bluuebunny/crossref_metadata_2025 huggingface dataset:
Detection of HLA antibodies by platelet crossmatching techniques
Authors: McGrath K. , Holdsworth R. , Veale M. , Bishop J. , Wolf M.
Published: March 2003

Thirty‐seven monospecific HLA antibodies directed against all common HLA‐A and ‐B loci and reactive by the microlymphocytotoxicity assay (LCT) were tested against platelets carrying the corresponding antigen by three platelet crossmatch methods, the platelet immunofluorescence test (PIFT), platelet enzyme‐linked immunosorbent assay (P‐ELISA), and platelet radioimmunoassay (P‐RIA). Positive reactions were obtained with the PIFT in 67 percent, the P‐ELISA in 41 percent, and the P‐RIA in 49 percent of 85 cell‐serum pairs. The same cell‐serum combinations gave 49 percent positive reactions in the lymphocyte immunofluorescence test. Three multispecific HLA antisera were positive in nine of nine cell‐serum combinations by all four methods. Thirteen transfusions were given to eight patients with known HLA antibodies. All donor‐recipient pairs were LCT positive, six were PIFT positive, and seven were PIFT negative. Three of seven PIFT‐negative and none of six PIFT‐positive transfusions were successful. Thus, platelet crossmatching is less sensitive than the LCT for the detection of complement‐binding monospecific HLA antibodies. The platelet crossmatch, however, is able to identify some potentially successful HLA‐incompatible donors for patients with multispecific HLA antibodies and limited access to HLA‐ identical donors.
The effects of irradiation on platelet function
Authors: Rock G. , Adams G. A. , Labow R. S.
Published: March 2003

Current medical practice involves the irradiation of blood components, including platelet concentrates, before their administration to patients with severe immunosuppression. The authors studied the effect of irradiation on in vitro platelet function and the leaching of plasticizers from the bag, both immediately and after 5 days of storage. The platelet count, white cell count, pH, glucose, lactate, platelet aggregation and release reaction, and serotonin uptake were not altered by the irradiation of random‐donor or apheresis units with 2000 rads carried out at 0 and 24 hours and 5 days after collection. The leaching of di(2‐ethylhexyl)phthalate from the plastic bags followed by the conversion to mono(2‐ethylhexyl)phthalate was not increased by irradiation. Therefore, it is possible to irradiate platelet concentrates on the day of collection and subsequently store them for at least 5 days while maintaining in vitro function. This procedure could have considerable benefit for blood banks involved in the provision of many platelet products.
Thawing of fresh‐frozen plasma with a new microwave oven
Authors: Söhngen D. , Kretschmer V. , Franke K. , Pelzer H. , Walker W. H.
Published: March 2003

In the Federal Republic of Germany fresh‐frozen plasma (FFP) is still the most important therapeutic agent for acquired coagulation disorders. However, thawing by waterbath (WB) requires about 30 minutes, which is too slow in emergency situations and carries the risk of bacterial contamination of the FFP. There are conflicting data about the use of microwaves for thawing. Therefore, we examined a new microwave oven (MWO; 2450 ± 50 MHz), which was developed with our cooperation and allows thawing of FFP in 5 minutes, heating FFP to a surface temperature of 21.5°C. A shaking WB (30 min, 37°C) was also used in parallel for comparison. We measured activated partial thromboplastin time (aPTT), nonactivated PTT (NaPTT), fibrinogen, factors VIII:C, X, and XI, fibrinopeptide A, β‐ thromboglobulin (β‐TG), thrombin‐AT III‐complexes, factor VIII‐ related antigen, C3c, C4, and the plasticizer di(2‐ethylhexyl)phthalate (DEHP) in 84 units of FFP as paired samples from 42 double aphereses. Immediately after thawing there was no significant difference in the coagulation test results of FFP with low‐cell contamination, regardless of the thawing procedure. Two hours later, after storage at room temperature, FFP thawed by MWO showed even less change than that thawed by WB (NaPTT, p < 0.01; FX, p < 0.01). The differences became more evident in comparison with FFP with higher cell contamination and could be observed immediately after thawing (FVIII:C p < 0.001; FXI, p < 0.05). Reduced release of β‐TG and DEHP (p < 0.01) was further indication that the MWO preserved plasma factors under the chosen conditions even better than the WB.
Donor self‐exclusion patterns and human immunodeficiency virus antibody test results over a twelve‐month period
Authors: CHIAVETTA JO ANNE , NUSBACHER JACOB , WALL ANGELA
Published: March 2003

ABSTRACT: Donor behavior in completing a pre‐donation confidential self‐exclusion form, which identified blood donors at high‐risk of AIDS exposure, was evaluated. The form was completed by all donors during a 12 month period beginning in September, 1985. 188,824 units of blood were collected from 123,608 donors. On the first donation occasion 901 donors (0.73%) laboratory (LAB) designated, 224 (0.18%) did not complete the form correctly, and the remaining 122,483 transfusion (TRAN) designated. A greater proportion of LAB donors were men, under the age of 30 and had not donated in the previous two years than TRAN designated donors. Confirmed reactive anti‐HIV, Western blot positive (WB+) results were greater in LAB than TRAN donors (1.664% vs 0.014%) on the first donation occasion. There were 43,982 donors who returned to donate on at least one other occasion. Of these, 43,778 designated TRAN initially, and only 217 (0.49%) changed their designation to LAB on any subsequent donation event. In contrast, of the 204 donors who designated LAB initially, 134 (65.6%) changed to TRAN on at least one other occasion. A variety of designation combinations from LAB to TRAN and back to LAB occurred. Thus, donors who initially LAB designated were more likely to change their designation on at least one other occasion than those who initially designated for TRAN. Of two donors who became anti‐HIV WB positive on the second donation, one of these LAB designated on both occasions, was negative for anti‐HIV by enzyme‐linked immunoassay (EIA‐) on the first donation but converted to EIA+, WB+ on the second. The initial donation was removed from inventory only because of the LAB designation. No donors who returned 3 or more times were WB+ for anti‐HIV.
Anti‐K1 of the IgA class associated with Morganella morganii infection
Authors: Pereira A. , Monteagudo J. , Rovira M. , Mazzara R. , Reverter J.C. , Castillo R.
Published: March 2003

An anti‐K1 alloantibody developed in a patient infected with Morganella morganii. The serologic behavior and response to dithiothreitol initially suggested that the alloantibody was an IgM. However, flow cytometry and the separation of immunoglobulin classes by serum chromatography revealed that the anti‐K1 was constituted solely of IgA. These data suggest that bacteria‐induced red cell antibodies might be of the IgA class.
Red blood cell mass in autologous and homologous blood units
Authors: GOODNOUGH LAWRENCE TIM , BRAVO JOANNE R. , HSUEH YENSHEN , KEATING LOUISE J. , BRITTENHAM GARY M.
Published: March 2003

ABSTRACT: A prospective analysis of 300 consecutively collected homologous blood (HB) units from a regional blood center and an analysis of 188 consecutively collected autologous blood (AB) units from a community hospital was conducted. Analysis of the red blood cell (RBC) mass content of these blood units revealed that HB contained 13 percent more RBC than AB: 200 ± 1.1 vs 177.1 ± 1.1 mL, (m ± SE), respectively (p < 0.05). Of 174 AB units eligible for crossover by AABB criteria for RBC mass (≥ 154 mL), 35 (20%) were below the 95 percent confidence interval range for RBC mass of HB units collected; mean RBC mass of 300 HB units was 12 percent greater than that of 174 AB units (200.1 ± 1.1 vs 178.9 ± 0.9 mL, p<0.001) and 20 percent greater than that of the 35 AB units outside the 95 percent confidence interval (200.1 ± 1.1 vs 161.2 ± 0.5 mL, p<0.001). These findings indicate that an evaluation of the issues of AB crossover for HB transfusion should include a risk/benefit analysis of AB units with lower RBC mass. These findings also indicate that the proposed changes in AABB standards regarding directed donation (DD) should consider the reduced benefit of DD units with lower RBC mass in a risk/benefit analysis of this practice, and support retention of homologous donor standards for directed donors.
Effects of room‐temperature exposure on bacterial growth in stored red cells
Authors: Hamill T.R. , Hamill S.G. , Busch M.P.
Published: March 2003

Experiments were performed to determine the effect of room‐temperature (RT) exposure on the growth rates of selected bacteria by deliberate contamination of AS‐1 packed red cell (RBC) units contained in PL146 plastic bags. Isolates of Staphylococcus aureus, S. epidermidis, Streptococcus faecalis, Pseudomonas aeruginosa, Citrobacter freundii, Enterobacter agglomerans, and Yersinia enterocolitica were inoculated into 3‐ to 5‐day‐old packed RBC units. The units were refrigerated at 4 to 6° C for 14 days. On two occasions during this period, one‐half of the units were removed from the refrigerator and held at 25 to 26° C for 2 hours. Timed samples taken during the periods at RT revealed stable or decreasing bacterial counts in the majority of exposed units, and in no instance was a marked increase in bacterial growth observed. Samples taken after subsequent prolonged rerefrigeration showed no significant increase in bacterial counts as compared with those in control units that were refrigerated constantly. These results indicate that RT exposure of contaminated RBC units does not result in accelerated bacterial proliferation over a period of 2 hours and that it may, in fact, have a detrimental effect on bacterial growth.
Transfusion of red cells after autologous bone marrow harvest in patients with acute leukemia and malignant lymphoma
Authors: Sonneveld P. , de Leeuw C.A. , Schipperus M. , Lindemans J. , Abels J.
Published: March 2003

Bone marrow was harvested for the purpose of autologous bone marrow transplantation (ABMT) in 21 patients previously treated with chemotherapy and in complete remission from acute leukemia or non‐Hodgkin's lymphoma. The volume required to obtain 2 times 108 nucleated cells per kg was less than 15 mL per kg in 13 patients and more than 15 mL per kg in 8 patients. The blood admixture was proportional to the aspirated volume (p<0.0001). The number of granulocyte‐macrophage colony‐forming units (CFU‐GM) harvested in the groups was 8.4 ± 2.2 and 3.4 ± 1.4 times 104 per kg, respectively (p<0.0001). Autologous red cells were transfused into 16 of 21 patients, who did not require further homologous transfusions. The mean drop in hemoglobin from the preoperative level was 1.0 ± 0.2 g per dL. No adverse effects were noted. It is concluded that large single‐volume bone marrow harvests are possible and may reduce the need for a second harvest, and that, through the transfusion of autologous red cells obtained during marrow harvest, homologous blood transfusion can be avoided in most patients.
The preservation of red cell antigens at low ionic strength
Authors: Allan J.C. , Bruce M. , Mitchell R.
Published: March 2003

Low‐ionic‐strength saline (LISS) techniques permit a safe and substantial reduction in incubation time and have therefore become the method of choice for antibody detection and compatibility testing in many transfusion laboratories. Consequently, the supply of reagent red cells (RBCs) in a low‐ionic‐strength preservative solution would remove the daily need for laboratories to wash and resuspend cells in LISS before use. However, the storage of fresh RBCs at low ionic strength in the presence of aminoglycoside antibiotics can cause a rapid loss of certain antigens, possibly as a result of the release of proteolytic enzymes from contaminating white cells. This article describes a low‐ionic‐strength solution that achieves preservation of antigens on liquid nitrogen‐frozen‐thawed RBCs for 21 days' storage at 4°C.
Anti‐idiotypic antibodies specific for a pathologic anti‐Pr2 cold agglutinin
Authors: Jefferies L.C. , Stevenson F.K. , Goldman J. , Bennett I.M. , Spitalnik S.L. , Silberstein L.E.
Published: March 2003

The heterogeneity of human red cell (RBC) autoantibodies may be assessed by using anti‐idiotypic antibodies. In this study, mouse monoclonal anti‐idiotypic antibodies were produced against a pathologic RBC autoantibody with anti‐Pr2 specificity. Epstein‐Barr virus‐transformed B‐cell clones were established from a patient who had splenic lymphoma and associated immune hemolysis due to an anti‐Pr2 cold autoantibody. Two of the eight clones producing this autoantibody were used to immunize mice for the establishment of hybridomas, and four monoclonal anti‐idiotypic antibodies were isolated (2 IgG1 kappa and 2 IgM kappa). By the use of these anti‐idiotypic antibodies, strong cross reactivity was seen on enzyme‐linked immunosorbent assay with other anti‐Pr2‐producing clones from the same patient, but no cross‐reactivity was seen with RBC autoantibodies from other individuals having anti‐Pr or different specificities. Each of the anti‐idiotypic antibodies inhibited hemagglutination (HA) by the patient's anti‐Pr2 but failed to inhibit HA by antisera of a different RBC specificity. Cross‐competition experiments indicated that all of the anti‐idiotypic antibodies may recognize the same or a closely related idiotope on the anti‐Pr2 autoantibody. These studies suggested that the four anti‐idiotypic antibodies are directed against the same (or closely related) idiotypic determinant(s), unique to this patient's anti‐Pr2 and located at or near the antigen‐binding site. These anti‐idiotypic antibodies may be useful tools for the study of this autoimmune response or for the development of immune therapeutic agents. Additional panels of anti‐idiotypic antibodies will be necessary to elucidate further the idiotypic diversity of RBC autoantibodies occurring both in healthy individuals and in patients with immune hemolysis.
Platelet transfusions administered to patients with splenomegaly
Authors: Hussein M.A. , Lee E.J. , Schiffer C.A.
Published: March 2003

It is generally felt that increments in platelet counts following platelet transfusions to patients with splenomegaly are severely reduced as a result of splenic sequestration. The results of 631 random‐donor platelet transfusions administered to 66 thrombocytopenic patients with palpable splenomegaly were analyzed. Increasing splenomegaly had a significant effect on corrected count increments (CCIs), with the greatest deterioration occurring in patients whose spleens were palpable >2.0 cm below the left costal margin. A similar trend was noted when the percentage of transfusions with satisfactory CCIs was compared, although it should be noted that 42 percent of the transfusions produced CCIs >7500, and a large proportion produced clinically helpful absolute increments. Splenomegaly also had an effect on platelet survival: in patients with CCIs >7500, the mean ratio of 24‐hour CCIs to 1‐hour CCIs was 0.29 to 0.47 in patients with various degrees of splenomegaly, as compared to an expected value of 0.6 to 0.7. Sixteen patients, most with spleens palpable <5.0 cm below the left costal margin, consistently had CCIs >7500. A significant fraction of patients with splenomegaly can benefit from platelet transfusion, and thus splenomegaly should not preclude intensive therapeutic approaches.
The effect of different agitation modes on platelet metabolism, thromboxane formation, and alpha‐granular release during platelet storage
Authors: Wallvik J. , Stenke L. , ÅKerblom O.
Published: March 2003

Platelet concentrates (PCs), prepared by plateletpheresis, were stored in aliquots in polyvinylchloride blood bags for 5 days at 22°C under rapid, slow, or no agitation. Nonagitated PCs were also stored in a 98‐percent oxygen atmosphere. In nonagitated PCs, pO2, lactate production, and platelet factor 4 (PF 4) concentration increased, whereas the ATP level and pH dropped rapidly. These changes were somewhat minimized in nonagitated PCs stored in oxygen. There was no significant difference between the two agitated groups. The increase in PF 4 correlated inversely to the decrease in ATP: r = ‐0.91, p < 0.001, n = 24. The formation of thromboxane B2 (TxB2) after stimulation with arachidonic acid or collagen was significantly higher in slowly agitated PCs on Day 5 than on Day 0 (p < 0.01). Nonagitated PCs produced lower levels of TxB2 (collagen stimulation) on Day 5 (p < 0.05). In unstimulated PCs, the levels of TxB2 and ATP were inversely correlated on Day 5 (r = ‐0.70, p < 0.001, n = 20). In vivo survival was performed after 72 hours of storage; mean survival (±SD) was 6.5 (±0.3) days for nonagitated oxygenated PCs and 6.8 (±0.7) days for agitated PCs. In nonagitated PCs, anaerobic metabolism increased, although oxygen diffusion through the container wall was sufficient. Agitation seems to facilitate the diffusion of oxygen through the storage medium. Nonagitated PCs were stored safely for 24 hours; this period can be extended to at least 72 hours when aerobic metabolism is maintained.
Heterogeneity of human red cell autoantibodies assessed by isoelectric focusing
Authors: Andrzejewski C. , Young P. J. , Cines D. B. , Silberstein L. E.
Published: March 2003

Human red cell (RBC) autoantibodies may be the products of a single lymphocyte clone or of a restricted number of clones. For insight into the clonal distribution of human RBC autoantibodies, serum fractions from 28 individuals with various forms of autoimmune hemolytic anemia (AHA) and two nonanemic individuals with positive direct antiglobulin tests were separated by isoelectric focusing (IEF), and RBC binding in each fraction was quantitated with a solid‐phase radioimmunoassay. IEF fractions of serum from normal volunteers and patients with nonimmune hemolytic anemia served as controls. These studies indicate that RBC antibodies are found in a restricted number of IEF fractions in sera from some patients with immune hemolytic anemia. IEF fractions containing RBC‐binding activity vary among patients with idiopathic AHA, and distinct patterns of binding activity are found in serum from some patients with AHA associated with alphamethyldopa and procainamide or with B‐cell immunoproliferative diseases. These findings suggest that the mechanism leading to autoantibody production may differ among patients with the various forms of immune hemolytic anemia.
Photodynamic inactivation of retrovirus by benzoporphyrin derivative: a feline leukemia virus model
Authors: North J. , Freeman S. , Overbaugh J. , Levy J. , Lansman R.
Published: March 2003

The ability of a photosensitizer, benzoporphyrin derivative monoacid ring A (BPD‐MA), and either broad‐spectrum (400–1200 nm) or narrow‐band (600–700 nm) red light to kill feline leukemia virus (FeLV) and FeLV‐infected cat T cells (cell line 3201) was investigated in culture medium containing fetal calf serum and in blood from infected cats. A molecular clone of FeLV, 61E, is minimally pathogenic and productively infects 3201 cells while causing no change in rate of cell division, viability, or size. Active virus (either free or within infected cells) was quantified by using a limiting dilution assay that involved cocultivation of test samples with naive 3201 cells, after which either the polymerase chain reaction or a reverse transcriptase assay was used to detect the presence of virus. It was shown that 61 E‐infected T cells in culture were slightly more sensitive to photodynamic killing than were uninfected cells. Infected cells and free virus were eliminated from whole blood taken from infected cats by using 4 μg per mL of BPD‐MA and 40 J per cm2 of red light. These results correlate well with previous results with BPD‐MA and vesicular stomatitis virus in whole human blood and suggest that this photosensitizer is a promising agent for the elimination of retroviruses that are either free or located within infected cells in blood.
Influence of C4B null genes on cytomegalovirus antibody titers in healthy blood donors
Authors: Moulds J.M. , DeJongh R.
Published: March 2003

C4B null genes (C4B*QO) have been found with increased frequency in persons with viral diseases, including hepatitis and human immunodeficiency virus infection. Whether a relationship might exist between the presence of C4B*QO and antibodies to cytomegalovirus (CMV) was investigated. Fifty blood donors who were seropositive for CMV antibodies and 101 healthy nondonors were C4‐allotyped with electrophoresis immmunofixation. CMV‐seropositive sera were titrated for CMV IgG‐specific antibody by enzyme‐linked immunosorbent assay, and serum IgG levels were assayed by rate nephelometry. C4B*QO was higher in the CMV antibody‐positive group than in nondonors (p = 0.05), but the increase was most significant (p = 0.028) in donors with the highest titers of CMV antibodies. There was poor correlation (r = 0.015) between CMV titers and plasma IgG levels. Serum C4B levels were lower in CMV antibody‐positive donors with one C4B null gene than in matched nondonors or nondonors not having any null genes.
Effects of prestorage white cell‐reduction of apheresis platelets on platelet glycoprotein Ib and von Willebrand factor
Authors: Garcia G.I. , Fitzpatrick J.E. , Hoernig L.A. , Stewart C.C. , Sweeney J.D.
Published: March 2003

Twenty plateletpheresis components were harvested from 11 healthy donors and stored in polyolefin bags on a horizontal flatbed agitator at 22°C. After 24 hours, white cells were reduced in one aliquot by centrifugation while the other aliquot was stored unaltered. Samples were obtained aseptically from each of these platelets at intervals for up to 10 days, and measurements were made of platelet glycoprotein Ib (GPIb) by both flow cytometry and polyacrylamide gel electrophoresis, of ristocetin‐induced platelet aggregation by impedance aggregometry, and of plasma and platelet von Willebrand factor (vWF) by enzyme‐linked immunosorbent assay. Storage of platelets under these conditions was associated with only minor decreases in surface GPIb, intraplatelet vWF, and ristocetin‐induced platelet aggregation, and no differences were observed between the white cell‐reduced and nonreduced aliquots. No benefit of white cell reduction in such components before prolonged storage is evident in the vWF‐platelet interaction.
Feasibility and success of a single‐donor red cell program for pediatric elective surgery patients
Authors: STRAUSS R.G. , WIELAND M.R. , RANDELS M.J. , KOERNER T.A.W.
Published: March 2003

Although the risks of allogeneic blood transfusions are small, it is wise to limit donor exposure whenever possible. A program has been developed in which one donor provided all red cell (RBC) units for each patient awaiting elective surgery. Patients were mostly children who were ineligible for autologous blood donation. Seventy‐three patients and 115 donors (mostly parents) entered the program. Of the 115 donors, 90 (78%) were eligible to participate and 25 (22%) were ineligible; 21 were ineligible because of RBC incompatibility. For each of the 73 patients, one eligible donor was selected to donate all RBC units. Preoperative RBC orders were 1 to 2 units for 41 patients and > or = 3 units for 32 patients. Of the 73 donors, 58 (79%) gave all RBC units ordered; 15 (21%) failed to complete all donations, but only 1 because of anemia (hematocrit < 33% [0.33]). Of 73 patients entered, 46 (63%) underwent transfusion, and 27 (37%) did not. Of 46 patients transfused, 38 (83%) received only single‐donor RBCs. Thus, the RBC needs of nearly all pediatric elective surgery patients were provided by a single donor for each patient. Single‐donor blood programs should be considered for elective surgery patients who are ineligible for autologous blood donation and who would otherwise be exposed to multiple donors.
The effects of blood transfusion on serum ferritin, folic acid, and cobalamin levels
Authors: Ho C.H.
Published: March 2003

