ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1994.34994378271.x

出版商:Blackwell Science Ltd    

年代:1994

数据来源: WILEY

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1994.34994378272.x

出版商:Blackwell Science Ltd    

年代:1994

数据来源: WILEY

摘要:

BACKGROUND:Currently, the maximum outdate for platelets is 5 days, because of the increasing chance of bacterial growth over time. Various methods for rapid detection of bacterial contamination of blood components have been described, with mixed results and no general acceptance. A recently described, molecular biologic approach for the detection of bacterial contamination involves a chemiluminescence‐ linked universal DNA bacterial probe to a highly conserved bacterial region of ribosomal RNA (rRNA).STUDY DESIGN AND METHODS:A multicenter trial of a chemiluminescence‐linked universal bacterial rRNA probe for the detection of bacterial contamination in platelet concentrates is described. At each of five sites, platelet concentrates (no older than 1 day from date of phlebotomy) were inoculated in triplicate with isolates of four bacterial species (Pseudomonas aeruginosa, Bacillus cereus, Staphylococcus epidermidis, and Staphylococcus aureus) to a final concentration of 10 to 50 colony‐forming units (CFUs) per mL and in triplicate to a final concentration of 1000 CFUs per mL. At one site, an additional 6 platelet concentrates were inoculated with sterile saline to serve as controls. Inoculated units were then subjected periodically to quantitative cultures and probe analyses. A total of 126 platelet concentrates were studied over a period of 7 days (120 inoculated with bacteria and 6 with sterile saline).RESULTS:This assay was, in some cases, able to detect S. aureus bacterial contamination in the range of 100 to 1000 CFUs per mL; the majority of samples (B. cereus, P. aeruginosa, S. aureus, and S. epidermidis) with contamination exceeding 10(4) CFUs per mL; and all samples with contamination of 2.1 × 10(5) CFUs per mL or greater. Increasing the sample size from the recommended 0.4 mL to 1.0 mL resulted in an unacceptable loss of specificity (83.3%).CONCLUSION:The routine use of this assay would be expected to result in a decreased risk of septic platelet transfusion reactions and could lead to a lengthening of the current 5 day storage period for platelets. Further, the pooling of random‐donor platelet concentrates before storage instead of immediately before transfusion may be possible if this rRNA probe is employed to detect bacteria in

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1994.34994378273.x

出版商:Blackwell Science Ltd    

年代:1994

数据来源: WILEY

摘要:

BACKGROUND:Because the Rh antigens E (Rh3) and c (Rh4) are relatively immunogenic, it has been suggested that R1R1 (E‐, c‐) patients who present with anti‐E alone receive prophylactic c‐ (Rh: −4) red cell transfusions.STUDY DESIGN AND METHODS:To determine the utility of this approach, the transfusion records of 100 consecutive R1R1 patients with anti‐E identified over a 6‐year period were reviewed.RESULTS:Thirty‐two (32%) had anti‐c concurrent with anti‐E. Twenty‐seven of the 68 patients who presented with anti‐E alone received random (i.e., not typed for c [Rh4]) red cell transfusions. Five (18.5%) of the 27 subsequently developed anti‐c 13 to 193 days (mean, 50) after transfusion of 2 to 14 (mean, 8) red cell units. None of the five had clinical evidence of hemolysis that could be attributed to a delayed hemolytic transfusion reaction. Twenty‐two (81.5%) of the 27 failed to develop anti‐c even after transfusion of 1 to 41 (mean, 9; median, 7) red cell units.CONCLUSION:The overall rate of immunization to c (Rh4) antigen in R1R1 patients with anti‐E was 37 percent. Production of anti‐ c following transfusion to R1R1 patients with anti‐E occurred in 18.5 percent of the cases in this series, which could have been avoided by the prophylactic use of R1R1 (E‐, c‐) blood for transfusion. The prophylactic use of c‐ (Rh: −4) blood in this patient population may be justified by the high immunization rate and the potential ris

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1994.34994378274.x

出版商:Blackwell Science Ltd    

年代:1994

数据来源: WILEY

摘要:

