bluuebunny/crossref_metadata_2025 huggingface dataset:
Identification of HIV‐infected transfusion recipients: the utility of crossreferencing previous donor records with AIDS case reports
Authors: Samson S. , Busch M. , Ward J. , Garner J. , Salk S. , Fernando L. , Holland P. , Rutherford G. , Benjamin R. , Perkins H.
Published: March 2003

An expanded “look‐back” program has been developed, in which patients who may have been exposed to HIV through blood transfusion were identified via three triggers: the blood that they received was donated by persons who 1) have subsequently been reported to local health departments as meeting the diagnostic criteria for AIDS, 2) have donated since the introduction of anti‐HIV screening and tested positive, or 3) have been found to be infected during investigation of reported transfusion‐associated HIV infections. In comparing triggers, cross‐referencing the list of patients reported to have AIDS (AIDS case list) proved to be the most efficient approach for identifying HIV‐infected donors and transfusion recipients. Of the 7973 AIDS patients reported in eight Northern California counties as of December 1988, 316 (4.0%) were determined to have donated at Irwin Memorial Blood Centers between 1977 and 1985. Despite the logarithmic increase in reported cases of AIDS in the San Francisco Bay area over the last 5 years, the rate of detection of previous donors from AIDS case lists remained between 3.3 and 5.4 percent. These persons accounted for 69 percent of the identified infected donors, and their identification led to notification of 60 percent of potentially exposed recipients and 51 percent of known infected recipients. The crossreferencing of AIDS case listings with blood bank records was equally efficient for regions with low and high AIDS prevalence. National adoption of AIDS case list crossreferencing is recommended as an effective means of identifying previously unidentified infected recipients in an effort to limit the secondary spread of HIV infection.
The relationship of blood transfusion, tumor staging, and cancer recurrence
Authors: Blumberg N. , Chuang‐Stein C. , Heal J.M.
Published: March 2003

Previous research demonstrated a relationship between transfusions of whole blood, or large numbers of red cell concentrates, and later recurrence of cancers of the colon, rectum, cervix, and prostate. It is possible that the transfusion of whole blood may represent a surrogate marker for advanced or more aggressive clinical disease. The relationship of clinical or histologic tumor stage, blood transfusion status, and disease outcome was studied in detail. Patients receiving no transfusions or small numbers of red cells (le;3 units) had uniformly better recurrence and survival experiences than patients receiving similar amounts of blood that included at least 1 unit of whole blood, regardless of the patient's clinical or histologic tumor stage. In multivariate analyses, stage was an independent predictor of outcome, and transfusion status was not a surrogate marker for stage. The effects on recurrence of stage and transfusion appear to be cumulative. These results are consistent with but do not prove the hypothesis that the transfusion of large amounts of stored plasma and cellular debris impairs the host defenses against cancer, regardless of the underlying biologic and clinical aggressiveness of the cancer.
Immunochemical studies on the differential binding properties of two monoclonal antibodies reacting with Tn red cells
Authors: King M.J. , Parsons S.F. , Wu A. M. , Jones N.
Published: March 2003

Two monoclonal antibodies (MoAbs), BRIC 66 (IgM) and BRIC 111 (IgG1), were produced by immunizing mice with ovarian cyst blood group A1 glycoprotein and Tn red cells (RBCs), respectively. Their specificities were determined by inhibitions using Tn sialoglycoproteins (SGPs), mucins (armadillo [ASG] and ovine [OSG] submaxillary glycoproteins), and monosaccharides. BRIC 66 agglutinated both Tn and group A RBCs and reacted immunohistochemically with both the vascular endothelium and tumor cells from a group A adenocarcinoma, BRIC 66 was inhibited by N‐ acetylgalactosamine (GalNAc), Tn SGPs, and mucins on both hemagglutination inhibition tests and radioimmunoassay. BRIC 111 agglutinated Tn RBCs only, and it specifically stained tumor cells from a group O patient's breast carcinoma and a group A patient's adenocarcinoma. In hemagglutination inhibition tests, BRIC 111 was readily inhibited by Tn SGPs, only partially inhibited by GalNAc, and not inhibited by mucins. In a sensitive radioimmunoassay, BRIC 111 was inhibitable by GalNAc. Tn SGP was 2000‐fold more effective as an inhibitor than the mucins (ASG and desialized OSG), which contain a high content of terminal alpha‐GalNAc‐O‐serine (threonine) residues. It is postulated that BRIC 66 is specific for terminal alpha‐GalNAc units in carbohydrate chains. The exclusive reaction of BRIC 111 with Tn SGP indicates a combining site larger than GalNAc alpha‐1, which probably includes amino acid residues in juxtaposition to GalNAc in Tn SGP. In view of its specific agglutination of Tn RBCs, BRIC 111 is a useful reagent for the examination of polyagglutinable RBCs.
Collection of platelets with a new cell separator and their storage in a citrate‐plasticized container
Authors: Simon T. L. , Sierra E. R. , Ferdinando B. , Moore R.
Published: March 2003

