bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hypotensive reactions: a previously uncharacterized complication of platelet transfusion?
Authors: Hume H.A. , Popovsky M.A. , Benson K. , Glassman A.B. , Hines D. , Oberman H.A. , Pisciotto P.T. , Anderson K.C. 
Published: March 2003

Background: In 1993, the American Association of Blood Banks (AABB) received reports of severe hypotensive reactions associated with platelet transfusions. The question arose as to whether these reports were indicative of a previously uncharacterized platelet transfusion reaction.Study Design and Methods: To further characterize these reactions, the AABB Transfusion Practices Committee developed a series of three questionnaires. The initial questionnaire was sent to all AABB institutional members; the two subsequent questionnaires were sent to those institutions reporting severe and/or unusual platelet transfusion reactions. This report focuses on the 24 responses to the third and most detailed questionnaire, which specifically addressed reactions that were characterized by hypotension and/or unexplained respiratory failure.Results: Of the 24 detailed responses received, 4 were not considered to represent unusual reactions to platelet transfusion, 3 described reactions consistent with a (presumably unrecognized) diagnosis of transfusion‐related acute lung injury, and 17 described reactions that were primarily characterized by hypotension. The majority of the hypotensive reactions occurred within 1 hour of the beginning of the transfusion (88%), were associated with respiratory distress (82%), and resolved rapidly after cessation of the transfusion (82%). Eighty‐eight percent of implicated components had been white cell reduced by filtration.Conclusion: The hypotensive platelet transfusion reactions that were described appear to represent a previously uncharacterized complication of platelet transfusion. However, the nature of the questionnaires used in this investigation does not allow the drawing of firm conclusions as to the frequency or the cause of these reactions.
Blood donation‐related neurologic needle injury: evaluation of 2 years' worth of data from a large blood center
Authors: Newman B.H. , Waxman D.A. 
Published: March 2003

Background: There is little information in the medical literature on t he clinical spectrum of blood donation‐related neurologic needle injury and on its frequency in a blood donor population.Study Design and Methods: Sixty‐six cases of blood donation‐related neurologic needle injury were identified from nursing reports made during a 2‐year collection period involving 419,000 whole blood donations. Telephone follow‐up was completed on 56 of the 66 cases to better define clinical symptoms, the donor's desire for physician consultation, recovery times, and residual effects.Results: Symptoms in 66 donors included numbness or tingling (n = 54), excessive or radiating pain (n = 43), and loss of arm or hand strength (n = 8). Of the 56 donors with complete follow‐up, 17 (30%) consulted a physician one or more times. Recovery times in these 56 donors were <3 days (n = 22), 4 to 29 days (n = 17), 1 to 3 months (n = 13) 3 to 6 months (n = 2), and >6 months (n = 2). Fifty‐two of 56 donors achieved a full recovery, and 4 other donors had only a mild, localized, residual numbness. The incidence of blood donation‐related neurologic needle injury was 1 of every 6300 donations.Conclusion: While donor recovery may in some cases require a great deal of time and/or physician consultation(s), total recovery appears to be the rule. The incidence of blood donation‐related neurologic needle injury is relatively low.
Chemokines in stored platelet concentrates
Authors: Bubel S. , Wilhelm D. , Entelmann M. , Kirchner H. , Kluter H. 
Published: March 2003

BACKGROUND: Platelets contain several mediators, belonging to a family of proinflammatory cytokines named chemokines, that are stored in the organelles. Release and accumulation of these chemokines during storage of platelet concentrates (PCs) might be responsible for nonhemolytic transfusion reactions.STUDY DESIGN AND METHODS: Analysis was done of pH and the levels of platelet factor 4, beta‐thromboglobulin, interleukin 8, RANTES, macrophage‐inflammatory protein‐1 alpha, lactate dehydrogenase, and serotonin in the supernatant of stored PCs on Days 1, 3, 5, and 8. PCs were prepared by apheresis or from pools of four buffy coats. Buffy coat PCs were filtered before storage.RESULTS: Nonfiltered apheresis PCs, which had a higher white cell contamination (p < 0.01), contained significantly more platelets than did buffy coat PCs (p = 0.02). The pH decreased significantly in apheresis PCs (p = 0.01), whereas there was a significant increase in lactate dehydrogenase (p < 0.001). In buffy coat PCs, pH remained stable and lactate dehydrogenase increased moderately. Concentrations of platelet factor 4 and beta‐thromboglobulin increased steadily in both preparations over the storage period (p < 0.001). Macrophage‐ inflammatory protein‐1 alpha was hardly detectable in the supernatant of both PCs, while RANTES levels increased significantly with storage time (p < 0.001). Interleukin 8 was not found in the supernatant of any PCs, with the exception of one apheresis PC with high white cell contamination (> 10(9)/ L). Serotonin levels were higher in apheresis PCs (p = 0.01), but the levels did not correlate with storage time.CONCLUSION: Platelet factor 4, beta‐thromboglobulin, and RANTES were released from platelets during storage and accumulated over time in the PCs. These chemokines might play a causative role in nonhemolytic transfusion reactions because of their inflammatory potential, but the clinical effects of the transfusion of PCs with high chemokine contents remain to be investigated.
All medium starches are not the same: Influence of the degree of hydroxyethyl substitution of hydroxyethyl starch on plasma volume, hemorrheologic conditions, and coagulation
Authors: Treib J. , Haass A. , Pindur G. , Grauer M. T. , Wenzel E. , Schimrigk K. 
Published: March 2003

