bluuebunny/crossref_metadata_2025_split huggingface dataset:
A review of transfusion‐associated AIDS litigation: 1984 through 1993
Authors: Kern J.M. , Croy B.B. 
Published: March 2003

Background: Since 1984, hundreds of lawsuits have been filed against health care providers in the United States, alleging transmission of human immunodeficiency virus by transfusion. While anecdotal reports of jury verdicts have been published, no quantitative study to identify trends in transfusion‐associated AIDS litigation has been undertaken.Study Design and Methods: To identify trends in lawsuits filed against health care providers alleging human immunodeficiency virus infection transmitted via transfusion, 163 legal actions were analyzed. Included were those for which the authors provided legal defense or consultation (n = 79) and cases reported nationally (n = 84). Cases were analyzed as to characteristics of defendant(s), date of transfusion and case filing, liability theories, and verdict, if applicable.Results: Defendants were blood centers (74% of cases), hospitals (58%), and physicians (53%). Of physicians, surgeons were named in 78 percent of cases; 42 percent of these surgeons were cardiothoracic surgeons. Nationally, 14 cases have resulted in plaintiff awards totalling $75,420,798. Physicians have been liable for 41 percent of that sum, blood banks 31 percent, and hospitals 26 percent. Of the 10 liability theories raised, the most frequent were claims of medical negligence (46% of cases), failure to identify high‐risk donors (45%), lack of informed consent (39%), and failure to conduct surrogate testing (39%). Twenty‐six trial results favorable to health care providers were noted nationally, 17 occurring in the San Francisco Bay Area, where case filings peaked before 1990 (40/56) and where new case filings decreased (1990, 5; 1991, 3; 1992, 1; 1993, 0) as verdicts favoring health care providers were reported.Conclusion: Transfusion‐associated AIDS litigation began with verdicts against blood banks, but has expanded to suits against physicians and hospitals that are based on theories of medical negligence and informed consent. Despite widely publicized verdicts for plaintiffs, health care professionals have successfully defended these lawsuits, and in one center of early litigation, a sharp decrease in new case filings has been observed.
New polymorphism on platelet glycoprotein IIIa gene recognized by endonuclease Msp I: implications for PlA typing by allele‐specific restriction analysis
Authors: Unkelbach K. , Kalb R. , Breitfeld C. , Santoso S. , Kiefel V. , Mueller‐Eckhardt C. 
Published: March 2003

BACKGROUND: Five human platelet alloantigen systems have been shown to result from single base pair substitutions in encoding regions of platelet glycoprotein genes IIIa, Ib, IIb, and Ia. For each of the diallelic systems, at least one restriction enzyme is known to cut only one of the two haplotypes. In the PlA system, restriction endonucleases Nci I and Msp I both recognize the PlA2 allele.STUDY DESIGN AND METHODS: A causal observation of an unexpected Msp I restriction pattern of a PlA2/PlA2 individual was made. Samples from 261 blood donors were then typed for antigens of the PlA system by restriction fragment length polymorphism analysis using the Nci I and Msp I restriction enzymes.RESULTS: Applying both enzymes, concordant restriction patterns were found in 258 of 261 blood donors. Three donors had a base pair mutation on the PlA2 allele, which creates an additional restriction site for Msp I 20 base pairs downstream from the PlA polymorphic site. Nucleotide sequence analysis revealed a CT217–>CG217G base exchange resulting in a Leu40–>Arg40 polymorphism of glycoprotein IIIa.CONCLUSION: Presuming that the mutation is not a singular phenomenon and also occurs with the PlA1 haplotype, it could lead to false interpretations of restriction analysis with Msp I. To exclude that possibility, Nci I is preferred for restriction fragment length polymorphism typing in the PlA system.
Effect of cold storage on platelet glycoprotein Ib and vesiculation
Authors: BODE A.P. , KNUPP C.L. 
Published: March 2003