A new apheresis device using microprocessor control for the collection of a high‐purity single‐donor platelet concentrate was evaluated, as was the storage of platelets for up to 5 days in a citrate‐plasticized polyvinylchloride blood bag. The study was conducted in three phases: collection of platelets for in vitro studies and determination of donor safety; autologous transfusion of platelets in healthy volunteers; and transfusion of platelets in patients requiring platelet transfusion therapy. Donors had mild hypocalcemia and minimal changes in blood counts except for a platelet count reduction from 288 +/− 50 × 10(3) (288 +/− 50 × 10(9)/L) to 217 +/− 43 × 10(3) per microL (217 +/− 43 × 10(9)/L). A mean of 3.36 +/− 1.24 × 10(11) platelets was collected in the mean volume of 214 mL with red cell and white cell contamination in the range of 10(7). Morphology and aggregation were as described previously in stored platelets. Platelet survival data in eight subjects showed a mean recovery of 61 +/− 11 percent and mean survival of 5.03 +/− 1.07 days by a weighted‐mean model. Patients transfused with platelets had mean increments of 23,000 immediately and of 8000 at 24 hours; corrected count increments were 6000 at 1 hour and 4000 at 24 hours. The platelets were successful in providing hemostasis to these patients. Clinically useful 5‐day‐stored platelets are obtained by using this apheresis technology with a functionally closed system and a citrate‐plasticized blood bag.
Transfusion‐transmitted babesiosis: a case report from a new endemic area
Authors: Mintz E. D. , Anderson J. F. , Cable R. G. , Hadler J. L.
Published: March 2003

The seventh documented case of babesiosis transmitted by transfusion is reported. Both the donor and the recipient are residents of Connecticut, where the presence of endemic babesiosis has only recently been established. As the range of Babesia microti, and its vector the Ixodes dammini tick, continues to expand, clinicians and blood bank directors should be aware that cases of transfusion‐transmitted babesiosis may occur in newly endemic areas.
Storage of platelet concentrates after high‐dose ultraviolet B irradiation
Authors: Snyder EL , Beardsley DS , Smith BR , Horne W , Johnson R , Wooten T , Napychank PA , Male P , Buchholz DH
Published: March 2003

Ultraviolet B (UVB) irradiation of platelet concentrates (PCs) may prevent the development of posttransfusion HLA alloimmunization. As irradiation performed in a blood center or a hospital will probably be associated with a variable postirradiation delay before transfusion, the ability to store PCs after UVB irradiation becomes important. The effects have been studied of a UVB dose of 10,000 mJ per cm2, the dose used in our institution for UVB clinical trials, on PCs pooled and stored for up to 96 hours after irradiation. Results showed that after 96 hours of storage, though there were no changes in pH, platelet count, white cell count, percent discharge of lactate dehydrogenase, or beta‐thromboglobulin, there were significant decreases in morphology score and osmotic recovery. These changes, however, were not evident after 24 hours of storage. Similarly, there was a 60‐percent decrease in immunoreactive membrane glycoprotein (GP) Ib after 96 hours of storage, but these changes were not seen after 48 hours of storage. No changes were seen in levels of GPIIb/IIIa in either group during the 96 hours of storage. On computer‐analyzed two‐dimensional polyacrylamide gel electrophoresis, PCs irradiated at 10,000 mJ per cm2 and stored for 72 hours had changes in over 50 platelet proteins as compared to those proteins in nonirradiated age‐matched control PCs. It can be concluded that UVB irradiation of PCs at 10,000 mJ per cm2 does not lead to significant platelet deterioration after short‐term storage (24‐48 hours) but is likely to be deleterious after long‐term (72‐96 hours) storage. Moreover, UVB induces rotein‐specific alterations stora in the platelet, such as altering GPlb, while leaving GPllb/llla relatively intact.
Captopril‐enhanced binding of PlA1 (HPA‐1a) antibodies in posttransfusion purpura
Authors: Bepler G. , Hoffman S.E. , Thompson B.P. , Telen M.J. , Rosse W.F.
Published: March 2003

A case of posttransfusion purpura is reported in a 90‐year‐old patient whose PlA1 antibody (anti‐HPA‐1a) was found to bind better to HPA‐1a in the presence of captopril, a drug the patient had taken. Initially, IgG antibodies were found in the serum that reacted with normal platelets, but the binding of the antibody was increased in vitro by captopril, which suggested that captopril was responsible for the thrombocytopenia. However, in vitro studies demonstrated that the patient's platelets were negative for HPA‐1a and that anti‐HPA‐1a was present in the serum, both of which findings were consistent with the diagnosis of posttransfusion purpura. The binding of this antibody was enhanced 50 percent by captopril in vitro, and increased binding in the presence of captopril did not occur when the anti‐HPA‐1a was removed. Similar results were obtained with serum containing anti‐HPA‐1a from another patient with posttransfusion purpura. Thus, captopril may increase the binding of anti‐HPA‐1a and confuse the determination of the cause of acute thrombocytopenia.
Validating the probability of paternity
Authors: Kaye D.H. , Vyvial T.M. , Young D
Published: March 2003

In cases of disputed parentage, it is commonly thought that the probability of paternity (P) represents the probability that the tested man is the biologic father of the child whose parentage is in doubt and that the paternity index (PI) is the likelihood ratio that enters into this probability. Using the results of HLA typing in a sample of disputed parentage cases, the distribution of P was examined within two groups: actual mother‐alleged father‐child trios, and simulated mother‐ unrelated man‐child trios. These distributions were found to be roughly consistent with the usual understanding of P.
Investigation of the effect of long‐term whole blood donation on immunologic parameters
Authors: Lewis S. , Kutvirt S. G. , Simon T. L.
Published: March 2003

Few studies addressing possible immune sequelae of long‐term whole blood donation have been published. The purpose of this study was to determine if there were any differences in lymphocyte subsets, monocyte and neutrophil receptors, and antigens important to host defense in committed whole blood donors and in nondonor controls. Blood samples were obtained from 27 whole blood donors who had been donating on a regular basis for at least 4 years and from 21 nondonor controls. A panel of single‐ and dual‐labeled monoclonal antibodies was used to characterize peripheral white cells, and then the cells were analyzed by flow cytometry. Lymphocyte subsets included T (CD3) cells, helper T (CD4) cells, suppressor T (CD8) cells, B (CD19) cells, natural killer (NK) (CD56) cells, and subpopulations of T cells defined by the coexpression of markers for CD3/HLA‐DR, CD3/CD56, and CD8/CD11b. Monocyte and neutrophil analysis included quantitation of receptors for C5a, formyl‐met‐leu‐phe, and C3bi (CR3). Monocytes were also analyzed for expression of HLA‐DR and CD14 antigens. No significant differences were observed in the whole blood donors and nondonor controls for any of these factors used to assess immunologic status, except for an increase in C3bi receptors on both neutrophils and monocytes from whole blood donors. These findings indicate that the lymphocyte parameters analyzed in this study are unaltered by long‐term whole blood donation. Further research is necessary to determine the significance of complement receptor upregulation in whole blood donors and to identify any changes in the functional characteristics of peripheral white cells from whole blood donors.
Experimental 6 log10 white cell‐reduction filters for red cells
Authors: Sadoff B.J. , Stromberg R.R. , Miller K. , Ngo D. , Friedman L.I.
Published: March 2003

White cell (WBC) reduction of blood components has been receiving increased attention as a way of reducing transfusion‐related complications such as WBC‐associated HLA alloimmunization and transmission of cell‐associated viral diseases. Currently available filters are limited to removing approximately 3 log10 (99.9%) of WBCs from red cells (RBCs). The performance of two experimental filters that were designed to remove 6 log10 WBCs from fresh RBCs during component preparation was evaluated. Both filters were able to meet this objective in less than 40 minutes with RBC losses of < 15 percent under nonoptimized conditions. Filtered RBCs showed storage parameters within the normal range over a 42‐day period. The use of these filters, if combined with a sterile docking device or if incorporated into a collection set, should provide the means to supply highly WBC‐reduced RBCs with a normal shelf life.
Experience with autologous bone marrow harvesting and transfusion of marrow‐derived red cells
Authors: Ciobanu N. , Weinberg V. , Sparano J.A. , Zervos G. , Walewski J. , Spivack M. , Wiernik P.H.
Published: March 2003

Marrow red cells (MRBCs) from 56 autologous bone marrow harvests were rescued after processing and transfused as the sole transfusion support after surgery. There was no correlation between volume of harvest and total mononuclear cell (MNC) count. The marrow collection induced a significant decrease in hematocrit values (mean, 6.1; range, ‐0.3‐12.3; p less than 0.001) unrelated to the patient's diagnosis, age, or gender. Processing of the marrows resulted in a mean transfused MRBC mass of 258 mL (range, 101–494 mL), representing 78 percent (range, 43‐ 100%) of the MRBC mass collected. The amount of MRBCs transfused correlated with total MNC count (p less than 0.01). All autologous MRBC transfusions were well tolerated. It can be concluded that autologous MRBC transfusions are safe and may eliminate the need for homologous blood transfusions after marrow harvest.
Detection of antibodies to human immunodeficiency virus type 2 (HIV‐2) in blood donor sera using United States assay methods for anti‐HIV type 1
Authors: Sazama K. , Kuramoto I.K. , Holland P.V. , Couroucé A‐M. , Gallo D. , Hanson C.V.
Published: March 2003

Twelve serum samples from French blood donors that were uniformly reactive in tests for antibody to human immunodeficiency virus type 2 (anti‐HIV‐2) also were reactive in 92 to 100 percent of tests with three anti‐HIV type 1 (anti‐HIV‐1) enzyme‐linked immunoassays currently in widespread use for donor screening in the United States. Supplemental tests for anti‐HIV‐1 on these anti‐HIV‐2‐reactive samples differed in their responses. All samples reacted in a licensed anti‐HIV‐1 Western blot, but there was an atypical band near the p41 position, which could be a clue to the fact that this result was a cross‐reaction with anti‐HIV‐2. A recombinant immunoblot gave an indeterminate result for anti‐HIV‐1 in all 12 samples. A local immunofluorescence assay for anti‐HlV‐1 reacted with 92 percent of the samples, but a commercial one detected only 58 percent.
Anti‐idiotypic antibody to T‐cell receptor in multiply transfused patients may play a role in resistance to graft‐versus‐host disease
Authors: NISHIMURA M. , SAKAI K. , AKAZA T. , MITOMI Y. , NIEDA M. , MINAMI M. , JUJI T.
Published: March 2003

