ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1994.34194098594.x

出版商:Blackwell Science Ltd    

年代:1994

数据来源: WILEY

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1994.34194098604.x

出版商:Blackwell Science Ltd    

年代:1994

数据来源: WILEY

摘要:

BACKGROUND:A hemoglobin (Hb) standard of 115 g per L on the copper sulfate test has been in use by the Canadian Red Cross Society Blood Services for female blood donor predonation screening since 1989.STUDY DESIGN AND METHODS:To determine if this lowered Hb standard results in increased iron deficiency in repeat blood donors, a study was conducted to evaluate the performance of the copper sulfate test and predonation capillary and venous Hb assays in a population of female blood donors most at risk of developing iron deficiency.RESULTS:Of the 174 donors who were of childbearing age, who were not taking iron supplements, and who had made at least three blood donations per year, 45 (25.9%) were iron deficient, and 64 (36.8%) had reduced iron stores; only 65 (37.3%) had normal iron stores. This study showed that capillary blood is more likely to have a higher Hb concentration (3.2 +/− 7.8 g/L) than venous blood samples, which could affect the performance of predonation screening assays that are based on capillary blood samples at a given discriminating value. With an Hb standard of 115 g per L, both the copper sulfate and capillary Hb assays were not sensitive enough to screen for iron deficiency (sensitivity, 27% and 33%; specificity, 96% and 93%, respectively) and were comparable only to the performance of a venous Hb assay with a cutoff value of 110 g per L (sensitivity, 27%; specificity, 99%). In contrast, an Hb standard of 125 g per L in the copper sulfate test could achieve a more optimal sensitivity of 79 percent and specificity of 78 percent.CONCLUSION:This study supports the use of a higher Hb cutoff value of 125 g per L for female blood donors in the predonation fingerstick copper sulfate tes

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1994.34194098609.x

出版商:Blackwell Science Ltd    

年代:1994

数据来源: WILEY

摘要:

BACKGROUND:Data from New York State indicate that about 1 of every 33,000 red cell units transfused is ABO‐incompatible with the recipient. National application of these data suggests that as many as 360 ABO‐incompatible whole blood and red cell transfusions might occur annually in the United States. Phlebotomy and blood bank laboratory errors cause some of these ABO‐incompatible transfusions, but the greatest number result either partially or solely from the failure of transfusionists to identify properly either a patient or the blood component a patient receives.STUDY DESIGN AND METHODS:A quality assessment/quality improvement (QA/QI), process is described that allowed for the direct oversight (monitoring) of transfusionists' practices and for the assessment of institutional policies for blood administration.RESULTS:At the beginning of the QA/QI process, monitoring of blood administration practices revealed that a variance from institutional blood administration policy occurred during 50 percent of blood and component transfusions. As a result of the QA/QI process, the percentage of transfusions with an associated variance from institutional policy dropped to nearly zero.CONCLUSION:The QA/QI process described in this report, or one similar to it, could improve transfusion safety and serve as a model for increased involvement by transfusion service medical directors in the oversight of transfusionists' prac

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1994.34194098595.x

出版商:Blackwell Science Ltd    

年代:1994

数据来源: WILEY

摘要:

BACKGROUND:Mononuclear phagocytes play a central role in hemolytic transfusion reactions by erythrophagocytosis and production of inflammatory mediators. Factors that affect the number or function of monocyters would be expected to alter the clinical course of hemolytic transfusion reactions, and thus the production of monocyte chemoattractant protein‐1 (MCP‐1), a recently described chemotactic and activating cytokine specific for monocytes, was investigated in two distinct settings of red cell (RBC) incompatibility.STUDY DESIGN AND METHODS:Fresh heparinized whole blood was incubated with ABO‐ compatible or ‐incompatible RBCs. Isolated peripheral blood mononuclear cells were incubated with anti‐D‐coated or uncoated RBCs. MCP‐1 was measured in the plasma or culture medium by enzyme‐linked immunosorbent assay. MCP‐1 gene expression was detected by Northern blot analysis of buffy coat or mononuclear cell total RNA.RESULTS:Significant levels of MCP‐1 protein in plasma or medium were detected 24 hours after the addition of incompatible RBCs, but not in the first 6 hours. Nonimmune hemolysis of added RBCs did not stimulate MCP‐1 production. The inactivation of complement by heat treatment of plasma prior to the addition of RBCs to whole blood did not prevent MCP‐1 production. Nor did neutralizing antibodies to tumor necrosis factor prevent MCP‐1 production in ABO incompatibility. MCP‐1 production was associated with increased steady‐state levels of white cell MCP‐1 mRNA, which occurred more rapidly in ABO than Rh incompatibility.CONCLUSION:The monocyte‐ specific chemotactic cytokine MCP‐1 is produced by peripheral blood leukocytes in response to RBC incompatibility. MCP‐1 may act in a positive feedback loop to recruit and activate monocytes during hemolytic transfusion reactions, thus contributing

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1994.34194098596.x

出版商:Blackwell Science Ltd    

年代:1994

数据来源: WILEY

摘要:

BACKGROUND:Cytokines, because of the nature of their immunoinflammatory actions, are potential mediators of the symptom complex of nonhemolytic transfusion reactions. One possible source of cytokines in the transfusion setting is the stored blood component itself.STUDY DESIGN AND METHODS:To test this possibility, the plasma portion of stored platelet concentrates (PCs) was assayed for the presence of interleukins 1 beta (IL‐1 beta), 6 (IL‐6), and 8 (IL‐8) and tumor necrosis factor alpha (TNF‐alpha). Samples were taken from PCs obtained from the inventory of a regional blood center (n = 120; 30 each of 2‐, 3‐, 4‐, and 5‐day‐old units).RESULTS:Detectable levels of IL‐8 were measured in 59 percent of the PCs sampled, ranging from 30 percent of the 2‐day‐old units to 83 percent of the 5‐day‐old units. The median IL‐8 concentration ranged from undetectable levels in 2‐day‐ old units up to 1100 pg per mL in 5‐day‐old units. The mean IL‐8 concentration in 5‐day‐old units, 11,600 pg per mL, was 100 times the mean for 2‐day‐old units, which was 116 pg per mL (p<0.0001). The highest levels of IL‐8, 50,000 to 200,000 pg per mL, in general were found in units with the longest storage times and highest white cell counts. Sequential sampling of 17 individual PCs over 7 days of storage confirmed that IL‐8 increases progressively with increasing storage time. Parallel, but smaller, increases in IL‐1 beta were observed in those units with high IL‐8 concentrations. TNF‐alpha was detected in 3 (10%) of 30 five‐day‐old PCs, but never exceeded 55 pg per mL in any unit tested. IL‐6 at levels of 740 and 508 pg per mL was detected in two 5‐day‐old units with high white cell counts of 9500 and 14,800 per microL, respectively, but not in 21 additional units tested with white cells

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1994.34194098597.x

出版商:Blackwell Science Ltd    

年代:1994

数据来源: WILEY

摘要:

BACKGROUND:Concern has been raised about the quality of white cell (WBC) reduction in blood components when it is performed by filtration at the patient's bedside. Thus, the quality of red cell (RBC) filtration performed at the bedside through two new flatbed WBC‐ reduction filters was evaluated.STUDY DESIGN AND METHODS:In the laboratory, 25 and 10 RBC units suspended in additive solution were stored for 1 to 2 and 14 to 21 days, respectively, and filtered through each filter. At the end of filtration, an automated complete blood count and a manual WBC count (Nageotte chamber) were determined in two samples collected from 1) a segment clamped at 5 and 25 cm below the filter along the line connecting prefiltration and postfiltration bags and 2) the postfiltration bag. In addition, 10 of the 11 nurses of the hematology outpatient clinic administered to hematologic patients 25 RBC units stored for 1 to 2 days through each type of filter. At the end of transfusion, a segment was collected from the transfusion set and a WBC count was performed as described above. No filter priming or rinsing with saline was done.RESULTS:WBC counts obtained after laboratory filtration in the segments were similar to those obtained from the postfiltration bags and from the segments collected at the bedside in all cases, with the exception of 14‐ to 21‐day‐old RBCs filtered in the laboratory through one of the filters, which produced slightly higher WBC counts in the segments than were seen in the postfiltration bags. The difference was not significant. In no case was the count in the postfiltration bag higher than that in the segment. Nurse training was easy, and bedside filtration was associated with no untoward effects.CONCLUSION:The RBC filtration at the patient's bedside can be equal in quality to that performed in the laboratory, at least in such clinical settings as hematology and oncology departments in which blood transfusion is common practice, and if simple training is provided to the nursing staff. Under the conditions of this study, it seems that quality control of RBC bedside filtration is feasible and

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1994.34194098598.x

出版商:Blackwell Science Ltd    

年代:1994

数据来源: WILEY

摘要:

BACKGROUND:There is intense interest in the potential of current white cell (WBC)‐reduction filters to prevent the alloimmunization of patients by the residual donor WBCs in filtered blood components transfused to them. Little attention has been paid to the capacity of current synthetic fiber filters to remove WBC membrane fragments bearing detectable leukocyte antigens.STUDY DESIGN AND METHODS:Fluorescein isothiocyanate‐conjugated monoclonal antibody to a universal WBC membrane antigen (CD45) and high‐speed centrifugation coupled with ficoll‐hypaque differential sedimentation were used to quantitate low‐density WBC fragments in single‐donor platelet components before and after filtration to determine if a polyester fiber filter retained WBC fragments.RESULTS:Prefiltration measurements in 25 single‐donor platelet components indicated that WBC fragments increased with length of storage up to 5 days at room temperature (p<0.0001). When fragments in eight components were measured before and after filtration, absolute values for differences were insignificant (p = 0.15). CONCLUSION: WBC fragments were poorly retained by these polyester fiber WBC‐reduction filters. The antigenicity of WBC fragments could contribute to the WBC alloimmunization of some recipients of WBC‐reduced

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1994.34194098599.x

出版商:Blackwell Science Ltd    

年代:1994

数据来源: WILEY

摘要:

BACKGROUND:Determination of the white cell (WBC) count in WBC‐reduced platelet components requires methods that have a detection limit in the range of approximately 5.0 × 10(2) to 5.0 × 10(4) per mL.STUDY DESIGN AND METHODS:With a 50‐microL Nageotte hemocytometer and bright‐field microscopy (200x magnification), studies were conducted to develop and validate a method that could be used routinely with filtered and apheresis‐harvested platelets. A 1‐in‐5 dilution of sample with a commercially available blood‐diluting fluid was used because, with a lower (1‐in‐2) dilution, the observed number of WBCs was substantially less than the number expected at relatively high platelet counts (>1.9 × 10(9)/mL).RESULTS:The observed and expected WBC counts in WBC‐ reduced platelet samples correlated well at levels between approximately 5 and 1100 WBCs per counting area (5.0 × 10(2)‐1.1 × 10(5)/mL). At levels of more than 300 to 400 WBCs per counting area, accurate counts were obtained when 10 of the 40 rectangles were counted.CONCLUSION:These studies provide data to confirm that the 50‐ microL Nageotte hemocytometer can be used to accurately count low levels of

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1994.34194098600.x

出版商:Blackwell Science Ltd    

年代:1994

数据来源: WILEY

摘要:

BACKGROUND:Currently, platelet concentrates (PCs) are stored in a suspending plasma volume of 45 to 65 mL. Previous studies using second‐ generation containers indicated that PCs stored for 5 days at volumes less than 30 mL have reduced in vivo percentage recoveries as compared to PCs stored at volumes of 50 mL or more.STUDY DESIGN AND METHODS:This study has evaluated the effect of PC plasma volume on the maintenance of in vivo and in vitro platelet properties following 5 days of storage, with the purpose of establishing the minimum plasma volume in the range of 30 to 50 mL. Twenty paired studies were performed in which identical populations of platelets from the same donor (obtained by double manual apheresis) were stored in a normal volume (55‐60 mL, control) and reduced volume (30‐50 mL, test) of plasma. Comparison of in vivo viability between test and control PCs was performed after random radiolabeling of 1 unit with 51Cr and of the other with 111In, with simultaneous transfusion and with calculation of percentage recovery and the area below the survival curve (integral) as measures of viability.RESULTS:When test unit volumes were>or = 35 mL, essentially identical platelet survival curves and in vitro results were obtained for test and control. The integral and the percentage recovery for the test units were (mean, 95% confidence interval) 98.7 (96.3‐101.0) and 99.0 percent (94.7‐103.3) of those values in the control units, respectively. Test units with volume

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1994.34194098601.x

出版商:Blackwell Science Ltd    

年代:1994

数据来源: WILEY