BACKGROUND: During storage of platelet concentrates at 22 degrees C, changes occur in surface glycoproteins, and membranous vesicles appear in the supernatant plasma. The extent of these changes during refrigerated storage is not known.STUDY DESIGN AND METHODS: Membranous microparticles and changes in surface or total glycoprotein Ib (GPIb) were studied in platelet concentrates divided into aliquots stored at either 4 degrees C or 22 degrees C for 5 days.RESULTS: The refrigerated platelets showed greater loss of total GPIb, slightly less binding of monoclonal antibodies to surface GPIb, and reduced aggregation response to ristocetin relative to the paired platelet controls at 22 degrees C. Moreover, the platelets stored at 4 degrees C produced 45‐percent more microparticles and 64‐percent more platelet factor 3 activity in the supernatant plasma than were produced by the controls. These differences were augmented by warming both 4 degrees C‐ and 22 degrees C‐stored platelets at 37 degrees C for 1 to 4 hours.CONCLUSION: Storage of platelets at 4 degrees C causes increased membrane vesiculation and accelerated loss of GPIb. The magnitude of these differences was small, but it may contribute to marked reductions in platelet survival in circulation
Removal of maternal antibodies from a woman with repeated fetal loss due to P blood group incompatibility
Authors: YOSHIDA H. , ITO K. , KUSAKARI T. , IDA K. , IHARA Y. , MORI T. , MATSUMURA M. 
Published: March 2003

BACKGROUND: Plasmapheresis is intended to lower plasma antibody levels in women with blood group incompatible pregnancies.CASE REPORT: Therapeutic specific antibody removal by using antigen‐positive red cells was applied to a blood group p pregnant women who had a high titer (128) of IgG anti‐PP1Pk and had lost all six previous fetuses in blood group P‐incompatible pregnancies. Plasma was taken from the patient with an intermittent‐flow cell separator, mixed with a volume of washed and packed P‐positive red cells equivalent to one‐fifth of the volume of plasma, and incubated for 10 minutes in an ice water bath. The PP1Pk antibodies were removed, and the autologous plasma was transfused. Treatment by specific antibody removal was started in the seventh week of gestation, and performed one to three times a week for a total of 56 times up to the 34th week. The volume of plasma treated was 2.4 L per procedure on average and totaled 135 L. After each treatment, the antibody titer in the patient's plasma usually decreased by 1 log2, and no deleterious effect on the women was noted. The titers of IgG anti‐P and anti‐Pk were kept between 4 and 16 after the ninth week of gestation. At the end of the 34th week of gestation, a male infant was delivered by cesarean section. The infant did not require an exchange transfusion and is now a healthy 2‐year‐old boy.CONCLUSION:s This therapeutic method is very useful in the management of fetomaternal P‐incompatibility.
Multi‐gallon blood donors: who are they?
Authors: Royse D. , Doochin K.E. 
Published: March 2003

BACKGROUND: Although vital to the nation's blood centers, multi‐gallon blood donors have never been the focus of investigation.STUDY DESIGN AND METHODS: In the fall of 1994, questionnaires were sent to 500 individuals who had donated 5 gallons or more and to 500 randomly selected donors.RESULTS: Multi‐gallon donors reported that they received little recognition or support for their efforts and were not pressured by friends or family. One‐third were not allowed time off from work to donate. One in five reported having a “bad experience” while donating. Donors who had family members or friends who had received blood donated a greater number of units than those who were not as close to blood recipients.CONCLUSION: Women and minorities are underrepresented among long‐term donors. Further research is needed to learn what “captures” donors and helps them to develop the psychological commitment to continue to give, as well as why few multi‐ gallon donors talk about blood donation.
Transfusion requirements, risks, and costs for patients with malignancy
Authors: Mohandas K. , Aledort L. M. 
Published: March 2003

BACKGROUND: Patients with cancer often develop significant anemia, which traditionally has been successfully managed by transfusion. Although substantially safer than in the past, transfusions continue to carry a variety of risks. The recent licensing of erythropoietin now provides a second treatment option, which indicates a need to reassess the use of transfusion to manage anemia in these patients.STUDY DESIGN AND METHODS: A 12‐month retrospective chart review of all patients receiving outpatient transfusions at a large institution was used to identify patients with solid tumors (including lymphoma) requiring transfusions for any cause. Transfusions were considered as aberrations if they necessitated unusual laboratory monitoring or resulted in clinical evidence of a transfusion reaction. Patient charges proximately related to the transfusion were calculated.RESULTS: A total of 219 patients requiring transfusions were identified, with 483 transfusion episodes and the use of 812 units of red cells to manage anemia (mean, 3.71 units/patient). A total of 100 aberrations were recorded. Twenty‐two (10%) of 219 patients had a positive antibody screen that required further work‐up; transfusion reactions occurred in 19 patients (8.7%).CONCLUSION: Careful assessment by hematologists and oncologists of the risk:benefit ratio of erythropoietin and transfusion in patients with cancer is urged.
Allogeneic transplantation combining mobilized blood and bone marrow in patients with refractory hematologic malignancies
Authors: Nemunaitis J. , Rosenfeld C. , Collins R. , Pallansch P. , Pineiro L. , Ohr S. , Waxman D. , Stone M. , Fay J. , Miller W. , Piñeiro Luis 
Published: March 2003

