ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1994.34394196613.x

出版商:Blackwell Science Ltd    

年代:1994

数据来源: WILEY

摘要:

Background:The recent recognition of idiopathic CD4+T‐lymphocytopenia (ICL) had led to concern that an unknown immunodeficiency virus may be transmissible by transfusion.Study Design and Methods:To evaluate the prevalence and significance of low CD4+values among blood donors, CD4+data on 2030 blood donors who were negative for antibody to human immunodeficiency virus type 1 (HIV‐1) were compiled. Those with CD4+values below ICL cutoffs (<300 CD4+T cells/μL, or<20% CD4+T cells) were recalled for follow‐up investigations. Serial CD4+data on 55 homosexual men who seroconverted during prospective follow‐up and data on 139 anti‐HIV‐1‐positive blood donors initially evaluated in 1986 were reviewed as well.Results:Five seronegative donors (0.25%) had absolute CD4+counts<300 cells per μL and/or<20 percent. On follow‐up, all five donors had immunologic findings within normal ranges, lacked HIV risk factors, and tested negative for HIV types 1 and 2 and human T‐lymphotropic virus type I and II infections by antibody and polymerase chain reaction assays. Four of five donors reported transient illness shortly after their low CD4+count donations. The median interval from HIV‐1 seroconversion to an initial CD4+value below ICL CD4+cutoffs was 63 months for infected homosexual men. Of 139 HIV‐1‐infected blood donors studied 1 to 2 years after seropositive donations, 34 (24%) had CD4+counts<300 cells per μL and/or<20 percent.Conclusion:Low CD4+counts are rare among anti‐ HIV‐1‐negative volunteer blood donors and are generally associated with transient illnesses. If any unknown virus progresses similarly to HIV‐ 1, CD4+count donor screening would be

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1994.34394196614.x

出版商:Blackwell Science Ltd    

年代:1994

数据来源: WILEY

摘要:

Background:Screening for human T‐lymphotropic virus type I (HTLV‐I) infection became systematic in 1989 in the French West Indies for blood from all donors and in France for blood from natives of endemic areas; in 1990, it was extended to blood from donors with at‐risk sex partners and in July 1991 to blood from all donors.Study Design and Methods:The epidemiologic characteristics of individuals found through the screening of donated blood to be HTLV‐I infected were compared for an endemic region (Guadeloupe, French West Indies) and a nonendemic region (Paris area) over a 3‐year period (1989 through 1991).Results:In Guadeloupe, 131 HTLV‐I‐infected individuals were detected in the screening of 28,801 units; in the Paris area, 38 HTLV‐I‐infected donors were detected in the screening of 109,824 units. All Guadeloupean HTLV‐ I‐infected donors were natives of endemic areas. Among the 38 Parisian HTLV‐I‐infected donors, 21 were natives of endemic areas, 10 were natives of endemic areas and had received transfusions, 2 were whites who had received transfusions, and 5 were whites who had had heterosexual contact with natives of endemic areas. The percentage of HTLV‐I‐infected individuals whose blood would have been excluded because of positivity for one or more markers for other viruses did not significantly change over the study period and did not significantly differ between regions (41%). Among the eight Parisian HTLV‐I‐infected blood donors detected after July 1991, six would not have been detected without the biologic screening.Conclusion:The generalization of biologic screening of HTLV‐I‐infected donated blood in France was useful for the prevention of HTLV‐I and HTLV

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1994.34394196615.x

出版商:Blackwell Science Ltd    

年代:1994

数据来源: WILEY

摘要:

Background:When the first‐generation enzyme immunoassay (EIA) for detection of antibody to hepatitis C virus (anti‐HCV) was approved in May 1990, blood banking agencies recommended testing of all components in inventory. In many cases, one or more components from these units had already been transfused.Study Design and Methods:Donors that reacted in first‐generation EIAs and recipients of their components were identified, and anti‐HCV test methods (including first‐generation EIA, second‐generation EIA, and recombinant immunoblot assay [RIBA]) were evaluated.Results:Of 66 donors identified as anti‐HCV‐positive by first‐generation EIA, 17 were positive in second‐generation EIA. Of these 17, 9 reacted in RIBA; 6 of these showed evidence of HCV infection in polymerase chain reaction (4) and/or probable transmission of HCV to a transfusion recipient (3). Of the 48 specimens that were positive in first‐generation EIA and negative in second‐generation EIA, only 1 was positive in RIBA; serum was not available for polymerase chain reaction testing, and there were no living transfusion recipients in whom to assess evidence of transmission of HCV.Conclusion:This study documents the low predictive value of EIAs for anti‐HCV in a low‐ prevalence blood donor population and emphasizes the need for additional testing to confirm the specificity of samples that r

