bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mathematical and computer modeling of acute normovolemic hemodilution
Authors: Brecher M.E. , Rosenfeld M. 
Published: March 2003

Background: Advocates of acute normovolemic hemodilution (ANH) frequently neglect to consider the decreasing hematocrit of the patient during both hemodilution and the subsequent operative procedure and the need to begin transfusion at some minimal hematocrit.Study Design and Methods: For more accurate prediction of the efficacy of ANH, equations were derived and a computer model developed that allowed accounting for the decreasing hematocrit due to blood loss in an isovolemic patient and calculating the red cell volume on a minute‐by‐minute basis; the model also began the transfusion of ANH blood on a mL‐for‐mL basis when the minimal hematocrit was reached and transfused any remaining blood following completion of the case. The red cell volume saved by performing ANH for a given estimated blood volume (EBV) was expressed as either the fraction of the red cell volume of a routinely banked unit of blood (red cells stored in additive solution: volume 350 mL, hematocrit 0.65) or the number of units saved.Results: The number of units saved in a typical example–EBV, 5000 mL; pre‐ANH hematocrit, 0.40; minimal hematocrit at which transfusion was begun, 0.25 over a range of estimated blood losses (500–2500 mL); and 1 to 5 ANH units drawn–never exceeded 0.6. Even with extensive hemodilution, as in a child (EBV, 1500 mL; pre‐ANH hematocrit, 0.40; minimal hematocrit at which transfusion was begun, 0.15; 5 units drawn; and estimated blood losses, 2500, 1500, and 1000 mL) with a postdilution hematocrit of 0.16, the savings would have been only 0.29, 0.44, and 0.49 units, respectively.Conclusion: Because of the decreasing hematocrit in a bleeding isovolemic patient and the need to begin transfusion at some minimal hematocrit, the theoretic savings in red cell volume attributable to ANH is less than had previously been appreciated, and additional ANH does not necessarily result in additional patient benefit.
Antigen‐matched donor blood in the transfusion management of patients with sickle cell disease
Authors: Tahhan H.R. , Holbrook C.T. , Braddy L.R. , Brewer L.D. , Christie J.D. 
Published: March 2003

BACKGROUND: Alloimmunization to red cell antigens is a significant risk in chronically transfused patients with sickle cell disease. Antigen matching, by decreasing the likelihood of alloantibody development, may significantly facilitate long‐term management while decreasing morbidity.STUDY DESIGN AND METHODS: The transfusion records of 86 patients who underwent chronic transfusion for sickle cell disease at a tertiary‐care medical center were reviewed retrospectively to determine the efficacy of an antigen‐matching program in the prevention of alloimmunization to clinically significant red cell antigens. Recipients were phenotyped and given units matched for the K, C, E, S, and Fya or Fyb antigens.RESULTS: None (0%) of the 40 patients who received antigen‐matched transfusions showed any evidence of alloimmunization, while 16 (34.8%) of the 46 patients who received both antigen‐matched and non‐antigen‐matched transfusions developed clinically significant alloantibodies. The cost was 1.8 to 1.5 times that for a standard transfusion protocol.CONCLUSION: On the basis of this experience, it is recommended that transfusion centers engaged in the management of chronically transfused sickle cell anemia patients consider providing antigen‐matched units for such patients. This is recommended not only because it prevents alloimmunization but also because such a program provides additional clinical benefits to the patient that may outweigh the higher costs of the process.
Use of bi‐level biotinylation for concurrent measurement of in vivo recovery and survival in two rabbit platelet populations
Authors: FRANCO R.S. , LEE K.N. , BARKER‐GEAR R. , GATES R. , MENITOVE J.E. 
Published: March 2003

BACKGROUND: The objectives of this research were 1) to determine whether two populations of platelets may be labeled with different levels of biotin and followed concurrently in vivo by flow cytometry and 2) to determine whether the level of biotinylation affects the in vivo platelet recovery and survival.STUDY DESIGN AND METHODS: Two platelet aliquots were biotinylated under conditions that resulted in either a lower or a higher number of biotin molecules per platelet. After transfusion, the two populations were distinguished and quantitated by flow cytometry.RESULTS: In five animals, recoveries were 69.8 +/− 27.0 percent for low‐biotin platelets and 72.6 +/− 26.7 percent for high‐biotin platelets. For each animal, the recoveries agreed closely. Life span, determined by the multiple‐hit method, was 2.68 +/− 0.63 days for low‐biotin platelets and 2.58 +/− 0.69 days for high‐biotin platelets. These values for recovery and life span are consistent with those measured in rabbits by using radioisotope labels.CONCLUSION: Platelet biotinylation offers a nonisotopic method for direct comparison of alternative harvest and storage conditions. It also offers the potential for simultaneous evaluation of the in vivo characteristics of platelets from at least two donors.
Severe outcomes of allogeneic and autologous blood donation: frequency and characterization
Authors: Popovsky M.A. , Whitaker B. , Arnold N.L. 
Published: March 2003

