bluuebunny/crossref_metadata_2025 huggingface dataset:
Targeted hepatitis C lookback: Quebec, Canada
Authors: Long Anne , Spurll Gwendoline , Demers H. , Goldman Mindy
Published: March 2003

BACKGROUND: Since March 1990, all blood donations in Canada are screened for antibodies to hepatitis C virus (HCV). Because HCV may cause chronic asymptomatic hepatitis, in February 1995, the Canadian Red Cross began targeted HCV lookback studies.

STUDY DESIGN AND METHODS: From March 1990 to March 1997, the Quebec Center of the Canadian Red Cross collected 1,750,846 donations, and there were 561 anti‐HCV‐positive repeat donors, from whom 3,196 blood components had been issued to the hospitals. Hospital blood bank directors were asked to test recipients and return results to the Quebec Center. One hundred nine hospitals were surveyed to determine methods and resources involved in lookback. The transfusion medicine service at the Royal Victoria Hospital (RVH) developed a standard operating procedure for performing lookbacks and analyzed the costs and outcomes of lookbacks.

RESULTS: As of April 1998, information has been received on 2329 (73%) of components; 1020 patients had died of unrelated causes, 590 were untraceable, and 353 were tested. Of those tested, 215 (61%) were anti‐HCV positive; their average age was 47, and at least 53 percent were already aware of their HCV status. Few hospitals had received any additional resources to perform lookbacks. At the RVH, lookback on 182 components resulted in the identification of nine seropositive recipients, average age 70, who did not previously know their HCV status; four of these patients had abnormal alanine aminotransferase levels. The cost of lookback per newly diagnosed case of HCV was estimated at $2727 (US) for the Quebec Center and $6014 (US) for the RVH.

CONCLUSION: Targeted lookback in the province of Quebec on 3196 components has resulted in the identification of 101 seropositive recipients who did not previously know their HCV status.
Predictive value of past and current screening tests for syphilis in blood donors: changing from a rapid plasma reagin test to an automated specific treponemal test for screening
Authors: Aberle‐Grasse John , Orton Sharyn L. , Notari Edward , Layug Lynne P. , Cable Richard G. , Badon Stanley , Popovsky Mark A. , Grindon Alfred J. , Lenes Bruce A. , Williams Alan E.
Published: March 2003

BACKGROUND: This study evaluated the change from a rapid plasma reagin (RPR) test to an automated specific treponemal test (PK‐TP) in screening for syphilis in blood donors.

STUDY DESIGN AND METHODS: A cross‐sectional seroprevalence analysis was performed on 4,878,215 allogeneic blood donations from 19 American Red Cross Blood Services regions from May 1993 through September 1995. Positive predictive values relative to the confirmatory fluorescent treponemal antibody absorption test (FTA‐ABS) were calculated. Differences in seroprevalence were compared in RPR and PK‐TP tests for 1) unconfirmed and confirmed tests, 2) first‐time and repeat donors, and 3) “recent” versus “past” infections. Donation data from three additional Red Cross regions were evaluated for repeat donation patterns of blood donors who had a donation that was positive in a serologic screening test for syphilis. The value of RPR and PK‐TP tests as surrogate markers for HIV infection was compared.

RESULTS: Reactive rates were lower but the positive predictive values was higher for the PK‐TP test than for the RPR test. Initially, donors screened by PK‐TP were more likely to be confirmed as positive than were donors screened by RPR, but these rates became comparable. It is estimated that a single HIV window‐period donation was removed by serologic testing for syphilis each year of this study period.

CONCLUSIONS: The change to the PK‐TP test resulted in a lower repeatedly reactive rate, better prediction that a confirmed‐positive test for syphilis would occur in testing in the FTA‐ABS, fewer donations lost, and comparable deferral rates. Because of the high rate of reactivity to serologic testing for syphilis among donors previously confirmed positive for syphilis, indefinite deferral after a confirmed‐positive index donation may be warranted. Serologic testing for syphilis is ineffective as a marker of HIV‐infectious window‐period donations.
Kinetics of peripheral blood stem cell harvests during a single apheresis
Authors: Smolowicz Adam G. , Villman Kenneth , Berlin Gösta , Tidefelt Ulf
Published: March 2003

BACKGROUND: The enumeration of CD34+ cells in the peripheral blood of patients before leukapheresis is commonly used to predict the outcome of stem cell harvests. The concept that an increased number of transplanted cells gives faster marrow reconstitution triggers an interest in investigating the kinetics of peripheral blood stem cells during leukapheresis. The aim of this study was to investigate the issue of recruitment of hematopoietic progenitor cells during a single leukapheresis.

STUDY DESIGN AND METHODS: Nine leukapheresis procedures (in 8 patients) were investigated. In each case, 3 blood volumes were processed. Samples from peripheral blood, the collection line of apheresis equipment, and the collected component were obtained after each blood volume was processed. The enumeration of CD34+ cells was performed, and the total number of progenitors, as a sum of the number of cells in the peripheral blood and the number of cells in the collected component, was calculated.

RESULTS: A mean of 13.3 L of blood was processed, and a component with a mean volume of 424 mL and a mean of 10.1 × 108 CD34+ cells per kg of body weight was collected. White cell and mononuclear cell counts in peripheral blood declined concomitantly during the procedures. The calculated total number of cells—that is, the sum of the number of cells in the collected component and the number of cells in the peripheral blood—showed a concomitant, but not equal, rise in polymorphonuclear cells, mononuclear cells, and CD34+ cells during the leukapheresis. This apparent mobilization of progenitors into the peripheral blood did not correlate with the slightly increased number of polymorphonuclear cells or with the more pronounced increase in mononuclear cells.

CONCLUSION: There is a substantial recruitment of progenitor cells during a single leukapheresis.
Transfusion‐associated transmissionof babesiosis in New York State
Authors: Linden J.V. , Wong S.J. , Chu F.K. , Schmidt G.B. , Bianco C.
Published: March 2003

BACKGROUND: Babesiosis can be life‐threatening in immunocompromised individuals. Although the disease is usually transmitted by tick bite, more than 20 cases have been reported of infection transmitted by transfusion of blood or blood components obtained from apparently healthy donors from endemic areas in the United States. This report describes several recent cases of transfusion‐transmitted babesiosis in New York State.

STUDY DESIGN AND METHODS: Transfusion‐associated incidents of babesiosis infection were identified and investigated. Seroprevalence of babesiosis in healthy blood donors in a highly endemic area was ascertained.

RESULTS: In three incidents, babesiosis was diagnosed in five of eight patients given infected blood: two premature infants, an elderly patient with gastrointestinal bleeding, and two patients with thalassemia. Seroprevalence in blood donors on Shelter Island (Suffolk County, eastern Long Island), a highly endemic area, was 4.3 percent in May 1998.

CONCLUSIONS: Infected donors lived in endemic areas and were asymptomatic with no history of tick bite. Blood collected in January 1997 from one donor was infectious. Those transfusion recipients who were infected were neonatal, elderly, or chronically transfused patients. Babesiosis should be included in the differential diagnosis of febrile illness in immunocompromised recipients of blood transfusion, particularly in the Northeastern United States.
Evidence supporting the requirement for two proline residues for expression of c
Authors: Westhoff C.M. , Silberstein L.E. , Wylie D.E.
Published: March 2003

BACKGROUND: In humans, c antigen expression is associated with a proline residue at amino acid position 103 in the second extracellular loop of the CE protein. Comparison of nonhuman primate Rh proteins suggested that c reactivity might actually involve two proline residues. It has been shown that the RBCs of New World capuchin monkeys (Cebus apella) react with anti‐c. To further define the amino acid residues involved in c expression, Rh cDNA from the capuchin was analyzed.

STUDY DESIGN AND METHODS: Rh transcripts were amplified by reverse transcription PCR from RNA isolated from the reticulocytes of a capuchin monkey and were cloned and sequenced.

RESULTS: Rh transcripts from the capuchin monkey, whose RBCs react with anti‐c, were found to encode adjacent proline residues at 102 and 103.

CONCLUSION: Sequencing of Rh transcripts from the capuchin monkey supports the hypothesis that the expression of c requires two adjacent proline residues. Proline causes bends or loops in proteins, which, in this case, might form a unique, stable structure resistant to perturbations induced by changes in upstream or downstream residues. This would explain the scarcity in humans of c variants as compared to the other major Rh antigen variants, and the preservation of c reactivity despite 24‐percent divergence between the human and capuchin Rh proteins.
Blood bank conditions and RBCs: the progressive loss of metabolic modulation
Authors: Messana I. , Ferroni L. , Misiti F. , Girelli G. , Pupella S. , Castagnola M. , Zappacosta B. , Giardina B.
Published: March 2003

BACKGROUND: Human RBC metabolism is modulated by the cell oxygenation state. Among other mechanisms, competition of deoxyhemoglobin and some glycolytic enzymes for the cytoplasmic domain of band 3 is probably involved in modulation. This metabolic modulation is connected to variations in intracellular NADPH and ATP levels as a function of the oxygenation state of the cell, and, consequently, it should have physiologic relevance. The present study investigates the effect of storage on this metabolic modulation and its relationship with the alteration of membrane protein composition.

STUDY DESIGN AND METHODS: RBCs stored in CPD–saline‐adenine‐glucose‐mannitol were assayed for glucose uptake and partition between glycolysis and the pentose phosphate pathway at high and low oxygen saturation by nuclear magnetic resonance spectroscopy after 1, 14, 21, 35, and 42 days of storage. Membrane protein composition was determined by SDS‐PAGE on Days 1, 14, 35, and 42. Metabolic values and 2,3 DPG concentration were also measured after rejuvenation for 1 hour at 37°C with pyruvate‐inosine‐phosphate‐adenine solution on Day 21.

RESULTS: Metabolic differences between RBCs incubated at high and low oxygen saturation decreased during storage, and, on Day 35, the two groups did not have significant differences (p = 0.111). SDS‐PAGE showed that membrane protein composition was concurrently modified. The percentage of unmodified band 3 decreased during storage, principally between Days 14 and 35. In rejuvenated RBCs, oxygen‐dependent modulation was not restored.

CONCLUSIONS: RBCs stored in CPD–saline‐adenine‐glucose‐mannitol do show a progressive loss of oxygen‐dependent metabolic modulation, which is not restored after rejuvenation and which seems partly related to modifications in membrane proteins, mainly band 3.
Effects of UVB radiation on cytokine generation, cell adhesion molecules, and cell activation markers in T‐lymphocytes and peripheral blood HPCs
Authors: Lankford K.V. , Mosunjac M. , Hillyer C.D.
Published: March 2003

BACKGROUND: Immunomodulatory effects of UV light have increasingly become a focus in transfusion medicine, BMT and transplantation immunology. In the transplant setting, the use of UVB radiation may reduce or abolish T‐cell activation without compromising either bone marrow (BM) engraftment or graft‐versus‐leukemia effect. In this study, BM and apheresis‐derived peripheral blood HPCs were used to investigate the effects of UVB on colony‐forming ability, CD34+ cell viability, and growth potential, as well as on the secretion of MNC cytokines and the expression of cell surface markers and adhesion molecules.

