bluuebunny/crossref_metadata_2025_split huggingface dataset:
Blood utilization in adult patients undergoing extracorporeal membrane oxygenated therapy
Authors: Butch S. H. , Knafl P. , Oberman H. A. , Bartlett R. H. 
Published: March 2003

Background: The impact of extracorporeal membrane oxygenation (ECMO), performed on adult patients, on the blood transfusion service of a tertiary‐care hospital was assessed. The quantity and pattern of blood component utilization by these patients were compared to those in a previous evaluation of neonatal patients receiving similar treatment.Study Design and Methods: The records of blood component transfusion to 74 adult patients, treated with ECMO within a 6‐year period, were reviewed. This information was correlated with the clinical indication for ECMO and duration of ECMO treatment. In addition, daily use of components for these patients was studied to ascertain whether the blood requirements were predictable and uniform.Results: Over 15,000 units of blood components, with platelet concentrates making up the largest portion, were transfused to these patients while they were undergoing ECMO. The duration of ECMO varied from less than 1 day to 53 days. However, the length of treatment could not uniformly be correlated with blood utilization or with survival. Daily blood transfusion needs often could not be anticipated, which meant that the transfusion service frequently had to respond to urgent requests for transfusion support. The provision of platelet concentrates proved to be the most difficult part of the maintenance of this program.Conclusion: Whereas ECMO treatment of neonatal patients has a relatively minor impact on a transfusion service, the same is not true for a program that uses this form of treatment for adults as well.
Generation of interleukin 8 in stored apheresis platelet concentrates and the preventive effect of prestorage ultraviolet B radiation
Authors: Fujihara M. , Takahashi T.A. , Ogiso C. , Hosoda M. , Ikebuchi K. , Sekiguchi S. 
Published: March 2003

BACKGROUND: Several recent studies have reported both the generation of cytokines, including interleukin (IL)‐1 β, IL‐6, tumor necrosis factor α (TNF‐α), and IL‐8, in the supernatants of stored platelet concentrates (PCs) and the implications of this generation in febrile nonhemolytic transfusion reactions. Prestorage filtration is regarded as highly effective in the prevention of cytokine generation.STUDY DESIGN AND METHODS: Studies evaluated 1) the levels of these cytokines in apheresis PCs during storage, 2) the effects of white cell inactivation by ultraviolet B or γ‐radiation on the generation of cytokines, and 3) the effects of poststorage filtration on cytokine levels. The apheresis PCs were treated by either ultraviolet B radiation (20,000 J/m2), γ‐radiation (30 Gy), or filtration. Samples were collected sequentially on various days after storage. Cytokines were determined by enzyme‐linked immunosorbent assay.RESULTS: The average white cell count in 15 PCs tested was 2.58 ± 0.7 × 106 per mL (range, 0.7–10 × 106/mL). A detectable level of IL‐8 was found at 3 days of storage, and the levels of this cytokine increased progressively with increasing storage time, ranging from 1.6 to 35,280 pg per mL on Day 5 and from 2.7 to 83,601 pg per mL on Day 8. Reverse transcriptase‐polymerase chain reaction analysis showed that the level of IL‐8 paralleled the expression of IL‐8 transcripts. The levels of IL‐1β, IL‐6, TNF‐α, and monocyte chemotactic protein‐ 1 were very low, even on Day 8. Ultraviolet B‐radiated PCs failed to generate IL‐8, even at 8 days of storage, whereas levels of IL‐8 in γ‐radiated PCs were similar to those in nonirradiated PCs. Poststorage filtration of PCs with a negatively charged polyester filter, but not with a positively charged one, markedly reduced the levels of IL‐8.CONCLUSION: Of the cytokines tested, IL‐8 had the most evident generation in apheresis PCs during storage. Prestorage inactivation of white cells by ultraviolet B radiation, but not by γ‐radiation, was effective in preventing the generation of cytokines during the storage of PCs.
High‐yield platelet concentrates attainable by continuous quality improvement reduce platelet transfusion cost and donor exposure
Authors: Kelley D.L. , Fegan R. L. , Ng A. T. , Kennedy M.K. , Blanda E. , Chambers L.A. , Kennedy M.S. , Lasky L.C. 
Published: March 2003

