bluuebunny/crossref_metadata_2025 huggingface dataset:
Infection or suspected infection after hip replacement surgery with autologous or homologous blood transfusions
Authors: Murphy P. , Heal J. M. , Blumberg N.
Published: March 2003

Homologous blood transfusions have been associated in both animals and humans with an increased risk of acute postoperative infectious complications. Eighty‐four patients who underwent hip replacement surgery and were transfused with 2 or 3 units of blood were analyzed to determine whether those receiving homologous transfusions had different outcomes than those receiving autologous blood only. Only patients free of other risks for postoperative infection were studied. Those receiving homologous blood had a 32 percent (16/50) rate of proven or suspected infections, which was significantly higher than the 3 percent (1/34) rate in patients receiving autologous blood (p = 0.0029). Wound infections accounted for only a minority (6/17) of the proven or suspected infections, which suggests that nonsurgical factors contributed to these complications. The patients identified as being infected required significantly more antibiotic therapy (mean, 7.6 days) and lengthier hospital stays (mean, 15.5 days) than the patients who remained free of evidence of infection (means: 2.3 days of antibiotics and 12.3 days in the hospital) (p = 0.0001 for each variable). Other potential risk factors for infection, such as duration of surgical procedure, advanced patient age, amount of blood loss, type of anesthesia, surgeon performing the operation, use of a cemented versus porous‐coat prosthesis, leukocytopenia, anemia, and underlying medical diagnosis, did not account for the differences in infection rates seen in those receiving homologous and autologous transfusions. These results confirm previous reports of an increased risk of postoperative infection in patients receiving homologous transfusions. Homologous transfusion may contribute to an increased risk of infection by immunologic modulation of the recipient. If confirmed by other studies, these results provide another powerful argument in favor of autologous blood transfusion.
Estimating the cost of expanding an apheresis program
Authors: Hart W , Jacobs P , Turner AR
Published: March 2003

To determine the cost of expanding blood product operations, the concept of marginal cost must be used. This article reports the development and implementation of a method of costing increases in collecting plasma using apheresis operations. The model takes into account the fact that certain resource inputs–notably, direct labor and machines–increase in discrete steps rather than in a continuous manner. To address this fact, a stepwise cost analysis function was developed, which related operating costs to the volume of apheresis collections. This function was used to predict the marginal costs of potential increases in the supply of plasma at a blood center in Canada. Differences were noted in the cost of plasma in Canada and the United States, much of which could be attributed to different standards regarding the volume of plasma per collection and to differences in pricing materials.
In vitro and in vivo activity of murine lymphokine‐activated killer cells after cryopreservation
Authors: Schmidt‐Wolf I. G.H. , Aihara M. , Negrin R. S. , Blume K. G. , Chao N. J.
Published: March 2003

The in vitro and in vivo effects of cryopreservation on the cytotoxic activity of murine lymphokine‐activated killer (LAK) cells were studied. LAK cells were generated by incubation of spleen lymphocytes of BALB/c mice for 3 days with recombinant interleukin‐2 (rIL‐2) and subsequent cryopreservation. Cytotoxicity was determined in a 51Cr release assay. After thawing, cytotoxic activity was reduced (40.4% 51Cr release at an effector:target cell ratio of 40:1 as compared to 68.5% 51Cr release before freezing) and could be restored to precryopreserved levels by reincubation with rIL‐2 for 2 days after thawing (78.8% 51Cr release). These cells were then tested in BALB/c mice injected with RAW 112 cells, a pre‐B‐cell lymphoma line. The results demonstrate that the survival rate of mice injected with cryopreserved and restimulated LAK cells (50% survival > 180 days after injection) did not differ significantly from that of mice injected with fresh unfrozen LAK cells (60% survival >120 days, 50% survival > 180 days). Cryopreserved LAK cells have potential use in adoptive immunotherapy.
Amphotericin B‐induced injury in stored human platelets
Authors: McGrath K. M. , Bertram J. F. , Houghton S. B. , Boothman J. , Manderson J. A. , Minchinton R.
Published: March 2003

Administration of intravenous amphotericin B is a major factor in the reduction of the recovery of transfused platelet concentrates (PCs). For the study of possible drug‐induced platelet lesions, fresh platelets and stored PCs were incubated with therapeutic concentrations of amphotericin B (10–50 micrograms/mL) and examined for membrane changes by scanning electron microscopy. Stored platelets demonstrated the formation of “pits” on the surface membrane, which were maximal immediately after preparation and gradually decreased with storage. The number of pits was significantly higher after exposure to amphotericin B. No increase was detected in fresh platelets following exposure to amphotericin B. The maximal effect of the drug was seen after 5 days of storage as PCs. Amphotericin B did not affect platelet shape or the number of pseudopodia. There was no correlation between pit formation and the pH, pO2, or pCO2 of the concentrates. Amphotericin B did not release 51Cr from prelabeled stored platelets after 2 hours' incubation at 37°C. Thus, amphotericin B appears to exacerbate a membrane lesion induced by the preparation and storage of PCs.
Accessory cell damage and loss of overall white cell viability inhibit lymphocyte responses after ultraviolet‐B irradiation but without evidence of in vitro suppression
Authors: Pamphilon D. H. , Alnaqdy A. A. , Wallington T. B.
Published: March 2003

