ISSN:0958-7578    

DOI:10.1111/j.1365-3148.1995.tb00224.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SUMMARY.The Rh blood group system is the next most important to the ABO system in terms of its clinical significance in blood transfusion. It is vital to the safe, efficient practice of transfusion medicine that Rh D phenotyping tests are selected, executed and interpreted correctly. However, the Rh D blood group antigen has been shown to be subject to many phenotypic variations, and different reagents and typing techniques vary in their ability to detect these variants. The range of D‐positive phenotypes are reviewed in terms of their reactivity with monoclonal antibody reagents and their clinical significance. In view of the available evidence, it is suggested that patient typing can be safely achieved by the duplicate use of one high‐avidity or two very similar IgM monoclonal anti‐D reagents that detect most variants except category DVIin simple tube or microplate saline tests. Antiglobulin testing for weak D should not be carried out on patient samples. Donor typing can be safely achieved by the use of the same monoclonal, used in parallel with a polyclonal anti‐D reagent that detects DVIon sensitive automated eq

ISSN:0958-7578    

DOI:10.1111/j.1365-3148.1995.tb00225.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SUMMARY.Cryptic antigens are detected by anti‐bodies present in a wide spectrum of patients with or without thrombocytopenia, and even in healthy individuals. They are produced for unknown reasons and do not react with antigens of native platelets, but only with altered platelets. Cryptantigen antibodies may not only result in spuriously low platelet counts, but also in ‘falsely’ positive tests for platelet antibodies. We report our experience in the characterization of the different types of antibodies directed against cryptantigens of platelets: EDTA‐dependent antibodies, PFA‐dependent antibodies, EDTA‐PFA‐dependent antibodies and cold agglutinins. These antibodies were detected in the course of the serological study of 37 patients from a group of 356 (10%) whose blood was sent to our laboratory for platelet antibody testing. Pseudothrombocytopenia was diagnosed in 24 cases. Twenty‐one of these showed EDTA‐dependent or EDTA‐PFA‐dependent platelet agglutination and three were due to the presence of cold agglutinins. In 13 patients the thrombocytopenia was genuine. Eleven of these presented EDTA‐dependent or EDTA‐PFA‐dependent antibodies in their serum and in the two remaining cases PFA‐dependent antibodies were found. Cryptantigen antibodies were also detected in 9 out of 228 (4%) blood donors who were used as healthy controls in the platelet immunofluorescence test. In the light of the results obtained we put forward some guidelines to detect the presence of these antibodies and establish an accurate serological and clinical diagnosis of the

ISSN:0958-7578    

DOI:10.1111/j.1365-3148.1995.tb00226.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SUMMARY.The human platelet alloantigens HPA‐1, ‐2, ‐3, ‐5 and ‐6b in the Finnish population were determined using allele specific restriction analysis (PCR‐ASRA) for HPA‐1, ‐2, ‐3 and ‐5 and monoclonal antibody immobilized platelet antigen (MAIPA) assay for HPA‐1, ‐3a, ‐5b and ‐6b. No discrepancies were observed between the results obtained with the PCR‐method and those obtained serologically. The gene frequencies obtained from 200 unrelated Finns were 0.86 and 0.14 for HPA‐1a and ‐1b, 0.91 and 0.09 for HPA‐2a and ‐2b, 0.59 and 0.41 for HPA.3a and ‐3b and 0.95 and 0.05 for HPA‐5a and ‐5b. The frequency of the HPA‐5b allele (10%) is lower in Finns than in Central‐ or South‐European populations (20–30%). The HPA‐1, ‐2 and ‐3 frequencies did not deviate from those observed in other European populations. The rare HPA‐6b antigen was observed in three of 127 individuals from south‐eastern Finland (2.4%), which suggests that the frequenc

ISSN:0958-7578    

DOI:10.1111/j.1365-3148.1995.tb00227.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SUMMARY.The purpose of this study was to determine the predictive value and reliability of using a ‘critical titre’ when assessing the ability of red cell alloantibodies to cause haemolytic disease of the newborn. Titration studies and clinical follow‐up of 418 antenatal cases where the mothers had red cell antibodies were studied retrospectively. The antibody specificities were anti‐D (n= 359), anti‐c (n= 34), anti‐E (n= 19) and anti‐K (n= 6). Depending on the titre being lower or higher than 16 in the indirect antiglobulin test, the severity of disease was established on the given therapy.Anti‐D antibodies with a titre 16 were present in 20% of all cases associated with transfusion need of the child; for anti‐c, ‐E and ‐K the figure was 4%. Titres ≥ 16 resulted in both groups in 50% of the cases in phototherapy only, or no therapy at all. Titres are therefore not reliable indicators for predicting the severity of haemolytic disease of the newborn. Neither should they be used as a guide to whether or not antenatal intervention is indicated. Alternative quantitative or functional assays that measure cytotoxic lysis or phagocytosis or a combination of both shou