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1994.34394196616.x

出版商:Blackwell Science Ltd    

年代:1994

数据来源: WILEY

摘要:

Background:It has previously been shown that full‐unit (200 mL) transfusions of red cells (RBCs) enzymatically converted from group B to group O by treatment with α‐galactosidase (ECO RBCs) are both safe and efficacious for normal group O or A subjects.Study Design and Methods:The present study describes the results of a comprehensive clinical and serologic assessment of 2‐unit (400 mL) ECO RBC transfusions to each of four normal group O subjects (after each had donated 1 unit of whole blood).Results:Clinical (hematologic tests, chemistry analysis, urinalysis) and serologic analyses revealed no evidence of immediate or delayed transfusion reaction, despite a threefold to fivefold elevation in pre‐existing anti‐B antiglobulin titer.51Cr‐labeled ECO RBCs were administered to one of the four subjects to allow direct measurement of ECO RBC survival in the circulation, which indicated that it was normal (24‐hour survival, 95%; t½, 29.5 days). The observed increases in hemoglobin (by 1.3 ± 0.4 g/dL [13 ± 4 g/L]) and hematocrit (by 3.2 ± 0.8% [0.032 ± 0.008]) in transfused subjects provide further evidence of the efficacy of these cells in vivo.Conclusion:These results extend those observed in our earlier 1‐unit transfusion studies and suggest that ECO RBCs pose little risk and will be useful in

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1994.34394196617.x

出版商:Blackwell Science Ltd    

年代:1994

数据来源: WILEY

摘要:

Background:Although HLA‐matched platelets are frequently requested for alloimmunized patients, recent evidence has indicated that 1‐hour posttransfusion platelet increments in these patients are specifically sensitive to crossmatch compatibility.Study Design and Methods:To determine the extent of advantage gained by use of single‐donor apheresis (SD) platelets selected on the basis of HLA match when crossmatch‐compatible SD platelets were available, a total of 220 platelet transfusions given in the absence of individually determined significant nonimmune factors were analyzed in a well‐characterized cohort of platelet‐refractory patients. Platelets were selected by solid‐phase crossmatch from a small donor pool of relatively poor HLA matches or, upon request, ordered as HLA‐matched and later crossmatched.Results:Alloimmunized patients responded better to SD platelets selected on the basis of HLA than to pooled platelet concentrates or SD platelets selected at random, although most of the benefit was limited to the 57‐percent subset of good HLA matches. Crossmatch‐compatible SD platelets provided similar posttransfusion platelet increments independent of the HLA match. None of 31 crossmatch‐ incompatible SD platelets transfused provided an adequate increment, including 13 that were ordered as HLA‐matched platelets.Conclusion:No benefit could be demonstrated from requesting that SD platelets be HLA‐ matched when crossmatch‐compatible

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1994.34394196618.x

出版商:Blackwell Science Ltd    

年代:1994

数据来源: WILEY

摘要:

Background:Recombinant growth factors are used increasingly often to stimulate bone marrow recovery after intensive chemotherapy and bone marrow transplantation. Their effects on the requirements for and responsiveness to coincident therapies, including transfusion, should be defined.Study Design and Methods:To determine whether treatment with recombinant granulocyte‐macrophage‐colony‐stimulating factor (GM‐ CSF) affects platelet transfusion responsiveness, the clinical and blood bank records were examined for 16 adult patients (8 controls, 8 receiving GM‐CSF) participating in a double‐blind study of GM‐CSF administration (250 μg/m2× 21 days) following autologous bone marrow transplantation for lymphoma. For each platelet transfusion, a corrected count increment was calculated, and note was made of the presence or absence of selected additional factors thought to decrease platelet responsiveness: fever, amphotericin treatment, HLA antibodies, platelet ABO incompatibility, and febrile transfusion reactions.Results:The total number of platelet transfusions (GM‐CSF patients, 145; controls, 145) and the mean number of transfusions per patient (GM‐ CSF, 18.3; controls, 18.0) were comparable in the two groups. GM‐CSF patients received significantly more platelets that were ABO incompatible, that were given during a febrile period, or that were given while the patient was on amphotericin. Nevertheless, the corrected count increments in patients who received GM‐CSF were at least as good as those in controls: for GM‐CSF patients: mean was 8,574 ± 5,868, median was 7,818, 49 percent were<7,500 and 66 percent were<10,000; for controls; mean was 7,618 ± 7,536, median was 6,100, 59 percent were<7,500, and 73 percent were<10,000.Conclusion:In this group of patients, GM‐CSF did not adversely affect the required number of, increments to, or incidence of refractori

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1994.34394196619.x

出版商:Blackwell Science Ltd    

年代:1994

数据来源: WILEY

摘要:

Background:A retrospective study was conducted to evaluate the efficacy of granulocyte transfusions in neutropenic patients with fungal infections following bone marrow transplantation.Study Design and Methods:Systemic fungal infection was detected in 87 patients during the first 100 days following bone marrow transplantation; 50 received granulocytes in addition to appropriate antifungal agents. The median age was 17 years in the transfused patients (range, 1.5–57) and 35 years in the nontransfused patients (range, 0.8–50). Granulocyte transfusions were given on a daily to twice‐daily basis. To evaluate their responses, patients were categorized by infection type (candidal [n = 38] vs. noncandidal [n = 49]) and site (fungemia alone [n = 30] vs. invasive infection [n = 57]). Resolution of infection was defined as the resolution of signs and symptoms and negative cultures and/or histopathology.Results:No benefit of granulocyte transfusions could be shown in the resolution of infection in patients with either invasive noncandidal infection (29% in the transfused patients vs. 23% in the nontransfused patients, p>0.1) or candidal sepsis (56% vs. 50%, p>0.1). Among patients with delayed marrow recovery, no difference was seen in the resolution of infection in the transfused (25.9%) and nontransfused (50%) patients (p>0.1); nor was any difference between the transfused and nontransfused patients evident in the duration of febrile episode associated with the fungal infection. Granulocyte transfusions were well tolerated, with the only complications being fever in 12 patients (24%), chills in 10 (20%), and respiratory distress in 2 (4%). Despite attempts to stratify by infection type, invasiveness, and marrow recovery, it was not possible to show any benefit of granulocyte transfusions in this group.Conclusions:It is likely that only through a prospective randomized trial can the question of the efficacy of granulocyte transfusions in treating fungal infections be conclusively ans

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1994.34394196620.x

出版商:Blackwell Science Ltd    

年代:1994

数据来源: WILEY

摘要:

Background:Reticulocyte phenotyping is used for transfused patients, who have red cell antibodies, to match blood for subsequent transfusion. Current methods are labor‐intensive and require a significant amount of sample.Study Design and Methods:A simple dual‐ color flow cytometry method developed for antigen typing of reticulocytes in mixed red cell populations is reported. Antigens were labeled by an indirect immunofluorescence technique using undiluted reagent sera as the primary label, biotinylated goat anti‐human IgG as the secondary label, and avidin‐phycoerythrin as the fluorescent stain. Reticulocytes were labeled with a thiazole orange fluorescent stain. Reticulocyte identification and antigen typing were performed on 319 samples to establish the validity of the procedure. Mixed red cells were prepared in all possible c antigen combinations to simulate transfusion concentrations of 25, 50, and 75 percent.Results:The anti‐ c flow cytometry profiles readily distinguished between antigen‐ positive and antigen‐negative populations and allowed the detection of reticulocytes at all simulated transfusion concentrations. Similar results were obtained in experiments using C, K, s, Fya, Fyb, Jka, or Jkbsera against equal volumes of antigen‐positive and ‐negative cells. Anti‐S gave inconsistent results. The in vitro results were confirmed in 19 transfused patients who had received red cells antigenically different from their own as well as cells from 1 chimera blood donor.Conclusion:This method provides a simpler, safer, less labor‐ intensive, and less subjective technique requiring far less sample volume than current methods for antigen typing of reticulocytes in mixed red cell samples from recentl

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1994.34394196621.x

出版商:Blackwell Science Ltd    

年代:1994

数据来源: WILEY

摘要:

Background:The ready availability of red cells of the Miltenberger (Mi) class III phenotype (6.28%) prompted the study of Mi antibodies among Chinese blood donors in Hong Kong, 98 percent of whom are descended from inhabitants of Guangdong Province in southern China.Study Design and Methods:Red cells of the Mi class III phenotype were used to conduct a survey of the frequency of Miltenberger antibodies in 56,161 random Chinese blood donors, over a period of 12 months, using a microplate technique.Results:Sera from 32 donors (0.057%) were found to contain Mi antibodies: sera from 22 contained anti‐Mur + Hut; sera from 4 contained anti‐Vw + Mur + Hut; sera from 4 had monospecific anti‐ Mur; and sera from 2 had monospecific anti‐Hil. The immunoglobulin isotypes of 24 sera were mixtures of IgM and IgG, 4 were pure IgM, and 4 were pure IgG.Conclusion:The majority of Mi antibodies detected were naturally occurring. This survey proved useful for mass screening of random donors for the procurement of valuable Mi a

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1994.34394196622.x

出版商:Blackwell Science Ltd    

年代:1994

数据来源: WILEY