BACKGROUND: Mobilized blood stem cells have been used successfully in autologous transplant recipients to reduce the complications of pancytopenia due to dose‐intensive chemotherapy. Reports of cytokine‐ mobilized blood progenitor cells in allogeneic transplant recipients are rare.STUDY DESIGN AND METHODS: This is a pilot trial of six patients. Patients with advanced hematologic malignancy received bone marrow (median total 2.6 × 10(8) mononuclear cells/kg) followed by four daily transfusions of blood (median total 9.5 × 10(8) mononuclear cells/kg) from HLA‐matched sibling donors who were mobilized with recombinant human granulocyte‐colony‐stimulating factor (5 micrograms/kg/day subcutaneously for 5 days). All patients received cyclosporine and prednisone for graft‐versus‐host disease (GVHD) prophylaxis.RESULTS: An absolute neutrophil count greater than 500 per mm3 was achieved on Day 12, and platelet transfusion independence was achieved on Day 16. The median day of hospital discharge was Day 23 after transplant. All patients achieved 100‐percent donor cell engraftment. Acute > or = Grade III GVHD did not develop in any patients, but all patients developed Grade I (n = 4) or Grade II (n = 2) acute GVHD. Chronic extensive GVHD developed in four of six patients. One patient died of pneumonia 263 days after transplant while undergoing immune‐suppressive therapy for chronic GVHD.CONCLUSION: The transfusion of blood stem cells in patients undergoing allogeneic bone marrow transplant is well tolerated soon after transplant, but the development of chronic GVHD may limit the general usage of unmanipulated blood stem cells.
Prestorage white cell reduction in saline‐adenine‐glucose‐mannitol red cells by use of an integral filter: evaluation of storage values and invivo recovery
Authors: Rogers S.E. , Edmondson D. , Goodrick M.J. , Standen G.R. , Franck V. , Reppucci A. , Pamphilon D.H. 
Published: March 2003

BACKGROUND: Prestorage white cell (WBC) reduction in blood components may decrease the incidence of adverse reactions and improve component quality. A bottom‐and‐top system with an integral third‐generation WBC‐ reduction filter has been studied.STUDY DESIGN AND METHODS: Whole blood was collected from 30 healthy donors: from 20 by using a blood container system with an integral filter and from 10 controls by using a standard blood container system. Ten test units were buffy coat‐ depleted, stored for 72 hours at 4 degrees C, and then filtered, while an additional 10 test units were buffy coat‐depleted and filtered at room temperature within 8 hours of collection. All units were stored at 4 degrees C for 42 days and sampled weekly.RESULTS: The mean WBC content of the 72‐hour, 4 degrees C units was 0.33 × 10(6), that of the room‐temperature units was 2.6 × 10(6), and that of the buffy coat‐ depleted controls was 460 × 10(6) (p < 0.0005). No significant differences were found among lactate, glucose, sodium, potassium, and plasma hemoglobin levels in the three groups. ATP and 2,3 DPG levels were significantly better preserved in control units than in 72‐hour, 4 degrees C units (p = 0.016 and p = 0.032, respectively), but not better than in the room‐temperature units. Significant differences were observed between pH values in filtered units and both groups of test units (p = 0.016). In biologic terms however, these differences were small. Red cells from an additional eight healthy volunteer donors were processed by an 8‐hour room‐temperature method and stored for 35 days. Studies in vivo 24‐hour recovery of autologous red cells were performed by transfusing a radiolabeled (51Cr plus 131I‐albumin) aliquot after 35 days' storage. Good recovery (mean > 80%) was found by both the single‐ and double‐isotope‐label methods. Recovery was significantly greater when calculated by the single‐isotope method (p = 0.02).CONCLUSION: The combination of buffy coat removal and filtration in the blood container system with an integral filter achieved effective WBC reduction (> or = 3 log10 reduction from whole blood) without biologically significant detriment to in vitro or in vivo storage values.
Suction‐induced hemolysis at various vacuum pressures: implications for intraoperative blood salvage
Authors: Gregoretti S. 
Published: March 2003

