ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1992.32492263438.x

出版商:Blackwell Science Ltd    

年代:1992

数据来源: WILEY

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1992.32492263439.x

出版商:Blackwell Science Ltd    

年代:1992

数据来源: WILEY

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1992.32492263440.x

出版商:Blackwell Science Ltd    

年代:1992

数据来源: WILEY

摘要:

The need to detect antibodies that agglutinate and/or hemolyze red cells (RBCs) directly at 37 degrees C, but do not react in subsequently performed indirect antiglobulin tests (IATs), is of concern relative to the streamlining and automation of antibody detection methods. To determine incidence and significance of such reactions, data from 87,480 tests, which used low‐ionic‐strength saline, 10‐minute incubation at 37 degrees C, and anti‐IgG, were analyzed for unexpected antibodies. There were 3590 positive tests, of which 475 showed reactions at 37 degrees C but not in subsequently performed IATs (37 + IAT‐). Of these, 196 reactions were due to autoantibodies or other factors usually considered insignificant with respect to the survival of transfused incompatible RBCs, 176 were due to alloantibodies of questionable clinical significance (M, Lea, P1, etc.), and 103 were associated with alloantibodies of potential clinical significance (63 E, 27 K, 5 Jka, 4 D, 3 cE, and 1 C). This latter reaction was seen in 72 patients, with two 37 + IAT‐antibodies occurring in each of 3 patients. Of the 75 potentially significant 37 + IAT‐antibodies, 57 were seen in patients recently exposed to homologous RBCs, 13 in patients with a history of transfusion and/or pregnancy, and 5 in patients with no known exposure to homologous RBCs. IAT reactivity was observed in subsequent samples with 27 of these antibodies. The predictive value of a 37 + IAT‐test was 21.7 percent for a potentially significant antibody. The incidence was 0.12 percent of all tests for unexpected antibodies. As 27 potentially significant 37 + IAT ‐ antibodies were found in subsequent samples to be IAT +, indicating a secondary (IgG) immune response, elimination of the 37°C reading for agglutination and hemolysis should not be

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1992.32492263441.x

出版商:Blackwell Science Ltd    

年代:1992

数据来源: WILEY

摘要:

The c100 hepatitis C virus (HCV) enzyme‐linked immunosorbent assay (ELISA) has been used to screen blood donors to prevent transfusion‐ associated non‐A, non‐B hepatitis. This test is not specific, and only about 25 percent of c100 HCV ELISA‐positive blood samples appear to transmit hepatitis C. However, the intensity of the ELISA (sample/cutoff ratio [S/C], greater than 2) could identify a subpopulation of donors that are at high risk for transmitting hepatitis. Blood samples from 20,186 volunteer blood donors at a Canadian Red Cross blood transfusion center were screened for antibodies to HCV using the c100 HCV ELISA. Fifty‐nine (0.3%) of these donors were repeatably reactive on ELISA. When their samples were tested with the c100 recombinant immunoblot assay (RIBA) and second‐ generation RIBA (RIBA‐2), 26 (44%) and 31 (52%) samples, respectively, were found to be positive. Thirty‐three of the 59 ELISA‐reactive donors had an S/C greater than 2. Of these 33 donors, 30 (91%) had elevated alanine aminotransferase (ALT), 27 (82%) were RIBA‐2 positive, and 22 (67%) had risk factors for hepatitis. In contrast, of the 26 ELISA‐ reactive donors with S/C less than 2, only 7 (27%) had elevated ALT, and 4 (15%) were RIBA‐2 positive and also had high risk factors for hepatitis. Thus, while the HCV ELISA may lack specificity, its intensity can serve to identify a subgroup of donors that are at high risk f

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1992.32492263442.x

出版商:Blackwell Science Ltd    

年代:1992

数据来源: WILEY

摘要:

The role of the immune system in microbial translocation must be clarified. In these studies, the effect of blood transfusion‐related immunosuppression on translocation was investigated in a burn animal model previously known to increase the gut's permeability to 14C‐ radiolabeled Escherichia coli. In a first experiment, Balb/c mice underwent transfusion (T) with 0.2 mL per mouse of allogeneic C3H/HeJ mouse blood 5 days prior to undergoing 30‐percent burn injury (B) and simultaneous gavage (G) with 10(9) E. coli bacteria labeled with 14C. An additional six groups of Balb/c mice underwent different combinations of T, B, and G procedures (TG, BG, TB, T, B, G). Survival rate was recorded for all groups on Day 10. This experiment suggested that B and T, to a lesser extent, were the factors affecting survival, although the combination of T, B, and G clearly showed a synergistic effect on mortality. In a second experiment, 18 Balb/c mice belonging to TBG, BG, TG, and G groups were sacrificed 1, 4, and 24 hours after burn or gavage. The residual radioactivity and the percentage of viable bacteria were computed for mesenteric lymph nodes, spleen, liver, lungs, blood, and peritoneal fluid. Statistical analysis of the radionuclide counts recognized B as the only variable able to enhance the magnitude of 14C E. coli translocation. The percentage of viable bacteria showed that T and, more moderately, B were the factors leading to the failure of bacterial clearance in the ti

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1992.32492263443.x

出版商:Blackwell Science Ltd    

年代:1992

数据来源: WILEY

摘要:

Adverse effects of the transfusion of homologous blood on tumor recurrence and resistance to bacterial infection have been reported previously, but the findings are inconclusive. A retrospective review of patients undergoing orthopedic surgery was conducted, and the rate of the postoperative infectious complications was compared among those receiving homologous blood, autologous blood, both types, or no transfusion support. An overall postoperative infection rate of 6.1 percent was observed: 6.9 percent among persons receiving homologous blood, 5.0 percent among those receiving autologous blood, 11.9 percent among those receiving both homologous and autologous blood, and 4.9 percent among those not receiving transfusions (p = 0.37). Among patients receiving homologous blood, a subset of 15 patients received homologous whole blood and had an infection rate of 20 percent. Significant predictors of postoperative infection included increasing age, spinal surgery, high admission hematocrit, and greater time in surgery. Of factors relating to transfusion, only the use of homologous whole blood was a significant predictor of postoperative infection, which suggests a detrimental effect of homologous plasma. It can be concluded that, in this group of patients undergoing relatively nontraumatic surgery, several variables that are not related to transfusion, as well as the use of homologous whole blood, were significant predictors of postoperative infection.

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1992.32492263444.x

出版商:Blackwell Science Ltd    

年代:1992

数据来源: WILEY

摘要:

When a patient receives blood from a closely related donor, there is the potential for transfusion‐associated graft‐versus‐host disease (TA‐ GVHD). With a mathematical model, the potential risk of TA‐GVHD was derived for six classes of related donors. This risk was considered to be present when an HLA‐heterozygous patient received blood from a donor who was homozygous for one of the patient's haplotypes. Calculations showed that second‐degree related donors present a greater risk of TA‐ GVHD than some (siblings) but not all (parents, children) first‐degree related donors. Moreover, there is, in general, no sharp cutoff of risk among the various classes of donors. These results should be considered in the determination of a policy for the irradiation of dir

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1992.32492263445.x

出版商:Blackwell Science Ltd    

年代:1992

数据来源: WILEY

摘要:

The effect of cotton wool filtration of apheresis platelet concentrates (PCs) on platelet viability and complement activation was evaluated by two laboratories. PCs were prepared by automated (Lab A, n = 5) or manual (Lab B, n = 5) apheresis. After storage for 1 day, the PC was filtered through cotton wool before transfusion on one occasion and, on the other occasion, filtered through a standard screen filter before transfusion to the same donor. Five paired studies were performed by each laboratory. Except for a small, but significant reduction in mean platelet size, from 7.3 +/− 1.1 to 6.6 +/− 0.9 microns 3, after cotton wool filtration, no effect of filtration on various tests of in vitro platelet function and morphologic integrity was found. As demonstrated by autologous radiolabeled studies, no effect of cotton wool filtration on platelet viability was found by Laboratory B, while Laboratory A found a slight increase in the percentage of recovery from 59 +/− 4 to 68 +/− 13 percent, and a small reduction in survival, from 8.2 +/− 0.9 to 7.7 +/− 0.5 days after cotton wool filtration (p less than 0.05). Cotton wool filtration was associated with a slight increase in C3a levels found in manual apheresis PCs. Neither laboratory found any effect of cotton wool filtration per se on the recipients' white cell (WBC) counts or C3a and C5a levels after transfusion. However, it was observed that the transfusion of automated PCs (whether filtered through cotton wool or not filtered) caused a small, but significant (p<0.05; F<0.05) drop of 13 percent i recipient WBC count after transfusion, which is indicative of some in vivo effect from the automated apheresis procedure. These studies show that WBC reduction by the cotton wool filtration of apheresis PCs does not cause any significant damage to the platelets or activate the recipient complement reaction, as measured by recipient posttransfusion levels of WBCs,

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1992.32492263446.x

出版商:Blackwell Science Ltd    

年代:1992

数据来源: WILEY

摘要:

The role of residual donor white cells (WBCs) in producing the storage lesion of platelets used for transfusion was studied. The effect of prestorage WBC reduction on in vitro and in vivo measurements of the quality of stored platelet concentrates (PCs) was examined by using a newly developed WBC‐reduction filter capable of preparing PCs with a mean residual WBC concentration of less than 1 per microL. For in vitro studies, a triplet study design was used, in which WBC‐reduced PCs were matched to standard PCs and to WBC‐enriched PCs obtained from the same donor at the same phlebotomy. Twelve donors were studied. Prestorage WBC reduction resulted in a higher pH and pO2 and a lower pCO2 than in standard PCs. In accord with previous in vitro studies, a significant rise in plasma glycocalicin and lactate dehydrogenase was measured during storage, but the levels were not significantly different in WBC‐ reduced PCs and standard PCs. Platelet aggregation and ATP release in response to graded doses of thrombin was similar in WBC‐reduced and standard PCs. In vivo recovery and survival studies were comparable in WBC‐reduced and standard PCs. Although the residual donor WBC content of PCs has a significant impact on storage pH, pO2, and pCO2, prestorage WBC reduction does not affect platelet structure, function, or viability as assessed by in vitro or in vivo m

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1992.32492263447.x

出版商:Blackwell Science Ltd    

年代:1992

数据来源: WILEY