Most patients who receive multiple blood or platelet transfusions do not develop graft‐versus‐host disease (GVHD) in spite of the transfusion of donor white cells–cells that are capable of engraftment and subsequent GVHD. The object of this study was to search for the factors responsible for resistance to GVHD in such patients. Some sera from patients who have received multiple platelet transfusions inhibit the proliferation of alloreactive T‐cell clones that function as an in vitro model of donor‐derived proliferating T cells recognizing recipient alloantigens. The humoral factor in such sera was capable of binding to the T‐cell clones, but not to stimulator cells. Further analysis revealed that the humoral factor in such sera was IgG, which specifically bound to membrane molecules of the T‐cell clones. The antibody competed with WT31, a monoclonal antibody (MoAb) to T‐cell receptor (TCR), in binding to TCR of the T‐cell clones. It did not compete with CD3 or CD2 MoAb. These observations strongly favor the view that the antibody against TCR exists in the sera of multiple transfusion recipients. It is suggested that the TCR antibody binds to TCR of the T‐cell clones, thus blocking the interaction of the T‐cell clone with alloantigens of stimulator cells and resulting in inhibition of the proliferation of T‐cell clones. Furthermore, in view of T‐cell clone‐specific binding of the antibody in sera, it might be concluded that the antibody is anti‐idiotypic.
Peripheral blood stem cell collection with a blood cell separator
Authors: Norol F. , Scotto F. , Duedari N. , Beaujean F.
Published: March 2003

Forty‐three patients with malignant nonmyeloid diseases underwent peripheral blood stem cell collections on an apheresis system (Spectra, COBE BCT, Lakewood, CO). Collections took place during the white cell (WBC) recovery phase following conditioning chemotherapy. One hundred two procedures were done after chemotherapy alone, and 72 procedures after chemotherapy plus granulocyte‐colony‐stimulating factor (G‐CSF). Four centrifugal separation factors were tested. One and one‐half patient blood volumes were processed in each procedure. The mean volume of the collected component was 158 +/− 16 mL. After chemotherapy alone, the procedures provided a mean of 0.8 × 10(8) WBCs per kg and 2.3 × 10(4) colony‐forming units‐granulocyte macrophage (CFU‐GM) per kg of recipient body weight. The mononuclear cell percentage in the components increased with the centrifugal separation factor from 85 to 96 percent. In parallel, platelet contamination increased from 2.1 to 3.8 × 10(11). The collect hematocrit ranged from 1.0 to 2.5 percent (0.01‐0.025). The collection efficiency for mononuclear cells and CFU‐ GM also increased with the centrifugal separation factors from 52 to 70 percent for mononuclear cells and from 55 to 68 percent for CFU‐GM. Collections performed after G‐CSF‐stimulated mobilization were characterized by a higher neutrophil contamination independent of centrifugal separation factor, which gave a mean mononuclear cell percentage of 64 percent in the collected component. The average yield for these procedures was 2 × 10(8) WBCs per kg and 28 × 10(4) CFU‐GM per kg. The collection efficiency for mononuclear cells increased with the separation factor from 43 to 77 percent. The collection efficiency for CFU‐GM was greater than 100 percent.
Frequency of platelet‐specific antigens among Chinese in Taiwan
Authors: Lin M. , Shieh S. H. , Yang T. F.
Published: March 2003

The frequencies of six platelet‐specific antigens among Chinese in Taiwan are reported, which have not previously been well studied. HPA‐ 1a (PlA1) antigen was positive in all 1100 Chinese tested. HPA‐4b (Yukb) antigen was positive in all 100 persons tested. HPA‐2b (Koa, Siba) antigen was positive in 9 percent of 100 persons tested, HPA‐3a (Baka) in 77 percent, and NAKa in 96 percent. HPA‐4a (Yuka) antigen occurred in 0 percent in this study but is estimated to be present in 0.5 percent of the Taiwanese population.
Time from diagnosis of acquired immune deficiency syndrome (AIDS) to death among persons with blood‐borne AIDS in Italy
Authors: Schinaia N. , Bellocco R. , Arcieri R. , Zaccarelli M.
Published: March 2003

The objective of the study reported here was to analyze survival time and factors associated with more rapid death among persons with acquired immune deficiency syndrome (AIDS) in Italy who acquired human immunodeficiency virus (HIV) infection through the transfusion of blood (n = 115) or blood components (n = 111). Subjects included all persons with AIDS all reported to the Italian AIDS Registry. The Kaplan‐Meier method was used to estimate both the median survival time from the date of AIDS diagnosis to the date of death and the median survival time stratified by age at diagnosis, time of diagnosis, and AIDS‐indicator disease. The Cox proportional‐hazard model was used to assess factors independently associated with death. The prognosis for persons with blood‐borne AIDS in Italy remains poor: overall median survival time was estimated to be 9.2 months, with no significant differences between hemophiliacs and transfusion recipients (p = 0.91). The median survival time for subject > 60 years old was 6.0 months, which is a significantly shorter time than that for younger subjects (p < 0.001). Subjects diagnosed prior to 1988 had a median survival time of 8.2 months, which is a significantly shorter time than that for subjects diagnosed after 1987 (p < 0.03). Subjects neurologically affected by AIDS had a median survival time of 4.1 months, which is a significantly shorter time than that for subjects diagnosed with any other disease (p = 0.03). Such factors were independently associated with more rapid death.
Development of a batch‐processed, passive latex agglutination test for cytomegalovirus
Authors: Spindler J. H. , Kerowgan M. , Goldmann S. F.
Published: March 2003

BACKGROUND: The passive latex agglutination test is commonly used for the identification of cytomegalovirus IgG and IgM antibodies. This test is used because of its sensitivity, specificity, speed, and ease of performance, but it is unsuitable for large numbers of samples or for batch processing.

STUDY DESIGN AND METHODS: To solve this problem, comparative studies to assess the cytomegalovirus passive latex agglutination test on microtiter plates were done with a new photometric particle agglutination method (PPAM) and an enzyme‐linked immunosorbent assay as a control.