Thirty patients with anemia of various causes received packed red cell transfusions. To evaluate the influence of blood transfusion on the serum levels of different nutrients, serum ferritin, folate, and cobalamin levels were determined before and 2, 2 to 4, 5 to 7, 8 to 10, and 11 to 14 days after blood transfusion. No significant change was found in these levels before or at any time after blood transfusion. Blood transfusion exerted little effect on the serum levels of ferritin, cobalamin, or folate. Moreover, if the blood for testing was drawn 1 to 14 days after transfusion, nearly all cases of nutritional deficiency anemia could have been diagnosed without the influence of blood transfusion.
Promotion of high school blood donations: testing the efficacy of a videotaped intervention
Authors: SARASON I.G. , SARASON B.R. , PIERCE G.R. , SAYERS M.H. , ROSENKRANZ S.L.
Published: March 2003

“Life to Life,” an 11‐minute videotape based on social learning principles, was used by 10 blood centers in presentations to 4970 high school students one week before school blood drives. At each school, some students saw the videotape and others attended a blood center's customary presentation. Students also completed a brief questionnaire assessing donation attitudes, donation history, and intent to donate. The videotape accounted for a relative increase of 18.7 percent in donations even when other factors were not controlled for. Results were analyzed with logistic models and showed a consistently positive effect over all models used. For students who had never donated, the estimated odds ratio for actual donation (videotape:control) was 1.528. When the model included both type of presentation and ethnicity, the relative increase in donation over that after the blood centers' usual presentation was 69.8 percent for first‐time donors. Among previous donors considered alone, the effect on donation was not significant. Whatever their donor history, students who viewed the videotape showed significantly more positive attitudes toward donation and had greater intention to donate than students who saw the blood centers' standard presentations. These results suggest that this videotape is a useful tool for recruitment of high school blood donors.
An anti‐EnaTS detected in the serum of an MiI homozygote
Authors: Spruell P. , Moulds J.J. , Martin M. , Gilcher R.O. , Howard P.B. , Blumenfeld O.O.
Published: March 2003

The serum of EH reacted with all red cells (RBCs) except her own, ficin‐ or trypsin‐treated red cells, and En(a‐) red cells. This reactivity defined an anti‐EnaTS specificity. The red cells of the proposita typed as M‐N+S‐S+, Vw+Mur‐Hil‐Hut‐Anek‐Lane‐, Wr(a‐b+), EnaKT+. Red cells of five relatives were Vw+ and positive with her serum. Titration studies suggest that EH is genetically an MiI homozygote and that her Vw+ relatives are MiI heterozygotes. There is no history of consanguinity. Sodium dodecyl sulfate‐polyacrylamide gel electrophoresis and immunoblotting studies have agreed with the serologic observations. A variant sialoglycoprotein of faster mobility than normal glycoprotein A, but no normal glycoprotein A, was detected on her red cells. Treatment with N‐glycanase did not alter the mobility, which indicated that there was no N‐glycosylation of residue 26. These findings are in agreement with the reported properties of the Mi.I‐specific glycoprotein A. The relatives' Vw+ red cells showed the variant sialoglycoprotein and normal glycoprotein A. EH appears to be the first reported MiI homozygote.
Polyclonal antibodies against the NB1‐bearing 58‐ to 64‐kDa glycoprotein of human neutrophils do not identify an NB2‐bearing molecule
Authors: Stroncek D.F. , Shankar R.A. , Plachta L.B. , Clay M.E. , Dalmasso A.P.
Published: March 2003

The neutrophil‐specific NB antigen system has been serologically characterized with human alloantisera. Two alleles, NB1 and NB2, have been described; however, there may be important quantitative or qualitative variation in the expression of NB1 and NB2. Human alloantibodies have been used to identify the 58‐ to 64‐kDa glycoprotein (GP) on which NB1 antigen is located, but an NB2 antigen‐ bearing molecule has not yet been identified. To identify the NB2 molecule, human alloantibody to NB1 was used to isolate the 58‐ to 64‐ kDa NB1 GP, and rabbits were immunized with this GP. Two rabbit antisera were produced. Both antisera immunoblotted and immunoprecipitated the 58‐ to 64‐kDa GP on which NB1 is located, but neither identified the molecule on which NB2 is located. The inability of two rabbit polyclonal antibodies specific for the NB1 molecule to react with the NB2‐bearing molecule suggests that considerable differences may exist between these two molecules or that NB2 as currently defined is not related to NB1.
Heterosexually acquired human immunodeficiency virus infection and the United States blood supply: considerations for screening of potential blood donors
Authors: Petersen L.R. , Doll L.S. , White C.R. , Johnson E. , Williams A. ,   HIV Blood Donor Study Group
Published: March 2003

The impact of heterosexual transmission of the human immunodeficiency virus (HIV) on the United States blood supply was assessed, and deferral criteria that may exclude potential donors who are at high risk for heterosexually acquired HIV infection were evaluated. Interviews were conducted with 508 HIV‐seropositive blood donors from May 1, 1988, to August 31, 1989 (Phase 1), and with 472 donors from January 1, 1990, to May 31, 1991 (Phase 2), at 20 blood centers. From Phase 1 to Phase 2, the overall HIV prevalence decreased from 0.021 to 0.018 percent (p < 0.001). HIV risk factors among HIV‐1‐seropositive donors were similar during both study phases. Eleven percent of the men and 56 percent of the women reported as their only risk that they had a heterosexual partner who was at increased risk for HIV or was known to have HIV. These percentages were similar during both study periods. During Phase 2, 13 percent of the men and 17 percent of the women with heterosexual transmission risk had a positive serologic test for syphilis, hepatitis B core antibody, or hepatitis C antibody. Among HIV‐ 1‐seropositive donors reporting heterosexual risk, the median numbers of previous‐year and lifetime sex partners for men were 2 and 30, respectively; for women, those numbers were 1 and 7, respectively. Thirty‐one percent of the men and 6 percent of the women reporting heterosexual transmission risk also reported having had syphilis or gonorrhea within 3 years of donation. It is concluded that the impact of heterosexual transmission of HIV infection on transfusion safety is not worsening at this time.(ABSTRACT TRUNCATED AT 250 WORDS)
Lack of effect on platelet increments of granulocyte‐macrophage‐colony‐ stimulating factor following autologous bone marrow transplantation for malignant lymphoma
Authors: Chambers L.A. , Garcia L.W.
Published: March 2003

Background: Recombinant growth factors are used increasingly often to stimulate bone marrow recovery after intensive chemotherapy and bone marrow transplantation. Their effects on the requirements for and responsiveness to coincident therapies, including transfusion, should be defined.

Study Design and Methods: To determine whether treatment with recombinant granulocyte‐macrophage‐colony‐stimulating factor (GM‐ CSF) affects platelet transfusion responsiveness, the clinical and blood bank records were examined for 16 adult patients (8 controls, 8 receiving GM‐CSF) participating in a double‐blind study of GM‐CSF administration (250 μg/m2 × 21 days) following autologous bone marrow transplantation for lymphoma. For each platelet transfusion, a corrected count increment was calculated, and note was made of the presence or absence of selected additional factors thought to decrease platelet responsiveness: fever, amphotericin treatment, HLA antibodies, platelet ABO incompatibility, and febrile transfusion reactions.

Results: The total number of platelet transfusions (GM‐CSF patients, 145; controls, 145) and the mean number of transfusions per patient (GM‐ CSF, 18.3; controls, 18.0) were comparable in the two groups. GM‐CSF patients received significantly more platelets that were ABO incompatible, that were given during a febrile period, or that were given while the patient was on amphotericin. Nevertheless, the corrected count increments in patients who received GM‐CSF were at least as good as those in controls: for GM‐CSF patients: mean was 8,574 ± 5,868, median was 7,818, 49 percent were < 7,500 and 66 percent were < 10,000; for controls; mean was 7,618 ± 7,536, median was 6,100, 59 percent were < 7,500, and 73 percent were < 10,000.

Conclusion: In this group of patients, GM‐CSF did not adversely affect the required number of, increments to, or incidence of refractoriness to platelet transfusions.
Development of a carbohydrate antigen during storage of red cells
Authors: Krugluger W. , Koller M. , Hopmeier P.
Published: March 2003

Background: Changes in surface antigens during the aging of red cells led to the expression of epitopes that can induce an immune response. Recently, irregular antibodies detected in the sera of two patients agglutinated in vitro aged red cells.

Study Design and Methods: The aging of red cells during storage was examined by flow cytometric analysis using fluorescein isothiocyanate‐labeled lectins, fluorescein isothiocyanate‐labeled anti‐human IgG, and fluorescein isothiocyanate‐ labeled IgM.

Results: Red cells stored for 1 day and 21 days exhibited no difference in the binding of wheat germ agglutinin, Ulex europaeus agglutinin, or concanavalin A. Only soybean agglutinin showed increased binding to old red cells. IgM antibodies present in the sera of two patients induced strong agglutination of stored red cells, but not of fresh red cells of the same or compatible ABO blood groups. The binding of these antibodies did not involve known red cell antigens and could be significantly inhibited by galactose and mannose in a dose‐dependent manner. Staining of red cells with sera from both patients indicated that the antibodies recognized the same structure on stored red cells. The number of binding sites on red cells stored for 21 days was between 7,000 and 10,000 per cell.

Conclusion: These results demonstrate that, during storage of red cells, gradual expression of galactosyl residues on the red cell membrane occurs.
Serologic evidence that factor IX inhibitor in the plasma of hemophilia B patients detects factor IX on normal red cells
Authors: Swanson J. L. , Moertel C. L. , Stroncek D. F. , Key N. S.
Published: March 2003

BACKGROUND: Patients with hemophilia B lack factor IX (F IX). These patients may become alloimmunized after the transfusion of F IX concentrates and may develop F IX inhibitors, which have been characterized as polyclonal IgG4 alloantibodies. Two cases in which F IX inhibitors caused difficulty in compatibility testing and antibody identification were encountered. It was hypothesized that, because F IX is present in normal plasma, it might be adsorbed by red cells in vivo and then be detected during antibody screening tests with serum containing F IX inhibitors.

CASE REPORT: Sera from two African American half‐brothers with hemophilia B were incompatible with all common and rare red cell phenotypes tested in the anti‐human globulin test, but did not react with each other's red cells. The brothers' red cell antibodies were neutralized with both normal plasma and a commercially available F IX concentrate, which indicated that the red cell incompatibility was most probably caused by their F IX inhibitors. Red cells from an unrelated patient with hemophilia B and a very low titer of F IX inhibitor were tested against the half‐brothers' sera and did not react. The compatible red cells from one of the half‐brothers and the unrelated patient with hemophilia B adsorbed F IX from normal plasma or F IX concentrate after 37 degrees C incubation; this rendered them incompatible with the plasma containing F IX inhibitor from the other half‐brother.

CONCLUSION: F IX appears to be present on normal red cells and may be detected during compatibility and antibody identification procedures when serum or plasma containing F IX inhibitors is tested.
Transfusion of donor peripheral blood buffy coat cells as effective treatment for relapsed acute leukemia after transplantation of allogeneic bone marrow or peripheral blood stem cells from the same donor
Authors: Tzeng C.‐H. , Lin J.‐S. , Lee J. C.‐I. , Yung C.‐H. , Hu H.‐Y. , Chen P.‐M.
Published: March 2003

BACKGROUND: The transfusion of same‐donor peripheral blood buffy coat (PBBC) cells to chronic myelocytic leukemia patients in relapse after bone marrow transplantation has been increasingly used as an effective antileukemic therapy. A graft‐versus‐leukemia effect mediated by immunocompetent donor T cells underlies its success. In acute leukemia, however, the effect of this adoptive cellular immunotherapy has not been established, and the results are generally poor. STUDY DESIGN AND METHODS: Five patients, three with acute lymphoblastic leukemia and two with acute myelocytic leukemia, who relapsed within 6 months after allogeneic marrow transplantation were enrolled in a nonrandomized pilot study to receive donor PBBC cell transfusions either before or after undergoing cytoreductive chemotherapy. ABO genotyping and polymerase chain reaction amplification of human tetrameric short tandem repeats DNA typing were used to test for marrow chimerism. RESULTS: Two acute lymphoblastic leukemia patients‐both of whom underwent chemotherapy before PBBC cell transfusions, experienced a complete remission, and developed acute and then chronic, extensive graft‐versus‐host disease‐have been leukemia‐free for 9 and 7 months, respectively. Repeated molecular studies of their marrow as early as 2 weeks to 8 months after treatment confirmed that the marrow was of donor origin. The other three patients, who chose not to undergo chemotherapy before PBBC cell transfusions, failed to achieve remission and died 14, 16, and 30 days, respectively, after leukemia relapse. CONCLUSION: Adoptive cellular immunotherapy may be effective for acute lymphoblastic leukemia patients in relapse after bone marrow transplantation if chemotherapy is administered before PBBC cell transfusions are initiated.
Invasive line placement in critically ill patients: do hemostatic defects matter?
Authors: DeLoughery T.G. , Liebler J.M. , Simonds V. , Goodnight S.H.
Published: March 2003

Background: Blood components are often given prophylactically before the placement of invasive lines in patients with coagulation defects. Little, however, is known about the epidemiology of defects in these patients. The purpose of this study is to ascertain what proportion of intensive care patients who receive invasive lines have hemostatic defects, what actions are taken by physicians to correct these abnormalities before invasive line insertion, and what the incidence is of bleeding complications after invasive line placement.

Study Design and Methods: Charts were retrospectively reviewed for 490 intensive care patients in whom 938 arterial, pulmonary artery, and central venous lines were placed.

Results: At least one defect in hemostasis was documented for 388 patients (41%) before line placement, with 253 (27%) of these patients evidencing severe abnormalities. Seventeen percent of patients had no preprocedure laboratory evaluation. Trauma patients showed the highest numbers of abnormalities in hemostatic testing, but medical patients had more‐severe defects. The occurrence of isolated abnormal laboratory values did not predict bleeding, but a score derived from a consideration of multiple defects did. Correction of the abnormalities was attempted in 37 percent of patients with hemostatic defects. Sixteen patients had bleeding complications, but only two had complications that were life‐threatening. None of the complications were fatal.

Conclusion: Invasive lines are used frequently in patients with hemostatic defects, often without any attempt to correct the abnormalities. Nevertheless, rates of hemorrhage are low and appear to be closely related to the level of experience of the physician rather than to defects in hemostasis. These findings suggest that the use of blood components for preprocedure correction of hemostatic defects is not necessary, except in those patients who have the most severe hemostatic abnormalities.
Generation of cytokines in red cell concentrates during storage is prevented by prestorage white cell reduction
Authors: Shanwell Agneta , Kristiansson Marianne , Remberger Mats , Ringdén Olle
Published: March 2003

BACKGROUND: The effect of prestorage white cell (WBC) filtration on the cytokine content in red cells (RBCs) has not been clarified. STUDY DESIGN AND METHODS: Six units of buffy coat‐poor RBC concentrates were prepared. Each unit was divided into three parts: one was used as a control, the second was made WBC‐rich by the addition of WBCs from the buffy coat, and the third was made WBC‐poor by filtration. All units were stored at 4 degrees C for 6 weeks. Immediately after preparation and every second week subsequently, samples for analyses of interleukin (IL) 1 beta (IL‐1), IL‐2, IL‐6, IL‐8, and tumor necrosis factor alpha (TNF alpha) were obtained. After 13 weeks, the procedure was repeated on the same donors. RESULTS: IL‐2 was not detected. The amounts of IL‐ 1, IL‐8, and TNF alpha increased during the storage period. With the exception of IL‐8, only low concentrations were found. Filtered units had lower concentrations of IL‐1, IL‐6, IL‐8, and TNF alpha after 2 weeks of storage than did the control and WBC‐rich units. The amounts of cytokines in filtered units did not increase during the study period. CONCLUSION: Prestorage filtration seems to diminish the amount of IL‐1, IL‐6, IL‐8, and TNF alpha RBCs during storage. The possible clinical implications of this should be elucidated.
Blood usage in lung transplantation
Authors: Triulzi D.J. , Grifith B.P.
Published: March 2003

BACKGROUND: Few published data are available regarding perioperative blood usage in lung transplantation. STUDY DESIGN AND METHODS: The medical records of all patients undergoing lung transplantation at a university medical center in 1994 and 1995 were reviewed. RESULTS: Ninety patients underwent lung transplantation during this period. Six patients were excluded: two received a living related‐donor lung, three underwent retransplantation and one underwent concomitant repair of a tetralogy of Fallot. Of the 84 evaluable patients, 59 underwent single lung transplantation and 25 double lung transplantation. Double‐lung recipients used more red cells (6.4 vs. 1.7 units, p = 0.0002) and were more likely to receive red cells, platelets, plasma, or any component (92 vs. 32%, p< or =0.0001) than were single‐lung recipients. Double‐ lung recipients were more likely to require cardiopulmonary bypass (40 vs. 12%, p = 0.003), and cardiopulmonary bypass was associated with greater transfusion requirements (p< or =0.0001). However, among patients requiring cardiopulmonary bypass, blood use did not differ between those undergoing double lung transplantation and those undergoing single lung transplantation. In the subset of patients not requiring cardiopulmonary bypass, double‐lung recipients received more red cells (4.5 vs. 0.7 units, p< or =0.0001) and more plasma (2.0 vs. 0.2 units, p = 0.006). CONCLUSION: Double‐lung recipients require more perioperative transfusions than single‐lung recipients. The greater transfusion requirement is due to the more frequent need for cardiopulmonary bypass as well as the greater complexity of the procedure. These data are useful for developing surgical blood ordering guidelines for lung transplantation.
Investigation of the survival of paroxysmal nocturnal hemoglobinuria red cells through the immunophenotyping of reticulocytes
Authors: Navenot J. M. , Muller J. Y. , Blanchard D.
Published: March 2003

BACKGROUND: Complement‐mediated lysis of red cells (RBCs) is a classic feature of paroxysmal nocturnal hemoglobinuria (PNH) that is traditionally studied with a combination of radiolabeling of RBCs and in vitro hemolysis tests. Phenotyping of reticulocytes was used as an alternative method for the evaluation of the relative life span of normal RBCs (PNH I) and RBCs that were partially (PNH II) or completely (PNH III) deficient in CD59.

STUDY DESIGN AND METHODS: Murine monoclonal antibodies CD55, CD58, and CD59 and thiazole orange were used to phenotype reticulocytes by two‐color flow cytometry in nine PNH patients. RBC survival could be calculated from the ratio of CD59‐ or CD59low mature RBCs to CD59‐ or CD59low reticulocytes obtained from these patients who had not received a transfusion.

RESULTS: The life span of PNH III RBCs varied from about 17 to 60 days. PNH II reticulocytes were found in the four patients with PNH II RBCs. The life span of PNH II RBCs varied with their residual expression of CD59, and cells with 15 to 20 percent of the normal amount of CD59 were protected against in vivo hemolysis.

CONCLUSION: Phenotyping of reticulocytes is a convenient and reliable tool for evaluating the relative survival of normal and PNH RBCs. PNH II and PNH III reticulocytes are phenotypically distinct, and some PNH II RBCs may be sensitive to complement‐mediated lysis in vitro, but normally they are complement‐resistant in vivo.
A pilot randomized trial comparing symptomatic vs. hemoglobin‐level‐ driven red blood cell transfusions following hip fracture
Authors: Carson J. L. , Terrin M. L. , Barton F. B. , Aaron R. , Greenburg A. G. , Heck D. A. , Magaziner J. , Merlino F. E. , Bunce G. , McClelland B. , Duff A. , Noveck H.
Published: March 2003

BACKGROUND: The indications for transfusion have never been evaluated in an adequately sized clinical trial. A pilot study was conducted to plan larger clinical trials.

STUDY DESIGN AND METHODS: Hip fracture patients undergoing surgical repair who had postoperative hemoglobin levels less than 10 g per dL were randomly assigned to receive 1) symptomatic transfusion: that is, transfusion for symptoms of anemia or for a hemoglobin level that dropped below 8 g per dL or 2) threshold transfusion: that is, patients receive 1 unit of packed RBCs at the time of random assignment and as much blood as necessary to keep the hemoglobin level above 10 g per dL. Outcomes were 60‐day mortality, morbidity, functional status, and place of residence.

RESULTS: Among 84 eligible patients enrolled, mean (± SD) prerandomization hemoglobin was 9.1 (± 0.6) g/ dL. The median number of units transfused in the threshold transfusion group was 2 (interquartile range, = 1–2), and that in the symptomatic transfusion group was 0 (6; interquartile range, = 0–2) (p < 0.001). Mean hemoglobin levels were approximately 1 g per dL higher in the threshold group than in the symptomatic group: for example, on Day 2, 10.3 (± 0.9) g per dL versus 9.3 (± 1.2) g per dL, respectively (p < 0.001). At 60 days, death or inability to walk across the room without assistance occurred in 16 (39.0%) of the symptomatic transfusion group and 19 (45.2%) of the threshold transfusion group. Death occurred by 60 days in 5 (11.9%) of the symptomatic transfusion group and 2 (4.8%) in the threshold transfusion group (relative risk = 2.5; 95% CI, 0.5–12.2). Other outcomes were similar for the two groups.

CONCLUSIONS: Symptomatic transfusion may be an effective blood‐sparing protocol associated with the transfusion of appreciably fewer units of RBCs and lower mean hemoglobin levels than are associated with the threshold transfusion policy. However, it is unknown whether these two clinical strategies have comparable mortality, morbidity, or functional status. A definitive trial is needed.