Biomedical subjects

W Sibrowski

Publications and source records attributed to W Sibrowski.

At least 55 records · Page 3Linked to original sources

PubMed1994

[Benefits and risks of autologous blood donation].

Aim of this review is to compare benefits and risks of autologous blood transfusion with special emphasize on donation and retransfusion risks. Autologous blood transfusion may reduce the transfusion-associated mortality by 70%. Another advantage of preoperative autologous blood donation is the increase in erythropoiesis. Immunologic and viral infectious complications have not been reported with transfusion of autologous blood. On the other hand, autologous blood predonation is associated with risks during donation and retransfusion. Reactions due to routine autologous predonation of blood have been examined in several studies. Mild and moderate reactions occurred in similar frequencies with autologous predeposit and homologous donations, respectively. High risk autologous predonation has also been successfully performed in patients with end-stage heart or lung disease and in pregnancy. No data could be retrieved concerning the frequency of retransfusion-associated risks, e.g., clerical error or contamination of blood products. Bacterial contamination of autologous blood is published only in case reports. Autologous blood transfusion has minor impact on hospital mortality since overall risk of transfusion is low compared to mortality of anesthesia and surgery. However, no reliable criteria exist by which rare severe complications such as unstable angina or transient ischaemic attacks could be predicted. In cases with minor blood loss isovolaemic haemodilution should be performed instead of autologous predeposit. Autologous predonation should be done whenever other forms of autologous transfusion are not sufficient to exclude homologous transfusion.

Acquired Immunodeficiency Syndrome↗

PubMed1994

[Possibilities of family blood donation for children and adults].

Directed donations are refused by the most transfusion services for some reasons. At first, voluntary donation is questionable when relatives will be used as blood donors. This fact leads to a higher risk of infections compared with a third party donation. In some rare instances, directed donations may be necessary or beneficial for the recipient. In all these cases, donors must be selected according to federal and institute guidelines. Production, storage, administration and distribution of blood products determined for a certain recipient require many personnel, material and logistic energy. These results in higher costs which have to be borne by the recipient himself. Cost of directed donations are in contrast to their benefit and in contrast to more cost-effectiveness.

Acquired Immunodeficiency Syndrome↗

PubMed1994

Flow cytometric determination of leukocytes and lymphocyte subsets in thrombocytapheresis products.

To determine the nature of the leukocyte contamination of platelet concentrates we developed a method to identify the immunophenotype of the leukocytes in platelet concentrates. Flow cytometry is ideally suited for this type of rare event detection. Using LDS-751, Forward Scatter and Side Scatter and a modified lysis protocol we were able to discriminate leukocytes from platelets and erythrocytes leaving 2 fluorescent channels free for immunophenotypic analyses. With this protocol we analyzed the leukocyte content and lymphocyte subset distribution pattern of peripheral blood and of the resulting thrombocytapheresis product of 40 blood donors at our institute. We found that the leukocyte content of the platelet concentrate existed almost purely (median 97%, 95-99%) of lymphocytes and monocytes (median 2%, 0-5%), granulocytes were < 1%. Within the lymphocyte population in thrombocytapheresis products the distribution of CD3, CD19, CD4, CD8, CD57, CD5, HLA-DR and gamma/delta T cells did not differ significantly from the corresponding distribution in the peripheral blood of the donors. We conclude that this flow cytometric method can be used as quality control to monitor leukocyte content and lymphocyte distribution of platelet concentrates.

Adult↗

PubMed1994

[Effective erythrocyte exchange by means of a cell separator in sickle cell anemia].

Sickle-cell anemia is one of the most common hemoglobinopathies. The therapy consists of symptomatical measures like giving analgetics, decreasing blood viscosity, and red cell transfusions. We present a cascuistic of a 23-year-old Turkish female patient with a homozygous form of sickle-cell disease, who was treated with analgetics, multiple red blood cell transfusions and Desferal because of severe pain crises. From November 1992 until June 1993 we performed automated red cell exchange transfusions with six fresh, washed and leukocyte-depleted red blood cell units with a continuous flow cell separator (Cobe Spectra). We propose to prefer the exchange with the cell separator to the conventional transfusion therapy by manual exchange or a chronic transfusion program in severe sickle-cell crises.