BACKGROUND: After the application of high volumes of high‐molecular‐ weight starch (hetastarch), bleeding complications have repeatedly been observed. Later studies showed that the application of medium‐molecular‐ weight starch led to far fewer disturbances of the blood coagulation system. However, the relationships among the degree of hydroxyethyl substitution, the rate of degradation, and the average in vivo molecular weight have not been investigated.STUDY DESIGN AND METHODS: A 10‐day hemodilution treatment (n = 20) was carried out using two medium‐molecular‐weight hydroxyethyl starches (HES) with a degree of hydroxyethyl substitution of 0.5 and 0.62, respectively (10% HES 200 was used for a substitution of 0.5 and 6% HES 200 for a substitution of 0.62). After a loading dose of 500 mL was administered, 1000 mL of HES was infused daily for 4 days, and then 500 mL was infused daily for 6 days.RESULTS: The more highly substituted starch was broken down more slowly and eliminated renally. This resulted in a higher intravascular molecular weight than for the less highly substituted HES (120 vs. 84 kDa) and a greater increase in serum concentration (20.3 vs. 9.0 mg/mL). Initially, the more highly substituted 6‐percent HES had a lesser effect on plasma volume (p < 0.01). Because of HES accumulation, there was no longer a significant difference between the starches by the end of treatment, even though a higher dose of the 10‐percent low‐ substitution starch was infused. Six‐percent HES caused an increase in plasma viscosity (+9%, p < 0.01) that was due to an accumulation of macromolecules. Ten‐percent HES 200/0.5 had no effect on the coagulation system beyond the dilution effect. Six‐percent HES, on the other hand, led to an acquired von Willebrand syndrome during the course of the 10‐day therapy. Factor VIII function was reduced by 72.2 percent, von Willebrand ristocetin cofactor by 61.3 percent, and von Willebrand factor antigen by 64 percent (p < 0.01).CONCLUSION: It is the intravascular and not the initial (in vitro) molecular weight that determines the properties of HES. Especially after repeated administration, a high degree of hydroxyethyl substitution leads to an accumulation of macromolecules that affect hemorrheologic measures and the coagulation system just as adversely as high‐molecular‐weight starch does. Depending on the degree of substitution, medium‐molecular‐ weight starches can have widely differing properties.
An acute hemolytic transfusion reaction caused by an anti‐P1 that reacted at 37°C
Authors: Arndt P. A. , Garratty G. , Marfoe R. A. , Zeger G. D. 
Published: March 2003

BACKGROUND: Hemolytic transfusion reactions (HTRs) due to anti‐P1 have rarely been reported. There is only one report (from 1945) of an acute HTR due to anti‐P1.CASE REPORT: A 74‐year‐old woman with anti‐P1 was given blood that had been found to be compatible by the use of prewarmed serum and saline‐suspended red cells (RBCs) and of an antiglobulin test with anti‐IgG. The test mixtures were not centrifuged or inspected for agglutination after the 37°C incubation phase. After transfusion of 50 mL of P1 + blood, the patient had an acute HTR (hemoglobinemia, hemoglobinuria, and increased blood pressure, temperature, and respiration).RESULTS: When studied by a reference laboratory, the anti‐P1 was shown to be easily detectable (3+ agglutination) by a prewarming technique (saline or low‐ionic‐strength saline [LISS]), which included centrifugation at 37°C, but only weak reactions were observed when centrifugation after 37°C incubation was omitted. The indirect antiglobulin test was weakly positive (1+) with anti‐IgG, but polyspecific anti‐human globulin reacted 2+. The anti‐P1 agglutinin was IgM, and its titer was 16 at 37°C (prewarmed) and 256 at 23°C; it caused hemolysis of RBCs at 37°C under conditions known to enhance hemolysis. An indirect monocyte monolayer assay gave results of 11.2 and 22 percent in testing of P1 + RBCs incubated with the patient's serum alone and with patient's serum plus fresh normal serum (as a source of complement), respectively (normal ≤3%).CONCLUSION: An acute HTR was caused by a hemolytic anti‐P1 that reacted at 37°C. This antibody was not detected by the hospital in a prewarmed crossmatch that omitted 1) the addition of LISS, 2) the reading for agglutination after the 37°C incubation, and 3) the use of antiglobulin sera containing anti‐complement.
Hepatitis C virus and GB virus C/hepatitis G virus viremia in Swedish blood donors with different alanine aminotransferase levels
Authors: Björkman P. , Sundström G. , Widell A. 
Published: March 2003

BACKGROUND: Hepatitis C virus (HCV) is a known blood‐borne hepatotropic virus for which antibody screening of blood donors is universally practiced. The newly identified GB virus C (GBV‐C) and its strain variant hepatitis G virus (HGV) are of unknown pathogenic significance, and screening of blood donors for this agent has not yet been implemented. Polymerase chain reaction (PCR) is the most sensitive method for detecting HCV viremia and is the only method presently available for the diagnosis of GBV‐C/HGV infection.STUDY DESIGN AND METHODS: RNA extracts of sera from 577 anti‐HCV‐negative blood donors (393 with elevated alanine aminotransferase [ALT] levels, 184 with normal ALT levels) were tested with nested PCR for HCV and GBV‐C/HGV directed at the 5′‐noncoding regions of the two viruses.RESULTS: One donor with elevated ALT was HCV PCR positive. This donor was anti‐HCV negative when recruited to the study but subsequently developed anti‐ HCV. Of the 19 donors with GBV‐C/HGV viremia in the series as a whole, 16 belonged to the group with elevated ALT levels and 3 to the group with normal ALT levels; the group difference in prevalence was nonsignificant (4.1% [16/393] vs. 1.6% [3/184; p = 0.20]). Phylogenetic analysis showed 16 of the GBV‐C/HGV isolates to be classifiable as subtype 2a and three as subtype 2b. At follow‐up 3 to 5 years later, 11 of 18 donors were still viremic.CONCLUSION: There was no significant difference in GBV‐C/HGV viremia in the group with elevated ALT levels and the group with normal ALT levels. The frequency and subtype distribution in the present series were similar to those in other Western countries.
Neutrophil transfusions: kinetics and functions of neutrophils mobilized with granulocyte‐colony‐stimulating factor and dexamethasone
Authors: Dale D.C. , Liles W.C. , Llewellyn C. , Rodger E. , Price T.H. 
Published: March 2003

BACKGROUND: The collection of adequate numbers of neutrophils (polymorphonuclear leukocytes, PMNs) from normal donors has long hampered the development of neutrophil transfusion therapy. The stimulation of donors with granulocyte‐colony‐stimulating factor (G‐ CSF) plus dexamethasone is a promising way of improving PMN collections.STUDY DESIGN AND METHODS:Sixteen normal subjects received G‐CSF (600 micrograms subcutaneously) and dexamethasone (8 mg by mouth) 12 hours before leukapheresis. Measurements included PMN morphology, immunophenotype analysis, chemiluminescence, bactericidal activity, in vivo kinetics, and adverse effects.RESULTS:A mean of 77.4 +/− 6.4 × 10(9) PMNs was collected with each leukapheresis; 14 percent were bands. PMNs had increased surface expression of CD11b, CD18, CD14, CD32, and CD64. Bactericidal capacity against Staphylococcus aureus was normal. Inducible respiratory burst was maintained, although the responses to some agonists were diminished. Returned leukapheresis cells labeled with 3H‐diisopropylfluorophosphate had a modestly decreased percentage of recovery and circulated with a prolonged half‐ life. Migration of these cells to skin chambers was approximately equal to that of the subjects' own blood PMNs. Adverse effects included transient bone pain, headache, hunger, and insomnia.CONCLUSIONS:Precollection treatment of leukapheresis donors with G‐CSF plus dexamethasone is an effective way to enhance the collection of PMNs with normal or near‐normal functional properties for PMN transfusion therapy.
Photodynamic sterilization of red cells and its effect on contaminating white cells: viability and mechanism of cell death
Authors: Moor A.C.E. , Van Der Veen A. , Dubbelman T.M.A.R. , VanSteveninck J. , Brand A. 
Published: March 2003

BACKGROUND: Phthalocyanines are useful sensitizers for photodynamic sterilization of red cell concentrates. Various lipid‐enveloped viruses can be inactivated with only limited red cell damage. Because white cells are involved in the immunomodulatory effects of blood transfusions, the study of the effect of photodynamic treatment on these cells is imperative.STUDY DESIGN AND METHODS: White cell‐enriched red cell suspensions were photodynamically treated with either the hydrophobic Pc4 (HOSiPcOSi‐(CH3)2(CH2)3N(CH3)2) or water‐soluble aluminum phthalocyanine tetrasulfonate (AlPCS4) under virucidal conditions. Viability of white cell subpopulations on Days 0, 1, and 4 after treatment was determined by fluorescence‐activated cell sorting by flow cytometric analysis of propidium iodide uptake. Apoptosis induction was studied by DNA ladder formation and staining for an early marker of apoptosis (annexin V).RESULTS: Treatment with Pc4 causes a significant decrease in cell viability of all white cells, as shown by prodidium iodide uptake. Monocytes and granulocytes are the most sensitive, and lymphocytes are relatively more resistant. Some of the cells die by apoptosis, which is induced within 30 minutes after treatment. Treatment with AlPCS4 damages only monocytes; other cell populations are not affected.CONCLUSIONS: Physicochemical properties of the photosensitizers partly determine their effect on white cells. Differences in intracellular localization are likely to be responsible for the effects observed.
Clinical consequences of alterations in platelet transfusion dose: a prospective, randomized, double‐blind trial
Authors: Klumpp T.R. , Herman J.H. , Gaughan J.P. , Russo R.R. , Christman R.A. , Goldberg S.L. , Ackerman S.J. , Bleecker G.C. , Mangan K.F. 
Published: March 2003

BACKGROUND: The dose‐response relationship for platelet transfusion has become increasingly important as the use of platelet transfusion has grown.STUDY DESIGN AND METHODS: One hundred fifty‐eight prophylactic apheresis platelet transfusions were administered to 46 patients undergoing high‐dose therapy followed by hematopoietic progenitor cell transplantation in a prospective, randomized, double‐blind, multiple‐crossover study. Transfusions were administered in pairs, differing only in platelet content. Each pair consisted of a lower‐dose platelet component (LDP) and a higher‐dose platelet component (HDP) administered in random order to the same patient. LDPs contained a mean of 3.1 × 1011 platelets (range, 2.3‐3.5 × 1011), and HDPs contained a mean of 5.0 × 1011 platelets (range, 4.5‐6.1 × 1011). Patients with active bleeding and those who were refractory to platelet transfusions were excluded.RESULTS: The mean posttransfusion platelet count increment with LDP was 17,010 per μL, and that with HDP was 31,057 per μL (p<0.0001). Only 37 percent of LDPs resulted in platelet count increments of at least 20,000 per μL, whereas 81 percent of HDPs resulted in increments above this level (p<0.0001). The mean transfusion‐free interval with LDP was 2.16 days, whereas that with HDP was 3.03 days (p<0.01). Administration of LDPs was associated with a 39 to 82 percent increase in the relative risk (per day) of requiring subsequent platelet transfusions (p<0.0001).CONCLUSION: As compared to the administration of HDPs, the administration of LDPs for prophylactic transfusion in hematopoietic progenitor cell transplant patients results in a lower platelet count increment, a lower likelihood of obtaining a posttransfusion platelet increment >20,000 per μL, a shorter transfusion‐free interval, and a greater relative risk per day of requiring additional transfusions.
Cost‐effectiveness of a limited‐donorblood program for neonatal red cell transfusions
Authors: Hilsenrath P. , Nemechek J. , Widness J.A. , Cordle D.G. , Strauss R.G. 
Published: March 2003

BACKGROUND: Very‐low‐birthweight infants have typically been given fresh red cells (RBCs), a practice in which aliquots of RBCs for several infants were issued each day from a single unit. Recently, to limit donor exposures, large volumes of RBCs are reserved for the long‐term transfusion support of individual infants.STUDY DESIGN AND METHODS: Medical records were examined retrospectively to assess the costs of a limited‐donor program for providing RBC transfusions to very‐low‐birthweight infants. Costs of multiple‐ and limited‐donor programs were compared by using two samples of 30 consecutive infants treated at The University of Iowa Hospitals and Clinics in 1993 and 1997. Effectiveness was evaluated with respect to the number of donor exposures per infant.RESULTS: The cost, in 1997 dollars, of preparing each small‐volume transfusion in the multiple‐donor program was $27.86 per transfusion, while that in the limited‐donor program was $34.83. This difference was largely attributable to use of white cell reduction in association with the limited‐donor program in 1997. Eliminating the costs associated with white cell reduction rendered the costs of the limited‐ and multiple‐donor transfusions comparable. The limited‐donor program had donor exposures of 2.0 per infant, while the multiple‐donor program had 3.6 exposures per infant (p<0.002).CONCLUSION: The limited‐donor blood program reduces donor exposure without adversely affecting costs.
Hepatitis C virus genotypes in hemophiliacs in the state of Minas Gerais, Brazil
Authors: Oliveira G.C. , Carmo R.A. , Rocha M.O.C. , Silva M.O. , Lima A.T. , Guimarães M.D.C. , Corrêa‐Oliveira R. 
Published: March 2003

BACKGROUND: Hepatitis C virus (HCV) is a positive‐strand RNA virus composed of at least 10 genotypes and dozens of subtypes. Six major genotypes can be distinguished by restriction fragment length polymorphism (RFLP) analysis of the amplified 5′ noncoding region (NCR) of the genome. The genotypes are unequally distributed throughout the world. Types 1 and 3 are most common in Europe and the United States. Although fewer studies have been performed in Brazil, the pattern seems to mirror that in the other areas. HCV infection is highly prevalent among hemophiliacs and is a major cause of chronic liver disease.STUDY DESIGN AND METHODS: This study investigated a sample of the hemophiliac population in the state of Minas Gerais, Brazil, by RFLP analysis of the 5′ NCR.RESULTS: It was observed that 84.1 percent were of genotype 1 and 13.6 percent of genotype 3. Sequence analysis of nine isolates confirmed the RFLP results and determined that all of the type 1 isolates belonged to subtype 1a. Phylogenetic analysis by parsimony and distance revealed that lineages of genotypes 1, 2, and 3, and 4 could be separated. The isolates of type 3 from this study were distinct from published sequences, which possibly indicated their different geographical origin.CONCLUSION: Although the frequency of genotypes observed (types 1 and 3) among hemophiliacs in the state of Minas Gerais was higher than that in the southern part of the country, these frequencies were not different from those in other groups of patients in Brazil and other countries studied. Further investigation is needed of the evidence that the type 3 isolates observed in these studies are significantly different from other isolates previously characterized by sequence analysis.
Evaluation of methods for detecting alloantibodies underlying warm autoantibodies
Authors: Leger Regina M. , Garratty George 
Published: March 2003

BACKGROUND: In pretransfusion testing of patients whose sera contain autoantibodies reacting optimally at 37°C, it must be determined whether alloantibodies are also present. Two approaches, testing a 1 ‐in‐5 dilution of patients' sera and the adsorption of sera in the presence of polyethylene glycol (PEG), have been proposed as alternatives to the time‐consuming approach of adsorbing sera with ficin‐ or ZZAP‐treated red cells (RBCs). The three approaches were compared.STUDY DESIGN AND METHODS: Patients' sera containing warm autoantibodies, with and without alloantibodies, were retested 1) after dilution (1‐in‐5) and 2) after adsorption with allogeneic RBCs in the presence of PEG. Results were compared to those after adsorption with ZZAP‐treated allogeneic RBCs.RESULTS: Dilution (1‐in‐5): Twenty‐seven of 119 sera (7/26 [27%] with and 20/93 [22%] without alloantibodies) did not react; one example each of alloanti‐D, ‐E, ‐e, ‐Fya, and ‐Jka, and two examples of anti‐Jkb were not detected at a dilution of 1 in 5. Alloantibodies were identified in 5 (19%) of 26 1‐in‐5 diluted sera containing alloantibodies; 87 (73%) of 119 sera still reacted with all cells and would have required further workup. PEG adsorption: Thirty‐nine sera were tested after parallel PEG and ZZAP adsorptions. The PEG adsorptions required a total of 55 aliquots of adsorbing cells and 13.75 hours, whereas ZZAP adsorptions required 61 aliquots and 30.5 hours. All alloantibodies (anti‐D [3], ‐C [2], ‐c [1], ‐E [4], ‐K [2], ‐Fya [1], ‐Jka[2], ‐Jkb[1]) reacted in the adsorbed serum‐PEG mixtures at a strength equal to or greater than that in the ZZAP‐adsorbed sera.CONCLUSION: Although the 1‐in‐5 dilution approach is convenient, only 22 percent of warm autoantibodies without alloantibodies were nonreactive, and 27 percent of alloantibodies of potential clinical significance were not detected. PEG adsorption appears to give similar results to those of ZZAP adsorption, but it has the advantages of eliminating the cost and time of prior treatment of the allogeneic adsorbing cells and of a reduction of at least a 50 percent in adsorption time.