bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multiple or uncommon red cell alloantibodies in women: association with autoimmune disease
Authors: Ramsey G. , Smietana S. J. 
Published: March 2003

BACKGROUND: Patients with multiple or uncommon red cell (RBC) alloantibodies require special efforts in the blood bank. This study investigated whether such persons had other immune‐related conditions that might help to explain or predict their propensity for RBC antibody formation.STUDY DESIGN AND METHODS: Charts were retrospectively reviewed of 29 men and 83 women with multiple (> or = 3) RBC antibodies of potential clinical significance, uncommon RBC antibodies (anti‐e, ‐ Kpb, ‐Jkb, ‐Fyb, ‐S, ‐U, ‐Yta, ‐Dib, ‐Ata), or both. The clinical features in 43 women with multiple antibodies were compared to those in two equal‐sized control cohorts of women matched for transfusion‐ related diagnoses, but having either one RBC antibody or none.RESULTS: Women with uncommon RBC antibodies had a 33‐percent (18/54) prevalence of autoimmune disease. Twenty‐eight percent of the 43 women with multiple antibodies had autoimmune disease, compared to 14 percent of women in the cohort with one RBC antibody (p = 0.09) and 7 percent of those in the cohort without RBC antibodies (p = 0.01). Only one of the 29 men had autoimmune disease.CONCLUSION: Autoimmune disease is a common underlying factor in women who make multiple or uncommon RBC alloantibodies of potential clinical significance.
Efficacy of autologous fresh whole blood or platelet‐rich plasma in adult cardiac surgery
Authors: Triulzi D.J. , Gilmor G.D. , Ness P.M. , Baumgartner W.A. , Schultheis L.W. 
Published: March 2003

BACKGROUND: Transfusing fresh autologous blood during cardiac surgery may improve hemostasis and decrease the need for transfusion.STUDY DESIGN AND METHODS: A prospective randomized study was performed with fresh whole blood (WB) obtained by intraoperative hemodilution (IH) and with platelet‐rich plasma (PRP) obtained by perioperative apheresis from adult cardiac surgery patients.RESULTS: Seventy patients were randomly assigned to three arms: 24 to the PRP arm, 18 to the IH arm, and 28 to serve as controls. A mean of 924 +/− 130 mL of WB was collected from the IH group, and a mean of 650 +/− 124 mL of PRP was collected from the PRP group (mean, 1.42 +/− 0.74 × 10(11) platelets); these components were transfused after bypass. Preoperative measures were similar among groups. Intraoperatively, the groups did not differ in bypass time, estimated blood loss, number of transfusions, or proportion receiving transfusion(s). Postoperatively, control patients had more mediastinal drainage (736 mL vs. 476 mL [IH] and 463 mL [PRP]; p = 0.014), but there was no difference in the proportion of patients requiring red cell transfusion (p = 0.87), the hemoglobin at discharge (p = 0.20), or the length of hospitalization (p = 0.57).CONCLUSION: Although a hemostatic benefit manifested as reduced postoperative bleeding was observed, this study does not support the use of fresh blood components obtained by IH or PRP collection during low‐risk cardiac surgery. Additional studies are needed to assess whether more aggressive component collection or the use of these techniques in high‐ risk cases may have a greater impact on clinical outcome variables, including transfusion.
Preoperative autologous blood donation: benefit or detriment? A mathematical analysis
Authors: Cohen J.A. , Brecher M.E. 
Published: March 2003

BACKGROUND: Advocates of preoperative autologous blood donation (PABD) often fail to consider the needs of individual patients and the effects of donation on hematocrit. Mathematical modeling is used here to analyze PABD.STUDY DESIGN AND METHODS: A model of PABD was constructed to simulate the transfusion of red cells once a predetermined minimum hematocrit was reached. Preoperatively deposited units not needed to maintain a hematocrit at this level were not transfused. Final hematocrits were compared to the hematocrit that would be expected if the patient had not donated blood for his or her own operative use.RESULTS: For many patients, particularly those with normal initial hematocrits, large estimated blood losses must occur before the minimum hematocrit is reached. It is also known that patients donating multiple units typically cannot maintain their baseline hematocrit. In such cases, for blood losses of any volume, the final hematocrit was lower if units were collected preoperatively and transfusion did not occur. Preoperatively donating patients are more likely to be transfused earlier and more frequently than nondonating patients. Derived figures, based on individual patient values, help predict which patients will benefit most from PABD.CONCLUSION: PABD may actually lead to decreased postoperative hematocritis (with enhanced risk of ischemia) and otherwise unnecessary transfusions.
Prevention of chemotherapy‐induced anemia by the use of erythropoietin in patients with primary malignant bone tumors (a double‐blind, randomized, phase III study)
Authors: Wurnig C. , Windhager R. , Schwameis E. , Kotz R. , Zoubek A. , Stockenhuber F. , Kurz R. W. 
Published: March 2003

