ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1994.34794330007.x

出版商:Blackwell Science Ltd    

年代:1994

数据来源: WILEY

ISSN:0041-1132    

DOI:10.1111/j.1537-2995.1994.tb05212.x

出版商:Blackwell Science Ltd    

年代:1994

数据来源: WILEY

摘要:

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

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1994.34794330008.x

出版商:Blackwell Science Ltd    

年代:1994

数据来源: WILEY

摘要:

BACKGROUND: Orthotopic liver transplantation (OLT) sometimes requires large amounts of blood. An adequate supply of Rh‐negative blood for Rh‐ negative patients is not always available.STUDY DESIGN AND METHODS: Seventeen Rh‐negative patients, out of 327 receiving OLT in this hospital, received from 5 to 41 units of Rh‐positive red cells during surgery. Each of the 17 patients was followed for 7 weeks to 70 months after OLT for detection of unexpected antibodies. Cyclosporin A and prednisone, azathioprine, and adjunctive rabbit antilymphocyte globulin or monoclonal OKT3 antibody were used to prevent graft rejection.RESULTS: Evidence of immunization, either to D or to antigens in the rest of the red cell antigen systems, did not appear in any patients.CONCLUSION: It is hypothesized that cyclosporin A affects the immune humoral response, inhibiting lymphocyte activation and the primary immune response; consequently, Rh‐positive blood may be transfused to Rh‐negative OLT recipients so treated with little or no risk of alloi

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1994.34794330009.x

出版商:Blackwell Science Ltd    

年代:1994

数据来源: WILEY

摘要:

BACKGROUND: The collection from a donor of 2 red cell units at one time would decrease recipient exposure to viruses and alloantigens. If the donor is a large person, the blood volume lost and the postdonation hemoglobin and/or hematocrit should be within acceptable limits. If the donor is a large person, the blood volume lost and the postdonation hemoglobin and/or hematocrit should be within acceptable limits. The effect on cardiovascular function and iron metabolism requires description.STUDY DESIGN AND METHODS: Manual 2‐unit erythropheresis was performed on eight donors, with the plasma returned. Donors had treadmill testing of maximum aerobic power (VO2max) before donation, 24 hours after, and 8 to 11 weeks after. Serial samples were drawn for iron metabolism studies.RESULTS: Donors weighed 61.2 to 74.8 kg, and 9.6 to 11.4 percent of their blood volume was removed. Mean VO2max decreased from 84 percent of that predicted before donation to 74 percent 24 hours afterward. By 8 to 11 weeks, hemoglobin returned to acceptable donor levels and mean VO2max was 92 percent of that predicted. Mean hemoglobin fell from 14.4 to 11.7 g per dL (144 to 117 g/L) and rose to 13.9 g per dL (139 g/L) at 16 weeks. At 16 weeks, serum iron (120 ± 47 vs. 83 ± 33 micrograms/dL [21 ± 8 vs. 15 ± 6 mumol/L]), ferritin (40 ± 24 vs. 18 ± 10 ng/mL [40 ± 20 vs. 20 ± 10 micrograms/L]), and free erythroprotoporphyrin (19 ± 5 vs. 28 ± 5 micrograms/dL [0.34 ± 0.09 vs. 0.50 ± 0.09 mumol/L]) differed significantly from baseline levels. No major donor symptoms occurred.CONCLUSION: Two‐unit erythropheresis was done with blood volume loss and postdonation hemoglobin no worse than those that would occur in a 50‐kg donor donating 450 mL. Cardiovascular effects and donor symptoms were mild. Two‐unit red cell donations would be clinically advantageous, and they warrant further studies of both utili

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1994.34794330010.x

出版商:Blackwell Science Ltd    

年代:1994

数据来源: WILEY

摘要:

BACKGROUND: The possible effects of long‐term plasma donation remain unknown, but it is important to investigate them so that donor safety is ensured. The purpose of this study was to determine if long‐term plasma donation alters plasma proteins or lymphocyte phenotypes.STUDY DESIGN AND METHODS: Two groups of long‐term plasma donors, source plasma donors (n = 20) and Rh immune globulin plasma donors (n = 26), were compared with whole blood donors (n = 29) and nondonor controls (n = 30). Blood samples were obtained prior to donation. Serum protein, albumin, globulin, and immunoglobulin levels were determined. In an assay using whole blood, lymphocyte phenotypes were characterized with a panel of single‐ and dual‐labeled monoclonal antibodies and subsequent analysis by flow cytometry.RESULTS: As compared to the nondonor controls and/or whole blood donors, the mean values for serum protein, globulin, and IgG levels were lower in both plasma donor groups, with a significant negative correlation between donation frequency and serum protein values for the source plasma donors. Albumin levels were within normal ranges for both groups of plasma donors. No significant differences existed among the donor groups in total white cell counts, the percentage or absolute number of lymphocytes, T (CD3) cells, or helper T (CD4) cells. However, there were increased percentages of B (CD19) cells and decreased percentages of suppressor T (CD8+/CD11b+) cells and natural killer cells in both groups of plasma donors as compared to nondonor controls.CONCLUSION: Many plasma donors have low levels of serum protein, globulin, and IgG. In addition, they have increased percentages of B cells and decreased percentages of suppressor T and natural killer cells. The clinical significance of these findings warrants further inve

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1994.34794330011.x

出版商:Blackwell Science Ltd    

年代:1994

数据来源: WILEY

摘要:

BACKGROUND: Currently, donors may arrive at blood collection sites without prior knowledge of eligibility and deferral criteria.STUDY DESIGN AND METHODS: The effects of distributing newly developed recruitment brochures 2 weeks in advance of blood drives and the provision of brochures on temporary deferral at the taking of health history were examined in four southeastern regional blood collection centers. Twenty‐four similar pairs of worksites, with employee‐only recruitment, were randomly assigned to a control (C) or experimental (E) group. Information about sponsor recruitment strategies, worksite factors, and first‐time, repeat, and temporarily deferred donors was obtained at three collection drives per site over a 1‐year period. Drive 1 was used as a baseline. Two weeks before Drives 2 and 3, the recruitment brochures were distributed to all Group E employees, with temporary deferral brochures provided as needed when the health history was taken.RESULTS: No significant differences between groups or drives were found in the total percentage of employees recruited or returning as a result of recruitment or deferral brochure distribution (Wilcoxon's signed rank test and t test). Substantiating previous observations by donor recruiters, the study results showed decreased donations during vacation periods and busier times at the workplace. Loudspeaker announcements led to decreased donations; increased donations followed special appeals in relation to a specific patient, an accident, or a natural disaster.CONCLUSION: The brochures may have encouraged previous donors to return, but their use did not significantly increase the recruitment of new donors or the return of temporarily deferred

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1994.34794330012.x

出版商:Blackwell Science Ltd    

年代:1994

数据来源: WILEY

摘要:

BACKGROUND: Five human platelet alloantigen systems have been shown to result from single base pair substitutions in encoding regions of platelet glycoprotein genes IIIa, Ib, IIb, and Ia. For each of the diallelic systems, at least one restriction enzyme is known to cut only one of the two haplotypes. In the PlA system, restriction endonucleases Nci I and Msp I both recognize the PlA2 allele.STUDY DESIGN AND METHODS: A causal observation of an unexpected Msp I restriction pattern of a PlA2/PlA2 individual was made. Samples from 261 blood donors were then typed for antigens of the PlA system by restriction fragment length polymorphism analysis using the Nci I and Msp I restriction enzymes.RESULTS: Applying both enzymes, concordant restriction patterns were found in 258 of 261 blood donors. Three donors had a base pair mutation on the PlA2 allele, which creates an additional restriction site for Msp I 20 base pairs downstream from the PlA polymorphic site. Nucleotide sequence analysis revealed a CT217–>CG217G base exchange resulting in a Leu40–>Arg40 polymorphism of glycoprotein IIIa.CONCLUSION: Presuming that the mutation is not a singular phenomenon and also occurs with the PlA1 haplotype, it could lead to false interpretations of restriction analysis with Msp I. To exclude that possibility, Nci I is preferred for restriction fragment length polymorphism typing in the PlA sys

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1994.34794330013.x

出版商:Blackwell Science Ltd    

年代:1994

数据来源: WILEY

摘要:

BACKGROUND: Hepatitis C virus (HCV) RNA was measured in immune globulins and its chemical and physical properties were characterized.STUDY DESIGN AND METHODS: The study examined 69 immune globulin lots from 7 manufacturers, including 44 intravenous and 25 intramuscular immune globulin preparations. In addition, 8 experimental intravenous immune globulin preparations were investigated. Detection and quantitation of HCV RNA were achieved by reverse transcription and nested polymerase chain reaction at limiting dilution. A multi‐antigen anti‐HCV enzyme immunoassay was also used to test these immune globulins.RESULTS: The highest level of HCV RNA was found in an experimental immune globulin lot derived from a plasma pool made up of 186 anti‐c100‐3‐reactive units. HCV RNA was detected only in 1 of 7 manufacturers' experimental intravenous immune globulin preparations derived from a pool made up of 2887 anti‐c100‐3‐negative units. It was also detected in commercial intravenous immune globulin lots prepared by the same manufacturer from source plasma, but not from recovered plasma. More than half of the commercial intramuscular immune globulin lots, including specific immune globulin products, were HCV RNA positive. All immune globulin products examined were reactive for anti‐ HCV. Certain similarities were found for HCV RNA present in an immune globulin product and plasma. Ethanol at 20 or 25 percent had no effect upon the buoyant density of HCV RNA.CONCLUSION: Many immune globulin preparations contained HCV RNA, with levels depending upon both the type of starting plasma and the manufacturing process. Exposure to ethanol did not appear to affect the physical character

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1994.34794330014.x

出版商:Blackwell Science Ltd    

年代:1994

数据来源: WILEY

摘要:

BACKGROUND: Recently, new immunoblot assays for the detection of antibodies to hepatitis C virus (HCV) became available.STUDY DESIGN AND METHODS: The performance of five confirmatory anti‐HCV immunoblot assays was studied with samples with known HCV antibody and HCV RNA status. The assays were a third‐generation strip recombinant immunoblot assay (RIBA‐3, Chiron Corp., Emeryville, CA), a second‐generation HCV blot (DB‐2 blot, Diagnostic Biotechnology, Singapore), the Wellcozyme HCV Western blot (Murex blot, Murex Diagnostics, Dartford, UK), an immunodot HCV assay (Matrix, Abbott Laboratories, Chicago, IL), and the third‐generation HCV line immunoassay (Liatek‐III, Organon Teknika, Boxtel, The Netherlands).RESULTS: Sensitivity on samples from 48 HCV RNA‐positive, second‐generation RIBA (RIBA‐2)‐positive persons and specificity on samples from 31 low‐risk donors was 96 percent or better for all assays. The sensitivity on 31 HCV RNA‐positive, RIBA‐2‐ indeterminate samples was as follows: Liatek‐III, 94 percent; RIBA‐3, 90 percent; Murex blot, 61 percent; Matrix, 55 percent; and DB‐2 blot, 39 percent. In testing 39 HCV RNA‐negative, RIBA‐2‐indeterminate donor samples, the percentage found to be negative was Liatek‐III, 77 percent; RIBA‐3, 67 percent; Murex blot, 49 percent; DB‐2 blot, 33 percent; and Matrix, 15 percent. The order of sensitivity on four HCV seroconversion series was (from high to low): RIBA‐3, Liatek‐III, DB‐2 blot, Murex blot, and Matrix; the differences were small.CONCLUSION: Detection of HCV antibodies was not refined by the addition of new HCV antigens (NS5, E2/NS1), but by improved classical antigens (core, NS3, NS4). Replacement of the commonly used RIBA‐2 will resolve the stat

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1994.34794330015.x

出版商:Blackwell Science Ltd    

年代:1994

数据来源: WILEY