The effect of different doses of ultraviolet B irradiation (UVR) on the proliferative responses of Balb/c spleen cells has been tested. In 72‐hour cultures, there was dose‐dependent suppression of proliferation in response to phytohemagglutinin (PHA). Cell viability after UVR was found to be reduced in a dose‐ and time‐dependent manner. Proliferation increased by > 100 percent after low‐dose (20 J/m2) UVR when either normal or gamma‐irradiated peritoneal cells were added to the cultures, but not at higher doses. Delaying UVR until 24 hours after stimulation of cultures with PHA did not substantially increase [3H]‐thymidine uptake. Stimulation of mixtures of UV‐irradiated and control cells or incorporation of medium conditioned with UV‐irradiated cells provided no evidence of suppression of proliferation. The accessory cell population is an important target for UVR, but cells are physically damaged to the extent that, at higher doses, the response to PHA stimulation cannot be restored.
Unbound immunoglobulins are a major source of error in the quantitation of platelet surface‐bound immunoglobulin levels
Authors: Leissinger C.A. , Stuckey W.J.
Published: March 2003

Analysis of assays for the determination of platelet‐associated immunoglobulins (PAIgs) has led to disagreement over the amount of surface‐bound Igs in both normal controls and patients with elevated platelet Ig levels. By the use of radiolabeled platelets and platelet counts, it was demonstrated that more than 108 platelets are disrupted after each centrifugation during platelet isolation procedures, releasing intraplatelet contents into the fluid phase of resuspended platelets in buffer. It was shown that suspensions of whole washed platelets contain a significant, but generally overlooked, amount of unbound Igs that have been liberated from platelets disrupted during processing. When platelet suspensions are evaluated for Igs with assays that fail to incorporate a final separation of whole platelets from the suspension fluid, unbound Igs as well as those bound to the platelet surface are measured, which yields a logarithmic overestimation of surface‐bound Igs. It has been further demonstrated that patients infected with human immunodeficiency virus type 1 can have elevations of PAIgG, PAIgA, and PAIgM in both the thrombocytopenic and nonthrombocytopenic states. These elevations are due to increased internal platelet pools of Igs and not to increased surface‐bound Igs.
Transfusion‐associated graft‐versus‐host disease: do transfusions from second‐degree relatives pose a greater risk than those from first‐ degree relatives?
Authors: Kanter M. H.
Published: March 2003

When a patient receives blood from a closely related donor, there is the potential for transfusion‐associated graft‐versus‐host disease (TA‐ GVHD). With a mathematical model, the potential risk of TA‐GVHD was derived for six classes of related donors. This risk was considered to be present when an HLA‐heterozygous patient received blood from a donor who was homozygous for one of the patient's haplotypes. Calculations showed that second‐degree related donors present a greater risk of TA‐ GVHD than some (siblings) but not all (parents, children) first‐degree related donors. Moreover, there is, in general, no sharp cutoff of risk among the various classes of donors. These results should be considered in the determination of a policy for the irradiation of directed‐donor units.
Human immunodeficiency virus infection due to clotting factor concentrates: results of the Seroconversion Surveillance Project
Authors: FRICKE W. , AUGUSTYNM L. , LAWRENCE D. , BROWNSTEIN A. , KRAMER A. , EVATT B.
Published: March 2003

From 1987 to the present, the Seroconversion Surveillance Project has provided the means by which to monitor the risk of transmission of human immunodeficiency virus (HIV) by clotting factor concentrates. One hundred thirty‐one hemophilia treatment centers in the United States are contacted regularly, and data on HIV testing of patients are collected. To date, 4366 (46.0%) of 9496 patients have been reported to be seropositive, and 37 new seroconversions have been identified. Nine of these have met the Centers for Disease Control criteria for seroconversion while the patient was taking factor concentrate. None of the nine seroconversions were due to concentrates that had been treated to inactivate viruses and made from plasma that had been tested for HIV antibody. These results indicate that there is a high prevalence of seropositivity in affected patient groups, but that the risk of HIV infection from currently available clotting factor concentrates is extremely low.
Prospective study of the evaluation of hepatitis C virus infectivity in a high‐purity, solvent/detergent‐treated factor VIII concentrate: parallel evaluation of other markers for lipid‐enveloped and non‐lipid‐ enveloped viruses.
Authors: Mariani G. , Di Paolantonio T , Baklaya R. , Morfini M. , Mannucci P.M. ,   The Ad Hoc Study Group of the Fondazione dell'Emofilia
Published: March 2003

This prospective study was carried out with the aim of evaluating the efficacy of solvent/detergent inactivation of the hepatitis C virus (HCV) as applied to a chromatographic factor VIII concentrate. In parallel, the markers for other viruses, either lipid‐enveloped (human immunodeficiency virus types 1 and 2 [HIV‐1 and ‐2] and hepatitis B virus [HBV]) or non‐lipid‐enveloped viruses (such as B19 parvovirus and hepatitis A virus [HAV]) were evaluated. The study included 14 hemophilia centers, which enrolled 36 previously untreated patients (median age, 3 years; range, 1–56). The length of follow‐up was 12 months, during which HCV (first‐ and second‐generation assays and recombinant immunoblot assay), HIV‐1 and ‐2, HBV, HAV (IgG and IgM), and parvovirus (IgG and IgM) antibodies, as well as alanine aminotransferase values were evaluated. Thirty‐one patients were analyzable; none seroconverted for HCV, HBV, or HIV after exposure to a total of 165,000 IU of factor VIII (41 different lots). In one patient, alanine aminotransferase values rose to 167 mU per mL, 6 weeks after the first concentrate infusion, and this patient seroconverted for HAV 1 week later. Furthermore, 10 patients seroconverted for parvovirus during follow‐up. This study suggests that the solvent/detergent method of virus inactivation is efficient in relation to lipid‐enveloped blood‐ borne viruses but not in relation to non‐lipid‐enveloped viruses.
Treatment with a pure factor IX concentrate in a patient with moderate hemophilia B undergoing bilateral total hip replacement
Authors: Tengborn L. , Stigendal L. , Gustafsson G. , Stromberg C. , Hultmark P.
Published: March 2003