BACKGROUND: Donor exposure risk and cost in platelet transfusion practice can be limited by increasing the recovery of platelets from donor units.STUDY DESIGN AND METHODS: This study presents results of continuous quality improvement efforts in platelet production and compares the in vivo therapeutic efficacy of currently produced platelet concentrates (PCs) with that of apheresis platelets. Production quality improvement measures included optimization of instrument performance (rotor speed trials), process (massaging whole‐ blood units, using cup liners, limiting spin‐expression time, and refining plasma expression technique), and staff (intensive training with observation and ongoing quality control data feedback). Corrected count increments and increments per kg were calculated for transfusions of 4 pooled PCs and apheresis platelets over a 30‐day period.RESULTS: The mean number of platelets per PC increased from 5.5 × 1010 in 1975 to 9.69 × 1010 in 1994. The mean platelet dose was 3.78 × 1011 for 4 PCs and 4.17 × 1011 for apheresis platelets. A total of 34 pooled PCs and 17 apheresis platelets was transfused to 21 patients. The mean increment, the increment per kg, and the corrected count increment were, respectively, 31 × 103 per μL, 4.8 × 102 per μL, and 14,700 for 4 PCs and 35.4 × 103 per μL, 5.4 × 102 per μL, and 14,700 for apheresis platelets. Differences were not significant.CONCLUSION: Therapeutic efficacy comparable to that of apheresis platelets can be obtained with 4 high‐yield PCs.
Demographic characteristics, unreported risk behaviors, and the prevalence and incidence of viral infections: a comparison of apheresis and whole‐blood donors. The Retrovirus Epidemiology Donor Study
Authors: Glynn S. A. , Schreiber G. B. , Busch M. P. , Kleinman S. H. , Williams A. E. , Nass C. C. , Ownby H. E. , Smith J. W. ,   Retrovirus Epidemiology Donor Study
Published: March 2003

BACKGROUND: The demographics, deferrable risk behaviors, and the prevalence and incidence of viral infections of apheresis (PH) and whole‐blood (WB) donors were compared, to characterize these two populations and to evaluate the relative safety of PH and WB donors in terms of transfusion‐transmitted viral infections.STUDY DESIGN AND METHODS: A comparison was made of 36,119 PH donors (> or = 1 PH donation) and 1.38 million WB donors (> or = 1 WB donation) in terms of demographics and the prevalence (/100,000 donors) and incidence (/100,000 person‐years) of viral infections, by using data collected at five United States blood collection centers between 1991 and 1994. Deferrable risk behaviors were defined as those risk behaviors that would have resulted in donor deferral, had they been reported. The prevalence of deferrable risk behaviors was estimated by using data collected through an anonymous mail survey.RESULTS: PH donors were older and more likely than repeat (2+ donations) WB donors to be female, white, and United States‐born and to have a higher degree of education (p ≤0.001). The prevalence of any viral infection was 50 percent higher in WB donors than in PH donors (p = 0.04), whereas the incidence of HIV, human T‐lymphotropic virus, and hepatitis B surface antigen was nonsignificantly higher in WB donors. The prevalence of deferrable risk behaviors did not differ in the two groups.CONCLUSION: Further studies will be needed to evaluate whether the difference in the prevalence of viral infections observed in this study can be explained by demographic characteristics and patterns of donation frequency.
Release of mediators of systemic inflammatory response syndrome in the course of a severe delayed hemolytic transfusion reaction caused by anti‐D
Authors: von Zabern I. , Ehlers M. , Grunwald U. , Mauermann K. , Greinacher A. 
Published: March 2003

BACKGROUND: In vitro studies suggest that mediators of systemic inflammatory response syndrome are generated in the course of hemolytic transfusion reactions. Evidence for the in vivo significance of these findings is given by the present clinical and laboratory analysis of a severe delayed hemolytic transfusion reaction (DHTR).CASE REPORT: A 67‐ year‐old patient (blood group O, D‐negative) with a negative pretransfusion antibody screen received a massive transfusion because of arterial bleeding (Day 1). The transfusion of group O, D‐positive red cell concentrates was unavoidable because of limited supplies. At Day 10, the patient developed a DHTR with symptoms of septic‐toxic syndrome and signs of hemolysis; he received an exchange transfusion. Serologic markers, as well as proinflammatory and anti‐inflammatory mediators, were monitored at the onset of the DHTR and during the exchange transfusion.RESULTS: At Day 10, the direct antiglobulin test was positive; anti‐D was present, most likely as the result of an anamnestic immune response. Interleukin (IL)‐1 was not detectable; all other mediators monitored were elevated: IL‐1 receptor antagonist, tumor necrosis factor, IL‐6, IL‐8, IL‐10, neopterin, elastase, C3a‐ desArg, C‐reactive protein, and fibrinogen. Most of the values declined during the exchange transfusion, which was followed by an improvement of the clinical presentation.CONCLUSIONS: Mediators of systemic inflammatory response syndrome were released in the course of a DHTR caused by anti‐D. Severe clinical symptoms could be treated successfully by exchange transfusion.
The cost‐effectiveness of autologous transfusion revisited: implications of an increased risk of bacterialinfection with allogeneic transfusion
Authors: Sonnenberg F.A. , Gregory P. , Yomtovian R. , Russell L.B. , Tierney W. , Kosmin M. , Carson J.L. 
Published: March 2003

BACKGROUND:Previous analyses have found autologous transfusion to be very expensive but have not considered avoidance of postoperative bacterial infections as one of its benefits.STUDY DESIGN AND METHODS:A cost‐utility analysis using a Markov cohort simulation model compared autologous blood transfusion to allogeneic transfusion in a hypothetical cohort of patients undergoing elective total hip replacement with respect to discounted quality‐adjusted life years (QALYs) and health‐care system costs.RESULTS:Assuming a base case rate of serious infection of 3.7 percent, a relative risk of infection of 1.85, and additional costs of $12,980 per infection, autologous transfusion has a cost‐effectiveness of $2,470 per QALY. If the relative risk of bacterial infection following allogeneic transfusion exceeds 1.1, the cost‐effectiveness of autologous transfusion is less than $50,000 per QALY and if the relative risk exceeds 2.4, autologous transfusion is dominant, resulting in both lower costs and greater QALYs. If there were no increased risk of transfusion, the cost‐effectiveness of autologous transfusion would be $3,400,000 per QALY.CONCLUSIONS:If there is only a modest increase in the risk of bacterial infection following allogeneic transfusion, autologous transfusion would result in improved outcomes at a cost of less than $50,000 per QALY. Autologous transfusion would be dominant above a relative risk of infection that is within the range of values observed in randomized controlled trials. However, if there is no increased risk of bacterial infection, autologous transfusion would be a very expensive strategy. Until more definitive data are available on the magnitude and costs of this risk, we advise against prematurely closing the debate about the cost‐effectiveness of autologous transfusion.
Comparison of volumetric capillary cytometry with standard flow cytometry for routine enumeration of CD34+ cells
Authors: Cabezudo E. , Querol S. , Cancelas J.A. , Garcìa J. 
Published: March 2003

BACKGROUND: This study assesses the feasibility of a new volumetric cytometry system for the enumeration of CD34+ cells in apheresis components, peripheral blood, and cord blood samples in routine laboratory work. This system is compared with the following flow cytometry protocols: Milan, ISHAGE, ISHAGE with 7‐AAD, and flow‐count fluorospheres.STUDY DESIGN AND METHODS: Correlation, linearity, and reproducibility studies were performed for the various methods. Clonogenic cultures were performed, as an external control, to assess the correlation between the number of CD34+ cells per μL and the number of colony‐forming units per μL.RESULTS: The linear regression analysis demonstrated that the five methods were comparable (R2 ranged from 0.86 to 0.96 and slopes were close to 1). The CD34+ assay and the flow‐count methods showed poor linearity for CD34+ cell counts below 10 cells per μL (R2 = 0.46 and 0.47). The reproducibility assay for a CD34+ count of 10 cells per μL showed a CV of 12 percent and 25 percent for the Milan and CD34+ assay methods, respectively. The mean CV among all five methods for the 46 evaluated samples was 20 percent. There was a strong correlation between the number of CD34+ cells per μL and colony‐forming units per μL in cord blood and apheresis samples (r = 0.71‐0.81).CONCLUSION: The CD34+ assay is useful in CD34 enumeration in cord blood, leukapheresis samples, and peripheral blood samples and provides comparable results to the Milan, ISHAGE, ISHAGE with 7‐AAD, and flow‐count methods. Nevertheless, peripheral blood samples with low CD34 absolute counts (below 10 cells/μL) should be analyzed by alternative flow cytometry protocols. Even though the same operator performed the study in a single laboratory, the high inter‐method CV suggests that differences in sample preparation and gating strategy are factors that increase variability. Protocols with fewer intermediate steps or fully automated protocols such as the CD34+ assay are expected to reduced intra‐ and inter‐laboratory variability.
Comparison of Adsol and CPDA‐1 blood preservatives during simulated massive resuscitation after hemorrhage in swine
Authors: Buchholz D.H. , Borgia J.F. , Ward M. , Miripol J.E. , Simpson J.M. 
Published: March 2003

BACKGROUND: In recent years, there has been a change from the use of blood stored in CPDA‐1 to the use of red cells (RBCs) stored in electrolyte mixtures, such as Adsol (AS‐1 RBCs). However, because Adsol contains mannitol, as well as increased amounts of glucose relative to CPD and CPDA‐1, concerns have been expressed as to possible harmful effects (recipient hyperglycemia, inappropriate osmotic diuresis) that it might induce under conditions of massive RBC transfusion.STUDY DESIGN AND METHODS: A hemorrhagic shock animal model was used to evaluate the effects of large‐volume infusion of CPDA‐1 or Adsol on glucose homeostasis and on urinary output under conditions that were devoid of extensive surgical manipulation. Hemorrhage was induced in 10 female Pitman‐Moore mini‐pigs to maintain mean arterial blood pressure at 55 mmHg for 90 minutes. After the return of autologous RBCs plus 1 L of 0.9‐percent sodium chloride, the animals were given solution equivalent to the solute load in either 20 units of CPDA‐1 whole blood (63 mL × 20 = 1260 mL) or 20 units of AS‐1 RBCs (100 mL × 20 = 2000 mL) over a period of 90 minutes. Animals were monitored to determine physiologic and blood chemical responses to infusion of the solutions and to determine if there was hyperglycemia or inappropriate diuresis in the Adsol‐treated group.RESULTS: Animals that received CPDA‐1 developed significant hypocalcemia, arterial hypotension, and elevated blood glucose concentrations; two of five animals died of circulatory collapse. In contrast, glucose metabolism in the Adsol recipients was well‐regulated, serum ionized calcium concentration was not significantly altered, and all animals survived. No evidence of inappropriate diuresis was observed.CONCLUSION: Administration of large amounts of Adsol was not associated with hyperglycemia or inappropriate osmotic duiresis in hemorrhaged and resuscitated mini‐pigs. These data suggest that fewer physiologic changes may be associated with the massive transfusion of AS‐1 RBCs than with that of CPDA‐1 whole blood.
Isolation of CD34+ progenitor cells from peripheral blood by use of an automated immunomagnetic selection system: factors affecting the results
Authors: Martín‐Henao G.A. , Picón M. , Amill B. , Querol S. , González J.R. , Martínez C. , Martino R. , Ferrá C. , Brunet S. , Grañena A. , Sierra J. , García J. 
Published: March 2003

BACKGROUND: The isolation of CD34+ cells from mobilized peripheral blood is being increasingly used in the setting of allogeneic or autologous hematopoietic cell transplantation. Investigation of variables that may influence the effectiveness of CD34+ cell selection is of interest.STUDY DESIGN AND METHODS: Fifty‐one CD34+ cell selections from peripheral blood progenitor cells (PBPCs) (39 allogeneic and 12 autologous) were performed using a magnetic cell separator (Isolex 300i, Baxter), including version 2.0 software. The results obtained were analyzed for different processing variables. The feasibility of transplanting these isolated CD34+ cells was also analyzed.RESULTS: The isolated CD34+ cell fraction had a median purity of 88.9 percent (range, 47.8‐98.3). The median recovery of CD34+ cells was 45.1 percent (13.8‐76.2), and the median colony‐forming unit– granulocyte‐macrophage (CFU–GM) content was 17.2 percent (0.8‐58.6). Logarithms of T‐ and B‐cell depletion had median values of 3.7 and 2.8, respectively. The version 2.0 software of the Isolex 300i gave a higher CD34+ cell recovery in the enriched cell fraction (median 57.8%) than did version 1.11 (39.4%) or 1.12 (44.4%) (p = 0.01). The use of recombinant human deoxyribonuclease I during cell processing yielded more CD34+ cells (53% vs. 41%, p = 0.01) and higher purity (92.8% vs. 87%, p = 0.03). There was a correlation between the percentage of CD34+ cells labeled with the monoclonal antibody 8G12 clone and the percentage of CD34+ cells labeled with the monoclonal antibody used during the processing technique (9C5 clone) in the initial, enriched, and depleted CD34+ cell fractions (R2 = 0.95; 0.92; 0.78, p< 0.005, respectively). Median times for recovering >0.5 × 109 per L of granulocytes and >20 × 109 per L of platelets were 13 and 16 days in the allograft patients and 13 and 14 days in the autograft patients.CONCLUSION: CD34+ cells can be highly and effectively isolated from allogeneic and autologous grafts by use of this automated technique, with a high grade of T‐ and B‐cell depletion. These purified CD34+ cell components can engraft normally.
Alterations in cytoskeletal organization and tyrosine phosphorylation in platelet concentrates prepared by the buffy coat method
Authors: Estebanell E. , Díaz‐Ricart M. , Escolar G. , Lozano M. , Mazzara R. , Ordinas A. 
Published: March 2003

BACKGROUND: Numerous morphologic and biochemical changes occurring during platelet storage may result in the impairment of platelet function.STUDY DESIGN AND METHODS: The effect of preparation and storage conditions on platelet function was analyzed through evaluation of cytoskeletal organization and signaling mechanisms involved in the activation of platelets by thrombin. Samples of platelets prepared by the buffy coat method were obtained before and after the platelet concentrates were prepared during storage for 1, 3, and 5 days. Thrombin‐induced aggregation was monitored, and changes in the organization of proteins in the cytoskeleton were analyzed by gel electrophoresis. For the analysis of tyrosine phosphorylation, proteins were transferred to nitrocellulose membranes and probed with a specific antibody.RESULTS: The aggregation and the cytoskeletal organization induced by thrombin activation were markedly impaired immediately after preparation of platelet concentrates, although they normalized after the first 24 hours of storage and decreased progressively after 3 days of storage. Results in tyrosine phosphorylation paralleled those obtained with cytoskeletal organization, except for samples obtained immediately after processing to obtain platelet concentrates.CONCLUSION: These data indirectly suggest that the stress induced by the preparation method has an activating effect on platelet function that may imply a delayed platelet response to further stimuli. This effect may result in a deficient redistribution of signaling molecules within platelets.
Cost‐effectiveness of epoetin and autologous blood donationin reducing allogeneic blood transfusions incoronary artery bypass graft surgery
Authors: Marchetti M. , Barosi G. 
Published: March 2003

BACKGROUND: Coronary artery bypass graft (CABG) surgery accounts for a substantial portion of all allogeneic units of blood transfused. Drugs and autologous blood donation (ABD) are alternative or adjunctive methods for reducing complications and costs induced by allogeneic blood transfusions. Recombinant human erythropoietin (epoetin) has the potential to decrease perioperative need for allogeneic blood during CABG, but its high cost calls for a careful economic evaluation before it can be recommended for widespread use.STUDY DESIGN AND METHODS: A decision tree was used to compare a hypothetical strategy of no epoetin with one in which epoetin was utilized to control blood transfusion needs in CABG; each strategy was tested with and without ABD. The impact of these strategies on both the quality‐adjusted life years (QALYs) and costs ($US) was calculated.RESULTS: Using epoetin alone and with ABD, respectively, avoided the transfusion of 0.61 and 1.35 units of allogeneic blood per patient and saved 0.000086 and 0.000146 QALYs per patient. This made cost‐effectiveness (CE) higher than $7 million and $5 million for each QALY saved, respectively. ABD alone cost more than $1 million per QALY saved. If the risk of bacterial infections following allogeneic transfusions was included in the model, epoetin alone cost $6288 per QALY saved, while ABD, both alone and with epoetin, saved money.CONCLUSION: On the basis of the existing evidence, neither of the blood‐saving strategies modeled was a cost‐effective means of avoiding the deleterious health effects of perioperative blood transfusions in CABG. However, if allogeneic blood‐related infections were to be considered, both ABD and epoetin would be acceptable interventions.
Preterm birth and the availability of cord blood for HPC transplantation
Authors: Surbek D.V. , Holzgreve W. , Steinmann C. , Hahn S. , Gratwohl A. , Wodnar‐Filipowicz A. , Tichelli A. 
Published: March 2003

BACKGROUND: Cord blood from deliveries at term can be used for HPC transplantation. The objective of this study was to determine the amounts of cord blood nucleated cells (NCs) and HPCs that were collectable from preterm deliveries.STUDY DESIGN AND METHODS: Cord blood collected from preterm deliveries between 22 and 36 weeks of gestation was compared with regard to volume, NC count (/mL), CD34+ cell count (/mL), and the NC and CD34+ cell counts per cord blood sample and at different gestational ages.RESULTS: A correlation was found between gestational age and NC count (r = 0.52, p<0.001), and an inverse relation was found between gestational age and CD34+ cell count (r = − 0.68, p<0.001). The CD34+ cell count per cord blood sample was independent of gestational age (r = − 0.13, p = NS), and no significant difference between early (22‐32 week) and late (33‐36 week) preterm deliveries was found (p = 0.870). Comparison with published data from cord blood transplantations revealed that up to one‐third of preterm samples contained at least as many NCs (or CD34+ cells) as the median cell dose transplanted (calculated for the median recipient weight) in the respective study. Furthermore, 77 percent of all preterm samples contained at least 1 × 107 NCs (and 42% at least 1 × 105 CD34+ cells) per kg for transplantation in a recipient of 20‐kg body weight, which corresponds to the lower threshold of cells per kg in the graft recommended by Eurocord.CONCLUSION: Preterm delivery should not be a reason to exclude cord blood collection if allogeneic cord blood transplantation in a sibling is planned.