ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1996.36896374368.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

BACKGROUND: Volume replacement could allow the safe collection of twice the normal amount of red cells in a standard donation. Studies in small numbers of donors have shown that a temporary decrease in red cell mass is well tolerated when donors give twice the usual amount (170–225 mL) of red cells in a standard 405‐ to 495‐mL donation. Sham‐donation control groups have not been included in previous studies of increased red cell donation, and perceptions of donation effects could have been biased. STUDY DESIGN AND METHODS: In the study reported here, 17 male and 13 female volunteers were randomly assigned to make a sham donation, 1‐unit donation, or 2‐unit donation on an automated blood cell separator. Donor tolerance was assessed by ambulatory heart rate monitoring and by a poststudy interview. Hemoglobin, hematocrit, ferritin, serum iron, total iron‐binding capacity, red cell 2,3 DPG, and serum erythropoietin were measured before and after donation for comparison of the erythropoietic responses in the three study groups. RESULTS: Red cells collected totaled 206 +/− 10 mL in the 1‐unit group and 414 +/− 21 mL in the 2‐unit group. Changes in heart rate, systolic blood pressure, and diastolic blood pressure with donation and changes in heart rate recorded by ambulatory monitoring did not differ for the experimental groups. Postdonation changes from baseline values were evaluated on Days 2, 7, and 14. Changes in hemoglobin were significantly different between groups (p<0.017) in all postdonation tests. There were differences between groups in erythropoietin response, red cell 2,3 DPG, ferritin levels, and hemoglobin synthesis. Hemoglobin synthesis and mean changes in 2,3 DPG, erythropoietin, ferritin, and postdonation hemoglobin were greater in the 2‐unit group than in the 1‐unit group. CONCLUSION: Donor tolerance of red cell donations of 414 +/− 21 mL, a volume of red cells twice that in a standard 450‐mL blood donation, does not differ from donor tolerance of standard or sham donations. Physiologic adjustments and the hematopoietic response to reduced red cell mass were greater in the 2‐ unit group, but the donation of 1 unit or 2 units did not cause detectable symptoms of r

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1996.36896374369.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

BACKGROUND: Whether transfusion increases the risk of AIDS‐defining cytomegalovirus (CMV) infection (CMV AIDS) in immunosuppressed patients is not known. Because of concerns about the risk of transfusion transmission of CMV and potential exposure to multiple strains of CMV through transfusion, the National Hemophilia Foundation recently recommended that CMV‐negative blood be used in human immunodeficiency virus‐positive hemophiliacs, regardless of their CMV serologic status. Although the multiple strains of CMV cause different CMV disease manifestations in transplant recipients, there are no data on CMV disease in human immunodeficiency virus‐positive hemophiliacs. STUDY DESIGN AND METHODS: It was hypothesized that if the transmission of CMV through transfusion causes CMV disease in human immunodeficiency virus‐ positive hemophiliacs, then hemophiliacs with CMV AIDS would be more likely to have received transfusions than those with AIDS‐defining disease not caused by CMV (non‐CMV AIDS). The number and type of transfusions were evaluated in 334 hemophiliacs with AIDS (35 with CMV AIDS and 299 with non‐CMV AIDS) enrolled in the multicenter Hemophilia Malignancy Study. RESULTS: There were no differences between hemophiliacs with CMV AIDS and those with non‐CMV AIDS in age, type, and severity of hemophilia; the proportion receiving transfusions; or the mean number of units transfused. These findings persisted after correction for transfusion practice, (i.e., CMV‐unscreened blood vs. CMV‐negative and/or white cell‐reduced blood). There was no difference between the groups in CMV lgG titers or in the proportion who were CMV seropositive, and there was no difference between these parameters in those who had received transfusion(s) and those who had not. CONCLUSION: Transfusion appears to have little, if any, effect on the development of CMV AIDS or CMV lgG seroprevalence in p

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1996.36896374370.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

BACKGROUND: The transfusion of same‐donor peripheral blood buffy coat (PBBC) cells to chronic myelocytic leukemia patients in relapse after bone marrow transplantation has been increasingly used as an effective antileukemic therapy. A graft‐versus‐leukemia effect mediated by immunocompetent donor T cells underlies its success. In acute leukemia, however, the effect of this adoptive cellular immunotherapy has not been established, and the results are generally poor. STUDY DESIGN AND METHODS: Five patients, three with acute lymphoblastic leukemia and two with acute myelocytic leukemia, who relapsed within 6 months after allogeneic marrow transplantation were enrolled in a nonrandomized pilot study to receive donor PBBC cell transfusions either before or after undergoing cytoreductive chemotherapy. ABO genotyping and polymerase chain reaction amplification of human tetrameric short tandem repeats DNA typing were used to test for marrow chimerism. RESULTS: Two acute lymphoblastic leukemia patients‐both of whom underwent chemotherapy before PBBC cell transfusions, experienced a complete remission, and developed acute and then chronic, extensive graft‐versus‐host disease‐have been leukemia‐free for 9 and 7 months, respectively. Repeated molecular studies of their marrow as early as 2 weeks to 8 months after treatment confirmed that the marrow was of donor origin. The other three patients, who chose not to undergo chemotherapy before PBBC cell transfusions, failed to achieve remission and died 14, 16, and 30 days, respectively, after leukemia relapse. CONCLUSION: Adoptive cellular immunotherapy may be effective for acute lymphoblastic leukemia patients in relapse after bone marrow transplantation if chemotherapy is administered before PBBC cell transfusion

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1996.36896374371.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

BACKGROUND: The potential for bacterial contamination limits the storage of platelets at 22 degrees C to 5 days. Refrigerated storage at 4 degrees C would abrogate this problem but would also result in a rapid loss of in vitro viability and functional activity and in vivo viability. The inhibition of platelets during storage by a combination of specific, reversible, second‐messenger effectors has been investigated to allow prolonged storage at 4 degrees C with significant retention of in vitro viability and functional activity. STUDY DESIGN AND METHODS: The combination of effectors was added directly to platelet concentrates, and this step was followed by storage at 4 degrees C. Control units were incubated at 4 degrees C without the effectors and at 22 degrees C according to standard blood‐banking techniques. At 1, 5, and 9 days, the units were tested for recovery of cell number, recovery of in vitro functional activity and viability, and expression of platelet surface markers. RESULTS: Treated platelets stored at 4 degrees C for 9 days, while spherical in shape, displayed no loss of cell number and had a recovery of viability and functional activity, as compared with control platelets stored at 22 degrees C for 5 days, as follows: ADP and collagen aggregation responses of 250 and 100 percent, respectively; a 70‐percent recovery of hypotonic shock response; and a 60‐percent recovery of extent of shape change. The treated platelets also expressed an equivalent amount of the surface marker glycoprotein lb and a lower amount of the activation marker alpha‐granule membrane protein‐140 on the membrane surface. CONCLUSION: Second‐messenger effectors added to platelets significantly maintained in vitro functional activity with storage at 4 degrees C. In vitro analysis demonstrates the potential for extended 4 degrees C storage of platelets with numerical and functional recovery comparable to that achieved with current methods. Refrigerated storage of platelet concentrates has the potential to reduce the risk of bacterial

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1996.36896374372.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

BACKGROUND: The purpose of this survey was to establish baseline information on blood component use in relation to patient diagnoses, procedures, and demographics and to identify patterns of blood use that may be used for blood program planning and transfusion audits. STUDY DESIGN AND METHODS: A cross‐sectional survey of the transfusion of blood components in teaching and nonteaching hospitals in central Ontario between September 1991 and August 1992 was carried out. Coders of hospital medical records routinely record demographics, procedures, diagnoses, and other relevant information. A protocol was created by which medical records coders could add the components transfused to the discharge abstract for this study. Red cell use is reported here. RESULTS: Of the 61 hospitals invited to participate, from which 547,279 patients were discharged during the 12‐month period of the study, 45 (74%) agreed to participate. Information was collected on 439,373 discharged patients. Of these, 26,611 (6.1%) received at least 1 unit of red cells. Of a total of 101,116 red cell units transfused, more than 74 percent were used in patients discharged with neoplasms, gastrointestinal diseases, circulatory system diseases, and trauma. High‐transfusion‐use procedures included operations and procedures on the digestive and cardiovascular systems, diagnostic and therapeutic procedures, musculoskeletal system, and hemic or lymphatic system procedures. CONCLUSION: This survey provides baseline blood transfusion information for a specific period that can help determine the need for hospital audits and maximum surgical blood‐order schedule guideline reviews. This information is relevant to current recommendations to reduce patient's exposure to blood components. These transfusion data will assist in blood program planning based on known disease trends, demographics, and populatio

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1996.36896374373.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

BACKGROUND: Biologic response modifiers infused with stored platelet concentrates (PCs) are believed to contribute to symptoms seen during transfusion reactions. Although prestorage white cell reduction is known to decrease the production of some biologic response modifiers during storage, the possibility that poststorage (bedside) white cell reduction could reduce the amount of biologic response modifiers already present in stored PCs during bedside filtration has not been well studied. STUDY DESIGN AND METHODS: Individual PCs were pooled on storage Days 2 and 5 and passed through a third‐generation white cell‐ reduction filter. The results from a series of in vitro PC assays were studied, before and immediately after filtration, as were levels of C3a and interleukin 8 (n = 5). Levels of other biologic response modifiers‐ C5a, interleukin 1 beta, interleukin 6, tumor necrosis factor alpha, and RANTES‐were also studied. Removal of interleukin 8 and RANTES was studied further by using serial filtration of units of PC. RESULTS: For the in vitro platelet assays studied, pH was unchanged after filtration from prefiltration values in units of PCs pooled on storage Day 2 or 5. A 4 log10 reduction in white cells was reliably seen after filtration in Day 2 and 5 pooled PCs. Postfiltration platelet loss was 14.8 percent for Day 2 pooled PCs and 9.6 percent for Day 5 pooled PCs. For pools of both Day 2 and Day 5 platelets, postfiltration levels of CD62 (P‐selectin, CD62P) were unchanged from prefiltration levels, as were results for morphology scores. Levels of C3a decreased after filtration in both the Day 2 pooled PCs (448 ng/mL before filtration vs. 20 ng/mL after filtration) and the Day 5 pooled PCs (1976 ng/mL before filtration vs. 124 ng/mL after filtration). Levels of interleukin 8 were similarly reduced after filtration in the Day 2 pooled platelets (188 pg/mL before filtration vs. 27 pg/mL after filtration) and the Day 5 pooled platelets (2234 pg/mL before filtration vs. 799 pg/mL after filtration). Levels of interleukin 8 in other components evaluated after filtration declined similarly. However, levels of the proinflammatory cytokines interleukin 1 beta and interleukin 6 did not decline after filtration. Serial filtration studies showed that, although levels of interleukin 8 and RANTES were initially lowered by filtration, they returned to prefiltration values with increases in the volume of filtration. CONCLUSION: The third‐generation bedside filter used in this study reliably reduced the level of white cell contamination to 4 log10 white cells per PC. It also lowered the levels of interleukin 8, RANTES, and C3a. The filter did not, however, remove (scavenge) the proinflammatory cytokines interleukin 1 beta and 6. The mechanism of chemokine and C3a removal by the filter is unknown, but it may be related to ionic interactions between these biologic response modifiers and the fi

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1996.36896374374.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