STUDY DESIGN AND METHODS: After UVB radiation, enriched populations of T cells and antigen‐presenting cells (APCs) were treated with PHA, and the MNC response was measured, as was colony‐forming ability. CD34+ cells were quantified and their growth potential was determined in culture. Next, T‐cell activation status, cell adhesion molecule and cell surface activation marker expression, and cytokine profiles were evaluated, and cytokine mRNA was quantitated. Parallel studies were done in unirradiated control cell populations.

RESULTS: Low‐dose (10 mJ/cm2) UVB mitigates MNC proliferative responses by 94 percent while maintaining 60 and 80 percent of colony‐forming ability in peripheral blood HPC and BM preparations, respectively, and >50 percent of colony‐forming ability in CD34+ cell‐enriched samples. Low‐dose UVB radiation also significantly reduces T‐cell production of TNFα, TNFα mRNA, TNFβ, IL‐2, and IL‐6 and downregulates T‐cell expression of CD28, CD25, CD69, and intercellular adhesion molecule 1.

CONCLUSION: These findings have shown that a “window” of low‐dose UVB radiation (10 mJ/cm2) exists, at which BM‐ and peripheral blood‐derived MNC proliferation is inactivated, while the HPCs are relatively spared. UVB light selectively affects T cells, while APCs are resistant to low doses of UVB. UVB radiation also alters the expression of some cell surface markers and cytokines that are important in T‐cell activation pathways. Reduction of T‐cell activation without cytocidal effect may allow UVB radiation to become an immunomodu‐lating agent in BM or HPC transplantation.
Fulminant babesiosis treated with clindamycin, quinine,and whole‐blood exchange transfusion
Authors: Dorman S.E. , Cannon M.E. , Telford S.R. , Frank K.M. , Churchill W.H.
Published: March 2003

BACKGROUND: Babesiosis is an increasingly recognized parasitic infection with manifestations that range from a subclinical or mild flu‐like illness to life‐threatening disease. Risk factors that may be associated with a more severe clinical course include immunosuppression, splenectomy, and advanced age. The most effective chemotherapeutic regimen, clindamycin plus quinine, is sometimes ineffective in cases of severe disease.

CASE REPORT: A previously healthy, 58‐year‐old man was infected by Babesia microti, presumably through a tick bite. He developed fulminant disease characterized by severe hemolytic anemia, disseminated intravascular coagulation, acute renal failure, and respiratory failure. There was no history of splenectomy or immunodeficiency. He was given oral clindamycin (300 mg/4×/day) 2 days before admission. Oral quinine (650 mg/3×/day) was added upon hospitalization. There was no clinical improvement despite antibiotic therapy with clindamycin and quinine. On the second hospital day, a whole‐blood exchange transfusion was performed to simultaneously lower the parasite load and replace the patient's plasma. With an automated blood cell separator, 87 percent of the patient's total blood volume was exchanged. As replacement fluid, 6.7 L of packed RBCs reconstituted with FFP (average Hct, 33%) was used. The patient's Hct increased from 26.9 percent before the exchange to 28.3 percent after the exchange. The percentage of parasitized RBCs decreased from 13.8 percent just before exchange to 4.2 percent immediately after exchange. There was rapid clinical improvement after the whole‐blood exchange transfusion. The patient's subsequent clinical course was marked by a disappearance of the parasitemia and continued slow, general improvement. Therapy with clindamycin was continued for 14 days after the exchange transfusion and quinine for 17 days.

CONCLUSION: In cases of severe babesiosis, prompt institution of whole‐blood exchange transfusion, in combination with appropriate antimicrobial therapy, can be life‐saving.
The release of unsuitable units through misinterpretation of laboratory results transmitted by facsimile
Authors: Linden J.V.
Published: March 2003

BACKGROUND: Preventable errors in transfusion medicine that have a significant risk of adverse outcome include the erroneous administration of blood of the wrong type or blood with unsuitable laboratory test results. Mandatory reports of errors by facilities providing blood services in New York State offer the opportunity for review and analysis of common factors. The state also collects statistics on the collection, laboratory testing, distribution, and disposition of blood in these facilities.

CASE REPORTS: Three serious errors in transfusion medicine occurred within 3 months as a result of the misinterpretation of laboratory test results transmitted by facsimile. Two unsuitable units of blood were erroneously released, and a unit mislabeled as to the ABO group was incorporated into the hospital inventory. One of the unsuitable units was repeatedly reactive for HIV (although negative on confirmatory testing), and the other was confirmed positive for HCV.

CONCLUSIONS: The vast majority of blood collected in New York State is tested by reference laboratories. Results are often transmitted by facsimile. Facsimile results may be misinterpreted because of distortion during transmission, misreading, or failure to note a separate report of pending results. Such misinterpretation results in an increased risk of adverse outcome for transfusion recipients. Laboratory results to be transmitted by facsimile could readily—and should—be clarified.
High prevalence of TT virus infection in French blood donors revealed by the use of three PCR systems
Authors: Biagini P. , Gallian P. , Touinssi M. , Cantaloube J.F. , Zapitelli J.‐P. , De Lamballerie X. , De Micco P.
Published: March 2003

BACKGROUND: The purpose of this study was to determine the prevalence of TT virus (TTV) infection in voluntary blood donors in Southeastern France.

STUDY DESIGN AND METHODS: The sera of 289 blood donors were tested for the presence of TTV DNA by two PCR systems detecting genes located in the 5′ UTR (primer set A [Set A]) and the open reading frame (ORF2) (primer set B [Set B]) of the viral genome. A randomized sample of 40 blood donors was also tested by a nested‐PCR system in the ORF1 by use of primer set C (Set C). Donors were questioned for possible risk factors for virus transmission.

