bluuebunny/crossref_metadata_2025_split huggingface dataset:
The effect of an intraoperative treatment algorithm on physicians' transfusion practice in cardiac surgery
Authors: Despotis G.J. , Grishaber J.E. , Goodnough L.T. 
Published: March 2003

Background: Inappropriate transfusion in cardiac surgery may, in part, be due to empiric transfusion therapy instituted in the absence of timely laboratory data. Therefore, the effect of a transfusion decision algorithm based on intraoperative coagulation monitoring of physicians' transfusion practice and the transfusion outcome was evaluated.Study Design and Methods: In a randomized, controlled trial, cardiac surgical patients determined to have microvascular bleeding at the cessation of cardiopulmonary bypass were assigned to algorithm (A) or standard (S) therapy. Group A was treated with plasma and platelet therapy according to a transfusion algorithm based on on‐site coagulation data available within 4 minutes. For Group S, the use of laboratory‐based data and the decision to transfuse blood components were at physician discretion.Results: Sixty‐six patients were entered into the study (Group A, n = 30; Group S, n = 36). Other than the fact that there were significantly more female patients in Group S than in Group A, no differences between cohorts in regard to perioperative risk factors for blood transfusion needs were identified. Therefore, gender was factored in as a covariate in the statistical analysis. Group A patients received fewer hemostatic blood component units (p = 0.008) and had fewer total donor exposures (p = 0.007) during the entire hospitalization period. Linear regression analysis of the differences in slopes in Groups A and S for the relationships between the red cell volume lost and the red cell volume transfused (p < 0.03), non‐red cell units transfused (p < 0.0001), and total number of blood components transfused (p < 0.0001) demonstrated that physicians' transfusion practice was significantly altered by the use of a transfusion algorithm with on‐site coagulation data, independent of surgical blood losses.Conclusion: The use of algorithms by transfusion decision makers can serve as an effective physician education intervention.
Long‐term survival after blood transfusion
Authors: Vamvakas E.C. , Taswell H.F. 
Published: March 2003

Background: Look‐back investigations of populations of patients admitted to major tertiary‐care hospitals in the 1980s found a 2‐year posttransfusion mortality rate in excess of 50 percent. To quantify the association of blood transfusion with mortality in a more broadly based population, a cohort of all residents of a United States county who underwent transfusion in 1981 was studied.Study Design and Methods: Retrospective cohort study comprised 802 county residents. Complete follow‐up (until death or for 10 years) was available on 93.9 percent.Results: The median length of survival was 95.0 (± 2.5) months. Twenty‐four percent of patients died within 1 year after the transfusion, 30 percent within 2 years, 40 percent within 5 years, and 52 percent within 10 years. The relative risk of death within 10 years increased by 4.1 percent per unit of red cells (p < 0.0001), by 1.2 percent per unit of platelets (p = 0.0003), and by 7.3 percent per unit of fresh‐frozen plasma (p = 0.0018) received in 1981, after adjustment for the effects on mortality of age, gender, and number of days of hospitalization in 1981.Conclusion: Receipt of a blood transfusion can be used as a descriptive epidemiologic index of morbidity in the general population, as it is independently predictive of mortality, adding to the predictive value of age, gender, and previous hospitalization. There is a dose‐response relationship between the amount of blood components received and a reduction in the subsequent length of survival. However, when a county's entire population is studied, posttransfusion mortality due to underlying disease is substantially lower than that previously reported in look‐back investigations.
Aprotinin efficacy on intraoperative bleeding and transfusion requirements in orthotopic liver transplantation
Authors: Patrassi G.M. , Viero M. , Sartori M.T. , De Silvestro G. , Rossaro L. , Burra P. , Nolli M.L. , Piccinni P. , Bassi N. 
Published: March 2003

Background: Bleeding complications frequently occur during orthotopic liver transplantation (OLT), particularly in patients with liver cirrhosis. Enhanced fibrinolytic activity in plasma was seen to play a key role in the development of the hemostatic disorder and of hemorrhages. Aprotinin, a serine protease inhibitor, has been used in the prevention and/or treatment of hyperfibrinolytic states.Study Design and Methods: In the present study, the effect of aprotinin on bleeding complications and transfusion requirements was investigated in OLT patients with liver cirrhosis. Seven consecutive cirrhotic patients undergoing OLT were infused with aprotinin following an original protocol (1,000,000‐KIU intravenous loading dose plus 500,000 kallikrein‐inhibitory units per hour until skin closure). Seven previous cirrhotic OLT patients not receiving aprotinin were used as controls.Results: In the treated group, a significant decrease in the number of transfused units of packed red cells (48.7%, p < 0.01), fresh‐ frozen plasma (24.4%, p < 0.05), platelets (35.9%, p < 0.01), and autologous blood (55.2%, p < 0.01) was observed as compared with the control group. Moreover, the mean length of operation was significantly shorter in the aprotinin‐infused patients than in untreated patients (8.3 ± 1.2 vs. 10.1 ± 1.8 hours, respectively; p < 0.01)). In the aprotinin‐treated group, the antifibrinolytic efficacy was confirmed by the lack of increase in D‐dimer levels and decrease of fibrinogen in plasma; on the contrary, these changes were always seen in the group not receiving aprotinin.Conclusion: Infusion of aprotinin during OLT in cirrhotic patients can be recommended for the prevention of hyperfibrinolysis‐triggered bleeding, thus reducing transfusion requirements. A possible protective effect on the primary nonfunction of the grafted liver is suggested.
Hepatitis C virus among blood donors: follow‐up study
Authors: Alonso C. , Pedroso M.L. , de Sanjosé S. , Montcharmont P. , Chèvre J.M. , Boucaud M.J. , Lambert V. , Cortey M.L. , Trépo C. 
Published: March 2003

Background: The exact significance of antibodies to hepatitis C virus (HCV) in blood donors remains unknown. Confirmatory tests of anti‐HCV‐ reactive serum and HCV RNA by polymerase chain reaction (PCR) are used to refute a large proportion of false‐positive results.Study Design and Methods: Ninety‐two blood donors who were anti‐HCV reactive in a first‐generation enzyme‐linked immunosorbent assay (ELISA) were reevaluated 10 months later with a second‐generation ELISA (ELISA‐2) as well as with second‐generation recombinant immunoblot assay (RIBA‐2) and by PCR.Results: Twenty‐five (43.9%) of the 57 ELISA‐2‐positive donors were confirmed as positive by RIBA‐2; of these, 84 percent were HCV RNA positive in PCR. Of the 57 who were still anti‐HCV positive, 46 were followed up and tested again in the same manner 2 years after the first screening. At that time, the pattern was little changed: 94 percent of RIBA‐2‐ and PCR‐positive donors remained positive. Of RIBA‐2‐ and PCR‐positive blood donors, 62 percent had abnormal alanine aminotransferase levels in at least one of the three evaluations. Among the anti‐HCV‐positive donors confirmed by RIBA‐2, 60 percent, versus 12.6 percent in the control group, had a significantly (p < 0.001) more frequent risk factor for HCV infection, due to parenteral exposure to blood.Conclusion: These data confirm a good correlation between RIBA‐2 reactivity and the detection of HCV RNA in a population of anti‐HCV‐ positive blood donors.
Inactivation of free and cell‐associated human immunodeficiency virus in platelet suspensions by aminomethyltrimethylpsoralen and ultraviolet light
Authors: BENADE L.E. , SHUMAKER J. , XU Y. , CHEN X. , DoDD R.Y. 
Published: March 2003

BACKGROUND: It has previously been reported that 40 micrograms per mL of aminomethyltrimethylpsoralen (AMT) plus 2.4 to 7.2 J per cm2 of ultraviolet A (UVA) light inactivated 4 to 6 log10 of several model viruses in platelet suspensions. This inactivation was achieved while satisfactory levels of platelet count, pH, morphology, aggregation, and hemostatic effectiveness were maintained.STUDY DESIGN AND METHODS: The efficacy of this procedure for inactivating free and intracellular human immunodeficiency virus (HIV), including integrated proviral sequences, was studied. RESULTS: The kinetics of inactivation for free HIV (4–5 log10 kill with 1.2–4.8 J/cm2) were similar to those obtained for the previously studied viruses. For studies on cell‐associated virus, H9 cells productively infected with HIV were added to platelet suspensions and treated with the above regimen of AMT and UVA. The phototreated cells were then cocultivated with uninfected H9 cells for 4 weeks and supernatants were assayed by enzyme‐linked immunosorbent assay for HIV p24. No evidence of HIV replication was detectable for cells receiving as little as 2.4 J per cm2 of UVA irradiation in the presence of AMT. Further, it has been demonstrated that stably integrated sequences from the HIV proviral env gene can no longer be amplified by polymerase chain reaction after 1.2 J per cm2 of UVA (with 40 micrograms/mL AMT) exposure. CONCLUSION: These data suggest that AMT and UVA is an effective antiviral treatment for free and cell‐ associated HIV in platelet suspensions
Gene frequencies of the five major human platelet antigens in African American, white, and Korean populations
Authors: Kim H.O. , Jin Y. , Kickler T.S. , Blakemore K. , Kwon O.H. , Bray P.F. 
Published: March 2003

BACKGROUND: The study of the immunogenetics of the human platelet antigens is important to the improvement of diagnosis and genetic counseling and to the development of screening programs for women at risk of having babies with neonatal alloimmune thrombocytopenia. Description of the immunogenetics of the human platelet antigens in some racial groups has been incomplete.STUDY DESIGN AND METHODS: A reverse dot blot technique employing polymerase chain reaction‐ amplified genomic DNA was applied in genotyping the five major human platelet antigens in the following populations: 100 African American and 100 white women admitted to the obstetric unit at Johns Hopkins Hospital (Baltimore, MD) and 100 inpatients at Yonsei University (Seoul, Korea).RESULTS: The gene frequencies of HPA‐2b (Koa) and HPA‐ 5b (Bra) in African Americans were twice those in whites (African Americans: 0.18 and 0.21, respectively; whites: 0.09 and 0.11, respectively). There is a very low gene frequency of the HPA‐1b (PIA2) allele in Koreans (0.005). No significant differences were found in the gene frequencies of the human platelet antigens in whites in this series and those in published European studies.CONCLUSION: These studies indicate a higher potential risk for alloimmunization to HPA‐2 (Ko) and HPA‐5 (Br) antigens in African Americans than in whites. In addition, the low gene frequency of HPA‐1b (PIA2) in African Americans and Koreans suggests that alloimmunization to HPA‐1a (PIA1) would be very unusual in these populations. These data may provide the basis for planning neonatal alloimmune thrombocytopenia screening programs in certain ethnic populations.
Selective protection against IgG binding to red cells treated with phthalocyanines and red light for virus inactivation
Authors: Rywkin S. , Ben‐Hur E. , Reid M. E. , Oyen R. , Ralph H. , Horowitz B. 
Published: March 2003

BACKGROUND: Irradiation with red light of red cells (RBCs) containing the photodynamically active phthalocyanine (Pc) dyes is being studied for inactivation of lipid‐enveloped viruses. One of the outstanding problems with this treatment is the binding of IgG to RBCs. The effects of oxygen and type I or type II quenchers on this IgG uptake were evaluated.STUDY DESIGN AND METHODS: The Pc compounds used were aluminum phthalocyanine tetrasulfonate (AIPcS4), HOSiPcOSi(CH3)2(CH2)3N(CH3)2 (Pc 4); HOSiPcOSi(CH3)2(CH2)3N+(CH3)3I‐ (Pc 5); and SiPcOSi[(CH3)2(CH2)3N+(CH3)3](2)2I‐ (Pc 6). RBCs were analyzed by flow cytometry for the presence of IgG.RESULTS: Irradiation with red light for 30 minutes of RBCs containing either 2 microM Pc 4, 2 microM Pc 5, 2 microM Pc 6, or 6.5 microM AIPcS4 resulted in an uptake of IgG. These conditions completely inactivated the lipid‐enveloped vesicular stomatitis virus (VSV) (> 5 log10 kill). IgG uptake was reduced when oxygen was depleted. The addition of reduced glutathione (GSH) or mercaptoethanol prevented the binding of IgG with RBCs treated with AIPcS4, Pc 4, Pc 5, and Pc 6. Specific binding of IgG2 but not of C3d was observed upon irradiation of RBCs with Pc 5 and Pc 6 in the absence of GSH. No gross changes were observed in RBC antigen strength after irradiation with the dyes in the presence of GSH. Inactivation of VSV by Pc plus light was not affected by GSH.CONCLUSION: Sulfhydryl compounds are useful in preventing IgG binding to RBCs following Pc photosensitization. Since virus inactivation proceeds at the same rate in the presence and the absence of sulfhydryl compounds, their addition to treated RBCs should allow crossmatching for transfusion after treatment. The binding of IgG depends to a large extent on the generation of reactive oxygen species.
Analysis of the expression of NB1 antigen using two monoclonal antibodies
Authors: Stroncek D. F. , Shankar R. A. , Norën P. A. , Herr G. P. , Clement L. T. 
Published: March 2003

BACKGROUND: Neutrophil‐specific antigen NB1 is expressed on neutrophil subpopulations in 97 percent of healthy individuals and is located on 56‐ to 64‐kDa glycoprotein. While the molecule carrying NB1 has been identified, the nature of the NB1 epitope has not been well characterized.STUDY DESIGN and METHODS: Two monoclonal antibodies (MoAbs), 1B5 and the recently produced 7D8, and four alloantibodies, all specific for NB1, were used to investigate the expression of NB1 on neutrophils from several donors.RESULTS: MoAb 7D8 was shown to be specific for NB1. It reacted with NB1‐positive neutrophils from 52 donors in the granulocyte immunofluorescence assay and did not react with NB1‐negative neutrophils from 8 donors. MoAb 7D8 immunoblotted a 56‐ to 64‐kDa molecule on neutrophils from eight NB1‐positive donors and did not react with this molecule on NB1‐negative neutrophils from two donors. When 7D8 was tested in the monoclonal antibody immobilization of granulocyte antigens assay, it reacted with two NB1 alloantibodies, but not with NA1 or NA2 alloantibodies. To determine if MoAbs 7D8 and 1B5 recognized the same epitope, both were tested against the same NB1‐positive neutrophils and the cells were analyzed by two‐ color flow cytometry. Both antibodies bound independently to neutrophils, which indicated that the antibodies recognized different epitopes. When similar studies were performed with MoAb 7D8 and three NB1 alloantibodies, 7D8 partially inhibited the binding of two of the alloantibodies. The size of the NB1‐positive subpopulation was analyzed in 25 people using flow cytometry with both MoAbs and three alloantibodies. The subpopulation of antigen‐positive cells was similar in all donors when 7D8 and the three NB1 alloantibodies were tested; however, the subpopulation recognized by MoAb 1B5 was smaller in two of the donors. Neutrophils from one of these people were analyzed by immunoblotting, and no differences were detected in the molecule carrying NB1 in those neutrophils and that molecule in control neutrophils.CONCLUSION: NB1 specificity is made up of at least two separate epitopes. The expression of NB1 varied among antigen‐positive individuals. While NB1 is expressed by a 56‐ to 64‐kDa glycoprotein, the structure of this protein on antigen‐negative cells has not been determined.
A prospective, randomized study of the use of platelet concentrates irradiated with ultraviolet‐B light in patients with hematologic malignancy
Authors: Blundell E.L. , Pamphilon D.H. , Fraser I.D. , Menitove J.E. , Greenwalt T.J. , Snyder E.L. , Repucci A.J. , Hedberg S.L. , Anderson J.K. , Buchholz D.H. , Kagen L.R. , Aster R.H. 
Published: March 2003

Background: Irradiation of platelet concentrates (PCs) with ultraviolet‐ B (UVB) light inactivates the contaminating white cells and might be an alternative to filtration for the prevention of alloimmunization to HLA antigens and subsequent refractoriness to further platelet transfusions in multiply transfused patients with bone marrow failure.Study Design and Methods: Patients with hematologic malignancy, mainly acute myeloid leukemia, were prospectively assigned in a random manner to receive either UVB‐irradiated or control, nonirradiated PCs. All patients were given red cells that were white cell reduced by filtration. Transfusion efficacy and alloimmunization were assessed by means of corrected count increments, requirement for red cells and PCs, and measurement of lymphocyte‐reactive antibodies.Results: UVB‐irradiated PCs had a clinical efficacy similar to controls as judged by corrected count increments at 1 to 6 and 12 to 24 hours and by the median requirement for red cell and platelet transfusions. Alloimmunization determined by measurements of lymphocyte‐reactive antibodies using both conventional and antiglobulin‐augmented lymphocytotoxicity techniques was not abolished in recipients of UVB‐irradiated PCs (4/30, 13%) but was less than that in controls (5/20, 25%; p = NS). The mean number of platelet transfusion episodes prior to the occurrence of alloimmunization was greater in the control group (27 vs. 10; p = 0.017).Conclusion: In this trial, UVB irradiation did not diminish the clinical efficacy of platelet transfusions. There was a small but nonsignificant reduction alloimmunization, but no difference in refractoriness of the two groups was observed. Larger prospective randomized studies are required to confirm these findings and to compare UVB irradiation with white cell reduction.
Polymorphisms at the ABO locus in subgroup A individuals
Authors: Olsson M.L. , Chester M.A. 
Published: March 2003

Background: The common ABO allele sequences are known, but little or no genetic information is available on the rare but important A subgroups.Study Design and Methods: Blood group ABO polymorphism was analyzed in genomic DNA from 45 rare subgroup A individuals by sequence‐specific primer polymerase chain reaction and amplified fragment length polymorphism investigating exons VI and VII in the ABO genes. These methods are used to detect specific mutations only, and not all changes that might be present can be detected. ABO genotypes discriminating six alleles (A1, A2, B, O1, O1var, and O2) were determined.Results: The C→T substitution at nucleotide position 467 (C467T) is not restricted to A2 and cis‐AB individuals, but was found also in some A subgroups. Detection of the functionally more relevant C1060‐single‐point deletion in A2 was accomplished by a novel sequence‐specific primer polymerase chain reaction approach. A 100‐percent correlation between the C467T and the C1060‐mutations was found. Fifteen of 17 samples showing the T646A mutation (described earlier in one case of Ax) showed a positive correlation with the C771T mutation in a frequently occurring O1var allele. The two exceptions were defined serologically as Ax.Conclusion: Indications have been found of an evolutionary relationship between A1 alleles and Ael and A3 subgroups as well as between A2 alleles and Aend and Aweak subgroups. Genetic heterogeneity within the Ax and Aint subgroups was also seen.
Optimal conditions for white cell reduction in red cells by filtration at the patient's bedside
Authors: Sirchia G. , Rebulla P. , Sabbioneda L. , Garcea F. , Greppi N. 
Published: March 2003

Background: A quality control program of white cell (WBC) reduction in red cells at the bedside was implemented, based on postfiltration counting in a Nageotte chamber of the residual WBCs from samples taken from a segment of the transfusion set, after 1‐in‐10 sample dilution with Turks's solution. During a 1‐year quality control program, 5.1 percent of counted units had apparent filtration failures, that is, WBC counts exceeding 5 × 106 per unit. The cause(s) for these apparent failures were investigated.Study Design and Methods: In Study 1, residual WBCs from 150 buffy coat‐free red cells filtered through one type of filter at 4°C, 20 to 24°C, or 27°C in 5 to 10 minutes, 50 to 100 minutes, or 100 to 200 minutes were counted as described above. In Study 2, residual WBCs in samples collected from segments of the transfusion set and from the postfiltration bags were counted in parallel by a new, more sensitive counting method. In this method, 5 mL of filtered red cells was diluted with 20 mL of 3‐percent paraformaldehyde and centrifuged, the pellet was resuspended to 500 μL with a lysis solution, and the WBCs were counted in a Nageotte chamber. In Study 3, residual WBCs were counted by the 3‐percent paraformaldehyde method in samples from postfiltration bags of 1‐ to 2‐ day‐old buffy coat‐rich red cell units filtered through a second type of filter. Filtration was started within 30 minutes of the removal of the unit from the refrigerator, ambient temperature was 20 to 24°C, and the median filtration time was 90 minutes per unit.results: Study 1: Median WBC counts per unit increased progressively from 51,000 at 4°C to 934,000 at 27°C, with intermediate values at 20 to 24°C. In no unit did the WBC count exceed 5 × 106 if filtration at 20 to 24°C was completed within 100 minutes, while counts in excess of 50 × 106 were found at 20 to 24°C and at 27°C with filtration times of 100 to 200 minutes, and 50 to 100 minutes, respectively. Study 2: The relation between segment and postfiltration bag WBC counts obtained by the 3‐ percent paraformaldehyde method was poor, with the latter being almost always lower than the former. Study 3: None of the 120 units filtered through the second type of filter at 20 to 24°C in 50 to 100 minutes contained more than 3.2 × 106 WBCs; the median value was 147,000 WBCs per unit.Conclusion: On the basis of the results with the 3‐percent paraformaldehyde method, which showed the unreliability of segment counts, a new policy was adopted for quality control of bedside WBC reduction, based on controlling the time of and temperature at transfusion. Bedside WBC reduction in 1‐ to 2‐day‐old red cells performed with the second type of filter at 20 to 24°C in less than 100 minutes per unit allowed the preparation of units that meet the standard of fewer than 5 × 106 WBCs in all tested cases. Bedside WBC reduction with the second type of filter and under the controlled conditions reported seems effective.