Infusionstherapie und Transfusionsmedizin最新文献

Forthcoming shortfall of blood products and persisting concerns about viral transmission and immunosuppressive side effects of allogeneic blood transfusion have reinforced the studies with alternative oxygen carriers in the last years. Modern perfluorochemicals and cell-free hemoglobin solutions can be applied without prior cross-matching and are now available as stable formulations with long shelf life. Both groups of oxygen carriers have shown their effectivity and tolerability in numerous animal studies. An emulsion of perflubron which has a 60% weight/volume relation is actually undergoing phase III studies with respect to its effectivity in augmented acute normovolemic hemodilution since it has been shown to reverse hemodynamic transfusion triggers. While clinical studies with human cross-linked hemoglobin (DCLHb) have been stopped last year because of the results of two clinical trials showing an increased mortality in patients with stroke and multiple injury shock being treated with DCLHb in comparison with saline, a phase III study with polymerized bovine hemoglobin HBOC-201 is actually being performed in noncardiac patients with perioperative bleeding. The objective of this multicenter study is to show that treatment with HBOC-201 can reduce or avoid allogeneic RBC transfusion. Besides its use in clinical transfusion protocols, artificial oxygen carriers have a unique potential to deliver oxygen to the tissues by plasmatic transport due to its different physiology of oxygenation when compared with conventional oxygenation provided by red blood cells. Future studies must show if these modern oxygen carriers are able to improve outcome of patients with impaired perfusion and organ oxygenation. Copyright 2000 S. Karger GmbH, Freiburg

Of all human herpesviruses, human cytomegalovirus (HCMV) is the most significant cause of transfusion-associated (TA) morbidity and mortality. The problem of TA HCMV infection differs from that of other transfusion-transmitted infections in that only certain groups of patients require HCMV-free blood or blood components, i.e. seronegative pregnant women, premature infants of low birth weight who are born to seronegative mothers, seronegative recipients of allogeneic bone marrow transplants from seronegative donors, seronegative AIDS patients, and seronegative immunosuppressed patients in general. HCMV is strictly cell-associated, and transmission appears to be due to reactivation of latent virus in white blood cells. TA HCMV infec-tion in risk groups can be minimized by selection of HCMV-seronegative donors. Since transmission of HCMV from seropositive donors by blood components containing fewer than 10 7 leukocytes per unit is unlikely, leukodepletion of transfusion products by filtration is an effective alternative to the use of seronegative blood products. Other human herpesviruses causing TA infections are Epstein-Barr virus (EBV) and the human herpesviruses 6 and 7 (HHV-6, HHV-7), whereas transmissions of herpes simplex viruses (HSV-1, HSV-2) and varicella-zoster virus (VZV) by blood transfusion - if occurring at all - are extremely rare events. Frequency and clinical significance of TA infections with the human herpesvirus 8 (HHV-8) have not yet been fully elucidated. Despite the low seroprevalence of HHV-8 in Germany, its oncogenic potential merits attention, and strategies to prevent transmission and spread of HHV-8 by blood and blood products should be discussed. Copyright 2000 S. Karger GmbH, Freiburg

Background: The clinical relevance of antibodies directed against members of the Gerbich (GE) family of antigens is not invariably clear. Given the scarcity of serologically compatible red blood cells (RBC), various methods may have to be applied to assess the safety of transfusing serologically incompatible RBC. Patient and Methods: The serum of a 57-year-old male Caucasian admitted to hospital for gastrectomy was found to contain a highly reactive anti-GE2 antibody (IgG(1)). In addition to a monocyte monolayer assay, 50 ml of GE2-positive RBC were transfused, and blood samples were taken before and 1 and 24 h after transfusion for flow-cytometric determination of transfused cells. Results: Both tests showed no increased destruction of GE2-positive RBC. The transfusion of 4 units of GE2-positive RBC was well tolerated, and hemoglobin increased adequately. Conclusion: This case may extend the information available not only on antibodies directed against members of the GE family of antigens but also on methods to estimate the survival of transfused RBC. Copyright 2000 S. Karger GmbH, Freiburg

Background: Reduced levels of protein S (PS) and alpha(2)-antiplasmin alpha(2)-AP) in solvent/detergent virus-inactivated plasma (S/D-VIP) might induce an imbalance of plasma coagulation factors and inhibitors in patients transfused. We investigated 40 patients (23 fresh frozen plasma (FFP), 17 S/D-VIP, random distribution by a list calculated by statisticians) who suffered from dilution coagulopathy, liver disease, disseminated intravascular coagulation (DIC), polytrauma or were connected to extracorporeal circulation. Study Design and Methods: The following markers of activated coagulation (MAC) were measured: Prothrombin fragment F1+2 (F1+2), fibrin monomers (FM), D-dimers (DD), thrombin-antithrombin (TAT) and plasmin-antiplasmin (PAP) complexes as well as fibrinogen degradation products (FgDP), and additionally antithrombin III (antithrombin), protein C (PC), PS and alpha(2)-AP. Blood was taken only just before and 1 h after the first plasma replacement (2 units). No additional blood products were transfused before the second blood withdrawal. Pre- and posttransfusion (pre/post) values of all parameters measured were compared within the same group and between both groups. Statistical evaluation of the data was done by Wilcoxon's paired test for data in the same plasma group and by the test of Mann and Whitney for data comparison between both plasma groups. Results: Average pretransfusion values of all inhibitors for both plasma groups were in the same range and increased after transfusion, except for PS in both groups. Whereas the pre/post values did not differ significantly in the FFP group, antithrombin (p = 0.02), PC (p = 0.0005), and alpha(2)-AP (p = 0.02) showed a significantly higher increase in the S/D-VIP group. Considering the pre/post differences between both plasma groups, there were no significant differences. The same was true for MAC measured pre- and posttransfusion. Conclusion: Data showed no significant difference between both plasma groups, indicating that S/D-VIP plasma behaves as FFP under the study conditions employed. Copyright 2000 S. Karger GmbH, Freiburg

