bluuebunny/crossref_metadata_2025 huggingface dataset:
Low incidence of HTLV infections in random blood donors with indeterminate Western blot patterns
Authors: Kwok S. , Lipka J.J. , McKinney N. , Kellogg D.E. , Poiesz B. , Foung S.K.H. , Sninsky J.J.
Published: March 2003

Peripheral blood mononuclear cells (PBMCs) were recovered from platelet units of 61 blood donors who were HTLV‐I positive and 3 blood donors who were HTLV‐I negative on enzyme‐linked immunosorbent assay (ELISA). Western blot analyses were performed on the sera and DNA was prepared from the PBMCs and analyzed by the polymerase chain reaction (PCR). Of the 61 repeatably reactive samples, 2 were positive, 26 were negative, and 33 were interpreted as indeterminate on Western blot. HTLV‐II sequences were detected by PCR in one of the Western blot‐positive samples, as well as in one Western blot‐indeterminate sample that showed reactivity to p24 only. HTLV‐I sequences were detected in the second Western blot‐positive sample. HTLV sequences were not detected in the remaining samples, which suggested that the majority of individuals with indeterminate results on Western blots that used one set of commercially available reagents are not infected with HTLV. It is demonstrated in this study that PCR can be used not only to resolve the infection status of individuals with indeterminate Western blots but also to distinguish between HTLV‐I and HTLV‐II.
Translumbar inferior vena cava catheters: safety and efficacy in peripheral blood stem cell transplantation
Authors: Haire W.D. , Lieberman R.P. , Lund G.B. , Wieczorek B.M. , Armitage J.O. , Kwessinger A.
Published: March 2003

Most patients who need peripheral blood stem cell transplantation do not have peripheral venous access that would allow apheresis for stem cell collection. Subclavian apheresis catheters have an unacceptably high incidence of thrombosis‐related access failure. A technique has been developed for translumbar placement of permanent, subcutaneously tunneled, silicone rubber apheresis catheters into the inferior vena cava, and 40 of these catheters have been placed in 36 patients for stem cell collection. Twenty‐six catheters have been left in place for venous access during the transplantation procedure. These catheters had a very low rate (2.3%) of apheresis‐related complications. Access failure was attributed to thrombosis in 10 catheters (25%) and to mechanical complications in another 9 (22%), but access was regained in all but 4 of these cases. The catheters functioned well as venous access devices during transplantation, only rarely developing complications during that time. Venograms performed at the time of removal of 16 catheters showed no case of caval occlusion. A residual fibrin sheath was found around 14 catheters. There was no clinical or computed tomographic scan evidence of bleeding after placement or removal of the catheters. Percutaneously placed, translumbar inferior vena cava apheresis catheters provide a safe and effective route for the collection of peripheral blood stem cells for transplantation, and they can be left in place for venous access during transplantation.
The use of tri(n‐butyl)phosphate detergent mixtures to inactivate hepatitis viruses and human immunodeficiency virus in plasma and plasma's subsequent fractionation
Authors: Piët M.P.J. , Chin S. , Pprince A.M. , B.rotman B. , Cundell A.M. , Horowitz B.
Published: March 2003

The treatment of plasma with organic solvent/detergent mixtures at the time of plasma collection or pooling could reduce the exposure of technical staff to infectious viruses and enhance the viral safety of the final product. Treatment of plasma for 4 hours with 2‐percent tri(n‐ butyl)phosphate (TNBP) at 37°C, with 1‐percent TNBP and 1‐ percent polyoxyethylensorbitan monooleate (Tween 80) at 30°C, or with 1‐percent TNBP and 1‐percent polyoxyethylene ethers, (Triton X‐ 45) at 30°C resulted in the rapid and complete inactivation of ≥ 104 tissue culture‐infectious doses (TCID50) of vesicular stomatitis and Sindbis viruses, which are used as surrogates. Treatment of plasma with TNBP and TNBP and Tween‐80 was shown to inactivate ≥ 104 TCID50 of human immunodeficiency virus. TNBP treatment of plasma contaminated with 106 chimpanzee‐infectious doses (CID50) of hepatitis B virus and 105 CID50 of non‐A, non‐B hepatitis virus prevented the transmission of hepatitis to chimpanzees. Immediately after treatment of plasma with 2‐percent TNBP, the recovery of factors VIII, IX, and V and antithrombin III was 80, 90, 40, and 100 percent, respectively. Recovery of all factors was ≥ 90 percent after treatment with TNBP and detergent mixtures. Treated plasma was fractionated by standard techniques into antihemophilic factor and prothrombin complex concentrates, immune globulin, and albumin. Prior treatment with TNBP or TNBP and detergent did not affect the separations of desired proteins. Therefore, it appears possible to inactivate viruses in plasma before the execution of standard fractionation procedures.
No evidence of frequent human immunodeficiency virus type 1 infection in seronegative at‐risk individuals
Authors: Lefrère J. J. , Mariotti M. , Vittecoq D. , Noel B. , Couroucé A. M. , Lambin P. , Salmon C. , Rouger P.
Published: March 2003

