bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quality control of red cell filtration at the patient's bedside
Authors: Sirchia G , Rebulla P , Parravicini A , Marangoni F , Cortelezzi A , Stefania A 
Published: March 2003

BACKGROUND: Concern has been raised about the quality of white cell (WBC) reduction in blood components when it is performed by filtration at the patient's bedside. Thus, the quality of red cell (RBC) filtration performed at the bedside through two new flatbed WBC‐ reduction filters was evaluated.STUDY DESIGN AND METHODS: In the laboratory, 25 and 10 RBC units suspended in additive solution were stored for 1 to 2 and 14 to 21 days, respectively, and filtered through each filter. At the end of filtration, an automated complete blood count and a manual WBC count (Nageotte chamber) were determined in two samples collected from 1) a segment clamped at 5 and 25 cm below the filter along the line connecting prefiltration and postfiltration bags and 2) the postfiltration bag. In addition, 10 of the 11 nurses of the hematology outpatient clinic administered to hematologic patients 25 RBC units stored for 1 to 2 days through each type of filter. At the end of transfusion, a segment was collected from the transfusion set and a WBC count was performed as described above. No filter priming or rinsing with saline was done.RESULTS: WBC counts obtained after laboratory filtration in the segments were similar to those obtained from the postfiltration bags and from the segments collected at the bedside in all cases, with the exception of 14‐ to 21‐day‐old RBCs filtered in the laboratory through one of the filters, which produced slightly higher WBC counts in the segments than were seen in the postfiltration bags. The difference was not significant. In no case was the count in the postfiltration bag higher than that in the segment. Nurse training was easy, and bedside filtration was associated with no untoward effects.CONCLUSION: The RBC filtration at the patient's bedside can be equal in quality to that performed in the laboratory, at least in such clinical settings as hematology and oncology departments in which blood transfusion is common practice, and if simple training is provided to the nursing staff. Under the conditions of this study, it seems that quality control of RBC bedside filtration is feasible and simple.
Electronic verification of donor‐recipient compatibility: the computer crossmatch
Authors: Butch S.H. , Judd W.J. , Steiner E.A. , Stoe M. , Oberman H.A. 
Published: March 2003

Background: This article describes standard operating procedures (SOPs) for a computer crossmatch to replace the immediate‐spin crossmatch for ABO incompatibility between patient blood samples submitted for pretransfusion testing and the blood component selected for transfusion. These SOPs were developed following recent changes to the Standards for Blood Banks and Transfusion Services of the American Association of Blood Banks (AABB).Study Design and Methods: SOPs were developed, utilizing currently available software, for pretransfusion testing. The SOP for donor unit processing entails bar code entry of the unit number, component name, and ABO/Rh type; computer entry and interpretation of serologic reactions; warning of discrepancies between bar code‐entered blood type and result interpretation; and quarantine of the donor unit in such instances. The SOP for patient sample testing requires bar code entry of specimen accession number, which accesses patient demographics; computer entry and interpretation of ABO/Rh tests; repeat blood typing at the time of crossmatch if only one patient blood type is on record; and warning if there are nonconcordant current and historical blood types. The computer crossmatch SOP requires bar code entry of specimen accession and donor unit numbers; release of group O red cells pending resolution of discrepancies; and immediate‐spin crossmatch during computer downtime. Tables validated on‐ site prompt warning messages and prevent both computer crossmatch and release if blood components of the wrong ABO type are selected.Results: These SOPs meet the requirements of the 15th edition of the AABB Standards. Projected annual time savings at this institution are > 100,000 workload recording units. Further benefits include reduced patient sample volume requirements, less handling of biohazardous material, and elimination of unwanted positive or negative reactions associated with the immediate‐spin crossmatch. Release of incompatible blood components when the wrong patient blood type is on record is addressed by requiring the use of group O red cells in the absence of two concordant blood types, one of which must be from a current sample.Conclusion: A combination of existing computer programs and carefully developed SOPs can provide a safe and efficient means of detecting donor‐recipient incompatibility without performance of serologic crossmatch.
Potential deferral criteria predictive of human immunodeficiency virus positivity among blood donors in Thailand
Authors: Kitayaporn D. , Bejrachandra S. , Chongkolwatana V. , Chandanayingyong D. , Weniger B.G. 
Published: March 2003

