bluuebunny/crossref_metadata_2025_split huggingface dataset:
Perioperative blood transfusion and cancer recurrence: meta‐analysis for explanation
Authors: Vamvakas E.C. 
Published: March 2003

BACKGROUND: Meta‐analysis was used to explain disagreements across observational studies in regard to the association between perioperative transfusion and cancer recurrence.STUDY DESIGN AND METHODS: Observational studies published in English from 1982 through 1994 were retrieved. Five or more articles published in complete form were identified for each of six cancer sites: colorectum, breast, head and neck, lung, prostate, and stomach. Necessary information for building a 2 × 2 contingency table could be extracted from 60 studies. Summary relative risks (RR) reflecting the “average” adverse transfusion effect were computed for each cancer site by the random‐ effects method. Seven study characteristics were examined as potential explanations for the disagreements among the published studies.RESULTS: Before any adjustment for the effect of confounding, computed crude summary RRs suggested a significant (p < 0.05) deleterious transfusion effect in all cancer sites, except for breast. The RR of an adverse outcome was 1.49 in colorectal cancer (95% CI, 1.23‐1.79) and ranged from 1.06 in breast cancers to 3.62 in head and neck cancers. The disagreements among published studies were most marked in the case of colorectal and gastric cancers. These discrepancies could be explained, in part, by study design, because prospective investigations had not produced a significant unadjusted transfusion effect (RR = 1.18; 95% CI, 0.93‐1.51 in the case of colorectal cancer).CONCLUSION: A reduction in the size of the computed unadjusted transfusion effect (of an appropriate magnitude to adjust for the effect of confounding) might eliminate the significance of the average adverse effect in most studied cancer sites. Whether the entire unadjusted transfusion effect should be ascribed to the effect of confounding or whether a true, deleterious transfusion effect also exists can be resolved only by randomized controlled trials.
A multicenter inspection of the swirling phenomenon in platelet concentrates prepared in routine practice
Authors: Bertolini F. , Murphy S. ,   Biomedical Excellence for Safer Transfusion (BEST) Working Party of the International Society of Blood Transfusion
Published: March 2003

BACKGROUND: In a previous multicenter study, the absence of the swirling phenomenon correlated well with platelet disc‐to‐sphere transformation, a morphology feature associated in the past with poor platelet viability.STUDY DESIGN and METHODS: In 13 centers, 5366 platelet concentrates (PCs) were prepared and stored under routine conditions and evaluated for the presence of swirling. PCs found not to have swirling were evaluated for pH and platelet and white cell counts in parallel with an equal number of PCs with swirling that were studied as controls.RESULTS: In 13 participating centers, swirling was reported to be absent after 3 and 5 days of storage in 0 to 3.8 percent and in 0 to 18 percent of PCs, respectively. In 94 percent of units with swirling, pH was 6.7 to 7.5; this is a range of values associated with adequate in vivo survival. In 69 percent of PCs without swirling, pH was lower than 6.4 or higher than 7.6; these values are associated with reduced platelet viability. Three‐quarters of the cases in which the absence of swirling was associated with pH values between 6.7 and 7.5 were reported from 2 out of the 13 participating centers.CONCLUSION: In PCs prepared and stored under routine conditions, the presence of swirling correlated well with pH values associated with adequate platelet in vivo viability. In about 20 percent of PCs without swirling, this was not due to a low or high pH value, and it would be useful to investigate whether this lack of swirling is associated with poor platelet viability. These data support the possibility that the evaluation of swirling by visual inspection might replace invasive and more cumbersome assays currently used for routine PC quality control.
Transmission of human immunodeficiency virus through blood transfusion: the use of lookback and traceback approaches to optimize recipient identification in a regional population
Authors: Gill M.J. , Towns D. , Allaire S. , Meyers G. 
Published: March 2003

BACKGROUND: The purpose of this study was to define the epidemiologic features of the transmission of human immunodeficiency virus (HIV) by blood transfusion in a region of Canada between 1980 and 1985 and the results of intensive recipient‐identification practices.STUDY DESIGN AND METHODS: Lookback (notification of all recipients of blood from an HIV‐infected donor) and traceback (identification of the HIV‐infected source donor, after an HIV‐infected recipient of blood cites transfusion as a risk for infection) programs were established linking (with patient consent) a transfusion service and an HIV clinic to identify HIV‐infected donors and the recipients of their blood.RESULTS: Twenty‐two cases of documented HIV infection and 26 cases of presumed infection were found in local blood recipients. Twenty‐eight recipients have died of causes unrelated to HIV. Twelve recipients have developed AIDS. Six of the seven living recipients have yet to develop an AIDS condition. These 48 infections have been linked to 11 donors who have subsequently tested positive for HIV infection. Six donors were found on subsequent blood donation. Five donors were found by traceback.CONCLUSION: Forty‐eight recipients of blood from donors who subsequently tested positive for HIV were identified in a low‐ prevalence area. Active lookback and traceback programs linking a transfusion service and an HIV clinic were successful in identifying infected recipients.
Relationship of the time of storage and transfusion reactions to platelet concentrates from buffy coats
Authors: Riccardi D. , Raspollini E. , Rebulla P. , Pappalettera M. , Marangoni F. , Greppi N. , Sirchia G. 
Published: March 2003

BACKGROUND: Transfusion reactions to platelet concentrates prepared from buffy coats (BC‐PCs) were reviewed to determine the effect of some variables of BC‐PC preparation and storage: time of BC storage before BC‐PC preparation (1–2 days); time of BC‐PC storage before transfusion (1–5 days); no white cell reduction versus laboratory and bedside BC‐PC white cell reduction.STUDY DESIGN AND METHODS: A multiple linear logistic regression model was used by which the relative effect of one variable is expressed as the relative risk of transfusion reaction against a baseline level (1‐day storage, no white cell reduction).RESULTS: During the 14 months of study, a total of 2707 BC‐PC transfusions were given to 192 patients; 37 reactions (1.4%) were reported in 25 patients (13%). The transfusion reactions were febrile, nonhemolytic in 23 cases; allergic in 5; febrile and allergic in 2; and other in 7. The relative risk of transfusion reaction to BC‐PCs prepared from BCs stored for 2 days was 1.98 times that to BC‐PCs prepared from BCs stored for 1 day (p = 0.07). The relative risk of transfusion reaction of 5‐day‐old BC‐PCs was 10.7 times that of 1‐day‐ old BC‐PCs (p = 0.001). The relative risk of transfusion reactions of BC‐PCs white cell‐reduced in the laboratory and at the bedside were 0.65 (p = 0.3) and 1.87 (p = 0.1) times, respectively, that of non‐ white cell‐reduced BC‐PCs.CONCLUSION: Time of storage seems to be an important variable associated with BC‐PC transfusion reaction.
Thrombotic thrombocytopenic purpura that is refractory to therapeutic plasma exchange in two patients with occult infection
Authors: Creager A.J. , Brecher M. E. , Bandarenko N. 
Published: March 2003

BACKGROUND: The etiology of thrombotic thrombocytopenic purpura (TTP) remains undetermined. TTP has been associated with a number of secondary causes including infections, drugs, menses, pregnancy, autoimmune diseases, and bone marrow transplantation. Regardless of the inciting factors, it is widely accepted that endothelial injury and platelet aggregation are integral components. The morbidity and mortality have been significantly reduced with the use of plasmapheresis. However, refractory forms of TTP remain a clinical management challenge. Refractory TTP has not previously been associated with occult bacterial infection.CASE REPORT: Two patients had classic TTP that was refractory to daily plasma exchange with fresh‐frozen plasma. Multiple attempts over a period of months to wean these patients off plasma exchange resulted in exacerbations of disease activity, as indicated by increased schistocytosis, decreased hematocrit, increased serum lactate dehydrogenase, and decreased platelet counts. Both patients were empirically treated for infections during hospitalization, although microbial cultures failed to isolate an organism. Discontinuation of antimicrobial therapy on multiple occasions in one patient was associated with recurrence of disease. In the other patient, dental extraction with drainage of an occult periodontal abscess resulted in sustained remission of disease.CONCLUSION: Occult bacterial infection may play a role in triggering and sustaining TTP that is refractory to conventional treatment. A careful search for such an infection and appropriate antimicrobial therapy should be considered in the management of these patients.
The transfusion needs of an autologous bonemarrow transplant patient with IgA deficiency
Authors: Meena‐Leist C.E. , Fleming D.R. , Heye M. , Herzig R.H. 
Published: March 2003

BACKGROUND: Transfusion management of the patient who is undergoing a marrow or peripheral blood stem and progenitor cell transplantation is often challenging. The situation is further complicated when the patient is IgA deficient with circulating anti‐IgA.CASE REPORT: This report describes an approach to transfusion therapy primarily using red cells washed by automated techniques and cryopreserved autologous plateletpheresis components. Additional platelet support was provided with manually washed allogeneic plateletpheresis components. Autologous fresh‐frozen plasma was collected concurrently, and IgA‐deficient allogeneic units were ordered and kept in storage, but they were not needed during transplantation. The patient experienced no transfusion sequelae as a result of the IgA deficiency.CONCLUSION: With this approach, the transfusion needs of an IgA‐deficient patient were adequately met during bone marrow transplantation.
Storage of whole blood before separation: the effect of temperature on red cell 2,3 DPG and the accumulation of  lactate
Authors: Högman C.F. , Knutson F. , Lööf H. 
Published: March 2003

BACKGROUND: Although whole blood intended for component preparation is commonly left to cool at ambient temperature, knowledge is insufficient as to the effects this may have on red cell quality, in particular after a prolonged hold.STUDY DESIGN AND METHODS: Whole blood collected in ACD‐A (7% wt/wt) and CPD (12% wt/wt) was incubated at 4, 10, 15, 20, 25, and 30°C for 24 hours. Blood gases, pH, bicarbonate, glucose, lactate, and red cell 2,3 DPG were investigated.RESULTS: When the blood was stored at 30°C, the 2,3 DPG concentration decreased within 4 hours from 858 ± 106 to 316 ± 172 mmol per mol of hemoglobin (a 63% decrease); 99 percent was lost within 18 hours. At 25°C, 46 percent was lost within 4 hours and 94 percent within 18 hours; at 20°C, the decrease at 18 hours was 62 percent and that at 15°C was 24 percent. No loss of 2,3 DPG was observed at 4°C and 10°C storage. No difference was attributable to the anticoagulant used. After 24 hours, the lactate concentration at 15°C was 2.9 times the original, that at 20°C was 3.8 times the original, that at 25°C was 7.0 times, and that at 30°C was 9.2 times.CONCLUSIONS: With current anticoagulants, storage of whole blood at temperatures of 25 to 30°C before separation causes a great and rapid loss of 2,3 DPG and an accumulation of acid metabolites. In a hold of blood for >4 hours, rapid cooling is desirable to avoid initial loss of 2,3 DPG.
Comparative evaluation of 14 immunoassays for detection of antibodies to the human T‐lymphotropic virus types I and II using panels of sera from Sweden and West Africa
Authors: Andersson S. , Thorstensson R. , Ramirez K. Godoy , Krook A. , Von Sydow M. , Dias F. , Biberfeld G. 
Published: March 2003

BACKGROUND: A new generation of assays for the detection of human T‐lymphotropic virus types I and II (HTLV‐I/II) antibodies has been released. These assays incorporate HTLV‐I‐ and HTLV‐II‐specific antigens, and some are based on new assay principles. Comparative evaluation data that include these new as well as previous assays are limited.STUDY DESIGN AND METHODS: Fourteen HTLV antibody assays were evaluated by using well‐characterized panels of sera from Guinea‐Bissau, West Africa, and Sweden. The sera included 127 HTLV‐I‐positive and 62 HTLV‐II‐positive specimens, as well as 919 consecutive negative samples.RESULTS: The sensitivity for HTLV‐I was 100 percent for all assays, except one, which repeatedly missed one sample. The sensitivity for HTLV‐II varied between 86 percent and 100 percent. In general, new‐generation assays incorporating HTLV‐II‐specific antigens, and some of which are based on new assay principles, had a higher sensitivity for HTLV‐II than previous assays, which mainly are based on HTLV‐I antigens. The specificity was generally higher for new assays than for the previous versions. Testing of Swedish blood donor sera gave higher specificities (94‐100%) than did that of African specimens (90‐99.7%). Most assays had low delta values (DVs), although there was a tendency toward increased DVs for the new generation of assays. Only two of the new generation of assays came close to a combination of high sensitivity for both HTLV‐I and HTLV‐II, high specificity, positive and negative predictive values, and high DVs.CONCLUSION: The sensitivity for HTLV‐I was generally high and appears to have improved for HTLV‐II with the introduction of a new generation of assays incorporating HTLV‐II‐specific antigens. However, some assays still give false‐negative results on HTLV‐II‐positive specimens. The specificities and the DVs were generally higher for the new assays than for the previous versions.
Reduction of blood loss by infusion of human platelets in a rabbit kidney injury model
Authors: Krishnamurti C. , Maglasang P. , Rothwell S.W. 
Published: March 2003

BACKGROUND: As a first step toward testing the efficacy of stored platelets or platelet substitutes in vivo, a kidney injury model was developed to assess the hemostatic properties of human platelets in normal and thrombocytopenic rabbits.STUDY DESIGN AND METHODS: New Zealand white rabbits were made thrombocytopenic by two consecutive injections of busulfan. Two weeks later, human platelets were transfused to animals whose reticuloendothelial systems were inhibited by the administration of ethyl palmitate. The left kidney was exposed and a slice excised from the anterior pole. The blood was contained in a parafilm boat and absorbed by preweighed gauze to assess blood loss. The percentage of human platelets transfused to the rabbit was determined by flow cytometry on blood collected from the cut site using anti‐CD42a (marker for human platelets). The degree of activation of the human platelets was determined using anti‐CD62a (marker specific for human p‐selectin).RESULTS: Blood loss was similar in normal animals treated with saline alone (35.4 ± 5.8 g; n = 4); ethyl palmitate and saline (42.5 ± 5.7 g; n = 6, p = 0.4); or ethyl palmitate and fresh human platelets (45.7 ± 7.9 g; n = 6, p = 0.3). Bleeding in thrombocytopenic rabbits infused with saline was increased (75.6 ± 3.9 g; n = 7) as compared with nonthrombocytopenic animals. A significant reduction in blood loss was noted in thrombocytopenic rabbits given fresh human platelets (51.6 ± 4.5 g; n = 6, p = 0.0023). Transfusion of human platelets to rabbits did not cause activation of the platelets. Furthermore, transfusion of thrombin‐activated platelets (60‐98% activated) to thrombocytopenic rabbits reduced blood loss (54 ± 7.3 g; n = 7) to the same extent as fresh platelets.CONCLUSIONS: This is the first report describing a kidney injury model developed to assess the efficacy of fresh and activated human platelets in reducing blood loss in thrombocytopenic rabbits. This model could monitor the efficacy of human platelets prepared by various preservation protocols in suppressing bleeding in rabbits.
A prospective, randomized, sequential, crossover trial of large‐volume versus normal‐volume leukapheresis procedures: effect on progenitor cells and engraftment
Authors: Humpe A. , Riggert J. , Munzel U. , Repas‐Humpe L.M. , Vehmeyer K. , Brunner E. , Wörmann B. , Köhler M. 
Published: March 2003

BACKGROUND: The influence of leukapheresis size on the number of harvested peripheral blood progenitor cells is still unclear. A prospective randomized crossover trial was thus performed, to evaluate the effect of large‐volume leukapheresis (LVL) versus normal‐volume leukapheresis (NVL) on progenitor cells and engraftment in 26 patients with breast cancer and 15 patients with non‐Hodgkin–s lymphoma who were eligible for peripheral blood progenitor cell transplantation.STUDY DESIGN AND METHODS: Patients were randomly assigned to undergo either LVL on Day 1 and on Day 2 or vice versa. The number of progenitor cells was evaluated in the harvest and before and after leukapheresis in the peripheral blood.RESULTS: The number of harvested CD34+ cells (4.8 × 106 vs. 3.4 × 106/kg body weight, p<0.001) and colony‐forming units–granulocyte‐macrophage (3.1 × 105 vs. 2.4 × 105/kg body weight, p = 0.0026) was significantly higher for LVL procedures than for NVL procedures. The median extraction efficacy, defined as the difference between the yield in the harvest and the decrease in the total number of CD34+ cells in peripheral blood during leukapheresis, was significantly (p<0.0001) higher for LVL than for NVL (2.6 × 108 and 8 × 107, respectively). In patients with breast cancer, the median amount of CD34+ cells in the harvest and the median extraction efficacy were higher for LVL than for NVL (p<0.0001). This was not found for patients with non‐Hodgkin's lymphoma.CONCLUSION: LVL results in a higher yield of CD34+ cells and colony‐forming units–granulocyte‐macrophage than NVL, but only in patients with breast cancer and with high numbers of CD34+ cells in the peripheral blood before leukapheresis.
Febrile and allergic transfusion reactions after the transfusion of white cell‐poor platelet preparations
Authors: Klüter H. , Bubel S. , Kirchner H. , Wilhelm D. 
Published: March 2003