RESULTS: In the entire population studied, 30.8 percent of blood donors tested positive with both Sets A and B, and 70.6 percent with at least one set. In the sample tested with three sets of primers, 27.5 percent of blood donors were positive in testing with all PCR systems and 80 percent with at least one system. The specificity of TTV DNA amplification was confirmed by sequencing 10 PCR products obtained with each set of primers. Statistical analysis revealed that the prevalence of TTV reactivity increased with age.

CONCLUSION: The high prevalence of TTV reactivity and the absence of a pathologic condition or risk factors obviously associated with the infection in blood donors suggest that there is no need for systematic detection of TTV infection before blood donation. Further studies are required to determine if TTV isolates can be responsible for a pathologic condition in humans after blood transfusion.
Combined administration of G–CSF and dexamethasone for the mobilization of granulocytes in normal donors: optimization of dosing
Authors: Liles W.C. , Rodger E. , Dale D.C.
Published: March 2003

BACKGROUND: The clinical utility of neutrophil (polymorphonuclear leukocyte, PMN) transfusion therapy has been compromised, in part, by the inability to obtain sufficient quantities of functional neutrophils from donors. Mobilization of PMNs in the peripheral blood of normal volunteers has been shown to be superior when G–CSF is administered in conjunction with dexamethasone to that when either agent is administered alone. The current study was conducted to determine the optimal dosages of G–CSF and dexamethasone to be administered to donors in a granulocyte transfusion program.

STUDY DESIGN AND METHODS: Five normal subjects were randomly assigned to each of the following single‐dose regimens over five consecutive weeks: 1) subcutaneous (SC) G–CSF at 600 μg and oral (PO) dexamethasone at 8 mg; 2) SC G–CSF at 450 μg and PO dexamethasone at 8 mg; 3) SC G–CSF at 450 μg and PO dexamethasone at 12 mg; 4) SC G–CSF at 450 μg; and 5) PO dexamethasone at 12 mg. Venous blood was collected at 0, 6, 12, and 24 hours after drug administration for determination of absolute neutrophil count (ANC). Side effects of drug administration were recorded by using a standardized symptom questionnaire.

RESULTS: Maximal ANC was achieved at 12 hours after administration of drugs under each regimen. All four regimens containing G–CSF caused greater than 10‐fold increases in the ANC. When administered in conjunction with dexamethasone, G–CSF resulted in statistically similar PMN mobilization at dosages of 450 μg and 600 μg. The combined single‐dose regimen of SC G–CSF at 450 μg and PO dexamethasone at 8 mg increased the mean ANC from a baseline value of 2800 per μL to 37,900 per μL at 12 hours after administration. This regimen was well tolerated by the normal volunteers.

CONCLUSION: In a single‐dose format designed for clinical granulocyte transfusion programs, optimal PMN mobilization can be achieved in normal donors with a combined regimen of SC G–CSF at 450 μg, and PO dexamethasone at 8 μg.
GB Virus type C/HGV markers in HCV RNA‐positive French blood donors: correlation with HCV genotypes and risk factors
Authors: Bouchardeau F. , Laperche S. , Pillonel J. , Elghouzzi M.H. , Maisonneuve P. , Tirtaine C. , Boiret E. , Razer A. , Girault A. , Beaulieu M.J. , Couroucé A.M.
Published: March 2003

BACKGROUND: Exposure to GB virus type C/HGV (GBV‐C/HGV) could be determined by detection either of RNA by RT‐PCR or of antibodies of the envelope protein E2.

STUDY DESIGN AND METHODS: The aim of the study was to determine the proportion of the GBV‐C/HGV markers of infection in a blood donor population infected with HCV and to identify GBV‐C/HGV routes of transmission that are associated with HCV genotypes and risk factors.

RESULTS: Among 306 HCV RNA‐positive blood donors, the proportion of GBV‐C/HGV RNA‐positive donors and anti‐E2‐positive donors was 19.3 percent (95% CI = 15.0‐24.2%) and 42.1 percent (95% CI = 36.6‐47.9%), respectively. Exposure to GBV‐C/HGV (RNA or anti‐E2) was significantly associated with the risk factor of IV drug use. There was a trend toward association with HCV subtypes 1a and 3a, probably because these HCV subtypes are the most frequent in IV drug users. No correlation was observed between ALT elevation and the presence of GBV‐C/HGV RNA.

CONCLUSION: In persons with HCV infection, IV drug use seems to be a major route of GBV‐C/HGV transmission. Precautions taken to avoid HCV infection will probably also decrease GBV‐C/HGV transmission.
Infusible platelet membranes improve hemostasis in thrombocytopenic blood: experimental studies under flow conditions
Authors: Galán Ana‐Maria , Bozzo Jordi , Hernández Maria‐Rosa , Pino Marcos , Reverter Juan‐Carlos , Mazzara Roberto , Escolar Ginés , Ordinas Antonio
Published: March 2003

BACKGROUND : The potential hemostatic effect of infusible platelet membranes (IPM; Cyplex, Cypress Bioscience) prepared from outdated human platelets is investigated.

STUDY DESIGN AND METHODS: Increasing concentrations of IPM were added to blood samples anticoagulated with low‐molecular‐weight heparin, in which platelets and WBC counts had been experimentally reduced by a filtration procedure. Thrombocytopenic blood with IPM was circulated in a perfusion chamber at various shear rates (300, 600, and 1200/sec–1), and platelet and fibrin deposition on the surface of a damaged vessel was measured. Prothrombin fragments 1 and 2 (F1+2) levels were also monitored.

