bluuebunny/crossref_metadata_2025_split huggingface dataset:
Immune modulation by helminthic infections: worms and viral infections
Authors: KAMAL S. M. , EL SAYED KHALIFA K. 
Published: September 2006

SUMMARY Helminthic infections occur worldwide, especially in developing countries. About one‐quarter of the world's population, 1·5 billion, are infected with one or more of the major soil‐transmitted helminths, including hookworms, ascarids, and whipworms. Schistosomes infect more than 200 million people worldwide with 600 million at risk in 74 countries. The interaction between helminths and the host's immune system provokes particular immunomodulatory and immunoregulatory mechanisms that ensure their survival in the host for years. However, these changes might impair the immunological response to bystander bacterial, viral, and protozoal pathogens and to vaccination. Modulation of the immune system by infection with helminthic parasites is proposed to reduce the levels of allergic responses and to protect against inflammatory bowel disease. In this review, we summarize the immunological milieu associated with helminthic infections and its impact on viral infections, mainly hepatitis B virus, hepatitis C virus, and human immunodeficiency virus in humans and experimental animals.
PL01 Background to Testing Deceased Tissue Donors for Variant CJD
Authors: Warwick R. 
Published: September 2006

Introduction  Hundreds of thousands of patients in Europe undergo therapeutic human allograft treatments. There have been three recent reports of possible transmission of vCJD or of abnormal prion by blood transfusion. There is no validated blood test for vCJD, but there are techniques using tissues, that have been used in vCJD epidemiological studies. The principle of testing tonsil, spleen or other reticulo‐endothelial or neurological tissues deserves discussion including issues of test validation, logistics of biopsy sampling, timeframes, potential implications for other human material procurement and ethical issues.Method  The advantages and disadvantages of instituting vCJD tests on deceased donors was considered, legal advice sought and logistical issues considered.The advantages of undertaking vCJD testing of tonsil  (i) Possibility of identifying potential vCJD deceased donors in the late latent phase of vCJD infection; and (ii) UK legal precedence suggests that the public is legitimately entitled to expect that blood, and presumably tissues, are 100% safe.Disadvantages to testing  (i) Unknown time when in the pre‐clinical phase abnormal PrP may be detectable; (ii) The sensitivity of tests may be less than required; (iii) The impact of false positive and false negative results (iv) Logistical aspects of testing to GMP standards; (v) Impact of laboratory turnaround time for any PrP test on tissues/organs requiring rapid release; (vi) Possible pre‐disposition to vCJD disease impact on counselling donor families; (vii) Implications for lookback on recipients an infected tissue donor where previous donations may have been given, either of blood or tissues; (viii) Risk of contamination of tissues or processing laboratories from biopsies; (ix) Loss of categories of tissue donors due to unwillingness of donor families to consent to testing; and (x) Loss of tissue donors from living donor programmes where tonsil testing could not be undertaken.Results  It was concluded that tonsil and splenic biopsies should be investigated logistically to provide analytes for vCJD testing.Conclusion  Multidisciplinary work is underway to take forward vCJD testing of deceased donors.
SI09 Analysing Platelet Function in Blood Donors: Selection of Subjects for Functional Genetic Studies
Authors: Garner S. F. , Jones C. I. , Angenent W. , Bernard A. , Carr P. , Hogwood J. , Rankin A. , Stephens J. , Tom B. D. , Walton J. , Dudbridge F. , Ouwehand W. H. , Goodall A. H. 
Published: September 2006

Introduction  The objective of this study; performed as part of the BLOODOMICS project, was to develop a methodology to characterise the platelet response phenotype following agonist induced activation, which would then be used to test a cohort of healthy blood donors.Method  The study consisted of three phases. Phase 1 evaluated a range of platelet function assays in 46 individuals to determine reproducibility and feasibility for a large cohort study. Calcium flux, flow cytometric detection of fibrinogen and Annexin V binding and P‐selectin expression, and aggregometry were used to measure responses to three concentrations of adenosine diphosphate (ADP) and cross linked collagen related peptide (XL‐CRP). From this study, whole blood flow cytometric measurement of fibrinogen binding and P‐selectin expression in response to a single sub‐maximal dose of ADP (10–7 M) and XL‐CRP (0.1 μg mL‐1) were selected for use in phase 2, during which the platelet responses were measured in 506 blood donors attending the Cambridge Centre. In these assays inhibitors of thrombin (hirudin), thromboxane (aspirin), and ADP (apyrase–XL‐CRP stimulated samples only) were included to ensure activation was pathway specific.Results  There was a wide range of response to both XL‐CRP (fibrinogen binding 3.1%–84.4% +ve; P‐selectin expression 6.2%–90.3% +ve) and ADP (fibrinogen binding 3.5%–78.8% +ve; P‐selectin expression 2.8%–54.1% +ve). Three groups of individuals were selected; two groups with responses to both agonists and both endpoints that were at the ‘Extreme Ends’ of the normal range, (15 low and 16 high responders) and a third group of 16 identified as having mid‐range responses. In phase 3 these 47 donors were re‐tested to confirm the reproducibility of the original classification. There was a high level of concordance between the two visits for the fibrinogen‐CRP, fibrinogen‐ADP, P‐Selectin‐CRP, and P‐Selectin‐ADP assays (P = 0.851, 0.794, 0.855 and 0.527 respectively).Conclusion  We have demonstrated that different measures of the platelet response to two separate agonists are highly variable between healthy subjects, but are consistent over time within an individual. This standard method for defining platelet functional phenotype is being used in the BLOODOMICS programme to define the association between genetic variation and the risk of atherothrombosis.
S128 Can the GP Assist in Donor Selection ?
Authors: Vaidyanathan I. , Lee‐Cooper S. , Gorman A. 
Published: September 2006

Introduction  To ensure donor and recepient safety when selecting donors we may request additional medical details from the donor's GP or Specialist. This procedure is referred to as GP referral (GPR). The resultant ‘wasted’ session visit and deferral for an unspecified period may adversely affect donor loyalty and deter re‐attendance, while increasing the workload and expense for both NBS and GP surgeries. Furthermore, GPR is perceived by some colleagues to be of questionable value. Because or these important implications we undertook an audit of current practice.Aims and Objectives  To examine whether GPR is useful, is used appropriately and to identify areas for improving the current practice. The major objectives were to assess whether GPRs were justified, the clinical conditions involved, the relative proportion reflecting donor/recepient safety, the quality of the enquiry, the number and quality of GP replies, the turn‐around time, the outcome of the enquiry and the re‐attendance pattern of reinstated donors.Method  A total of 242 DHCs with related correspondence were examined retrospectively from three centres first without, then with, the GP reply in order to assess whether GPR was justified. Non justified (avoidable) referrals were defined (Asagba et al 2003) as those in which eligibility could have been determined with the original information given by the donor, and in which the GP reply either endorsed this information or did not alter the outcome.Results  The majority (90%) of referrals were justified. CVS (43%), NUR (12%) problems generated most referrals. More GPRs reflected donor welfare (69%) than recepient safety. Most of our enquires were focused (98%). Most (96%) doctors replied and 93% of replies were useful. Of 57% reinstated donors, 68% reattended. More regular (83%) than new donors (47%) re‐attended. Average time taken to resolve the enquiry (turnaround time) was 55 days.Conclusion  GPR makes a significant contribution to the donor selection process. We however recommend further measures to improve the current practice by reducing avoidable GPRs, speedy resolution of enquiry, a donor information leaflet and improved communication with the donors to retain donor loyalty.
SI36 The Development of a Microarray for Direct Antiglobulin Testing
Authors: Robb J. S. , Knowles L. K. , Petrik J. 
Published: September 2006

Background  Blood testing is currently performed using a variety of test platforms. Microarray technology has the potential to include all relevant tests on one testing platform, using the feature of multiplexing. This work demonstrates the development and optimisation of this technology to perform the Direct Antiglobulin Test (DAT) including the examination on the effects of spotting buffer pH on antibody reactivity and the level of sensitisation of DAT positive samples.Methods  Monoclonal anti‐IgG3 and anti‐C3, rabbit polyclonal anti‐human IgG, monoclonal IgG3 anti‐D plus control proteins were used. This panel was spotted onto a gold microarray surface using specialized microarray preparation equipment and processed under standardised conditions. Directly FITC labelled erythrocytes of Rhesus phenotype R1r were prepared and an aliquot sensitised with the IgG3 anti‐D. Both the native (unsensitised) and sensitised cells were incubated with the microarrays. Following washing, the microarrays were scanned and analysed to determine specifically bound erythrocytes. In a preliminary experiment the polyclonal anti‐IgG was dialysed into pH 7.0, 9.0, 9.8 and 10.4 spotting buffers before spotting. In a subsequent series of experiments, cells were sensitised with varying concentrations of the IgG3 anti‐D, and DAT positive donor blood was included.Results  The native R1r gave signal/noise (S/N) ratio of up to 100 with IgG3 anti‐D and S/N of <1 with all anti‐IgG and anti‐C3. R1r strongly sensitised with anti‐D IgG3 gave signal/noise (S/N) ratio of over 120 with the anti‐IgGs and <1 with the anti‐D and the anti‐C3.Conclusions  The microarray demonstrates its suitability for use in the DAT. A high level of sensitisation with IgG blocks the binding of sensitised cells to the same IgG antibody on the microarray. The microarray format can be successfully used for Direct Antiglobulin Testing using a nonagglutination fluorescent readout.
SI39 West of Scotland Blood Centre Audit of Hospital Compliance with Traceability Arrangements for Cross‐Matched Blood
Authors: Mathur K. , Thomson A. , Peterkin M. 
Published: September 2006

Introduction  Since 8th November 2005, the Blood Transfusion Services in the UK have been governed by ‘The UK Blood Safety and Quality Regulations 2005’. The Secretary of State for Health, the Competent Authority, can authorise, suspend, or revoke the licence of a Blood Establishment if its activities are not found safe for the purpose of transfusion. The UK Law requires Blood Establishments to establish, and maintain, a quality system based on the Principles of Good Practice (Regulations 6–8). Regulation 8 demands a system for unambiguous vein‐to‐vein traceability and retention and accessibility of traceability data for a minimum period of 30 years. This Blood Centre regularly meets demands to supply cross‐matched blood for patients with multiple irregular allo/auto‐antibodies. To comply with the traceability requirements, we devised a manual system of documentation, a ‘Transfer Receipt’ form, to record the safe supply of cross‐matched blood to Regional hospitals.Audit Design  Relevant hospital staff were prospectively educated to witness and document the safe and appropriate receipt of blood issues in the bottom section of the accompanying transfer receipt. The completed transfer receipts were returned to the BTC as proof of supply of these components. We audited the completeness of returns of these transfer receipts for a period of 3 months ‐ December 2005–February 2006.Results  A total of 311 issues of cross‐matched blood were supplied to 21 Regional hospitals during the audit period, with 2/3rd of them (235) involving 10 hospitals, each of which received cross‐matched blood at least once per week. Total returns was 64% (199) and 31% of the returned transfer receipts were incompletely documented. Time of receipt was not recorded on 65% of forms and 21% failed to document the condition of the blood when received. In addition, 16% of receipts were not witnessed and a further 16% were returned with no information. The integrity of blood packs was not documented on a further 3% of transfer receipts. Although completeness of receipts improved during the audit period, the return rate of transfer receipts did not, being 68%, 58%, and 66% in months 1, 2, and 3 respectively.Conclusion  This audit raises issues about compliance with the UK Blood Safety Law and suggests a need for staff education to ensure that the Law is not breached.
P01 Use of the DiaMed Impact R to Test Platelet Function in Stored Platelet Concentrates
Authors: Morrison A. , Hornsey V. , Macgregor I. 
Published: September 2006

Aim  The DiaMed Impact R tests platelet function under close to physiological flow conditions using cone and plate technology. A blood sample is applied to a polystyrene well and plasma proteins (eg VWF and fibrinogen) adhere to the well surface. Shear force is applied to produce arterial flow conditions leading to adhesion and aggregation of platelets via interaction of various platelet membrane glycoproteins including GPIbα and GPIIb/IIIa with vWF and fibrinogen on the well surface. The adhered platelets are quantified by an image analyser and results expressed as % well surface covered by aggregates (SC %) as an index of adhesion and average size of the aggregates (AS μm2) as an index of aggregation. The machine is designed to use whole blood and we found in preliminary studies that adhesion and aggregation do not occur when platelet concentrates (PCs) are used instead. The aim of this study was to add red cells back to PCs so that function could be studied and changes during storage followed and compared with those observed in our established in vitro assays.Method  ABO compatible routine leucoreduced red cells in SAGM (1 mL) were mixed with 0.6 mL PC to give a final Hct of 35% and platelet count of 400 × 106 mL‐1. These are conditions seen in whole blood except for the reduced levels of leucocytes. Red cells diluted with platelet poor plasma were used as negative controls. The shear rate and time of activation were varied and conditions optimised. Routine PCs were then tested on days 2 and 7. Samples were also stored at 4 °C or 37 °C for 1 to 2 h before assay to see if function could be improved.Results  Optimum conditions of 1800 s‐1 and 4 min activation produced normal values of SC >7.5% and AS >25 μm2 Mean values ± SD are shown below.

Temperature
Day
SC (%)
AS (μm2)

22°C
2 7
11.1 ± 0.3  5.7 ± 1.4
29.6 ± 0.4 22.2 ± 2.3

4°C
2 7
10.8 ± 1.4  1.9 ± 0.7
26.5 ± 4.1 20.6 ± 1.0

37°C
2 7
14.4 ± 0.1  7.5 ± 0.6
35.8 ± 5.7 24.8 ± 8.6

Conclusions  Red cells are required as well as plasma proteins for platelet adhesion and aggregation to be measurable in the Diamed Impact R. Platelet functions of adhesion and aggregation were shown to decrease during storage but improved at 37°C. The decreases seen were similar to those observed in GPIbα and GPIIb/IIIa binding sites, HSR, ESC and swirl.
P10 Transfusion‐Related Cost of Aprotinin in Scoliosis Surgery for Children and Adolescents.
Authors: McCahon R. , Lamb J. 
Published: September 2006

Introduction  Scoliosis surgery causes major blood loss. Previous research has demonstrated that aprotinin reduces perioperative blood loss and thus transfusion. To date there has not been a cost analysis of the effect of aprotinin on transfusion requirement in scoliosis surgery.Methods  Retrospective case series of all patients <18 years old at the time of their scoliosis surgery. All patients were operated on and anaesthetised by the same consultant surgeon and anaesthetist between May 2002 and February 2006. Estimated blood volume (EBV) was 70 mL kg−1. Postoperative care was on the Paediatric Intensive Care Unit (PICU) or Spinal High Dependency Unit (HDU). The anaesthetic chart and cell salvage audit form recorded intra‐operative blood loss. The PICU/HDU charts recorded postoperative drain blood loss for the first 24 h. Aprotinin was given as a bolus prior to the start of surgery followed by an infusion until wound closure. Cost data for allogeneic blood products, autologous blood collection/processing and aprotinin were collected from the start of surgery until 24 h postoperatively. The analysis used current tariffs. Other consumables and drugs were excluded. Comparisons between groups were made using unpaired t tests.Results  A total of 27 patients were reviewed. Fifteen patients received aprotinin and 12 did not. Intra‐operative cell salvage was used for all patients. Two thirds of the patients in each group were at high risk of major blood loss due to neuro‐muscular disease. The groups (aprotinin versus no aprotinin) were comparable for age (mean ± SD) 13 ± 2.8 versus 14 ± 2.7 years, weight 50.9 ± 16.9 versus 51.2 ± 30.4 kg, surgical time 254 ± 58.8 versus 286 ± 109.6 min and vertebral levels fused (median + interquartile range) 15 (10–16) versus 14.5 (8.5–16). Mean aprotinin bolus dose was 21.14 ± 10.91 kiU kg−1 and mean aprotinin infusion rate was 7.17 ± 2.44 kiU kg−1 h−1. The median transfusion‐related cost of aprotinin was £638.02 (£319.73–£1010.60) compared to £1086.00 (£423.42–£1476.01)(P = 0.107) without aprotinin, equating to a relative cost saving of 41.2%. Total peri‐operative blood loss (as a fraction of EBV), in the aprotinin group was 0.66 ± 0.40 EBV versus 1.25 ± 1.06 EBV(P = 0.09). Median units of blood product transfused in the aprotinin and no aprotinin groups were; blood 1 ( 0–2.5) versus 2.5 (1–5.25) (P = 0.06), fresh frozen plasma 2 (1–2.5) versus 2 (2.3–3.25) (P = 0.07), cryoprecipitate bags 0 (0–0) versus 0 (0–2) (P = 0.16), platelets 0 (nil given) versus 0 (0–1) (P = 0.07).Conclusions  The reduction in peri‐operative blood loss and thus transfusion requirements associated with aprotinin has translated to a cost reduction. A small sample size has prevented the cost analysis from reaching statistical significance. As blood products become more scarce and costly, blood preservation techniques will become increasingly vital.
P12 An Audit of Fresh Frozen Plasma Transfusion Use in the Royal Hospitals Trust (RGHT)
Authors: Atkinson S. 
Published: September 2006

Allogeneic fresh frozen plasma (FFP) transfusions have increased in recent years, in the Royal Group of Hospitals Trust and in the UK as a whole. In the 2003 Serious Hazards of Transfusion report, FFP was the blood product most commonly attributed to the development of transfusion associated acute lung injury and a leading cause of transfusion related mortality. In the British Committee for Standards in Haematology (BCSH) guidelines there are few indications for FFP transfusion. Stainsby found that appropriateness of FFP transfusion in England varied from 62–92%.Audit objectives (i) To assess the appropriateness of FFP transfusions in the RGHT against BCSH guidelines ‐ 100% standard; and (ii) To assess the adequacy of documentation for FFP transfusion episodes re indication for transfusion and clinical effectiveness ‐ 100% standard.Method Data relating to FFP transfusion episodes between October 2004 and January 2005 inclusive, was extracted retrospectively from available patient notes by an SpR in haematology and a consultant anaesthetist. Anonymously completed proformas were jointly assessed for appropriateness of transfusion by the same investigators.

FFP transfusion episodes
Appropriate
Inappropriate

137 episodes (114 patients)
93 (68%)
44 (32%)

Reversal of warfarin effect, bleeding not severe or absent

16

Hepatic disease induced coagulopathy, no bleeding

6

Heparin/antiplatelet induced coagulopathy, with bleeding

4

Other causes of coagulopathy without bleeding

13

Ongoing blood loss, normal coagulation screen

4

Normal coagulation screen, no evidence of bleeding

1

Clinical documentation
Present
Absent

Statement re indication for FFP transfusion
73 (53%)
64 (47%)

Statement re clinical effectiveness of transfusion
52 (38%)
85 (62%)

Conclusion and Recommendations A significant number of FFP transfusions are inappropriate, based on recent BCSH guidance. Documentation in clinical notes concerning the indication and response to FFP transfusion is frequently lacking. Appropriateness of FFP transfusion and associated clinical documentation should be improved by staff education and greater awareness of BCSH guidelines. Education should also include appropriate monitoring and management of bleeding secondary to warfarin or antiplatelet therapy. FFP transfusions should be re‐audited 1 year hence. Guidelines for the use of fresh‐frozen plasma, cryoprecipitate and cryosupernatant. The British Society for Haematology 2004, 126: 11–28 Stainsby D. Audit of the Appropriate Use of Fresh Frozen Plasma, National Blood Service, May 2002.
P16 What is the Best Way to Achieve Sustained Changes in Transfusion Prescribing Behaviour by Physicians?
Authors: Hyde C. , Stanworth S. J. , Murphy M. , Brunskill S. , Stearn B. , Howell C. 
Published: September 2006

Background and Aim  Many different forms of behavioural interventions continue to be undertaken by UK hospitals and blood transfusion services to change transfusion practice, including adoption and dissemination of guidelines, retrospective and prospective audit, educational events and algorithms or IT linked prescribing modules (such as based in hospital blood banks). But how much do we know about their effectiveness and how best to achieve sustained change in transfusion practice.Method  The currently available evidence on effectiveness of alternative methods of behaviour change was identified, based on our current methods (Systematic Reviews Initiative, NBS ‐Oxford) for selecting and appraising the evidence base for a focused question.Results  There are several systematic reviews published by the Effective Practice and Organisation of Care Group of the Cochrane Collaboration. Two recent systematic reviews specifically examined the most rigorous research on changing behaviour in transfusion practice (1,2). These emphasise that, although there is evidence to support a positive effect of interventions, the existing research is limited in amount and generally poor in quality. Long‐term outcomes were rarely examined. The effectiveness and cost‐effectiveness of one approach relative to another is virtually unexplored.Conclusions  Further robust and higher quality research on this topic is essential. A framework for the most plausible approach to change transfusion behaviour, selecting the right intervention to overcome any perceived barriers to changes in practice, is critical, including to identify those comparisons most likely to yield both meaningful and sustained results.1. Tinmouth A, MacDougall L, Fergusson D, Amin M, Graham ID, Hebert P & Wilson K. (2005) Reducing the amount of blood transfused. Arch Int Med;165, 845–852.2. Wilson K, MacDougall L, Fergusson D, Graham I, Tinmouth A, & Hebert P. (2002) The effectiveness of interventions to reduce physician's levels of inappropriate transfusion: what can be learned from a systematic review of the literature. Transfusion;42, 1224–1229.