bluuebunny/crossref_metadata_2025 huggingface dataset:
Disproportionate outdating of group A blood
Authors: Axelrod Frederick B. , Grindon Alfred J. , Vroon David H.
Published: March 2003

The authors studied the factors responsible for the disproportionate outdating of group A blood compared with group O blood over a 6‐month interval. Distribution, transfusion, and outdate data for 99,251 units of blood were collected from representative hospitals within the region served by the Atlanta Regional Red Cross Blood Center. Factors evaluated included: neonatal transfusion of type O blood to type A recipients; use of type O blood in emergencies or due to group‐specific shortages; demographic donor and recipient differences; and blood importing practices. Of 43,757 group O units (44.1% of total) available for distribution, 2050 (4.7%) were outdated, compared with 3908 (10.7%) of 36,501 group A units (36.8% of total). One thousand two hundred and seventy‐nine units of type O blood were transfused to recipients who were not type O, including 842 group A neonatal patients. A larger inner‐city hospital, where 46.8 percent of recipients were group O and 29.2 percent were group A, accounted for 180 more group O and 509 fewer group A transfusions than would be expected if donor‐recipient ABO distributions were the same. Three hundred and seventy‐four more group A units were imported than were needed. ABO‐mismatched transfusions due to shortage or emergency were insignificant. It was concluded that increased use of group O blood for neonatal transfusions, donor‐ recipient differences in blood group frequencies, and blood importing practices are the major factors that increase the rate of group A outdating.
Disulphide bonds are a requirement for adsorption of cephalosporins on the red cell membrane
Authors: Duran‐Suarez J. R. , Martin‐Vega C. , Massuet L. , Ribera A. , Pujol M.
Published: March 2003

The authors studied the behavior of red cells (RBCs), treated with 2‐ aminoethylisothiouronium bromide (AET), against 100 serums containing cephalothin antibodies and 27 serums with cephapirin antibodies. None of the serums reacted with cephalosporin‐coated RBCs that had been exposed previously to AET. The possibility of the Kell system acting as a receptor for cephalosporins was excluded. The authors discuss the significance of cysteine disulphide bonds and the tertiary or quaternary structure of red cell membrane proteins in the binding of cephalosporins to RBCs.
The preparation of leukocyte‐poor red cells from AS‐1 red cells by the spin‐cool‐filter method
Authors: Helton M. R. , Huang S. T. , Floyd D. M. , Mcgowan E. I.
Published: March 2003

Ninety‐eight units of AS‐1 red cells (RBC) were studied to determine the optimal unit age for the preparation of leukocyte‐poor red cells by the spin‐cool‐filter method. After 1 week of storage, the residual leukocyte counts of AS‐1 units prepared by this method averaged 0.5 × 10(9) or fewer white cells, which indicated removal of more than 79 percent of the total white cells. The spin‐cool‐filter method, in conjunction with the rapid degeneration of the white cells in the AS‐1 RBC, yielded leukocyte‐poor units comparable to those prepared from citrate‐phosphate‐dextrose‐adenine (CPDA‐1) RBC.
Limitations of paternity testing calculations
Authors: Silver H. , Schoppmann A.
Published: March 2003

A total of 252 black and white trios (mother, child, and putative father) in which the alleged father was known not to be the biological father (BF) were generated from paternity studies. The likelihood of paternity (W) and the paternity index (P) were calculated on the basis of ABO, Rh, MNS, and HLA phenotyping. The results were then reviewed to evaluate the arbitrary limits proposed by a number of states in recent paternity legislation. Two hundred forty‐four of 252 non‐fathers (NFs) (96.8%) were excluded. Of the 152 white NFs, 147 (96.7%) were excluded; 97 of the 100 blacks (97%) were excluded. Eight NFs could not be excluded by the routinely performed tests. The W value for those eight trios ranged from 1.2 to 98.8 percent. Based on limits proposed in legislation, had the NFs actually been alleged fathers, as many as four of the eight of these men could have had the burden of proving that they were not the BFs.
Frozen maternal platelets for neonatal thrombocytopenia
Authors: McGill M. , Mayhaus C. , Hoff R. , Carey P.
Published: March 2003

A case is reported of an alloimmunized, neonatal, thrombocytopenic patient who was successfully transfused with maternal platelets collected by cytapheresis and cryopreserved 3 months before delivery. Phlebotomy or cytapheresis of the mother immediately before delivery was avoided. Transfusion of maternal platelets over a 7‐day period with aliquots containing an average of 7.1 × 10(10) platelets in 50 ml of plasma was possible. Satisfactory increases in platelet counts were sustained after transfusion.
The utility of platelet washing using an automated procedure for severe platelet allergic reactions
Authors: Buck S.A. , Kickler T.S. , McGuire M. , Braine H.G. , Ness P.M.
Published: March 2003

Increased use of platelets in patients requiring chronic platelet support has increased platelet transfusion reactions. The authors reviewed more than 300 platelet transfusion reactions, evaluated an automated platelet washing technique, and studied the effectiveness of washing platelets to reduce reactions. Febrile reactions (66%) were most frequently reported, followed by moderate and severe allergic reactions (15%), and urticaria alone (19%). Washed platelets were prepared by an automated technique (IBM/COBE 2991). In vitro studies indicated no apparent adverse effects to the platelets due to the wash procedure, and in vivo studies demonstrated good platelet increments in 10 thrombocytopenic patients. Twenty‐two patients with histories of platelet transfusion reactions received a total of 554 washed platelet transfusions. Washed platelets were not effective in reducing febrile transfusion reactions in 16 patients receiving 347 washed products. The efficacy of washed platelets in reducing transfusion reactions was demonstrated in six patients with histories of severe allergic reactions who received 207 washed products. Severe allergic reactions were completely alleviated in this group. In conclusion, automated platelet washing is simple and efficacious in preventing or reducing the severity of allergic reactions to platelet transfusions.
The use of frozen intravenous crystalloid solutions as the refrigerant for shipping blood
Authors: Berger J.J. , Monaghan W.P. , Hann W.D.
Published: March 2003

The authors studied whether cooled sterile intravenous crystalloid solutions could be used to refrigerate red cells during shipment. Six 1000‐ml bags of 0.9 percent normal saline and lactated Ringers (RL) solutions were supercooled and tested separately at temperatures ranging from 1 to −78 ° C, with either 5 or 30 units of packed red cells (PRBCs). The PRBCs were shipped in a standard military container that permitted separation of the supercooled solutions from the PRBCs. Cooling RL solutions to 6 ° C and to −22 ° C maintained acceptable storage temperatures of the PRBC for 36 and 50 hours, respectively, and did not cause visible damage to the units. No significant changes were observed in various biochemical measurements of the cells and plasma. Cooling the RL solution to −78 ° C caused a significant (p less than 0.05) increase in plasma potassium concentration. The effectiveness of the crystalloid solutions in refrigerating blood varied with the ratio of the number of PRBCs to the volume of cooled solutions and with the ambient temperature surrounding the container. The results of this study suggest that cooled intravenous crystalloid solutions can be used as refrigerants for PRBCs during shipment.
Preparation and physical characteristics of a hemoglobin solution modified by coupling to 2‐nor‐2‐formylpyridoxal 5‘‐phosphate
Authors: van der Plas J. , de Vries‐van Rossen A. , Damm J.B. , Bakker J.C.
Published: March 2003

Stroma‐free hemoglobin (Hb) solutions were prepared on a 20‐I scale. In 3‐I batches, the beta chains of hemoglobin were crosslinked with 2‐nor‐ 2‐formylpyridoxal 5′‐phosphate (NFPLP) that was synthesized on a gram scale. The coupling efficiency was 60 to 80 percent. The oxygen dissociation curve of these Hb/HbNFPLP mixtures was shifted to the right with P50 (PO2 for 50% saturation with oxygen) values of 26 to 38 torr versus values of 12 to 16 torr for the nonmodified hemoglobin solutions. Both the H+ Bohr factor and the Hill coefficient were lower for the Hb/HbNFPLP mixture than for the original hemoglobin solution. The oxygen‐binding coefficient β was the same for both types of Hb solutions. The viscosity and the colloid osmotic pressure of both solutions were also the same. During storage at 4 ° C for 18 months, no precipitation or denaturation of hemoglobin was detectable in either solution. There was also no conversion of the modified hemoglobin molecules, HbNFPLP, to the native hemoglobin tetramers, dimers, or monomers. The percentage of methemoglobin remained at 5 percent for about 6 months; it increased to 26 percent over the next 12 months. The results indicate that intramolecular coupling of hemoglobin with NFPLP yields a stable product with physiologic oxygen‐carrying properties.
Cytomegalovirus‐seronegative blood components for the prevention of primary cytomegalovirus infection after marrow transplantation. Considerations for blood banks
Authors: Bowden R.A. , Sayers M. , Gleaves C.A. , Banaji M. , Newton B. , Meyers J.D.
Published: March 2003

The authors report 2.5 years' experience with the use of cytomegalovirus (CMV)‐seronegative blood components for the prevention of primary CMV infection after allogeneic marrow transplantation from seronegative marrow donors to 104 CMV‐seronegative patients. Patients and blood donors were screened for CMV‐seronegativity by a combination of passive latex agglutination, complement fixation, and indirect hemagglutination CMV antibody screening methods. Changes in blood banking procedures necessary to provide CMV‐seronegative components are detailed. Providing CMV‐seronegative components was a considerable undertaking; a mean, per patient, of 19 units of red cells and 105 units of platelets was required. Twenty percent of the platelet support was provided by family members and 80 percent by volunteer donors. CMV‐ infection was eliminated in all but one patient not considered infected at the time of transplantation. The capability to provide CMV‐ seronegative components depends on an adequate supply of seronegative donors, a sensitive and practical screening method for CMV antibody, a major commitment by the blood bank, and close communication between the blood bank and the patients' physicians.
Risk of transmission of human immunodeficiency virus (HIV) by heat‐ treated factor VIII concentrates in patients with severe hemophilia A
Authors: Daenen S. , Hoogeveen Y. , Smit J.W. , van Imhoff G.W. , van der Meer J. , DeWolf J.T. , Sibinga C.T. , Halie R.M.
Published: March 2003

Risk of transmission of human immunodeficiency virus (HIV) by heat‐ treated factor VIII concentrates in patients with severe hemophilia A

