ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1994.341095026966.x

出版商:Blackwell Science Ltd    

年代:1994

数据来源: WILEY

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1994.341095026967.x

出版商:Blackwell Science Ltd    

年代:1994

数据来源: WILEY

摘要:

BACKGROUND:Ultraviolet B (UVB) irradiation of platelet concentrate (PCs) reduces platelet alloimmunization, but the mechanism of the effect is unclear. Evidence suggests that UVB may downregulate the expression of surface adhesion molecules on passenger antigen‐ presenting cells in PCs.STUDY DESIGN AND METHODS:The effect of blood bank storage, platelet preparation from whole blood, and UVB irradiation on the quantitative expression of intercellular adhesion molecule‐1 (ICAM‐1, or CD54), HLA‐DR, CD45, and CD11c on CD14‐positive antigen‐presenting cells (monocytes) was studied by using two‐color flow cytometry.RESULTS:Blood bank storage for 4 days resulted in upregulation of ICAM‐1 and HLA‐DR and downregulation of CD14 but left the expression of CD11c and CD45 unchanged. Preparation of PCs from fresh whole blood was associated with a rapid increase in CD11c without upregulation of ICAM‐1 and HLA‐DR. UVB irradiation before storage inhibited the upregulation of ICAM‐1 and HLA‐DR, resulted in accelerated downregulation of CD14, and was associated with increased loss of monocytes. Agitation of the PC bag during irradiation was of critical importance, since omission of agitation resulted in largely uninhibited upregulation of ICAM‐1 but was still associated with significantly higher cell loss than that seen in unirradiated controls. CONCLUSION: UVB exposure nonspecifically affects monocytes in PCs, resulting in downregulation of surface molecules that are important for antigen presentation, as well

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1994.341095026968.x

出版商:Blackwell Science Ltd    

年代:1994

数据来源: WILEY

摘要:

BACKGROUND: While prestorage white cell (WBC) reduction by filtration may improve platelet and red cell quality, it also may remove an important anti‐bacterial defense mechanism, especially if blood is WBC‐ reduced shortly after collection. STUDY DESIGN AND METHODS: The question of whether WBC reduction of platelet concentrates and red cells altered bacterial proliferation kinetics in components prepared from deliberately contaminated, freshly collected blood was investigated. Two‐unit pools of whole blood were inoculated, at a concentration of approximately one colony‐forming unit per mL, with one of 17 bacterial species reported to have caused septicemia in transfusion recipients. Each pool was divided after inoculation, and components were prepared from the 2 units after a 7‐hour room‐ temperature holding period. One unit of each AS‐1 red cell or platelet pair was WBC‐reduced, and the pairs were then stored for 42 days at 4 degrees C (red cells) or for 10 days at 22 degrees C (platelets). Quantitative bacterial cultures were performed at periodic intervals. RESULTS: In red cells, clinically significant bacterial proliferation occurred in only one instance (Serratia marcescens), and growth was less rapid in the WBC‐reduced unit than in the control. Three patterns of growth were seen in platelet concentrates. In four cases, there was rapid proliferation in both test and control units, while on 13 occasions there was minimal replication in either pair. On six occasions, substantial growth was noted in control units, while few or no bacteria could be found in the WBC‐reduced units. There was no evidence in either red cells or platelets that bacteria proliferated more rapidly in units that had been WBC‐reduced before storage than they did in units in which WBCs were retained. CONCLUSION: Rather than increasing the risk of bacterial proliferation through removal of active phagocytic cells, WBC reduction by filtration before blood storage may act to reduce the likelihood of significant bacterial proliferation, possibly by removal of microorga

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1994.341095026969.x

出版商:Blackwell Science Ltd    

年代:1994

数据来源: WILEY

摘要:

BACKGROUND: The long‐term course of human immunodeficiency virus type 1 (HIV‐1)‐related disease among seropositive blood donors has not been described. The enrollment and epidemiologic background of HIV‐1‐ infected donors in the Transfusion Safety Study and their immunologic and clinical progression are described. STUDY DESIGN AND METHODS: Through the testing of approximately 200,000 sera from donations made in late 1984 and early 1985, 146 anti‐HIV‐1‐positive donors and 151 uninfected matched donors were enrolled. These two cohorts were followed with 6‐month interval histories and laboratory testing. RESULTS: Seropositive donors detected before the institution of routine anti‐HIV‐1 screening disproportionately were first‐time donors and men with exclusively male sexual contacts. The actuarial probability of a person's developing AIDS within 7 years after donation was 40 percent; the probability of a person's dying of AIDS was 28 percent. AIDS developed more often when the donor was p24 antigen‐positive at donation. Over a 3‐year period, significant decreases occurred in CD4+, CD2+CD26+, CD4+CD29+, and CD20+CD21+ counts, but not in CD8+ subsets, CD20+, or CD14+. CONCLUSION: The high proportions of first‐time donations and exclusively homosexual men among seropositive donors suggest that test‐seeking may have contributed to the high HIV‐1 prevalence in the repository. Implementation of alternative test sites when routine donor screening began in 1985 may have averted many high‐ risk donations. The disease course in HIV‐1‐infected donors had the same wide spectrum of immunologic and clinical manifesta

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1994.341095026970.x

出版商:Blackwell Science Ltd    

年代:1994

数据来源: WILEY

摘要:

BACKGROUND: The confidential unit exclusion (CUE) option is intended to reduce human immunodeficiency virus (HIV) transmission by excluding donors newly infected with HIV who have not yet developed HIV antibody (window‐period donors); however, its efficacy in excluding window‐ period donors has not been evaluated. STUDY DESIGN AND METHODS: The use of the CUE option was studied among the donors of 3.7 million units at 18 American Red Cross blood services regions during 1991 and 1992 and among 322 previously HIV‐1‐seronegative donors who subsequently donated a seropositive unit between 1987 and 1990 at 40 United States blood centers. These seroconverting donors had previously been shown to be highly likely to donate during their window period. RESULTS: On the basis of data from these two populations, it was estimated that only 3 to 5 percent of units donated by window‐period donors were not transfused because of the CUE option, that 0.4 percent of all donations were from donors who confidentially excluded their blood from transfusion, and that donors who confidentially excluded their blood were 21 times more likely to be HIV antibody‐positive than donors who did not use the CUE option. It is estimated that, if all US blood centers used the CUE option, a total of 2 to 17 otherwise acceptable units donated by window‐period donors would not be transfused annually. CONCLUSION: Although donors who confidentially exclude their blood from transfusion are 21 times more likely to have HIV antibody, the rarity of window‐period donors and the infrequency of confidential exclusion by window‐period donors cause the CUE option to have minimal impact on

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1994.341095026971.x

出版商:Blackwell Science Ltd    

年代:1994

数据来源: WILEY

摘要:

BACKGROUND: Most blood centers utilize a confidential unit exclusion (CUE) process, intended to reduce the risk of transfusion‐associated infectious diseases by allowing high‐risk donors confidentially to exclude their blood from use for transfusion. The effectiveness of this method remains controversial. STUDY DESIGN AND METHODS: Confirmatory or supplemental test results for antibodies to human immunodeficiency virus, human T‐lymphotropic virus type I, and hepatitis C virus, as well as hepatitis B surface antigen and syphilis and screening test results for antibodies to hepatitis B core (antigen) and alanine aminotransferase levels were obtained for approximately 1.8 million units donated during 1991 and 1992 at five blood centers within the United States. The prevalences of these infectious disease markers in units that the donors confidentially excluded (CUE+) and units that the donors did not exclude (CUE‐) were calculated and examined within demographic subgroups. RESULTS: Units that were CUE+ were 8 to 41 times more likely to be seropositive for antibodies to human immunodeficiency virus and hepatitis C virus, hepatitis B surface antigen, and syphilis and three to four times more likely to react for antibody to hepatitis B core (antigen) or to have elevated alanine aminotransferase levels than units that were CUE‐ (p<0.001). The positive predictive value of CUE (the percentage of CUE+ units that were confirmed seropositive for any marker) was 3.5 percent, and the sensitivity of CUE (the percentage of confirmed‐seropositive units that were CUE+) was 2.3 percent. CONCLUSION: The current CUE process has low sensitivity and apparently low positive predictive value, and in many cases, it appeared that donors misunderstood it. Yet, CUE was not a “random process,” as CUE+ units were more likely to be seropositive for any infectious disease marker than CUE‐ units. This suggests that efforts to improve the CUE system may be warranted. As risk factors for transfusion‐transmitted infection become more difficult to identify by history‐based screening, however, such efforts ma

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1994.341095026972.x

出版商:Blackwell Science Ltd    

年代:1994

数据来源: WILEY

摘要:

BACKGROUND: Between January 1993 and January 1994, Dutch blood banks screened approximately 674,000 volunteer donors for the presence of antibodies to human T‐lymphotropic virus type I (HTLV‐I). STUDY DESIGN AND METHODS: Confirmatory testing was performed on samples from 870 different anti‐HTLV‐I‐reactive donors (0.13% of the total tested). RESULTS: According to the authors' Western blot (WB) interpretation criteria, 15 (0.002%) donors tested HTLV‐I‐positive in the WB; 201 tested negative, and 654 (75% of donors reacting on enzyme‐linked immunosorbent assay) tested indeterminate. Fresh samples from 234 of 870 anti‐HTLV‐reactive donors were tested for HTLV‐I and type II (HTLV‐ II) DNA by polymerase chain reaction: all 15 WB‐positive donors tested positive for HTLV‐I DNA; 206 WB‐indeterminate and 13 WB‐negative donors tested negative for HTLV‐I and ‐II DNA. Application of the manufacturer's (World Health Organization‐based) guidelines for WB interpretation would have resulted in the misclassification of 48 (23%) of 206 polymerase chain reaction‐negative donors as HTLV‐I/II‐positive. Risk factors were present in 14 of 15 HTLV‐I‐infected donors: 8 had a partner from an HTLV‐I‐endemic area, 4 were from HTLV‐I‐endemic countries, and 2 had received blood transfusions. CONCLUSION: HTLV‐I and ‐II infection is rare among Dutch blood donors. HTLV screening will prevent few cases of HTLV‐related disease, but it will prevent a further spread of the virus by transfusion. In a low‐risk population, conservative guidelines for WB interpreta

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1994.341095026973.x

出版商:Blackwell Science Ltd    

年代:1994

数据来源: WILEY

摘要:

BACKGROUND: The preparation of platelet concentrates (PCs) from buffy coats (BCs) stored at room temperature is controversial, because of the strong metabolic activity of cells in BCs and the possible detrimental effect of neutrophil enzymes on platelets when the holding time before separation is prolonged. Despite good in vitro and in vivo behavior of BC‐PCs stored in synthetic solution, little is known of the quality of BC‐PCs stored in plasma. STUDY DESIGN AND METHODS: Comparison was made of PCs prepared from BCs held at 22 degrees C for 3 hours (3‐hour BC‐ PCs) or overnight (12‐hour BC‐PCs) and stored in plasma. Platelet and white cell counts, pH, response to osmotic shock, and morphologic scores were determined on 20 PCs of each type. The decrease in dense granule and alpha granule content, a marker of platelet activation, were estimated by mepacrine counting and beta‐thromboglobulin measurement, respectively (n = 8–10). Platelet function was studied in terms of aggregation and thromboxane production in response to various concentrations of collagen and thrombin (n = 8–17). PCs prepared from unstored BCs (n = 15) and from BCs held for 90 minutes (n = 15) were used as controls. RESULTS: Platelet yield was increased from 53 +/− 10 percent of donated platelets to 73 +/− 4 percent by increasing the BC holding time from 0 to 90 minutes to 3 hours (por = 240. During storage, the dense granule content decreased moderately (30% after 5 days), whatever the conditions. By contrast, the total platelet beta‐thromboglobulin content was better preserved in 12‐hour BC‐PCs than in 3‐hour BC‐PCs (p<0.04). No significant differences were observed in collagen‐induced aggregation and thromboxane production in the two PC preparations. However, aggregation responses to thrombin were higher in 12‐hour BC‐PCs on Day 5 of storage (p<0.01). CONCLUSION: BCs can be held at 22 degrees C for up to 12 hours, with no detrimental effect on the quality of PCs stored for up to 5 days in plasma. Such a holdi

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1994.341095026974.x

出版商:Blackwell Science Ltd    

年代:1994

数据来源: WILEY

摘要:

BACKGROUND: A direct chemical toxicity of dimethyl sulfoxide (DMSO) to hematopoietic progenitor cells has been suggested. However, a recent study failed to corroborate these earlier findings. Thus, a series of experiments was undertaken to address this issue. STUDY DESIGN AND METHODS: Bone marrow was collected from 18 donors and cryopreserved with 10 percent (vol/vol) DMSO. Aliquots of frozen bone marrow were thawed, diluted with ACD‐A to 8 percent (vol/vol) DMSO, and allowed to remain in DMSO for up to 2 hours before mononuclear cells were plated for colony‐forming assays. After 14 days in culture, burst‐forming units‐erythroid, colony‐forming units–granulocyte/macrophage, and colony‐forming units–granulocyte/erythrocyte/macrophage/megakaryocyte colonies were enumerated. RESULTS: There was no significant difference (p>0.5) seen in colony formation over the 2‐hour exposure to DMSO. CONCLUSION: These results support and extend a previous study that bone marrow hematopoietic progenitor cells, including burst‐forming units–erythroid, colony‐forming units–granulocyte/macrophage, and colony‐ forming units–granulocyte/erythrocyte/macrophage/megakaryocyte are resistant to any toxic effects of 8‐ to 10‐percent (vol/vol) DMSO during

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1994.341095026975.x

出版商:Blackwell Science Ltd    

年代:1994

数据来源: WILEY