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PubMed1982

Transfusion malaria: treatment with exchange transfusion after delayed diagnosis.

A 65-year-old woman was rehospitalized for increasing mental confusion 16 days after open heart surgery for mitral stenosis. A diagnosis of transfusion-acquired falciparum malaria was made from a routine peripheral blood smear 24 hours after admission. Because progressive encephalopathy developed while she was receiving antimalarial drugs, a therapeutic exchange transfusion was performed. Clinical improvement occurred promptly during the exchange, and the patient went on to complete recovery from her malaria. The putative blood donor involved met the currently accepted standards for blood donors.

Aged↗
PubMed1997

[Intrauterine transfusion in fetal alloimmunothrombocytopenia: comparison of maternal and fetal weight-adjusted IgG therapy with exclusive fetal thrombocyte transfusion].

Fetal alloimmune thrombocytopenia is caused by maternal immunization against a fetal platelet antigen and transplacental transfer of the antibody into the fetal circulation. Since 10-20% of the fetuses or newborns are threatened by intracranial hemorrhages, early management is required. Fetal blood sampling should be started between the 20th and 22nd week of gestation to assess fetal phenotype and platelet count. Different concepts to elevate the fetal platelet count have been discussed: maternal intravenous immunoglobulins, fetal intravenous immunoglobulins, or only repeated fetal platelet transfusions. Our investigations suggested that platelet transfusions in short intervals appear to be the only effective regimen to increase platelet counts in thrombocytopenic fetuses at risk.

Birth Weight↗
PubMed1991

Post-transfusion purpura as the main manifestation of a trilineal transfusion reaction, responsive to steroids: flow-cytometric investigation of granulocyte and platelet antibodies.

We report a typical case of post-transfusion purpura (PTP) due to anti-PlA1 in a 65-year-old woman. Serological studies were carried out using flow cytometry (FCM). The patient also developed red cell alloantibodies that produced a delayed hemolytic transfusion reaction (DHTR) and broad HLA antibodies. Treatment with high-dose intravenous IgG (HDIgG; a first-generation preparation) was ineffective, but a course of steroids resulted in a rapid increase in the the platelet count.

Aged↗
PubMed1975

Prevention of post-transfusion hepatitis. Role of sensitive hepatitis B antigen screening tests, source of blood and volume of transfusion.

Aliquots from units of blood were screened by radioimmunoassay (RIA) and reverse passive hemagglutination (RPHA) shortly after transfusion. Recipients of positive units, as well as control subjects, were followed prospectively for evidence of either post-transfusion hepatitis (PTH) or exposure to hepatitis B (HB). There was a significant correlation between receipt of either an RPHA-positive or RIA-confirmed positive unit and the subsequent development of PTH or HB exposure. Recipients of all volunteer units had a lower incidence of PTH than did recipients of all commercial units. The frequency of PTH and HB exposure was not statistically different in groups receiving 1 to 5, 6 to 10, 11 to 20 and greater or less than 21 units of blood. The PTH seen in the study presented over a wide clinical spectrum, but it was usually anicteric and frequently asymptomatic.

Adult↗
PubMed1990

Leukocyte immunophenotyping by flow cytometry in a multisite study: standardization, quality control, and normal values in the Transfusion Safety Study. The Transfusion Safety Study Group.

The Transfusion Safety Study (TSS) is a multicenter, cooperative investigation of factors that may determine the occurrence and modify the expression of transfusion-transmitted infections. A flow cytometry laboratory was established in each of the six participating centers in order to avoid alterations in cell phenotypes which may be caused by shipping delays, temperature changes, and handling. As a consequence, in order to assure compatibility of results, stringent standardization, quality control, and proficiency testing procedures were developed. This paper documents (i) the effect of time from phlebotomy to specimen staining and then to analysis for the antibodies used in the study; (ii) the effects of variations in light scatter cursor location for certain antibodies; (iii) a quality control program and data management and analysis system, each specifically designed for the study; and (iv) presents extensive data on age- and sex-related reference (normal) ranges for the several individual and paired monoclonal antibodies used in the study. Problems encountered, including obtaining reliable absolute lymphocyte counts, interference by nucleated erythrocytes, and sources of variability in results, are discussed. This study is meant to serve as a reference for future TSS publications.

Blood Transfusion↗
PubMed1997

The effect of the source of transfused blood on the rate of consumption of transfused red blood cells in pregnancies affected by red blood cell alloimmunization.

OBJECTIVE: Our purpose was to compare the rate of consumption of maternally donated red blood cells with the rate of red blood cells from volunteers in fetuses affected by red blood cell alloimmunization. STUDY DESIGN: The rate of hemoglobin decline was calculated in 293 fetal transfusions in 52 pregnancies, in 43 patients affected by red blood cell alloimmunization from 1987 to 1996. Fifty-eight transfusions were excluded from analysis. Hemoglobin decline was stratified by gestational age. The rates of consumption were compared with use of unpaired t tests. RESULTS: The rates of hemoglobin decline (in grams per deciliter per day) were 18 to 24 weeks, 0.47 volunteer and 0.38 maternal (p = 0.174); 25 to 28 weeks 0.41 volunteer, 0.34 maternal (p = 0.46); 29 to 32 weeks, 0.35 volunteer, 0.33 maternal; > or = 33 weeks, 0.37 volunteer, 0.25 maternal, p = 0.048). Hemoglobin decline was less for the maternal donation group than for the volunteer donation group throughout gestation, becoming significant only in fetuses at > or = 33 weeks. CONCLUSION: In the red blood cell-alloimmunized fetus, there is less consumption of maternal than of volunteer red blood cells. This difference reaches a statistical significance only in late gestation.

Blood Donors↗
PubMed1995

Centralized transfusion service: a novel approach to the delivery of transfusion services.

The development and expansion of the CTS in Pittsburgh shows the feasibility of this transfusion medicine delivery system. Few of the changes driven by health care reform both improve patient care and reduce costs. When properly implemented, a CTS achieves these objectives, benefits the community as a whole, and enhances the role of transfusion medicine specialists and the blood center in the region.

Blood Banks↗
PubMed2003

Transfusion-related acute lung injury (TRALI) following platelet transfusion in a patient receiving high-dose interleukin-2 for treatment of metastatic renal cell carcinoma.

Transfusion-related acute lung injury (TRALI) is an uncommon life-threatening complication of hemotherapy. It is hypothesized to be the result of two independent insults: the first related to the clinical status of the patient and the second to the infusion of biologic response modifiers within blood components. We present a case of TRALI in a patient who received high-dose Interleukin-2 (IL-2) as treatment for metastatic renal cell carcinoma, where IL-2 is speculated to have been the first insult and transfusion of platelet concentrate the second. This is the first reported case of TRALI complicating treatment with high-dose immunotherapy.

Blood Platelets↗
PubMed2004

[Autologous transfusion -- from euphoria to reason: clinical practice based on scientific knowledge (Part II). Autologous transfusion in children -- blood saving techniques].

It is uncontested that blood-saving strategies should also be applied in children. However, in the past, blood-saving techniques saw limited use in children, although they are well-established in adults. This is due to technical and methodical problems, but also to the physiologically limited compensatory mechanisms for diminished oxygen delivery in this age group. For this reason, the various blood saving-techniques cannot be universally applied to all age groups. During the first year of life most perioperative techniques are of only limited benefit: even only a small amount of blood loss in relation to total blood volume makes a transfusion of allogeneic blood necessary, which is far before enough shed blood can be recovered for retransfusion. Preoperative autologous donation of blood calls for a high degree of cooperation by the child and the parents an is equally demanding in terms of organization and skills. Therefore, this procedure is used mainly in school-age children and in adolescents. Intraoperative blood salvage, by contrast, is already worthwhile in children from age one year with an expected blood loss of 20 % of blood volume. Acute normovolemic hemodilution and deliberate hypotension should be recommended only in an age group where cardiovascular compensatory mechanisms are given. Supporting procedures aimed at avoiding the need for allogeneic blood include perioperative administration of erythropoietin, iron supplementation, blood-saving surgical techniques and careful hemostasis. These prerequisites, the combination of various techniques, as well as the definition of an age-specific low transfusion trigger have contributed to a marked decrease in the need for allogeneic blood products in children in recent years.

Adult↗
PubMed1997

Role of viral load in heterosexual transmission of human immunodeficiency virus type 1 by blood transfusion recipients. Transfusion Safety Study Group.

Eighteen transfusion recipients infected with human immunodeficiency virus type 1 (HIV-1) were followed prospectively with their 19 long-term sexual partners from 1986 to 1993 in California, Florida, and New York. Follow-up included clinical, behavioral, immunologic, serologic, and virologic evaluations. Two partners were already infected when seen 18 and 34 months after sexual contact began following the infectious transfusion. Four of 17 initially seronegative partners seroconverted during 23 person-years of observation. The recipient's clinical status, mononuclear cell subset variations, and time trend in CD4+ counts had no association with transmission. Individual plasma HIV-1 ribonucleic acid (RNA) loads were stable during observation, and sexual transmission was not attributable to an upward trend or transient burst in viremia. However, recipients who transmitted HIV-1 to their sexual partners had higher mean viral RNA levels than did nontransmitting recipients (4.3 vs. 3.6 log10 copies/ml; p = 0.05). Although this series was small, the prospective observations suggest that viral load was the only characteristic in the recipient that contributed to heterosexual infectiousness.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Induction of antiidiotypic antibodies by blood transfusions. Characterization of T cell alloantigen-specific receptors by sera from transfused mice.

Balb/c (H-2d) mice were transfused weekly with 0.1 ml of whole blood from C3H (H-2k) mice. One week after 3 blood transfusions (BT), the mice were bled and the sera collected and pooled. The 3BT serum was absorbed twice with C3H lymphocytes and IgG isolated by ion-exchange chromatography. Balb/c anti-C3H, Balb/c anti-Balb/c, and Balb/c anti-SJL (H-2s) lymphocytes were generated in the mixed lymphocyte cultures and metabolically labeled with 35S-methionine. Cell lysates were prepared from labeled lymphocytes and precleared by absorption with normal mouse serum. Immunoprecipitation was carried out by 3BT-IgG and NMS-IgG. 3BT-IgG specifically precipitated 7 molecules (30K, 60K, 72K, 86K, 92K, 97K, 145K) from Balb/c anti-C3H lymphocytes. In contrast, 3BT-IgG did not precipitate these molecules from Balb/c anti-Balb/c or from Balb/c anti-SJL lymphocytes. The data suggest that BT induces antibodies directed against the blood donor alloantigen-specific receptors on recipient's T lymphocytes.

Animals↗
PubMed2001

Transfusion of peripheral blood stem cells from donor homozygous for a shared HLA-haplotype: avoiding fatal transfusion-associated graft-versus-host disease while preserving anti-leukemic effect.

BACKGROUND: Fatal transfusion-associated graft-versus-host disease was observed in immunocompetent patients transfused with blood from donors homozygous for a shared haplotype with the recipient (the P-F1 barrier). We tested whether it was possible to carry out successful transplantation in a patient with relapsed acute myeloid leukemia, using peripheral blood stem cells from his HLA-homozygous brother (HLA A2, B46, DRB1 901) who shared a haplotype with the patient (HLA A2, B46,75, DRB1 901,12). METHODS: A CD34 positively selected cell fraction (5.46x 10(6) CD34 cells/kg) was infused first, followed by subsequent infusion of graded doses of donor T cells (total 7.25x10(7) T cells/kg). Nonmyeloablative chemotherapy with idarubicin and cytarabine was given during the transplantation to reduce the leukemic burden and facilitate engraftment. Polymerase chain reaction with the VNTR primers, D1S80, was used to detect engraftment. RESULTS: Complete remission (>300days) and successful donor engraftment (90%) were achieved. CONCLUSIONS: Peripheral blood stem cells transplantation from a donor with a homozygous shared haplotype is possible with a minimal preparative regimen.

Acute Disease↗
PubMed1987

Post-transfusion purpura secondary to passive transfer of anti-P1A1 by blood transfusion.

A patient developed severe post-transfusion purpura (PTP) following transfusion of two units of packed red blood cells. The timing of the patient's thrombocytopenia suggested passive immunization rather than the typical anamnestic response associated with classical PTP. Investigation of the blood donors revealed one with evidence of a platelet specific antibody of high titre. This donor was typed as P1A1 negative and the antibody was shown to have anti-P1A1 specificity.

Aged↗
PubMed1990

The M1 Kegworth aircraft disaster: experience in three hospital blood transfusion laboratories and the regional transfusion centre.

Eighty-eight survivors of an aircraft accident on the M1 motorway were taken to three major hospitals, two of which were teaching hospitals, in the immediate vicinity. We describe the effects of this on the three blood transfusion and haematology laboratories concerned and on the regional transfusion centre, describe how the work was processed, and list the lessons learnt.

Accidents, Aviation↗
PubMed2006

Repeat ABO-incompatible platelet transfusions leading to haemolytic transfusion reaction.

A 65-year-old woman, blood group A RhD positive, who had completed her first course of induction chemotherapy for acute myeloid leukaemia was transfused with apheresis platelets over a number of days. On three occasions she received group O RhD positive units, which had been screened and found not to contain high-titre anti-A,B isoagglutinins. Following the third unit, she developed a haemolytic transfusion reaction and died soon thereafter. This has led to change in policy of the supplying centre in testing for high-titre anti-A,B isoagglutinins. Blood group O apheresis platelets and fresh-frozen plasma units are now labelled as high titre with a cut-off of 1/50 as compared to the previous cut-off of 1/100 for anti-A,B isoagglutinins. A universal approach to testing donations for high-titre anti-A,B isoagglutinins, better compliance of guidelines and monitoring of patients is necessary.

ABO Blood-Group System↗
PubMed1984

An immediate hemolytic transfusion reaction due to anti-C and a delayed hemolytic transfusion reaction due to anti-Ce+e: hemoglobinemia, hemoglobinuria and transient impaired renal function.

A patient with phenotype R2r and anti-C has a hemolytic transfusion reaction (HTR) with hemoglobinemia and hemoglobinuria which occurred within 2 h of receiving an R1r transfusion. Transient impaired renal function ensued. A patient with phenotype R2R2 and anti-Ce+e had the same experience on day 4 after receiving three R1r and one rr units. 2 other patients, 1 R2r with anti-C who received one R1r unit and the other R2R2 with anti-Ce+e who received two R1r units, showed no clinical evidence of HTR. Both anti-C antibodies were entirely IgG while both anti-Ce+e antibodies initially were predominantly IgM. IgG subclassing was unsuccessful and red blood cell-mononuclear phagocyte assays were normal. These cases occurred from 1979 to 1981.

Aged↗
PubMed2005

Platelet alloimmunization after long-term red cell transfusion in transfusion-dependent thalassemia patients.

BACKGROUND: The platelet (PLT) alloimminization status after long-term red cell (RBC) transfusion in thalassemia patients was investigated, including antibodies against HLA antigens and PLT-specific glycoprotein antigens. STUDY DESIGN AND METHODS: Blood samples from a total of 60 thalassemia patients who routinely received washed RBCs were tested for the presence of HLA antibodies and PLT-specific glycoprotein antibodies with a commercial enzyme immunoassay kit. All patients were rescreened at a follow-up period of 12 to 15 months. RESULTS: At the first year of study, 19 (31%) patients had HLA antibodies, 13 (22%) had HLA antibodies and PLT-specific antibodies, and 1 (2%) had PLT-specific antibodies. One patient showed weak reactive PLT autoantibody. The follow-up study showed that 7 patients developed HLA antibodies, whereas 1 patient lost HLA antibody activity. Nine patients developed new PLT-specific antibodies, yet 12 patients lost at least one of their PLT-specific antibodies. CONCLUSION: Long-term RBC transfusions can induce PLT alloimmunization, both to HLA antigens and to PLT-specific antigens. The residual PLTs and white blood cells in RBC components could be the sources of immunization. In our thalassemia patients, HLA antibodies likely sustain longer than PLT-specific antibodies.

Adolescent↗