The possible existence of human immunodeficiency virus type 1 (HIV‐1) infection in asymptomatic seronegative at‐risk individuals was investigated in a prospective study of 55 seronegative high‐risk individuals (42 homosexual men and 13 heterosexual individuals) and 32 seronegative hemophiliacs treated with factor VIII or IX concentrates before viral inactivation by heat treatment and systematic screening of blood donations. Tests used include the polymerase chain reaction assay with three primer pairs (one in the gag region and two in the pol region) and tests for serum p24 antigen, anti‐nef serology (Western blot), and five biologic markers frequently altered by HIV infection (CD4 lymphocyte count, serum beta 2‐microglobulin and neopterin concentration, and serum IgG and IgA concentration). Although 91 of 92 HIV‐1‐seropositive persons were positive in testing with at least one primer pair, no positive result was observed in seronegative at‐risk individuals or in 117 seronegative low‐risk controls. No nef antibody was found in seronegative at‐risk individuals or seronegative controls, but 44 (47%) of 92 HIV‐1‐seropositive persons had nef antibodies. These findings do not support the existence of frequent HIV‐1 infection in seronegative at‐risk individuals.
Transfusion practice in central Virginia
Authors: Cook S. S. , Eppsz J.
Published: March 2003

Increasing concern about the safety of transfusions and a desire to balance blood supply and blood needs stimulated a regional blood center to study the utilization of blood, rather than simply looking at distribution. A comprehensive survey of transfusion use, including packed red cells (RBCs), fresh‐frozen plasma (FFP), and platelets (PLTs), was conducted in 12 Central Virginia hospitals. The medical records of 2579 transfused patients showed that the principal diagnoses in 23 percent of patients involved diseases of the circulatory system and those in 16 percent involved neoplasms, as classified under the diagnosis‐related groups. Sixty‐six percent (n = 1691) of patients had some type of surgery, with surgical patients overall using 1.9 times as many units of blood (RBCs, FFP, and PLTs) as nonsurgical patients. Mean patient age was 61 years, and the male:female ratio was 48:52 percent. This descriptive analysis of regional blood utilization has facilitated planning for local blood needs, provided indicators for areas of largest blood use, and given this region and others baseline data for future comparison.
Complement activation by artificial blood substitute Fluosol: in vitro and in vivo studies
Authors: Hhong F. , Shastri K.A. , Logue G.L. , Spaulding M.B.
Published: March 2003

A perfluorocarbon blood substitute, Fluosol, is undergoing clinical trials as an adjunct to chemotherapy. The adverse effects associated with its administration have been postulated to result from complement activation. When gel electrophoresis and Western blotting of Fluosol are used after its incubation with serum, activated C3 and factors Bb and H are bound to the Fluosol particles in a time‐dependent fashion, which suggests that complement activation with Fluosol, as does that with zymosan, occurs on the surface of the particles. Paradoxically, it is found, both by the measurement of Fluosol‐bound C3d and by fluid‐ phase C5a, that lower concentrations of Fluosol cause greater amounts of complement activation, which suggests a complex interaction of activators and inhibitors that changes as the available surface area is decreased. Studies performed with bystander red cell‐bound C3d demonstrated in vivo complement activation occurring in six patients receiving Fluosol as an adjunct to chemotherapy for colon cancer. In two patients, there was a marked increase in red cell‐bound C3d after Fluosol infusion; these two patients also developed adverse reactions during Fluosol infusion. These studies suggest that the Fluosol surface plays a major role in the initiation and regulation of complement activation that is seen during Fluosol infusion.
Safety of blood donations following a natural disaster
Authors: Busch M.P. , Guiltinan A. , Skettino S. , Cordell R. , Zeger G. , Kleinman S.
Published: March 2003

To evaluate the relative safety of blood donations given in response to a major disaster, donor demographics and infectious disease test results were compared for donations made during the 10 days following the October 17, 1989, San Francisco Bay Area earthquake and those made during the preceding 6 months. These comparisons were made for donations given to the regional blood center in the area that was immediately affected by the disaster (Irwin Memorial Blood Centers) and for those given in an unaffected region (Los Angeles/Orange Counties Region, American Red Cross Blood Services). The rate of donation increased more than 200 percent during the 5 days following the earthquake in both the disaster‐affected and unaffected regions. Both the disaster‐affected and unaffected regions observed significant increases in the proportions of donations by first‐time donors, by persons aged 20 to 39 years, and by women. The rates of confirmed positivity for infectious disease markers for post‐earthquake donations did not differ significantly from rates for homologous donations given during the preceding 6 months, particularly when the rates were adjusted for the increased representation of first‐time donors. Approximately 39 percent of post‐earthquake first‐time donors gave blood again within the following 6‐month period. It is concluded that donations given after major disasters are essentially as safe as routine donations and that active efforts to recruit these donors again can be undertaken without reservation
A case of transfusion‐associated graft‐versus‐host disease not prevented by white cell‐reduction filters
Authors: Akahoshi M. , Takanashi M. , Masuda M. , Yamashita H. , Hidano A. , Hasegawa K. , Kasajima T. , Shimizu M. , Motoji T. , Oshimi K. , Mizoguchi H.
Published: March 2003

A case of transfusion‐associated graft‐versus‐host disease (TA‐GVHD) in a patient with non‐Hodgkin's lymphoma is reported. The patient, a 67‐year‐old woman, was diagnosed as having diffuse, mixed type non‐Hodgkin's lymphoma, at clinical stage IMA. She was treated with combination chemotherapy and received multiple blood transfusions for anemia and thrombocytopenia. Although white cells (WBCs) were reduced in the transfused components by WBC‐reduction filters, the patient developed TA‐GVHD that was confirmed by skin biopsy. It is suggested that the WBC reduction attained with these filters does not prevent TA‐GVHD in immunocompromised patients. It is recommended that all blood components should be irradiated before transfusion to such patients.
Autoimmune hemolytic anemia associated with anti‐Sc1
Authors: Owen I. , Chowdhury V. , Reid M.E. , Poole J. , Marsh J.C.W. , Hows J.M.
Published: March 2003

