ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1996.361097017168.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1996.361097017169.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

Background:Anemia and transfusion are predictors of disease progression in AIDS patients. This study was designed to examine the effects of blood transfusion on human immunodeficiency virus type 1 (HIV‐1) expression.Study Design and Methods:Assays of plasma viral load were performed before and after transfusion in nine HIV‐1‐infected patients who required blood transfusion for refractory anemia.Results:There was a modest rise in plasma HIV‐1 p24 antigen and plasma HIV‐1 RNA beginning 1 to 2 weeks after the blood transfusion. The mean change in plasma p24 antigen for all patients was 9.3 ± 5.1 (mean ± SE) pg per mL at Week 2 after transfusion and 18 ± 11.1 pg per mL at Week 4. Plasma HIV‐1 RNA levels were unchanged immediately after transfusion and exceeded pretransfusion levels with a mean rise of 84 ± 40 percent (SE) at Week 1, 70 ± 27 percent at Week 2, and 67 ± 38 percent at Week 4 (p equals; 0.006, exact permutation test). There was no increase in spontaneous or interleukin 2‐induced lymphocyte proliferation or p24 antigen production by patients' lymphocytes that were examined immediately after blood transfusion.Conclusion:The transfusion of blood to persons with advanced HIV‐1 infection modestly increases plasma levels of HIV‐1. The activation of HIV‐1 expression by transfusion may help to explain the accelerated course of HIV‐1 disease in reci

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1996.361097017170.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

Background:IgG preparations have rarely transmitted infectious diseases; however, because such transmission has occurred a few times, manufacturers are required to present experimental proof that their specific production process removes and/or inactivates viruses that may be present in the starting material.Study Design and Methods:The kinetics of virus inactivation mediated by pepsin treatment at pH 4 during the production of intravenous immunoglobulin was assessed with spiking experiments using human immunodeficiency virus, bovine viral diarrhea virus, Semliki Forest virus, and pseudorabies virus. The influence of various factors on the rate of virus inactivation also was studied by modifying the composition of the IgG solutions with respect to IgG, sucrose, and NaCl content.Results:Virus inactivation at 37° C was extremely rapid and resulted in a complete loss of infectivity within 5 minutes to 1 hour. Inactivation was much slower at lower temperatures. Furthermore, inactivation was dependent on the solute composition. Increasing the sucrose content from 0 to 15 percent reduced the rate of inactivation of pseudorabies virus but did not affect the rate of inactivation of Semliki Forest virus. In contrast, increasing the NaCl content from 0 to 150 mMresulted in a reduction in the rate of inactivation of Semliki Forest virus, whereas the rate of inactivation of pseudorabies virus remained unaffected. Moreover, increasing the IgG concentration from 0 to 10 percent resulted in an increased rate of inactivation of pseudorabies virus but a decreased rate of inactivation of Semliki Forest virus.Conclusion:Inactivation of viruses by pepsin treatment at pH 4 essentially is temperature‐dependent, and the reaction rate is selectively influenced by the solute composition of the IgG solution. This has to be taken into account when safety data for different products are compar

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1996.361097017171.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

Background:Despite recent optimism about the use of erythropoietin therapy to treat the anemia of prematurity, very‐low‐birth‐weight infants who are severely ill receive multiple red cell (RBC) transfusions. Many physicians transfuse relatively fresh RBCs to newborn infants, exposing them to multiple donors and possibly increasing their risk of acquiring transfusion‐transmitted infections.Study Design and Methods:A randomized, single‐blind clinical trial was conducted to determine, as the primary endpoint, whether RBCs collected from one dedicated donor and stored for ≤ 42 days in AS‐1 storage media could safely supply all small‐volume RBC transfusions (15 mL/kg/dose) needed by very‐low‐birth‐weight infants (0.6‐1.3 kg) during the first 84 days of life. Secondary endpoints were the assessment of the possible adverse clinical and biochemical effects of transfusing AS‐1 RBCs stored for ≤ 42 days. Control infants received identical nursery care, except they received fresh RBCs stored ≤ 7 days in CPDA‐1.Results:Infants transfused with AS‐1 RBCs were exposed to a mean of 1.6 donors,‐compared with an exposure to 3.7 donors for infants given CPDA‐1 RBCs (p<0.05). Neither clinical transfusion reactions nor the results of multiple laboratory tests were significantly different in infants who received slow transfusions (15 mL/kg) of AS‐1 RBCs stored for ≤ 42 days and in infants who received the same volume of CPDA‐1 RBCs stored ≤ 7 days.Conclusion:AS‐1 RBCs, usually from only one dedicated donor, can safely supply all RBCs needed by most very‐low‐birth‐weight infants—a practice that decreases