BACKGROUND: Patients undergoing chemotherapy for treatment of malignancy frequently experience clinically significant anemia. Myelosuppressive chemotherapy impairs erythropoiesis, which may not fully recover between treatment cycles. Recombinant human erythropoietin (rHuEPO) has been effectively introduced in anemic patients suffering from chronic renal failure. The present study was designed to assess, first, whether rHuEPO treatment decreases transfusion requirements in chemotherapy‐induced anemia and, second, whether high‐dose rHuEPO application is safe.STUDY DESIGN and METHODS: Thirty consecutive anemic patients (hemoglobin <11 g/dl) receiving combination chemotherapy for primary malignant bone tumors were studied in a prospective, double‐blind, randomized, Phase III trial. Patients received chemotherapy according to one of two German protocols, depending on histologic diagnosis. All subjects enrolled were randomly assigned either to receive 600 IU of rHuEPO per kg of body weight intravenously twice a week or to receive a placebo during chemotherapy. To obtain comparable data, an observation period of 20 weeks was chosen. Twenty‐nine patients fulfilled the criteria and were eligible for statistical evaluation.RESULTS: Transfusion requirements were significantly decreased from Week 8 of therapy (p<0.05) in the treatment group. Therapeutic benefits were even more evident with continuation of therapy (Week 12, p = 0.03; Week 16, p = 0.016; Week 20, p = 0.002). The blood required was 2.1 units of red cells in the treatment group and 8.4 units of red cells in the placebo group. All patients tolerated rHuEPO with no serious side effects.CONCLUSION: These findings suggest that rHuEPO is an effective and well‐tolerated therapeutic option for decreasing the transfusion requirements in chemotherapy‐induced anemia.
Antigen testing for human immunodeficiency virus (HIV) and the magnet effect: will the benefit of a new HIV test be offset by the numbers of higher risk, test‐seeking donors attracted to blood centers? Retrovirus Epidemiology Donor Study
Authors: Korelitz J.J. , Busch M.P. , Williams A.E. ,   the Retrovirus Epidemiology Donor Study
Published: March 2003

Background: There currently is debate on whether to include new assays for viral antigens and nucleic acids in the battery of screening tests applied to all blood donations. Proposals call for implementation of p24 antigen screening tests to help identify donors who are infected with human immunodeficiency virus type 1 (HIV‐1) but have not yet seroconverted (window‐period donors). There is concern, however, that people at higher risk for HIV infection will be attracted to blood centers in order to obtain the results of an HIV assay that is not routinely available elsewhere. Therefore, the benefit of antigen testing may be offset by an increase in the HIV incidence rate among blood donors.Study Design and Methods: Estimates were obtained from previous reports for the HIV incidence rate among blood donors, the percentage of donations from test‐seeking donors, the duration of the HIV‐infectious window period, and the performance of p24 antigen screening assays. Sensitivity analyses were performed by using various percentages of test‐seeking donors following implementation of antigen testing and various HIV incidence rate ratios of test‐seekers to nonseekers. Hypothetical residual HIV risks were calculated for multiple scenarios and compared to the current estimate of HIV risk without antigen screening of blood donations.Results: If antigen testing reduces the window period by 27 percent (e.g., from 22 days to 16 days), and the HIV incidence rate among test‐seekers is 30 times that among nonseekers, then the benefit of antigen testing will be eliminated if the percentage of test‐seekers (currently estimated at 3.2%) increases to 5.7 percent. If antigen testing reduces the window period by approximately 45 percent (e.g., from 22 days to 10 days or from 13 days to 6 days) and the HIV incidence rate ratio (test‐seekers vs. nonseekers) is assumed to be equal to the HIV prevalence ratio (5.3), then the percentage of donations from test‐seeking donors would have to increase to 25 percent of all donations to offset the benefit of antigen screening.Conclusion: This model helps identify the key measures for assessing the potential adverse effect of increased test seeking as a consequence of the addition of p24 antigen (or other direct virus) assays to blood donor screening programs. In most scenarios, the beneficial effect of antigen screening exceeded the potential detrimental effect of attracting higher‐risk, test‐seeking donors. The possibility cannot be ruled out, however, that a subgroup of high‐risk, test‐seeking donors attracted to the blood centers by a new HIV test will offset the reduction in the residual risk of HIV infection associated with antigen screening.
Coexistent IgG2 and IgA deficiencies in blood donors
Authors: Sandler S.G. , Trimble J. , Mallory D.M. 
Published: March 2003

Background: To meet the transfusion requirements of IgA‐deficient patients with anti‐IgA, blood services screen random donors to identify potential donors of IgA‐deficient blood components. New information reveals that some IgA‐deficient persons may also be deficient in IgG2 and may be at increased risk for bacterial infections.Study Design and Methods: Serum samples from IgA‐deficient blood donors and patients were tested for IgG2 concentration by radial immunodiffusion using monospecific anti‐IgG2.Results: Four (9.0%) of 44 IgA‐deficient blood donors and 14 (31.5%) of 44 IgA‐deficient patients had coexistent IgG2 and IgA deficiencies. Follow‐up interviews with the 4 donors who had coexistent IgG2 and IgA deficiencies revealed that 3 had recurrent respiratory infections and had been hospitalized at least once for pneumonia. The fourth donor did not report a history suggestive of recurrent infections.Conclusion: Some blood donors, recruited specifically because they are IgA deficient, may also be deficient in IgG2. Persons identified by donor screening programs as being IgA deficient should be tested for IgG2. If deficient in IgG2, they should be evaluated for a history of recurrent bacterial infections and counseled accordingly.
Sources and sequelae of bacterial contamination of hematopoietic stem cell components: implications for the safety of hematotherapy and graft engineering
Authors: Webb I.J. , Coral F.S. , Andersen J.W. , Elias A.D. , Finberg R.W. , Nadler L.M. , Ritz J. , Anderson K.C. 
Published: March 2003

Background: It is important to compare the incidence of bacterial contamination of components collected from the peripheral blood or bone marrow (BM), as well as of components processed with or without cell selection or depletion, and to evaluate the sequelae of such contamination. Study Design and Methods: Bacterial contamination rates were compared in 1380 untreated autologous peripheral blood progenitor cells (PBPCs), 291 untreated autologous BM samples, 916 monoclonal antibody (MoAb)‐treated autologous and allogeneic BM samples, and in 45 autologous PBPC components from which the CD34+ cells were selected. Bacterial cultures were performed at sequential time points during the processing of MoAb‐treated BM. Results: Bacterial contamination was documented in 44 of 2632 components from 1593 patients (1.67% of components, 2.76% of patients) before cryopreservation. Although only 0.65% of untreated PBPCs were contaminated before cryopreservation, each patient was more likely to have given a contaminated PBPC component than a contaminated BM component (2.41% vs. 0%, p < 0.01). Bacterial contamination of MoAb‐treated BM was greater during or after manipulation than it was before (2.33% vs. 0.77%, p < 0.05). At thawing, contamination was documented in 42 (1.97%) of 2136 components cultured. Ten (13.7%) of 73 patients who received hematopoietic progenitor cells that were contaminated before cryopreservation or at thawing developed fever or positive blood cultures within 48 hours of transfusion. Fever was associated with bacteremia in two cases, but no irreversible clinical sequelae were noted. Conclusion: These studies suggest that, despite careful attention to sterile procedures, low‐level contamination of hematopoietic stem cell components can be introduced before or during manipulation as well as at thawing, and that standards for monitoring of the procedures for collection, processing, cryopreservation, thawing, and transfusion of hematopoietic progenitor cells are necessary.
Intraoperative bleeding: a mathematical model for minimizing hemoglobin loss
Authors: Smetannikov Y. , Hopkins D. 
Published: March 2003

Background: The rationale for intraoperative blood transfusion is often based on incorrect concepts and criteria. Study Design and Methods: A mathematical model based on physiologic measures and describing the usual pattern of surgical blood loss is presented, and a theoretical means of minimizing intraoperative hemoglobin loss with hypervolemic hemodilution is proposed. Results: Intraoperative hemoglobin loss is often overestimated especially in connection with high‐volume blood loss. The model of intraoperative hypervolemic hemodilution shows significant improvement in hemoglobin concentration in the immediate postoperative period, compared with normovolemic conditions. The difference is most marked at a high volume of blood loss and a high degree of maintained hypervolemia. Conclusion: The practice of intraoperative blood transfusion according to volume of blood lost is to be discouraged, and regular monitoring of the hematocrit is necessary to avoid unnecessary transfusion. The theoretical advantages of hypervolemic hemodilution warrant further testing of the model in a clinical setting.
Transmission of parvovirus B19 by coagulation factor concentrates exposed to 100°C heat after lyophilization
Authors: Santagostino E. , Mannucci P.M. , Gringeri A. , Azzi A. , Morfini M. , Musso R. , Santoro R. , Schiavoni M. 
Published: March 2003

BACKGROUND: Double inactivation by solvent/detergent treatment plus heating at 100°C for 30 minutes after lyophilization has been adopted to improve viral safety of factor VIII and factor IX concentrates, particularly with respect to non‐lipid‐enveloped viruses. The aim of this study was to evaluate the safety of concentrates exposed to these virucidal methods.STUDY DESIGN AND METHODS: Twenty‐ six previously untreated hemophiliacs, 19 with factor VIII deficiency and 7 with factor IX deficiency, were investigated in a prospective multicenter study over a 12‐month follow‐up period by the use of serologic and virologic markers for lipid‐ and non‐lipid‐enveloped viruses (human immunodeficiency virus types 1 and 2; hepatitis A, B, and C viruses; B19 parvovirus antibodies; and B19 DNA). Overall, 270,000 U of factor VIII and 102,000 U of factor IX concentrate were administered during the study period.RESULTS: None of the 26 patients seroconverted for human immunodeficiency virus or hepatitis C virus. Hepatitis B virus markers remained negative in the 10 unvaccinated hemophiliacs. No hepatitis A virus seroconversion occurred among 17 susceptible patients. B19 seroconversion (IgM) and B19 viremia were observed within 2 weeks of the first concentrate infusion in 8 of 15 susceptible patients, 5 of 11 treated with factor VIII and 3 of 4 with factor IX concentrate.CONCLUSION: This prospective study indicates that very high temperatures applied to lyophilized concentrates appear to prevent the transmission of hepatitis A virus to hemophiliacs. However, B19 parvovirus still contaminates concentrates despite the use of this robust virucidal method.
Effective removal of copper by plasma exchange in fulminant Wilson's disease
Authors: Kiss J. E. , Berman D. , Van Thiel D. 
Published: March 2003

BACKGROUND: Patients who present with fulminant hepatic failure due to Wilson's disease may develop hemolytic anemia and renal insufficiency. In this entity, acute hepatocellular necrosis triggers the release of copper ions into the circulation, which leads to toxic effects on red cell metabolic pathways and hemolysis.STUDY DESIGN AND METHODS: The utility of therapeutic plasma exchange to rapidly remove copper and reduce toxic serum copper levels was studied in two patients with fulminant Wilson's disease.RESULTS: Intensive plasma exchange using fresh‐frozen plasma replacement removed substantial amounts of copper from the hypercupremic patients, resulting in a rapid reduction in serum copper levels and decreased hemolysis. The net copper removal was proportional to the serum level, ranging from 7,000 to 11,800 micrograms per procedure in one patient and from 3,700 to 6,800 micrograms in the other.CONCLUSION: Plasma exchange allows a rapid reduction in elevated serum copper levels in patients with fulminant Wilson's disease. This leads to an amelioration of hemolytic anemia and provides clinical stabilization until liver transplantation can be performed.
Evaluation of an automated microbiologic blood culture device for detection of bacteria in platelet components
Authors: Wagner SJ. , Robinette D. 
Published: March 2003

BACKGROUND:Automated culture methods have been used by several investigators to detect bacterial contamination of cellular blood components. We investigated several factors affecting detection by automated culture of bacteria in platelet concentrates (PCs).These factors included the initial contamination level in PCs, the PC sample volume, the PC sample time, and the white cell level in relation to bacteria levels in the PCs.STUDY DESIGN AND METHODS:Staphylococcus epidermidis or Escherichia coli was inoculated into freshly prepared PCs or white cell‐reduced PCs to yield colony‐forming unit (CFU) levels of 10, 1, or 0.1 per mL. At the time of inoculation (t=0) and at t=6, t=24, and t=48 hours, 0.5, 1.0, and 2.0 mL samples of the contaminated PCs were transferred into culture bottles. The presence of bacteria in the culture bottles was subsequently monitored by an automated blood culturing instrument. Bacteria levels in the PC at the time of first automated culture detection were determined by quantitative plating.RESULTS:E. coli was detected in 92 percent of experiments when 1.0‐ or 2.0‐mL samples were taken at t=6 hours. At t=24 hours, 100‐percent detection was observed with all tested inoculation volumes; however, by that time,>10(7) CFU per mL of bacteria were present in every PC. For S. epidermidis, 89 percent and 83 percent of contaminated PCs were detected with a t=24 hour sampling time and 2.0‐ or 1.0‐mL sampling volume. Seven of 36 PCs with a 2.0‐mL sampling volume and 10 of 36 PCs with a 1.0‐mL sampling volume contained>10(6) CFU per mL of S. epidermidis at the time of first detection. CONCLUSION: Data from this preliminary evaluation suggest that sampling times of 24 hours or more would be necessary to provide confidence in detection of E. coli or S. epidermidis in PCs using this culture method.
Recovery and viability of Orientia tsutsugamwhi from packed red cells and the danger of acquiring scrub typhus from blood transfusion
Authors: Casleton B.G. , Salata K. , Dasch G.A. , Strickman D. , Kelly DJ. 
Published: March 2003

BACKGROUND:The purpose of this study was to determine whether infective Orientia tsutsugamushi, the etiologic agent of scrub typhus, could survive normal blood banking processing and storage procedures.STUDY DESIGN AND METHODS:Mononuclear cells isolated from whole blood by density gradient centrifugation were inoculated with O. tsutsugamushi, Karp strain. Infection of the mononuclear cells was confirmed by Giemsa stain, direct fluorescent antibody assay, and polymerase chain reaction using primers specific for the groESL operon of O. tsutsugamushi. The quantity of rickettsial particles in each preparation was determined by direct counts from the Giemsa‐stained preparations. Infected mononuclear cells were returned to their respective aliquots of packed red blood cells, which were then either stored at 4 degrees C or glycerolized and frozen at −70 degrees C.RESULTS:Rickettsiae survived up to 10 days (but not 30 days) of refrigerated storage and 45 days of frozen storage, as determined by inoculation of mice with 0.5‐mL aliquots of the blood components. Infection of the mice was determined by illness, death, direct fluorescent antibody assay of peritoneal smears, polymerase chain reaction of blood, and enzyme‐linked immunosorbent assay detection of antibodies in plasma. CONCLUSION: Because the quantity of rickettsiae injected into the mice was comparable to the quantity reported in the literature for human blood during natural infections, scrub typhus could present a risk in blood collected from donors in endemic areas. This may especially be true, because people can be rickettsemic before illness, after successful antibiotic treatment, and chronically after resolution of disease.
Transfusion and postoperative pneumonia in coronary artery bypass graft surgery: effect of the length of storage of transfused red cells
Authors: Vamvakas E.C. , Carven J.H. 
Published: March 2003

BACKGROUND: Various bioactive substances are released from white cell (WBC) granules into red cell (RBC) components in a time‐dependent manner during blood storage. Some of these substances may have immunosuppressive effects and may contribute to transfusion‐induced immunomodulation. RBCs transfused after prolonged storage may be associated with a higher incidence of postoperative infections than fresh RBCs. This hypothesis does not seem to have been investigated in a clinical study.STUDY DESIGN AND METHODS: The records of 416 consecutive patients undergoing coronary artery bypass graft operations at the Massachusetts General Hospital were reviewed. The association between the length of storage of the transfused RBCs, as well as the number of units of non‐WBC‐reduced allogeneic RBCs and/or platelets transfused, and the occurrence of postoperative pneumonia was calculated by logistic regression analyses adjusting for the effects of confounding factors. Among these were the numbers of days of intubation, days of impaired consciousness, and units of RBCs transfused.RESULTS: By Centers for Disease Control and Prevention criteria, pneumonia developed in 54 patients (13.0%). Among 269 patients given RBCs, the risk of pneumonia increased by 1 percent per day of increase in the mean storage time of the transfused RBCs (p<0.005). In an analysis of all patients, the risk of pneumonia increased by 5 percent per unit of non‐WBC‐reduced allogeneic RBCs and/or platelets received (p = 0.0584).CONCLUSION: After adjustment for the effects of the risk factors for pneumonia and the number of transfused RBCs, an association was observed between the length of storage of transfused RBCs and the development of postoperative pneumonia. This association should be investigated further in future studies of the outcomes of blood transfusion.