bluuebunny/crossref_metadata_2025 huggingface dataset:
Storage of platelets in balanced salt solutions: a simple platelet storage medium
Authors: Rock G. , White J. , Labow R. S.
Published: March 2003

When a commercially available intravenous solution, plasmalyte‐A, was added to platelet pellets as a platelet storage medium (PSM) after more than 85 percent of the plasma had been expressed, the platelets functioned equally well, after 5 days of storage, in platelet aggregation, release reaction, and serotonin uptake as did platelets stored in plasma. The level of fibrinopeptide A was significantly different in the PSM. Similarly, lower levels of kallikrein and complement components in the PSM‐stored platelets indicated reduced activation of plasma enzyme systems. Morphology scores showed better shape maintenance in PSM, with values of 255 versus values of 185 in plasma (time zero, 280); electron microscopy also showed somewhat better structural maintenance in PSM. Glucose consumption, lactate and ammonia production, and fatty acid oxidation were also reduced in PSM. No significant differences in pH, white cell count, pO2, pCO2, or lactic dehydrogenase were observed after 5 days of storage in plasma or PSM; however, platelet counts were reduced after 5 days in plasma but remained constant in PSM. The beta‐thromboglobulin release was significantly lower in the PSM‐stored platelets after 5 days. The volume of platelet membrane glycoprotein lb (which is responsible for platelet adhesion) decreased 15 percent in plasma following storage, whereas a decrease of only 5 percent was noted in PSM. There was less leaching of plasticizers in PSM than in plasma. Survival and recovery using 51Cr‐labeled autologous platelets showed that, after 5 days of storage, the recovery of PSM‐stored platelets was 63 percent and the survival was 7.7 +/− 0.8 days (multiple hit model) The data support the hypothesis that plasma is not necessary for the storage of platelet concentrates and that removal of the plasma may benefit by removing enzymes systems that effect the biochemical alterations that occur during storage.
Hemolytic transfusion reaction following transfusion of frozen and washed autologous red cells
Authors: Cregan P. , Donegan E. , Gotelli G.
Published: March 2003

A case of hemolytic transfusion reaction, accompanied by hypotension and followed by transient renal failure, occurred after the transfusion of 1 unit of previously frozen autologous red cells. Subsequent investigation revealed the probable cause of the hemolysis to be inadequate deglycerolization of the unit. The cause of the associated symptoms is unknown. Possibilities include nephrotoxic effects of hemoglobin or stroma, toxic effects of glycerol, or release of vasoactive or thrombogenic substances from lysed red cells. This case of a hemolytic reaction adds to the known risks of autologous transfusion.
Sampling errors and the precision associated with counting very low numbers of white cells in blood components
Authors: Dumont L. J.
Published: March 2003

Attention to the accurate and precise measurement of the white cell (WBC) content of transfused products has risen in response to awareness of the potential benefits of WBC‐depleted components and the development of technical capabilities to produce these components. The techniques thus far reported have focused on the reliability of detecting a WBC, provided it is present in the test system. The likelihood of selecting a WBC from the product of interest for counting in the analytical system–that is, the sampling error–must also be considered. The occurrence of a WBC in a WBC‐depleted component is a rare event and may be modeled with the binomial or the Poisson distribution. Several assay techniques were analyzed by using these distribution models to determine the confidence intervals of the WBC content. The 95‐percent confidence intervals spanned more than 2 logs10 for some methods at 3 × 10(5) WBCs per product. It is concluded that the reporting of WBC content for research provides not only the estimate of the mean but also a confidence interval for this estimate. Quality control procedures should be designed to verify that the WBC content is less than the targeted amount and should provide an associated statement of confidence.
Flow cytometric detection of human red cells labeled with a fluorescent membrane label: potential application to in vivo survival studies
Authors: Read EJ , Cardine LL , Yu MY
Published: March 2003

In vivo survival studies of human red cells (RBCs) are commonly carried out by using chromium‐51 (51Cr), a gamma‐emitting radionuclide, as the cell label. The effects of labeling human RBCs with PKH‐2, a nonradioactive lipophilic fluorescent dye that binds to the cell membrane, and the feasibility of detecting the labeled cells by flow cytometric analysis were investigated. Optimal labeling, defined as maximum mean fluorescence intensity with minimal cell‐to‐cell variability in fluorescence intensity and minimal cell loss, was achieved with the use of 15.0 × 10(−6) M (15.0 × 10(−6) mol/L) PKH‐2 and a cell concentration of 4.0 × 10(9) RBCs per mL. Both freshly drawn and stored RBCs could be labeled, but RBCs stored for more than 20 days did not take up the label as uniformly as fresher cells. Although labeling with PKH‐2 did not interfere with the detection of ABO, Rh(D), or common minor RBC antigens by routine serologic methods, it resulted in a morphologic appearance resembling echinocytosis and an increased resistance to osmotic lysis by hypotonic saline. RBCs labeled by this method could be quantitated accurately in blood samples in which their proportion was 0.01 percent, or 1 labeled cell in 10,000 cells. This method holds promise as a simple, reliable, and sensitive method for the detection of labeled human RBCs, but the in vivo significance of the label's effects on cell morphology and osmotic fragility is not known. Further studies directly comparing PKH‐2‐labeled and 51Cr‐ labeled RBCs will be necessary to establish the accuracy of the former method in determining the in vivo survival of human RBCs.
Improved alanine aminotransferase assay using the microtiter plate
Authors: Spindler J , Neppert J
Published: March 2003

