ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1993.331094054611.x

出版商:Blackwell Science Ltd    

年代:1993

数据来源: WILEY

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1993.331094054612.x

出版商:Blackwell Science Ltd    

年代:1993

数据来源: WILEY

摘要:

It is generally assumed that febrile nonhemolytic transfusion reactions are an immunologically mediated reaction involving the recipient's plasma and the white cells in the donor unit. This has led to the use of white cell reduction and pretransfusion medication, to try to minimize these reactions. To better understand febrile transfusion reactions, a prospective study was performed in which all patients receiving platelet and red cell transfusions in a tertiary‐care medical center were interviewed before and after transfusion to obtain information about the typical presentation of the syndrome. It was found that transfusion reactions were much more frequently associated with platelet transfusion (30.8%) than with red cell transfusion (6.8%, p<0.0005). The routine use of antipyretics prevented most episodes of fever but did not prevent the occurrence of other symptoms such as chills, cold, and discomfort. The application of logistic regression analysis revealed that the dominant factor determining the risk of a reaction was not white cell contamination, but the age of the component (p<0.005). The significant relationship between reaction and the increasing age of the component suggests that cytokines released in the component during storage may be responsible for many reactions to blood component

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1993.331094054613.x

出版商:Blackwell Science Ltd    

年代:1993

数据来源: WILEY

摘要:

Platelet transfusion effectiveness may be limited in multiply transfused patients by the development of the refractory state. White cell (WBC)‐reduction filters with variable efficiency (1–3 log10 reduction) are available and have been shown to be effective in reducing the incidence of platelet alloimmunization. However, the threshold number of WBCs below which alloimmunization would no longer occur is yet to be determined. A previously established animal model was used to examine the relative efficiency of second‐ and third‐ generation filters in reducing the frequency of refractoriness to allogeneic platelets. In this model, California Black rabbits are used as blood donors and New Zealand White rabbits as transfusion recipients. Eight weekly transfusions of either second‐generation or third‐generation WBC‐reduced blood resulted in no difference between the two groups in mean platelet survival and rate of refractoriness to allogeneic platelets. To evaluate the possible incremental benefit of removing supernatant plasma to prevent platelet refractoriness, experiments were performed in which groups of animals were given transfusion(s) with red cell suspensions that had been WBC‐reduced or both plasma‐depleted and WBC‐reduced. A significantly lower rate of allogeneic platelet refractoriness was seen in the rabbits that received WBC‐reduced and plasma‐depleted red cells than in those that received red cells that had been WBC‐reduced only. These data provide evidence that the combined use of plasma depletion and WBC reduction can decrease still further the frequency of refractoriness produced by allo

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1993.331094054614.x

出版商:Blackwell Science Ltd    

年代:1993

数据来源: WILEY

摘要:

The growth of two strains ofSerratia marcescensin blood components was tested in this study. One of the strains had been implicated in the epidemic of transfusion‐associated sepsis experienced in Denmark and Sweden in 1991. In whole blood with a final concentration of 100 colony‐ forming units per mL ofS. marcescens, there was an immediate reduction of more than 95 percent of colony‐forming units, but no reduction of the bacterial concentration if the blood had been white cell‐reduced before inoculation. This is interpreted as an effect due to phagocytosis by white cells and as a lack of bactericidal effect of the plasma. A reduction to 10 percent of the original concentration, observed if the blood had a nominal content of white cells, was most likely due to phagocytosis. White cell reduction by filtration after inoculation further reduced the bacterial concentration of one of the strains tested, but, after a 1‐week lag phase, growth accelerated to high concentrations by 6 weeks. In platelet‐rich plasma prepared fromS. marcescens‐inoculated units, abundant growth was found after 24 hours, increasing to very high concentrations (10(12) colony‐forming units/mL) during 10‐day storage at 22 +/− 2 degrees C. Keeping the whole blood at ambient temperature for 20 hours before preparation of platelet‐rich plasma caused only temporary reduction of bacterial concentration in the S. marcescens experiments, but resulted in a complete absence of bacteria in the platelet‐rich plasma for 10 days in control experiments performed withStaphylococcus epidermidis. In another control experiment usingStaphylococcus aureus, the initial growth pattern was similar to that ofS. marcescens, but the final bacterial concentrations were not as high. Thus, the protection against bacterial growth was insufficient with respect toS. marcescensas well as to S. aureus. Growth of one of two strains ofS. marcescenswas inhibited in whole blood. This growth inhibition did not occur in white cell‐reduced units. The resistance ofS. marcescensto antibacterial mechanisms in the blood shows that contamination, even with low numbers of these b

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1993.331094054615.x

出版商:Blackwell Science Ltd    

年代:1993

数据来源: WILEY

摘要:

The purpose of this study was to compare the results of supplementary testing of volunteer whole blood donors who had been screened by the first hepatitis C virus antibody assay licensed in the United States with results from donors screened by a newer, more sensitive, multi‐ antigen assay. In contrast to the earlier assay, the multi‐antigen assay incorporates a recombinant hepatitis C virus antigen, c22‐3, which is encoded by a structural region of the viral genome. Supplementary testing included a second‐generation recombinant immunoblot assay and a highly sensitive polymerase chain reaction assay for evidence of hepatitis C virus genomic RNA. A comparison of supplementary test results reveals a higher percentage of donors screened by the newer assay to be indeterminate on recombinant immunoblot (34.4% vs. 6.4%, p<0.05). Furthermore, polymerase chain reaction testing of donors with indeterminate blot results shows that 14 percent have evidence of viral RNA. For this reason, counseling of donors with indeterminate patterns on immunoblot must include informing them of the possibility that they are i