At the change from unheated to heat‐treated Factor VIII concentrates for the treatment of hemophilia A, 17 severe adult hemophiliacs (mean monthly dose, 4927 IU) were evaluated prospectively for signs of infection with human immunodeficiency virus (HIV). Viral serology and lymphocyte subpopulations (OKT3, OKT4, and OKT8‐positive cells) were examined monthly for 1 year. One patient seroconverted for HIV in the enzyme‐linked immunoabsorbent assay but was positive on the Western blot analysis from the outset. There was a slight but significant increase in OKT4+ cells and OKT4/OKT8 ratio. These data suggest that heat‐treated Factor VIII concentrates even when used in large amounts have a low risk of transmitting HIV.
Effect of virucidal heat treatment on proteins in human factor VIII concentrates
Authors: Thomas K.B. , McGrath K.M. , Taylor M. , Young I.F. , Herrington R.W. , Schiff P.
Published: March 2003

Intermediate‐purity and fibrinogen‐poor factor VIII concentrates were heated in the lyophilized state at 60°C for up to 72 hours to inactivate blood‐borne viruses. The effect of heat treatment on factor VIII, von Willebrand factor (vWf), and other proteins present in the concentrates (albumin, fibrinogen, fibronectin, IgG, and IgM) was evaluated. Heat‐induced protein aggregation, particularly of fibrinogen and fibronectin, occurred within 48 hours in the intermediate‐purity concentrates and correlated well with decreased solubility of these products. Heated fibrinogen‐poor concentrates were readily soluble and did not show protein aggregation even after 72 hours at 60°C. Neither concentrate developed detectable neoantigens when tested against antisera to whole human plasma and to heated and unheated concentrates. Aggregation of the vWf molecule, detected by altered mobility in crossed immunoelectrophoresis and multimeric analysis in SDS agarose gels, occurred in heated intermediate‐purity concentrates but not in fibrinogen‐poor concentrates. Thus, higher‐purity factor VIII concentrates withstand heat treatment better than concentrates that contain greater levels of contaminating proteins, particularly fibrinogen.
Patient‐related blood drives
Authors: Newman B.H. , Burak F.Q. , McKay‐Peters E. , Pothiawala M.A.
Published: March 2003

Ten patient‐related blood drives were evaluated and compared to five other blood drives. The patient‐related blood drives were easier to organize, more fruitful, and more satisfying for the donors and workers. The authors suggest a role for patient‐related blood drives in the present recruitment system and discuss how hospitals and blood centers can coordinate their efforts to have this type of blood drive. Finally, it is suggested that patient‐related blood drives can increase recruitment, especially in large metropolitan areas that suffer from chronic blood shortages.
Solid phase red cell adherence immunoassay for anti‐HIV 1: a simple, rapid, and accurate method for donor screening
Authors: Watson‐Williams E.J. , Yee J.L. , Carlson J.R. , Mertens S.C. , Holland P. , Sinor L. , Plapp F.V.
Published: March 2003

In technically developed countries in which acquired immunodeficiency syndrome is a risk to the recipients of blood or tissue, it is mandatory to screen the donor for evidence of HIV (human immunodeficiency virus) infection. Current tests, based on enzyme‐ linked immunoassay, are time‐consuming and expensive and as such are unsuitable for developing countries. We describe a second generation test using anti‐human IgG coupled to red cells as the indicator of antibody having reacted with test antigen (1). The test is complete within ten minutes, simple to perform and to read and has 100% sensitivity and 99% specificity compared with Western blot. It is ideal for the rapid screening of organ donors and for the screening of blood donors where cost is a major consideration.
Kell blood group activity of gram‐negative bacteria
Authors: Savalonis J. M. , Kalish R. I. , Cummings E. A. , Ryan R. W. , Aloisi R.
Published: March 2003

To understand better the relationships between blood‐group antigens and bacterial constituents, examples of 23 gram‐negative bacteria (representing the 10 genera Citrobacter, Edwardsiella, Enterobacter, Escherichia, Klebsiella, Proteus, Pseudomonas, Salmonella, Serratia, and Shigella) were tested for the presence of Kl‐like antigens by hemagglutination‐inhibition (HAI) assays against both IgG and IgM anti‐ Kl. Saline‐suspended whole organisms, cell‐free culture media, and disrupted organisms were used to test for such antigens in, on, and secreted by the microorganisms examined. Disrupted organisms of an isolate of Shigella sonnei nonspecifically inhibited IgG anti‐Kl as well as IgG antibodies of the specificities Kpb, Fya, S, and c. However, only Escherichia coli 0125:B15, subtype 12808, had specific K1‐ like activity (no activity with other IgG [(k, Kpb, Jka, Fya, S, c] and IgM [A, B, M, P1] antibodies). Disrupted organisms inhibited IgM but not IgG anti‐K1 in the HAI assay. A second subtype, E. coli 0125:B15, subtype 12809, exhibited no K1‐like activity. These findings support the report of K1 activity in cell‐free broth cultures of E. coli 0125:B15 (subtype unspecified). Thus, although not all E. coli 0125:B15 possesses K1‐like activity, the finding of such activity in at least one E. coli subtype confirms the idea that bacterial components may play a role in the production of naturally occurring antibodies directed against non‐ABO red cell antigens.
TREACT: An expert system consultation program to aid in the diagnosis of transfusion reactions
Authors: Shifman M. A. , Vesilind G. W.
Published: March 2003