Background: To develop deferral criteria to prevent human immunodeficiency virus (HIV) transmission by recently infected blood donors in the seronegative “window” phase, routine data on donors at a university hospital were examined for factors predicting seropositivity.Study Design and Methods: Records of all 281 HIV‐ positive blood donors from August 1987 through September 1991 were retrospectively compared with those of 1076 randomly selected control donors matched only by year of donation. Four controls were selected for each HIV‐positive donor.Results: The prevalence of HIV in 102,684 donor units during the period rose from 0.02 percent in 1987 to 0.52 percent in 1991. Multivariable analysis revealed that male sex (odds ratio [OR] = 26.4), VDRL test positivity (OR = 3.0), age 21 to 30 years (OR = 2.2; referent: 16–20‐year‐old group), and replacement donorship (OR = 1.4; referent: voluntary donors) were independent factors significantly associated with HIV positivity among these donors (p < 0.05). Since replacement donorship cannot be avoided, only male sex, age 21 to 30 years, and VDRL test positivity were considered as potential criteria. When these findings were extrapolated to all donors in 1990 and 1991, those with all three or only two (excluding VDRL test, because the results are known only after donation) of these high‐ risk factors had HIV positivity probabilities of 2.2 and 1.0 percent, respectively. These probabilities were, respectively, 4.9 times (95% CI: 2.9 8.3) and 4.1 times (3.1, 5.4) the risk among other donors. However, applying such criteria would have eliminated 1.5 and 31.2 percent, respectively, of all HIV‐negative donors in 1990 and 1991. The latter deferral proportion is too high to be acceptable.Conclusion: In Thailand, improved donor deferral criteria addressing sexual risk factors could lead to decreased probability of window‐period donation, with an acceptable rate of deferral. Additional p24 antigen testing may be indicated for donors at increased risk for HIV infection, specifically, men aged 21 to 30.
Incest diagnosis by comparison of alleles of mother and offspring at highly heterozygous loci
Authors: Wenk R.E. , Chiafari F.A. , Houtz T. 
Published: March 2003

Background: Methods that detect a child's homozygosity by examination of allelic products are insensitive for diagnosing incest because, at a given locus, a homozygous state is expected with a frequency of only 0.25 when parents are first‐degree relatives. Furthermore, these methods are not specific if the population contains many homozygous individuals or silent alleles that cause apparent homozygosity.Study Design and Methods: Use of highly heterozygous loci improves specificity, but not sensitivity. Sensitivity may be increased by observing for two kinds of mother‐offspring similarities: an offspring of incest tends to be homozygous or heterozygous‐identical with respect to its mother's phenotype. At each locus, two conditional probabilities may be calculated for a genetic observation, using allele frequencies expected under a state of incestuous mating versus mating within a specified population. The conditional probabilities at each locus are compared in a likelihood ratio to express a relative probability of incest.Results: In a case of known sibling incest, three likelihood ratios were derived from variable number of tandem repeat phenotypes at five loci. When only offspring homozygosity was observed, the likelihood ratio was 75.3:1. When both homozygous‐ and heterozygous‐ identical phenotype similarities of offspring and mother were noted, the likelihood ratio was 130.4:1. When maternal obligatory alleles of the offspring were considered, the likelihood ratio was 262.4:1.Conclusion: Comparison of maternal and offspring phenotypes at highly heterozygous loci increases both sensitivity and specificity of genetic tests in cases of suspected incest.
Evaluation of clinical and laboratory aspects of antibody tests for detection of hepatitis C virus infection in blood donors and recipients from a low‐risk population
Authors: MacDonald K.L. , Mills W.A. , Wood R.C. , Hanson M. , Kline W. , Bowman R.J. , Polesky H.F. , Williams A.E. , Osterholm M.T. 
Published: March 2003

Background: When the first‐generation enzyme immunoassay (EIA) for detection of antibody to hepatitis C virus (anti‐HCV) was approved in May 1990, blood banking agencies recommended testing of all components in inventory. In many cases, one or more components from these units had already been transfused.Study Design and Methods: Donors that reacted in first‐generation EIAs and recipients of their components were identified, and anti‐HCV test methods (including first‐generation EIA, second‐generation EIA, and recombinant immunoblot assay [RIBA]) were evaluated.Results: Of 66 donors identified as anti‐HCV‐positive by first‐generation EIA, 17 were positive in second‐generation EIA. Of these 17, 9 reacted in RIBA; 6 of these showed evidence of HCV infection in polymerase chain reaction (4) and/or probable transmission of HCV to a transfusion recipient (3). Of the 48 specimens that were positive in first‐generation EIA and negative in second‐generation EIA, only 1 was positive in RIBA; serum was not available for polymerase chain reaction testing, and there were no living transfusion recipients in whom to assess evidence of transmission of HCV.Conclusion: This study documents the low predictive value of EIAs for anti‐HCV in a low‐ prevalence blood donor population and emphasizes the need for additional testing to confirm the specificity of samples that react in the screening tests.
Pseudoaneurysm of the brachial artery: a rare complication of blood donation
Authors: Popovsky M.A. , McCarthy S. , Hawkins R.E. 
Published: March 2003

Background: Serious complications of blood donation are rare. Reported here is a significant vascular event that resulted from whole‐blood phlebotomy and required surgical repair.Case Report: A 49‐year‐old woman donated whole blood without incident in November 1992, but reported ecchymosis and tenderness in the antecubital area of the right arm immediately following the procedure (her medical history was unremarkable). Over the next several days, the ecchymosis extended to the axilla and she complained of numbness in all her fingers, particularly the thumb and adjacent two fingers of the involved side. Coincident to these findings, an egg‐sized lump developed under the skin at the phlebotomy site. Her symptoms and the mass persisted for several weeks. Examination and ultrasound performed in January 1993 demonstrated a pulsatile mass over the brachial artery. The donor underwent an exploratory surgical procedure that revealed a 3.3 × 2.5 × 2.0‐cm pseudoaneurysm of the brachial artery. Unlike a true aneurysm, this lesion was composed only of a blood clot that was compressing the outer wall of the artery. A pinpoint‐sized hole was seen in the artery when the lesion was excised. The phlebotomy is believed to have caused blood to leak out of the artery, creating the lesion and exerting pressure on the median nerve.Conclusion: Pseudoaneurysm of the femoral artery is a well‐documented complication of cardiac catheterization and other invasive arterial procedures, but this is the first known reported case following blood donation. Blood collectors should be made aware of this potentially serious complication of blood donation.
Identification of a new white cell antigen
Authors: STRONCEK D.F. , RAMSEY G. , HERR G.P. , EIBER G. , CLAY M.E. , KETYER E.C. 
Published: March 2003

BACKGROUND: Antibodies to white cell antigens can cause alloimmune neonatal neutropenia, autoimmune neutropenia, and transfusion reactions.CASE REPORT: A full‐term male infant developed a skin infection and was found to be neutropenic on his fourth day of life. He had a transient increase in his neutrophil count after treatment with intravenous immunoglobulin, but his neutrophil count was not consistently normal until he was 6 weeks old. Serum from the baby's mother reacted in a granulocyte immunofluorescence assay but not in a granulocyte agglutination assay. The mother's serum was tested in the granulocyte immunofluorescence assay against neutrophils from 103 healthy, unrelated people, and it reacted with cells from 66 percent of those people. The expression of SL correlated weakly with the expression of NA1 (r = 0.23; p = 0.02) and 5a (r = 0.20; p = 0.05) antigens. SL antigen expression on neutrophils was not associated with the expression of NA2, NB1, NB2, NC1, 5b, 9a, or Mart. The expression of SL on neutrophils from members of an extended family was analyzed, and the antigen was found to be inherited in an autosomal‐dominant manner. Anti‐SL also reacted with T‐lymphocytes in a flow cytometry assay but did not react with red cells or platelets. No lymphocytotoxic antibodies were detected in the mother's sera. The anti‐SL was tested against neutrophils in an immunoprecipitation and immunoblotting assay, but no molecules were identified. The neutrophil‐specific antigens NA are located on Fc gamma receptor III (CD16). To determine if the SL antigen was also located on Fc gamma receptor III, anti‐SL was also tested in a monoclonal antibody immobilization of granulocyte antigens assay. Anti‐SL did not react with molecules recognized by CD16 monoclonal antibodies.CONCLUSION: A new white cell antigen SL, with a frequency of 66 percent, was identified on neutrophils and T‐ lymphocytes as a result of the evaluation of a case of neonatal alloimmune neutropenia. The molecule bearing the SL antigen was not identified in immunoblotting, immunoprecipitation, or monoclonal antibody immobilization of granulocyte antigens assays.
An evaluation of intravenous immunoglobulin in the treatment of human immunodeficiency virus‐associated thrombocytopenia
Authors: JAHNKE L. , APPLEBAUM S. , SHERMAN L.A. , GREENBERGER P.A. , GREEN D. 
Published: March 2003

BACKGROUND: Anecdotal evidence suggests that high‐dose intravenous immunoglobulin (IVIG) is useful in the management of human immunodeficiency virus (HIV)‐associated thrombocytopenia.STUDY DESIGN AND METHODS: To rigorously evaluate this therapy, a crossover study was designed to compare IVIG, given at 1 g per kg per day for 2 consecutive days each week for 4 weeks, with intravenous saline placebo administered according to the same schedule. Subjects were randomly assigned to receive either IVIG or saline during the first 4 weeks; if IVIG was given, there was a 4‐week period of no therapy before beginning placebo administration. Criteria for eligibility were platelet count of less than 50,000 per microL (50 × 10(9)/L), elevated platelet‐associated IgG levels, increased megakaryocytes in the bone marrow, and positive HIV antibody test. Twelve patients (11 men, 1 woman) were studied. Seven patients completed the full protocol. Four dropped out: after 2, 5 (2 patients), and 8 weeks that included at least 2 weeks of IVIG.RESULTS: All patients sustained an increase in platelet count in response to IVIG, with increments ranging from 15,000 to 358,000 per microL (15 to 350 × 10(9)/L) (mean, 180,000/microL [180 × 10(9)/L]; median, 174,000/microL [174 × 10(9)/L]). No patient had an increase after placebo infusions. There were no adverse effects of treatment, and weekly chemical analyses showed no new abnormalities except for mild elevations in the serum protein. The duration of responses ranged from 2 to 10 weeks. No patient demonstrated refractoriness to IVIG.CONCLUSION: IVIG consistently raises platelet counts in patients with HIV‐associated thrombocytopenia.
Molecular basis of the K:6,‐7 [Js(a+b−)] phenotype in the Kell blood group system
Authors: Lee S. , Wu X. , Reid M. , Redman C. 
Published: March 2003

BACKGROUND: The Kell blood group system consists of at least 21 antigens. KEL6(Jsa) is a low‐incidence antigen that has an antithetical relationship with the high‐incidence KEL7(Jsb) antigen. The molecular basis of KEL6 that appears in less than 1.0 percent of the general population, but in up to 19.5 percent of African Americans, was unknown.STUDY DESIGN AND METHODS: Nineteen exons of the Kell gene (KEL) were amplified by polymerase chain reaction (PCR) assays of genomic DNA obtained from individuals with K:6,‐7 [Js(a+b‐)] phenotype. The PCR products were sequenced. A comparison was made of the sequence of the PCR products and the sequence of K:‐6,7, the common phenotype.RESULTS: KEL from individuals with the K:6,‐7 phenotype had two base substitutions in exon 17. One was a missense mutation (T‐to‐C base substitution) at nucleotide (nt) 1910, which predicts an amino acid change from leucine to proline; the other was a silent substitution (A‐ to‐C) at nt 2019. The T‐to‐C substitution eliminated a restriction site for Mnl I, whereas the A‐to‐G substitution eliminated a Dde I site. Analyses of exon 17 in seven unrelated persons with K:6,‐7 phenotype by Mnl I and Dde I enzymes showed the expected presence of restriction fragment length polymorphisms.CONCLUSION: The base substitutions T‐to‐ C at nt 1910 and A‐to‐G at nt 2019 are unique to KEL6. The predicted Leu–>Pro change may disrupt the alpha‐helical structure and thus form the epitope for KEL6.
Declining value of alanine aminotransferase in screening of blood donors to prevent posttransfusion hepatitis B and C virus infection. The Retrovirus Epidemiology Donor Study
Authors: Busch M.P. , Korelitz J.J. , Kleinman S.H. , Lee S.R. , AuBuchon J.P. , Schreiber G.B. 
Published: March 2003

BACKGROUND: Since the mid‐1980s, blood banks in the United States have screened donors for elevated alanine aminotransferase (ALT) in an effort to prevent posttransfusion hepatitis. The present study was designed to quantitate the residual value of ALT screening following the implementation of hepatitis C virus (HCV) assays.STUDY DESIGN AND METHODS: Two approaches were used. First, a database of 2.3 million donations made by 586,507 volunteer blood donors between 1991 and 1993 was used to compare the incidence of seroconversion to hepatitis B virus (HBV) and HCV marker positivity in donors with elevated ALT values and with normal ALT values. Second, the duration of ALT elevation prior to HBV and HCV seroconversion was determined from 34 well‐documented cases of posttransfusion HBV and HCV; elevated‐ALT window periods were multiplied by rates of HBV and HCV incidence in donors to project the yield of ALT screening. Predictive value and cost‐ effectiveness analyses were also performed to compare the value of ALT screening before and after HCV screening was implemented.RESULTS: Both approaches indicate that ALT testing does not detect HBV in the window phase but does currently identify approximately 3 HCV window‐phase donations per 1 million donations; this contrasts with ALT detection of approximately 1800 HCV‐infectious units per 1 million donations prior to anti‐HCV screening. Currently, only 8 in 10,000 donated units with elevated ALT (negative anti‐HCV) are infected with HCV. The cost of continued ALT screening was estimated at $7,931,000 per quality‐ adjusted year of life saved.CONCLUSION: The yield, predictive value, and cost‐effectiveness of ALT screening of blood donors have declined dramatically with the implementation of progressively improved anti‐HCV assays. ALT screening of volunteer blood donors should be discontinued.
The RoHar antigenic complex is associated with a limited number of D epitopes and alloanti‐D production: a study of three unrelated persons and their families
Authors: Beckers E.A.M. , Porcelijn L. , Ligthart P. , Vermey H. , von dem Borne A. E.G.Kr. , Overbeeke M. A.M. , van Rhenen D. J. 
Published: March 2003

BACKGROUND: the RoHar antigenic complex has been characterized serologically by difficulties in D typing, weak e expression, lack of G antigen, presence of Rh33, a low‐frequency Rh antigen, and, more recently, a second low‐frequency antigen, FPTT. Allocation to one of the partial D catagories was not considered because of the unuaual reactions of RoHar cells and because anti‐D production was not observed in RoHar persons.STUDY DESIGN and METHODS: Three unrelated RoHar donors and their families were studied in detail with special emphasis on D epitope mapping, e and G typing, and screening for antibodies.RESULTS: Only D epitopes 5 and 6/7 were demonstrable, and D epitopes 1, 2, 3, 4, 8, and 9 seem to be absent in the RoHar complex. In one individual, the presence of alloanti‐D with limited specificity, not reacting with RoHar red cells of other individuals, was found 6 months after a second D+ pregnancy.CONCLUSION: The finding of alloanti‐D in an RoHar r person supports the concept that the D characteristic of this phenotype is a partial D antigen, which is consistent with the presence of the limited number of D epitopes found in epitope mapping. As has been suggested for other partial D antigens, RoHar individuals should be regarded as D‐ for the receipt of blood, and pregnant RoHar women who have had D+ pregnancies should receive anti‐D prophylaxis.
Treatment of chronic autoimmune thrombocytopenic purpura with monoclonal anti‐D
Authors: Godeau B. , Oksenhendler E. , Brossard Y. , Bartholeyns J. , Leaute J.‐B. , Duedari N. , Schaeffer A. , Bierling P. 
Published: March 2003

Background: The platelet count increases transiently after treatment with polyclonal anti‐D in about 50 percent of D+ patients with autoimmune thrombocytopenic purpura (AITP). The effect is usually attributed to macrophage Fc‐receptor blockade by antibody‐coated red cells. As polyclonal anti‐D is in limited supply, prospective testing was performed on a monoclonal anti‐D (MoAb D) in such patients.Study Design and Methods: Seven D+ patients with chronic AITP received MoAb D intravenously at doses of 47 to 95 μg per kg of body weight. Response was assessed by studying platelet count increment. Hemolysis and red cell‐bound MoAb D were measured before and after MoAb D administration.Results: MoAb D red cell binding was demonstrated in all patients at a ratio higher than that observed in AITP patients successfully treated with polyclonal anti‐D. However, little or no platelet count increment was observed in six patients, while a transient response was observed in only one (platelet count 97 × 109/L before MoAb D infusion and 163 × 109/L 4 days later). Furthermore, because five patients showed signs of hemolysis and two became anemic, higher doses of MoAb D should be used only with caution in patients with AITP.Conclusion: The MoAb D used in this study cannot be proposed as an alternative treatment for patients with AITP.