ISSN:0958-7578    

DOI:10.1111/j.1365-3148.1995.tb00228.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SUMMARY.A flow cytometry method for quantifying levels of anti‐D is described. The method is based on the indirect antiglobulin test and uses an FITC Fab anti‐human IgG reagent for detection of bound anti‐D. A standard curve is generated from the fluorescence measured by flow cytometry using the British Standard anti‐D preparation 73/515. The fluorescence obtained from test samples by flow cytometry is converted into IU/mL anti‐D, using the standard curve. In a limited study with 42 serum samples the assay showed good correlation with results obtained using the AutoAnalyser for sera with anti‐D levels less than 100 IU/mL. The method is simple to perform and has potential as a replacement for the A

ISSN:0958-7578    

DOI:10.1111/j.1365-3148.1995.tb00229.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SUMMARY.A reterospective analysis of records of the deferred donors from 1 October 1992 to 31 December 1993 was performed. Of 14,269 prospective blood donors (13,030 males and 1,239 females), 2,431 (16.4%) donors were disqualified for various reasons: 8‐1% of the donors were deferred for non‐pathological causes while 91‐9% were deferred for medical reasons. The most common cause for non‐pathological deferral was volunteers attending below the minimum acceptable age (5‐2%). Abnormal findings on physical examination accounted for 57‐2% of the deferrals in which low body weight was the most common finding (32‐3%) followed by low Hb (18‐6%). A past history of jaundice was the leading cause for deferral on medical interview.Numerous prospective donors are currently being deferred based on empirically derived criteria. By developing strategies to identify and rationalize donor selection criteria, the blood transfusion services should be able to decrease unnece

ISSN:0958-7578    

DOI:10.1111/j.1365-3148.1995.tb00230.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SUMMARY.In order to evaluate the role of hepatitis C virus (HCV) in post‐transfusion hepatitis (PTH) in Greece we prospectively followed 143 transfusion recipients, receiving 790 units of blood and/or products from 789 donors, between October 1989 and December 1991. The mean number of units transfused per patient was 5–52. PTH was observed in 18 patients (12–59%). One patient (0–70%) developed hepatitis B, in four (2–80%) hepatitis could be attributed to CMV infection, 10 (6–99%) developed hepatitis C and three (2–10%) showed only raised alanine aminotransferase (ALT) levels. The risk of PTH per 1000 units transfused was 22–8. The patient who developed hepatitis B (PTH‐B) was transfused with four units, one of which was positive for anti‐HBc and anti‐HBe. Seven of the 10 patients (70%) who developed hepatitis C (PTH‐C) were transfused with at least one unit seropositive in the anti‐HCV screening with 2nd‐generation tests (ELISA‐2 and RIBA‐2), whereas 9/10 of PTH‐C cases (90%) were transfused with at least one unit positive in 3rd‐generation assays. Of the three patients who showed only ALT elevation, none was transfused with anti‐HCV seropositive blood, although one of them was transfused with at least one unit with elevated ALT levels. We conclude that: (1) the incidence of PTH in Greece remains high, (2)screening of all donations for anti‐HCV with an ELISA‐2 does not exclude transmission of HCV and (3) ELISA‐3 and RIBA‐3 seem to be more sensitive in blood donor screening and in dete

ISSN:0958-7578    

DOI:10.1111/j.1365-3148.1995.tb00231.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SUMMARY.Samples from 1828 donations were screened for anti‐HBc at seven sites in the UK using kits supplied by 10 manufacturers. Only 10 (0.55%) donations were considered to have true anti‐HBc reactivity and these were detected by all 10 kits. Additional markers of HBV infection were found in nine of these 10 donations. Additional reactives were found by all kits, the number ranging from 1 to 43.In the four more specific kits, the 10 true reactives were clearly distinguished from the ‘false reactives’ by the strength of the reaction. It is concluded that the reliance on a single ELISA test for anti‐HBc diagnosis is unwise. The use of a second test known to be more specific than the screening ELISA is re

ISSN:0958-7578    

DOI:10.1111/j.1365-3148.1995.tb00232.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SUMMARY.Detailed information is provided about primary product costing and price issues as they affect transfusion manufacturing practice and clinical transfusion practice. Product price is shown to have a crucial influence upon clinical practice and associated research. By focusing particularly upon cost‐benefit analysis of blood product transfusion therapy a substantive conclusion is drawn that price should equal the associated manufacturing cost. Clinical outcome studies relate clinical efficacy to the manufacturing specification of the product, which should therefore determine the product cost. Thus, the true manufacturing cost is the sum of all the process activity costs that create the final product specification, e.g. red cell number + volume reduction + leucocyte reduction + microbiological safety, for processed red cells. Sometimes different product specifications may compete for a single activity cost, e.g. one‐spin processing achieves volume reduction and leucocyte reduction for processed red cells but also plasma removal for protein fractionation. A method for understanding the relative clinical importance of different products is described, which guides the cost allocation process. Furthermore, for some products there is uncertainty about the clinical benefits of some components of the specification, e.g. leucocyte load and immunomodulation, and a method is described for ranking this quality‐uncertainty level objectively. The optimal costing model must ensure that the product with the highest uncertainty ranking is assured a high degree of cost stability. These concepts prepare the way for a Quality Associated Costing model for blood products that correlates with clinical eff

ISSN:0958-7578    

DOI:10.1111/j.1365-3148.1995.tb00233.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY