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PubMed1989

Paroxysmal nocturnal hemoglobinuria and the transfusion of washed red cells. A myth revisited.

Paroxysmal nocturnal hemoglobinuria (PNH) is an uncommon, acquired clonal stem cell disorder primarily affecting red cells that have an abnormal sensitivity to complement lysis. Since 1948, the use of saline-washed red cells (WRBCs) has been advocated to minimize hemolysis after transfusion to patients with PNH. Thirty-eight years of experience (1950 through 1987) with patients who had PNH were reviewed. Twenty-three patients with a positive Ham's test had been transfused with 556 blood components, including 431 RBC products: 94 units of whole blood, 208 units of packed RBCs, 80 units of white cell-poor RBCs, 38 units of WRBCs, 5 units of frozen RBCs, and 6 units of intraoperatively salvaged RBCs. Only one documented episode of posttransfusion hemolysis related to the underlying diagnosis of PNH was found, and it was associated with the transfusion of a unit of type O whole blood to an AB-positive individual. This unit contained ABO-incompatible plasma; this case was similar to one in an earlier report from which originated the recommendation for using WRBCs. The posttransfusion increment in hemoglobin concentration in patients receiving ABO-identical packed RBCs was comparable to that in patients receiving frozen or washed RBCs. These findings indicate that the use of WRBCs is unnecessary and that patients with PNH should be transfused with group-specific blood and blood products.

ABO Blood-Group System↗

PubMed1993

Transmission of human T-lymphotrophic virus type I infection to a neonatal infant by transfusion of washed and irradiated red cells.

Human T-lymphotropic virus type I and/or II (HTLV-I/II) may be transmitted by the transfusion of blood and blood components. Several factors are critical to the efficiency of transmission. These include the number of contaminating white cells, the component volume, and the age of the component. After look-back notification, there was an investigation of the HTLV-I/II serostatus of three patients who had received blood from a donor now found to be positive for HTLV-I antibodies by enzyme immunoassay and Western blot. The donor red cell unit was group O negative and cytomegalovirus antibody negative; it was washed and irradiated at 2800 cGy and aliquoted into six small-volume transfusions for four neonatal infants. Three of the four patients were available for testing 3.5 years after their exposure. The fourth neonatal infant died on Day 11 of life. The three tested infants received 14, 14, and 44 mL of component, respectively. HTLV-I seroconversion was documented by enzyme immunoassay and Western blot (p19, p24) and occurred only in the patient receiving 44 mL. On the basis of quality control data, it is estimated that the affected infant received 8 x 10(7) white cells in the 44-mL aliquot. Washing and irradiation will not necessarily eliminate HTLV-I transmission.

Blood Component Transfusion↗

PubMed2000

The survival, function, and hemolysis of human RBCs stored at 4 degrees C in additive solution (AS-1, AS-3, or AS-5) for 42 days and then biochemically modified, frozen, thawed, washed, and stored at 4 degrees C in sodium chloride and glucose solution for 24 hours.

BACKGROUND: A study was done to assess the quality of RBCs stored at 4 degrees C in AS-1, AS-3, or AS-5 for 42 days before biochemical modification and freezing. STUDY DESIGN AND METHODS: RBCs were stored at 4 degrees C for 42 days in AS-1, AS-3, or AS-5 and then biochemically modified with pyruvate, inosine, phosphate, and adenine solution (Rejuvesol), frozen with 40-percent (wt/vol) glycerol, and stored at -80 degrees C for at least 2 months. The RBCs were deglycerolized by the use of a cell washer (Haemonetics 115), and stored for 24 hours at 4 degrees C in a 0.9-percent sodium chloride and 0.2-percent glucose solution before the autologous transfusion. RESULTS: The mean freeze-thaw-wash recovery process produced RBC recovery values of 85 percent, with the mean 24-hour posttransfusion survival at 75 percent, and the mean index of therapeutic effectiveness at 64 percent for the RBCs stored at 4 degrees C in AS-1, AS-3, or AS-5 for 42 days before biochemical modification and freezing. All the units exhibited normal or slightly higher than normal 2,3 DPG levels after deglycerolization and postwash storage at 4 degrees C for 24 hours. CONCLUSION: RBCs stored in AS-1, AS-3, or AS-5 at 4 degrees C for 42 days and then biochemically modified with pyruvate, inosine, phosphate, and adenine and glycerolized, frozen, washed, and stored at 4 degrees C for 24 hours before autologous transfusion had acceptable in vitro and in vivo measurements.

Adenine↗

PubMed2000

Transfusion of washed and centrifuged shed RBCs during maxillofacial surgery affects cytokine concentrations.

BACKGROUND: In patients undergoing elective maxillofacial surgery, hyperthermic reactions have been observed after the transfusion of autologous washed and centrifuged shed blood. It was the aim of this study to correlate the clinical features with changes in cytokine levels. STUDY DESIGN AND METHODS: In 24 consecutive patients, TNFalpha, IL-1, and IL-6 levels were determined in washed and centrifuged shed RBCs (CS RBCs) and in the patient's serum before, as well as 15 and 120 minutes after transfusion. At the same time, blood was drawn for culture. Patients in whom whole blood was saved through the use of acute normovolemic hemodilution served as a control group (n = 6). RESULTS: After the transfusion of CS RBCs, patients had not only elevated cytokine levels but also transient bacteremia involving the pathogens previously detected in CS RBCs. No rise in body temperature occurred. CONCLUSION: In the light of these results, the use of CS RBCs in patients undergoing maxillofacial surgery should be restricted to those patients with no primary bacterial contamination.

Adolescent↗

PubMed1992

Evaluation of four commercial automatic endoscope washing machines.

Four commercially available endoscope washing machines (Pyser System 83, Wolf Fiberscope Disinfector, Olympus EW20, Keymed Auto-Disinfector) were evaluated. In most cases the machines were expensive, immobile and noisy, and could only wash one endoscope per cycle. Daily use involved repetitive chores and contact with glutaraldehyde. Disinfection procedures were flawed; no machine auto-disinfected adequately. In conclusion, these machines are unsatisfactory and represent a potential source of serious infection.

Disinfection↗

PubMed1982

[Problems on early detection of the endometrial adenocarcinoma with a critical examination of jet-wash and curity-technique (author's transl)].

The difficulties to find an appropriate screening-technique for the recognition of endometrial adenocarcinoma are described. Some methods of the last ten years are mentioned, advantages and disadvantages are shortly debated. Our clinical study contains 100 patients, who were examined by the jet-wash or curity-method with following abrasion. Practicability, security and the agreement of both techniques with histological results are compared. The most serious objection against jet-wash is the abdominal spreading of cells along the tubes. Curity-screenings are yet carried on with good results.

Abdomen↗

PubMed1976

Immunoglobulin content in the bronchial washings of patients with benign and malignant pulmonary disease.

The bronchial washings of 58 patients with benign and neoplastic conditions involving the lungs were evaluated for immunoglobulin content. Levels in the washings from the diseased lung were compared with those from the normal contralateral lung. In normal patients and those with either bilateral inflammatory diseases or unilateral bronchiectasis or tuberculosis, the mean variation in igA/K and igG/K ratios between diseased and uninvolved lungs was minimal. In unilateral pneumonitis, however, igG/K was markedly elevated (P less than 0.01). Significant changes in the igA/K occurred on the affected side in patients with cancer. In the group with squamous-cell cancer. the mean elevation was 4.6 times that of contralateral lung (P less than 0.005), whereas with adenocarcinoma and undifferentiated carcinoma, the rise was 6.4 and 2.8 times, respecitvely (P less than 0.01 and P less than 0.01). Thus, carcinoma appears to alter local immunoglobulin production in the affected lung as compared to its normal counterpart. (N Engl J Med 295:694-698, 1976).

Adult↗

PubMed2001

Effectiveness of laundry washing agents and conditions in the removal of cat and dust mite allergen from bedding dust.

BACKGROUND: There is limited information about the removal of allergens by laundry washing. OBJECTIVE: The purpose of this investigation was to determine the dynamics of the removal of mite allergen (Der p 1) and cat allergen (Fel d 1) from bed dust during simulated laundry processes. METHODS: Three studies were performed. The first compared combinations of 4 laundry agents (water alone, soap, detergent with enzymes, and detergent without enzymes), 4 temperatures (15 degrees, 25 degrees, 45 degrees, and 60 degrees C), and 3 extraction times (5, 20, and 60 minutes). The second study examined allergen extraction by 11 common brands of detergents at 25 degrees and 45 degrees C for 5 minutes. The third study compared 4 detergents containing enzymes before and after the denaturation of their enzymes. To measure the quantity of allergens extracted, each study used an ELISA assay as well as a more sensitive but semiquantitative Halogen immunoassay to detect any allergens remaining after the simulated laundry extraction. RESULTS: Study 1 showed that detergents extracted more of both Fel d 1 and Der p 1 than either soap or water alone and that almost all allergens were extracted within 5 minutes at 25 degrees. However, washing at 60 degrees C extracted slightly more Fel d 1 and denatured Der p 1, resulting in lower residual amounts of both allergens. Study 2 showed that all of the commercial detergents performed similarly. Study 3 showed that the presence of enzymes in detergent formulations did not produce a significant effect on the extraction of allergens. CONCLUSION: Using detergent solutions at 25 degrees for at least 5 minutes was sufficient to extract most mite and cat allergen from dust of bedding.

Allergens↗

PubMed1999

Microfibril-associated protein 4 is present in lung washings and binds to the collagen region of lung surfactant protein D.

We have purified a glycoprotein from bovine lung washings using affinity chromatography on a maltose-affinity column. On SDS-polyacrylamide gel electrophoresis the protein showed a molecular mass of 36 kDa in the reduced state and 66 kDa in the unreduced state. On gel permeation chromatography the apparent molecular mass was 250 kDa. N-terminal sequencing showed homology to the human matrix protein microfibril-associated protein (hMFAP4), and the glycoprotein was designated bovine MFAP4 (bMFAP4). Lung surfactant protein D (SP-D) was also purified from lung washings, and calcium-dependent binding was demonstrated between bMFAP4 and SP-D. hMFAP4 was cloned, and recombinant hMFAP4 showed the same binding pattern to SP-D as bMFAP4. No binding was seen to recombinant SP-D composed of the neck region and carbohydrate recognition domain of SP-D, indicating that the interaction between MFAP4 and SP-D is mediated via the collagen region of SP-D. MFAP4 also showed calcium-dependent binding to mannan, which was partially inhibited by maltose. Our findings indicate that MFAP4 has two binding specificities, one for collagen and one for carbohydrate, and we suggest that MFAP4 may fix the collectins in the extracellular compartment during inflammation.

Amino Acid Sequence↗

PubMed2002

The real contamination of femoral head allografts washed with pulse lavage.

At the Tampere Bone Bank, all the discarded femoral heads from September 1997 to May 2000 were recultured. The grafts had been washed with pulse lavage at harvesting. 48 grafts had been discarded because of a positive culture and 85 with negative cultures because of positive or insufficient serological information. The femoral heads were split into halves, which were recultured as a whole in thioglycolate broth for 14 days. The contamination of previously culture positive and negative femoral heads did not differ. In only 2 cases did we find the same type of bacteria in the primary as in the new culture. Most of the primary contamination proved to be false positive. The real contamination seems to be very low, at least after pulse lavage washing of the femoral head.

Bacteria↗

PubMed2006

Treatment of recycled carrot washing water.

Large volumes of effluents and solid waste derive from industrial fresh packing and processing of carrots. Due to high organic loads and suspended solids and due to insufficient wastewater treatment, surface waters are polluted by effluents of carrot washing, as shown for one enterprise in Germany. Over a period of four months the water quality was studied at the stages of a treatment system consisting of a grit chamber, a settling tank combined with aeration devices and a constructed wetland. Organic pollutants were measured as COD and BOD5 in different fractions of the wastewater. The daily washing of carrots produces up to 300 m3 wastewater with a mean filterable solids content of 453 mg l(-1) and a mean COD concentration of 179 mg l(-1). On average the current efficiency of total COD reduction is 52%. Due to the fine grain size and the low density of suspended solids, settling is very slow and incomplete, primarily during the winter. As much as 29 mg COD l(-1) in the effluent derive from the fraction of particles which do not settle within 18 hours. The dissolved COD fraction accounts for 30 mg l(-1) and reflects the insufficient oxygenation of the wastewater. Strategies for enhancing the removal of organic compounds can be derived from the results of this study. Spatial separation of settling and aeration processes is recommended to optimise the treatment process. Furthermore, the area of the constructed wetland should be increased to maintain its hydraulic conductivity and to guarantee a high COD reduction.

Biodegradation, Environmental↗

PubMed1998

Impairment of the mucosal immune system: IgA and IgM cleavage detected in vaginal washings of a subgroup of patients with bacterial vaginosis.

The integrity of the immunoglobulins in vaginal washings of patients with bacterial vaginosis was examined to answer the question of the lack of immune response against Gardnerella vaginalis cytolysin. Clinically diagnosed patients (n=100) were recruited and their vaginal washings examined by Western blotting. Many showed IgA and IgM partially or extensively degraded. According to the degradation pattern, the patients were subdivided into 4 subsets, from intact (score 0) to completely degraded IgA (score +3). Statistical analysis of the data showed a correlation between IgA degradation and absence of immune response to G. vaginalis cytolysin. The extent of IgA degradation correlated also with the sialidase (but not with the prolidase) activity level. All women showed intact IgG and human serum albumin and no trypsin-like activity. Patients with bacterial vaginosis having high sialidase activity and extensive IgA degradation in their secretions could incur more dangerous infections and adverse pregnancy outcomes.

Adolescent↗

PubMed2005

Efficiency of hand drying for removing bacteria from washed hands: comparison of paper towel drying with warm air drying.

OBJECTIVE: To evaluate warm air and paper towel drying for removing bacteria from washed hands. METHODS: After hands were washed with non-antibacterial soap, they were dried using warm air with and without ultraviolet light, while being rubbed or held stationary, or paper towels. Each method was performed as a randomized trial using 30 hands. RESULTS: Log colony-forming units (CFU) on palms and fingers increased significantly when hands were dried with warm air while being rubbed for 15 seconds (P < .001), and many bacteria remained at 30 seconds without ultraviolet light (P < .001) Holding hands stationary while drying significantly decreased log CFU on palms, fingers, and fingertips (P < .01 or < .001). Few CFU were detected on palms and fingers dried with ultraviolet light. Although log CFU of palms and fingers did not decrease after drying with three sheets of paper towel, those of fingertips decreased significantly (P < .001). For palms and fingers, log reductions were greater with warm air drying while holding hands stationary, paper towels, and warm air drying while rubbing hands. For fingertips, the log reduction was often greater with paper towels than with warm air. CONCLUSIONS: Holding hands stationary and not rubbing them was desirable for removing bacteria. Ultraviolet light reinforced the removal of bacteria during warm air drying. Paper towels were useful for removing bacteria from fingertips but not palms and fingers.

Adult↗

PubMed2006

Randomized controlled trial of chlorhexidine gluconate for washing, intranasal mupirocin, and rifampin and doxycycline versus no treatment for the eradication of methicillin-resistant Staphylococcus aureus colonization.

BACKGROUND: Eradication of methicillin-resistant Staphylococcus aureus (MRSA) carriage may reduce the risk of MRSA infection and prevent transmission of the organism to other patients. METHODS: To determine the efficacy of decolonization therapy, patients colonized with MRSA were randomized (3:1 allocation) to receive treatment (2% chlorhexidine gluconate washes and 2% mupirocin ointment intranasally, with oral rifampin and doxycycline for 7 days), or no treatment. Follow-up samples for MRSA culture were obtained from the nares, perineum, skin lesions, and catheter exit sites monthly for up to 8 months. The primary outcome measure was detection of MRSA at 3 months of follow-up. Univariate and multivariable analyses were performed to identify variables associated with treatment failure. RESULTS: Of 146 patients enrolled in the study, 112 patients (87 treated; 25 not treated) were followed up for at least 3 months. At 3 months of follow-up, 64 (74%) of those treated had culture results negative for MRSA, compared with 8 (32%) of those not treated (P=.0001). This difference remained significant at 8 months of follow-up, at which time, 54% of those treated had culture results negative for MRSA (chi2=64.4; P<.0001, by log-rank test). The results of the multivariable analysis indicated that having a mupirocin-resistant isolate at baseline was associated with treatment failure (relative risk, 9.4; 95% confidence interval, 2.8-31.9; P=.0003), whereas decolonization therapy was protective (relative risk, 0.1; 95% confidence interval, 0.04-0.4; P=.0002). Mupirocin resistance emerged in only 5% of follow-up isolates. CONCLUSIONS: Treatment with topical mupirocin, chlorhexidine gluconate washes, oral rifampin, and doxycycline for 7 days was safe and effective in eradicating MRSA colonization in hospitalized patients for at least 3 months.