We have developed a rule‐based, expert system consultation program, TREACT, to aid in the diagnosis of transfusion reactions. Given clinical signs, symptoms, and laboratory results, the program generates diagnoses, alerts the user when a medical director should be called, suggests follow‐up actions, and makes recommendations for future transfusion. Diagnoses made by TREACT, including 121 reactions, were compared with those of the medical directors over a 6‐month period. The overall diagnostic concordance between the medical directors and the program was 0.777. When this was corrected for chance association (kappa statistic), the concordance was 0.703 (p < 0.0001), which can be interpreted on a qualitative scale as substantial agreement. The program has also been used successfully as a tool for training new technologists. Other advantages and possibilities that expert systems offer to transfusion medicine are discussed.
Erb, an allele to Era, and evidence for a third allele, Er
Authors: Hamilton J.R. , Beattie K.M. , Walker R.H. , Hartrick M.B.
Published: March 2003

An antibody against a low‐incidence antigen was detected in the serum of a woman whose newborn infant was found to have a positive direct antiglobulin test. The antibody failed to agglutinate 79 examples of red cells having low‐incidence antigens and 16 examples of high‐incidence antigen‐negative red cells. The woman's serum reacted strongly with her husband's red cells in the antiglobulin test and with 5 of 6 Er(a−) cell samples from unrelated donors, suggesting that the antigen has an antithetical relationship to Era. The failure of the serum to react with one Er(a−) cell sample and with cells from the Er(a+) daughter of an Er(a−b+) mother gives evidence for a silent allele, Er. Four Er(b+) bloods were found among 605 random white donors, indicating a gene frequency for Erb of 0.0033.
Comparative study of the efficacy and safety of intranasal DDAVP administered to normal blood donors
Authors: Palmer D.S. , Nair R.C. , Rock G.
Published: March 2003

A study of the efficacy and safety of intranasal 1‐deamino‐8‐D‐arginine vasopressin (DDAVP; 300 μg) in normal blood donors was carried out in a double‐blind, controlled, comparative study. In addition, the effect of heparin or citrate anticoagulation of blood on the recovery of factor VIII (FVIII) in plasma, cryoprecipitate, and a FVIII concentrate was assessed. Citrated plasma from placebo (CP) or DDAVP‐treated donors (CD) contained 1103 ± 73 and 1470 ± 141 units per liter of FVIII, respectively (p < 0.01), whereas the heparinized plasma from placebo (HP) or DDAVP‐treated donors (HD) contained 1328 ± 130 (p < 0.01) and 2023 ± 358 units per liter (p < 0.01), respectively. The FVIII could be recovered in both cryoprecipitate and cold‐reprecipitated cryoprecipitate (CRC) fractions. DDAVP treatment improved FVIII recovery by 41 percent in the concentrate from citrated plasma (p < 0.01) and by 127 percent in that from heparinized plasma (p < 0.01). The specific activity of concentrates from the CP, CD, HP, and HD groups was 0.95 ± 0.1, 1.4 ± 0.1 (p < 0.01), 0.9 ± 0.1, and 1.47 ± 0.2 U per mg of protein (p < 0.01), respectively. The stability of the final product was the same, regardless of the method of treatment or collection. The side effects of intranasal treatment were mild and transient and occurred with similar frequency in both placebo and DDAVP treatment groups. The results demonstrate that the stimulation of donors with DDAVP and the use of heparin anticoagulant provide a safe and effective means of achieving significant increases of FVIII in purified concentrates.
Validity of testing alanine aminotransferase in refrigerated whole blood
Authors: Shulman G. , Baker D. , Stewart N. C. , Liles B. A.
Published: March 2003

Alanine aminotransferase (ALT) was tested in the sera and plasma of in‐ line segments as well as the main bags of whole blood units collected from blood donors. The purpose of this study was to evaluate the stability of enzyme activity during blood storage when the analysis of ALT is postponed over weekends or holidays. In addition, when validation of a particular result is requested, an in‐line segment may be convenient for confirmatory testing. While a dilutional effect was found, the anticoagulant in the main collection bag was not shown to have affected enzyme activity. During storage the mean enzyme concentration decreased. Appropriate plasma ALT cutoffs for respective time periods during storage were calculated to compensate for downward drift. This correction prevented the use of the blood units (40% of total) that would erroneously have appeared transfusable if the serum cutoff had been used. If the Day 0 plasma cutoff was used throughout the total storage time period, 14 percent of the blood would erroneously have appeared transfusable.
Unusual suppression of Kell system antigens in a healthy blood donor
Authors: Norman P. C. , Daniels G. L.
Published: March 2003

Red cells of a Kp(a+) donor, ascertained as a result of screening donor red cell units with anti‐Kpa, reacted only very weakly with anti‐Kpb and demonstrated weakened expression of various other Kell and para‐ Kell antigens. Family studies revealed a Kp(a+) sister with similarly weakened expression of Kpb and other Kell and para‐Kell antigens. Red cell morphology was normal in both of these individuals. This phenotype is different from any previously reported and is named the Allen phenotype.
Some observations on the Inb antigen and evidence that anti‐Inb causes accelerated destruction of radiolabeled red cells
Authors: Ferguson D. J. , Gaal H. D.
Published: March 2003

