ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1992.32893032092.x

出版商:Blackwell Science Ltd    

年代:1992

数据来源: WILEY

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1992.32893032093.x

出版商:Blackwell Science Ltd    

年代:1992

数据来源: WILEY

摘要:

All blood donors in the United States are tested for hepatitis B surface antigen (HBsAg) upon donation; if the test result is positive, the primary method of notification is by letter. To assess the effectiveness of this notification methods in stimulating HBsAg‐ positive donors to seek medical care and take preventive measures, 54 donors who tested HBsAg‐positive on donation at the American Red Cross Blood Services. Atlanta Region, from January 1987 to July 1989 were interviewed. Thirty‐nine donors (72%) had sought medical care after notification; the only motivating factor was that the letter told the donor to consult with his or her physician. Compared with donors who did not seek medical care, donors who did so were more likely to understand that the blood test was abnormal or that they were infected, and they were more likely to understand how hepatitis B virus is transmitted and that a vaccine is available. The differences were not significant, however. Of those donors who sought medical care, less than half received appropriate recommendations for protection of contacts, and of those who did, only one‐third received prophylaxis. In‐ person and telephone interviews with donors, revision of the notification letter, and hepatitis B education programs targeted at medical care providers are

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1992.32893032094.x

出版商:Blackwell Science Ltd    

年代:1992

数据来源: WILEY

摘要:

From 1987 to the present, the Seroconversion Surveillance Project has provided the means by which to monitor the risk of transmission of human immunodeficiency virus (HIV) by clotting factor concentrates. One hundred thirty‐one hemophilia treatment centers in the United States are contacted regularly, and data on HIV testing of patients are collected. To date, 4366 (46.0%) of 9496 patients have been reported to be seropositive, and 37 new seroconversions have been identified. Nine of these have met the Centers for Disease Control criteria for seroconversion while the patient was taking factor concentrate. None of the nine seroconversions were due to concentrates that had been treated to inactivate viruses and made from plasma that had been tested for HIV antibody. These results indicate that there is a high prevalence of seropositivity in affected patient groups, but that the risk of HIV infection from currently available clotting factor concentrates is extremely lo

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1992.32893032095.x

出版商:Blackwell Science Ltd    

年代:1992

数据来源: WILEY

摘要:

The Canadian Apheresis Study Group recently completed a randomized clinical trial involving 102 patients with thrombotic thrombocytopenic purpura (TTP), in which treatment with plasma infusion and treatment with plasma exchange were compared. Thirty‐three other patients were ineligible or refused to be randomly assigned in the trial. Of the 33 patients, 24 were assessed as ineligible because they would be unable to tolerate the fluid input that would occur if they were randomly assigned to receive plasma infusion. All 24 patients had oliguria and elevated creatinine and/or blood urea nitrogen level. These 24 patients were treated with acetylsalicyclic acid, dipyridamole, and plasma exchange according to the standardized protocol defined in the trial. Blood for tests of factors possibly involved in the pathogenesis of TTP was drawn before exchange and at intervals during and after exchange. The mean platelet count before exchange was 35.5 × 10(9) per L. In 12 of the 24 patients, the platelet count reached 150 × 10(9) per L or greater by 7 days after the initiation of plasma exchange. Three patients responded partially, in that their platelet count increased to at least twice that at presentation, but remained below 150 × 10(9) per L. One patient died during the first week. Of the eight other patients who experienced treatment failure at the 7‐day assessment point, six subsequently responded, four while continuing to receive plasma exchange and two after plasma exchange had been discontinued. Of the 15 patients who either responded fully or responded partially by the end of the first cycle, all survived.(ABSTRACT TRUNCATED AT 250

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1992.32893032096.x

出版商:Blackwell Science Ltd    

年代:1992

数据来源: WILEY

摘要:

The effect of brief 37 degrees C pretransfusion incubation of apheresis platelets (n = 25) was studied in 14 allogenic bone marrow transplant recipients (5 children, 9 adults). Apheresis platelets were collected on a cell separator, divided in two aliquots, and stored 1 to 5 days at 22 degrees C during agitation. One aliquot was incubated at 37 degrees C for 1 hour before transfusion, and the other was transfused as a paired control. When the patient's peripheral platelet count fell below 30 × 10(9) per L, one aliquot was transfused. The other aliquot was transfused the following day. Each patient received the two aliquots in random order. Corrected count increment (CCI) at 1 hour after transfusion of 37 degrees C incubated platelets was 12.2 +/− 9.5 (mean +/− SD) compared to 7.5 +/− 5.4 for paired control platelets (p<0.05). CCIs the next day were 4.4 +/− 6.1 and 2.4 +/− 2.7, respectively (not significant). It can be concluded that 37 degrees C incubation of apheresis platelets improves posttrans

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1992.32893032097.x

出版商:Blackwell Science Ltd    

年代:1992

数据来源: WILEY

摘要:

