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Biomedical subjects

A Shanwell

Publications and source records attributed to A Shanwell.

At least 37 records · Page 2Linked to original sources
PubMed1996

Transplantation of peripheral blood progenitor cells from unrelated donors.

Six patients with high risk haematological malignancies received peripheral blood progenitor cells (PBPC) from unrelated donors. Four patients received PBPC as primary treatment and 2 following graft failure. Five donors were HLA-A, -B and -DR identical and one had a one antigen mismatch. PBPC were mobilised by treatment with G-CSF for 4-6 days. The patients received a range of 3.4 to 11.4 x 10(8) mononuclear cells/kg and 1.0 to 15.0 x 10(6) CD34 positive cells/kg. Four patients were given Campath 1G and 2 ATG prior to transplantation. The patient with one antigen mismatch received in vitro T-cell depleted PBPC using Campath 1M. All received cyclosporin and 5 in addition methotrexate. All recipients were given G-CSF and all engrafted. The patients developed no or mild acute GVHD. Two patients had limited chronic GVHD of the skin. The recipient of the mismatched graft died from extensive chronic GVHD. Three patients have had a relapse and two are alive and free of leukaemia.

Adolescent↗
PubMed1996

Rejection of the second allogeneic graft in a patient with severe aplastic anemia reversed by antilymphocyte globulin and donor lymphocyte infusions.

Rejection after allogeneic BMT for aplastic anemia is a complication with a high risk of mortality. We describe a patient who, following a second episode of rejection after a second BMT entered a third durable remission subsequent to treatment with ALG, donor lymphocyte infusions, GM-CSF, and erythropoietin. Therapy was well tolerated. At 5 years after rejection treatment, his hematopoiesis is of complete donor origin as determined by analyses of short tandem repeats. Thus, donor lymphocyte infusions can be considered as a therapy option for marrow rejection after allogeneic BMT for aplastic anemia.

Adult↗
PubMed1995

[High-dose chemotherapy in breast cancer. Promising results in combination with stem cell support].

Thirty-three women with breast cancer have undergone high dose chemotherapy with autologous stem cell support at Huddinge Hospital. Twenty-eight patients had stage IV disease while five patients had disease stage II or III with involvement of > 10 axillary lymph nodes. Patients who received peripheral stem cells had a shorter duration of neutropenia than patients who received autologous bone marrow (p < 0.001). The transplant related mortality was 3 per cent. The calculated progression free survival was 39 per cent at 24 months after high dose therapy in women with stage IV chemosensitive breast cancer. Patients who got a complete remission after standard dose chemotherapy had a better survival rate than patients who got a partial remission. All women with refractory disease progressed within five months from therapy. Four out of five patients with disease stage II or III are progression free with the longest follow-up time of 46 months. High dose chemotherapy with stem cell support can be given with acceptable toxicity. The follow-up time is short but the results are promising, in particular for women who obtain a complete remission before the high dose therapy starts.

Adult↗
PubMed1995

A solid-phase test using antiglobulin and enzyme-enhanced techniques for erythrocyte antibody screening during pregnancy.

We have modified previously described solid-phase tests for erythrocyte antibody screening to develop a method, suitable for antiglobulin- and enzyme-enhanced techniques (SPH-IAT and SPH-ENZ). In this study we compared the SPH tests with an autoanalyzer (AA) technique. The results were more specific with the SPH tests than with the AA. Of 4,234 unselected samples from pregnant women, screen-positive samples were reduced from 96 (2.27%) by the AA, to 56 (1.32%) by the SPH tests. This difference was due to the reduced number of false-positive reactions with the SPH tests, 0.47% compared to 1.44% with the AA. Antibodies detected by the AA and the SPH-IAT and -ENZ were: 9 Rh prophylaxis, 2 anti-c, 1 anti-K and anti-M, and 1 anti-Jka. Antibodies detected only by the SPH tests were 1 anti-K, 1 anti-Le(a) (SPH-IAT and -ENZ), 1 anti-M (SPH-IAT) and 4 anti-Jka (SPH-ENZ). One anti-C, 2 anti-D, 3 Rh prophylaxis and 1 anti-E were detected by the AA and the SPH-ENZ but failed to react by the SPH-IAT. One anti-Le(a) and 8 Rh prophylaxis antibodies were detected by AA only. All clinically important antibodies were detected by the SPH tests. We conclude that the SPH-IAT and SPH-ENZ are screening methods with high specificity that are readily adaptable to larger series of samples from pregnant women and suitable for automated handling throughout the screening and identification process.

Antibodies, Anti-Idiotypic↗
PubMed1994

Altered expression of adhesion molecules (L-selectin and Mac-1) on granulocytes during storage.

BACKGROUND: The success of granulocyte transfusion therapy for neutropenic patients with sepsis is dependent on the number and quality of the granulocytes transfused. There is a progressive impairment in granulocyte function during storage. STUDY DESIGN AND METHODS: The effect of 1 to 2, 4, 24, and 48 hours' storage on receptor expression associated with granulocyte function has been analyzed. RESULTS: After 24 hours' storage, significant changes were found in the expression of receptors associated with adhesion to the endothelium: a decrease in L-selectin expression (p < 0.01) and an increase in Mac-1 expression (p < 0.01). Receptors (CR1 and FcRIII), associated with adhesion to target, were either increased (CR1) or unaltered (FcRIII). The capacity to produce a reactive oxygen metabolite (hydrogen peroxide) remained essentially unchanged after 48 hours' storage. The ability of N-formyl-methionyl-leucyl-phenyl alanine to mobilize Mac-1 and CR1 was reduced after 48 hours' storage. CONCLUSION: Since the regulation of adhesion molecules is important for the recruitment of granulocytes into an inflammatory site, the observed in vitro changes in L-selectin and Mac-1 expression during storage may be of importance for the quality of granulocyte concentrates.

Blood Preservation↗
PubMed1994

Electrical impedance alterations of red blood cells during storage.

The electrical impedance of blood is determined mainly by the resistance of the plasma (Rp), resistance of the red cell interior fluid (Ri), and capacitance of the cell membranes (Cm). These parameters were measured on 10 stored blood samples consecutively during 4 or 5 weeks of storage at 4 degrees C, once every week. Compared to the values of fresh samples, a statistically significant decrease in Rp was found mainly during the first week of storage, Ri did not decrease significantly until after 3 weeks, whereas Cm decreased progressively with time. These alterations can be explained by known red cell lesions during storage. The results indicate that electrical impedance measurements might be useful for monitoring red cell ageing and assessing the quality of stored red blood cells.

Blood Preservation↗
PubMed1993

Platelet concentrates in an additive solution prepared from pooled buffy coats. In vivo studies.

Leukocyte-depleted platelet concentrates were prepared from pools of 4 buffy coats on the day after blood collection (BC-PC). The storage medium was composed of citrate phosphate dextrose plasma and a platelet-additive solution. Autologous transfusions of 111In-labelled platelets in 9 healthy volunteers were performed on the day of preparation (day 1) and on day 5. The recovery was 54.6 +/- 8.7 (day 1) and 51.9 +/- 10.4% (day 5), T1/2 was 101 +/- 28 and 61 +/- 9 h, respectively. The survival was 8.3 +/- 1.7 and 5.7 +/- 1.0 days, respectively, using linear plot, and 7.8 +/- 2.0 and 5.8 +/- 0.5 days using the multiple hit method. In a prospective clinical study a comparison of the corrected posttransfusion increments was made between BC-PCs and apheresis-PC, and between fresh (1-2 days) and stored (3-5 days) preparations. No difference was found between BC-PCs and apheresis PCs. However, fresh BC-PCs gave higher increments than stored BC-PCs. A slight numerical difference between fresh and stored apheresis-PCs was not statistically significant. It is concluded that the BC-PC method results in platelets of equal quality to apheresis-PC.

Adult↗
PubMed1992

Pretransfusion incubation of apheresis platelets at 37 degrees C improves posttransfusion recovery.

The effect of brief 37 degrees C pretransfusion incubation of apheresis platelets (n = 25) was studied in 14 allogenic bone marrow transplant recipients (5 children, 9 adults). Apheresis platelets were collected on a cell separator, divided in two aliquots, and stored 1 to 5 days at 22 degrees C during agitation. One aliquot was incubated at 37 degrees C for 1 hour before transfusion, and the other was transfused as a paired control. When the patient's peripheral platelet count fell below 30 x 10(9) per L, one aliquot was transfused. The other aliquot was transfused the following day. Each patient received the two aliquots in random order. Corrected count increment (CCI) at 1 hour after transfusion of 37 degrees C incubated platelets was 12.2 +/- 9.5 (mean +/- SD) compared to 7.5 +/- 5.4 for paired control platelets (p < 0.05). CCIs the next day were 4.4 +/- 6.1 and 2.4 +/- 2.7, respectively (not significant). It can be concluded that 37 degrees C incubation of apheresis platelets improves posttransfusion CCI.

Adult↗
PubMed1992

Alterations of glycosphingolipid-based blood group antigen expression on erythrocytes and in plasma studied on consecutive samples after a blood group O to A bone marrow transplantation.

A blood group A1Le(a-b+) individual with chronic myeloid leukaemia had received a bone marrow graft from an HLA-identical OLe(a+b-) donor. Twelve months after bone marrow transplantation (BMT), the red blood cells of the patient became agglutinable with anti-A blood group reagents. To elucidate whether the blood group A antigen expression was of plasma or of bone marrow origin, total non-acid glycosphingolipid fractions were prepared from red blood cells and plasma collected 17 months after BMT, and from plasma collected 13, 15 and 19 weeks after BMT. The glycolipid fractions were analysed by thin-layer chromatography and immunostained with monoclonal A-antibodies, and permethylated and permethylated-reduced derivatives of selected plasma samples were analysed by mass spectrometry. The results strongly indicate the presence of host bone marrow-produced blood group A red blood cells. Furthermore, the presence of a blood group H active pentaglycosylceramide type 1 (H-5-1) (Table I), characteristic for an OLe(a-b-) secretor, was seen in plasma 3-4 weeks before clinical chronic graft versus host disease (GVHD). After treatment of chronic GVHD, this expression disappeared. The blood group ALeb (A-7-1) antigen produced by the recipient seems to be present and to increase with time in all plasma samples. This also seems to be the case for the Leb and A-6-1 antigens.

ABO Blood-Group System↗
PubMed1992

A randomized trial comparing the use of fresh and stored platelets in the treatment of bone marrow transplant recipients.

Patients undergoing allogeneic bone marrow transplantation (BMT) were randomized into two groups. One group (n = 21) received single donor platelet concentrates (PC) that were as fresh as possible, the other group (n = 18) received single donor PC stored for 2 to 5 days. Actual mean storage times for PC were 1.12 +/- 1.25 (mean +/- SD) and 2.67 +/- 1.30 d, respectively (p < 0.001). The total need for platelets during 60 d after BMT in patients receiving fresh PC was 22.1 +/- 17.8 x 10(9) platelet/liter blood volume/d, and for stored PC 29.2 +/- 19.2 x 10(9) platelets/liter blood volume/d (n.s.). A multiple regression analysis of the data showed no correlation between PC storage time and the PC requirement (p = 0.85). Posttransfusion corrected count increment (CCI) at 1 hour was 10.4 +/- 5.1 for PC stored 0-1 d, 10.3 +/- 7.0 for PC stored 2-3 d, and 11.4 +/- 9.2 for PC stored 4-5 d. The corresponding CCI, at 18 h were 6.5 +/- 4.4, 5.4 +/- 3.3 and 6.8 +/- 4.6. We conclude that there is no major difference between fresh and stored single donor PC.

Adolescent↗
PubMed1991

An alloimmunized, thrombocytopenic patient successfully transfused with acid-treated, random-donor platelets.

Alloimmunized, thrombocytopenic patients, refractory to random-donor platelet transfusion, often respond to HLA-identical single-donor platelets. HLA-compatible platelets are expensive, take time to prepare, and donors are sometimes not to be found. We have used random-donor platelets and 'peeled' the HLA-antigen off the platelets, using a modified laboratory method (incubation of platelets with citric acid solution at 0 degrees C). Platelet recovery in two healthy subjects was 72.0% for acid-treated platelets, and 73.5% for untreated control platelets, using 111In-labelled autologous platelets. Survival time (multiple hit) was 6.25 and 7.95 d, respectively. Random-donor platelets that were strongly positive in the crossmatch with serum from a patient became negative after treatment with the acid solution. Furthermore, transfusion of these platelets gave a post-transfusion, platelet-count increment comparable with transfusion of HLA-compatible single-donor platelets.

Blood Component Transfusion↗
PubMed1991

A study of the effect of ABO incompatible plasma in platelet concentrates transfused to bone marrow transplant recipients.

Bone marrow transplant recipients at Huddinge Hospital have routinely received single-donor platelet concentrates (PC) from blood group O donors. These PC contain approximately 350 ml plasma, which is incompatible with patients of group A, B and AB. In 27 patients transplanted with an ABO-identical bone marrow, serological investigations have been performed every week after transplantation (median 6 weeks, range 3-14). Nine of 11 recipients with blood group A developed a positive direct antiglobulin test (DAT) after PC transfusions, while none of 15 patients of blood group O developed a positive DAT. Anti-A could be eluted in DAT-positive cases. In no case was there any clinical sign of hemolysis. Nor did recipients of groups A, B or AB (n = 34) require more red blood cells or PC transfusions compared to recipients of group O (n = 47).

ABO Blood-Group System↗
PubMed1991

Storage of platelets in a new plastic container. Polyvinyl chloride plasticized with butyryl-n-trihexyl citrate.

The effect of storage of platelets in a new polyvinyl chloride (PVC) plastic material with a butyryl-n-trihexyl citrate (BTHC) plasticizer (PL 2209) was evaluated. The PL 1240 container, i.e. PVC plastic with a different plasticizer, tri-(ethylhexyl)-tri-mellitate, was used as a reference. Measurements of pH, pO2, pCO2, glucose, lactate, adenosine triphosphate, total adenine nucleotide content, lactate dehydrogenase and platelet factor 4 (PF4) were made during 5 days of storage. Similar results were noted comparing PL 2209 and PL 1240. Differences in pO2 and pCO2 indicate greater gas permeability in PL 2209 than in PL 1240. Significantly higher PF4 levels were found in PL 2209, but the difference could not be attributed to the PL 2209 container itself. Paired autologous reinfusion studies (111Indium) of 6 normal donors gave mean recovery values after 5-day storage of 41.1 +/- 7.4% (PL 2209) and 45.5 +/- 7.7% (PL 1240), t1/2 66 +/- 13 and 75 +/- 5 h, survival time (linear model) 6.3 +/- 1.0 and 6.8 +/- 0.7 and survival time (multiple-hit model) 6.0 +/- 0.7 and 6.5 +/- 0.4 days, respectively. Only the difference in survival time (multiple-hit) was significantly higher in PL 1240. The corrected count increments at 12-24 h following transfusion were 13,300 +/- 10,800 (PL 2209) and 13,600 +/- 11,600 (PL 1240) with no statistically significant difference found. These results indicate PL 2209 as an equivalent alternative to PL 1240 for the 5-day storage of platelets.

Blood Component Transfusion↗