BACKGROUND:Anecdotal evidence suggests that high‐dose intravenous immunoglobulin (IVIG) is useful in the management of human immunodeficiency virus (HIV)‐associated thrombocytopenia.STUDY DESIGN AND METHODS:To rigorously evaluate this therapy, a crossover study was designed to compare IVIG, given at 1 g per kg per day for 2 consecutive days each week for 4 weeks, with intravenous saline placebo administered according to the same schedule. Subjects were randomly assigned to receive either IVIG or saline during the first 4 weeks; if IVIG was given, there was a 4‐week period of no therapy before beginning placebo administration. Criteria for eligibility were platelet count of less than 50,000 per microL (50 × 10(9)/L), elevated platelet‐associated IgG levels, increased megakaryocytes in the bone marrow, and positive HIV antibody test. Twelve patients (11 men, 1 woman) were studied. Seven patients completed the full protocol. Four dropped out: after 2, 5 (2 patients), and 8 weeks that included at least 2 weeks of IVIG.RESULTS:All patients sustained an increase in platelet count in response to IVIG, with increments ranging from 15,000 to 358,000 per microL (15 to 350 × 10(9)/L) (mean, 180,000/microL [180 × 10(9)/L]; median, 174,000/microL [174 × 10(9)/L]). No patient had an increase after placebo infusions. There were no adverse effects of treatment, and weekly chemical analyses showed no new abnormalities except for mild elevations in the serum protein. The duration of responses ranged from 2 to 10 weeks. No patient demonstrated refractoriness to IVIG.CONCLUSION:IVIG consistently raises platelet counts in patients with HIV‐associated thr

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1994.34994378275.x

出版商:Blackwell Science Ltd    

年代:1994

数据来源: WILEY

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1994.34994378276.x

出版商:Blackwell Science Ltd    

年代:1994

数据来源: WILEY

摘要:

BACKGROUND:In December 1990, the Food and Drug Administration recommended that all United States blood centers implement a policy of asking prospective donors direct oral questions (DOQs) about human immunodeficiency virus (HIV) risk behaviors to increase the safety of the blood supply.STUDY DESIGN AND METHODS:To evaluate the impact of the DOQ policy, HIV‐related deferral and HIV seroprevalence data were analyzed at four American Red Cross blood centers for the year before the policy change and the year after. An epidemiologic analysis with stratification was conducted, including the calculation of odds ratios (OR) and 95‐percent CIs.RESULTS:Two of the four blood centers showed an overall significant increase in HIV‐related deferral after implementation of the DOQ policy: OR = 4.04, (95% CI = 3.41, 4.76); OR = 2.93, (95% CI = 2.67, 3.21). The increase in HIV‐related deferral was higher for women. HIV seroprevalence decreased at all four centers, including the two that did not see an increase in HIV‐related deferrals. Seroprevalence declined by 14 percent in the two centers with increases in HIV‐related deferral, which was neither significant nor attributable to DOQs.CONCLUSION:Given that HIV antibody screening cannot detect HIV‐seronegative (but infectious) “window‐period” donations, the deferral of at‐risk donors may offer some additional protection to the blood supply. However, evidence was not found of an increase in safety of the blood supply as measured

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1994.34994378277.x

出版商:Blackwell Science Ltd    

年代:1994

数据来源: WILEY

摘要:

BACKGROUND:Transfusion‐associated graft‐versus‐host disease can be prevented by gamma radiation of blood components. The increased use of blood components donated for patients by their family members has resulted in an increased demand for the storage and handling of irradiated units, and the ability to freeze the cells would allow storage beyond their current expiration date.STUDY DESIGN AND METHODS:To assess the effect of freezing and deglycerolization on irradiated red cells, studies of autologous radiolabeled red cell recovery were performed using normal volunteers. Each unit of CPDA‐1 red cells was immediately divided into two equal volumes. Further handling of each half was identical except that one was irradiated (3500 cGy). The units were grouped under three protocols: I, irradiated on Day 0 and frozen on Day 5 (n = 4); II, irradiated on Day 7, rejuvenated, and frozen on Day 14 (n = 5); and III, irradiated on Day 14, rejuvenated, and frozen on Day 18 (n = 3). All cells were frozen for 3 to 10 months at −80 degrees C.RESULTS:Irradiated and control units showed no significant differences in supernatant potassium or hemoglobin. Autologous 24‐hour posttransfusion recoveries (mean +/− SD) for the three groups were: I, 89.7 +/− 5.6 percent (control, 90.6 +/− 3.2%); II, 85.3 +/− 5.7 percent (control, 83.7 +/− 3.0%); and III, 79.5 +/− 1.4 percent (control, 82.6 +/− 5.2%). CONCLUSION: Irradiated red cells can be frozen after being stored under various conditions and can still meet established guidelines requiring 75‐percent recovery

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1994.34994378278.x

出版商:Blackwell Science Ltd    

年代:1994

数据来源: WILEY

摘要:

BACKGROUND:There are conflicting data on the effect of irradiation and subsequent storage on the quality of platelet components.STUDY DESIGN AND METHODS:The retention of platelet properties during storage of gamma‐irradiated apheresis suspensions was studied in 22 apheresis components obtained on a cell separator with a specialized centrifugation chamber. Immediately after collection, each suspension was divided equally into two 1‐L polyolefin containers. On Day 1 (n = 12) and Day 3 (n = 10) one of each pair of suspension containers was gamma radiated with 2500 cGy. All platelet suspensions were stored for 5 days at 20 to 24 degrees C. Samples were drawn on Day 5 from each of the 22 pairs of containers for evaluation of an array of in vitro properties. Samples were taken from 10 pairs of containers for platelet labeling with either 51Cr or 111In for subsequent transfusion and concurrent in vivo measurement of recovery and survival. Posttransfusion samples were drawn after 24 hours for ex vivo whole blood aggregation.RESULTS:Comparable in vitro and in vivo properties were measured in irradiated and control platelets, whether irradiation was performed on Day 1 or Day 3. The mean +/− 1 SD in vivo recovery and survival time for controls and platelets irradiated on Day 1 was 52 +/− 14 percent and 146 +/− 34 hours and 51 +/− 7 percent and 147 +/− 36 hours, respectively. For Day 3 irradiation, the values were 46 +/− 12 percent and 150 +/− 60 hours and 47 +/− 9 percent and 151 +/− 53 hours, respectively. A small, but measurable adverse effect of irradiation on ex vivo platelet aggregation was present.CONCLUSION:These data indicate that storage of apheresis platelets after gamma radiation is without clinically significant, demonstrably adverse effect

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1994.34994378279.x

出版商:Blackwell Science Ltd    

年代:1994

数据来源: WILEY

摘要:

BACKGROUND:The objectives of this research were 1) to determine whether two populations of platelets may be labeled with different levels of biotin and followed concurrently in vivo by flow cytometry and 2) to determine whether the level of biotinylation affects the in vivo platelet recovery and survival.STUDY DESIGN AND METHODS:Two platelet aliquots were biotinylated under conditions that resulted in either a lower or a higher number of biotin molecules per platelet. After transfusion, the two populations were distinguished and quantitated by flow cytometry.RESULTS:In five animals, recoveries were 69.8 +/− 27.0 percent for low‐biotin platelets and 72.6 +/− 26.7 percent for high‐biotin platelets. For each animal, the recoveries agreed closely. Life span, determined by the multiple‐hit method, was 2.68 +/− 0.63 days for low‐biotin platelets and 2.58 +/− 0.69 days for high‐biotin platelets. These values for recovery and life span are consistent with those measured in rabbits by using radioisotope labels.CONCLUSION:Platelet biotinylation offers a nonisotopic method for direct comparison of alternative harvest and storage conditions. It also offers the potential for simultaneous evaluation of the in vivo characteristics of platelets from at

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1994.34994378280.x

出版商:Blackwell Science Ltd    

年代:1994

数据来源: WILEY