This report describes an example of anti‐Inb, a red cell alloantibody directed against a high‐frequency antigen, detected in a prenatal sample obtained from a Canadian woman of Asian Indian extraction. Although the antibody is IgG1, it could not be detected in the serum or on the red cells (RBCs) of her In(b+) infant. Evidence is provided that the Inb antigen is denatured by papain, ficin, trypsin, bromelin, cystein‐activated papain/dithiothreitol, 6 percent aminoethylisothiouronium, and 50 mM dithiothreitol, but not by neuraminidase. Inb antigen strength appears reduced on the In(Lu) type but not on the LuLu type of Lu(a−b−) RBCs. RBCs from a patient with paroxysmal nocturnal hemoglobinuria showed normal Inb antigen strength as did Ko, Ge:−2,3, Ge:−2,−3, and Yt(a−) RBCs. A RBC survival study using 51Cr‐labeled In(b+) RBCs showed 97 percent survival 90 minutes after injection but reduced survivals of 62 and 14 percent at 24 and 96 hours, respectively. These results indicate that this example of anti‐ Inb is unlikely to be implicated in an immediate hemolytic transfusion reaction, but that delayed extravascular hemolysis might occur.
Influence of climate on donor deferrals
Authors: Lau P. , Hansen M. , Sererat M.
Published: March 2003

The purpose of this study was to ascertain the cause for seasonal variations of donor deferral. Deferred donors and monthly temperatures from 1981 to 1984 were tallied and analyzed. Temperatures were categorized at 10‐degree intervals from 15°F to 75°F. Donors failing the hemoglobin screening then underwent a microhematocrit evaluation. Of the 65,531 donors seen at this blood center, 4537 were deferred, for an annual deferral rate of 6.7 to 7.2 percent (p < 0.1). Deferrals for low hematocrit were significantly higher for both sexes at and above 45°F. Similar experiences were also observed in 79,563 donors who came to the bloodmobiles over 19 months in 1983 and 1984. The percentages of deferrals at the blood center for low hematocrit in 1984 were 1.22, 2.6, and 3.5 for men and 6.7, 11.3, and 13.2 for the women at monthly average temperatures of 15.1 to 45°F, 45.1 to 65°F, and 65.1 to 75°F, respectively. These differences of deferral rates are significant (p < 0.05‐0.001). Although other personal demographics remained constant, more of the donors deferred in this study had also been deferred in the past. The climatic changes had a significant effect on the blood composition that resulted in the deferral of blood donors with a borderline low hematocrit.
The sensitivity and specificity of the immediate‐spin crossmatch
Authors: Meyer E. A. , Shulman I. A.
Published: March 2003

The immediate‐spin (IS) crossmatch is used to detect ABO incompatibility between donor red cells (RBCs) and the serum of the intended recipient. However, this test may be positive in the absence of ABO incompatibility (false positive) or it may be negative when ABO incompatibility exists (false negative). During a 25‐month study, the rates of both false‐positive and false‐negative IS crossmatch results were evaluated, and the sensitivity and specificity of the IS crossmatch were determined. During the study period, 53,656 IS crossmatches were performed for patients without significant RBC antibodies. Fifty‐five patients had positive IS crossmatches, and no false‐negative reactions were found. In tests of 55 patients with positive IS crossmatches, 77 false‐positive and 5 true‐positive reactions were noted. The causes of the false‐positive reactions were rouleaux (36 patients), cold‐reactive antibodies (8 patients), a combination of rouleaux and cold‐reactive antibodies (2 patients), fibrin clot (1 patient), and undetermined (3 patients). The sensitivity and specificity of the IS crossmatch were 100 and 99.86 percent, respectively. Laboratory personnel should be aware that the IS crossmatch may have false‐positive or false‐negative results, and they should develop written protocols to distinguish quickly between true‐positive and false‐positive reactions.
Evaluation of two instruments for noninvasive platelet concentrate quality assessment
Authors: GEORGE V. , HOLME S. , MOROFF G.
Published: March 2003

ABSTRACT: The Platelet Monitoring System (PMS) and the Non‐invasive Assessment of Platelet Shape and Concentration (NAPSAC) instruments which relate light scattering characteristics of platelet concentrates (PC) to platelet concentration and shape, were evaluated to determine their accuracy in assessing platelet quality during storage from 1 to 7 days. The results were correlated with platelet concentration, % discs and pH on 121 PC stored in PL732 containers. NAPSAC output is in the form of platelet concentration and % discs. When NAPSAC and standard method values were compared, correlation coefficients (r) did not exceed 0.76 for counts and 0.62 for % discs. PMS output is in the form of lights with red indicating poor quality and green or amber indicating acceptable quality. Sensitivity of the PMS instrument did not exceed 83% and specificity did not exceed 63%. Mean platelet number, % discs and pH were comparable for units triggering red versus green or amber lights. In a separate study, 13 PL732 PC stored 5 days and transfused autologously were evaluated on the PMS. Three red light units exhibited recovery and survival times similar to those observed with PC triggering green/amber lights. These data indicate that neither instrument adequately assesses the quality of PL732 PC.
Lymphokine‐activated killer cell generation and recovery. Comparison of an automated cell processing device and a manual procedure
Authors: Ryan T. , Atkins M. B. , Mier J. W. , Berkman E. M.
Published: March 2003

This report describes the separation or processing of leukapheresis‐derived peripheral blood mononuclear cells, their culture in the presence of interleukin‐2 (IL‐2) to generate lymphokine‐activated killer (LAK) cells, and the harvest of LAK cells using the Du Pont SteriCell processor and culture containers. The report compares this automated closed system to the standard National Cancer Institute (NCI) manual protocols. Lymphocytes (approximately 2.0 × 1010) were harvested on the Cobe 2997 blood cell separator for each set of experiments. A set of experiments using automated Ficoll‐Isopaque (FI) separation and a set of experiments using an automated wash for platelet reduction were compared to the respective manual methods. SteriCell culture containers were compared to roller bottles, and automated harvest was compared to manual harvest. The cytolytic activity of LAK cells was assayed against that of Daudi cells in a standard 51Cr release assay. The cytolytic activity of LAK cells prepared by a manual method and by the automated SteriCell method are equivalent. The manual and SteriCell FI separation procedures were substantially equivalent. The SteriCell harvest method gave higher recoveries than the manual harvest method (p = 0.04 and p = 0.07), but the overall recovery of LAK cells was not significantly different. Differential counts on the products were similar. Platelet reduction by the SteriCell automated wash procedure was greater than that by the manual procedure (p = 0.05). The SteriCell system represents an acceptable alternative to the manual methods for LAK cell generation and recovery.
Risk of hemolytic disease of the newborn as a result of directed donations from relatives
Authors: Kanter M. H. , Hodge S. E.
Published: March 2003

Women of childbearing age are more and more often requesting directed blood donations from their husbands or other relatives. With a mathematical model, the risk was derived of such transfusions causing hemolytic disease of the newborn (HDN) in subsequent pregnancies. Calculations were performed for six classes of relatives of the recipient and her husband and for four racial groups. In general, the risk of HDN increases with the donor's degree of relatedness to the husband and decreases with the donor's degree of relatedness to the recipient in a fairly continuous manner. The relative risk for subsequent HDN was as high as 4.1 if the husband donated. The risk varied with the recipient's race as well as Rh(D) status. Although small, the risk involved in transfusing a woman of childbearing age with blood from her husband or his relatives should be considered when using directed donors. TRANSFUSION 1989;29:620–625.
Should autologous blood that tests positive for infectious diseases be used or discarded?
Authors: DZIK W. H. , DEVARAJAN S.
Published: March 2003

Decision analysis was applied to the question of whether to keep or discard autologous blood donations that test positive for viral markers. The decision is reached by analyzing a series of different events that lead to different outcomes. The probability of each event must be estimated and a value (“utility”) assigned to specific outcomes. The underlying assumptions of the analysis are reviewed. After assigning a probability to each event and a utility to each outcome, one can compute a probability (P*) that is compared to the likelihood that the autologous donor will need transfusion. If the probability of transfusion exceeds P*, then keeping the infectious unit is favored. Otherwise, discarding the infectious unit is preferred. The analysis argues against a single, uniform national policy regarding the disposition of infectious autologous units. The method outlined provides a rational basis for setting policy regarding a controversial issue in Transfusion Medicine.
The relative roles of major and minor histocompatibility antigens in the induction of immunologic unresponsiveness by blood transfusion
Authors: Quigley R. L. , Wood K. J. , Morris P. J.
Published: March 2003

Renal allograft survival may be prolonged indefinitely in some strains of rats following preoperative transfusion with whole blood from the organ donor. Similarly donor‐specific transfusion results in a reduction in the proliferative response of lymph node (LN) white cells (WBCs) to donor‐specific stimulators in mixed‐lymphocyte culture (MLC). To determine the relative roles of major and minor histocompatibility antigens in the depression of the proliferative response, in vitro lymphocyte proliferation assays were performed using congenic rat strains as blood donors. Unidirectional MLCs were set up between haplotype‐disparate responder and stimulator LN cells, in cases in which the responding cells had been harvested from rats transfused with blood that shared either some, all, or none of the major histocompatibility complex genes with the stimulator strain. The proliferative response of LN cells harvested from rats transfused with blood sharing major (class I or II) or minor antigens, or both, with the in vitro stimulator cells was significantly less than the response of cells harvested from nontransfused controls. No single‐locus product was more or less effective than whole blood in depressing cell proliferation. These data suggest that the beneficial effect of preoperative random blood transfusions observed in clinical transplantation may arise from the fortuitous sharing by the blood donor and the subsequent organ donor of not only a single major histocompatibility antigen but also of minor histocompatibility antigens.
Virus inactivation during production of intravenous immunoglobulin
Authors: Kempf C. , Jentsch P. , Poirier B. , Barré‐Sinoussi F. , Morgenthaler J. J. , Morell A. , Germann D.
Published: March 2003

The effect of pepsin treatment at pH 4 on the infectivity of several enveloped viruses was assessed under the conditions used during the production of intravenous immunoglobulins. It was shown that the prototypes of four virus families–human immunodeficiency virus (Lentivirinae), herpes simplex virus type 1 and human cytomegalovirus (Herpesviridae), Semliki Forest virus (Togaviridae), and vesicular stomatitis virus (Rhabdoviridae)–were inactivated by this procedure. With vesicular stomatitis virus as a model, the contributions of both low pH and pepsin were demonstrated, and pepsin had a synergistic or additive action.
The safety of preoperative autologous blood donation in the nonhospital setting
Authors: AuBuchon JP , Popovsky MA
Published: March 2003

The increasing use of preoperative autologous donation (PAD) of blood has led to more frequent donation in settings outside of hospitals, despite concerns that persons making PADs may face increased risks of postdonation reaction. Analysis was conducted of 5660 PADs made at 25 different blood centers, to determine the risks of PAD in nonhospital settings and to search for predictors of severe reactions. Sixteen percent (886) of the donations studied were by persons who did not meet all usual homologous donor criteria. The most common variances were for cardiovascular disease, including the use of cardiac drugs (416 donors, 41% of those not meeting criteria), history of angina (204, 23%), and history of myocardial infarction (192, 22%). Donation by persons not meeting routine criteria was followed by a higher reaction rate than that by donors without any variance (4.3 vs. 2.7%; p less than 0.0001). An increased likelihood of reaction was associated with donor age less than 17 years, female gender, weight less than 110 pounds, and a history of reaction. Four reactions were graded as severe (transient ischemic attack, 1; angina, 3), and all occurred in donors not meeting all criteria (0.4% of 886 donations). A review of these donors' histories failed to identify distinguishing features from which their severe reactions could have been predicted. This study documents the infrequency of severe reactions after PADs by persons referred to a blood center for donation, even those not meeting routine homologous donor criteria, and quantitates the risk to these donors of a severe reaction.
Automated processing of human bone marrow can result in a population of mononuclear cells capable of achieving engraftment following transplantation
Authors: Areman E.M. , Cullis H. , Spitzer T. , Sacher R.A.
Published: March 2003

A concentrate of mononuclear bone marrow cells is often desired for ex vivo treatment with pharmacologic agents, monoclonal antibodies, cytokines, and other agents prior to transplantation. A method has been developed for automated separation of mononuclear cells from large volumes of harvested bone marrow. A programmable instrument originally designed for clinical ex vivo cell separation and the plasma‐pheresis of patients and blood donors was adapted to permit rapid preparation, in a closed sterile system, of a bone marrow product enriched with mononuclear cells. A mean (±/− SEM) of 53 ±/− 30 percent of the original mononuclear cells was recovered in a volume of 125 ±/− 42 mL containing 82 ±/− 12 percent mononuclear cells. This technique removed 95 ±/− 9 percent of the red cells in the original marrow. No density gradient materials or sedimenting agents were employed in this process. Of 36 marrows processed by this technique, 19 autologous (6 of which were purged with 4‐hydroperoxycyclophosphamide) and 7 allogeneic marrows have been transplanted, with all evaluable patients achieving a neutrophil count of 0.5 × 10(9) per L in a mean (±/− SEM) of 21 ±/− 6 days.
Autologous blood donation: hemodynamics in a high‐risk patient population
Authors: Spiess B. D. , Sassetti R. , McCarthy R. J. , Narbone R. F. , Tuman K. J. , Ivankovich A. D.
Published: March 2003

Transfusion practices have changed dramatically in recent years as a result of the acquired immune deficiency syndrome crisis. The use of preoperative donation of autologous blood units has gained popularity. Healthy individuals tolerate phlebotomy well, experiencing a 2‐ to 5‐ percent incidence of vasovagal reactions. However, no systematic study of hemodynamic function during phlebotomy exists for patients who have major cardiovascular or multiple organ disease (high‐risk patients). The following protocol examines blood pressure, heart rate, cardiac output, lead II electrocardiogram, and pulse oximetry in 123 patients donating a total of 224 units of blood in a new high‐risk autologous blood donation program that was conducted in a postanesthesia care unit over the past 18 months. Changes in hemodynamic variables during phlebotomy were consistent with mild volume depletion; the changes did not result in overall differences in the courses of the groups. Significant numbers of patients exhibited systolic or diastolic hypotension, dysrhythmias, syncope, and tachycardia. Because tolerance for hypotension (vasovagal reactions) is decreased in patients with coronary artery disease, appropriate monitoring may be warranted to maximize the safety of elective phlebotomy. Further study is required to stratify risks and to determine which hemodynamic variables are predictive of adverse events.
False‐negative results by polymerase chain reaction due to contamination by glove powder
Authors: de Lomas J. G. , Sunzeri F. J. , Busch M. P.
Published: March 2003

ABSTRACT: The polymerase chain reaction (PCR) technique has become an important, widely employed method for the detection and quantitation of the nucleic acid sequences used in the diagnosis and monitoring of genetic and infectious diseases. Much attention has been directed at the problem of false‐positive PCR results, which are generally attributed to low‐level laboratory contamination of amplified sequences (“carryover”). In contrast, few investigators have commented on the somewhat less frequent, but equally problematic, false‐negative PCR results. Investigation of the source of sporadic false‐negative PCR reactions found that glove powder, inadvertently introduced into tubes when gloves are changed in an effort to reduce false‐positive results, can nonspecifically inhibit each of the major steps in the PCR detection process. Methodologic precautions are recommended to minimize this problem.
Visual identification of bacterially contaminated red cells
Authors: Kim D.M. , Brecher M.E. , Bland L.A. , Estes T.J. , Carmen R.A. , Nelson E.J.
Published: March 2003

There have been increasing numbers of reports of transfusion‐acquired Yersinia enterocolitica bacteremia (including several fatal cases). Fifteen units of whole blood were inoculated with various concentrations of Y. enterocolitica serotype 0:3 and processed into AS‐ 3 preserved red cells (RBCs). Consistent growth of the organism was found at inoculum concentrations greater than or equal to 10 colony‐ forming units per mL. In all 13 units of RBCs that supported the growth of Y. enterocolitica, a darkening in color (due to hemolysis and a decrease in pO2) was observed in the bag. The attached sample segments, which were sealed from the main unit, remained sterile and did not darken. This color change was apparent in all the contaminated units by Day 35, which was 1.5 to 2 weeks after the bacteria were first detected in cultures of the blood. Hence, by comparison of the color of the segment tubing with that of the unit itself, units grossly contaminated with Y. enterocolitica can be identified prior to transfusion. Moreover, review of photographs on file at the Centers for Disease Control revealed this dramatic color change in 2 units of blood that caused transfusion‐transmitted sepsis (Enterobacter agglomerans and an unidentified gram‐negative bacillus, not Yersinia sp.), which demonstrated that the color change was not limited to Y. enterocolitica. This method of visual identification of contaminated units of blood could decrease the incidence of posttransfusion bacterial sepsis.
Storage of platelets in additive solutions: the effect of citrate and acetate in in vitro studies
Authors: Gulliksson H.
Published: March 2003

The in vitro effects of storage of platelets prepared from 6 pooled buffy coat units and stored in a platelet storage medium consisting of CPD and plasma and different platelet additive solutions were evaluated. The total count of platelets per pooled unit included in the present investigation (n = 20) was 335 +/− 35 × 10(9) (mean +/− SD). Measurements of pH, pO2, pCO2, glucose, lactate, ATP, total adenine nucleotide content, and extracellular adenylate kinase activity were performed in a three‐part study. The observations were 1) During storage in saline and citrate (10 mmol/L of citrate), the consumption of glucose and the production of lactate were significantly increased over the values with storage in saline, which were used as a reference. The values for pH at Day 6 were significantly lower. 2) The effects of different concentrations (10, 20, and 30 mmol/L) of acetate in saline were studied. With the exception of significantly higher pH values in saline and acetate, no significant differences were seen in the effects with saline and those with saline and acetate. 3) The combined effect of citrate and acetate was evaluated. The consumption of glucose and the production of lactate, the values for pO2, and extracellular adenylate kinase activity were significantly lower with saline and citrate and acetate than with saline and citrate. Significantly higher values for pH were found at Day 5.The results of these studies indicate that an increase in the concentration of citrate in a platelet storage medium from approximately 8 mmol per L (saline) to 14 mmol per L or more (saline and citrate media) is associated with significantly increased consumption of glucose and production of lactate. This effect can be reversed by the addition of acetate and can be reduced to the same levels that were found with saline.
The use of a chemiluminescence‐linked universal bacterial ribosomal RNA gene probe and blood gas analysis for the rapid detection of bacterial contamination in white cell‐reduced and nonreduced platelets
Authors: Brecher M. E. , Boothe G. , Kerr A.
Published: March 2003

Because of the rising incidence of bacterial growth and septic platelet transfusions in aging units, platelet storage is currently limited in the United States to 5 days. This approved shelf life of platelets might be altered if methods were devised to rapidly detect infected units and/or to decrease the incidence of bacterially contaminated platelets. An investigation was conducted on the effect of a prototype blood collection system with an in‐line filter for the production of white cell‐reduced platelet‐rich plasma on the growth of bacteria in platelets prepared from whole blood that had been inoculated with Staphylococcus epidermidis. Additional studies were conducted with a chemiluminescence‐linked ribosomal RNA (rRNA) gene probe and with blood gas analysis to identify possible methods for the rapid detection of bacterial contamination. All units were followed for 9 days of storage. The filtration of the platelet‐rich plasma resulted in an approximate 2 log10 reduction in white cells with an average loss of 6.7 percent of platelets. Filtration did not appear to alter bacterial growth. In all platelet units that supported growth, pO2 dropped to negligible values and pCO2 rose relative to culture‐negative units. The changes were most sensitive and specific beyond 5 days of storage. The universal bacterial rRNA probe assay was able to detect S. epidermidis in concentrations as low as 1 × 103 colony‐forming units per mL in some cases and reliably detected all units contaminated at a concentration of 1 × 104 colony‐forming units per mL. The use of this probe for the testing of older (or all) platelet units (pooled, individual, or apheresis) could lead to a decrease in the incidence of septic platelet transfusion reactions and possibly to an increase in the acceptable storage period of platelets.
Monitoring transfusionist practices: a strategy for improving transfusion safety
Authors: Shulman I.A. , Lohr K , Derdiarian AK , Picukaric JM
Published: March 2003

BACKGROUND: Data from New York State indicate that about 1 of every 33,000 red cell units transfused is ABO‐incompatible with the recipient. National application of these data suggests that as many as 360 ABO‐incompatible whole blood and red cell transfusions might occur annually in the United States. Phlebotomy and blood bank laboratory errors cause some of these ABO‐incompatible transfusions, but the greatest number result either partially or solely from the failure of transfusionists to identify properly either a patient or the blood component a patient receives.

STUDY DESIGN AND METHODS: A quality assessment/quality improvement (QA/QI), process is described that allowed for the direct oversight (monitoring) of transfusionists' practices and for the assessment of institutional policies for blood administration.

RESULTS: At the beginning of the QA/QI process, monitoring of blood administration practices revealed that a variance from institutional blood administration policy occurred during 50 percent of blood and component transfusions. As a result of the QA/QI process, the percentage of transfusions with an associated variance from institutional policy dropped to nearly zero.

CONCLUSION: The QA/QI process described in this report, or one similar to it, could improve transfusion safety and serve as a model for increased involvement by transfusion service medical directors in the oversight of transfusionists' practices.