Background: Suction vacuum pressure (VP) not exceeding 150 torr is recommended during intraoperative blood salvage to minimize hemolysis. When the suction provided by this VP becomes inadequate because of brisk bleeding, an alternative high‐VP suction should be used and the blood discarded. This approach often results in the salvage of only a small fraction of the blood shed during surgery complicated by large hemorrhage.Study Design and Methods: This laboratory study was designed to quantitate the hemolysis caused by various VPs in a suction system commonly used for intraoperative blood salvage. For each experiment, a batch of blood with a hematocrit of 30 to 35 percent was prepared by mixing of outdated units of red cells, fresh‐frozen plasma, and saline solution. Aliquots of this blood were suctioned at VPs of 150, 200, 250, and 300 torr, either without (6 experiments) or with (4 experiments) maximal air entrainment. Total hemoglobin, hematocrit, red cell count, plasma‐free hemoglobin, and serum potassium were measured in the blood before suction and in each aliquot after suction.Results: Suction of blood mixed with air caused much greater hemolysis than suction of blood alone (p < 0.01 at each VP tested). Raising the VP from 150 to 300 torr increased hemolysis from 0.14 +/− 0.20 percent (mean +/− SD) to 0.32 +/− 0.21 percent (p < 0.05) when blood alone was aspirated and from 1.45 +/− 0.50 percent to 2.85 +/− 0.22 percent (p < 0.05) when blood was suctioned with air. With either type of suction, red cell count, hematocrit, and serum potassium did not change significantly throughout the range of VPs tested.Conclusion: Hemolysis was found to depend on the VP applied and, to a much greater extent, on the amount of blood and air mixing. Increasing the VP above the recommended limit of 150 torr was not associated with inordinate hemolysis. Even when a VP as high as 300 torr was used, hemolysis ranged between 0.3 and 3.0 percent, depending on whether air was suctioned with the blood or not. The data support the idea that the lowest VP compatible with a clear surgical field should be used during intraoperative blood salvage and that the suctioning of air should be avoided as much as possible. These data also suggest that, in contrast to current recommendations, suction VP during intraoperative blood salvage can be increased up to 300 torr if required by the rate of bleeding, without causing excessive hemolysis.
Photochemical inactivation of duck hepatitis B virus in human platelet concentrates: A model of surrogate human hepatitis B virus infectivity
Authors: Eble B. E. , Corash L. 
Published: March 2003

BACKGROUND: Photochemical decontamination of platelet concentrates (PCs) has been demonstrated by the use of 8‐methoxypsoralen and ultraviolet A light. Systems for studying the inactivation of blood‐ borne viruses facilitate the evaluation of photochemical decontamination protocols.STUDY DESIGN AND METHODS: Duck hepatitis B virus (HBV), a model for human HBV, was adapted for the study of hepadnavirus inactivation. A highly specific in vitro infectivity assay used primary duck hepatocyte cultures and was followed by the detection of replicated duck HBV sequences. RESULTS: Duck HBV‐infected primary duck hepatocyte cultures produced authentic infectious virus. High‐ titer (> 10(9) virus genome equivalents/mL) duck HBV‐infected sera were completely inactivated in serum or PCs by the use of 100 micrograms per mL of 8‐methoxypsoralen and 70 J per cm2 of ultraviolet A light. Intracellular duck HBV (> 4.2 log10) in PCs was also inactivated. Culture results were confirmed by a sensitive duckling infectivity assay that indicated that 6.3 log10 of infectious duck HBV had been inactivated by photochemical decontamination.CONCLUSION: The sensitivity of the culture assay was comparable to that of the duckling assay using polymerase chain reaction gene amplification to detect duck HBV. Duck HBV inactivation in PCs was dependent on the dose of ultraviolet A light and independent of 8‐methoxypsoralen concentrations of 100 to 300 micrograms per mL: 100 micrograms per mL 8‐ methoxypsoralen inactivated 4 to 5 log10 of virus in conjunction with 20 to 40 J per cm2 of ultraviolet A light. The polymerase chain reaction‐enhanced duck HBV culture system has utility in optimizing photochemical decontamination protocols.
Acute gram‐negative urosepsis mimicking an acute hemolytic transfusion reaction
Authors: Friedmany H. D. , Noonan M. 
Published: March 2003

BACKGROUND: The acute hemolytic transfusion reaction (AHTR) is one of the most feared complications of blood transfusion. Over the years, several clinical conditions, as well as errors in blood component preparation and administration, that mimic AHTR have been identified. This report describes a novel variation on the theme of pseudo‐AHTR.CASE REPORT: A 47‐year‐old diabetic man with drug‐induced pancytopenia suddenly manifested severe shaking chills, flank pain, and back pain during a red cell transfusion. The passage of bright red urine immediately after the transfusion virtually confirmed for the clinicians administering the transfusion that an AHTR had occurred. In the laboratory, the hematuria was shown to be due principally to red cells and not to free hemoglobin. Further posttransfusion work‐up showed a urinary tract infection and overwhelming bacterial sepsis with Escherichia coli. CONCLUSION: As a pseudo‐AHTR, gram‐negative bacterial sepsis of urinary tract origin may surpass other forms of sepsis. Urosepsis should be considered in the work‐up of a suspected AHTR in a pancytopenic patient with a urinary tract infection.
Considerations of pool size in the manufacture of plasma derivatives
Authors: Lynch T.J. , Weinstein M.J. , Tankersley D.L. , Fratantoni J.C. , Finlayson J.S. 
Published: March 2003

Background: The pooling of human plasma from many donors for the purpose of manufacturing therapeutic proteins increases the risk of exposing recipients of these proteins to pathogens that may contaminate 1 or a few units included in the pool. Study Design and Methods: This risk is estimated for a range of manufacturing scales that would derive material from a varied number of donors and for a number of hypothetical infectious agents that may exist in the donor population over a wide range of prevalence. Risk is also calculated both for recipients of single doses of a plasma protein and for those who depend on long‐term treatment with plasma derivatives. Results: Risk of exposure increases with pool size and the prevalence of the agent in question and accumulates with repeated treatments with material manufactured from different pools. Conclusion: Reducing pool size would at best decrease this risk in proportion to the reduction in manufacturing scale. However, for individuals requiring repeated or continuous treatments, the risk of exposure to all but the rarest infectious agents would be only minimally affected, even by large reductions in manufacturing scale.
The effect of hypotonicity, glutamine, and glycine on red cell preservation
Authors: Greenwalt T.J. , Rugg N. , Dumaswala U.J. 
Published: March 2003

BACKGROUND: Red cells (RBCs) stored in hypo‐os‐molar additive solutions with the same concentrations of adenine, dextrose, mannitol, and sodium chloride and varied amounts of ammonium, phosphate, glycerol, and glutamine were better preserved than RBCs in the standard additive solution (Adsol). Cell swelling occurred in all the experimental additives. This observation prompted the evaluation of glutamine and glycine alone, as well as a combination of glutamine and glycine, all of which have been described as producing swelling of rat liver cells.STUDY DESIGN AND METHODS: Aliquots of RBCs were stored at 4°C in Adsol or experimental additive solutions (EASs) all containing adenine, 2 mM; dextrose, 110 mM; mannitol, 55 mM; and sodium chloride, 50 mM. EAS 42 had, in addition, glutamine, 10 mM; glycine 5 mM; and phosphate, 20 mM. EAS 43 had glutamine, 10 mM; glycine, 10 mM; and phosphate 20 mM. EAS 44 had glutamine, 10 mM; EAS 45 had glutamine, 10 mM, and phosphate, 20 mM; and EAS 46 had only glycine, 10 mM. At intervals, measurements were made of mean corpuscular volume, mean corpuscular hemoglobin concentration, morphology, ATP, hemolysis, supernatant potassium, ammonia, pH, and microvesicles shed.RESULTS: The initial mean corpuscular volumes were larger in all EASs than in Adsol, but the greatest difference was between EASs 44 and 46 (108 fL) and Adsol (86 fL) (p<0.001). The morphology scores were significantly better in all the EASs (p<0.04). The ATPs were significantly greater in all the EASs (p<0.001), and highest in those with phosphate. Potassium leakage and hemolysis were less in the EASs (p<0.001). The ammonia levels were higher in all the EASs than in Adsol, with the exception of EAS 46. During storage, the extracorpuscular and intracorpuscular pH levels were essentially identical. The shedding of microvesicles was greatly reduced in all the EASs.CONCLUSION: Cell swelling induced in RBCs after collection appears to improve preservation. Ammonia and phosphate enhance RBC ATP maintenance. Glycine decreases the formation of ammonia by RBCs stored in a hypotonic medium.