Adult↗

PubMed1993

[Autologous blood donation and isovolemic hemodilution--indications and practical implementation].

OBJECTIVE: The state of the art of autologous blood transfusion is described with special emphasis on safety aspects, indications and medicolegal implications. DATA SOURCES AND SELECTION CRITERIA: Literature was retrieved using the MEDLINE literature database. Medical and legal expert opinions on autologous blood transfusion programmes are presented as well as the actual German jurisdiction. Guidelines for autologous predeposit and haemodilution used in the University of Münster are described. RESULTS: In the past decade all forms of autologous transfusions gained increasing influence in haemotherapy due to the ongoing discussion on the safety of blood products. The German Federal Court has demanded that whenever homologous perioperative transfusion is considered likely, patients have to be offered autologous predeposit. Legal conditions for autologous programmes directed by anaesthetists not specialised in transfusion medicine are described. Whole-blood predeposit should be limited to two autologous units. In cases with minor blood loss, isovolaemic haemodilution may be performed instead of autologous predeposit. However, autologous transfusions have their specific risks that are either related to the patient or to the procedure of autologous predeposit, e.g., clerical error, contamination of blood products and technical faults. Standard procedures of the University of Münster to ensure low-risk autologous transfusion are presented. They consist in adequate handling and proper identification, testing of donor for virus infection markers, bacterial culture from blood products and a list of contraindications: anaemia, unstable angina, myocardial infarction within 3 months, decompensated heart insufficiency, aortic valve stenosis with angina, and cases with infection and fever. CONCLUSION: The risks related with autologous transfusion should be lower compared to homologous transfusions. Well-defined standards concerning indications and techniques are required to reach this goal.

Blood Donors↗

PubMed1993

[Transfusion-induced virus infections: how great is the risk?].

The risk of infection by blood transfusions contaminated with the human immunodeficiency virus (HIV) and/or the hepatitis C virus (HCV) was dramatically reduced after the introduction of blood donor screening using specific and sensitive 2nd- or 3rd-generation enzyme immunoassays for virus antibody detection. In addition, donors selection provides the greatest safety. The strategy for safe blood supply includes medical examination and self-exclusion of donors. For example, in German blood donors, the current detection rate of HIV is between 1.36 and 1.82 confirmed positive results per 100,000 blood donations. For hepatitis C the rate of anti-HCV-positive donors is between 0.27 and 0.49%. The overall risk of HIV infection ranges from 1 in 500,000 to 1 in 3 million and that of a transfusion-associated HCV infection from 1 in 20,000 to 1 in 40,000 per transfused blood unit. From the observed virus load among German blood donors, the transfusion-associated mortality was calculated to be 1 in 260,000 per transfused blood unit. Implications are discussed resulting from this low risk of HIV and/or HCV infection by blood transfusions.

Blood Component Transfusion↗

PubMed1992

Immunomodulatory activity of different blood products on the mitogen-induced human lymphocyte transformation.

Blood transfusions have an immunosuppressive effect on the recipient and induce changes in several immunological parameters. We studied the effect of homologous and autologous fresh plasma (FP), fresh frozen plasma (FFP), heparinized plasma, as well as the influence of red blood cells (RBC), CPDA-1, CPD, heparin, PAGGS-mannitol, SAG-mannitol and ADSOL on mitogen-induced lymphocyte transformation. Both homologous and autologous FP and FFP decreased the PHA and ConA response of human lymphocytes (P < 0.05). The PWM response was reduced by FP (P < 0.05). The mean t1/2 of plasma-induced suppression was approximately 38 h. Dose-dependent suppression rates were observed with pure CPDA-1 and CPD solutions. In contrast, heparinized plasma showed an elevated PHA- and ConA-induced transformation rate (P < 0.025), whereas PWM induction was unaffected. In addition, washed RBC, pure PAGGS-M, SAG-M and ADSOL solutions revealed no effect on the PHA response. Freezing, heating or recalcification of plasma resulted in an increase in the PHA response. Adenine was not immunosuppressive in vitro. We conclude that, in addition to unspecific mechanisms by CPDA-1 or CPD, an unknown plasma factor, which is susceptible to changes in temperature or storage conditions, suppresses the PHA-, PWM- or ConA-induced T-cell immune response. Further clinical studies are needed to correlate these observations with clinical phenomena.