RESULTS: Under conditions of severe thrombocytopenia (<6000 platelets/μL) IPM did not increase platelet deposition. However, a dose‐dependent increase in fibrin deposition was observed with concentrations of IPM ranging from 0.5 to 2 mg per kg in perfusions at 300 and 600 per sec–1 (p<0.05 vs. thrombocytopenic blood). Experimental studies performed under conditions of moderate thrombocytopenia and higher shear rates (25,000‐30,000 platelets/μL; at 600 and 1200/sec–1) showed that IPM concentrations equivalent to 0.5 or 1 mg per kg improved fibrin deposition (33.5 ± 9.5% and 37.7 ± 12.8%, respectively, vs. 22.7 ± 5.2% in controls) and also promoted a moderate increase in platelet deposition, with a concomitant significant increase in the size of platelet aggregates (p<0.05). Exposure of thrombocytopenic blood to a damaged vessel resulted in an increase of F1+2 levels from 0.8 ± 0.15 to 1.7 ± 0.22 nM at 300 per sec–1 and 1.94 ± 0.46 nM at 600 per sec–1. Postperfusion levels of F1+2 after the addition of IPM were always similar to levels in untreated controls.

CONCLUSION: IPM promotes local procoagulant activity at sites of vascular damage under conditions of severe and moderate thrombocytopenia. IPM also appears to facilitate platelet cohesive functions under conditions of moderate thrombocytopenia.
Transfusion of washed and centrifuged shed RBCs during maxillofacial surgery affects cytokine concentrations
Authors: Rohling Roman G. , Zimmermann Axel P. , Zellweger René , Schanz Urs
Published: March 2003

BACKGROUND: In patients undergoing elective maxillofacial surgery, hyperthermic reactions have been observed after the transfusion of autologous washed and centrifuged shed blood. It was the aim of this study to correlate the clinical features with changes in cytokine levels.

STUDY DESIGN AND METHODS: In 24 consecutive patients, TNFα, IL‐1, and IL‐6 levels were determined in washed and centrifuged shed RBCs (CS RBCs) and in the patient's serum before, as well as 15 and 120 minutes after transfusion. At the same time, blood was drawn for culture. Patients in whom whole blood was saved through the use of acute normovolemic hemodilution served as a control group (n = 6).

RESULTS: After the transfusion of CS RBCs, patients had not only elevated cytokine levels but also transient bacteremia involving the pathogens previously detected in CS RBCs. No rise in body temperature occurred.

CONCLUSION: In the light of these results, the use of CS RBCs in patients undergoing maxillofacial surgery should be restricted to those patients with no primary bacterial contamination.
Allelic polymorphisms of human Fcγ receptor IIa and Fcγ receptor IIIb among distinct groups in Brazil
Authors: Kuwano Sachie T. , Bordin José O. , Chiba Akemi K. , Mello Adriana B. , Figueiredo Maria S. , Vieira‐Filho João P.B. , Fabron Antonio , Kerbauy José
Published: March 2003

BACKGROUND: The FcγRIIA gene is expressed in two polymorphic forms, R131 and H131, which differ by the replacement of histidine by arginine at position 131. The FCGR3B (FcγRIIIB) gene exists in two allelic isoforms, known as FCGR3B1 (FcγRIIIB‐NA1) and FCGR3B2 (FcγRIIIB‐NA2), which differ in nucleotides 141, 147, 227, 277, and 349. An additional polymorphism is the SH antigen that is associated with the FCGR3B3 (FcγRIIIB‐SH) allele.

STUDY DESIGN AND METHODS: By use of a PCR with allele‐specific primers, the allelic polymorphisms of FcγRIIA and FcγRIIIB were determined among 263 unrelated Brazilian subjects, including Amazon Indians (n = 92), blood donors (n = 85), and patients with sickle cell disease (SCD) (n = 86).

RESULTS: Amazon Indians had a significantly higher frequency of the R131 allele than did blood donors and SCD patients (0.91 vs. 0.55 vs. 0.55; p<0.001). NA1 and NA2 gene frequencies were found to be 0.67 and 0.21 for Amazon Indians, 0.58 and 0.42 for blood donors, and 0.61 and 0.39 for SCD patients, respectively. The FcγRIIIB‐SH allele was absent from the Amazon Indians, but 9 (10.6%) blood donors and 10 (11.6%) SCD patients expressed this allele.

CONCLUSION: Overall, the data indicate that the distribution of the FcγRIIIB alleles is significantly different in Amazon Indians from the distribution in Brazilian blood donors or African Brazilian patients with SCD, but that it is similar to the distributions reported in Asian populations. Moreover, the distribution of the FcγRIIA and FcγRIIIB alleles among Brazilian blood donors and SCD patients is comparable to the distributions reported in whites from the United States and Europe.
Potassium‐adsorption filter for RBC transfusion: a Phase III clinical trial
Authors: Inaba Shoichi , Nibu Keiko , Takano Hisayo , Maeda Yoshiaki , Uehara Kouichi , Oshige Takaaki , Yuasa Takeshi , Nakashima Hitoshi
Published: March 2003

BACKGROUND: Within the past 2 years, three cases of cardiac arrest just after rapid transfusion of RBCs preserved for over 7 days after 15‐Gy irradiation were found. This severe complication caused transient hyperkalemia. To prevent potassium (K+) overload by RBC transfusion at the bedside, a K+‐adsorption filter made of sodium polystyrene sulfonate was developed.

STUDY DESIGN AND METHODS: After in vitro and animal safety and efficacy tests, a Phase III clinical trial was conducted with 65 patients given transfusions via the newly developed filter (filter group) and 37 patients in whom the filter was not used (control group) and transfusions were given at twice the usual flow rate (20 mL/min).

RESULTS: More than 85‐percent (94.4 ± 3.8%) removal of K+ in RBCs in mannitol‐adenine‐phosphate (MAP) that had been preserved for more than 14 days or that were used 3 days after 15‐Gy irradiation (calculated K+: 3.8 ± 1.3 mEq/bag) was achieved in 82 of 83 bags of MAP RBCs in the filter group, with 79.6 percent removed in the other, even in rapid transfusions. RBC recovery 1 day after transfusion, determined by increments in RBCs, Hb, and Hct, were 24 and 0.4 × 104 per μL, 0.7 and 0.3 g per dL, and 1.6 and 0 percent, respectively, in the filter and control groups. No adverse transfusion reactions, such as hypotension, anaphylactoid reactions, or asthma‐like attacks, were observed, except for one case of urticaria in the filter group. Mild fever (within 1°C) after transfusion was observed in both groups. Serologic markers of hemolysis rose slightly in both groups, but there was no significant difference between the two groups.

CONCLUSION: The newly developed K+‐adsorption filter is useful, especially in a rapid transfusion setting.
A MAR‐like antibody in a DCWe/DCWe person
Authors: O'Shea Kathleen P. , Øyen Ragnhild , Sausais Laima , Stephens Vivian A. , Stillwell Gail F. , Bisgard Leslie A. , Martin Judy , Reid Marion E.
Published: March 2003

BACKGROUND: MAR (RH51), a high‐incidence antigen in the Rh blood group system, is absent from RBCs with a double dose of CW or CX or a single dose each of CW and CX antigens, as well as from rare Rh phenotypes including D–– and Rhnull. The MAR antigen is associated with the presence of Ala36 and Gln41 on the RhCe protein. The original example of anti‐MAR, described in 1994, was made by a DCWe/DCXe woman. It was possible that the antibody directed against a high‐incidence antigen in the Rh system made by a DCXe/DCXe woman (CM) in 1983 was anti‐MAR.

CASE REPORT: A 52‐year‐old, multiply transfused, white woman (CJ) with pre‐existing anti‐c, ‐E, and ‐Jka presented for preoperative work‐up for her fifth open heart procedure. The strength of the reaction of her RBCs with anti‐CW suggested a double dose of CW antigen. Her serum, which unexpectedly was strongly reactive with c–, E–, Jk(a–) RBCs by PEG indirect antiglobulin test, was incubated with E–c–, Jk(a–) RBCs, and an eluate was prepared. This eluate reacted 3+ with E–c–, Jk(a–) RBCs but did not react with Rhnull (n = 5), –– (3), DCW– (2), Dc– (1), or DCWe/DCWe (1) RBCs. Two related DCXe/DCXe and two unrelated DCWe/DCXe RBC samples were weakly agglutinated. The patient's RBCs were negative with the original anti‐MAR but reacted as strongly as the positive control RBCs with the antibody made by the DCXe/DCXe person.

CONCLUSION: This is the first example of a MAR‐like antibody made by a DCWe/DCWe woman. The specificity cannot be called anti‐MAR, because some MAR‐negative samples react, albeit weakly. The original anti‐MAR, made by a DCWe/DCXe woman, did not react with DCWe/DCWe, DCWe/DCXe, or DCXe/DCXe RBCs. It is apparent that the specificity of “anti‐MAR” differs slightly, depending on the CW/CX status of the antibody maker.
Severity of iron overload in hemochromatosis: effect of volunteer blood donation before diagnosis
Authors: Barton James C. , Preston Benjamin L. , McDonnell Sharon M. , Rothenberg Barry E.
Published: March 2003

BACKGROUND: An effort was made to determine if volunteer blood donation before diagnosis decreases the severity of iron overload at diagnosis in persons with hemochromatosis.

STUDY DESIGN AND METHODS: A study was performed in 1089 persons in the United States with hemochromatosis who responded to a convenience sample survey and in 124 C282Y/C282Y hemochromatosis probands diagnosed during routine medical care.

RESULTS: Less than half of questionnaire respondents (46.2%) and probands (35.5%) reported that they had been volunteer blood donors; 5.4 percent and 4.0 percent, respectively, had donated >20 units of blood. In either subject group, there were no significant differences according to age in the mean numbers of units that needed to be removed by therapeutic phlebotomy to induce iron depletion in subgroups of men and women, respectively. Similarly, there was no significant correlation of units of voluntary blood donation or of therapeutic phlebotomy index (= therapeutic phlebotomy units ÷ age in years) with the number of therapeutic phlebotomy units needed to induce iron depletion. When questionnaire respondents were stratified by sex, there was no significant correlation of units of blood donation with the number of therapeutic phlebotomy units needed to induce iron depletion or with the therapeutic phlebotomy index.

CONCLUSION: Routine blood donation does not, on average, decrease the severity of iron overload in persons with hemochromatosis. These findings have implications for the understanding of the severity of iron overload and its complications in hemochromatosis, for advising persons with hemochromatosis about treatment, and for considering persons with hemochromatosis as possible blood donors.
Platelet transfusions in the neonatal intensive care unit:factors predicting which patients will require multiple transfusions
Authors: Del Vecchio Antonio , Sola Martha C. , Theriaque Douglas W. , Hutson Alan D. , Kao K.J. , Wright Dale , Garcia Maria G. , Pollock Brad H. , Christensen Robert D.
Published: March 2003

BACKGROUND:Previous studies suggest that recombinant thrombopoietin (rTPO) will increase platelet production in thrombocytopenic neonates. However, the target populations of neonates most likely to benefit should be defined. Studies suggest that rTPO will not elevate the platelet count until 5 days after the start of treatment. Therefore, the neonates who might benefit from rTPO are those who will require multiple platelet transfusions for more than 5 days. This study was designed to find means of prospectively identifying these patients.

STUDY DESIGN AND METHODS:A historic cohort study of all patients in the neonatal intensive care unit (NICU) at the University of Florida who received platelet transfusions from January 1, 1997, through December 31, 1998, was conducted.

RESULTS:Of the 1389 patients admitted to the NICU during the study period, 131 (9.4%) received platelet transfusions. Seventeen were treated with extracorporeal membrane oxygenation and were excluded from further analysis. Of the remaining 114 patients, 55 (48%) received one transfusion and 59 (52%) received more than one transfusion (21 had >4). None of the demographic factors examined predicted multiple platelet transfusions. However, two clinical conditions did; liver disease and renal insufficiency. Neonates who received one platelet transfusion had a relative risk of death 10.4 times that in neonates who received none (p = 0.0001). Neonates who received >4 platelet transfusions had a risk of death 29.9 times that in those who received no transfusions (p = 0.0001).

CONCLUSION:NICU patients with liver disease or renal insufficiency who receive one platelet transfusion are likely to receive additional transfusions. Therefore, these patients constitute a possible study population for a Phase I/II rTPO trial.
Seroprevalence of human herpes virus 8 antibody in populations at high or low risk of transfusion, graft, or sexual transmission of viruses
Authors: Challine Dominique , Roudot‐Thoraval Françoise , Sarah Turiaf , Laperche Liliane , Boisson Bruno , Mauberquez Stéphanie , Dubernet Fabienne , Rigot Pïerrette , Lefrère François , Mercier Bernard , Brossard Yvon , Rouet François , Girot Robert , Loiseau Pascale , Girard Danièle , Claquin Jacky , Loty Bernard , Lerable Joëlle , Mariotti Martine , Pawlotsky Jean‐Michel , Lefrère Jean‐Jacques
Published: March 2003

BACKGROUND: The routes of transmission of human herpes virus 8 (HHV‐8) remain unclear. In particular, HHV‐8 transmission by blood components and organ transplantation is still debated and raises public health issues. The objective of this study was to determine the prevalence of anti‐HHV‐8 in selected populations of persons or patients with or without risk factors for the transmission of viral infections, in order to determine the routes of HHV‐8 transmission.

STUDY DESIGN AND METHODS: A total of 1431 persons or patients at low or high risk of sexually, blood‐, or graft‐transmitted viral infections were tested by means of a standardized immunofluorescence serologic assay detecting anti‐HHV‐8.

RESULTS: The persons or patients could be classified into three distinct groups according to anti‐HHV‐8 prevalence: a low prevalence group (0.0% to 5.0%), including healthy blood donors, healthy pregnant women, multiply transfused patients with thalassemia major, and IV drug users; an intermediate prevalence group (5.0% to 20.0%), including organ donors, kidney transplant recipients, and multiply transfused patients with sickle cell disease; a high prevalence group (>20.0%), including HIV‐negative persons at high risk of sexually‐transmitted viral infections, and HIV‐infected homosexual men and heterosexuals.

CONCLUSION: The sexual route appears to be the main route of HHV‐8 transmission; bloodborne transmission of HHV‐8, if it exists, is rare. In contrast, organ transplantation recipients might be exposed to HHV‐8 transmission by the transplanted organ, which raises the issue of systematic screening of organ donors.
Autologous blood transfusion in the United States: clinical and nonclinical determinants of use
Authors: Segal Jodi B. , Guallar Eliseo , Powe Neil R.
Published: March 2003

BACKGROUND : Preoperative donation of blood lowers the risk of allogeneic RBC transfusion. The use of autologous blood is not well quantified. This study aimed at identifying the frequency and determinants of use of autologous transfusion in the United States.

STUDY DESIGN AND METHODS: This national cross‐sectional study, using the Nationwide Inpatient Sample, included all patients admitted to 900 hospitals in 19 states in 1996. Logistic regression with weighting yielded nationally representative results for the independent effects of clinical and nonclinical patient characteristics on autologous blood use.

RESULTS: Autologous transfusion was used in 19 of 1000 hospitalizations. The procedures using autologous blood most frequently were knee arthroplasty, hip replacement, prostatectomy, spinal fusion, and hysterectomy. Blacks and Hispanics were less likely to receive autologous transfusion than were whites (OR, 0. 64; 95% CI, 0.45‐0.83); patients with Medicaid were less likely than the privately insured to receive autologous transfusions (OR, 0.29; 95% CI, 0.20‐0.43), with racial differences greatest among the privately insured. Women received autologous blood for cardiovascular surgeries much less often than men (OR, 0.32; 95% CI, 0.20‐0.49).

CONCLUSION: Ethnic minorities, women, and patients with Medicaid appear to receive fewer autologous blood transfusions than the rest of the population. Although this could reflect either better or worse quality of care, nonclinical determinants of transfusion practice warrant attention and further investigation.
Detection and removal of fat particles from postoperative salvaged blood in orthopedic surgery
Authors: Ramírez Gemma , Romero Adolfo , García‐Vallejo Juan Jesús , Muñoz Manuel
Published: March 2003

BACKGROUND: Although transfusion or return of salvaged shed blood has become popular in major orthopedic procedures, this blood‐saving method is still controversial because shed blood may be contaminated with chemical and tissular debris, such as fat particles, which may increase the risk of fat embolism after bone surgery.