RESULTS: A total of 3430 sera were tested using both the PPAM and enzyme‐linked immunosorbent assay. A high degree (97.6%) of correspondence between the results of the tests was observed. The new PPAM was easier and faster to use (96 wells in 25 min).

CONCLUSION: These results, as well as the possibility of adapting this method to a fully automated system, suggest that the PPAM could be an important contribution to the field of infection serology.
Human T‐lymphotropic virus type II in Panamanian Guaymi Indians
Authors: Feigenbaum F. , Fang C. , Sandler S.G.
Published: March 2003

Background: Currently, human T‐lymphotropic virus type II (HTLV‐II) is the most prevalent human retrovirus, detected in persons presenting to donate blood in the United States. Only scant information is available with which to counsel HTLV‐II‐seropositive deferred donors or other persons about the ways in which they may spread HTLV‐II to others.

Study Design and Methods: To increase understanding of the modes of transmission of HTLV‐II, a seroepidemiologic study was conducted among Panamanian Guaymi Indians, a recently identified focus of endemic HTLV‐ II infection. Subjects were tested for serologic evidence of infection by HTLV‐II, HTLV type I, hepatitis B virus, and nine other infectious agents by enzyme immunoassays and specific confirmatory tests.

Results: Nine (8.3%) of 109 persons tested HTLV‐II‐seropositive. HTLV‐II seropositivity was more likely in persons with serologic evidence of prior hepatitis B virus infection. Sexual contact with HTLV‐II‐ seropositive partners, but neither parenteral exposure nor breast‐ feeding, was identified as a risk factor for HTLV‐II.

Conclusion: In Guaymi Indians, HTLV‐II appears to be spread primarily through sexual transmission.
In vitro evaluation of platelet concentrates, prepared from pooled buffy coats, stored for 8 days after filtration
Authors: Boomgaard M.N. , Joustra‐Dijkhuis A.M. , Gouwerok C.W.N. , Steneker I. , Reesink H.W. , Loos J.A. , Pietersz R.N.I. , De Korte D.
Published: March 2003

Background: Posttransfusion complications can be prevented by pretransfusion removal of donor white cells from platelet concentrate. The filtration used for this removal seems to have little effect on platelet function and activation, but more information is needed on its effect on function during subsequent long‐term storage of concentrate.

Study Design and Methods: The effect of prestorage filtration of buffy coat‐prepared platelet concentrates (PCs) on platelet function, metabolism, and activation was investigated. A pool of three PCs, each made of four buffy coats, was split into three equal volumes; two were filtered over two different filters and the third served as a control. Variables monitored immediately after filtration and during the subsequent 8‐day storage period at 22°C included aggregation upon stimulation with collagen and/or ADP, platelet adhesion capacity to collagen and fibrinogen in flowing blood, nucleotide content of and nucleobase release by the platelets, expression of activation‐dependent antigens, and β‐thromboglobulin release by the platelets.

Results: No differences were observed between the PCs filtered over two different filters and the nonfiltered control PCs immediately after filtration and during storage, except for a selective removal (20%) of β‐thromboglobulin by one filter.

Conclusion: PCs prepared from a pool of four buffy coats can be filtered and subsequently stored for 8 days (starting +/− 24 hours after whole blood collection) without detriment to platelet function, metabolism, or activation.
Red cell loss following orthopedic surgery: the case against postoperative blood salvage
Authors: Umlas J. , Foster R.R. , Dalal S.A. , O'Leary S.M. , Garcia L. , Kruskall M.S.
Published: March 2003

BACKGROUND: Expensive devices have been developed for the collection and transfusion of blood salvaged after hip or knee arthroplasty.

STUDY DESIGN AND METHODS: The volume of salvaged red cells was measured for the first 6 hours after operation. This volume was compared to total red cell loss during hospitalization and to the volume of allogeneic red cells transfused.

RESULTS: Mean postoperative red cell loss in 31 patients following hip replacement was 55 ± 29 mL and that in 20 patients following knee replacement was 121 ± 50 mL. The 6‐hour wound drainage represented 8.7 and 16.8 percent of overall red cell loss during hospitalization for hip and knee replacement, respectively. The transfusion of postoperatively salvaged red cells would have supplanted transfusion of less than one‐third of a unit of allogenic blood after hip replacement and two‐thirds of a unit after knee replacement. Only three patients (5.9%) lost red cell volume in the drainage equivalent to or in excess of 1 unit of red cells (180 mL). The volume of red cells salvaged postoperatively bore no relationship to perioperative red cell losses as a whole.

CONCLUSION: The relatively small red cell loss in the postoperative period in most arthroplasty patients does not appear to justify the routine use of this technique for the recovery of autologous blood.
Frequency of human platelet antigens among blood donors in northeastern Thailand
Authors: Urwijitaroon Y. , Barusrux S. , Romphruk A. , Puapairoj C.
Published: March 2003

BACKGROUND: Platelet transfusions have been widely used in Thailand, but little is known about the phenotyping of human platelet antigens.

STUDY DESIGN AND METHODS: Whole blood was collected from 483 blood donors for preparation of platelets. An improved mixed passive hemagglutination assay was used for this study.

RESULTS: Frequencies demonstrated were 100 percent for HPA‐1a (PlA1), 15.94 percent for HPA‐ 2b (Siba), 60.25 percent for HPA‐3a (Baka), 98.76 percent for HPA‐4a (Yukb), 1.86 percent for HPA‐4b (Yuka), 5.38 percent for HPA‐5b (Br(a)), and 97.72 percent for Naka.

CONCLUSION: HPA‐1a was found in 100 percent of Thais, which is the same frequency as in other Asian populations but somewhat different from that in whites (97.9%). Therefore, HPA‐1a will not cause neonatal alloimmune thrombocytopenia or post‐transfusion purpura in Thais. According to the frequencies of HPA‐2b, HPA‐3a, HPA‐4a, HPA‐4b, HPA‐5b, and Naka antigens, they may induce neonatal alloimmune thrombocytopenia, posttransfusion purpura, and platelet refractoriness in Thais.
Bacteria levels in components prepared from deliberately inoculated whole blood held for 8 or 24 hours at 20 to 24 degrees C
Authors: Wagner S.J. , Robinette D. , Nazario M. , Moroff G.
Published: March 2003

BACKGROUND: An increase from 8 to 24 hours in the time that units of whole blood can be held at room temperature after phlebotomy would give blood centers more flexibility in component manufacturing and might allow receipt of many infectious disease test results prior to component preparation. However, the potential for bacterial growth during prolonged holding periods requires further study.

STUDY DESIGN AND METHODS: In the Phase I study, 2‐unit pools of ABO‐identical whole blood were deliberately inoculated on Day 0 with Staphylococcus aureus or Pseudomonas fluorescens. They were then divided in half and stored at 20 to 24 degrees C. Red cells (RBCs) with additive solution, platelet concentrates (PCs), and frozen plasma were prepared after 8 and 24 hours. Bacteria levels in PCs and RBCs were monitored on Day 1; bacteria levels were measured in plasma after thawing. In the Phase II study, the same basic design as in Phase I was used, except that 10 bacterial species were studied, lower inocula were used, and RBCs prepared after a 24‐hour room‐temperature whole‐blood hold were white cell‐reduced by filtration. Bacterial growth was monitored during 42‐ day storage of RBCs (1 – 6 degrees C) and 5‐day storage of PCs (20 – 24 degrees C) and after thawing of frozen plasma.

RESULTS: For Phase I, significantly higher bacteria levels were observed in RBCs prepared after a prolonged hold (p < 0.05); higher levels were not observed in PCs and thawed plasma units. In Phase II, prior to white cell reduction by filtration, 8 of 10 organisms had significantly higher levels in RBCs prepared after a 24‐hour hold than in RBCs prepared after an 8‐ hour hold, when both were examined on Day 1 (p < 0.05). For seven of eight organisms examined on Days 1, 21, and 42, filtration (white cell reduction) reduced the bacteria in RBCs prepared from 24‐hour whole blood units to those levels found in unfiltered RBCs prepared from whole blood units held at 8 hours. A prolongation of the holding time from 8 to 24 hours resulted in significantly lower bacteria levels (p < 0.05) in PCs early in storage (Days 1, 1 – 2, or 1 – 3) for seven organisms, with no significant difference for two organisms, and a small but significant increase for one organism (Day 3, p < 0.05). There was no difference in bacteria or endotoxin levels in thawed units of plasma prepared from whole blood after 8‐ or 24‐hour holding times.

CONCLUSION: The levels of bacteria present in components after deliberately inoculated whole blood units are held for 8 and 24 hours depended on the organisms tested, the whole‐blood holding period, and the blood component assayed; for RBCs, they also depended on whether WBC reduction by filtration was performed.
Hepatitis C virus RNA in factor VIII concentrates
Authors: Guo Z. P. , Yu M. W.
Published: March 2003

BACKGROUND: Hepatitis C virus (HCV) RNA was measured in commercial factor VIII concentrates, that is, antihemophilic factor (human) (AHF), to allow the retrospective evaluation of the effect of various virus‐ inactivation procedures. The impact on AHF of recent anti‐HCV screening of plasma was also investigated. STUDY DESIGN AND METHODS: A total of 183 lots of AHF made by six United States‐licensed manufacturers from anti‐HCV‐unscreened (1976–1991) or screened (1992–1993) plasma were examined. Detection and quantitation of HCV RNA were achieved by reverse transcription and nested polymerase chain reaction at limiting dilution. Anti‐HCV in AHF was also measured. RESULTS: Earlier AHF lots subjected to non‐virus‐inactivated treatment (36 lots), dry heat (11 lots), or heating in n‐heptane (4 lots) had relatively high levels of HCV RNA. Most (76%) wet‐heated lots prepared before 1992 contained HCV RNA. No HCV RNA was detected in lots purified by immunoaffinity and subsequently heated or solvent/detergent (S/D)‐treated. However, trace levels of HCV RNA were detected in S/D‐treated lots made by one of four manufacturers before 1992. Since the start of anti‐HCV plasma screening in 1992, 38 lots prepared by six manufacturers were negative for HCV RNA. Prevalence of anti‐HCV was also associated with earlier concentrates and with S/D‐treated lots from that single manufacturer. CONCLUSION: Anti‐HCV screening of plasma by manufacturers in conjunction with current virus‐inactivation procedures, wet‐heating or S/D treatment (either process with or without affinity purification), appears to reduce HCV RNA to undetectable levels in AHF.
Comparison of hematopoietic progenitor cells in human umbilical cord blood collected from neonatal infants who are small and appropriate for gestational age
Authors: Hiett A. K. , Britton K. A. , Hague N. L. , Brown H. L. , Stehman F. B. , Broxmeyer H. E.
Published: March 2003

BACKGROUND: Cord blood has been used for transplantation. The purpose of this study was to compare numbers of hematopoietic progenitors in cord blood collected from neonatal infants who are small for their gestational age and those who are normal.

STUDY DESIGN AND METHODS: Sixteen pregnant women diagnosed with intrauterine growth restriction were prospectively identified. Cord blood was collected at delivery. Fourteen cord blood samples were obtained from gestational age‐matched, appropriately grown newborns. In vitro assays for hematopoietic progenitors were performed and results of the two compared. Comparisons were also made with numbers of hematopoietic progenitor cells previously found by this laboratory in samples collected with the possibility of use for transplantation.

RESULTS: Gestational age, the women's pregnancy and delivery histories, maternal risk factors for intrauterine growth restriction, maternal age, delivery method, umbilical cord blood gases, and 5‐minute Apgar scores were similar in the two groups. Newborns who were small for their gestational age had significantly lower birth weights and longer stays in the neonatal intensive care unit with no evidence for viral infections in the immediate neonatal period. The mean number of progenitors per collection of cord blood in the small newborns was about half that per collection from appropriately grown newborns, but in most cases, these differences were not significant in the two groups, and many numbers in the small newborns fell within the range associated with successfully engrafting cord blood collections.

CONCLUSION: Hematopoietic progenitor cells in the small newborns may be adequate for transplantation purposes in many cases. Their possible use in this context should, however, involve careful consideration of the numbers of progenitors collected as well as of possible viral or other contamination.
Simulated ABO and Rh blood typing
Authors: Anderson B.V. , Warden B.A.
Published: March 2003

BACKGROUND: Blood typing historically has been used to introduce students to the concepts of immunohematology. Risk of disease transmission has compelled school districts to prohibit the use of human blood in student laboratories. A method is needed that will safely simulate ABO and Rh typing.

STUDY DESIGN AND METHODS: A method that uses inorganic salt solutions to simulate ABO and Rh antigens and antibodies was studied. Additional salt solutions and diluents were tested to investigate the feasibility of simulating both ABO and Rh typing in a more realistic medium.

RESULTS: Cobalt nitrate and sodium hydroxide were found to successfully simulate D and anti‐D, respectively. The addition of these solutions did not produce cross‐ reactions in ABO tests. Use of simulated blood as a diluent improved the appearance of the samples.

CONCLUSION: This method can safely and inexpensively simulate ABO and Rh blood typing procedures and provide students with hands‐on blood‐typing experience.
Fibrin sealant: summary of a conference on characteristics and clinical uses
Authors: Alving B.M. , Weinstein M.J. , Finlayson J.S. , Menitove J.E. , Fratantoni J.C.
Published: March 2003

The 2‐day conference clearly outlined the formulations of products that are being developed or are commercially available in Europe. The major difference between products in the United States and those in Europe is that US manufacturers are preparing fibrin sealant that does not contain aprotinin, epsilon amino caproic acid, or any other type of antifibrinolytic agent, whereas antifibrinolytic agents are included in all such preparations used in Europe. The conference provided no clear consensus that such agents are essential to the efficacy of the product. Although many investigators believe in the clinical benefit of fibrin sealant, most of the studies to demonstrate efficacy have not been performed in a well‐controlled fashion. However, fibrin sealant, if found in a controlled trial to have clinical efficacy, could be approved by the FDA for a narrow indication. Opportunities remain for greater exploration of different forms of the product, not only as a hemostatic agent, but as an adjunct to wound healing and as a matrix for delivery of drugs and proteins with other biologic activities.
Buffy coat platelets stored in apyrase, aprotinin, and ascorbic acid in a suspended bag: combined strategies for reducing platelet activation during storage
Authors: Mrowiec Z. R. , Oleksowicz L. , Zuckerman D. , de Leon‐Fernandez M. , Khorshidi M. , Dutcher J. P. , Puszkin E. G.
Published: March 2003

Background: Platelet activation is an important factor impeding the clinical effectiveness of platelet transfusions. In this study, platelet concentrates (PCs) were prepared by a novel suspended‐bag buffy coat technique that was followed by the addition of a mixture of platelet activation inhibitors to the storage bag.

Study Design and Methods: In vitro platelet function was evaluated in PCs prepared by the suspended‐bag buffy coat technique and stored at 22 degrees C for 5 days in the presence of (n = 12) or absence (n = 12) of apyrase, ascorbic acid, and aprotinin (AAA).

Results: Platelets from AAA‐ incubated PCs demonstrated mean ATP levels 17 percent (p < 0.004), 13 percent (p < 0.02), and 22 percent (p < 0.003) higher than those measured in parallel control PCs on Days 1, 3, and 5, respectively. Similarly, on Days 3 and 5 of storage, respectively, 45‐percent (p < 0.001) and 50‐percent (p < 0.001) greater ADP‐induced maximum aggregation was observed in AAA‐incubated PCs than was seen in control preparations. AAA‐incubated PCs demonstrated alpha‐granule membrane protein‐140 expression 92 percent (p < 0.01), 133 percent (p < 0.003), and 104 percent (p < 0.001) below that in control PCs on Days 1, 3, and 5, respectively. At similar intervals, a significant increase in recovery from hypotonic shock also was observed in AAA‐incubated PCs. Further, Day 5 AAA‐PCs demonstrated significantly higher morphology scores and O2 consumption than did control preparations.

