0.001) reduction was observed in the subsequent length of survival associated with the transfusion of packed red cells in the first trimester of the illness. However, when the most stringent assumptions with regard to control for illness severity were applied, this association was marginally significant (p = 0.055) only when transfusion was analyzed as a categorical variable. Analysis of transfusion as a continuous variable in this latter case failed to demonstrate a significant association. In this way, the findings substantiated but did not prove the hypothesis that the transfusion of packed red cells may be detrimental in patients with AIDS. There is a need for an experimental study directly comparing currently available alternative technologies to the transfusion of packed red cells to resolve the issue.
Rapid freezing of whole blood or buffy coat samples for polymerase chain reaction and cell culture analysis: application to detection of human immunodeficiency virus in blood donor and recipient repositories
Authors: Adams M. , Lee T‐H. , Busch M.P. , Heitman J. , Marshall G.J. , Gjerset G.F. , Mosley J.W. ,   Transfusion Safety Study Group
Published: March 2003

Storage of lymphocytes for later use in prospective epidemiologic studies of blood donors and transfusion recipients has been limited by the cost of separating peripheral blood mononuclear cells (PBMCs). When the Transfusion Safety Study began in 1985, it was decided to establish a cell repository of cryopreserved buffy coat (BC) samples, and thus far over 20,000 samples have been accumulated from enrolled subjects. To determine if these specimens could be used for polymerase chain reaction, a simple thawing and pelleting technique for recovering hemoglobin‐free total white cells (WBCs) was developed. To validate the technique, parallel analysis was conducted of BCs, whole blood (WB), and PBMC samples from human immunodeficiency virus type 1 (HIV‐1)‐seropositive subjects. Immediate postthaw cell courts of 29 frozen‐thawed (F‐T) WB and BC samples averaged 90 percent of the prefreeze (input) values. Representative WBC populations were obtained by immediate pelleting. Amplification of HIV‐1 gag sequences from F‐T BCs and F‐T WB was 94 and 75 percent, respectively, which is as sensitive as that obtained with freshly separated PBMC lysates. Quantitative HIV‐1 proviral load analysis by serial dilution of 23 F‐T BCs and 8 WB lysates showed results comparable to those obtained with lysates of fresh PBMCs. Values for WBC differential and immunophenotyping could be applied to express viral load relative to total WBCs, PBMCs, or CD4+ cells. These results establish the basis for simplified virologic analysis of cryopreserved BC or WB specimens.
Human T‐lymphotropic virus (HTLV) types I and II infection in sexual contacts and family members of blood donors who are seropositive for HTLV type I or II
Authors: Sullivan M.T. , Williams A.E. , Fang C.T. , Notari E.P. , Poiesz B.J. , Ehrlich G.D. ,   American Red Cross HTLV‐I/II Collaborative Study Group
Published: March 2003

Interviews and laboratory testing were conducted for 168 contacts referred by former blood donors identified as seropositive for antibody to human T‐lymphotropic virus type I (HTLV‐I) or type II (HTLV‐II). Thirty‐two (28%) of 114 heterosexual contacts of seropositive donors, including 12 women and 20 men, were found to be antibody positive. None of 40 offspring (except one adult man who reported sexual contact in Puerto Rico) or 14 other (nonspousal) family members were seropositive. Thirty‐one of the seropositive contacts were typeable as having either HTLV‐I (52%) or HTLV‐II (48%). Assessment of couples found that the median duration of the sexual relationship was significantly longer (p = 0.03) for those in which both partners were infected than in discordant pairs. Analysis of risk history data for 22 infected couples revealed that, in three cases, risk factors (Japanese ancestry or sexual contact with an injecting drug user) could be identified in the women, but not in their male partners. Among couples in which the male had the greater risk history, the risk factor was either a history of transfusion, birth or sexual exposure in an endemic area, or injected drug use. Counseling strategies for individuals with HTLV‐I or HTLV‐II infection should take into account the relatively high seroprevalence in their partners and should address the potential for sexual transmission in both directions.
Efficacy of preoperative donation of blood for autologous use in radical prostatectomy
Authors: Toy P.T. , Menozzi D. , Strauss R.G. , Stehling L.C. , Kruskall M. , Ahn D.K.
Published: March 2003

To determine the amount of blood lost, the number of transfusions, and the effectiveness of preoperative autologous blood donation in radical prostatectomy, 163 patients' records from 1987 to 1991 were reviewed at four university hospitals and three community hospitals. Calculated red cell volume lost was 1003 ± 535 mL (mean ± SD), which corresponds to 44 ± 18 percent (mean ± SD) of total red cell volume. Preoperative donation of blood for autologous use reduced the rate of transfusion of allogeneic blood from 66 to 20 percent (p < 0.001). Of the patients who donated 1 to 2 units, 32 percent received allogeneic blood; 14 percent of those who donated 3 units received allogeneic blood. Donation of 4 units reduced the allogeneic transfusion rate to 11 percent. However, as the number of units donated increased (1–3 units), the units not transfused also increased (0–21%). Ninety‐one (56%) of 163 patients donated fewer than 3 units. Autologous blood donation is effective in minimizing the transfusion of allogeneic blood to radical prostatectomy patients, but many patients do not donate enough blood (< 3 units). The donation of 3 units of blood for autologous use is recommended for patients who undergo radical prostatectomy.
Effect on platelet properties of exposure to temperatures below 20°C for short periods during storage at 20 to 24°C
Authors: Moroff G. , Holme S. , George V.M. , Heaton W.A.
Published: March 2003

Background: When platelet concentrates (PCs) are shipped over long distances, it is not always possible to ensure that their temperature is maintained at 20 to 24°C. In addition, PCs are not agitated as during routine storage.

Study Design and Methods: Studies have been conducted to evaluate how exposure to temperatures below 20°C in the absence of agitation influences properties of platelets. In initial studies, exposure to 4°C for 3 or 5 hours or to 12°C for 5 or 17 hours on Day 2 of a 5‐ to 6‐day storage period was associated with a loss of discoid shape. This was reflected by slightly lower but statistically different morphology scores after storage compared to those observed with control platelets that were stored only at 20 to 24°C. In addition, a qualitative difference in morphology was noted in controls and PCs held at 16°C for 17 hours. In more detailed studies, both the in vivo viability and in vitro properties of platelets exposed between Day 1 and Day 2 to either 12°C or 16°C for 17 hours were evaluated. The protocol involved a paired study design (n = 4 for each exposure temperature) with the simultaneous storage of two identical PCs, one exposed to 12 or 16°C and the other one maintained at 20 to 24°C throughout the 5‐day storage.

Results: Exposure to 12°C significantly reduced (p < 0.05 by paired t test) the in vivo recovery to 37.6 ± 13.8 percent (mean ± 1 SD) from 47.8 ± 11.5 percent and the survival time to 2.0 ± 0.3 days from 6.5 ± 1.4 days. On exposure to 16°C, the differences in viability from those of control units were much less but still significant. The in vivo recovery was 42.7 ± 3.8 percent compared to 49.2 ± 3.0 percent and the survival time was 3.5 ± 1.2 days compared to 6.6 ± 0.3 days. The loss of in vivo viability of the test platelets was associated with a loss of discoid shape, as reflected by morphology scores, extent of shape change, and mean platelet volume. In addition, platelet metabolism also appeared to be affected, as suggested by increased lactate production. All of the in vitro properties except for total ATP and residual glucose that were statistically different from those of controls on exposure to 12°C were also significantly different on exposure to 16°C.

Conclusion: These findings demonstrate that platelets undergo substantial changes in in vivo viability and in vitro properties when they are exposed to temperatures below 20°C for short periods.
In vitro characteristics of white cell‐reduced single‐unit platelet concentrates stored in syringes
Authors: Pisciotto P.T. , Snyder E.L. , Snyder J.A. , Frattaroli S. , Hopfer S.M. , Rinder H.M. , Smith B.R.
Published: March 2003

BACKGROUND: Platelet concentrates (PCs) for premature infants may be subjected to filtration, centrifugation, and various storage conditions before transfusion.

STUDY DESIGN AND METHODS: As there are few data on the cumulative effect of these procedures on PCs, platelet properties (including biochemical and functional in vitro assays) were evaluated after the processing of single units of PCs through a 1‐unit‐capacity high‐efficiency white cell (WBC)‐reduction filter followed by syringe storage at either 22 or 37 degrees C for 6 hours. Two‐ and 5‐day‐old PCs, volume‐reduced PCs, and prestorage WBC‐reduced PCs were evaluated.

RESULTS: WBC filtration consistently resulted in a 3 to 4 log10 reduction in WBCs, with less than 15‐percent platelet loss. No adverse effects of platelet function or evidence of increased platelet activation as determined by the percentage of P‐selectin positivity were noted. A decrease in pH associated with increased lactate production and consumption of glucose was observed following syringe storage under all conditions tested. Such changes were most pronounced, however, with volume‐reduced PCs stored at 37 degrees C (pH 6.31 ± 0.15, lactate 23.0 ± 3.06 mmol/L). All pH levels at the end of storage were above the minimum Food and Drug Administration requirement (pH 6.0).

CONCLUSION: The in vitro data suggest that single units of PCs can undergo WBC filtration followed by syringe storage for up to 6 hours and still maintain acceptable storage characteristics. The practice of maintaining volume‐reduced PCs in syringes for 6 hours at 37 degrees C in isolettes during transfusion should, however, be avoided.
Storage of apheresis platelets after gamma radiation
Authors: SWEENEY J.D. , HOLME S. , MOROFF G.
Published: March 2003

BACKGROUND: There are conflicting data on the effect of irradiation and subsequent storage on the quality of platelet components.

STUDY DESIGN AND METHODS: The retention of platelet properties during storage of gamma‐irradiated apheresis suspensions was studied in 22 apheresis components obtained on a cell separator with a specialized centrifugation chamber. Immediately after collection, each suspension was divided equally into two 1‐L polyolefin containers. On Day 1 (n = 12) and Day 3 (n = 10) one of each pair of suspension containers was gamma radiated with 2500 cGy. All platelet suspensions were stored for 5 days at 20 to 24 degrees C. Samples were drawn on Day 5 from each of the 22 pairs of containers for evaluation of an array of in vitro properties. Samples were taken from 10 pairs of containers for platelet labeling with either 51Cr or 111In for subsequent transfusion and concurrent in vivo measurement of recovery and survival. Posttransfusion samples were drawn after 24 hours for ex vivo whole blood aggregation.

RESULTS: Comparable in vitro and in vivo properties were measured in irradiated and control platelets, whether irradiation was performed on Day 1 or Day 3. The mean +/− 1 SD in vivo recovery and survival time for controls and platelets irradiated on Day 1 was 52 +/− 14 percent and 146 +/− 34 hours and 51 +/− 7 percent and 147 +/− 36 hours, respectively. For Day 3 irradiation, the values were 46 +/− 12 percent and 150 +/− 60 hours and 47 +/− 9 percent and 151 +/− 53 hours, respectively. A small, but measurable adverse effect of irradiation on ex vivo platelet aggregation was present.

CONCLUSION: These data indicate that storage of apheresis platelets after gamma radiation is without clinically significant, demonstrably adverse effects on platelet quality.
NA gene frequencies in the German population, determined by polymerase chain reaction with sequence‐specific primers
Authors: Bux Jiirgen , Stein Ernst‐Ludwig , Santoso Sentot , Mueller‐Eckhardt Christian
Published: March 2003

BACKGROUND: The granulocyte antigens NA1 and NA2 are often targets of granulocyte antibodies causing immune neutropenia. Currently, NA typing relies on the properties of the typing sera or antibodies and the techniques used. Therefore, the technique of polymerase chain reaction with sequence‐specific primers (PCR‐SSP) was adapted for DNA‐based NA typing and was used for determining the NA gene frequencies in the German population. STUDY DESIGN AND METHODS: The genomic DNA of 160 unrelated healthy individuals was typed for NA1 and NA2 by PCR‐SSP. In 60 granulocyte samples, the NA phenotype was additionally determined by the antigen capture assay and the granulocyte immunofluorescence test (GIFT) and correlated with the genotyping results. RESULTS: Results of the antigen capture assay and PCR‐SSP correlated precisely, whereas nine individuals were typed heterozygous only by GIFT. The gene frequencies were 0.35 for NA1 and 0.65 for NA2. CONCLUSION: The NA2 gene is more frequent in the German population than the NA1 gene, as determined by genotyping using PCR‐SSP. In contrast to GIFT, which showed an error rate for NA typing of 15 percent, PCR‐SSP and the antigen‐capture assay are more reliable methods of NA typing of granulocytes.
Time course of detection of viral and serologic markers preceding human immunodeficiency virus type 1 seroconversion: implications for screening of blood and tissue donors
Authors: BUSCH M.P. , LEE L.L.L. , SATTEN G.A. , HENRARD D.R. , FARZADEGAN H. , NELSON K. E. , READ S. , DODD R.Y. , PETERSEN L.R.
Published: March 2003

BACKGROUND: Almost all human immunodeficiency virus (HIV) transmission via blood or tissues that has occurred since anti‐HIV screening was implemented in 1985 is traceable to blood given after infection but before antibody seroconversion, a time that is referred to as the window period. In this study, the performance of newer assays designed to detect viral and serologic markers soon after infection is assessed, and the reduction in the window period achieved by these assays is estimated. STUDY DESIGN AND METHODS: Three cohort studies of persons at high risk for acquiring HIV infection were identified. These studies included well‐controlled HIV type 1 (HIV‐1) polymerase chain reaction (PCR) analyses of serial preseroconversion specimens from HIV‐1‐ seroconverting homosexual men or intravenous drug users. Of 81 enrollees with anti‐HIV‐1 seroconversion documented by a viral lysate anti‐HIV‐1 enzyme immunosorbent assay (EIA) available in 1989, 13 (16%) had PCR‐positive preseroconversion specimens. In the present study, sera from these 13 PCR‐positive samples were further tested for anti‐ HIV by 10 contemporary EIAs and 6 supplemental assays, as well as being tested for plasma p24 antigen and HIV‐1 RNA. Preseroconversion sera from 38 HIV‐1 DNA PCR‐negative cohort participants were also tested by selected anti‐HIV EIAs and tested for p24 antigen and HIV‐1 RNA. On the basis of these laboratory data and the intervals between blood drawing in all 81 men, the reduction in the preseroconversion window period achieved by these new assays was estimated with a mathematical model developed to analyze seroconversion data. RESULTS: Nine (69%) of the 13 preseroconversion PCR‐positive samples had anti‐HIV that was detectable by one or more contemporary anti‐HIV‐1 or anti‐HIV type 2 EIA. Supplemental antibody assays were negative on all four EIA‐nonreactive preseroconversion samples and negative or indeterminate on a high proportion of the nine EIA‐reactive PCR‐positive samples. Eight (61%) of the 13 samples were p24 antigen‐positive, and 11 (85%) were HIV‐1 RNA‐positive. The estimated reductions in the window period (relative to the index viral lysate‐based anti‐HIV EIA) were as follows: contemporary anti‐HIV‐1/2 EIAs, 20.3 days (95% Cl, 8.0–32.5); p24 antigen and DNA PCR, 26.4 days (95% Cl, 12.6–38.7); and RNA PCR, 31.0 days (95% Cl, 16.7–45.3). CONCLUSION: Recent improvement in the sensitivity of anti‐HIV assays has resulted in significant shortening of the preseroconversion window period. Consequently, the incremental reduction in the window period that could be achieved by implementing direct virus‐detection assays has diminished significantly.
Identification of variant glycophorins of human red cells by lectinoblotting: application to the Mi.III variant that is relatively frequent in the Taiwanese population
Authors: Wu A. M. , Duk M. , Lin M. , Broadberry R. E. , Lisowska E.
Published: March 2003

BACKGROUND: Detection of normal and variant glycophorin electrophoretic bands with T‐ and Tn‐specific lectins is based on the possibility of glycophorin transformation into T or Tn antigens by simple chemical modifications in the blot.

STUDY DESIGN AND METHODS: Human red cell membrane proteins were fractionated by sodium dodecyl sulfate‐ polyacrylamide gel electrophoresis and blotted onto nitrocellulose. The blots were submitted to mild acid hydrolysis (desialylation of glycophorins exposing T antigens) and then to Smith degradation (degalactosylation of asialo‐glycophorins exposing Tn antigens). The modified glycophorin bands were detected with biotinylated lectins and horseradish peroxidase‐conjugated avidin.

RESULTS: The lectins from Artocarpus integrifolia (jacalin, anti‐T/Tn), Amaranthus hybridus (anti‐ T), Salvia sclarea (anti‐Tn), and Vicia villosa (anti‐Tn) were used. The lectins detected normal glycophorin bands in control and variant red cells and characteristic additional bands in Mi.III (GP.Mur) red cells. The sensitivity of the method is comparable to that obtained by immunoblotting with glycophorin monoclonal antibodies. Comparison of the electrophoretic mobility of normal and variant bands is helpful in the classification of glycophorin variants.

CONCLUSION: Lectinoblotting, based on carbohydrate recognition, enables the detection in a red cell sample, with high sensitivity, of all normal and variant glycophorin bands. The method can be also applied to other purposes, such as the identification of poly‐O‐glycosylated glycoproteins in other cells or the characterization of glycosylation of glycophorins and other poly‐O‐glycosylated proteins.
Platelet membrane glycoproteins and microvesicles in blood from postoperative salvage: a study in cardiac bypass patients
Authors: Sloand E. , Alyono D. , Yu M. , Klein H.
Published: March 2003

BACKGROUND: Transfusion of blood collected by intraoperative and postoperative salvage systems has been linked to the development of thrombocytopenia and disseminated intravascular coagulation. Although functional defects have been reported in platelets from unwashed salvaged blood, platelet membrane glycoprotein (GP) composition, a potentially important determinant of function and survival, has not been studied.

STUDY DESIGN AND METHODS: Platelets from 22 patients whose blood was salvaged at the completion of surgery were analyzed and compared to platelets obtained from the venous blood from the same patient. Platelet membranes were stained with fluorescein isothiocyanate‐conjugated CD41a monoclonal antibody (anti‐GPIIb/IIIa) to identify platelets, a phycoerythrin‐conjugated monoclonal antibody, CD62 (anti‐P‐selectin) to identify activated platelets, and CD42b (anti‐ GPIb) or anti‐GPIb/IX to assess GPIb. Samples were analyzed with a flow cytometer using software.

RESULTS: Platelets obtained from salvaged blood demonstrated lower GPIb expression (CD42b and GPIb/IX monoclonal antibody binding), higher P‐selectin expression, and greater numbers of platelet‐derived microvesicles.

CONCLUSION: The clinical significance of transfusing blood containing activated platelets and microvesicles merits investigation.
Characterization of reactions after transfusion of cellular blood components that are white cell reduced before storage
Authors: Federowicz I. , Barrett B. B. , Andersen J. W. , Urashima M. , Popovsky M. A. , Anderson K. C.
Published: March 2003

Background: During the storage of cellular components before transfusion, cytokines that may mediate transfusion reactions are released from white cells (WBCs). Adverse effects of transfused cellular blood components therefore depend not only on the number of residual WBCs in blood components, but also on the timing of WBC reduction.

Study Design and Methods: Febrile nonhemolytic transfusion reactions (FNHTRs), allergic reactions, and other reactions were characterized in recipients of 4728 units of red cells (RBCs) and 3405 bags of single‐donor apheresis platelets (SDAPs), all of which underwent prestorage WBC reduction. To delineate the impact of prestorage versus poststorage WBC reduction of RBCs on transfusion reactions, these results were compared with reactions occurring after the transfusion to similar recipients of 6447 bags of RBCs that underwent poststorage WBC reduction by bedside filtration and 5197 units of SDAPs that underwent prestorage WBC reduction. The levels of interleukin (IL) 1 beta, IL‐6, IL‐8, and tumor necrosis factor‐alpha (TNF‐alpha) were measured in a subset of 20 implicated cellular blood components at the time of transfusion reactions and correlated with the duration of storage before transfusion.

Results: The incidence of reactions was greater after transfusions of SDAPs (5.49%) than of RBCs (1.63%). The incidence of FNHTRs after transfusion of RBCs that were WBC reduced before storage (1.1%) was significantly lower (p = 0.0045) than that after transfusion of RBCs that were WBC reduced after storage (2.15%). Although allergic reactions to RBCs that were WBC reduced before storage were also less common (0.41%) than those to RBCs that were WBC reduced after storage (0.51%), the difference was not significant (p = 0.067). At the time of reactions to RBCs and SDAPs that were reduced before storage, the level of IL‐6 was negatively correlated (r = ‐0.54, p = 0.014) with the duration of storage before transfusion, and there was no correlation between the level of either IL‐1 beta or IL‐8 and the interval before transfusion. TNF‐alpha was not detectable in any implicated component.

Conclusion: FNHTRs, but not allergic reactions, were less common after transfusion of RBCs that were WBC reduced before storage than after the transfusion of those WBC reduced after storage at the bedside by filtration. The level of IL‐6 in implicated cellular blood components that were WBC reduced before storage was inversely correlated with the length of storage before transfusion. Further studies are needed to determine whether the transfusion of cellular blood components that were WBC reduced before storage can both diminish the incidence of adverse reactions and improve outcome.
The predictors of red cell transfusions in total hip arthroplasties
Authors: Nuttall G. A. , Santrach P. J. , Oliver W. C. , Horlocker T. T. , Shaughnessy W. J. , Cabanela M. E. , Bryant S.
Published: March 2003

BACKGROUND: Most blood crossmatched in a hospital blood bank is for surgical patients, and the majority is never transfused. The maximal standard blood order schedule is used to promote efficient ordering practices for surgical patients.

STUDY DESIGN and METHODS: To ascertain the predictors of red cell transfusions for patients undergoing total hip arthroplasty, the charts of 299 adult patients undergoing primary and revision total hip arthroplasty were reviewed. A surgical blood order equation was developed for calculating the number of units of red cells that should be ordered. Stepwise regression analysis was used to determine which patient‐and‐case‐related variables should be considered in the surgical blood order equation.

RESULTS: The significant indicators for allogeneic red cell transfusion to patients on the day of total hip arthroplasty were preoperative hemoglobin concentration, weight, age, estimated blood loss, and aspirin use. The surgical blood order equation would result in a lower crossmatch‐to‐transfusion ratio than would the maximal standard blood order schedule (1.23 vs. 3.14). Costs were also lower with the surgical blood order equation.

CONCLUSION: Incorporation of patient factors resulted in increased efficiency of blood‐ordering practices in total hip arthroplasty.
Loss of volunteer blood donors because of unconfirmed enzyme immunoassay screening results. Retrovirus Epidemiology Donor Study
Authors: Ownby H.E. , Korelitz J.J. , Busch M.P. , Williams A.E. , Kleinman S.H. , Gilcher R.O. , Nourjah P. ,   The Retrovirus Epidemiology Donor Study
Published: March 2003

BACKGROUND: Blood donors who test repeatably reactive on enzyme immunoassay (EIA) and are not confirmed as positive are a continuing problem for blood banks. Units are discarded and donors are deferred, in spite of multiple studies indicating that such donors are very rarely infected with the transmissible agents. Few data are available, however, with which to evaluate whether the discarded units are more likely to come from particular demographic subgroups. STUDY DESIGN AND METHODS: The Retrovirus Epidemiology Donor Study database of over 2 million allogeneic whole‐blood donations collected in the years 1991 through 1993 was utilized. The prevalence of false‐positive and indeterminate test results within demographic subgroups was computed for antibodies to human immunodeficiency virus, hepatitis C virus, and human T‐lymphotropic virus (anti‐HIV, anti‐HCV, anti‐HTLV, respectively) and hepatitis B surface antigen (false‐positive only) as the proportion of donations that were repeatably reactive on EIA but negative or indeterminate on the confirmatory or supplemental test. RESULTS: Several demographic groups with increased prevalence of false‐ positive and indeterminate anti‐HIV results were the same females, younger age groups, blacks, and first‐time donors. Likewise, many of the demographic subgroups with increased prevalence of false‐positive and indeterminate anti‐HCV results were similar: older age groups, non‐ whites, lower education levels, first‐time donors, donors making directed donations, and donors who had received transfusions. For anti‐ HTLV, by contrast, the oldest group had the highest prevalence of false‐ positive results but the lowest prevalence of indeterminate results: blacks had the lowest prevalence of false positive results but the highest prevalence of indeterminate results. CONCLUSION: If units that test repeatably reactive on EIA but that are not confirmed as positive are almost always from individuals not infected with the virus in question, then these results indicate that there may be sex‐, race‐, and/or age‐linked proteins cross‐reacting with the test kit materials. Elucidation of these antigenic determinates and their subsequent removal should be a priority.