A case of autoimmune hemolytic anemia (AIHA) in a young child is described. The hemolysis was resistant to steroid therapy but responded to splenectomy and intravenous immunoglobulin. The autoantibody was shown to be anti‐Sci by both serologic and immunoblotting techniques. This seems to be the first report of an autoanti‐Sc1 detected by immunoblotting and the first example of AIHA in a child caused by autoanti‐Sc1.
A comparison of two supplemental procedures for confirmation of antibody to hepatitis C virus c100–3 antigen in Louisiana blood donors
Authors: Smith D. , Delaney S. , Allain J.P. , Vallari D. , Lee H.
Published: March 2003

In a pilot study designed to evaluate the performance of supplemental hepatitis C virus (HCV) tests, 146 consecutive HCV enzyme immunoassay (EIA)‐reactive samples (0.98% of 14,949 donors) were comparatively evaluated with two sets of supplemental tests: HCV antibody neutralization/c100–3 peptide EIA and the first‐generation HCV recombinant immunoblot assay (RIBA). Of these samples, 68.5 percent were positive and 17.8 percent were negative on both supplemental assays. Nineteen samples were discordant. Eleven samples were positive on one assay (9 on neutralization/peptide, 2 on RIBA) and negative or indeterminate on the alternate supplemental test, but reacted with two additional HCV antigens outside the c100–3 region in a second‐generation dot immunoblot assay. The dot immunoblot assay was used as a reference and reactive samples were considered confirmed. The remaining eight discordant samples were indeterminate or negative on either assay and did not react on the dot immunoblot assay. These data indicate a 0.74‐percent prevalence of HCV exposure detected by reactivity with the c100–3 antigen in blood donors in southern Louisiana.
Selection of platelets for refractory patients by HLA matching and prospective crossmatching
Authors: Moroff G. , Garratty G. , Heal J.M. , MacPherson B.R. , Stroncek D. , Huang S.T. , Ho W. , Petz L.D. , Leach MF , Lennon S.S. , Rowe Jacob M. , Saleh Mansoor N. , Arndt Patricia , Foley Karen , Masel Debra , Postoway Nina
Published: March 2003

A multi‐site clinical study compared platelets chosen for refractory patients by prospective platelet crossmatching using stored donor platelets and HLA‐based selection. Seventy‐three patients who were refractory to random‐donor platelets received two plateletpheresis components, one chosen by HLA‐based criteria and the other by crossmatching. Patients were carefully evaluated to exclude nonimmune factors that could adversely affect transfusion results. Each of the five study sites used a crossmatch procedure with which it had experience. Results from this study indicate the following: 1) The overall rate of successful transfusion was similar when an HLA‐based method of donor selection that includes all grades of matching and mismatching was compared to a crossmatch‐based method of donor selection. 2) HLA‐based selection that restricts recipients to grade A and BU matches was superior to a selection method based upon crossmatching alone. Donor selection based on HLA matching (grades A or BU) was also superior to selection based on any degree of HLA mismatching (grades BX, C, or D). 3) Selection of donors based on HLA‐ cross‐reactive groups (defined by in vitro serologic crossreactivity) was no more successful than that based on grade C and D mismatches and was no more successful than selection by crossmatching alone. 4) Lymphocytotoxic and platelet antibodies were not detected in many of the enrolled patients, even though patients demonstrating nonimmune factors were eliminated from the study. It can be concluded that HLA‐ compatible (grades A and BU) platelets provide optimal support for refractory patients, but that crossmatch‐selected platelets are acceptable as an alternative component.
A survey of hepatitis B surface antigen‐positive blood donors: degree of understanding and action taken after notification
Authors: MOYER L.A. , SHAPIRO C.N. , SHULMAN G. , BRUGLIERA P.D. , ALTER M. J.
Published: March 2003

All blood donors in the United States are tested for hepatitis B surface antigen (HBsAg) upon donation; if the test result is positive, the primary method of notification is by letter. To assess the effectiveness of this notification methods in stimulating HBsAg‐ positive donors to seek medical care and take preventive measures, 54 donors who tested HBsAg‐positive on donation at the American Red Cross Blood Services. Atlanta Region, from January 1987 to July 1989 were interviewed. Thirty‐nine donors (72%) had sought medical care after notification; the only motivating factor was that the letter told the donor to consult with his or her physician. Compared with donors who did not seek medical care, donors who did so were more likely to understand that the blood test was abnormal or that they were infected, and they were more likely to understand how hepatitis B virus is transmitted and that a vaccine is available. The differences were not significant, however. Of those donors who sought medical care, less than half received appropriate recommendations for protection of contacts, and of those who did, only one‐third received prophylaxis. In‐ person and telephone interviews with donors, revision of the notification letter, and hepatitis B education programs targeted at medical care providers are suggested.
Detection of three types of hepatitis C virus in blood donors: investigation of type‐specific differences in serologic reactivity and rate of alanine aminotransferase abnormalities
Authors: McOmish F. , Chan S.W. , Dow B.C. , Gillon J. , Frame W.D. , Crawford R.J. , Yap P.L. , Follett E.A. , Simmonds P.
Published: March 2003

The serologic reactivity and epidemiology associated with different hepatitis C virus (HCV) variants were investigated in a cohort of 113 anti‐HCV‐positive donors. In Scotland, HCV type 1 accounted for one‐ half of all infections; 40 percent of subjects were infected with HCV type 3, and the remainder were infected with type 2. Reactivity with the NS‐4‐encoded antigens in the first‐generation anti‐c100 assay was absent in 68 percent of donors infected with types 2 and 3, as compared with 10 percent for those infected with type 1. Even when combined with surrogate marker testing, first‐generation tests would have failed to detect 12 percent of HCV‐infected blood donors. The age distribution, incidence of past infection with hepatitis B virus, and reported risk factors were similar in donors infected with types 1 and 3 (mean ages were 31.9 and 29.9; 18 and 17.5% were positive for antibody to hepatitis B core antigen; and 47 and 48% had past intravenous drug abuse). However, the distributions of alanine aminotransferase levels were significantly different in those infected with type 3 (abnormally raised in 83%) and those infected with type 1 (55% abnormal alanine aminotransferase; p < 0.05) or type 2 (60%; p < 0.01) and those who were nonviremic (8%; p < 0.0001). These data suggest that HCV type 1 is the most common HCV infection in blood donors and that infection with HCV type 3 may be associated with more severe liver disease, because of more recent infection or because of a greater inherent pathogenicity of type 3 variants.
Absence of hepatitis B virus DNA detected by polymerase chain reaction in blood donors who are hepatitis B surface antigen negative and antibody to hepatitis B core antigen positive from a United States population with a low prevalence of hepatitis B serologic markers
Authors: Douglas D.D. , Taswell H.F. , Rakela J. , Rabe D.
Published: March 2003

A recent study in hepatitis B surface antigen (HBsAg)‐negative, antibody to hepatitis B core antigen (anti‐HBc)‐positive blood donors from a population with a high prevalence of hepatitis B serologic markers showed the presence of hepatitis B virus DNA (HBV DNA) as detected by polymerase chain reaction (PCR) in 4 percent of these donors. A sensitive, nested PCR assay was used to assess the prevalence of HBV DNA in a population of HBsAg‐negative, anti‐HBc‐positive blood donors from a United States population with a low prevalence of hepatitis B serologic markers. The lower limit for detection by the PCR assay was 10(‐5) pg per mL of HBV DNA. There was a review of 26,492 consecutive blood donations in a 12‐month period. During this time, only 1 unit (0.004%) was HBsAg positive. An additional 158 units (0.6%) were repeatably reactive for anti‐HBc. These 158 HBsAg‐negative, anti‐ HBc‐positive units were given by 119 donors of blood for allogeneic and autologous use. HBV DNA was not detected by PCR in blood from 83 allogeneic blood donors (93 samples) or 36 autologous blood donors (65 samples). Anti‐HBc testing is an inefficient means of screening for potential hepatitis B infectivity and is associated with low test specificity in populations with a low prevalence of hepatitis B serologic markers.
Induction of additional red cell alloantibodies after intrauterine transfusions
Authors: Viëtor H. E. , Kanhai H. H. H. , Brand A.
Published: March 2003

BACKGROUND: The aim of this study was to determine the frequency and origin of additional alloantibodies directed against red cells (RBCs) after intrauterine transfusion (IUT).

STUDY DESIGN AND METHODS: Between March 1987 and December 1992, fetuses with severe hemolytic disease (n = 91) received a total of 280 ultrasound‐guided IUTs of RBCs from unrelated donors. The specificity of alloantibodies to RBCs in maternal serum was determined both before and after each IUT. If additional alloantibodies directed against RBCs were detected, their origin was determined by phenotyping the fetal, donor, and paternal RBCs for each particular antigen. The study included a control group of 69 pregnant women who underwent either amniocentesis or fetal blood sampling.

RESULTS: Production of additional alloantibodies directed against RBC antigens was detected in 24 women (26%). The source of the immunizing antigen, either donor or fetus, was identified in 14 patients. The additional alloantibodies were directed against fetal antigens in 11 women and against donor antigens in 3. One additional alloantibody directed against donor antigen clearly reduced the survival of donor RBCs. The fetus and the donor shared the immunizing antigen in four cases, and in one case, the antibody occurred naturally. In five cases, the source of the immunizing antigen was not determined. In the control group, additional antibodies were detected in two patients.

CONCLUSION: IUT therapy is associated with a high incidence of additional alloantibodies. In the majority of patients, the use of maternal RBCs for IUT would not have prevented additional formation of alloantibody to RBCs.
A phase III trial of recombinant human erythropoietin therapy in nonanemic orthopedic patients subjected to aggressive removal of blood for autologous use: dose, response, toxicity, and efficacy
Authors: Goodnough L.T. , Price T.H. , Friedman K.D. , Johnston M. , Ciavarella D. , Khan N. , Sacher R. , Vogler W.R. , Wissel M. , Abels R.I.
Published: March 2003

BACKGROUND: Previous clinical trials have shown that the use of recombinant human erythropoietin (EPO) can facilitate autologous blood donation and reduce allogeneic blood transfusions in autologous blood donors who are anemic at first donation. However, the role of EPO therapy in nonanemic patients remains undefined. To identify this role, a randomized, controlled, multicenter dose‐escalation trial was conducted in patients whose initial hematocrit was > 39 percent (0.39).

STUDY DESIGN AND METHODS: EPO (150, 300, or 600 units/kg) or placebo was administered intravenously at each of six phlebotomy visits over a 3‐week study period. Sixteen (14%) of 116 patients were unable to complete the treatment protocol because of adverse events (n = 11) or for personal reasons (n = 5); 2 patients (1 EPO and 1 placebo) experienced serious adverse events.

RESULTS: In 91 evaluable patients, additional red cell production during the study period was 440 +/− 176, 621 +/− 215, 644 +/− 196, and 856 +/− 206 mL (mean +/− SD), respectively, for patients receiving placebo and EPO at 150, 300, and 600 units/kg (p < 0.05 for all EPO groups compared to placebo). However, the percentages of patients in each group who received allogeneic blood did not differ: 2 (9%) of 23 placebo patients and 6 (9%) of 68 EPO patients.

CONCLUSION: It is concluded that, while EPO therapy increased preoperative red cell production, no clinical benefit could be demonstrated in autologous blood donors who were not anemic at first blood donation.
Prevalence and risk factors for hepatitis C antibodies in volunteer blood donors in Brazil
Authors: Patin̄o‐Sarcinelli F. , Hyman J. , Camacho L.A.B , Linhares D.B. , Azevedo J.G.
Published: March 2003

Background: Little is known about the prevalence, risk factors, and transmission of hepatitis C virus (HCV) in a nontransfused population, particularly in developing countries.

Study Design and Methods: To investigate the association between HCV seropositivity and some demographic variables, a case‐control study was conducted on 138 seropositive donors among 4762 consecutive volunteer blood donors and 1101 seronegative controls in Rio de Janeiro, Brazil. Donors were initially screened by interview for male homosexuality, use of illicit drugs, tattoos, previous transfusions, venereal diseases, and jaundice. Eligible donors were then tested for HCV antibodies by enzyme‐linked immunosorbent assay. A multivariate analysis was performed on age, ethnic group, gender, and prior donation.

Results: The overall prevalence of HCV seropositivity was 2.89 percent. An increased risk of seropositivity was demonstrated for nonwhite donors at an odds ratio of 2.11 (95% CI, 1.43‐3.13), for males at 2.39 (95% CI, 1.01–5.7), and for prior donors at 1.66 (95% CI, 1.09‐2.52). The risk of anti‐HCV positivity increased markedly with age. Those at highest risk were the group 40 to 49 years old, with an odds ratio of 4.37 (95% CI, 2.39‐ 7.99) versus the group 20 to 29 years old. The group under 20 years old showed an odds ratio of 0.50 (95% CI, 0.06‐3.87) compared to the group 20 to 29 years old. These findings were equally significant in a univariate analysis.

Conclusion: Our results suggest that HCV seropositivity is strongly associated with male sex, nonwhite ethnicity, and greater age. A significant number of seropositive donors were not detected by screening interview.
Mathematical and computer modeling of acute normovolemic hemodilution
Authors: Brecher M.E. , Rosenfeld M.
Published: March 2003

Background: Advocates of acute normovolemic hemodilution (ANH) frequently neglect to consider the decreasing hematocrit of the patient during both hemodilution and the subsequent operative procedure and the need to begin transfusion at some minimal hematocrit.

Study Design and Methods: For more accurate prediction of the efficacy of ANH, equations were derived and a computer model developed that allowed accounting for the decreasing hematocrit due to blood loss in an isovolemic patient and calculating the red cell volume on a minute‐by‐minute basis; the model also began the transfusion of ANH blood on a mL‐for‐mL basis when the minimal hematocrit was reached and transfused any remaining blood following completion of the case. The red cell volume saved by performing ANH for a given estimated blood volume (EBV) was expressed as either the fraction of the red cell volume of a routinely banked unit of blood (red cells stored in additive solution: volume 350 mL, hematocrit 0.65) or the number of units saved.

Results: The number of units saved in a typical example–EBV, 5000 mL; pre‐ANH hematocrit, 0.40; minimal hematocrit at which transfusion was begun, 0.25 over a range of estimated blood losses (500–2500 mL); and 1 to 5 ANH units drawn–never exceeded 0.6. Even with extensive hemodilution, as in a child (EBV, 1500 mL; pre‐ANH hematocrit, 0.40; minimal hematocrit at which transfusion was begun, 0.15; 5 units drawn; and estimated blood losses, 2500, 1500, and 1000 mL) with a postdilution hematocrit of 0.16, the savings would have been only 0.29, 0.44, and 0.49 units, respectively.

Conclusion: Because of the decreasing hematocrit in a bleeding isovolemic patient and the need to begin transfusion at some minimal hematocrit, the theoretic savings in red cell volume attributable to ANH is less than had previously been appreciated, and additional ANH does not necessarily result in additional patient benefit.
Antigen‐matched donor blood in the transfusion management of patients with sickle cell disease
Authors: Tahhan H.R. , Holbrook C.T. , Braddy L.R. , Brewer L.D. , Christie J.D.
Published: March 2003

BACKGROUND: Alloimmunization to red cell antigens is a significant risk in chronically transfused patients with sickle cell disease. Antigen matching, by decreasing the likelihood of alloantibody development, may significantly facilitate long‐term management while decreasing morbidity.

STUDY DESIGN AND METHODS: The transfusion records of 86 patients who underwent chronic transfusion for sickle cell disease at a tertiary‐care medical center were reviewed retrospectively to determine the efficacy of an antigen‐matching program in the prevention of alloimmunization to clinically significant red cell antigens. Recipients were phenotyped and given units matched for the K, C, E, S, and Fya or Fyb antigens.

RESULTS: None (0%) of the 40 patients who received antigen‐matched transfusions showed any evidence of alloimmunization, while 16 (34.8%) of the 46 patients who received both antigen‐matched and non‐antigen‐matched transfusions developed clinically significant alloantibodies. The cost was 1.8 to 1.5 times that for a standard transfusion protocol.

CONCLUSION: On the basis of this experience, it is recommended that transfusion centers engaged in the management of chronically transfused sickle cell anemia patients consider providing antigen‐matched units for such patients. This is recommended not only because it prevents alloimmunization but also because such a program provides additional clinical benefits to the patient that may outweigh the higher costs of the process.
Use of bi‐level biotinylation for concurrent measurement of in vivo recovery and survival in two rabbit platelet populations
Authors: FRANCO R.S. , LEE K.N. , BARKER‐GEAR R. , GATES R. , MENITOVE J.E.
Published: March 2003

BACKGROUND: The objectives of this research were 1) to determine whether two populations of platelets may be labeled with different levels of biotin and followed concurrently in vivo by flow cytometry and 2) to determine whether the level of biotinylation affects the in vivo platelet recovery and survival.

STUDY DESIGN AND METHODS: Two platelet aliquots were biotinylated under conditions that resulted in either a lower or a higher number of biotin molecules per platelet. After transfusion, the two populations were distinguished and quantitated by flow cytometry.

RESULTS: In five animals, recoveries were 69.8 +/− 27.0 percent for low‐biotin platelets and 72.6 +/− 26.7 percent for high‐biotin platelets. For each animal, the recoveries agreed closely. Life span, determined by the multiple‐hit method, was 2.68 +/− 0.63 days for low‐biotin platelets and 2.58 +/− 0.69 days for high‐biotin platelets. These values for recovery and life span are consistent with those measured in rabbits by using radioisotope labels.

CONCLUSION: Platelet biotinylation offers a nonisotopic method for direct comparison of alternative harvest and storage conditions. It also offers the potential for simultaneous evaluation of the in vivo characteristics of platelets from at least two donors.
Mathematical analysis of isovolemic hemodilution indicates that it can decrease the need for allogeneic blood transfusion
Authors: Weiskopf Richard B.
Published: March 2003

BACKGROUND: The implementation of acute isovolemic hemodilution prior to surgical blood loss is a strategy used in an attempt to diminish the need for or obviate allogeneic transfusion and to avert the potential, attendant complications. Studies examining the efficacy of this technique have produced conflicting results. STUDY DESIGN AND METHODS: The present mathematical analysis was undertaken to resolve these conflicts by determining the efficacy of hemodilution and examining the influence of the variables affecting the outcome. Efficacy was defined as the volume of additional blood loss permitted and the volume and number of units of allogeneic blood saved from transfusion. A mathematical analysis evaluated the impact of circulating blood volume and initial and target hematocrits on the efficacy of isovolemic hemodilution. It was assumed that 1) hemodilution was completed before surgical blood loss; 2) transfusion of removed blood was begun when the target hematocrit was reached and lost surgical blood was replaced at a rate that maintained the target hematocrit; 3) allogeneic transfusion was begun after all autologous blood drawn was transfused; 4) normovolemia was maintained; and 5) a unit of allogeneic blood contains 175 mL of red cells. RESULTS: The analysis showed that isovolemic hemodilution can result in substantial additional allowable surgical blood loss that can diminish the need for or obviate allogeneic transfusion of red cells. Larger circulating blood volume, higher initial hematocrits, and lower target hematocrits increase the efficacy of hemodilution. Removal and isovolemic replacement of 1 to 2 units of blood provide minimal potential savings, as does hemodilution to a circulating (target) hematocrit of 30 percent. The extension of hemodilution to a hematocrit of (or below) 20 percent allows a disproportionately greater surgical blood loss and diminishes the need for allogeneic transfusion. It allows, for example, an additional 4.5 L of surgical blood loss, which represents a savings of 4 units of allogeneic blood when a patient with an initial blood volume of 5.0 L and a hematocrit of 45 percent undergoes isovolemic hemodilution to a hematocrit of 15 percent. CONCLUSION: Isovolemic hemodilution can diminish or in some circumstances eliminate the need for allogeneic transfusion.
Pseudothrombocytopenia in plateletpheresis donors
Authors: Sweeney Joseph D. , Holme Stein , Heaton W.A.L. , Campbell Donna , Bowen Mary L.
Published: March 2003

BACKGROUND: EDTA pseudothrombocytopenia (PTCP) is an in vitro artifact in which the anticoagulation of blood with EDTA is associated with in vitro agglutination of platelets, resulting in a spuriously low platelet count. In apheresis donors, whole‐blood samples for complete blood counts are routinely drawn into tubes anti‐coagulated with EDTA. STUDY DESIGN AND METHODS: Records of apheresis donors were examined to identify persons in whom the postdonation counts were less than 100 × 10(9) per L. Identified donors were studied to confirm the presence of PTCP by drawing blood samples into EDTA, heparin, and trisodium citrate for serial platelet counts at room‐temperature incubation. Platelet counts in citrated plasma were measured before and after the addition of EDTA. A single HLA‐matched component from an identified PTCP donor was monitored for response by corrected count increment in the recipient. RESULTS: A total of nine donations were identified, involving 2 donors from a population of 945 donors (prevalence 0.2%). On testing, both donors were confirmed to have PTCP. The addition of EDTA to citrated plasma did not affect the platelet count. Response in a recipient to an HLA‐matched component showed an acceptable corrected count increment. CONCLUSION: PTCP may occur in plateletpheresis donors and result in needless medical referral or donor deferral. PTCP does not appear to alter the yield content of the component or to be passively transferred to a recipient.
Human T‐lymphotropic virus type I and type II infections and correlation with risk factors in blood donors from São Paulo, Brazil
Authors: Ferreira O. C. , Vaz R. S. , Carvalho M. B. , Guerra C. , Fabron A. L. , Rosemblit J. , Hamerschlak N.
Published: March 2003

BACKGROUND: Little is known about the prevalence of and risk factors for human T‐lymphotropic virus type I and type II (HTLV‐I, HTLV‐II) infections in Brazil. STUDY DESIGN AND METHODS: Sera from 17,063 healthy Brazilian donors were screened by enzyme‐linked immunosorbent assay for antibody to HTLV‐I/II between August 1991 and July 1993. Repeatedly reactive samples were confirmed by Western blot, and discrimination between HTLV‐I and HTLV‐II was made by polymerase chain reaction or synthetic peptide enzyme‐linked immunosorbent assay. A univariate analysis was performed on demographic and serologic data. RESULTS: HTLV‐I infection was demonstrated in 83 percent of the 30 donors with reactive serologic tests (0.15% of the total tested [17,063]; 95% CI, 0.09‐0.20) and HTLV‐II infection in 17 percent (0.03% of the total tested [17,063]; 95% CI, 0.01‐0.05). HTLV‐I‐positive donors were more likely than reference groups to be of Asian ethnicity (odds ratio [OR] 15.1; reference group: whites), more than 50 years old (OR 4.2; reference group: 20–29 years old), and positive for antibody to hepatitis C virus (anti‐HCV) (OR 21.8) or to hepatitis B core (antigen) (anti‐HBc) (OR 5.7). HTLV‐II showed a significant association with anti‐HCV (OR 75.2) and anti‐HBc (OR 21.8). Eleven of the 25 HTLV‐I‐ positive donors were counseled. Family origin in endemic areas of Japan (n = 4), prior blood transfusion (n = 3), or sexual contact with prostitutes (n = 1) were the risk factors reported by 8 donors. In 3 white men, no risk factors could be identified. CONCLUSION: Both HTLV‐I and HTLV‐II occur among Brazilian blood donors. HTLV‐I is associated with Asian ethnicity, greater age, and the presence of anti‐HCV and anti‐HBc. Three HTLV‐I‐positive donors had a history of blood transfusion, which emphasizes the need for HTLV‐I/II screening in Brazil.
Severe outcomes of allogeneic and autologous blood donation: frequency and characterization
Authors: Popovsky M.A. , Whitaker B. , Arnold N.L.
Published: March 2003

BACKGROUND: There are few published data on severe outcomes of the donation of blood for allogeneic or autologous use. It would be helpful if blood collectors could better characterize and/or predict the likelihood of significant complications of blood donation.

STUDY DESIGN AND METHODS: Very severe outcome (VSO) was defined as an event requiring hospitalization. Approximately 4.1 million American Red Cross whole‐blood donation records (July 1993‐March 1994) were reviewed for the incidence and type of VSO.

RESULTS: A total of 33 VSOs occurred for all donations. The incidence of VSOs for allogeneic donation was 1 (0.0005%) in 198,119 and that for autologous donation was 1 (0.006%) in 16,783 (p < 0.001). First‐time donors were three times as likely to have a VSO. Donors > 40 years old had 87.9 percent of the VSOs, and donors > 60 years old had 48.5 percent. Vasovagal (66.7%) and anginal (12.1%) episodes were the most frequent complications, and 66.7 percent of reactions occurred at the blood collection site. The mean hospital stay was 1.9 days.

CONCLUSION: VSO is an infrequent complication of all types of blood donation, but its occurrence may be associated with significant morbidity and cost. VSO is nearly 12 times as likely in autologous blood donors.
Febrile reactions to platelet transfusion: the effect of increased interleukin 6 levels in concentrates prepared by the platelet‐rich plasma method
Authors: Muylle L. , Wouters E. , Peetermans M.E.
Published: March 2003

Background: A relation between febrile reactions to platelet transfusion and high cytokine levels in platelet concentrates (PCs) was found previously. The levels of cytokines such as interleukin (IL)‐6 are related to the while cell content of the PC during storage. Therefore, early removal of white cells should prevent reactions.

Study Design and Methods: This prospective study was set up to compare methods for the preparation of random PCs, the platelet‐rich plasma method (PRP‐PCs), which results in a high white cell content, and the buffy coat method (BC‐PCs), which results in a low white cell content, with regard to the frequency and severity of reactions to platelet transfusion and the IL‐6 level of the PC. IL‐6 was chosen because it is the major mediator of the acute‐phase response. White cells were reduced in all PCs before transfusion.

Results: Platelet transfusions (n = 584) in 64 patients were studied. An overall reaction frequency of 7.2 percent was observed. Transfusion reactions were seen predominantly in patients who received PRP‐PCs (PRP‐PCs: 9.3% vs. BC‐PCs: 2.7%, p = 0.007). Allergic reactions were limited to transfusions of PRP‐PCs. The following PRP‐PC characteristics were significantly correlated with febrile transfusion reactions: IL‐6 level (p < 0.0001), initial white cell count (p = 0.001), and storage time (p = 0.02). In this group, reactions were less frequent in patients receiving pretransfusion medication (p < 0.001). In the PRP‐PC group, IL‐6 content (p = 0.01) and initial white cell count (p = 0.04) were also significantly correlated with allergic reactions, which indicated that these or associated factors might have an effect on the outcome of this type of reaction.

Conclusion: Febrile reactions are highly correlated with IL‐6 levels in PCs. The low white cell content of BC‐PCs is associated with undetectable IL‐6 levels and a reduced frequency of febrile as well as allergic reactions in recipients. The BC method is the preferable one for the production of random‐donor PCs.
Influence of antibiotics on posttransfusion platelet increment
Authors: Böck M. , Muggenthaler K.‐H. , Schmidt U. , Heim M. U.
Published: March 2003

BACKGROUND: Fever has been identified as a major cause of platelet refractoriness. However, it is regularly attended by the administration of antibiotics, and thus it cannot be determined whether fever, the administration of antibiotics, or both are responsible for the reduced platelet increment. The present study was undertaken to discern the effect of body temperature and antibiotics on transfusion success. STUDY DESIGN AND METHODS: Single‐donor platelet transfusions (n = 400) were monitored retrospectively. Besides other influencing factors (e.g., spleen size, number of previous transfusions, diagnosis, bone marrow transplantation), body temperature and the administration of antibiotics were documented from the patients' records. To distinguish the effects of fever and antibiotics, a general mixed model of variance was used for analysis. RESULTS: Besides the well‐known factors of splenomegaly, hepatomegaly, bone marrow transplantation, and pretransfusion storage time, both body temperature and antibiotics independently reduced the corrected count increment. Among the various antibiotics, amphotericin B, ciprofloxacin, and vancomycin had the greatest influence. CONCLUSION: The administration of antibiotics has a negative effect on the corrected count increment, independent of the presence of fever. Besides amphotericin B, which has previously been shown to influence the corrected count increment, vancomycin and ciprofloxacin reduce it significantly. Because these antibiotics are widely used in patients with bone marrow failure, these observations should be proven by further prospective in vivo and in vitro studies.
Infusible platelet membrane microvesicles: a potential transfusion substitute for platelets
Authors: Chao F. C. , Kim B. K. , Houranieh A. M. , Liang F. H. , Konrad M. W. , Swisher S. N. , Tullis J. L.
Published: March 2003

BACKGROUND: Several substitutes for intact, viable platelets have been used for transfusion, both to people and in animal models, with varied success. Infusible platelet membrane (IPM) is prepared from human platelets. IPM retains the glycoprotein (GP)lb receptor and has platelet factor 3 activity (procoagulant activity). However, factor V, serotonin, a cytoplasmic marker enzyme (purine nucleotide phosphorylase), GPIIb/IIIa complex, and HLA class I and II antigens are all absent in IPM. STUDY DESIGN AND METHODS: IPM is prepared from outdated platelets. The platelets were disrupted by freezing and thawing; they were washed and heated to inactivate possible viral contaminants, and then the sonicated membrane microvesicle fraction was separated and lyophilized. The hemostatic activity of IPM was measured by its ability to reduce the prolonged bleeding time in thrombocytopenic rabbits. RESULTS: Administration of IPM at a dose of 2 mg per kg results in a substantial reduction in the bleeding time. In a series of 23 experiments, a median preinjection bleeding time of 15 minutes was reduced to 6 minutes within 4 hours after IPM administration. Administration of IPM did show a mild enhancement in the thrombogenicity index, as measured in the Wessler rabbit model. This enhancement is, however, not significant, as a thrombogenicity index value of up to 0.6 is clinically acceptable. CONCLUSION: IPM may have clinical potential as a substitute for platelets in the treatment of bleeding due to thrombocytopenia.
Recovery of in vitro functional activity of platelet concentrates stored at 4 ° C and treated with second‐messenger effectors
Authors: Connor J. , Currie L. M. , Allan H. , Livesey S. A.
Published: March 2003

BACKGROUND: The potential for bacterial contamination limits the storage of platelets at 22 degrees C to 5 days. Refrigerated storage at 4 degrees C would abrogate this problem but would also result in a rapid loss of in vitro viability and functional activity and in vivo viability. The inhibition of platelets during storage by a combination of specific, reversible, second‐messenger effectors has been investigated to allow prolonged storage at 4 degrees C with significant retention of in vitro viability and functional activity. STUDY DESIGN AND METHODS: The combination of effectors was added directly to platelet concentrates, and this step was followed by storage at 4 degrees C. Control units were incubated at 4 degrees C without the effectors and at 22 degrees C according to standard blood‐banking techniques. At 1, 5, and 9 days, the units were tested for recovery of cell number, recovery of in vitro functional activity and viability, and expression of platelet surface markers. RESULTS: Treated platelets stored at 4 degrees C for 9 days, while spherical in shape, displayed no loss of cell number and had a recovery of viability and functional activity, as compared with control platelets stored at 22 degrees C for 5 days, as follows: ADP and collagen aggregation responses of 250 and 100 percent, respectively; a 70‐percent recovery of hypotonic shock response; and a 60‐percent recovery of extent of shape change. The treated platelets also expressed an equivalent amount of the surface marker glycoprotein lb and a lower amount of the activation marker alpha‐granule membrane protein‐140 on the membrane surface. CONCLUSION: Second‐messenger effectors added to platelets significantly maintained in vitro functional activity with storage at 4 degrees C. In vitro analysis demonstrates the potential for extended 4 degrees C storage of platelets with numerical and functional recovery comparable to that achieved with current methods. Refrigerated storage of platelet concentrates has the potential to reduce the risk of bacterial contamination.