New procedures and new devices have been developed to improve the alanine aminotransferase (ALT) assay by using microtiter plates with 96 wells. Sera for ALT determination and reagents are distributed with a computer‐controlled multiple syringe for simultaneous filling of the 96 wells. The volumes simultaneously distributed by this new multiple syringe show very little variation. The coefficient of variation (CV) is 0.6 percent (n = 96). Repeated filling of the wells with this syringe results in good reproducibility of distributed volumes (CV = 0.5%, n = 10). The temperature of sera, reagents, and mixtures, even during photometry, is actively regulated (down or up) to 25 degrees C in special chambers. Thus, the temperature varies minimally +/− 0.05 degrees C. ALT values in the low normal range as well as the high pathologic range show little variation (CV less than 2.3%) in aliquots of the same sample simultaneously or subsequently examined by the new procedure and with new devices. There is good correlation between the improved method using microtiter plates and the conventional methods (r greater than 0.9900, ALT values from 1–154 U/L). False‐low and false‐ high values are excluded by computerized evaluation of many single determinations during the kinetic reactions in each sample. The new method is precise as well as simple, saves time, and may become important for the determination of other serum constituents on the basis of kinetics.
Preparation of white cell‐reduced platelet concentrates from whole blood during component preparation
Authors: Dzik WH , Cusack WF , Gacek MJ
Published: March 2003

This article introduces a new method of component preparation that is capable of producing white cell (WBC)‐reduced platelet concentrates (PCs) from whole blood. Whole blood is separated into packed red cells (RBCs) and platelet‐rich plasma (PRP) by centrifugation, and the PRP is expressed through a newly designed WBC removal filter into the platelet storage bag. The filtered PRP is then centrifuged and yields WBC‐ reduced PCs and plasma for freezing as fresh‐frozen plasma (FFP). The method uses standard triple‐pack blood bags and centrifugation protocols. Fifteen WBC‐reduced PCs prepared with this technique had an average volume of 56.7 mL, an average Day 5 platelet content of 8.6 × 10(10) per unit, and an average Day 5 WBC content of 0.83 +/− 0.7 × 10(4) per unit (0.14 WBCs/microL). This represents WBC removal equal to at least 99.9 percent (3 log10) of the WBCs found in standard PCs prepared in our laboratory by an identical centrifugation protocol. Paired studies documented a 4.5‐percent platelet loss by filtration. Filtration had no effect on the plasma prepared for FFP as measured by prothrombin time; activated partial thromboplastin time; factors I, V, VIII:C, and VIII:von Willebrand factor; antithrombin‐III; albumin; globulin; or total protein. This method holds promise as a simple and highly effective technique for the production of WBC‐reduced PCs by filtration during component preparation.
Impact of blood transfusion and burn injury on microbial translocation and bacterial survival
Authors: GIANOTTI L. , F'YLES T. , ALEXANDER J.W. , BABCOCK G.F. , CAREY M.A.
Published: March 2003

The role of the immune system in microbial translocation must be clarified. In these studies, the effect of blood transfusion‐related immunosuppression on translocation was investigated in a burn animal model previously known to increase the gut's permeability to 14C‐ radiolabeled Escherichia coli. In a first experiment, Balb/c mice underwent transfusion (T) with 0.2 mL per mouse of allogeneic C3H/HeJ mouse blood 5 days prior to undergoing 30‐percent burn injury (B) and simultaneous gavage (G) with 10(9) E. coli bacteria labeled with 14C. An additional six groups of Balb/c mice underwent different combinations of T, B, and G procedures (TG, BG, TB, T, B, G). Survival rate was recorded for all groups on Day 10. This experiment suggested that B and T, to a lesser extent, were the factors affecting survival, although the combination of T, B, and G clearly showed a synergistic effect on mortality. In a second experiment, 18 Balb/c mice belonging to TBG, BG, TG, and G groups were sacrificed 1, 4, and 24 hours after burn or gavage. The residual radioactivity and the percentage of viable bacteria were computed for mesenteric lymph nodes, spleen, liver, lungs, blood, and peritoneal fluid. Statistical analysis of the radionuclide counts recognized B as the only variable able to enhance the magnitude of 14C E. coli translocation. The percentage of viable bacteria showed that T and, more moderately, B were the factors leading to the failure of bacterial clearance in the tissues.
Prevention of growth of Yersinia enterocolitica in blood by polyester fiber filtration
Authors: Wenz B , Burns E.R. , Freundlich L.F.
Published: March 2003

The ability of polyester white cell‐reduction blood filters to prevent the growth of Yersinia enterocolitica in units of donated blood was studied. Sixteen units of freshly drawn blood were inoculated with 10, 50, 100, or 150 colony‐forming units (CFU) per mL of a clinical isolate of Y. enterocolitica (serotype O:3). The units were subsequently fractionated into red cell concentrate and resuspended in AS‐1 or AS‐3 solution. One‐half of the red cell concentrates in each solution were filtered within 15 hours of phlebotomy and stored for 42 days. The remaining units served as unfiltered controls. Bacterial growth was monitored by weekly cultures and, on the last storage day, by the presence of endotoxin and the formation of methemoglobin. One hundred twelve primary cultures (560 plates) were performed. Units collected in AS‐1 and filtered remained sterile when initially inoculated with 50 CFU or less. Filtered units spiked with 100 CFU or less and collected in AS‐3 remained sterile throughout their shelf life. All unfiltered units supported bacterial growth and the formation of endotoxin and methemoglobin. The filtration of freshly donated blood proves to limit the growth of Y. enterocolitica in red cell components.
Potential for transfusion‐associated graft‐versus‐host disease due to apheresis platelets matched for HLA class I antigens
Authors: Grishaber J.E. , Birney S.M. , Strauss R.G.
Published: March 2003