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1996.361097017172.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

Background:Recruitment of progenitors during a large‐volume collection, as defined by increasing relative and absolute numbers of progenitors (colony‐forming units‐granulocyte‐macrophage [CFU‐GM] of CD34+ cells), has been reported previously.Study Design and Methods:To ascertain whether intra‐apheresis recruitment occurs in pediatric patients who have undergone mobilization with chemotherapy and granulocyte‐colony‐stimulating factor (G‐CSF), each hour's portion of a 4‐hour leukapheresis was collected into separate bags, and assessed by complete blood count, CFU‐GM, and CD34+ cell assays. Seven pediatric patients (median age, 7; range, 2–19) were studied in connection with 2 to 4 collections each, for a total of 21 collections (with hourly samples). The collections lasted for 4 hours, at an inlet rate of 1 to 3 mL per kg per minute, for daily processing totals of 5 to 12 blood volumes. (One blood volume [mL] is estimated by the patient's weight in kg × 70 mL/kg.) Smaller (younger) patients had inlet rates exceeding 2 mL per kg per minute, and larger (older) patients had rates of 1 to 1.5 mL per kg per minute. CFU‐GM and CD34+ cell counts obtained each hour of the collection and divided by the first hour's value were compared by nonparametric repeated‐measures ANOVA.Results:Second‐, third‐ and fourth‐hour CD34+ progenitor cell counts were arithmetically higher than first‐hour counts, but the trend did not reach significance (p = 0.1561). Second‐hour counts were higher than first‐hour counts in the overall analysis (mean ± standard error [SE], 1.00 and 1.39 ± 0.1, respectively; p = 0.0525) and in children older than 5 years (1.00 vs. 1.70 ± 0.30, respectively; p = 0.0259), but not in children younger than 5 years (p = 0.8125). CFU‐GM counts did not differ among the 4 hours of collection (p = 0.1717) or between the first and second hour (p = 0.9587).Conclusion:In larger (older) patients, from whom fewer blood volumes were collected, there is a trend toward intra‐apheresis recruitment, although less than reported previously. In the smaller (younger) patients, from whom more blood volumes were collected, no trend was observed. Lack of (or submaximal) prior mobilization in previously reported studies may have facilitated intracollection recruitment. Alternatively, the larger number of blood volumes collected from the smaller (younger) patients may have masked intra‐apheresis recruitment. The study documents the feasibility of large

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1996.361097017173.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

Background:A relation between febrile reactions to platelet transfusion and high cytokine levels in platelet concentrates (PCs) was found previously. The levels of cytokines such as interleukin (IL)‐6 are related to the while cell content of the PC during storage. Therefore, early removal of white cells should prevent reactions.Study Design and Methods:This prospective study was set up to compare methods for the preparation of random PCs, the platelet‐rich plasma method (PRP‐PCs), which results in a high white cell content, and the buffy coat method (BC‐PCs), which results in a low white cell content, with regard to the frequency and severity of reactions to platelet transfusion and the IL‐6 level of the PC. IL‐6 was chosen because it is the major mediator of the acute‐phase response. White cells were reduced in all PCs before transfusion.Results:Platelet transfusions (n = 584) in 64 patients were studied. An overall reaction frequency of 7.2 percent was observed. Transfusion reactions were seen predominantly in patients who received PRP‐PCs (PRP‐PCs: 9.3% vs. BC‐PCs: 2.7%, p = 0.007). Allergic reactions were limited to transfusions of PRP‐PCs. The following PRP‐PC characteristics were significantly correlated with febrile transfusion reactions: IL‐6 level (p<0.0001), initial white cell count (p = 0.001), and storage time (p = 0.02). In this group, reactions were less frequent in patients receiving pretransfusion medication (p<0.001). In the PRP‐PC group, IL‐6 content (p = 0.01) and initial white cell count (p = 0.04) were also significantly correlated with allergic reactions, which indicated that these or associated factors might have an effect on the outcome of this type of reaction.Conclusion:Febrile reactions are highly correlated with IL‐6 levels in PCs. The low white cell content of BC‐PCs is associated with undetectable IL‐6 levels and a reduced frequency of febrile as well as allergic reactions in recipients. The BC method is the preferable one for

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1996.361097017174.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