Adenine↗

PubMed1992

[Effect of plasma and plasma components on lymphocyte transformation].

Blood transfusions have an immunosuppressive effect on the recipient and induce changes of several immunological parameters. We therefore studied the effect of homologous and autologous fresh plasma, fresh-frozen plasma, heparinized plasma, as well as the influence of i.v. immunoglobulins on the MLC- and mitogen-induced lymphocyte transformation. We conclude from our study that, besides unspecific mechanisms, an unknown plasma factor enriched in the immunoglobulin fraction suppresses the MLC- and mitogen-induced T-cell immune response.

Humans↗

PubMed1992

[Effect of various plasma preparations and i.v. immunoglobulins on the function of lymphocytes and monocytes in vitro].

Transfusion of whole blood or blood components has an immunosuppressive effect on the recipient and induces changes of several immunological parameters. Especially blood plasma or plasma components were suspected to show an immunosuppressive action. We therefore studied in vitro the effects of autologous and homologous fresh frozen plasma (FFP), fresh plasma (FP) and heparin plasma (HP) as well as the influence of different commercial i.v. immunoglobulins (IVIG) on the mixed lymphocyte reaction (MLR), the mitogen-induced lymphocyte transformation and the inhibition of phagocytosis of red blood cells, measured in the monocyte-monolayer assay (MMA). We demonstrate that autologous and homologous plasma inhibit the PHA and ConA response of lymphocytes (p < 0.025). Minimal differences between homo- and autologous plasma were only observed for FP in PHA-induced lymphocytes. IVIG reduced, in a dose-dependent manner, the MLR and PHA response to basal values. In contrast, plasma and IVIG showed only small effects on the PWM response rates. The addition of FFP, FP, HP or IVIG to cultured monocytes resulted in a significant inhibition of red blood cell phagocytosis, ranging from 76 to 87%. We conclude from our study that, besides unspecific mechanisms, an unknown plasma factor which is enriched in the immunoglobulin fraction of plasma is able to suppress the T-cell immune response.

Cells, Cultured↗

PubMed1991

[Retrospective study of a borreliosis infected blood donor].

Lyme disease is caused by a spirochete, Borrelia burgdorferi, and represents a potential transfusion hazard. Some Borrelia burgdorferi-infected blood donors may not be disqualified by standard donor selection procedures, thus possibly transmitting the disease. In a follow-up of 14 recipients of blood products donated by such a donor, no clinical signs or serologic evidence of a transfusion-transmitted borreliosis could be demonstrated.

Adult↗

PubMed1991

[Effect of various blood components and additive solutions on phytohemagglutinin (PHA)-induced lymphocyte proliferation].

The effect of red blood cells (RBC), fresh plasma (FP), fresh frozen plasma (FFP) and different storage solutions (e.g. CPDA-1, CPD, PAGGS-M, SAG-M, Adsol) on the immune response was investigated in human lymphocyte cultures. The inhibitory activity was measured by determining the effect of different components on the PHA-induced T-cell proliferation. Our results indicate that the inhibitory effect is caused by an as yet unidentified plasma factor (e.g. anti-idiotypic antibodies, soluble HLA-class I or II antigens). In contrast, pure RBC or blood storage solutions revealed only minimal effects on the T-cell response.

Blood Component Transfusion↗

PubMed1990

[Viral safety in hemotherapy. Current aspects of hepatitis C and parvovirus B19 detection for plasma component therapy].

A major risk of plasma component therapy was the transmission of infectious diseases. Heat inactivation, TNBP/detergent- or beta-propiolactone/UV-treatment were introduced to reduce the risk of virus transmission, most notably those that cause hepatitis or AIDS. Therefore we discuss topical problems of virus inactivation, particularly for the recently discovered hepatitis C-virus and the well-known parvovirus B19.

Antibodies, Viral↗

PubMed1990

[Hepatitis C virus antibodies (HCV) in patients treated with chronic hemodialysis].

Patients undergoing chronic hemodialysis are frequently affected by nosocomial viral infections, as indicated by the high prevalence of HBV antibodies. The question, to what extent HCV is transmitted by blood transfusions (NANB-PTH), or acquired in a nosocomial manner, is still unanswered. We therefore evaluated the HCV antibody rate of 387 sera of dialysis patients on the "Eurotransplant" waiting list. The HCV antibody reactivity ranged from 5.4 to 12.0% between different dialysis centers. In highly immunized (HLA antibody positive) long-term dialysis patients 31.3% (vs. 8.3% in non-immunized patients) were HCV antibody positive.