Recently, a pure factor IX concentrate, licensed in Sweden as Immunine, was prepared through ion exchange and hydrophobic chromotography. Virus inactivation included two steps of steam treatment. Reconstituted Immunine could be kept at room temperature for at least 7 days without any substantial loss of activity. A patient with moderate hemophilia B undergoing bilateral total hip replacement was continuously infused with Immunine by use of a pump. There were no bleeding complications or signs of thrombosis, and the operation markedly improved the patient's range of motion and quality of life.
The routine use of soluble Lewis antigens in the identification of Lewis system antibodies
Authors: Shulman I.A. , Nakayama R.
Published: March 2003

Approximately 3 percent of the blood samples tested at the authors' laboratory have contained unexpected red cell (RBC) antibodies, of which about one‐third have been anti‐Le(a) or anti‐Le(b). Although these antibodies are usually clinically insignificant, considerable workload was expended in their identification. In hopes of reducing this workload, an alternative approach for identifying these antibodies was implemented. If a patient had no history of unexpected antibodies, with the exception of Lewis system antibodies, and if the results of serum antibody detection testing were typical for the presence of anti‐ Le(a) and/or anti‐Le(b), the serum was treated with commercially standardized soluble human Le(a) and Le(b) blood group substances, and the Lewis phenotype of the patient's red cells was determined. If the treated serum demonstrated specific antibody neutralization and the red cell phenotype was Le(a‐b‐), the results were interpreted as positive for anti‐Le(a) or anti‐Le(b), and no further antibody identification workup was performed. If the patient was Le(a+b‐) or Le(a‐b+), or if the treated serum failed to demonstrate specific antibody neutralization, the serum was tested against panels of reagent RBCs that were licensed for the identification of unexpected antibodies. During the study period (8‐1‐89 to 6‐16‐90), 498 of 46,965 patients' samples met the criteria for testing for specific antibody neutralization. Of these 498 blood samples, 452 showed specific neutralization of antibody activity by Lewis substance and were Le(a‐b‐). Only 1 of these samples was discovered to contain an additional non‐ Lewis antibody (anti‐Bg). The remaining 46 samples either showed specific neutralization but were not Le(a‐ b‐) (n = l), did not show specific antibody neutralization (n = 30), or showed antibody activity that was abolished in a dilution control (indeterminate results, n = 15). The follow‐up on 31 transfused patients whose Lewis antibodies were identified on the basis of specific neutralization of antibody activity demonstrated that the use of the protocol was safe. None of the patients developed a clinically significant non‐Lewis alloantibody or suffered a hemolytic transfusion reaction. A net savings of 10,296 College of American Patholo‐ gists workload units was realized over a 10.5‐month period. This protocol (or one similar to it) might appeal to other facilities that perform antibody detection testing in large patient populations of black or pregnant individuals, in whom a relatively high incidence of Lewis antibodies occurs.
Hypericin as an inactivator of infectious viruses in blood components
Authors: Lavie G. , Mazur Y. , Lavie D. , Prince A. M. , Pascual D. , Liebes L. , Levin B. , Meruelo D.
Published: March 2003

BACKGROUND: Hypericin is a potent virucidal agent with activity against a broad range of enveloped viruses and retroviruses. The effective virucidal activity emanates from a combination of photodynamic and lipophilic properties. Hypericin binds cell membranes (and, by inference, virus membranes) and crosslinks virus capsid proteins. This action results in a loss of infectivity and an inability to retrieve the reverse transcriptase enzymatic activity from the virion.

STUDY DESIGN AND METHODS: Since hypericin is devoid of adverse action in most blood components and blood analyses, it is investigated as an additive with potential to inactivate infective viruses in blood components intended for transfusion.

RESULTS: Complete inactivation of 10(6) tissue culture‐infective doses of human immunodeficiency virus was obtained in whole blood and in diluted packed red cells after illumination with fluorescent light for 1 hour. Loss of viral infectivity to cultured CEM cells has been monitored by use of a detection assay for human immunodeficiency virus p55 in enzyme‐linked immunosorbent assay and cytopathic assays. In physiologic media, hypericin interacts with albumin and lipoproteins, retaining the virucidal activity in bound form. The molecule is negatively charged and forms organic and inorganic monobasic salts (ion pairs) in physiologic pH. Various ion pairs differ in virucidal efficacy.

CONCLUSION: The apparent transfusibility of hypericin, taken together with the efficacy of the virucidal activity, the broad range of enveloped viruses affected, and the absence of adverse effects on stored red cells, may render hypericin useful for inactivation of infectious viruses in red cells.
Contribution of polymerase chain reaction and radioimmunoprecipitation assay in the confirmation of human T‐lymphotropic virus infection in French blood donors
Authors: Defer C. , Coste J. , Descamps F. , Voisin S. , Lemaire J.‐M. , Maniez M. , Couroucé A.‐M. ,   Retrovirus Study Group of the French Society of Blood Transfusion
Published: March 2003

BACKGROUND: To verify the criteria for human T‐lymphotropic virus (HTLV) seropositivity in Western blot (WB) proposed by the Retrovirus Study Group of the French Society of Blood Transfusion, 186 blood donations that were repeatedly reactive in HTLV enzyme‐linked immunosorbent assay, selected according to their WB pattern, were tested by polymerase chain reaction (PCR) and radioimmunoprecipitation assay (RIPA).

