Transfusion science最新文献

There is no report in which three episodes of delayed hemolytic transfusion reaction (DHTR) occurred from multiple antibodies to red cells (RBCs) in the course of treatment of a patient. This paper describes episodes of anemia and hyperbilirubinemia in concert with the development of three alloantibodies in a multiple transfused patient. The patient was a 71-year-old male suffering from valvular heart disease and hemophilia B with a history of transfusions. Although he received compatible RBCs from 14 donors as judged by a crossmatch test using the albumin–antiglobulin method, three episodes of DHTR occurred after surgery. The first hemolytic episode on day 7 after surgery was due to anti-Di^a because of clinical and laboratory evidence which included jaundice, sudden increases in total bilirubin (T-Bil) and lactate dehydrogenase (LD) levels, and a decrease (2.2 g/dl) in hemoglobin (Hb) level. The second hemolytic episode on day 16 resulted from newly producted anti-Jk^b. The patient experienced fever, fatigue, nausea and anorexia, and laboratory data showed a second increase in T-Bil, a second decrease (3 g/dl) in Hb, and moderate elevations of blood urea nitrogen (BUN) and creatinine (CRE) levels. The third hemolytic episode on day 39 was due to anti-E. The patient complained of fever and fatigue and had a third unexplained drop (1.5 g/dl) in Hb despite no bleeding. This is the first reported case in which three episodes of DHTR occurred from different red cell antibodies.

Background. Donor plasma proteins are associated with non-hemolytic allergic reactions, such as urticaria or laryngeal edema, in platelet-transfusion recipients. Replacement of plasma with synthetic media from platelet concentrates (PCs) is considered to be effective in preventing such reactions. However, platelets preserved in media depleted of less than 10% plasma are reported to have functions inferior to those preserved in plasma.

Methods. Fukushima Cocktails (FCs) contain glycerol (25, 50 or 100 mM), sodium acetate, glucose and other components. To test the effect and determine the most suitable concentration of glycerol for platelet preservation, functions of platelets including aggregation, hypotonic shock response and swirling pattern and released biochemicals were measured with platelets preserved in Fukushima Cocktails. The effects of residual plasma on platelet functions were also evaluated. Autologous platelets stored for 3 days in solution containing 50 mM glycerol were transfused into healthy volunteer donors to evaluate their safety and survival.

Results. The functions (aggregation and hypotonic shock response) of platelets preserved in Fukushima Cocktails with 10% residual plasma were preserved for 5–7 days as well as plasma controls, whereas platelets stored for 9 days in a medium lacking glycerol became swollen and β-thromboglobulin and thromboxane B₂ increased. When the residual plasma was more than 5%, platelet functions including aggregation, hypotonic shock response and swirling pattern were well preserved for 7 days. The in vivo platelet survival rates at 24 and 48 h after transfusion of platelets stored for 3 days in Fukushima Cocktail were 77% and 60%, respectively, which were not less than autologous plasma-stored platelets.

Conclusion. Glycerol at a concentration of around 50 mM has a beneficial effect on platelet preservation for more than 7 days. The results of these experiments indicate that platelets stored in Fukushima Cocktail should be useful clinically.

While blood products become more safe in terms of viral contamination, the risk of transfusion-related bacterial infection has re-emerged to one of the major hazards in transfusion medicine. In recent prospective studies the rate of contaminated platelets ranged from 0.04 to 0.5%, and a rate of transfusion reactions between 0.007% and 0.046%.

It is generally agreed that most of the organisms isolated from donated blood originate from the normal skin flora or from the environment. As it is unlikely that antiseptic methods can achieve absolute sterilization of the skin before venepuncture, blood banks have to rely on laboratory tests to detect contaminated blood products before release. But most of the currently available methods detecting bacterial contaminations do not have the potential to be sensitive and fast enough for a routine contamination screening in transfusion services.

Here we present two alternative strategies based on molecular genetic techniques (Real-Time-PCR and Haystack processing) that detect or semi-quantify bacterial rRNA gene sequences for the majority of bacterial species. In addition we discuss some aspects on target selection, routine preparation and residual 16S-rDNA-contamination of enzymes.

New IgM alloantibody detection system that uses anti-human IgM-antibody-sensitized magnetic particles mixed passive hemagglutination (IgM-M-MPHA) has been developed. IgM antibodies are well detected by direct agglutination using the saline tube test. Anti-IgM using IgM antibody detection is not used routinely. In our evaluation, IgM-M-MPHA showed good detection of IgM alloantibodies. When IgM-M-MPHA is used together with IgG-M-MPHA (anti-human IgG-antibody-sensitized magnetic particles mixed passive hemagglutination), alloantibodies can be distinguished easily whether it is IgG, IgM or both.

Transfusion of platelet concentrates (PC) reduced the incidence of fatal hemorrhages in several thrombocytopenic conditions. Unfortunately, long-term platelet supportive care may be complicated by the development of a state of refractoriness, resulting in inadequate recovery of functional platelets. PC handling, clinical conditions of the patients and alloimmunization are the main factors affecting refractoriness. We evaluated the post-transfusion platelet increase in 25 patients (M=6, F=19) with hypomegakaryocytic thrombocytopenia receiving random ABO-compatible PC within 24 h after collection. Quality of PC was assessed by platelet count, pH measuring, LDH release, glycocalicin levels, CD-62 and CD-42b expression. Besides history, clinical status and therapy, we searched for the presence of anti-HLA class 1 and anti-HPA 1-4-5 antibodies. Only six patients (24%) were refractory to PC transfusion, as assessed by a corrected count increment (CCI)<5000. Four of such six patients (67%) had anti-HLA antibodies, as compared to zero of 19 responders (P<0.02). No other investigated clinical or laboratory feature was significantly different in refractory and responsive patients. Although post-transfusion bleeding time was shorter in responders than in refractory patients (297.33 ± 249.95 versus 673.33 ± 409.96; P<0.02), it did not significantly change even in patients with adequate correct count increment. Our data confirm the importance of anti-HLA antibodies in determining adequate post-transfusion recovery or refractoriness.

Although autologous blood donation is an alternative to allogeneic transfusion, some authors had questioned its cost-effectiveness. New techniques, like red blood cell apheresis could improve the cost-effectiveness of autologous blood transfusion, therefore we have valued the efficiency of this procedure in autologous blood donation.

Materials and Methods. We studied 131 patients undergoing different types of surgery who entered the preoperative autologous blood donation program over a one year period. Apheresis was performed with the MCS 3p from Haemeonetics.

Results. We were able to collect 304 red blood cell units from 131 patients. The average yield per procedure was two units (88 cases, 67.2%). In 41 patients (31.3%), we collected 3 units and, in two cases, 4 units were collected. The mean volume of the units was 255 (191–280). 18 (13.7% patients had an adverse reaction. Most of these were mild. Only in one case was it necessary to stop the procedure. 202 units (66.4%) were transfused to 97 patients (74%). 12 (9.2%) patients also used allogeneic transfusions (mean units: 0.18±0.05 with a range 1–5).

Conclusion. Red blood cell apheresis is a useful procedure in autologous blood donation.

We have analysed the blood transfusion requirements in 288 consecutive adult patients undergoing cardiac surgery using data from the discharge reports, coded in accordance with the international disease classification. 114 patients were transfused (39.6%). The transfusion rate was higher in patients with a principal diagnosis of two valve disorders, acute/subacute ischemic heart disease, congenital anomalies, tumour and injuries. All of these had a transfusion rate greater than 50%. Controlling the confounding effects by multivariate logistic regression analysis, there was an adjusted association of the transfusion rate only with the principal diagnosis and with sex, not with type of admission, preoperative anemia, surgical procedure or age.