Background:Threonine145/methionine145dimorphism in platelet glycoprotein (GP) Ibα defines the human platelet antigen (HPA)‐2 system that has been implicated in refractoriness to HLA‐matched platelet transfusion and in neonatal immune thrombocytopenic purpura.Study Design and Methods:The occurrence of this amino acid dimorphism was investigated in 379 Italian blood donors by studying their genomic DNA. Two oligonucleotide primers, Ibα‐3 (5′‐GGACGTCTCCTTCAACCGGC‐3′) and Ibα‐4 (5′‐GCTTTGGTGGGGAACTTGAC‐3′), were used in a polymerase chain reaction to generate a 591‐base pair fragment that was digested with the restriction enzymeAcyI. To investigate whether this dimorphism is involved in the binding of von Willebrand factor (vWF) to GPlb, the binding of vWF to the GPlb/IX complex was measured in twoMet145/Met145and twoThr145/Thr145subjects.Results:The genotypic frequencies are 78.9% for Thr/Thr, 19.8% for Thr/Met), and 1.3% for Met/Met; the allelic frequencies are 88.8% for Thr145and 11.2% for Met145. Estimates for binding of subunit molecules per platelet at saturation and inhibition constant in mol per L, respectively, follow. In the presence of ristocetin (0.5 mg/mL), they are 11,460 ± 2,040 and 1.26 ± 0.44 × 10−8for normals and 11,230 ± 2,330 and 1.29 ± 0.48 × 10−8for patients. In the presence of botrocetin (2.5 μg/mL), they are 64,260 ± 7,760 and 2.99 ± 0.96 × 10−8for normals and 65,770 ± 11,570 and 2.47 ± 0.22 × 10−8for patients. Platelet aggregation responses obtained using platelet‐rich plasma from donors withMet145/Met145orThr145/Thr145genotype were within normal limits.Conclusion:Genotypic and phenotypic frequencies in the HPA‐2 system in this population are consistent with those reported among the white population. Furthermore, the HPA

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1996.361097017175.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

Background:The granulocyte antigens NA1 and NA2 are the two recognized allelic forms of Fcγ receptor IIIB. These antigens are clinically relevant, because they are the most frequent targets of neutrophil antibodies in alloimmune neonatal neutropenia, transfusion‐related acute lung injury, and chronic benign autoimmune neutropenia of infancy.Study Design and Methods:A genotyping assay for NA1 and NA2 using polymerase chain reaction with sequence‐specific forward and reverse oligonucleotide primers has been developed and validated. Genomic DNA was isolated from the peripheral blood of 478 unrelated individuals of five ethnic groups and used as template for NA genotyping.Results:A validation study of 22 serologically typed samples (2 NA1/NA1, 10 NA1/NA2, and 10 NA2/NA2) was performed. A concordance rate of 100 percent (22/22 samples) was observed between the genotyping assay and serologic typing. In the genotyping study conducted, theNA1andNA2gene frequencies observed were 0.31 and 0.69 for African Americans, 0.30 and 0.70 for Asian Indians, 0.37 and 0.63 for whites, 0.53 and 0.47 for Hispanics, and 0.55 and 0.45 for Native Americans, respectively.Conclusion:Polymerase chain reaction with sequence‐specific primers provides a simple and rapid alternative to neutrophil antigen typing by serologic tests. TheNA1andNA2gene frequencies observed in Asian Indians and African American populations are similar to those observed in white populations, while those observed in Native American and Hispanic populations are more similar to those previously reported for Asian popul

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1996.361097017176.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

Background:Hypotensive reactions to platelet transfusions performed with white cell (WBC)‐reduction filters with negatively charged surfaces have been reported recently in patients taking angiotensin‐converting enzyme (ACE) inhibitors. Experimental studies have shown that the filter material can activate bradykinin, which may cause symptoms in patients with reduced bradykinin catabolism. Symptomatic adverse reactions after the administration of fresh‐frozen plasma (FFP) through a WBC‐reduction filter have not been reported in a patient on ACE Inhibitor medication.Case Report:A 58‐year‐old man with congenital coagulation factor V deficiency and hypertension treated with an ACE inhibitor was admitted for rehabilitation after orthopedic surgery. On 3 consecutive days, he received FFP through a WBC‐reduction filter; within minutes of the beginning of each infusion, he experienced a drop in blood pressure, facial erythema, abdominal pain, and anxiety. When the infusions were stopped, symptoms quickly abated without treatment. Multiple prior transfusions of unfiltered FFP and FFP filtered through a WBC‐reduction filter made by a different manufacturer, as well as subsequent transfusions of unfiltered FFP, had not produced such reactions.Conclusion:Facial flushing, hypotension, and abdominal pain after FFP administration in a patient on ACE inhibitor medication appeared to be associated with a specific type of WBC‐reduction filter. This association and other reported studies suggest that special caution is warranted when patients who are treated with ACE inhibitors receive blood components administered through WBC‐reduction filters capable of ge

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1996.361097017177.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY