bluuebunny/crossref_metadata_2025_split huggingface dataset:
Anti‐D in a D‐positive renal transplant patient
Authors: Saba N.F. , Sweeney J.D. , Perm L.C. , Lawton J.C. , Yankee R.L. , Huang C.H. , Schanfield M.S. 
Published: March 2003

BACKGROUND: The detection of anti‐D in a D‐positive renal transplant recipient is unusual and may arise by several potential mechanisms. These include passive transfer of alloantibody and the presence of autoanti‐D or alloanti‐D that is due to microchimerism when the allograft is from a D‐negative donor. In the latter case, overt hemolysis has been seen or suspected. The occurrence of anti‐D in a D‐positive renal transplant recipient without hemolysis, which is most likely attributable to microchimerism, is reported.CASE REPORT: A 51‐year‐old group O, D‐positive woman, who was serologically HLA type A1, A2; B8, B44; DR3, DR6, DR52; DQ1, DQ2, underwent the transplantation of a kidney from a cadaveric donor who was serologically HLA type A1, A2; B8, B44; DR13, DR17, DR52; DQ1, DQ2. The donor was known to be D‐negative and immunized to D. No Wood components or derivatives were administered at the time of organ graft. Ten weeks after the transplant, the direct antiglobulin test was positive in the recipient, and anti‐D was eluted. Polymerase chain reaction amplification using primers to distinguish DR13 (donor) from DR14 alleles (recipient split of DR6) in the peripheral Wood showed the recipient to be DR14. No DR13 could be detected, and thus microchimerism could not be confirmed. However, in the peripheral blood, GM and KM allotyping of the serum (GM A,F,X B,G and KM 1,3) and eluate (G1M F, KM 3) showed a pattern of allotypes most consistent with an alloantibody. Eleven months after transplantation, the graft continued to function; the direct antiglobulin test was still positive, and elution of anti‐D persisted.CONCLUSION: This case of anti‐D in a D‐positive renal transplant recipient is attributed to microchimerism, despite the lack of confirmation by genotypic analysis of the peripheral Wood. It raises the possibility that microchimerism may be a more common phenomenon in solid allograft recipients than is realized.
Differentiation of anti‐D, ‐C, and ‐G: clinical relevance in alloimmunized pregnancies
Authors: Shirey R.S. , Mirabella D.C. , Lumadue J.A. , Ness P.M. 
Published: March 2003

BACKGROUND: The differentiation of anti‐D, ‐C, and ‐G specificities is seldom considered clinically important in pretransfusion testing. However, distinguishing these antibody specificities in alloimmunized pregnancies may be essential. The clinical prognosis as well as Rh immune globulin prophylaxis depends on the accurate identification of these antibodies.CASE REPORT: A pregnant woman, para 1 gravida 4, who had received Rh immune globulin at appropriate intervals during her previous pregnancies was reported to have anti‐D (titer = 4) and anti‐C (titer = 32). Differential adsorption and elution studies showed that the patient had anti‐C and anti‐G, but not anti‐D. This case prompted retrospective examination of the sera from six other women with anti‐D and anti‐C who were referred to a high‐risk pregnancy clinic. Of six pregnant women reported to have anti‐D and anti‐C; two had anti‐D, ‐C, and ‐G; three had anti‐D and ‐G, but not anti‐C; and one had anti‐C and ‐G, but not anti‐D. This last is similar to the index case.CONCLUSION: Cases of pregnant women with anti‐C and ‐G, but not anti‐D, are not infrequent. Studies to differentiate anti‐D, ‐C, and ‐G should be performed on alloimmunized pregnant women presumptively identified as having anti‐D and anti‐C when the medical history (Rh immune globulin prophylactic therapy) and/or titer values (e.g., anti‐C titer higher than anti‐D titer) suggest that anti‐D may not actually be present. Rh immune globulin has not failed in these patients, and they should receive this therapy during pregnancy to prevent immunization to D.
Prospective validation of a point score system for predicting blood transfusion following hip or knee replacement
Authors: Larcique B. J. , Gilbert K. , Brien W. F. 
Published: March 2003

BACKGROUND: The purpose of this study was to validate a previously published point score system for predicting the likelihood of a postoperative blood transfusion following hip or knee replacement.STUDY DESIGN AND METHODS: Data were collected prospectively on 460 sequential patients undergoing elective hip and knee replacement at two academic hospitals. Blood transfusion frequency was determined for patients in each of the four risk strata, as defined by the point score system. The accuracy of the system was validated by calculating the area under the receiver operating characteristic (ROC) curve for each site. Data were then combined and inappropriate blood transfusions were eliminated, by using the American College of Physicians guidelines. The frequencies of blood transfusion within each strata were recalculated along with an ROC curve.RESULTS: The point score system accurately predicted the likelihood of blood transfusion at both hospitals, despite marked differences in overall transfusion frequencies. The calculated areas under the ROC curves were 0.78 and 0.79 for the two sites. The point score system also proved valid when only appropriate blood transfusions were considered, with a calculated area under the ROC curve of 0.74.CONCLUSION: The point score system can accurately predict the likelihood of postoperative blood transfusion following hip or knee replacement. Such a system can be used to target high‐risk patients for preoperative autologous blood donation.
The Collaborative Hospital Transfusion Study: variations in use of autologous blood account for hospital differences in red cell use during primary hip and knee surgery
Authors: Churchill W. H. , McGurk S. , Chapman R. H. , Wallace E. L. , Bertholf M. F. , Goodnough L. T. , Kao K. J. , Olson J. D. , Woodson R. D. , Surgenor D. M. 
Published: March 2003

BACKGROUND: Red cell use in patients undergoing Diagnosis Related Group (DRG) 209 procedures (major joint and limb reconstruction procedures of the lower extremities) has been shown to have large, unexplained interhospital variations.STUDY DESIGN AND METHODS: Abstracted records of 2590 consecutive DRG 209 patients at five university hospitals from January 1992 to December 1993 were stratified by procedure and preoperative blood deposit status. Patient characteristics and transfusion and in‐hospital outcomes were compared across hospitals.RESULTS: Blood use among patients who did not preoperatively deposit blood was similar across hospitals. Significant differences were found across hospitals for total hip replacement patients in the percentage of patients preoperatively depositing blood (59–80%), percentage of patients receiving transfusion(s) (51 to > 99%), the mean number of units collected per patient (1.6‐2.9), and the mean number of unused autologous units per 100 patients (1–185). No significant differences were found in the percentage of those who deposited blood and then required allogeneic units. There was little variability in length of hospital stay or in last hematocrits. Findings were similar for total knee replacement patients.CONCLUSIONS: Interhospital variations in red cell use for primary total hip and knee reconstruction are primarily due to hospital‐specific differences in autologous blood collection and transfusion.
Survival of fresh human platelets in a rabbit model as traced by flow cytometry
Authors: Rothwell S. W. , Maglasang P. , Krishnamurti C. 
Published: March 2003

BACKGROUND: In the event of hemorrhage and blood loss, platelets play a vital role in the coagulation process. However, there are currently no acceptable protocols for long‐term storage of platelets. As a first step toward testing the efficacy of stored platelets or platelet substitutes in vivo, a flow cytometric technique was developed to detect human platelets in rabbit blood.STUDY DESIGN AND METHODS: Human platelets were transfused to rabbits whose reticuloendothelial system was inhibited by the administration of ethyl palmitate. Because human and rabbit platelets display surface molecules with different epitopes, human platelets were selectively labeled with antibodies specific for glycoprotein IX (CD42a). As this antibody does not label rabbit platelets, it allows discrimination of human from rabbit platelets in samples of rabbit blood containing both types of platelets.RESULTS: Survival of human platelets in rabbits was monitored by flow cytometry and fluorescence microscopy in blood drawn at various times after the platelet transfusion. Fresh human platelets transfused to untreated control rabbits (n = 3) were removed from circulation within 10 minutes of the completion of the transfusion. Fresh platelets (1 day old) transfused to rabbits treated with ethyl palmitate (n = 5) survived for 24 hours with an average half‐life of 8.6 hours. In contrast, 8‐day‐old platelets were cleared from the circulation sooner with an average half‐ life of 2.9 hours (n = 4).CONCLUSION: This report describes a rapid and efficient method of assessing the survival of human platelets in a rabbit model using flow cytometry. This technique will enable the monitoring in rabbits of human platelets prepared by various preservation protocols.
Hemochromatosis probands as blood donors
Authors: Barton J.C. , Grindon A.J. , Barton N.H. , Bertoli L.F. 
Published: March 2003

BACKGROUND: There has been no estimate of the potential eligibility of hemochromatosis probands or patients as blood donors or the suitability for transfusion of their blood that was removed by therapeutic phlebotomy.STUDY DESIGN AND METHODS: According to guidelines of the American Association of Blood Banks, a retrospective estimate of these factors in 211 adult white hemochromatosis probands diagnosed during routine medical care was performed. The findings were compared to those in volunteer white whole‐blood donors.RESULTS: Before diagnosis of hemochromatosis, 49 probands had voluntarily donated 597 units of blood; 88 percent were donated by men. After diagnosis, 142 (67%) of 211 probands were potentially eligible. Data on each unit removed during iron‐depletion therapy and during the first year of maintenance therapy (therapeutic phlebotomy) were available in 86 eligible probands. Of 1592 units, 1029 (65%) obtained during iron‐depletion therapy in eligible probands were potentially suitable; 86 percent were from men. During maintenance therapy, 106 (88%) of 121 units from eligible probands were potentially suitable. In volunteer donors, 255,567 (94%) of 273,302 presenting donors were accepted. After testing and laboratory losses, 239,300 (94%) units were acceptable for transfusion.CONCLUSIONS: In comparison with normal volunteers, hemochromatosis probands at diagnosis are less likely to be eligible as blood donors. The percentage of units obtained from patients during iron‐depletion therapy that are suitable for transfusion is also lower, although the percentage increases during maintenance therapy.
Platelet surface p‐selectin, platelet–granulocyte heterotypic aggregates, and plasma‐soluble p‐selectin during plateletpheresis
Authors: Barnard M.R. , MacGregor H. , Mercier R. , Ragno G. , Pivacek L.E. , Hechtman H.B. , Michelson A.D. , Valeri C.R. 
Published: March 2003

BACKGROUND: Plateletpheresis components have been shown to contain p‐selectin‐positive platelets after collection and storage. P‐selectin mediates binding of activated platelets to granulocytes and monocytes. This study was undertaken to assess platelet activation, granulocyte activation, platelet–granulocyte heterotypic aggregate formation, and the plasma‐soluble p‐selectin level during plateletpheresis performed on a particular instrument (MCS+, Haemonetics).STUDY DESIGN AND METHODS: Flow cytometry was used to assay platelet surface p‐selectin, granulocyte iC3b receptor, and platelet–granulocyte aggregates in the platelet component, residual blood in the disposable polycarbonate bowl of the MCS+, and in the donor blood with and without the addition of in vitro agonists before, during, and after plateletpheresis. The plasma‐soluble p‐selectin levels in the platelet component, disposable bowl, and donor venous blood were measured by an enzyme‐linked immunosorbent assay.RESULTS: Levels of p‐selectin‐positive platelets, activated granulocytes, and platelet–granulocyte aggregates were greater in the disposable bowl than in the preapheresis donor blood. Levels of p‐selectin‐positive platelets, activated granulocytes, and platelet–granulocyte aggregates in the postapheresis donor blood were similar to those in the preapheresis donor blood. The platelet components contained no activated granulocytes or detectable platelet–granulocyte heterotypic aggregates, and only about 10‐percent activated platelets. The plasma‐soluble p‐selectin level in the platelet component was significantly greater than that in the preapheresis donor blood, the residual blood in the disposable bowl, or the postapheresis donor blood.CONCLUSIONS: Measurements of platelet surface p‐selectin, platelet–granulocyte heterotypic aggregates, and plasma‐soluble p‐selectin can be used to detect platelet activation during plateletpheresis.
Efficacy of donor screening for HTLV‐I and the natural history of transfusion‐transmitted infection
Authors: Inaba S. , Okochi K. , Sato H. , Fukada K. , Kinukawa N. , Nakata H. , Kinjyo K. , Fujii F. , Maeda Y. 
Published: March 2003

BACKGROUND: It has been 10 years since the implementation in Japan of donor blood screening for human T‐cell lymphotropic virus type I (HTLV‐I). This report reviews the effectiveness of screening in preventing transmission of HTLV‐I through blood transfusion and the current status of patients with confirmed seroconversion due to transfusions given before the implementation of screening.STUDY DESIGN AND METHODS: Patients who received blood at Kyushu University Hospital from 1990 to 1997 were followed. Serum samples were collected before transfusion and 60 days or more after transfusion. Seroconversion was determined by a second‐generation particle agglutination test. Confirmation tests were an immunofluorescence assay, enzyme‐linked immunosorbent assay, and immunoblotting. Confirmed seroconverted patients were followed by a search of hospital records.RESULTS: Seroconversion was found in one of 4672 transfused patients, but the donor was identified and confirmed to be negative for anti‐HTLV‐I and virus genome by nested polymerase chain reaction. A total of 23,323 red cell concentrates and 17,237 platelet concentrates were transfused to these 4672 patients. Therefore, the anti‐HTLV‐I prevalence in blood for transfusion after screening was estimated at 1 in 45,560 (0.0022%; the upper 95% CI was 0.0080%). One hundred two seroconverted patients who were transfused before donor screening for HTLV‐I were followed. One patient developed HTLV‐I‐associated myelopathy, diagnosed 18 weeks after seroconversion, and another patient developed uveitis 1 month after seroconversion. No patients developed adult T‐cell lymphoma, and the survival rate of seroconverted patients was 92.5 percent 15 years after transfusion.CONCLUSION: This study confirmed that the present donor screening program for HTLV‐I by the new particle agglutination test can almost completely prevent virus transmission by transfusion. Complications of HTLV‐I transmission were at lower rates than expected.
Virus reduction in the preparation of intravenous immune globulin: in vitro experiments
Authors: Chandra Sudhish , Cavanaugh James E. , Lin Chaomei M. , Pierre‐Jerome Claudette , Yerram Nagender , Weeks Richard L. , Flanigan Everett , Feldman Fred 
Published: March 2003

BACKGROUND: While immune globulins for intravenous administration (IGIV) have an excellent record with respect to virus safety, concern regarding these preparations has been raised by reports of transmission of hepatitis C virus (HCV) to patients treated with IGIV and the presence of genetic material for HCV in IGIV preparations.STUDY DESIGN AND METHODS: This in vitro study evaluated the effectiveness of several manufacturing steps, including ethanol precipitation and pasteurization, in reducing HIV and model viruses including encephalomyocarditis (EMC) virus, pseudorabies virus (PRV), bovine viral diarrhea virus (BVDV), Sindbis virus, vaccinia virus, and vesicular stomatitis virus (VSV), as well as HCV RNA, in IGIV.RESULTS: Ethanol precipitation carried out after pasteurization resulted in virus reductions (log10) of >3.97 for HIV, 1.95 for EMC virus, >5.39 for PRV, and 3.52 for BVDV. Pasteurization inactivated EMC virus by 4.52 log10 and resulted in a log10reduction of >6.54 for HIV, >5.39 for PRV, >6.64 for BVDV, >7.78 for Sindbis virus, >5.84 for vaccinia virus, and >6.99 for VSV. All viruses except EMC virus were reduced below the limit of detection within 6 hours of the beginning of pasteurization. Cohn processing of Fraction II + III paste and the 4.5‐percent alcohol precipitation step prior to pasteurization provided additional virus removal. Studies using the polymerase chain reaction technique found that HCV RNA was detectable in the starting fraction of Cohn Fraction II paste, but not in the final IGIV preparation.CONCLUSION: These findings strongly support the viral safety of IGIV prepared by this method and show a significant added measure of virus safety associated with pasteurization of this preparation.
Distinguishing immunosilent AIDS from the acute retroviral syndrome in a frequent blood donor
Authors: Kopko Patricia M. , Calhoun Loni , Petz Lawrence D. 
Published: March 2003

BACKGROUND: There are seven reports of “immunosilent AIDS” in which there was a lack of development of anti‐HIV for more than 6 months. Thus, when a frequent blood donor presented with clinical findings highly suggestive of overt AIDS, there was concern that he may have had a prolonged immunosilent infection.CASE REPORT: A 24‐year‐old man who had donated blood six times in the previous year was diagnosed as having AIDS; he presented with fever, nausea, vomiting, diarrhea, weight loss, and oral candidiasis. The anti‐HIV enzyme immunoassay was positive, the Western blot was indeterminate (gp160 only), the CD4+ count was 174 per mL, the HIV polymerase chain reaction was positive (2.8 × 106 copies/mL), and the HIV p24 antigen assay was positive. Twelve components from previous donations had been transfused, and 2 units of fresh‐frozen plasma were still in inventory. Repeat donor testing 57 days after donation indicated seroconversion with a positive anti‐HIV enzyme immunoassay, a positive Western blot, a negative HIV p24 antigen assay, and a positive test for HIV by polymerase chain reaction (89,000 copies/mL). Both units of fresh‐frozen plasma tested negative for HIV by polymerase chain reaction. Four transfusion recipients had died, and the remaining eight are anti‐HIV negative with >6 months' follow‐up.CONCLUSION: The donor had an unusually severe acute retroviral syndrome and presented with findings that were difficult to distinguish from overt AIDS.
The value of oxygen‐carrying solutions in the operative setting, as determined by mathematical modeling
Authors: Brecher Mark E. , Goodnough Lawrence T. , Monk Terri 
Published: March 2003

BACKGROUND: The use of oxygen carriers (red cell [RBC] substitutes) in acute trauma and in surgery, with or without the use of acute normovolemic hemodilution (ANH), is being investigated. Mathematical modeling was used to assess the impact of RBC substitutes, with or without ANH, in the elective surgical setting.STUDY DESIGN AND METHODS: Mathematical equations and computer models were developed on the basis of previously described mathematical principles, for better understanding of the potential efficacy of RBC substitutes for blood needs with or without ANH. Savings were calculated for a patient with a blood volume of 5000 mL and an initial hematocrit (Hct) of 45 or 30 percent.RESULTS: Substantial increases in the tolerable blood losses (or reduced allogeneic RBC needs) were most evident when the use of an RBC substitute to achieve severe ANH to a Hct that the patient might not otherwise have been able to tolerate was combined with the use of RBC substitutes as replacement for the surgical blood subsequently lost. However, the benefit was greatly dependent on the patient's initial Hct. For example, for a patient with a blood volume of 5000 mL and an initial Hct of 45 percent, a blood loss of approximately 2500 mL resulted in a final Hct of 28 percent without the use of an RBC substitute or ANH. In contrast, with the combined use of staged ANH with an RBC substitute and the RBC substitute for lost surgical blood, a blood loss of up to 14.5 L could be tolerated. However, in an anemic patient (blood volume 5000 mL, initial Hct 30%), a Hct of 28 percent cannot be sustained without the use of allogeneic RBCs for any of the described strategies, even when blood losses were as low as 1 L.CONCLUSION: The use of RBC substitutes has the potential to result in a substantial reduction in allogeneic RBC exposure. This benefit is essentially limited to the nonanemic patient when the use of an RBC substitute is combined with severe ANH and there is concomitant large perioperative blood loss. Anemic patients can be expected to have only limited benefit, because of an inability to sequester an adequate volume of autologous RBCs via ANH.
Immune hemolytic anemia induced by 6‐mercaptopurine
Authors: Pujol M. , Fernández F. , Sancho J.M. , Ribera J.M. , Millá F. , Feliu E. 
Published: March 2003

BACKGROUND: Myelosuppression is the main hematotoxic effect of 6‐mercaptopurine (6‐MP), which is an antimetabolite chemotherapy drug. Immune hemolytic anemia associated with this drug has not been previously reported.CASE REPORT: A 67‐year‐old man with chronic myelomonocytic leukemia presented with anemia 2 weeks after 6‐MP therapy had been initiated. Additional tests provided laboratory evidence of hemolysis. When treatment was stopped, the patient's condition and laboratory results showed a progressive improvement.RESULTS: The direct antiglobulin test was positive for IgG. The eluate and the serum were not reactive with panel red cells but reacted with 6‐MP‐treated red cells, while the normal serum pool was unreactive. The direct antiglobulin test was no longer positive by 20 days after the cessation of 6‐MP therapy.CONCLUSION: This drug, 6‐MP, should be added to the list of drugs that have been reported to cause immune hemolytic anemia by means of the so‐called hapten mechanism.
Neutrophil antigen 5b is carried by a protein, migrating from 70 to 95 kDa, and may be involved in neonatal alloimmune neutropenia
Authors: De Haas M. , Muniz‐Diaz E. , Alonso L.G. , Van Der Kolk K. , Kos M. , Buddelmeijer L. , Porcelijn L. , Von Dem Borne A.E.G.Kr. 
Published: March 2003

BACKGROUND: Neutrophil antigen 5b has been described as involved in transfusion reactions and not in neonatal alloimmune neutropenia.CASE REPORT: Anti‐5b was found in the serum of a mother of a persistently neutropenic newborn, who had several bacterial infections. The neutropenia responded to treatment with recombinant human granulocyte–colony‐stimulating factor. Immunoprecipitation experiments performed with this and three other 5b antisera identified a protein, migrating from 70 to 95 kDa, as carrier of 5b. The observed pattern of migration may point to heavy glycosylation of this protein.RESULTS: Six 5b‐negative donors were identified among 54 screened white donors, for a 5b gene frequency of 0.66.CONCLUSION: Alloimmunization to 5b in pregnancy is rare. In the patients with neonatal neutropenia analyzed in the last decade, this was the first case discovered.