Most patients who receive multiple blood or platelet transfusions do not develop graft‐versus‐host disease (GVHD) in spite of the transfusion of donor white cells–cells that are capable of engraftment and subsequent GVHD. The object of this study was to search for the factors responsible for resistance to GVHD in such patients. Some sera from patients who have received multiple platelet transfusions inhibit the proliferation of alloreactive T‐cell clones that function as an in vitro model of donor‐derived proliferating T cells recognizing recipient alloantigens. The humoral factor in such sera was capable of binding to the T‐cell clones, but not to stimulator cells. Further analysis revealed that the humoral factor in such sera was IgG, which specifically bound to membrane molecules of the T‐cell clones. The antibody competed with WT31, a monoclonal antibody (MoAb) to T‐cell receptor (TCR), in binding to TCR of the T‐cell clones. It did not compete with CD3 or CD2 MoAb. These observations strongly favor the view that the antibody against TCR exists in the sera of multiple transfusion recipients. It is suggested that the TCR antibody binds to TCR of the T‐cell clones, thus blocking the interaction of the T‐cell clone with alloantigens of stimulator cells and resulting in inhibition of the proliferation of T‐cell clones. Furthermore, in view of T‐cell clone‐specific binding of the antibody in sera, it might be concluded that the

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1992.32893032098.x

出版商:Blackwell Science Ltd    

年代:1992

数据来源: WILEY

摘要:

Seven patients with refractory lymphomas underwent marrow reconstitution with peripheral blood stem cells (PBSCs) harvested by large‐volume leukapheresis (LVL). PBSCs were collected from all patients more than 1 month after the last cycle of chemotherapy, and no patient received growth factors. The median number of LVL procedures performed per patient was 4.5, with a mean volume of 24.5 L of blood processed per procedure to obtain 7 × 10(8) mononuclear cells per kg. Autologous PBSCs and platelets were frozen at a controlled rate in plasma and 10‐percent dimethyl sulfoxide and stored in the vapor phase of liquid nitrogen. This group of patients was compared to a control group (n = 18) who received medullary marrow (MM) transplants for the same diagnoses under the same protocols during the same period. Posttransplant days to white cell engraftment (PBSC = 17, MM = 15.5) were no different. Days to platelet independence were significantly longer in the LVL PBSC group (PBSC = 33, MM = 16; p<0.05). This pattern of engraftment is typical of patients treated in this manner. Although Day 0 platelet counts (PBSC = 75.5 × 10(9)/L, MM = 85 × 10(9)/L) and total single‐donor unit platelet use (PBSC = 8, MM = 9) were no different, Day 1 platelet counts (PBSC = 128 × 10(9)/L, MM = 61.5 × 10(9)/L; p<0.05) and Day 14 platelet use (PBSC = 5, MM = 8; p<0.05) were significantly different, because of the transfusion of cryopreserved autologous platelets with PBSC

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1992.32893032099.x

出版商:Blackwell Science Ltd    

年代:1992

数据来源: WILEY

摘要:

Large‐volume leukapheresis (LVL, 15–35 L) was performed in two groups of patients (n = 10) with hematologic malignancies to obtain peripheral blood stem cells for bone marrow rescue following high‐dose chemotherapy. The target cell count was 7 × 10(8) mononuclear cells (MNCs = lymphocytes and monocytes) per kg of body weight. Group A patients (n = 4) were studied on Day 1 of LVL, and components were collected from them as four sequential samples. Total MNCs collected averaged 1.29 × 10(10), total colony‐forming‐units granulocyte‐ macrophage (CFU‐GM) averaged 12.1 × 10(6), and a 1.8‐fold mobilization of CFU‐GM was observed (p<0.05, Sample 1 vs. Sample 4). Group B patients (n = 6) were studied throughout the three consecutive planned days of 5‐hour LVL. An average of three LVL procedures per patient was performed (range, 1.25‐4), and an average of 27 L (range, 24–33) of blood per LVL was processed. The blood:ACD‐A ratio was 24:1 with 3000 units of heparin per 500 mL of ACD‐A; heparin was also added to the collection bags. The component had an average hematocrit (Hct) of 0.02 and MNC content of 93 percent. The patients' pre‐LVL and post‐LVL average Hct varied significantly (before Day 1, 0.36 +/− 0.08; after Day 3, 0.28 +/− 0.06; p<0.05). Platelet counts also decreased, with post‐Day 3 counts averaging 19 percent of the average pre‐Day 1 counts (p<0.05). A decrease in the average MNC count after LVL was significant on Day 1 only

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1992.32893032100.x

出版商:Blackwell Science Ltd    

年代:1992

数据来源: WILEY

摘要:

A non‐diethylhexyl phthalate (DEHP)‐plasticized blood bag for 5‐day storage of random‐donor platelet concentrates has been developed. The plastic bag is composed of polyvinylchloride plastic with a butyryl trihexyl citrate plasticizer. The suitability of this plastic for the storage of platelet concentrates for use in clinical transfusion practice was evaluated. In vitro storage studies showed no significant differences at Day 5 for a series of in vitro assays (test plastic vs. control plastic) including pH (7.31 vs. 7.44), lactate dehydrogenase discharge (21.8 vs. 17.1%), pO2 (103 vs. 120 torr), osmotic recovery (52 vs. 57%), and morphology score (527 vs. 516). For paired radiolabeled recovery and survival data from autologous blood donors, results showed equivalence between the test plastic and two control plastics. A small but significant difference between test and control plastics in regard to survival was found by using a linear computer model, but not with a gamma function (multiple‐hit) model. For paired transfusions to thrombocytopenic patients, the corrected count increments at 1 to 4 hours (test vs. control) were 13,534 versus 15,494 (p>0.05, NS). Similar results were seen for corrected count increments determined at 12 to 24 hours. It can be concluded that platelets stored in the test plastic are acceptable for use in clinical

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1992.32893032101.x

出版商:Blackwell Science Ltd    

年代:1992

数据来源: WILEY