STUDY DESIGN AND METHODS: In two commercially available WBs, 12 samples were confirmed as positive (rgp21+p19+p24) and 174 were interpreted as indeterminate (one or two reactivities to these proteins). The primer pairs used for the PCR allowed the amplification of type I (HTLV‐I) or type II (HTLV‐II) (or both) sequences. The RIPA was performed with two 35S‐labeled cell lines: HTLV‐I infected HUT 102/B2 and HTLV‐II‐infected MoT.

RESULTS: Of the 12 positive samples, 11 were classified as HTLV‐I‐positive and one as HTLV‐II‐positive. Among the 174 indeterminate samples, three (WB pattern: rgp21+, p19+, p24‐) were HTLV‐I positive in PCR (one of them was positive in RIPA also); the other 171 were HTLV negative.

CONCLUSION: In the study of a population in which 97 percent of HTLV infections are due to HTLV‐I, these data support the three‐protein criteria (rgp21, p19, and p24) for a positive blot reading. No HTLV infection was observed when rgp21 did not react. Consequently, p19 and/or p24 band patterns represent false reactivity and do not require PCR or RIPA confirmation. To discriminate between false‐ and true‐positive results in the absence of MTA‐1 or K55 reactivity, PCR and/or RIPA is required only when rgp21 reactivity is associated with one gag band (p19 or p24).
Isoimmune neonatal neutropenia caused by Fc gamma RIIIb antibodies in a Spanish child
Authors: Puig N. , De Haas M. , Kleijer M. , Montoro J.A. , Perez A. , Villalba J.V. , Gomez I. , von dem Borne A.E.
Published: March 2003

BACKGROUND: FcγRIIIB deficiency is a rare defect in which neutrophils do not express FcγRIIIB and therefore the individuals with this defect have an NA null phenotype. Soluble Fc gamma RIII in plasma is severely decreased and almost undetectable. During pregnancy, FcγRIIIB deficiency may cause the formation of maternal FcγRIIIB antibodies, which leads to an isoimmune neonatal neutropenia. The first known case of isoimmune neonatal neutropenia caused by these antibodies in a Spanish child was identified. CASE REPORT: A newborn infant was severely affected by omphalitis; analysis of his blood showed an absolute neutropenia, but he responded well on intravenous immunoglobulin therapy. The maternal antiserum reacted strongly with all tested FcγRIIIB‐positive neutrophils. A family study showed that the infant's mother, one of the mother's sisters, and her mother were FcγRIIIB deficient. No neutrophil antibodies were found in the plasma from these other FcγRIIIB‐negative women, although both had had numerous pregnancies. The three women were healthy, but one had recurrent otitis. DNA analysis of the family showed the absence of both FcγRIIIB genes in the three FcγRIIIB‐negative women. The father of the child and all the children of the FcγRIIIB gene‐deficient women were shown to lack one of the FcγRIIIB genes.

CONCLUSION: A new case of isoimmune neonatal neutropenia caused by anti‐FcγRIIIB is identified. The family study indicates that the FcγRIIIB deficiency is a hereditary genetic defect. In accordance with the location of FcγRIIIB on chromosome 1, an autosomal pattern of inheritance of the FcγRIIIB‐deficient allele was observed.
Posttransfusion purpura following bone marrow transplantation
Authors: Evenson D.A. , Stroncek D.F. , Pulkrabek S. , Perry E.H. , Radford J. , Miller J.S. , Verfaillie C.
Published: March 2003

BACKGROUND: Thrombocytopenia is a major cause of morbidity and hospital expense following bone marrow transplantation. Platelet transfusions in these patients are frequently complicated by the recipient's development of antibodies to HLA class I antigens. When these patients become refractory to the transfusion of HLA‐matched platelets, the recipient's platelet antigen phenotype must be determined, to ensure that donor platelets will be phenotypically compatible. Cases of alloimmunization to HPA‐1a and HPA‐1b resulting in refractoriness to transfused platelets and the subsequent development of a posttransfusion purpura‐like syndrome are reported. CASE REPORTS: In the first case, a 43‐year‐old woman with Stage IV infiltrating ductal breast cancer presented to the hospital for a transplant of autologous peripheral blood stem cells. After the transplant, her platelet count remained less than 10 × 109 per L, despite daily platelet transfusions, including HLA‐matched platelets. Fourteen days following the transplant, her serum was found to contain anti‐HPA‐1a. Initially, the patient was refractory to the transfusion of HPA‐1a‐negative platelets, but after treatment with intravenous immunoglobulin, she had transient increases in posttransfusion platelet counts. She was also treated with a staphylococcal protein A immunoadsorption column and has not had any such subsequent refractoriness. Her genotype has been found, by use of allele‐specific oligonucleotide hybridization with white cell DNA, to be HPA‐1b/1b. The second case involved a 32‐year‐old woman with chronic myelogenous leukemia who received an unrelated‐donor marrow transplant. Three years later, her CML recurred, and she was treated with interferon‐alpha. Four months afterward, she experienced interferon‐alpha‐induced thrombocytopenia and the interferon therapy was discontinued. She received 12 platelet transfusions in 20 days, but none was effective. Antibodies specific for HLA antigens and HPA‐1b were detected, and three HLA‐matched, HPA‐1b‐negative apheresis platelet components were given, but without effect. Two days after treatment with methylprednisolone (1 g intravenously) and prednisone (2 mg/kg/day orally), her platelet count was 26 × 109 per L, and after 8 more days, it was 102 × 109 per L, without further transfusions. She was found to be homozygous for HPA‐1a (HPA‐1a/1a).

CONCLUSION: Anti‐HPA‐ 1a and anti‐HPA‐1b can cause refractoriness to platelet transfusions in bone marrow transplant patients. Testing for platelet‐specific antibodies should be considered in all patients who are refractory to HLA‐matched platelets.
Frequency and functional relevance of genetic threonine145/methionine145 dimorphism in platelet glycoprotein Ibα in an Italian population
Authors: Mazzucato M. , Pradella P. , Angelis V. de , Steffan A. , Marco L. de
Published: March 2003

Background: Threonine145/methionine145 dimorphism in platelet glycoprotein (GP) Ibα defines the human platelet antigen (HPA)‐2 system that has been implicated in refractoriness to HLA‐matched platelet transfusion and in neonatal immune thrombocytopenic purpura.

Study Design and Methods: The occurrence of this amino acid dimorphism was investigated in 379 Italian blood donors by studying their genomic DNA. Two oligonucleotide primers, Ibα‐3 (5′‐GGACGTCTCCTTCAACCGGC‐3′) and Ibα‐4 (5′‐GCTTTGGTGGGGAACTTGAC‐3′), were used in a polymerase chain reaction to generate a 591‐base pair fragment that was digested with the restriction enzyme Acy I. To investigate whether this dimorphism is involved in the binding of von Willebrand factor (vWF) to GPlb, the binding of vWF to the GPlb/IX complex was measured in two Met145/Met145 and two Thr145/Thr145 subjects.

Results: The genotypic frequencies are 78.9% for Thr/Thr, 19.8% for Thr/Met), and 1.3% for Met/Met; the allelic frequencies are 88.8% for Thr145 and 11.2% for Met145. Estimates for binding of subunit molecules per platelet at saturation and inhibition constant in mol per L, respectively, follow. In the presence of ristocetin (0.5 mg/mL), they are 11,460 ± 2,040 and 1.26 ± 0.44 × 10−8 for normals and 11,230 ± 2,330 and 1.29 ± 0.48 × 10−8 for patients. In the presence of botrocetin (2.5 μg/mL), they are 64,260 ± 7,760 and 2.99 ± 0.96 × 10−8 for normals and 65,770 ± 11,570 and 2.47 ± 0.22 × 10−8 for patients. Platelet aggregation responses obtained using platelet‐rich plasma from donors with Met145/Met145 or Thr145/Thr145 genotype were within normal limits.

Conclusion: Genotypic and phenotypic frequencies in the HPA‐2 system in this population are consistent with those reported among the white population. Furthermore, the HPA‐2 system is not involved in the binding of vWF to GPlb.
The effect of recombinant human erythropoietin on the efficacy of autologous blood donation in patients with low hematocrits: a multicenter, randomized, double‐blind, controlled trial
Authors: Price T. H. , Goodnough L. T. , Vogler W. R. , Sacher R. A. , Hellman R. M. , Johnston M. F.M. , Bolgiano D. C. , Abels R. I.
Published: March 2003

Background: This randomized controlled study was undertaken to determine the effect of recombinant human erythropoietin (rHuEPO) on erythropoiesis, autologous blood collection, and allogeneic transfusion risk in elective surgery patients with low baseline hematocrits.

Study Design and Methods: Patients (n = 204) with low baseline hematocrits (< or = 39%), scheduled for orthopedic surgery within 25 to 35 days, were seen every 3 to 4 days for 21 days. At each visit, 450 mL of blood was collected if the hematocrit was > or = 33 percent, and rHuEPO (600 U/kg) or placebo was administered intravenously.

Results: One hundred seventy‐three patients were evaluable. The number of autologous units collected from the rHuEPO and control groups, respectively, was 4.5 ± 1.0 and 3.0 ± 1.1 (p < 0.001), and marrow production of red cells increased by 668 ± 222 and 353 ± 155 mL over and above baseline production (p < 0.05). Allogeneic blood transfusion was required by 31 percent of control and 20 percent of rHuEPO patients (p = 0.09). Excluding 8 patients who received > 6 units, 29 percent of control and 14 percent of rHuEPO patients required allogeneic blood (p = 0.015). Logistic regression modeling determined that the risk of allogeneic transfusion was reduced by rHuEPO (p = 0.025).

Conclusion: The use of rHuEPO stimulates erythropoiesis, permits the storage of more autologous blood, and reduces allogeneic transfusion risk in patients with low hematocrits who are undergoing elective orthopedic surgery. Additional studies are necessary to determine the optimal schedules of rHuEPO administration and autologous blood collection as well as the cost‐effectiveness of this strategy.
Blood utilization in adult patients undergoing extracorporeal membrane oxygenated therapy
Authors: Butch S. H. , Knafl P. , Oberman H. A. , Bartlett R. H.
Published: March 2003

Background: The impact of extracorporeal membrane oxygenation (ECMO), performed on adult patients, on the blood transfusion service of a tertiary‐care hospital was assessed. The quantity and pattern of blood component utilization by these patients were compared to those in a previous evaluation of neonatal patients receiving similar treatment.

Study Design and Methods: The records of blood component transfusion to 74 adult patients, treated with ECMO within a 6‐year period, were reviewed. This information was correlated with the clinical indication for ECMO and duration of ECMO treatment. In addition, daily use of components for these patients was studied to ascertain whether the blood requirements were predictable and uniform.

Results: Over 15,000 units of blood components, with platelet concentrates making up the largest portion, were transfused to these patients while they were undergoing ECMO. The duration of ECMO varied from less than 1 day to 53 days. However, the length of treatment could not uniformly be correlated with blood utilization or with survival. Daily blood transfusion needs often could not be anticipated, which meant that the transfusion service frequently had to respond to urgent requests for transfusion support. The provision of platelet concentrates proved to be the most difficult part of the maintenance of this program.

Conclusion: Whereas ECMO treatment of neonatal patients has a relatively minor impact on a transfusion service, the same is not true for a program that uses this form of treatment for adults as well.
Absence of human immunodeficiency virus type 2 infection among patients in a hospital serving a New York community at high risk for infection. Centers for Disease Control and Prevention/Bronx‐Lebanon Hospital Center HIV Serosurvey Team
Authors: Irwin K. L. , Olivo N. , Schable C. , Weber J. T. , Janssen R. , Ernst J. ,   For the Centers for Disease Control and Prevention,   Bronx‐Lebanon Hospital Center HIV Serosurvey Team
Published: March 2003

BACKGROUND: Although human immunodeficiency virus type 2 (HIV‐2) infection among United States residents is considered rare, there are US populations at high risk. Few studies have surveyed these populations with a high likelihood of infection, that is, those with high percentages of persons from HIV‐2‐endemic areas and high prevalences of behaviors that would allow for transmission. STUDY DESIGN AND METHODS: Patients (n = 832) enrolled in a confidential HIV serosurvey at a hospital that serves a community with a relatively high percentage of West African immigrants, drug injectors, and persons who practice high‐risk sexual activity were evaluated. Sera were tested for HIV type 1 (HIV‐1) and HIV‐2 by rapid enzyme immunoassays, standard enzyme immunoassays and Western blots. RESULTS: Eight of 832 patients were weakly reactive to HIV‐2 on rapid assay, but none was confirmed to be infected when tested by standard immunoassay and Western blot. Five of these eight were reactive to HIV‐1. CONCLUSION: Weak reactivity to HIV‐2 antibody on the rapid assay is best explained by cross‐reactivity with HIV‐1 antibody; thus, even in this population at high risk for infection, false‐positive reactions are more likely than true infections. The finding that HIV‐2 is absent in this population at potentially high risk for infection corroborates the findings of other studies that HIV‐2 infection is rare among US residents. These results support previous recommendations that, in settings other than blood collection facilities, HIV‐2 testing should be selectively offered to persons with epidemiologic risk factors.
Generation of interleukin 8 in stored apheresis platelet concentrates and the preventive effect of prestorage ultraviolet B radiation
Authors: Fujihara M. , Takahashi T.A. , Ogiso C. , Hosoda M. , Ikebuchi K. , Sekiguchi S.
Published: March 2003

BACKGROUND: Several recent studies have reported both the generation of cytokines, including interleukin (IL)‐1 β, IL‐6, tumor necrosis factor α (TNF‐α), and IL‐8, in the supernatants of stored platelet concentrates (PCs) and the implications of this generation in febrile nonhemolytic transfusion reactions. Prestorage filtration is regarded as highly effective in the prevention of cytokine generation.

STUDY DESIGN AND METHODS: Studies evaluated 1) the levels of these cytokines in apheresis PCs during storage, 2) the effects of white cell inactivation by ultraviolet B or γ‐radiation on the generation of cytokines, and 3) the effects of poststorage filtration on cytokine levels. The apheresis PCs were treated by either ultraviolet B radiation (20,000 J/m2), γ‐radiation (30 Gy), or filtration. Samples were collected sequentially on various days after storage. Cytokines were determined by enzyme‐linked immunosorbent assay.

RESULTS: The average white cell count in 15 PCs tested was 2.58 ± 0.7 × 106 per mL (range, 0.7–10 × 106/mL). A detectable level of IL‐8 was found at 3 days of storage, and the levels of this cytokine increased progressively with increasing storage time, ranging from 1.6 to 35,280 pg per mL on Day 5 and from 2.7 to 83,601 pg per mL on Day 8. Reverse transcriptase‐polymerase chain reaction analysis showed that the level of IL‐8 paralleled the expression of IL‐8 transcripts. The levels of IL‐1β, IL‐6, TNF‐α, and monocyte chemotactic protein‐ 1 were very low, even on Day 8. Ultraviolet B‐radiated PCs failed to generate IL‐8, even at 8 days of storage, whereas levels of IL‐8 in γ‐radiated PCs were similar to those in nonirradiated PCs. Poststorage filtration of PCs with a negatively charged polyester filter, but not with a positively charged one, markedly reduced the levels of IL‐8.

CONCLUSION: Of the cytokines tested, IL‐8 had the most evident generation in apheresis PCs during storage. Prestorage inactivation of white cells by ultraviolet B radiation, but not by γ‐radiation, was effective in preventing the generation of cytokines during the storage of PCs.
High‐yield platelet concentrates attainable by continuous quality improvement reduce platelet transfusion cost and donor exposure
Authors: Kelley D.L. , Fegan R. L. , Ng A. T. , Kennedy M.K. , Blanda E. , Chambers L.A. , Kennedy M.S. , Lasky L.C.
Published: March 2003

BACKGROUND: Donor exposure risk and cost in platelet transfusion practice can be limited by increasing the recovery of platelets from donor units.

STUDY DESIGN AND METHODS: This study presents results of continuous quality improvement efforts in platelet production and compares the in vivo therapeutic efficacy of currently produced platelet concentrates (PCs) with that of apheresis platelets. Production quality improvement measures included optimization of instrument performance (rotor speed trials), process (massaging whole‐ blood units, using cup liners, limiting spin‐expression time, and refining plasma expression technique), and staff (intensive training with observation and ongoing quality control data feedback). Corrected count increments and increments per kg were calculated for transfusions of 4 pooled PCs and apheresis platelets over a 30‐day period.

RESULTS: The mean number of platelets per PC increased from 5.5 × 1010 in 1975 to 9.69 × 1010 in 1994. The mean platelet dose was 3.78 × 1011 for 4 PCs and 4.17 × 1011 for apheresis platelets. A total of 34 pooled PCs and 17 apheresis platelets was transfused to 21 patients. The mean increment, the increment per kg, and the corrected count increment were, respectively, 31 × 103 per μL, 4.8 × 102 per μL, and 14,700 for 4 PCs and 35.4 × 103 per μL, 5.4 × 102 per μL, and 14,700 for apheresis platelets. Differences were not significant.

CONCLUSION: Therapeutic efficacy comparable to that of apheresis platelets can be obtained with 4 high‐yield PCs.
Immunologic events during the incubation period of hepatitis C virus infection: the role of antibodies to E2 glycoprotein. Multicentre Hemodialysis Cohort Study on Viral Hepatitis
Authors: Psichogiou Mina , Katsoulidou Antigoni , Vaindirli Efi , Francis Bryan , Lee Stephen R. , Hatzakis Angelos ,   Multicentre Hemodialysis Cohort Study on Viral Hepatitis
Published: March 2003

BACKGROUND: The study of the sensitivity of screening assays is greatly facilitated by testing the sequential changes in seroconverting individuals. The aim of this study was to investigate the early immunologic response after hepatitis C virus (HCV) infection and to evaluate whether HCV envelope (E2) recombinant antigen would provide a significant increase in sensitivity for detection of anti‐HCV. STUDY DESIGN AND METHODS: Twenty hemodialysis patients who were seroconverting to anti‐HCV were included in this study. They were followed up for a mean period (+/− SD) of 10.5 +/− 3.3 months, in which 13 to 46 serum samples per case were collected. Each sample was tested for anti‐HCV by second‐ and third‐generation enzyme immunoassay (EIA‐2 and EIA‐3) and recombinant immunoblot assay (RIBA‐3). E2 antibodies were tested by a prototype EIA in which E2 was expressed as a recombinant antigen in Chinese hamster ovary cells. RESULTS: Alanine aminotransferase elevation was observed in 18 of 20 cases. Reactivity against c100, c33c, c22, NS5, and E2 was detected in 15 (75%), 19 (95%), 15 (75%), 2 (10%), and 17 (85%) patients, respectively; c33c was the most immunogenic antigen, followed in descending order by E2, c22, c100, and NS5. E2 antibody reactivity resolved the two RIBA‐3‐ indeterminate cases. However, there was no case in which E2 reactivity preceded all other HCV antigens. Anti‐E2 was found to react in all patients of genotypes 1a, 1b, and 3a but in only 2 of 4 patients of genotype 4a. CONCLUSION: In this group of seroconverting individuals, E2 antigen was shown to be highly immunoreactive and did resolve some RIBA‐3‐indeterminate samples as being positive, on the basis of reactivity to multiple antigens, but it did not improve early detection of seroconversion.
The effect of short‐term, temporary deferral on future blood donation
Authors: Halperin D. , Baetens J. , Newman B.
Published: March 2003

BACKGROUND: Most blood donor deferrals are temporary and short‐term. The effect of short‐term, temporary deferral (STTD) on blood donor return rates and subsequent blood donations is an important issue. STUDY DESIGN AND METHODS: Donors given STTDs during the first 3 months of 1993 were computer‐matched with nondeferred donors on the basis of age, sex, and donation date. Computer records were evaluated during the next 4.25 years (4/93‐6/97) to determine donor return rates and subsequent blood donations. RESULTS: The most common reasons STTD were low hemoglobin (46%), colds and/or sore throats (19%), and elevated temperature (10%). Nondeferred donors were 29 percent more likely than donors with STTD to return over the next 4.25 years (80% vs. 62%), and nondeferred donors donated 81 percent more whole blood units (13,798 vs. 7,615) over the same period. CONCLUSION: The study showed that STTD have a very negative impact on blood donor return rates and subsequent blood donations. Actions to alleviate these negative effects are indicated.
Demographic characteristics, unreported risk behaviors, and the prevalence and incidence of viral infections: a comparison of apheresis and whole‐blood donors. The Retrovirus Epidemiology Donor Study
Authors: Glynn S. A. , Schreiber G. B. , Busch M. P. , Kleinman S. H. , Williams A. E. , Nass C. C. , Ownby H. E. , Smith J. W. ,   Retrovirus Epidemiology Donor Study
Published: March 2003

BACKGROUND: The demographics, deferrable risk behaviors, and the prevalence and incidence of viral infections of apheresis (PH) and whole‐blood (WB) donors were compared, to characterize these two populations and to evaluate the relative safety of PH and WB donors in terms of transfusion‐transmitted viral infections.

STUDY DESIGN AND METHODS: A comparison was made of 36,119 PH donors (> or = 1 PH donation) and 1.38 million WB donors (> or = 1 WB donation) in terms of demographics and the prevalence (/100,000 donors) and incidence (/100,000 person‐years) of viral infections, by using data collected at five United States blood collection centers between 1991 and 1994. Deferrable risk behaviors were defined as those risk behaviors that would have resulted in donor deferral, had they been reported. The prevalence of deferrable risk behaviors was estimated by using data collected through an anonymous mail survey.

RESULTS: PH donors were older and more likely than repeat (2+ donations) WB donors to be female, white, and United States‐born and to have a higher degree of education (p ≤0.001). The prevalence of any viral infection was 50 percent higher in WB donors than in PH donors (p = 0.04), whereas the incidence of HIV, human T‐lymphotropic virus, and hepatitis B surface antigen was nonsignificantly higher in WB donors. The prevalence of deferrable risk behaviors did not differ in the two groups.

CONCLUSION: Further studies will be needed to evaluate whether the difference in the prevalence of viral infections observed in this study can be explained by demographic characteristics and patterns of donation frequency.
Release of mediators of systemic inflammatory response syndrome in the course of a severe delayed hemolytic transfusion reaction caused by anti‐D
Authors: von Zabern I. , Ehlers M. , Grunwald U. , Mauermann K. , Greinacher A.
Published: March 2003

BACKGROUND: In vitro studies suggest that mediators of systemic inflammatory response syndrome are generated in the course of hemolytic transfusion reactions. Evidence for the in vivo significance of these findings is given by the present clinical and laboratory analysis of a severe delayed hemolytic transfusion reaction (DHTR).

CASE REPORT: A 67‐ year‐old patient (blood group O, D‐negative) with a negative pretransfusion antibody screen received a massive transfusion because of arterial bleeding (Day 1). The transfusion of group O, D‐positive red cell concentrates was unavoidable because of limited supplies. At Day 10, the patient developed a DHTR with symptoms of septic‐toxic syndrome and signs of hemolysis; he received an exchange transfusion. Serologic markers, as well as proinflammatory and anti‐inflammatory mediators, were monitored at the onset of the DHTR and during the exchange transfusion.

RESULTS: At Day 10, the direct antiglobulin test was positive; anti‐D was present, most likely as the result of an anamnestic immune response. Interleukin (IL)‐1 was not detectable; all other mediators monitored were elevated: IL‐1 receptor antagonist, tumor necrosis factor, IL‐6, IL‐8, IL‐10, neopterin, elastase, C3a‐ desArg, C‐reactive protein, and fibrinogen. Most of the values declined during the exchange transfusion, which was followed by an improvement of the clinical presentation.

CONCLUSIONS: Mediators of systemic inflammatory response syndrome were released in the course of a DHTR caused by anti‐D. Severe clinical symptoms could be treated successfully by exchange transfusion.
The cost‐effectiveness of autologous transfusion revisited: implications of an increased risk of bacterialinfection with allogeneic transfusion
Authors: Sonnenberg F.A. , Gregory P. , Yomtovian R. , Russell L.B. , Tierney W. , Kosmin M. , Carson J.L.
Published: March 2003

BACKGROUND:Previous analyses have found autologous transfusion to be very expensive but have not considered avoidance of postoperative bacterial infections as one of its benefits.

STUDY DESIGN AND METHODS:A cost‐utility analysis using a Markov cohort simulation model compared autologous blood transfusion to allogeneic transfusion in a hypothetical cohort of patients undergoing elective total hip replacement with respect to discounted quality‐adjusted life years (QALYs) and health‐care system costs.

RESULTS:Assuming a base case rate of serious infection of 3.7 percent, a relative risk of infection of 1.85, and additional costs of $12,980 per infection, autologous transfusion has a cost‐effectiveness of $2,470 per QALY. If the relative risk of bacterial infection following allogeneic transfusion exceeds 1.1, the cost‐effectiveness of autologous transfusion is less than $50,000 per QALY and if the relative risk exceeds 2.4, autologous transfusion is dominant, resulting in both lower costs and greater QALYs. If there were no increased risk of transfusion, the cost‐effectiveness of autologous transfusion would be $3,400,000 per QALY.

CONCLUSIONS:If there is only a modest increase in the risk of bacterial infection following allogeneic transfusion, autologous transfusion would result in improved outcomes at a cost of less than $50,000 per QALY. Autologous transfusion would be dominant above a relative risk of infection that is within the range of values observed in randomized controlled trials. However, if there is no increased risk of bacterial infection, autologous transfusion would be a very expensive strategy. Until more definitive data are available on the magnitude and costs of this risk, we advise against prematurely closing the debate about the cost‐effectiveness of autologous transfusion.
Comparison of volumetric capillary cytometry with standard flow cytometry for routine enumeration of CD34+ cells
Authors: Cabezudo E. , Querol S. , Cancelas J.A. , Garcìa J.
Published: March 2003

BACKGROUND: This study assesses the feasibility of a new volumetric cytometry system for the enumeration of CD34+ cells in apheresis components, peripheral blood, and cord blood samples in routine laboratory work. This system is compared with the following flow cytometry protocols: Milan, ISHAGE, ISHAGE with 7‐AAD, and flow‐count fluorospheres.

STUDY DESIGN AND METHODS: Correlation, linearity, and reproducibility studies were performed for the various methods. Clonogenic cultures were performed, as an external control, to assess the correlation between the number of CD34+ cells per μL and the number of colony‐forming units per μL.

RESULTS: The linear regression analysis demonstrated that the five methods were comparable (R2 ranged from 0.86 to 0.96 and slopes were close to 1). The CD34+ assay and the flow‐count methods showed poor linearity for CD34+ cell counts below 10 cells per μL (R2 = 0.46 and 0.47). The reproducibility assay for a CD34+ count of 10 cells per μL showed a CV of 12 percent and 25 percent for the Milan and CD34+ assay methods, respectively. The mean CV among all five methods for the 46 evaluated samples was 20 percent. There was a strong correlation between the number of CD34+ cells per μL and colony‐forming units per μL in cord blood and apheresis samples (r = 0.71‐0.81).

CONCLUSION: The CD34+ assay is useful in CD34 enumeration in cord blood, leukapheresis samples, and peripheral blood samples and provides comparable results to the Milan, ISHAGE, ISHAGE with 7‐AAD, and flow‐count methods. Nevertheless, peripheral blood samples with low CD34 absolute counts (below 10 cells/μL) should be analyzed by alternative flow cytometry protocols. Even though the same operator performed the study in a single laboratory, the high inter‐method CV suggests that differences in sample preparation and gating strategy are factors that increase variability. Protocols with fewer intermediate steps or fully automated protocols such as the CD34+ assay are expected to reduced intra‐ and inter‐laboratory variability.