BACKGROUND: Nonhemolytic transfusion reactions (NHTRs) frequently occur after platelet transfusions. White cell (WBC)‐derived inflammatory cytokines can cause these reactions, but they are rarely found in WBC‐poor platelet preparations. Transfusion reactions were investigated with regard to the residual WBC content in the stored platelet concentrate in two consecutive study periods.STUDY DESIGN AND METHODS: In the first study period, platelet concentrates were WBC‐reduced by bedside filtration. In the second period, all platelet concentrates were filtered before storage. Recipients who experienced transfusion reactions were examined with regard to their main clinical symptoms during and after transfusion. In the supernatant of the involved platelet concentrates, concentrations of interleukin (IL)‐1β, IL‐6, IL‐8, tumor necrosis factor (TNF)α, macrophage inflammatory protein 1α, and RANTES were analyzed.RESULTS: The incidence of transfusion reactions remained steady when the transfusion regimen was changed from bedside filtration to prestorage WBC filtration (1.63% and 1.56%; p = 0.84). In both periods, NHTRs were predominantly of allergic origin. Inflammatory mediators IL‐1β, IL‐6, IL‐8, and TNFα were detectable in only a minority of platelet components involved in NHTRs. Platelet concentrates involved in allergic reactions contained high concentrations of RANTES (668 ± 223 ng/mL).CONCLUSIONS: Prestorage WBC filtration did not reduce the incidence of these reactions, and inflammatory cytokines were of minor relevance. The proinflammatory platelet‐derived chemokine RANTES, which accumulates even in WBC‐reduced platelet concentrates, was associated with allergic transfusion reactions. Platelet‐derived mediators may be a key to understanding NHTRs.
High platelet contamination in progenitor cell concentrates results in significantly lower CD34+ yield after immunoselection
Authors: Reiser M. , Draube A. , Scheid C. , Fuchs M. , Josting A. , Diehl V. , Söhngen D. 
Published: March 2003

BACKGROUND: Selection of CD34+ cells by specific immunoselection leads to a significant loss of those cells. The factors influencing the yield and purity are not well identified. The results of CD34+ selection from peripheral blood progenitor cells (PBPCs) with high and low platelet contamination that are harvested with two different cell separators are reported.STUDY DESIGN AND METHODS: A progenitor cell concentrator (Ceprate SC, CellPro) was used to select CD34+ cells from 41 PBPC concentrates from 23 consecutive patients with relapsed non‐Hodgkin's lymphoma (n = 3), breast cancer (n = 17), and multiple myeloma (n = 3). PBPC collection was performed by using two cell separators (CS3000 Plus, Fenwal: Group A, n = 11; and Spectra, COBE: Group B, n = 9). To reduce platelet contamination in the Spectra PBPC concentrates, an additional low‐speed centrifugation was performed before CD34+ cell selection (Group C, n = 3). Leukapheresis components were stored overnight at 4°C and combined with the next day's collection before the CD34+ selection procedure in 19 patients.RESULTS: A median of 1.5 leukapheresis procedures per patient were performed. Pooled PBPC concentrates showed no statistical difference in median numbers of white cells and CD34+ cells in Groups A and B: 3.2 (0.8‐9.2) versus 4.4 (1.6‐8.3) × 1010 white cells per kg and 15.0 (4.7‐24.0) versus 12.0 (5.6‐34.0) × 106 CD34+ cells per kg. Platelet contamination was significantly higher in Group B: 0.67 (0.15‐2.4) versus 2.3 (0.5‐7.1) × 1011 (p = 0.0273). After the selection process, there was a significantly greater loss of CD34+ cells in Group B than in Group A: 39.1 versus 63.2 percent (p = 0.0070), with a median purity of 78.0 percent versus 81.0 percent. An additional low‐speed centrifugation before CD34+ cell selection seemed to reduce CD34+ cell loss in Group C with 16.9, 31.9, and 37.5 percent, respectively.CONCLUSION: CD34+ cell selection from PBPC concentrates resulted in an increased loss of CD34+ cells in concentrates with a higher platelet content. To improve CD34+ yield, PBPC concentrates with an initially low platelet contamination should be used, or additional low‐speed centrifugation should be performed.