Administration, Intranasal↗

PubMed1998

An observational study of hand washing and infection control practices by healthcare workers.

During a 6-week period, a medical student conducted an observational study of hand washing and infection control practices in a community teaching hospital. There was no difference in the prevalence of handwashing practices among the three work shifts. The prevalence of hand washing was higher in surgical (56.4%) and medical intensive-care units (39.2%) than in intermediate (30.0%) or general units (22.8%).

Gloves, Protective↗

PubMed2001

Detection and quantification of HIV type 1 RNA in nasopharyngeal washes from HIV-infected subjects.

Human immunodeficiency virus type 1 (HIV) RNA load was measured in paired samples of peripheral blood plasma and nasopharyngeal (NP) washes from 97 Thai subjects infected with subtype E or B. HIV RNA was quantifiable in 93% of peripheral blood plasma samples tested and was inversely correlated (rho =-0.524; p < 0.001) with CD4 absolute count. HIV RNA was quantifiable in 29% of NP samples tested, and the median value was less than that of plasma viral load. HIV RNA load in NP samples was correlated (rho = 0.388; p < 0.001) with viral load in peripheral blood. HIV RNA was not detected in NP washes from subjects with undetectable plasma viral load. Virus isolation attempts on two NP samples were negative. The results do not support local HIV production in the nasopharynx, but extend current knowledge of HIV shedding to include the NP compartment.

CD4 Lymphocyte Count↗

PubMed2004

Washing hands before and after performing massages? Changes in bacterial survival count on skin of a massage therapist and a client during massage therapy.

OBJECTIVE: Massage therapy involves direct contact between the therapist and the client in a clinical setting, which can result in the transfer of bacteria. The purpose of this study was to determine the degree of bacteria transfer between a therapist and a client during a massage session and differences between types of lubricants used. DESIGN: Medium cultures were taken from the therapist's palms and the client's skin before, during, and after the massage session. Experiments proceeded with the following settings: use of three different types of lubricants, without the use of a lubricant, and without massage as control. After each massage session, the therapist washed his or her hands and a bacterial sample was again taken. MAIN OUTCOME MEASURES: Changes in bacteria count. RESULTS: (1) Bacteria count on the therapist's palms increased during and after massage with and without the use of lubricant. There was no change in the case of no massage. (2) Bacteria count on the client's skin decreased during and after massage with the use of three different kinds of lubricants compared to the no-massage control. However, an increase was evident when no lubricant was used. (3) After hand washing with water for 20 seconds after each massage session, there were still bacteria on the therapist's palms. However, bacteria count differed with the type of lubricant used. CONCLUSION: Bacteria from the client's skin transferred to the therapist's hands during massage therapy. Bacteria count when no lubricant was used was greater than massage sessions using lubricants.

Adult↗

PubMed1984

Radioisotopic studies concerning the efficacy of standard washing procedures for the cleansing of hair before zinc analysis.

Various standard procedures were investigated in relation to the removal of exogenously applied 65Zn from human hair and endogenously incorporated 65Zn from rat hair. Human hair was found to adsorb zinc and a variety of other metal ions from aqueous solutions in a manner which suggested some ion-exchange capacity. Uptake of zinc varied considerably between human hair samples, but in most cases accumulation of zinc occurred rapidly and often resulted in hair zinc levels several-fold higher than found in control samples. Extraction of zinc and other metal ions was greatest after treatment with disodium EDTA and sodium lauryl sulfate than after washing with water or aqueous Triton X-100. However, no procedure effectively removed all exogenous zinc, while all treatments extracted varying proportions of the endogenous zinc component. Because of the inability of standard washing procedures to remove exogenous zinc without reducing endogenous or indicator zinc levels, use of hair zinc analyses to indicate nutritional zinc status are inadvisable if hair zinc contamination is likely to have occurred.

Animals↗