Transfusion‐associated graft‐versus‐host disease (TA‐GVHD) has been reported in immunocompetent recipients of nonirradiated cellular blood components from donors who are homozygous for an HLA haplotype shared with the patient. In these cases, donor lymphocytes have no antigens foreign to the recipient, and this similarity in HLA antigens appears important for the development of TA‐GVHD. Experience with 65 patients receiving apheresis platelets matched for class I HLA antigens was reviewed to determine the incidence of such a transfusion among HLA‐ matched, unrelated donor‐recipient pairs. In 5 percent of transfusions (31/673), the patient received lymphocytes from a donor exhibiting no antigens foreign to the recipient, but the patient had additional HLA‐A or ‐B antigens not present on donor lymphocytes. Twenty‐three percent (n = 15) of patients received at least one such transfusion. In addition, most patients were immunosuppressed as a result of their underlying disease or therapy, which may decrease the degree of antigen matching required to initiate TA‐GVHD. Until the pathogenesis of this disease is better understood, it is recommended that the transfusion of an HLA‐matched cellular blood component be considered a risk factor for the development of TA‐GVHD regardless of the patient's immune status, and that all such blood components be irradiated.
Report on the Fifth International Society of Blood Transfusion Platelet Serology Workshop
Authors: Kiefel V. , Mueller‐Eckhardt C.
Published: March 2003

The Fifth International Society of Blood Transfusion (ISBT) Platelet Serology Workshop took place in 1990. A total of 21 laboratories participated in the wet workshop. Results were discussed at a meeting of the International Committee on Standardization in Haematology (ICSH) Expert Panel on Platelet Serology at the Joint Congress of the ISBT and the American Association of Blood Banks in Los Angeles in November 1990. Each of the participants analyzed 37 serum samples for platelet‐ reactive alloantibodies and isoantibodies. In addition, two drug‐ dependent (quinine) platelet‐specific antibodies had to be identified among a subset of seven sera. For the first time in a platelet serology workshop, five platelet suspensions had to be typed for the alloantigens of the HPA‐1, ‐3, ‐4, and ‐5 systems.
National acceptability of American Association of Blood Banks Pediatric Hemotherapy Committee guidelines for auditing pediatric transfusion practices
Authors: Strauss R. G. , Blanchette V. , Hume H. , Levy G. , Schloz L. , Blazina J. , Werner A. , Sotelo‐Avila C. , Barrasso C. , Hines D.
Published: March 2003

In 1989, guidelines for the auditing of pediatric transfusion practices were developed by the Pediatric Hemotherapy Committee of the American Association of Blood Banks (AABB) and made available to AABB members. A survey of members who requested the guidelines was conducted to determine how consistent the guidelines were with local transfusion practices and how useful they were for the conduct of audits. The majority of respondents indicated that the recommended audit criteria agreed with local practices and that most of them could be applied to their transfusion practice audits with little or no modification. An exception was that criteria for the transfusion of platelets to premature infants were considered by some to be too liberal. However, after review of the comments and the published information available, the committee elected not to revise the guidelines pertaining to platelet transfusions for premature infants. Bearing in mind that audit criteria are intended to identify circumstances in which transfusions are acceptable as reasonable therapy without need for further justification, rather than to serve as indications for transfusions, the AABB Pediatric Hemotherapy Committee guidelines for auditing pediatric transfusion practices are fairly representative of national practice.
Time‐dependent loss of surface complement regulatory activity during storage of donor blood
Authors: Long K.E. , Yomtovian R. , Kida M. , Knez J.J. , Medof M.E.
Published: March 2003

The survival of transfused red cells (RBCs) diminishes with time of in vitro storage in blood banks, but the molecular mechanisms underlying the slow but incessant deterioration are incompletely understood. To investigate the possibility that impaired resistance to autologous complement attack could play a role in this phenomenon, packed RBCs stored for variable periods were assayed for decay‐accelerating factor (DAF) and CD59, two glycoinositol‐phospholipid (GPI)‐anchored, membrane‐ associated complement regulatory proteins that function physiologically to protect blood cells from autologous complement activation on their surfaces. Immunoradiometric and flow cytometric assays employing DAF and CD59 monoclonal antibodies showed that levels of both surface proteins gradually declined over 6 weeks. Digestion analyses with phosphatidylinositol‐specific phospholipase C, an enzyme that releases GPI‐anchored proteins from cell surfaces, showed that DAF and CD59 molecules with GPI anchors containing unacylated inositol were preferentially lost. These findings suggest: 1) that DAF and CD59 molecules with acylated GPI anchors are more stable in RBC membranes than are molecules with unacylated GPI anchors, and 2) that DAF and CD59 loss may participate with other membrane alterations that occur during in vitro storage in compromising the survival of transfused cells.
IgA cold agglutinins recognize Pr and Sa antigens expressed on glycophorins
Authors: Roelcke D. , Hack H. , Kreft H. , Macdonald B. , Pereira A. , Habibi B.
Published: March 2003

Three cases of IgAκ cold agglutinins (CAs) were studied. One had anti‐Pr1 specificity, one had anti‐Pra, and one had anti‐Sa. The CAs recognize O‐glycans of glycophorins. The findings supplement previous data on anti‐Pr1 specificities of four IgAκ CAs. Because all IgA kappa CAs described recognize O‐glycans of glycophorins, a close association between the CA IgA isotype and specificities for O‐glycans becomes apparent. It is unlikely, however, that the striking association reflects interrelations between IgA CA structure and specificity, because anti‐Sa specificity and all anti‐Pr subspecificities were originally defined with IgM CAs.
Laboratory tests to exclude IgA deficiency in the investigation of suspected anti‐IgA transfusion reactions
Authors: Eckrich R.J. , Mallory D.M. , Sandler S.G.
Published: March 2003

Four methods were compared as to their suitability for excluding IgA deficiency in the investigation of suspected anti‐IgA transfusion reactions. The methods were radial immunodiffusion, passive hemagglutination inhibition, sandwich enzyme‐linked immunosorbent assay, and membrane enzyme immunoassay. Parallel testing was performed on sera from 40 patients or blood donors previously found to have anti‐IgA and low or undetectable levels of IgA. All test methods identified the 40 sera as having abnormally low IgA levels. The membrane enzyme immunoassay required 10 minutes or less for testing, as compared to 3 hours for passive hemagglutination inhibition, 4 hours for sandwich enzyme‐linked immunosorbent assay, and 48 hours for radial immunodiffusion. The membrane enzyme immunoassay offers the potential for a rapid, instrument‐free screen of IgA levels and therefore may be useful in identifying those patients with suspected anti‐IgA anaphylactic transfusion reactions who are not IgA deficient and do not require IgA‐deficient blood components for additional transfusions.
Effect of prestorage white cell reduction on bacterial growth in platelet concentrates
Authors: Wenz B. , Ciavarella D. , Freundlich L.
Published: March 2003

Platelet concentrates stored with and without autologous white cells were produced from units of whole blood that had been purposefully contaminated with bacteria immediately after phlebotomy. The blood was inoculated with one of five species of bacterium at either 10 or 50 colony‐forming units per mL. The growth of the organisms was quantified throughout the conventional 5‐day, 22°C storage period of the platelet concentrates. One species, Klebsiella pneumoniae, failed to grow in any of the components. The remaining species, Staphylococcus epidermidis, S. aureus, Enterococcus faecalis, and Salmonella enteritidis, achieved log growth after 1 day of storage and reached a relative maximum concentration by Day 3. Although the concentration of bacteria immediately after inoculation was lower in the units reduced in white cells by filtration, no significant differences were observed thereafter. Data from this in vitro study support the concept that prestorage white cell reduction of platelet concentrates should not increase the likelihood of transfusion‐induced septicemia.
Hemolytic anemia associated with injection of fluorescein
Authors: Munizza M. , Kavitsky D. , Schainker B.A. , Poyser A. , Peek C. , Nance S.
Published: March 2003

A 49‐year‐old woman presented with a hemoglobin level of 9.5 g per dL (95 g/L), reticulocyte count of 6.7 percent (0.067), and hemoglobinuria. The next day, the hemoglobin had dropped to 5.8 g per dL (58 g/L), and total bilirubin was 8.8 mg per dL (150 μmol/L). The serum reacted 2+ with all red cells (RBCs). The direct antiglobulin test (DAT) was 3+ with anti‐IgG and 1+ with anti‐C3, but eluates prepared by two different methods did not react with untreated RBCs. The eluate reacted 2+ with amoxicillin‐coated RBCs; amoxicillin had been listed in the patient's record as a previous medication. The patient denied recent ingestion of amoxicillin. Further investigation documented the injection of a dye, fluorescein sodium (AK‐FLUOR‐25%), for a ophthalmologic fluorescein angiographic study 2 days before admission. RBCs coated with AK‐FLUOR reacted with the eluate. Controls consisting of normal serum, an eluate prepared from DAT‐negative RBCs, and a serum known to contain anti‐penicillin did not react with AK‐FLUOR‐coated RBCs. Nine days later, the DAT was negative and the serum did not react with untreated RBCs. In the presence of AK‐FLUOR (1‐in‐125) or amoxicillin (1 mg/mL), the serum reacted 2+ in the antiglobulin test. Antibodies to AK‐FLUOR and amoxicillin appeared to react by two mechanisms, which is similar to results in recent reports of other drugs associated with hemolytic anemia. AK‐FLUOR has not previously been reported to be associated with hemolytic anemia.
Phenotyping autologous red cells within 1 day after allogeneic blood transfusion by using immunomagnetic isolation of reticulocytes
Authors: Brun A. , Skadberg Ø. , Hervig T.A. , Sandberg S.
Published: March 2003

Background: When a transfused patient develops multiple or weak blood group antibodies, posttransfusion phenotyping is useful in antibody identification. To perform a correct phenotyping after transfusion, isolation of autologous red cells is necessary. However, mature autologous red cells are impossible to separate from their donor counterparts. Since the proportion of autologous reticulocytes compared to donor reticulocytes increases rapidly after transfusion, selective isolation of reticulocytes provides autologous cells for antigen typing.

Study Design and Methods: Extensive phenotyping was performed on red cells from 10 surgical patients before transfusion and on red cells and reticulocytes after the transfusion of 5 or more red cell units. Reticulocytes were isolated by using an antibody against the human transferrin receptor coupled to magnetic beads.

Results: The data showed nearly full agreement between pretransfusion phenotyping of red cells and posttransfusion typing of reticulocytes. Correct phenotyping of transferred patients could be obtained 8 to 10 hours after transfusion using isolated reticulocytes.

Conclusion: This method is helpful in selecting compatible blood when patients have developed antibodies and have an urgent need for further transfusions.
Changes in ABH antigen expression on red cells during in vivo aging: a flow cytometric analysis
Authors: Fibach E. , Sharon R.
Published: March 2003

Background: During aging of red cells they undergo a multitude of physical and chemical changes.

Study Design and Methods: Age‐dependent changes in the expression of ABH major blood group antigens on red cells were studied in a two‐variable flow cytometric analysis. The expression of the antigens was measured after staining with fluorescence antibodies (for A and B) or lectin (for H). Cell age was related to size as measured by forward light scattering. Aging senescent cells are smaller and have low forward light scattering properties.

Results: The results indicated that, within a given population, the A and/or B and H antigens decreased with the decrease in forward light scattering (i.e., increase in age), but A and B antigen expression decreased to a greater extent than did H.

Conclusion: During aging, red cells lose the antigens of the major blood groups, but the degree of this loss is related to the fact that these antigens are located on the cell surface.
Multiple unconfirmed‐reactive screening tests for viral antibodies among blood donors
Authors: Buffington J. , Shapiro C.N. , Holman R.C. , Strine T.W. , Grossman B.J. , Williams A.E. , Alter M.J. , Schonberger L.B.
Published: March 2003

BACKGROUND: In December 1991, the United States Food and Drug Administration received reports of blood donations with unconfirmed reactivity on screening tests for antibodies to human immunodeficiency virus, human T‐lymphotropic virus type I, and hepatitis C virus (HCV). Of 91 donors with these test results, 57 (63%) reported a recent influenza vaccination.

STUDY DESIGN AND METHODS: To determine the extent of unconfirmed reactivity, the time at which it began, and its association or nonassociation with specific manufacturers' tests, a nationwide survey of blood centers was conducted. A case‐donation was defined as a blood donation that was repeatedly reactive, but not confirmed positive, on at least two of the three tests from May 1990 through December 1991.

RESULTS: Among 14 million donations screened by 110 centers, 582 case‐donations were identified. An increase in case‐ donations was evident in the fall of 1990 (2.8/100,000 donations). In 1991, rates increased from 0.9 per 100,000 donations in the first quarter to 1.3, 3.2, and 19.7 in subsequent quarters. A significantly higher rate of case‐donations was observed among donations tested with one of the two available anti‐HCV screening tests (8.0 vs. 1.2/100,000 donations; risk ratio = 6.8; 95% CI = 5.4–8.5).

CONCLUSION: Although unconfirmed reactivity on multiple screening tests appeared to be seasonal, its documentation prior to the availability of influenza vaccine in 1991 and higher rates among donations tested with one manufacturer's anti‐HCV test indicated that test‐specific factors were also involved.
Modification of glutathione content in platelet concentrates by the use of acivicin
Authors: Burch P.T. , Aman M. , Burch J.W.
Published: March 2003

BACKGROUND: Intracellular glutathione declines progressively in platelet concentrates stored for transfusion, but little is known about the nature of this process.

STUDY DESIGN AND METHODS: Acivicin, an irreversible inhibitor of gamma‐glutamyl transpeptidase, was used to determine the fate of glutathione lost from platelets during storage. Glutathione, cysteinylglycine, cysteine, and their disulfides were measured by high‐performance liquid chromatography.

RESULTS: In control and acivicin‐treated platelet concentrates, intracellular glutathione declined progressively during 7 days' storage, with half‐disappearance times of 2.12 ± 0.22 and 2.13 ± 0.23 days, respectively. No glutathione accumulated accumulated in the medium of control concentrates. In concentrates treated with acivicin, glutathione accumulated in plasma to a level equal to 150 percent of that present in platelets and plasma on Day 1 of storage, which suggested a net synthesis of glutathione during storage. The sum of glutathione, cysteinylglycine, and cysteine in plasma was not different in control and acivicin‐treated concentrates; however, plasma from control concentrates contained significantly higher amounts of cysteinylglycine and cysteine. Treatment of concentrates with acivicin had a small favorable effect on plasma lactate dehydrogenase, beta‐thromboglobulin, and beta‐N‐acetylglucosaminidase during storage.

CONCLUSION: The loss of glutathione from platelets during their storage as concentrates for transfusion is due to its egress into the suspending medium and catabolism by gamma‐glutamyl transpeptidase.
Fatal graft‐versus‐host disease associated with transfusions of HLA‐ matched, HLA‐homozygous platelets from unrelated donors
Authors: Benson K. , Marks A.R. , Marshall M.J. , Goldstein J.D.
Published: March 2003

BACKGROUND: Transfusion‐associated graft‐versus‐host disease (TA‐GVHD) due to blood from HLA‐homozygous related and unrelated blood donors has been described. CASE REPORT: Fatal TA‐GVHD due to the transfusion of HLA‐matched platelets from an unrelated HLA‐homozygous donor is reported. A 61‐year‐old man with a history of diabetes mellitus and myelodysplastic syndrome was diagnosed with acute myelogenous leukemia in November 1991. Induction chemotherapy resulted in aplasia, which was followed by a normocellular marrow with mild dysplasia and continued karyotypic abnormalities. High‐dose chemotherapy was given in a second attempt to achieve complete remission. HLA‐matched platelets were ordered when platelet refractoriness developed. The patient was HLA‐ heterozygous for HLA‐A and ‐B antigens (A2, 29; B37, 44). Over the next 7 days, four unirradiated HLA‐matched plateletpheresis units were transfused; one was probably homozygous for both HLA‐A and ‐B antigens (A2, ‐; B44, ‐) and was transfused first, and three were probably homozygous for an HLA‐B antigen (A2, 29; B44, ‐) and were white cell reduced. No blood relatives served as donors. Seven days after the first HLA‐matched platelet transfusion, fever, chills, and diarrhea developed; 2 days later, a rash was present. Liver enzymes increased markedly. Renal and respiratory failure ensured. A skin biopsy was consistent with GVHD. Despite immunosuppressive therapy, the patient died 19 days after the first HLA‐matched platelet transfusion.

CONCLUSION: TA‐GVHD has been recognized in immunocompromised, HLA‐ heterozygous patients receiving blood from blood relatives who are HLA‐ homozygous. patients receiving blood from either blood relatives or non‐ blood relatives who are HLA‐homozygous. This HLA‐heterozygous patient received transfusions of unirradiated, class I HLA‐homozygous platelets, which were specifically ordered as HLA‐matched, and his death was attributed to TA‐GVHD. Consideration should always be given to providing irradiated blood for immunosuppressed patients, especially when HLA‐matched platelets are used, to prevent TA‐GVHD.
A “new” low‐incidence red cell antigen, LOCR, associated with altered expression of Rh antigens
Authors: Coghlan G. , McCreary J. , Underwood V. , Zelinski T.
Published: March 2003

Background: Mild cases of hemolytic disease of the newborn were being studied when it was recognized that the propositi's red cells carried a novel antigen.

Study Design and Methods: Serologic and genetic studies of a new low‐incidence antigen, LOCR (International Society of Blood Transfusion series number 700.53), were performed.

Results: The antigen is associated with altered expression of the Rh antigen c in two unrelated families and in a third proposita and with an altered expression of e in a fourth proposita. The lods for the gene controlling LOCR relative to Rh are 2.107 at θ = 0.00; that is, they fall short of the requirement for inclusion of the antigen in the Rh blood group system. LOCR is excluded from the ABO, MNS, Lutheran, Kell, Duffy, Kidd, Xg, Chido/Rodgers, Kx, and Gerbich blood group systems. Genetic evidence suggests it is not part of the Yt, Colton, or LW systems.

Conclusion: Serologic evidence that LOCR is associated with altered expression of c or e strongly suggests that LOCR is part of the Rh blood group system. However, the genetic evidence falls short of the level required for system assignment.
Effect on cardiovascular function and iron metabolism of the acute removal of 2 units of red cells
Authors: Sherman L.A. , Lippmann M.B. , Ahmed P. , Buchholz D.H.
Published: March 2003

BACKGROUND: The collection from a donor of 2 red cell units at one time would decrease recipient exposure to viruses and alloantigens. If the donor is a large person, the blood volume lost and the postdonation hemoglobin and/or hematocrit should be within acceptable limits. If the donor is a large person, the blood volume lost and the postdonation hemoglobin and/or hematocrit should be within acceptable limits. The effect on cardiovascular function and iron metabolism requires description.

STUDY DESIGN AND METHODS: Manual 2‐unit erythropheresis was performed on eight donors, with the plasma returned. Donors had treadmill testing of maximum aerobic power (VO2max) before donation, 24 hours after, and 8 to 11 weeks after. Serial samples were drawn for iron metabolism studies.

RESULTS: Donors weighed 61.2 to 74.8 kg, and 9.6 to 11.4 percent of their blood volume was removed. Mean VO2max decreased from 84 percent of that predicted before donation to 74 percent 24 hours afterward. By 8 to 11 weeks, hemoglobin returned to acceptable donor levels and mean VO2max was 92 percent of that predicted. Mean hemoglobin fell from 14.4 to 11.7 g per dL (144 to 117 g/L) and rose to 13.9 g per dL (139 g/L) at 16 weeks. At 16 weeks, serum iron (120 ± 47 vs. 83 ± 33 micrograms/dL [21 ± 8 vs. 15 ± 6 mumol/L]), ferritin (40 ± 24 vs. 18 ± 10 ng/mL [40 ± 20 vs. 20 ± 10 micrograms/L]), and free erythroprotoporphyrin (19 ± 5 vs. 28 ± 5 micrograms/dL [0.34 ± 0.09 vs. 0.50 ± 0.09 mumol/L]) differed significantly from baseline levels. No major donor symptoms occurred.

CONCLUSION: Two‐unit erythropheresis was done with blood volume loss and postdonation hemoglobin no worse than those that would occur in a 50‐kg donor donating 450 mL. Cardiovascular effects and donor symptoms were mild. Two‐unit red cell donations would be clinically advantageous, and they warrant further studies of both utility and donor safety.
Alloimmune neonatal neutropenia resulting from immunization to a high‐ frequency antigen on the granulocyte Fc gamma receptor III
Authors: Bux J. , Hartmann C. , Mueller‐Eckhardt C.
Published: March 2003

BACKGROUND: Alloimmune neonatal neutropenia is mainly caused by NA‐ or NB1‐specific alloantibodies. An antibody in the serum of a Turkish mother who had given birth to an infant with alloimmune neonatal neutropenia showed no NA or NB specificity and was therefore investigated further.

STUDY DESIGN AND METHODS: The number of antibody‐ binding sites was calculated by determination of elutable IgG from granulocytes using a quantitative sandwich enzyme‐linked immunosorbent assay. Complement activation was tested by immunofluorescence (C3d) and cytotoxicity tests. The antigen was identified using the antigen‐ capture assay, monoclonal antibody‐specific immobilization of granulocyte antigens, and a modified immunoprecipitation method based upon biotinylation of proteins and visualization by luminescence (luminoimmunoprecipitation). Family study and determination of antigen frequency were done by immunofluorescence and agglutination tests.

RESULTS: A noncytotoxic, granulocyte‐specific alloantibody that recognized the Fc gamma receptor III, independent of the NA phenotype, was detected, and 242,000 binding sites per cell were calculated. Of granulocytes from 150 randomly selected German blood donors, the alloantibody bound to all. The maternal cells were typed NA1/NA2‐ and NB1‐positive.

CONCLUSION: These data reveal the presence of a previously unrecognized, high‐frequency epitope on the granulocyte Fc gamma receptor III. Luminoimmunoprecipitation proved to be a simple, nonradioactive technique that was useful in identifying the molecule involved.
Impact of screening blood donors for hepatitis C antibody on posttransfusion hepatitis: a prospective study with a second‐generation anti‐hepatitis C virus assay
Authors: HUANG Y.Y. , YANG S.S. , WU C.H. , SHIH W.S. , HUANG C.S. , CHEN P.H. , LIN Y.M. , SHEN C.T. , CHEN D.S.
Published: March 2003

BACKGROUND: Hepatitis C is the major cause of posttransfusion hepatitis. Blood components that are positive for antibody to hepatitis C virus (anti‐HCV) can transmit posttransfusion hepatitis. STUDY DESIGN AND METHODS: To investigate the effect on posttransfusion hepatitis of screening blood donors with a second‐generation test for anti‐HCV, 249 transfusion recipients who underwent cardiovascular surgery were prospectively followed. Six recipients who were positive for anti‐HCV before transfusion and 51 subjects with incomplete follow‐up were excluded from this study. RESULTS: Eleven (13.8%) of 80 subjects who received unscreened blood had two successive serum alanine aminotransferase levels > 90 U per L. Seven (8.8% of total) developed anti‐HCV and HCV RNA and two (2.5% of total) developed IgM antibody to cytomegalovirus (IgM anti‐CMV). By contrast, 3 (2.7%) of the 112 subjects who received anti‐HCV‐screened blood had two successive serum alanine aminotransferase levels > 90 U per L. None of these three developed anti‐HCV and HCV RNA, but two (1.8% of total) showed the development of IgM anti‐CMV. The study shows that screening for anti‐ HCV in blood donors with a second‐generation test almost abrogated posttransfusion viral hepatitis C. CONCLUSION: After anti‐HCV screening, other body fluid‐transmitted viruses such as CMV may become important in posttransfusion hepatitis.
Direct oral questions to blood donors: the impact on screening for human immunodeficiency virus
Authors: JOHNSON E.S. , DOLL L.S. , SATTEN G.A. , LENES B. , SHAFER A.W. , KAMEL H. , CASANOVA R.J. , PETERSEN L.R.
Published: March 2003

BACKGROUND: In December 1990, the Food and Drug Administration recommended that all United States blood centers implement a policy of asking prospective donors direct oral questions (DOQs) about human immunodeficiency virus (HIV) risk behaviors to increase the safety of the blood supply.

STUDY DESIGN AND METHODS: To evaluate the impact of the DOQ policy, HIV‐related deferral and HIV seroprevalence data were analyzed at four American Red Cross blood centers for the year before the policy change and the year after. An epidemiologic analysis with stratification was conducted, including the calculation of odds ratios (OR) and 95‐percent CIs.

RESULTS: Two of the four blood centers showed an overall significant increase in HIV‐related deferral after implementation of the DOQ policy: OR = 4.04, (95% CI = 3.41, 4.76); OR = 2.93, (95% CI = 2.67, 3.21). The increase in HIV‐related deferral was higher for women. HIV seroprevalence decreased at all four centers, including the two that did not see an increase in HIV‐related deferrals. Seroprevalence declined by 14 percent in the two centers with increases in HIV‐related deferral, which was neither significant nor attributable to DOQs.

CONCLUSION: Given that HIV antibody screening cannot detect HIV‐seronegative (but infectious) “window‐period” donations, the deferral of at‐risk donors may offer some additional protection to the blood supply. However, evidence was not found of an increase in safety of the blood supply as measured by HIV seroprevalence.
Multiple‐unit and second transfusions of red cells enzymatically converted from group B to group O: report on the end of phase 1 trials
Authors: Lenny L.L. , Hurst R. , Zhu A. , Goldstein J. , Galbraith R.A.
Published: March 2003

BACKGROUND: It has previously been shown that 1 and 2 units (200 – 400 mL) of red cells (RBCs) enzymatically converted from group B to group O by treatment with alpha‐galactosidase (ECO RBCs) are safe and efficacious when transfused to normal group O or A persons.

STUDY DESIGN AND METHODS: The current report describes studies in which 1) normal group A and O subjects received large volumes of these cells (3 units), 2) some group O subjects underwent transfusion several months later, and 3) ECO RBCs were prepared by the use of recombinant coffee bean alpha‐galactosidase and transfused to a group O subject, to demonstrate the in vivo equivalence of ECO RBCs, whether prepared with native or recombinant alpha‐galactosidase.

RESULTS: Clinical evaluation (hematologic tests, chemistry analysis, urinalysis) and serologic analyses did not reveal any evidence of subtle or acute transfusion reaction or significant increase in preexisting anti‐B titer. ECO RBC survival within the circulation of the recipients was normal (24‐hour survival, 95.5 +/− 0.9%; t1/2, 34.7 +/− 6.1 days; n = 8 transfusions), and the efficacy of the transfusions was manifested in elevations in recipient hemoglobin and hematocrit (hemoglobin increase, 1.5 +/− 0.6 g/dL; hematocrit increase, 3.6 +/− 1.6%; n = 8 transfusions).