STUDY DESIGN AND METHODS: In an effort to find an easy, reliable method for determination of both fat particle content and removal from shed blood, analyses of perioperative blood samples were performed with a cell counter (Technicon H3 [H3]) in orthopedic patients undergoing spinal fusion in which postoperative shed blood was collected and returned with a blood collection canister. A screen or surface filter was intercalated in the return line to eliminate microaggregates, fat particles, and/or WBCs.

RESULTS: Fat particles in shed blood are clearly detected as a condensed, sigmoidal‐shaped area at the right‐hand side of the PMN zone in the channel in which the H3 measures particles according to their degree of lobularity. This signal can be reproduced by the addition of animal or vegetable fat to venous blood, but not by the addition of activated platelets or RBC membranes. Fat particles, together with WBCs and microaggregates, in shed blood were effectively removed by surface filters, whereas screen filters were not effective.

CONCLUSION: The use of the TH3 seems to be an easy, reliable, and low‐cost approach for monitoring fat particle content and removal from postoperative salvaged shed blood in orthopedic procedures.
Production of pathogen‐inactivated RBC concentrates using PEN110 chemistry: a Phase I clinical study
Authors: AuBuchon James P. , Pickard Constance A. , Herschel Louise H. , Roger Jill C. , Tracy James E. , Purmal Andrei , Chapman John , Ackerman Samuel , Beach Kathleen J.
Published: March 2003

BACKGROUND: Despite extensive reductions in risk, donor selection and testing cannot eliminate pathogen transmission. The objective of this study was to evaluate clinically the viability of pathogen‐inactivated RBCs.

STUDY DESIGN AND METHODS: Twelve healthy subjects each donated two units of blood that were handled as additive system control units or were inactivated using the PEN110 process (INACTINE, V.I. Technologies) in randomized order. PEN110, which inactivates pathogens by reacting with nucleic acid bases, was incubated with RBCs for 6 hours, followed by washing and quenching with sodium thiosulfate. Radiolabeled RBC recovery and survival determinations were undertaken after 28 days of storage; biochemical and hematologic variables were assessed over 42 days.

RESULTS: After 28 days, treated units had a 24‐hour double‐label (51Cr/99mTc) recovery (85.0 ± 5.0%) that was indistinguishable from control units (85.9 ± 2.7%); the times required for reduction of radioactivity of labeled cells to half the Day 1 activity (T50) were similar for both groups (treated, 31.9 ± 8.2 days; control, 32.9 ± 3.3 days). No deleterious effects of PEN110 treatment were found on RBC antigens tested. Treatment reduced 2,3‐DPG levels by half and slightly lowered pH levels. Throughout the 42‐day storage period, treated RBCs had a lower level of lactate production and a trend toward lower glucose consumption. Hemolysis remained below 1 percent; supernatant potassium and ATP levels were lower than those seen in control RBCs.

CONCLUSION: PEN110‐treated RBCs stored for 28 days meet all critical requirements for therapeutically useful units.
Absence of anti‐D alloimmunization in hematologic patients after D‐incompatible platelet transfusions
Authors: Cid Joan , Ortin Xavier , Elies Enric , Castellà Dolors , Panadés Marta , Martín‐Vega Carmen
Published: March 2003

BACKGROUND: Rh antigens are not present on the platelet surface. However, platelet concentrates may contain enough RBCs to elicit an anti‐D response. Thus, D status must be considered in platelet transfusion. In immunosuppressed patients, frequencies of D alloimmunization of up to 19 percent have been previously reported.

STUDY DESIGN AND METHODS: Here a prospective study is reported in which 22 D– patients with hematologic disease received D+ platelet transfusions. Platelet concentrates were prepared from whole‐blood donations according to the buffy coat method and were pooled before administration. The antibody screen test to detect anti‐D was performed by LISS‐ IAT using the gel test.

RESULTS: Our series comprises 22 immunosuppressed D+ patients with a median age of 56 years (range, 23–79). The patients received 121 D‐incompatible pooled platelet transfusions. The mean ± SD of RBC content was 4.17 ± 1.74 mL. None of the 22 patients developed detectable anti‐D after a median follow‐up of 8 weeks (range, 1–37).

CONCLUSION: The risk of D alloimmunization is low in patients with hematologic disease after D‐incompatible platelet transfusions using platelet concentrates prepared by the buffy coat method.
Comparative analysis of normal prion protein expression on human, rodent, and ruminant blood cells by using a panel of prion antibodies
Authors: Barclay G. Robin , Houston E. Fiona , Halliday Sue I. , Farquhar Christine F. , Turner Marc L.
Published: March 2003

BACKGROUND: It is not known whether variant CJD can be transmitted within the human population by blood transfusion. The expression of normal cellular prion protein (PrPC) by different blood cell types may permit selective uptake and dissemination of infectivity.

STUDY DESIGN AND METHODS: The normal distribution of PrPCon the major blood cell types of species known to be susceptible to natural or experimental transmissible spongiform encephalopathies was studied. Blood from healthy humans, mice, hamsters, cattle, and sheep was examined by flow cytometry by using a large panel of antibodies with different prion protein (PrP) epitope specificities to maximize the detection of PrP variants across species and cell type.

RESULTS: PrP was detected on all major human blood cells types except eosinophils, but was not detected as ubiquitously or uniformly on major blood cell types of different animal species.

CONCLUSION: Different animal species have unique patterns of expression of PrPCon blood cell types, with none equivalent to the human pattern. This needs to be considered when extrapolating from animal models of blood‐borne transmissible spongiform encephalopathy infectivity, particularly in regard to the risk assessment of potential variant CJD spread within the human population. The relationship between PrP distribution and infectivity distribution in blood needs further investigation.