Background: Sera with high-titer cold agglutinins (CAs) of unclear or even of apparently definite specificity may contain mixtures of CAs with different specificities. The combination of anti-I plus anti-Sia-b1 CAs in sera of patients with Mycoplasma pneumoniae infections is well documented. No systematic studies on CA mixtures in sera of patients with other diagnoses are available. Material and Methods: Sera of 322 patients with high-titer CAs were exhaustively absorbed with sialidase-treated red blood cells (RBCs). By absorption, CAs against the sialidase-resistant I/i antigens are removed. If CAs reacting with untreated RBCs are left after absorption, they are directed against the sialidase- and protease-sensitive Pr(1,2,3) antigens or against the sialidase-labile but protease-resistant antigens of the Sia-I/b/Ib complex. If CA mixtures were found, specificities and isotypes of the CAs obtained by cold adsorption and warm elution were determined. Results: Three patients had mixtures of anti-i plus anti-Pr CAs, 2 patients had mixtures of anti-I plus anti-Pr CAs. Conclusion: The occurrence of CAs directed against biochemically different antigens in individual sera proves two autoimmune processes against the same cells (erythrocytes) in the same patient. One explanation for this constellation would be a postinfection cold agglutination in a patient with chronic CA disease. Copyright 2000 S. Karger GmbH, Freiburg

The preparation of platelet concentrates by automated apheresis started in the early 1970s. Originally intended to increase the amount of platelets from selected (HLA compatible) donors to supply HLA-immunized patients, plateletpheresis has permanently expanded. Further development of plateletpheresis is described. Considering medical and economical perspectives, actual trends and possible future developments of plateletpheresis are discussed. Copyright 2000 S. Karger GmbH, Freiburg

Background: The aim of the continuous development of anti-HIV-ELISA tests is the improvement of their specificity and sensitivity. With this study the precision and the specificity of the Cobas Core Anti-HIV-1/HIV-2 DAGS, a 3rd-generation anti-HIV assay, were evaluated.

Materials and methods: 1,557 frozen and 1,654 fresh sera from blood donors were tested with the Cobas Core Anti-HIV-1/HIV-2 DAGS (Roche Diagnostic Systems, Basel, Switzerland) and the Abbott Recombinant HIV-1/HIV-2 3rd Generation EIA (Abbott GmbH Diagnostika, Wiesbaden, Germany), which was used as a reference assay. Positive sera were tested with a Westernblot. 34 sera, previously not negative in the Abbott test, were retested with the two anti-HIV assays and with a Westernblot. The intra- and inter-assay precision was evaluated with the positive and negative controls of the test kits and with control sera.

Results: The intra- and inter-assay precision of the Roche test was very good. The specificity of the Roche test is 99.91%. Out of 3,211 tested sera those of three blood donors were false positive in the Roche test and one sample false positive in the Abbott test.

Conclusions: The precision and specificity of the new anti-HIV test fulfil the demands of transfusion medicine.

Objective: The role of iron metabolism, the value and the limits of oral as well as intravenous iron substitution in preoperative autologous blood donation are discussed according to the literature.

Data sources and selection criteria: The critical review of the German and English literature is based on a Medline backsearch covering the last 20 years.

Results: The success of preoperative autologous blood donation substantially depends on the volume of whole-body iron and on the amount of storage iron which is available at the beginning of the donation phase. Since iron losses due to repeated blood donations within a few weeks cannot be replaced sufficiently by food, medical iron substitution seems to be appropriate. Nevertheless, hitherto neither oral nor intravenous iron substitution could be demonstrated as useful instruments for an improvement of erythropoietic response in non iron deficient patients after autologous blood donation. Merely, intravenous iron used in combination with recombinant erythropoietin seems to be an effective support for erythropoiesis during predeposit.

Conclusions: At the moment intravenous iron medication in autologous blood donation should be restricted to well-established exceptional cases. The use of intravenous iron combined with erythropoietin seems to be justified to avoid ineffective erythropoieses and to achieve a dose reduction of recombinant erythropoietin. Since there are nearly no risks and a possible efficacy cannot be totally excluded, oral iron supplementation may be applied to patients who tolerate it well. Real iron deficiency has to be treated with iron application. Further clinical studies have to be done for a final validation of the efficacy of iron substitution in non iron deficient preoperative autologous blood donors.

Background: Weak expression of ABO antigens in newborns has been known for many years. In the near future reduced availability of polyclonal sera for ABO testing is to be expected. Therefore, it was the aim of our study to compare the suitability of monoclonal reagents for ABO testing of newborns to that of polyclonal sera.

Material and methods: One monoclonal and 1 polyclonal reagent of each of the specificities anti-A, and anti-B and anti-AB from 7 manufacturers were tested by titration with blood from 5 newborns of blood group A, 5 of blood group B, and 3 of blood group AB.

Results: All monoclonal anti-A reagents showed better results than the polyclonal sera (for newborns of blood group A on the average of the 7 pairs of reagents 1.3 geometrical titration steps). Most of the monoclonal anti-B reagents showed higher titers than the polyclonal sera (on the average for newborns of blood group B 0.7 titration steps). Also most monoclonal anti-AB reagents were stronger than the polyclonal sera in testing newborns of blood group B the monoclonal anti-AB-reagents were slightly weaker than the polyclonal sera (on the average 0.4 titration steps).

Conclusion: Use of monoclonal reagents for ABO testing of newborns shows some advantages in comparison to the use of polyclonal sera.