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1993.331094054616.x

出版商:Blackwell Science Ltd    

年代:1993

数据来源: WILEY

摘要:

This prospective study was carried out with the aim of evaluating the efficacy of solvent/detergent inactivation of the hepatitis C virus (HCV) as applied to a chromatographic factor VIII concentrate. In parallel, the markers for other viruses, either lipid‐enveloped (human immunodeficiency virus types 1 and 2 [HIV‐1 and ‐2] and hepatitis B virus [HBV]) or non‐lipid‐enveloped viruses (such as B19 parvovirus and hepatitis A virus [HAV]) were evaluated. The study included 14 hemophilia centers, which enrolled 36 previously untreated patients (median age, 3 years; range, 1–56). The length of follow‐up was 12 months, during which HCV (first‐ and second‐generation assays and recombinant immunoblot assay), HIV‐1 and ‐2, HBV, HAV (IgG and IgM), and parvovirus (IgG and IgM) antibodies, as well as alanine aminotransferase values were evaluated. Thirty‐one patients were analyzable; none seroconverted for HCV, HBV, or HIV after exposure to a total of 165,000 IU of factor VIII (41 different lots). In one patient, alanine aminotransferase values rose to 167 mU per mL, 6 weeks after the first concentrate infusion, and this patient seroconverted for HAV 1 week later. Furthermore, 10 patients seroconverted for parvovirus during follow‐up. This study suggests that the solvent/detergent method of virus inactivation is efficient in relation to lipid‐enveloped blood‐ borne viruses but not in relation t

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1993.331094054617.x

出版商:Blackwell Science Ltd    

年代:1993

数据来源: WILEY

摘要:

To determine the feasibility of collecting 2 units (450 mL) of red cells per donation by apheresis technology, apheresis red cell collections were compared to whole‐blood donations. Forty blood donors were equally divided between the two study arms on the basis of gender and iron supplementation (650 mg ferrous gluconate/day vs. no supplementation). During the 1‐year study period, the apheresis participants donated 450 mL of red cells three times, and the whole‐ blood donors gave 225 mL of red cells (1 unit of blood) on six occasions. There were no reported side effects during the 102 whole‐ blood donations, whereas symptoms were noted in 83 percent of the 59 apheresis procedures. The most common symptoms were numbness and tingling, which were relieved by a decrease in the plasma‐return rate or by the administration of oral calcium supplements. Seven donors dropped out or were deferred during the study. Two whole‐blood donors left with medical problems unrelated to the study, one apheresis donor and one whole‐blood donor dropped out of the study because of excessive fatigue, and three non‐iron‐supplemented whole‐blood donors had unacceptably low hematocrit levels. By the end of the study, 70 percent of the apheresis donors considered the procedure acceptable, 15 percent were undecided, and 15 percent thought it was not acceptable. As measures of iron balance, the serum ferritin and the red cell zinc protoporphyrin:heme ratios were significantly more abnormal in the non‐ iron‐supplemented donors than in the iron‐supplemented donors. However, there were no differences in iron balance accordi

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1993.331094054618.x

出版商:Blackwell Science Ltd    

年代:1993

数据来源: WILEY

摘要:

The efficacy of subcutaneous recombinant human erythropoietin (rhEPO) (500 U/kg; administered twice a week during the 3 weeks before surgery) in the recovery of preoperative hemoglobin concentrations within a 3‐ week period was studied in 40 patients, each of whom donated 2 units (900 mL) of blood for their own use before total hip replacement surgery. Twenty autologous blood donors received rhEPO (EPO group) and 20 were not treated (control group). The initial hemoglobin concentration (14.0 ± 1.0 g/dL [140 ± 10 g/L]) was completely recovered before surgery (14.0 ± 1.6 g/dL [140 ± 16 g/L]) in the EPO group, while a decrease from 13.8 ± 1.1 to 12.2 ± 1.3 g per dL (138 ± 11 to 122 ± 13 g/L) was observed in the control group. The preoperative reticulocyte count showed more than sixfold increase in the EPO group, whereas a twofold to threefold increase was found in the control group. Serum ferritin concentration fell to 42 ± 29 micrograms per L in the EPO group and to 54 ± 35 micrograms per L in the control group. The postoperative serum erythropoietin concentration in the EPO group was significantly lower than that in the control group, but it did not differ from the pretreatment value and was attended by a higher hemoglobin concentration after surgery. Only transient flu‐like symptoms were mentioned by patients who were treated with rhEPO. Changes in blood pressure or platelet count or other adverse events were not observed. This study demonstrates that subcutaneous rhEPO is safe and effective for the complete correction of the loss of 2 units of blood within a

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1993.331094054619.x

出版商:Blackwell Science Ltd    

年代:1993

数据来源: WILEY

摘要:

Blood transfusion is one of the principal routes of transmission of Chagas' disease, a major endemic disease in Latin America. Methods for blood screening are not accurate and may yield false results that lead to high social and economic costs. This study compares two methods of diagnosing Chagas' disease (indirect immunofluorescence and hemagglutination) and several enzyme‐linked immunosorbent assays (ELISAs) with regard to specificity and sensitivity, by using human sera with known serologic and parasitologic characteristics, as well as samples with discrepant results on conventional serologic tests. An ELISA using recombinant antigens showed no cross‐reactivity with sera that were positive for other diseases. All evaluated ELISAs performed well, and their use may lead to a reduction of more than 50 percent in the number of discordant sera. Further improvements are needed in view of the complexity of the serologic diagnosis of Chagas' dise

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1993.331094054620.x

出版商:Blackwell Science Ltd    

年代:1993

数据来源: WILEY