BACKGROUND: There are few published data on severe outcomes of the donation of blood for allogeneic or autologous use. It would be helpful if blood collectors could better characterize and/or predict the likelihood of significant complications of blood donation.STUDY DESIGN AND METHODS: Very severe outcome (VSO) was defined as an event requiring hospitalization. Approximately 4.1 million American Red Cross whole‐blood donation records (July 1993‐March 1994) were reviewed for the incidence and type of VSO.RESULTS: A total of 33 VSOs occurred for all donations. The incidence of VSOs for allogeneic donation was 1 (0.0005%) in 198,119 and that for autologous donation was 1 (0.006%) in 16,783 (p < 0.001). First‐time donors were three times as likely to have a VSO. Donors > 40 years old had 87.9 percent of the VSOs, and donors > 60 years old had 48.5 percent. Vasovagal (66.7%) and anginal (12.1%) episodes were the most frequent complications, and 66.7 percent of reactions occurred at the blood collection site. The mean hospital stay was 1.9 days.CONCLUSION: VSO is an infrequent complication of all types of blood donation, but its occurrence may be associated with significant morbidity and cost. VSO is nearly 12 times as likely in autologous blood donors.
Febrile reactions to platelet transfusion: the effect of increased interleukin 6 levels in concentrates prepared by the platelet‐rich plasma method
Authors: Muylle L. , Wouters E. , Peetermans M.E. 
Published: March 2003

Background: A relation between febrile reactions to platelet transfusion and high cytokine levels in platelet concentrates (PCs) was found previously. The levels of cytokines such as interleukin (IL)‐6 are related to the while cell content of the PC during storage. Therefore, early removal of white cells should prevent reactions.Study Design and Methods: This prospective study was set up to compare methods for the preparation of random PCs, the platelet‐rich plasma method (PRP‐PCs), which results in a high white cell content, and the buffy coat method (BC‐PCs), which results in a low white cell content, with regard to the frequency and severity of reactions to platelet transfusion and the IL‐6 level of the PC. IL‐6 was chosen because it is the major mediator of the acute‐phase response. White cells were reduced in all PCs before transfusion.Results: Platelet transfusions (n = 584) in 64 patients were studied. An overall reaction frequency of 7.2 percent was observed. Transfusion reactions were seen predominantly in patients who received PRP‐PCs (PRP‐PCs: 9.3% vs. BC‐PCs: 2.7%, p = 0.007). Allergic reactions were limited to transfusions of PRP‐PCs. The following PRP‐PC characteristics were significantly correlated with febrile transfusion reactions: IL‐6 level (p < 0.0001), initial white cell count (p = 0.001), and storage time (p = 0.02). In this group, reactions were less frequent in patients receiving pretransfusion medication (p < 0.001). In the PRP‐PC group, IL‐6 content (p = 0.01) and initial white cell count (p = 0.04) were also significantly correlated with allergic reactions, which indicated that these or associated factors might have an effect on the outcome of this type of reaction.Conclusion: Febrile reactions are highly correlated with IL‐6 levels in PCs. The low white cell content of BC‐PCs is associated with undetectable IL‐6 levels and a reduced frequency of febrile as well as allergic reactions in recipients. The BC method is the preferable one for the production of random‐donor PCs.
The expression of p‐selectin during collection, processing, and storage of platelet concentrates: relationship to loss of in vivo viability
Authors: Holme S. , Sweeney J.D. , Sawyer S. , Elfath M.D. 
Published: March 2003

BACKGROUND: Recent studies suggested that platelet activation with surface expression of p‐selectin on stored platelets may be related to a loss of viability. At present, there has been no thorough investigation of the extent or significance of p‐selectin expression during the collection, processing, and storage of platelet concentrates (PCs) under various conditions.STUDY DESIGN AND METHODS: Platelet surface expression of p‐selectin (CD62) was determined on fixed platelet samples using fluorescein‐conjugated monoclonal antibodies. Platelet viability was assessed by autologous transfusion of platelets stored for 5 days and labeled with either 51Cr or 111in.RESULTS: Little (2–10%) platelet expression of p‐selectin was found in whole blood and platelet‐rich‐plasma preparations, whereas PCs showed a substantial increase in p‐selectin expression to levels of 20 to 30 percent. Both fresh PCs and those stored for 5 days, obtained with one cell separator (MCS, Haemonetics) showed substantially lower levels of p‐selectin expression than PCs from two other cell separators (Spectra, COBE, and CS‐3000 with TNX‐6, Baxter Healthcare). Exposure of platelets to EDTA, cold, or a pH below 6.2, conditions that are known to result in the loss of viability upon transfusion, produced substantial and irreversible p‐selectin expression. PCs with a pH of 6.2 to 6.8 (conditions in which no loss of viability has been demonstrated) also showed pronounced p‐selectin expression, which returned to control values after incubation at 37° C in plasma at pH 7.0 to 7.2. With storage under current conditions the in vivo studies (n = 61) demonstrated a rather poor correlation between p‐selectin expression and the percentage of recovery (r = −0.25) but a somewhat better correlation with survival (r = −0.42). Better correlations were observed with the extent of shape change, lactate, and hypotonic shock response.CONCLUSION: These studies show that p‐selectin expression on the platelet surface is a predictor of platelet viability, although the extent of shape change and the hypotonic shock response may be more sensitive.
Preapheresis peripheral blood CD34+ mononuclear cell counts as predictors of progenitor cell yield
Authors: Benjamin R.J. , Linsley L. , Fountain D. , Churchill W.H. , Sieff C. , Cannon M.E. , Uhl L. , Gaynes L. , Antin J.H. , Wheeler C. 
Published: March 2003

BACKGROUND: Peripheral blood progenitor cells, harvested by apheresis after mobilization, provide rapid hematologic recovery after high‐dose chemotherapy. However, because harvesting these cells is expensive and time‐consuming, there has been much interest in optimizing collection protocols. An investigation was made to determine whether, in this clinical setting, peripheral blood progenitor cell yields may be predicted from preapheresis progenitor cell counts, allowing the length of each procedure to be “fine tuned” to achieve specific target goals.STUDY DESIGN AND METHODS: Preapheresis peripheral blood CD34+ cell and total colony‐forming cell counts were assessed before 78 peripheral blood progenitor cell collections from 13 consecutive patients were performed. Preapheresis counts were correlated with actual progenitor cell yields. Factors affecting this correlation were analyzed.RESULTS: With the use of linear regression analysis preapheresis progenitor cell counts were found to correlate significantly but weakly with actual yields per kg of body weight per liter of blood processed (CD34+ cells: r = 0.43; colony‐forming cells: r = 0.56). Further analysis revealed two possible causes: 1) circulating progenitor cell concentrations fluctuate widely during harvest, which implies that preapheresis counts are not representative of actual concentrations during apheresis, and 2) the efficiency with which apheresis machines extract mononuclear cells varies greatly between procedures.CONCLUSION: Preapheresis CD34+ and colony‐forming cell counts correlated poorly with subsequent yields in this clinical setting, which suggests that it is not practical to use such counts to predict with certainty the length of apheresis needed to achieve a target yield.
A general method for concentrating blood samples in preparation for counting very low numbers of white cells
Authors: Szuflad P. , Dzik W.H. 
Published: March 2003

BACKGROUND: To count extremely low levels of white cells (WBCs) in WBC‐reduced blood components, a larger volume of sample must be processed. The goal was to develop an all‐purpose method for concentrating the samples obtained from WBC‐reduced red cells or platelets. The method was designed to be compatible with a variety of counting techniques.STUDY DESIGN AND METHODS: Coded samples of red cell concentrates with an expected WBC concentration of 200, 100, 50, and 10 per mL and of the diluent (undetectable WBCs/mL) were sent to three sites on five occasions and counted by the use of the concentration method, crystal violet stain, and a Nageotte counting chamber. Additional samples were tested by flow cytometry, polymerase chain reaction, and volumetric capillary cytometry.RESULTS: The results from the three test sites showed good linearity, with an overall r2 = 0.9994. The lower limit of accurate detection of the assay was 10 WBCs per mL. The results were biased toward underestimation, particularly at one of the test sites (Site A). There were no significantly different results in Sites B and C. The intra‐assay CV was acceptable. Precision (reproducibility) at the three test sites varied.CONCLUSION: This method allows reliable determination of WBC concentrations as low as 0.01 per μL in blood. Despite the use of technologists trained in Nageotte chamber counting, validation testing demonstrated that one test site's performance was significantly different from that of the other two sites, because of both underestimation bias and variation in count results. The sample concentration method, when used in conjunction with an automated assay for WBC identification, should permit larger volume analysis with a greater degree of precision and a lower limit of detection than is found in assays that do not concentrate the sample before counting.
Detection of fetal red cells in fetomaternal hemorrhage using a fetal hemoglobin monoclonal antibody by flow cytometry
Authors: Davis B.H. , Olsen S. , Bigelow N.C. , Chen JC. 
Published: March 2003

BACKGROUND: The laboratory determination of the level of fetal cells in maternal circulation remains an important support in the obstetrical management of women with suspected uterine trauma and in the proper dose administration of anti‐D for prevention of Rh hemolytic disease of the newborn. Limitations in the sensitivity and precision of the widely used manual Kleihauer‐Betke test have prompted an increased utilization of flow cytometric methods for fetal cell detection in maternal blood samples.STUDY DESIGN AND METHODS:Murine monoclonal antibodies directed against fetal hemoglobin (HbF) were developed, conjugated to fluorescein isothiocyanate, and used in a multiparametric flow cytometric assay developed for the quantitation of fetal red cells. A rapid intracellular staining method using brief glutaraldehyde fixation and Triton X‐100 permeabilization prior to monoclonal antibody incubation was developed, along with optimization of the flow cytometric analysis protocol for the analysis of 50,000 cells. The performance of the assay was assessed for linearity and precision and correlated with the Kleihauer‐Betke acid elution method.RESULTS:The anti‐HbF flow cytometric method showed good correlation with the Kleihauer‐Betke method (r2 = 0.86) and superior precision with a CV < 15 percent for blood samples with > 0.1 percent fetal cells. Analysis of 150 blood samples from nonpregnant adults, including individuals with elevated HbF due to hemoglobinopathies and hereditary persistence of HbF, gave a mean value of 0.02 percent fetal cells, and all results were less than 0.1 percent.CONCLUSIONS:The anti‐HbF flow cytometric method for detection of fetal cells offers a simple, reliable, and more precise alternative to the Kleihauer‐Betke manual technique for the assessment of fetomaternal hemorrhage. The method has additional potential applications for the study of HbF levels or frequency of adult red cells with low levels of HbF (F cells) in individuals with hemoglobinopathies.
A prospective randomized trial of the surgical blood order equation for ordering red cells for total hip arthroplasty patients
Authors: Nuttall G. A. , Santrach P. J. , Oliver W. C. , Ereth M. H. , Horlocker T. T. , Cabanela M. E. , Trousdale R. T. , Bryant S. , Currie T. W. 
Published: March 2003

BACKGROUND: The majority of crossmatched blood is for surgical patients, and most of it is never transfused. An alternative system for ordering red cell (RBC) units, called the surgical blood order equation (SBOE), which incorporates specific patient variables for surgical patients, has been developed.STUDY DESIGN AND METHODS: A prospective double‐blind randomized trial compared the SBOE with the maximal surgical blood order schedule (MSBOS) system for ordering allogeneic RBC units in 60 patients undergoing total hip arthroplasty. Autologous RBCs were available for none of the patients.RESULTS: There were no differences in patient demographic, surgical, or laboratory variables at any time. The median number (range) of allogeneic RBC units ordered was 2 (2–3) for the MSBOS and 0 (0–3) for the SBOE (p<0.0001). The SBOE ordered the correct number of RBC units for 58 percent of patients, while the MSBOS did so for 7 percent (p<0.0001). The SBOE had a lower crossmatch‐to‐transfusion ratio than the MSBOS (0.83 vs. 4.12). Costs were also lower with the SBOE.CONCLUSION: Incorporation of patient factors in the use of the SBOE system resulted in increased efficiency of blood‐ordering practices for total hip arthroplasty.
The predictive value of white cell or CD34+ cell count in the peripheral blood for timing apheresis and maximizing yield
Authors: Yu J. , Leisenring W. , Bensinger W.I. , Holmberg L.A. , Rowley S.D. 
Published: March 2003

BACKGROUND: The collection of peripheral blood stem and progenitor cells (PBPCs) for transplantation can be time‐consuming and expensive. Thus, the utility of counting CD34+ cells and white cells (WBCs) in the peripheral blood was evaluated as a predictor of CD34+ cell yield in the apheresis component.STUDY DESIGN AND METHODS: The WBC and CD34+ cell counts in the peripheral blood and the apheresis components from 216 collections were assessed. Sixty‐three patients underwent mobilization with chemotherapy plus filgrastim, and 17 patients and 14 allogeneic PBPC donors did so with filgrastim alone. The relationship between the number of WBC and CD34+ cells in the peripheral blood and in the apheresis component was analyzed by using rank correlation and linear regression analysis.RESULTS: The correlation coefficient for CD34+ cells per liter of peripheral blood with CD34+ cell yield (× 106/kg) was 0.87 (n = 216 collections). This correlation existed for many patient and collection variables. However, patients with acute myeloid leukemia had fewer CD34+ cells in the apheresis component at any level of peripheral blood CD34+ cell count. Components collected from patients with CD34+ cell counts below 10 × 106 per L in the peripheral blood contained a median of 0.75 × 106 CD34+ cells per kg. When the WBC count in the blood was below 5.0 × 109 per L, the median number of CD34+ cells in the peripheral blood was 5.6 × 106 per L (range, 1.0‐15.5 × 106/L). A very poor correlation was found between the WBC count in the blood and the CD34+ cell yield (p = 0.12, n = 158 collections).CONCLUSION: The number of CD34+ cells, but not WBCs, in the peripheral blood can be used as a predictor for timing of apheresis and estimating PBPC yield. This is a robust relationship not affected by a variety of patient and collection factors except the diagnosis of acute myeloid leukemia. Patients who undergo mobilization with chemotherapy and filgrastim also should undergo monitoring of peripheral blood CD34+ cell counts, beginning when the WBC count in the blood exceeds 1.0 to 5.0 × 109 per L.
The effect of unmodified or prestorage white cell‐reduced allogeneic red cell transfusions on the immune responsiveness in orthopedic surgery patients
Authors: Bordin J.O. , Chiba A.K. , Carvalho K.I.L. , Takata E.T. , Falcão R.P. , Garcia A.B. , Bordin I.A.S. , Maciel M.M. , Andreoni S. , Kerbauy J. 
Published: March 2003

BACKGROUND: The immunomodulatory effects of allogeneic blood transfusions have been attributed to the white cells (WBCs) present in the cellular blood components transfused to patients.STUDY DESIGN AND METHODS: The effect of the transfusion of allogeneic red cells (RBCs) or allogeneic prestorage WBC‐reduced RBCs (WBC‐reduced RBCs) on host immune responsiveness was evaluated by measuring the lymphocyte subsets and the in‐vitro cytokine production in response to phytohemagglutinin stimulation of WBCs of orthopedic surgery patients. Forty‐seven patients undergoing hip replacement surgery were randomly assigned to receive allogeneic RBCs (n = 17) or WBC‐reduced RBCs (n = 14; 99.95% WBC removal). Sixteen patients were not transfused. Patient blood samples taken before surgery and on Days 1 and 4 after surgery were tested for complete blood count, lymphocyte subset analysis, and measurement of cytokine levels.RESULTS: After surgery, the lymphocyte count was significantly decreased in patients transfused with ≥3 units of allogeneic RBCs (2.0 ± 0.5 vs. 1.3 ± 0.3 × 109/L; p = 0.017), but not in patients transfused with ≥3 units of WBC‐reduced RBCs (2.0 ± 0.9 vs. 1.7 ± 0.8 × 109/L). Compared with preoperative levels, on Day 4 after surgery, patients transfused with ≥3 units of allogeneic RBCs also had a decrease in the number of natural killer cells (0.07 ± 0.05 vs. 0.04 ± 0.03 × 109/L; p = 0.018). Postoperatively, interleukin‐2 was decreased in one patient who received WBC‐reduced RBCs compared with that in four patients transfused with allogeneic RBCs (p = 0.32), and eight untransfused patients (p = 0.01). On Day 4, about 70 percent of patients transfused with allogeneic RBCs showed a 20‐percent decrease in the interferon gamma level.CONCLUSION: Taken together, these data support the hypothesis that transfusion of ≥3 units of allogeneic RBCs is associated with early postoperative lymphopenia in otherwise healthy individuals undergoing surgery. These findings were not observed in those individuals transfused with RBCs that had undergone prestorage WBC reduction.