bluuebunny/crossref_metadata_2025_split huggingface dataset:
A cost analysis comparing erythropoietin and red cell transfusions in the treatment of anemia of prematurity
Authors: Fain J. , Hilsenrath P. , Widness J.A. , Strauss R.G. , Mutnick A.H. 
Published: March 2003

BACKGROUND: Anemia of prematurity is invariably observed in very low birth weight infants and may become symptomatic enough to be treated with packed red cell transfusions. Recently, treatment of this condition with recombinant human erythropoietin has been advocated.STUDY DESIGN AND METHODS: To compare the costs of training symptomatic anemia in hospitalized premature infants with transfusions alone or with erythropoietin plus red cell transfusions as needed, cost estimates were derived from local hospital and published cost data. Decision analysis and sensitivity analysis were applied to a “base case.” The base case was derived from results of a multicenter erythropoietin trial in the United States in which premature infants received 500 U of erythropoietin per kg of body weight each week. Because erythropoietin treatment began on average at 3 weeks of life, when infants were clinically stable, they had already received 3.5 red cell transfusions. During the 6‐week treatment period, erythropoietin‐ treated infants received significantly fewer additional transfusions: a mean of 1.6 versus 1.1.RESULTS: The base‐case cost in 1993 dollars for treating anemia in hospitalized premature infants with erythropoietin and transfusions was $1,326. This was nearly twice the cost of conventional treatment with transfusions alone ($721). If the 6‐week treatment period alone is considered, erythropoietin is 3.6 times more costly: $840 versus $235.CONCLUSION: The largest available US study using erythropoietin to treat anemia in premature infants has demonstrated a small, but significant, reduction in transfusion needs. However, this study's cost data alone do not justify the widespread use of erythropoietin in premature infants. When this issue is probed in great depth, sensitivity analyses demonstrate that major reductions in erythropoietin's cost and/or improvements in its effectiveness quite possibly will make its use economically more attractive.
Spontaneous resolution of transfusion‐associated graft‐versus‐host disease
Authors: Mori S. , Matsushita H. , Ozaki K. , Ishida A. , Tokuhira M. , Nakajima H. , Kizaki M. , Sugiura H. , Kikuchi A. , Handa M. , Kawai Y. , Yamamori S. , Ikeda Y. 
Published: March 2003

BACKGROUND: Transfusion‐associated graft‐versus‐host disease (TA‐GVHD) is a serious complication of blood transfusion that is characterized by high fever, a scaly maculopapular erythematous rash, diarrhea, hepatocellular damage with marked elevation of liver function test values, and pancytopenia. It can occur in immunocompetent as well as immunocompromised recipients. The existence of atypical TA‐GVHD that resolves spontaneously and does not exhibit all of the manifestations has been suggested, but there has been to date no documented diagnosis of GVHD supported by evidence of engraftment.CASE REPORT: A female patient presented and was diagnosed with acute myelogenous leukemia (AML:M4), and, after unsuccessful combination chemotherapy, she received a transfusion and developed manifestation of TA‐GVHD as well as evidence of chimerism. TA‐GVHD was proved by demonstrating Y chromosome‐specific genes in the skin by polymerase chain reaction. The manifestations of clinical GVHD abated within 4 months.CONCLUSION: Polymerase chain reaction analysis of Y chromosomes in specimens from female patients is useful in the diagnosis of suspected cases of spontaneously resolving TA‐GVHD.
How much would the safety of blood transfusion be improved by including p24 antigen in the battery of tests?
Authors: le Pont F. , Costagliola D. , Rouzioux C. , Valleron A. J. 
Published: March 2003

BACKGROUND: Because p24 antigen may be detectable during seroconversion, before antibodies, some of the infected blood undetected by antibody screening could be identified through antigen screening.STUDY DESIGN AND METHODS: The potential benefit of antigen screening was evaluated in a simulation model incorporating present knowledge of the time sequence from antigen exposure to antibody development during seroconversion and the incidence of seroconversion among repeat donors. The model was designed so that the results were consistent with the observed rate of antibody‐positive blood donations and the CIs of surveys that did not find any antibody‐negative/antigen‐ positive donated blood.RESULTS: In the United States in 1990, the number of expected, undetected, contaminated blood components was estimated at 68; of these 8 to 17 could have been identified by antigen screening, depending on the hypothesis explored. (In 1992, 20 undetected, contaminated blood components were expected according to this model, of which 2 to 5 could have been identified by antigen screening.) In France, the comparable figures were 1 to 4 of 13 in 1990 and 1 to 2 of 7 in 1992.CONCLUSION: The projected benefit must be weighted against possible negative consequences, including 1) an increase in recently infected persons seeking p24 antigen screening at blood banks (assuming this test is not incorporated into screening in non‐blood bank settings) and 2) the need for additional quality assurance procedures to avoid operational flaws associated with the increase in the donor screening test battery. In any case, the best way of increasing the safety of blood is improvement in the selection of donors, which can diminish the residual risk of transmission of any viruses.
Transfusion of donor‐type red cells as a single preparative treatment for bone marrow transplants with major ABO incompatibility
Authors: Nussbaumer W. , Schwaighofer H. , Gratwohl A. , Kilga S. , Schönitzer D. , Nachbaur D. , Niederwieser D. 
Published: March 2003

BACKGROUND: Major ABO incompatibility of a bone marrow donor and recipient entails the risk of severe hemolytic transfusion reactions.STUDY DESIGN AND METHODS: Nineteen patients who received transplants of bone marrow from donors whose ABO type was a major mismatch with the recipients were treated with plasma exchanges transfusion (n = 7) or donor‐type red cell transfusion (n = 12) to remove isoagglutinins from the recipient. Efficacy, side effects, engraftment, and transfusion requirements were analyzed for the two treatment groups.RESULTS: Both treatment methods were well tolerated, were of comparable efficacy in removing ABO antibodies, and did not affect the engraftment of platelets, red cells, or white cells. Except for observations in one patient, whose renal function was already impaired before red cell treatment and who developed reversible renal failure after transplant, no significant differences in serum creatinine levels were observed in the two groups after treatment. Only serum levels of lactate dehydrogenase measured, as a sign of hemolysis, on Day 0 (488 +/− 110 vs. 191 +/− 30 U/L in the red cell and plasma exchange groups, respectively, p < 0.05) were higher in the red cell group than in the plasma exchange group.CONCLUSION: Transfusion of donor‐type red cells is an effective means of preventing hemolytic reactions in patients who receive marrow transplants from donors whose ABO type is a major mismatch. It is technically simple and well tolerated, even in patients with high‐titer isoagglutinins, but it should be avoided in patients with abnormal renal function.
Serum hepatitis C virus (HCV) RNA: a reliable tool for evaluating HCV‐ related liver disease in anti‐HCV‐positive blood donors with persistently normal alanine aminotransferase values
Authors: Nalpas B. , Romeo R. , Pol S. , Thiers V. , Carnot F. , Berthelot P. , Brechot C. 
Published: March 2003

BACKGROUND: The significance of hepatitis C virus (HCV) antibodies in blood donors with persistently normal alanine aminotransferase (ALT) levels requires evaluation.STUDY DESIGN AND METHODS: The serum and the liver were assayed for HCV RNA. Liver histology was analyzed in 14 HCV‐ positive subjects who had repeatedly normal ALT values over a follow‐up period of at least 3 months.RESULTS: HCV RNA was not detected in liver and serum, and liver histology showed minimal changes in more than one‐ half of the subjects (8/14), even if third‐generation recombinant immunoblot assay was positive; this demonstrated that HCV can be eradicated spontaneously. Moderately histopathological liver lesions were usually found in HCV RNA‐positive subjects (6/14), but one subject had active disease that required interferon therapy; this shows that chronic hepatitis may be present in HCV‐positive individuals despite repeatedly normal transaminase values. HCV genotypes other than 1b (II) were usually identified, and the presence or absence of serum and liver HCV RNA correlated completely in all 14 patients.CONCLUSION: Serum HCV RNA should be assayed in those HCV‐positive donors having repeatedly normal transaminase activity; if it is positive, indicating an ongoing HCV infection, a liver biopsy should be performed to measure the degree of the liver disease and determine the appropriate antiviral therapy.
Red cell compatibility testing in baboon xenotransplantation
Authors: Triulzi D.J. , Jochum E.E. 
Published: March 2003

BACKGROUND: Although baboon ABO group and human anti‐baboon heteroagglutinin (HA) titers have been considered in the selection of baboon donors for clinical hepatic xenotransplantation, the biologic role of these antibodies is not yet known. However, because of the potential importance of ABO hemagglutinins, a method for baboon ABO group determination is described, as are the titers of HA observed in both baboons and normal human donors.STUDY DESIGN AND METHODS: The ABO group of 62 baboons was determined by modified reverse typing. Baboon sera were heated and absorbed with human group O red cells. Reverse typing was then performed by standard techniques. HA titers at room temperature (RT) and in the antiglobulin test (AGT) were assessed in 10 baboons by using human red cells and in 33 normal donors by using baboon red cells.RESULTS: Ten (16%) baboons were group A, 29 (47%) were group B, 23 (37%) were group AB, and none were group O. In tests using human group O red cells, HA titers in 10 baboons ranged from 1 to 32 at RT and from negative to 64 in the AGT. All 33 normal human sera contained anti‐baboon HA. Under a hemagglutination scoring system, group A persons had the lowest HA scores (17 +/− 15 at RT, 31 +/− 19 in the AGT), and group B persons had the highest HA scores (67 +/− 4 at RT, 85 +/− 9 in the AGT).CONCLUSION: Baboon ABO group can be easily determined by modified reverse serum typing. Both baboons and humans possess HAs of variable titer. Among humans, titers appear to be highest in group B individuals and lowest in group A. Additional studies are needed to determine the clinical significance of these antibodies.
Interviews of individuals diagnosed as anti‐human immunodeficiency virus‐positive through the screening of blood donations in the Paris area to 1994: reflections on the selection of blood donors
Authors: Lefrère J.‐J. , Elghouzzi M.‐H. , Salpétrier J. , Duc A. , Dupuy‐Montbrun M.‐C. 
Published: March 2003

BACKGROUND: One of the aims of the medical interview routinely preceding each blood donation is the identification of individuals with a risk factor for infection with the human immunodeficiency virus (HIV).STUDY DESIGN and METHODS: Interviews were performed with individuals diagnosed as being seropositive for HIV through the systematic biologic screening of blood donations in the Paris area to establish, first, the circumstances allowing HIV‐seropositive individuals to pass through the predonation medical interview and, second, the motivation of these individuals as blood donors. Risk factors of 30 HIV‐infected donors identified between 1991 and 1994 were determined.RESULTS: When asked whether they recognized the eventual risk to recipients of donated blood, 14 (47%) of 30 answered positively. Fifteen (50%) admitted having given their blood to determine their HIV status.CONCLUSION: These individuals did not exclude themselves from blood donation and probably hid their risk factor(s) at the predonation interview in order to be accepted as blood donors.
Transfusion patterns in pediatric open heart surgery
Authors: Chambers L. A. , Cohen D. M. , Davis J. T. 
Published: March 2003

BACKGROUND: Transfusions in pediatric open heart surgery were analyzed to determine the percentage of patients transfused, the types and volumes of blood components used, and the relationships among transfusions, patient characteristics, surgeon, and surgical procedure.STUDY DESIGN and METHODS: In a 9‐month period, 122 patients, aged 12 or less (median, 1 year; 31% <4 months old), underwent 126 procedures (37 routine, 60 complex, 29 repeat operations). Bypass circuit size and priming solution, target intraoperative hematocrit, heparinization, protamine reversal, and transfusion indications and doses were standardized. The number of full “adult” units of packed red cells (RBCs), units of fresh‐frozen plasma (FFP), and platelet concentrates (PCs) transfused in the operating room through postoperative Day 3 were tabulated.RESULTS: RBCs, FFPs, and PCs were transfused in 98, 54, and 58 percent of cases, respectively. Twenty‐two percent of components were transfused postoperatively. The average numbers of components transfused for complex procedures (3.4 RBCs, 6.1 total) and repeat operations (4.0 RBCs, 8.1 total) were greater than those for routine procedures (1.8 RBCs, 2.1 total) (p<0.01). The average total number of components transfused did not correlate with surgeon or patient age; patients <4 months old used the largest mean numbers of RBCs and total components of all types. For four procedures, preoperative crossmatch and directed‐donation collection orders that would be expected to produce acceptable utilization rates and a <15‐percent chance of needing additional components were determined.CONCLUSION: Blood order protocols for pediatric open heart surgery can be procedure‐specific, should address the use of non‐red cell components, and should cover early postoperative transfusions.
Parvovirus B19 infection in patients with hemophilia
Authors: Ragni M.V. , Koch W.C. , Jordan J.A. 
Published: March 2003

Background: The long‐term consequences of parvovirus B19 infection in transfusion recipients are not known, and thus the value of B19 screening of blood donors remains unresolved. Hemophiliacs, at risk for B19 through their chronic exposure to clotting factor concentrates, have frequent, close medical follow‐up and thereby constitute an ideal group in which to study the hematologic sequelae of B19 infection.Study Design and Methods: An enzyme‐linked immunosorbent assay was used to detect B19 IgG and IgM and the polymerase chain reaction was used to detect B19 DNA in frozen, stored plasma samples, obtained between 1987 and 1994, from 136 subjects with hemophilia, including 71 who were human immunodeficiency virus (HIV)‐positive and 65 who were HIV‐ negative. Then the results of the tests were compared with clinical hematological data and blood product usage data.Results: B19 seroprevalence in the hemophilic cohort was 81.6 percent (111/136), including 74.6 percent (53/71) of HIV‐positive and 89.2 percent (58/65) of HIV‐negative hemophiliacs. It was not affected by age, type or severity of hemophilia, HIV status, CD4 number, or yearly blood product usage. Only 1 (0.7%) of the 136 samples was positive for B19 IgM and none was positive in polymerase chain reaction for B19 DNA. After adjusting for HIV status, there were no differences between B19‐ positive and B19‐negative hemophiliacs in hematologic values, CD4 counts, or blood product use.Conclusion: Although B19 IgG seroprevalence in this hemophilic cohort is high and indicative of past B19 infection, there is no detectable B19 viral activity or any associated long‐term clinical or hematologic sequelae.
Sensitivity and specificity of four assays to detect human T− lymphotropic virus type I or type I/II antibodies
Authors: Vrielink H. , Reesink H.W. , Zaaijer H.L. , Poel C.L. van der , Cuypers H.T.M. , Lelie P.N. 
Published: March 2003

Background: Assays that detect human T‐lymphotropic virus type I and type II antibody (HTLV‐I/II) are widely used in the routine screening of blood donors.Study Design and Methods: Four commercially available anti‐HTLV‐I (Fujirebio and Organon Teknika) or ‐HTLV‐I/II assays (Murex and Ortho) were evaluated in various serum panels: A) HTLV‐I‐positive specimens (n = 41), confirmed by Western blot and polymerase chain reaction; B) a commercially available anti‐HTLV‐I/II panel; C) serial dilutions of sera from HTLV‐I‐positive individuals (n = 30), confirmed by immunofluorescence assay and Western blot: D) serial dilutions of HTLV‐II‐positive blood donors (n = 20), confirmed by Western blot and polymerase chain reaction, and E) sera from first‐time blood donors (n = 1055).Results: All four assays elicited reactions in all 82 HTLV‐I‐ positive samples in Panels A, B, and C. Of 32 HTLV‐II‐positive specimens in Panels B and D, 31 (96.9%) reacted in the Organon Teknika assay and all 32 reacted in the remaining tests. Probit analysis of test results in Panels C and D indicated that the Fujirebio test was the most sensitive assay, followed by Organon Teknika, Ortho, and Murex. The specificities of Fujirebio, Murex, Organon Teknika, and Ortho tests in 1055 first‐time blood donors were 99.9, 100, 99.6, and 99.9 percent, respectively.Conclusion: All four studied assays for detecting HTLV‐I or HTLV‐I/II antibodies are appropriate as screening tests.
Fatal hemolytic transfusion reaction resulting from ABO mistyping of a patient with acquired B antigen detectable only by some monoclonal anti‐ B reagents
Authors: Garratty G. , Arndt P. , Co A. , Rodberg K. , Furmanski M. 
Published: March 2003

Background: Some monoclonal anti‐B reagents are prepared exclusively from an anti‐B clone, ES4, that is known to detect acquired B antigens that are not detectable by other anti‐B clones or polyclonal anti‐B reagents.Case Report: A 92‐year‐old group A, Rh‐negative man with diverticulitis was mistyped as group AB with the use of a monoclonal anti‐B. The hospital did not detect anti‐B in the patient's serum. After a negative antibody screen, blood was issued through an abbreviated crossmatch (i.e., immediate‐spin crossmatch). The patient was given 3 units of group AB blood and 1 unit of group A blood, and no problems were reported. After the transfusion of a inverted question markfourth unit of AB blood the patient had a severe hemolytic transfusion reaction which resulted in kidney failure and death 10 days later. After the transfusion reaction, the patient's pretransfusion red cells were found to be group A with an acquired B antigen. The monoclonal anti‐B used the hospital was formulated from the ES4 clone. A sample of the patient's serum taken before the transfusion was later found to contain a weak anti‐B, detectable most obviously by the antiglobulin test, which was not performed at the crossmatch stage. The manufacturers of monoclonal anti‐B reagents prepared from ES4 have since modified their reagents (i.e., lowered the pH) so that they now detect only the strongest examples of acquired B antigen.Conclusion: A fatal hemolytic transfusion reaction resulted because a monoclonal anti‐ B that detected acquired B antigen was used to type red cells from an elderly man whose serum had weak anti‐B that was not detected by abbreviated compatibility testing.
Data on apheresis, blood collection, and transfusion‐related activities: statistical analyses of the American Association of Blood Banks institutional membership questionnaires
Authors: Devine P. , Goldstein R. , Linden J.V. , Postoway N. , Hoffstadter L.K. , Hines D.M. 
Published: March 2003

Background: The American Association of Blood Banks annually surveys institutional members on activities pertinent to blood collections, apheresis, and transfusions.Study Design and Methods: Retrospective descriptive statistics and comparative statistical analyses including trend tests were performed on selected topics from the 1989, 1990, and 1991 Institutional Questionnaires. The data were compiled by institution type, namely, regional and community blood donor collection centers and hospital‐based facilities. Evaluated topics included the apheresis and therapeutic procedures performed, transfusion‐associated AIDS and hepatitis, and the blood components (red cells, platelets, fresh‐frozen plasma, and cryoprecipitate) that were collected, transfused, or outdated or discarded.Results: Significant findings (p<0.05) included upward trends over time in the numbers of donor plateletpheresis units collected and transfused and in the numbers of random‐donor platelet concentrates collected by hospitals. There was an upward trend over time in the outdating or discarding of all blood component types that was reported by hospitals. Data from blood centers showed the outdating or discarding of significant numbers of apheresis platelets, fresh‐frozen plasma, and cryoprecipitate. No significant trends were identified in the reported cases of transfusion‐associated hepatitis or AIDS.Conclusion: Ongoing data analysis of the institutional questionnaires provides information on trends in blood collection and transfusion‐related activities.
The red cell chemokine receptor is distinct from the Fy6 epitope
Authors: Hausman E. , Dzik W. , Blanchard D. 
Published: March 2003

BACKGROUND. Previous studies established an association between the red cell chemokine receptor and Fy6 of the Duffy glycoprotein. The relationship between Duffy system antigens and interleukin 8 binding by red cells was examined.STUDY DESIGN AND METHODS. Interleukin 8 adsorption was measured by using red cells from owl, squirrel, and rhesus monkeys, and human red cells before and after saturation with anti‐Fya (anti‐Fy1), anti‐Fyb (anti‐Fy2), or anti‐Fy6. The effect of cell saturation with interleukin 8 on Duffy system antigen expression and the effect of enzyme treatment on interleukin 8 adsorption were also examined. RESULTS. Fy:1,‐2,6 or Fy:‐1,2,6 (owl monkey, squirrel monkey, human) red cells adsorbed interleukin 8 over a wide range of concentrations (125–1000 pg/mL). Human Fy:‐1,‐2,‐6 red cells bound minimal interleukin 8. Human red cells saturated with corresponding antibodies displayed decreased interleukin 8 binding. Saturation of human cells with interleukin 8 failed to interfere with Duffy system antigen expression. Rhesus monkey cells lacking Fy1, Fy2, and Fy6 were able to adsorb interleukin 8 in a manner similar to Fy:1,‐2,6 or Fy:‐ 1,2,6 primate cells. Ficin treatment eliminated both Duffy system antigen expression and interleukin 8 adsorption from red cells.CONCLUSIONS. The Duffy glycoprotein binds interleukin 8. Although previous studies suggested that interleukin 8 bound either directly to or close to the Fy6 epitope, the ability of Fy:‐1,‐2,‐6 rhesus monkey cells to adsorb interleukin 8 suggests that the interleukin 8 receptor is distinct from Fy6, Fy1, and Fy2.