CONCLUSION: ECO RBCs are safe and efficacious when transfused more than once or in multiple‐unit volumes to group O or A subjects, and ECO RBCs prepared with recombinant or native enzyme are equivalent in vivo.
The differentiation of delayed hemolytic and delayed serologic transfusion reactions: incidence and predictors of hemolysis
Authors: Vamvakas Eleftherios C. , Pineda Alvaro A. , Reisner Rebecca , Santrach Paula J. , Moore S. Breanndan
Published: March 2003

BACKGROUND: After differentiation of the entities of clinically detectable delayed hemolytic (DHTR) and delayed serologic transfusion reactions (DSTR), previous investigators calculated a DHTR:DSTR incidence ratio of 18:72 from a retrospective review of patients with serologic evidence of DHTR or DSTR. There are no published data on factors that may influence the occurrence of DHTR versus DSTR in a given patient. STUDY DESIGN AND METHODS: Retrospective review was conducted of 292 patients at the Mayo Clinic who, between 1980 and 1992, received a clinical diagnosis of DHTR or DSTR concurrently with a serologic diagnosis. Red cell alloantibody specificity, the activity of the patient's reticuloendothelial system, and concurrent immunosuppression were evaluated as potential predictors of the occurrence of DHTR versus DSTR in different patients. RESULTS: The incidence of DHTR or DSTR was 1 in 1899 allogeneic red cell units transfused, with a DHTR:DSTR ratio of 36:64. Alloantibody specificity was the only variable that affected the occurrence of DHTR versus DSTR at the clinical level, with the anti‐Jka and anti‐Fya specificities, as well as multiple coexisting specificities, significantly associated with detectable hemolysis (p < 0.05). CONCLUSION: Clinically detectable DHTRs are found to occur more commonly than previously believed when the clinical and serologic diagnoses are made concurrently and appropriate work‐ups for hemolysis are ordered. The association of certain alloantibody specificities with detectable DHTRs may have implications for clinical transfusion practice.
Prevention of transfusion‐associated Chagas' disease by sterilization of Trypanosoma cruzi‐infected blood with gentian violet, ascorbic acid, and light
Authors: Ramirez L. E. , Lages‐Silva E. , Pianetti G. M. , Rabelo R. M. C. , Bordin J. O. , Moraes‐Souza H.
Published: March 2003

BACKGROUND: Allogeneic blood transfusions are the second most frequent route of Chagas' disease transmission in countries where the disease is endemic. The prevention of transfusion‐associated Chagas' disease has been attempted through clinical and serologic screening of blood donors and/or by the addition of trypanomicidal substances such as gentian violet (GV) to stored blood for 24 hours. The present study describes an alternative method of chemoprophylaxis of transfusion‐associated Chagas' disease that reduces the sterilization time by using a combination of low‐concentration GV, ascorbic acid (AA), and photoradiation with visible light. STUDY DESIGN AND METHODS: To better reproduce the conditions of blood transfusion in developing areas, normal human blood was collected in blood collection bags, infected with different concentrations of Trypanosoma cruzi, and treated with GV, AA, and photoradiation. Mice were then inoculated with the T. cruzi‐ infected human blood that had been stored at different incubation intervals. Active parasites were sought in mouse blood for parasitologic diagnosis and serologic evaluation (mice inoculation, blood culture, and indirect immunofluorescence). RESULTS: The association of GV (250 micrograms/mL), and photoradiation with visible light (75W) sterilized T. cruzi‐infected blood even after treatment for less than 30 minutes and even when chagasic blood was treated with low‐ concentration GV (62.5 micrograms/mL for 30 min). Moreover, the trypanomicidal activity of GV associated with AA and photoradiation with visible light was found even when blood was infected with a 10‐ fold parasite concentration. CONCLUSIONS: The proposed alternative prophylactic method is reproducible, easy to perform, and inexpensive, and it may have practical importance in endemic areas where serologic screening of donor blood is not always available. In addition, the reduction of the GV trypanomicidal concentration might further minimize the potential for GV‐related side effects.
Should patients with human immunodeficiency virus infection or chronic hepatitis donate blood for autologous use?
Authors: Vanston V. , Smith D. , Eisenstaedt R.
Published: March 2003

BACKGROUND: The purpose of this project is to formally evaluate the benefits and the risks of allowing patients with human immunodeficiency virus (HIV) infection or hepatitis to donate blood for autologous use. STUDY DESIGN AND METHODS: With data on the incidence of transfusion‐ transmitted hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV; administrative error; and health‐care worker exposure, decision analysis was used to quantitate the benefits and risks of autologous blood transfusions versus those of transfusions of blood from allogeneic donors. RESULTS: Assuming the highest documented probability of transfusion‐related infection, the days of life saved by allowing the transfusion of autologous blood to a 30‐year‐old noninfected or HBV‐, HCV‐, or HIV‐infected patient are 92.52, 70.60, 0.95, and 5.69, respectively. Assuming the lowest documented probability of transfusion‐ related infection, the days of life saved decrease to 2.96, 2.26, 0.15, and 0.18, respectively. Avoidance of HCV accounts for over 90 percent of the days gained. The days of life lost by other noninfected patients through administrative error average 0.11 in the case of HIV and those lost by health care workers average 0.04, 0.18, and 0.07 in the case of HBV, HCV, and HIV, respectively. CONCLUSION: The benefit of autologous transfusions in patients infected with HBV, HCV, and HIV is significantly less than that in noninfected patients. The risks of this infected blood to other noninfected patients are significant only in the case of HIV‐infected blood transfusions; however, there is a measurable risk to health‐care workers should all infected blood be allowed into the blood supply.