Conclusion: Buffy coat platelets prepared in suspended bags and stored in the presence of AAA demonstrate significantly reduced activation and enhanced functional and metabolic activity.
Report on the Sixth International Society of Blood Transfusion Platelet Serology Workshop
Authors: Teramura G. , Slichter S. J.
Published: March 2003

Background: The Sixth International Society of Blood Transfusion Platelet Serology Workshop continued studies to identify methods to detect platelet‐specific antigens and antibodies.

Study Design and Methods: The study was designed to meet three goals. The first was the establishment of antigen‐typed platelet panels and determination of the correlation between serologic and DNA typing of platelet‐specific antigens. The second goal was the determination of the proficiency of detecting platelet‐specific antibodies by laboratory and by technique. The third goal was the identification of any platelet‐specific antibodies present in uncharacterized (unknown) antisera.

Results: For platelet‐antigen typing, concordance between serologic testing and DNA techniques was 93 percent for oligonucleotide typing and 92 percent for allele‐specific restriction site analysis. Agreement between these two was 98 percent. Individual laboratories correctly identified the antibodies contained in coded sera 79 +/− 17 percent of the time. The expected results were obtained from the modified antigen‐capture enzyme‐ linked immunosorbent assay in 75 +/− 46 percent of instances, from the monoclonal antibody‐specific immobilization of platelet antigens assay in 72 +/− 24 percent of instances, from the mixed passive hemagglutination assay in 71 +/− 13 percent, from radioimmunoprecipitation procedures in 67 +/− 47 percent, and from Western blot 34 +/− 40 percent. Seven (54%) of 13 antisera of unknown specificity were determined to contain clearly identifiable platelet‐ specific alloantibodies.

Conclusion: Concordant results were achieved by using either serologic or DNA techniques to identify platelet‐ specific antigens. Except for the significantly lower results found with Western blotting, all other platelet‐specific antibody assays were comparable. Established serologic laboratories can identify and characterize plate‐specific antibodies.
A cost‐effectiveness analysis of the use of a mechanical barrier system to reduce the risk of mistransfusion
Authors: AuBuchon J.P. , Littenberg B.
Published: March 2003

Background: A blood component is transfused to a patient other than the intended recipient because of patient and sample identification problems once in about every 24,000 transfusions. An investigation was performed of the cost‐effectiveness of a barrier system to prevent mistransfusion of a unit of red cells through this kind of error.

Study Design and Methods: A decision analysis model was constructed that took into account nonfatal and fatal events, costs of patient care, and legal costs. The model was used to determine the cost‐effectiveness of the barrier system in terms of cost per year of life saved and lives saved per million transfusions.

Results: The barrier system is predicted to save 1.5 lives per million transfusions when used as intended. If the cost‐effectiveness calculations are based on an average damage award for a fatality of more than $725,000 and a chance of mistransfusion exceeding 1 in 16,700, use of the system results in reduced healthcare expenditures. If no legal costs are included in the cost‐effectiveness calculations, use of the system costs $197,000 per year of life saved. Routine use of the system extends patient life by 1 year per 60,000 units transfused.

Conclusion: The application of a barrier system to prevent mistransfusion and related morbidity and mortality can be cost‐effective. If legal costs are included in the calculations, the use of a barrier system reduces total costs.
Comparison of CD34+ cell numbers and colony growth before and after cryopreservation of peripheral blood progenitor and stem cell harvests: influence of prior chemotherapy
Authors: Humpe A. , Riggert J. , Vehmeyer K. , Troff C. , Hiddemann W. , Kohler M. , Wormann B.
Published: March 2003

BACKGROUND: Quantitative determination of hematopoietic progenitor cells is a major issue in peripheral blood progenitor and stem cell collection and transfusion, although the extent is still an object of discussion. STUDY DESIGN AND METHODS: In 116 leukapheresis collections from 42 patients, immunophenotyping for CD34+ cells, evaluation of in vitro proliferative capacity by a colony‐forming unit‐granulocyte‐ macrophage (CFU‐GM) assay, and viability assessment by trypan blue exclusion were performed before and after storage in liquid nitrogen at ‐196 degrees C. RESULTS: Before storage, the median number of CD34+ cells was 1.46 × 10(6) (range, 0.01–54.05 × 10(6)) per kg of body weight (BW). There was no significant difference between precryopreservation and postcryopreservation numbers. The median number of CFU‐GM was 2.25 × 10(5) (range, 0.02–157.49 × 10(5)) per kg of BW before cryopreservation and significantly (p < 0.001) lower, 0.83 × 10(5) (range, 0–220.36 × 10(5)) per kg of BW, after cryopreservation. The correlation coefficient of prestorage and poststorage values was 0.92. The median ratio of poststorage and prestorage values was 42.3 percent (0–304.8%). Male patients who underwent intense chemotherapy (> 5 cycles) showed a significantly lower ratio of postcryopreservation and precryopreservation CFU‐GM values than other patients (p = 0.0047). A strong linear correlation was determined between the number of CD34+ cells per kg of BW and the number of CFU‐GM per kg of BW before and after cryopreservation. A viability below 50 percent predicted a high loss of in vitro proliferative capacity, while a viability above 50 percent did not correlate with a high ratio of CFU‐GM from after and before cryopreservation. CONCLUSION: A good correlation between the variables used for characterization of peripheral blood progenitor cells–the number of CD34+ cells and the number of CFU‐GM–was observed. Viability assessment by trypan blue exclusion does not seem to be a substitute for assays evaluating in vitro proliferative capacity.