Antibodies, Viral↗

PubMed1990

HLA antigen frequencies in familial Crohn's disease (CD).

A possible association of Crohn's disease (CD) with MHC (major histocompatibility complex) markers was investigated in families with more than one affected member. HLA-A, B, C, DR and DQ typing was performed in 21 CD families with two or more CD patients. The following HLA-antigens showed increased relative risk (RR) values for CD: B44 (RR = 2.43; B15 (Bw62, Bw63) (RR = 2.03); DR7 (RR = 1.85); DR4 (RR = 1.06). Three of 44 patients were DR4- and four DR7-homozygous. The risk haplotype B44/DR7 was observed in four and Bw62/DR4 in three CD patients, respectively. CD affected family members (female greater than male) shared HLA haplotypes more frequently than expected by mendelian laws. None of the differences reached statistical significance.

Adult↗

PubMed1990

HLA-antigen frequencies in patients with progressive systemic sclerosis and morphea.

A possible HLA disease association was investigated in 40 patients (38 female, 2 male) with progressive systemic sclerosis (PSS) and 42 patients (32 female, 10 male) with morphea. The HLA A, B, C, DR phenotypes of patients were compared with 193 healthy controls. The following relative risk (RR) values were determined in PSS: A1 (1.38), A2 (1.39), B8 (1.67), B15 (3.22), DRw8 (6.30) and in morphea patients: A3 (1.43), B7 (1.39), B40 (1.81), Bw60 (2.49), DR2 (2.38) and DRw8 (2.55), indication a relatively weak, HLA-linked genetic predisposition for the manifestation of the disease. The HLA "risk" antigens for the two clinically different subtypes of the disease are also different: raised A1/B8 frequencies, like in our PSS group, correlate with a high, pathological immune response (autoimmune disorders). In contrast, A3/B7/DR2 prevalence, like in our morphea group, correlates with a low immune response. HLA typing may contribute to clinical differential diagnosis and possibly also prognosis.

Adult↗

PubMed1990

[Hepatitis C antibodies in non-A, non-B hepatitis patients and members of HIV risk groups (pilot study)].

In a multi-center study sera from NANB-hepatitis (NANBH) patients and members of so-called HIV-risk groups (homosexuals, i.v.-drug abusers, hemophiliacs) were investigated by the recombinant-based HCV-antibody EIA, 74.4% of chronic NANBH-patients and 20% of acute NANBH patients were anti-HCV reactive, 33.3% of HIV-1-positive homosexuals, 43.5% of i.v.-drug abusers and 73.5% of hemophiliacs. The true prevalence of infection remains to be determined by a second, independent (confirmatory) test.

Antibodies, Viral↗

PubMed1990

[Evaluation of the immunomagnetic beads separation technique as a routine method for HLA typing].

We analyzed the HLA data of 1,427 patients and healthy blood donors from Hamburg and Hessen, to evaluate the reliability of the immunomagnetic beads method (IMB), compared to the standard NIH and the twocolor fluorescence (TCF) typing method. Concerning HLA class I, the IMB method and the NIH-method yielded almost identical results, whereas the determination of class II HLA-DR/DQ antigens required a higher rate of retyping (20%), compared the TCF method. Hence, the IMB method should not replace the standard typing procedures, particularly in organ-donor crossmatching, unless quality controls, e.g. of HLA-genotyped families have rendered unanimous results.

HLA Antigens↗

PubMed1990

[Cytomegalovirus diagnosis in blood donors and risk patients].

The transfusion transmitted CMV is a possibly dangerous complication of transfusion therapy in immunodeficient patients. We therefore investigated blood donors and patients at increased risk of CMV-infection for CMV-IgG-and-IgM-antibodies. The following CMV IgG and CMV IgM prevalence rates were observed: blood donors 63.7% (0.98%), organ donors 76.9% (0%), patients on hemodialysis 83.0% (17.0%) and drug abusers 57.7% (1.3%). We conclude from our results that CMV IgG testing is useful at every blood donation to provide a large pool of CMV negative blood donors.

Antibodies, Viral↗