BACKGROUND: The preparation of blood components by hard centrifugation results in red cell concentrates with a small amount of plasma. The influence of various plasma factors, temperature, and storage time on white cell reduction by filtration was studied. STUDY DESIGN AND METHODS: Red cell concentrates were suspended in 100 mL of saline‐ adenine‐glucose‐mannitol (SAGMAN) solution or in SAGMAN solution in which 5 or 10 mL had been replaced with an equal amount of fresh plasma, albumin (4%), or heat‐inactivated plasma. After overnight storage at 4 degrees C, filtration at a slow flow rate (2 hours) was performed. The effect of temperature was studied by filtration at 4 degrees C and 37 degrees C. To study the influence of storage time, red cell concentrates were stored for 4 to 8 hours or 14 to 20 hours at 4 degrees C and filtered through another model of filter. The number of white cells was counted microscopically or by flow cytometry. RESULTS: When 5 or 10 mL of plasma was added, a significantly smaller number of white cells were found after filtration than were found in the SAGMAN control (the median difference between pairs: 23.6 × 10(6) for 5 mL [p = 0.006] and 14.9 × 10(6) for 10 mL [p = 0.003]). The number of white cells was significantly higher with 10 mL of albumin than with 10 mL of plasma (difference, 15.0 × 10(6); p = 0.006). When heat‐inactivated plasma was used, the number of white cells was significantly lower than when fresh plasma was used (difference, 0.3 × 10(6); p = 0.009). Filtration at 37 degrees C resulted in a 64‐percent reduction in white cells and that at 4 degrees C led to a 99.7‐percent reduction (p = 0.006). When the second filter was used, a slight but significantly lower number of white cells was found in the red cell concentrate stored for 14 to 20 hours than in that stored for 4 to 8 hours (difference, 0.03 × 10(6); p<0.001). CONCLUSION: The amount of plasma in the red cell concentrate and the storage time and temperature are important factors in the outcome of white cell reduction by filtration. The effect of plasma does not seem to be due to a general influence of protein or to the activity of comple

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1996.36896374375.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

BACKGROUND: Red cells devoid of glycophorin B (GPB)‐borne S, s, and U antigens are classified as an S‐s‐U‐ or S‐s‐U variant (U+var) and can arise from deletion and nondeletion genetic backgrounds. In nondeletion forms of S‐s‐U‐, little information is available on whether the altered GPB gene (GYPB) is expressed in red cells. STUDY DESIGN AND METHODS: Red cells classified as S‐s‐U‐ or S‐s‐U+varwere tested with anti‐U, anti‐U/GPB, anti‐He, and anti‐N by hemagglutination. Selected samples were tested by flow cytometry, immunoblotting, and polymerase chain reaction amplification using allele‐specific primers. RESULTS: He (MNS6) was found on 23 percent (20/87) of samples. These and another 21 of the 87 samples were agglutinated by an anti‐U/GPB reagent; this indicated that approximately 50 percent of S‐s‐samples possessed GPB variants. The strength of He varied among the samples. Genomic polymerase chain reaction with allele‐specific primers showed the presence of expected DNA GPB‐like products encoding He. Immunoblotting showed that He was carried on a membrane component with a relative molecular mass indistinguishable from that of GPB. CONCLUSION: The finding of He on S‐s‐ red cells provides direct evidence for the presence of an altered form of GPB in red cells previously thought to be devoid of this glycophorin. Quantitative variation in He antigen ex

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1996.36896374376.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

BACKGROUND: Passive transfer of antibody to hepatitis C virus (HCV) has been thought to occur after infusion of human intravenous immunoglobulin (IVIG), as anti‐HCV and/or HCV RNA was commonly found in that product. Recently, however, HCV RNA was detected in the serum of recipients of IVIG. Establishment of a causal relationship between IVIG therapy and HCV infection in recipients was attempted. STUDY DESIGN AND METHODS: Anti‐HCV and HCV RNA sequences were investigated in serum samples from 39 persons who received a human IVIG product in seven different hospitals in Spain. HCV RNA was also investigated in two batches of the IVIG shared by some recipients. All the viral RNA detected were characterized with a line probe assay, restriction fragment length polymorphism analysis of the 5′‐noncoding and core regions, and sequencing of the nonstructural 5 region. RESULTS: On the basis of both clinical and laboratory data, a relationship could be established between the IVIG therapy and the acquisition of the HCV infection by the recipients. Several HCV strains were detected among the recipients, with most of the recipients coming from the same hospital presenting with closely related strains. Moreover, an HCV strain almost identical to the main strain detected among the recipients was found in one batch of the IVIG that probably was shared by most of them. Follow‐up studies and evaluation of low‐avidity anti‐ HCV IgG suggested that both acute primary infections and reinfections were produced. In one case, direct evidence of reinfection by a different HCV strain was obtained. CONCLUSION: The results did not exclude the possibility that a second HCV strain associated with a further, unidentified batch of the IVIG could have contributed to

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1996.36896374377.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY