Survival and biochemical characteristics of stored red cells preserved with citrate-phosphate-dextrose-adenine-one and two and prepared from whole blood maintained at 20 to 24 degrees C for eight hours following phlebotomy

Studies were conducted to evaluate the characteristics of red cells stored for 35 days following preparation from units of whole blood anticoagulated with citrate-phosphate-dextrose-adenine-one and two (CPDA-1 and CPDA-2) and maintained at 20 to 24 degrees C for 8 hours after phlebotomy. The mean (+/- 1 SD) 24-hour survival for transfused CPDA-1 autologous red cells with hematocrit levels of 78.1 +/- 2.3 percent was 78.0 +/- 8.1 percent (n = 9). The 24-hour survival of red cells from units preserved with CPDA-2 with hematocrit levels of 79.3 +/- 4.5 percent was 74.8 +/- 8.6 percent (n = 15). This difference in survival was not significant. Red cells from control units stored for 1 day showed a 24-hour survival of 91.9 +/- 4.2 percent (n = 7). During the 8-hour holding, red cell adenosine triphosphate levels increased by 15 to 25 percent in units drawn into both CPDA-1 and CPDA-2. After the initial 8-hour period, the red cell 2,3 diphosphoglycerate levels were 54 +/- 12 percent (mean +/- 1 SD) of initial levels in units drawn into CPDA-1 and 58 +/- 8 percent of initial levels in units drawn into CPDA-2. Following 35 days of storage, units of red cells prepared from whole blood drawn into CPDA-1 and CPDA-2 had comparable plasma cation and ammonia levels and similar amounts of cell-free hemoglobin. These data indicate that red cells can be stored satisfactorily for 35 days when prepared from whole blood held at 20 to 24 degrees C for 8 hours.

Platelet preservation in large containers

The influence of the size of the container on platelet concentrate storage at 20-24 degrees C was examined. Baseline studies were obtained with 50 platelet concentrates in 300-ml PL-146 plastic containers. Experimental studies included 6 platelet concentrates each in 300-, 600- and 2,000-ml containers made of PL-146 plastic. Platelet count, total platelets, pO2, pCO2, pH, glucose consumption, lactate production, platelet morphology and recovery by platelets to osmotic stress were monitored during storage. During storage, the best pH and morphology values were observed with 2,000-ml containers. The lowest glucose consumption and lactate production were also associated with the 2,000-ml containers. Intermediate improvement in these parameters was noted in 600-ml containers. Recovery from osmotic stress was better in 2,000- and 600-ml containers as compared to 300-ml containers. In addition, characteristic changes in pO2 and pCO2 during storage suggest that improved platelet preservation in larger containers is due to improved gas exchange conditions obtained with increased surface area available for gas exchange.

DNA polymorphism of the C4 genes. A new marker for analysis of the major histocompatibility complex

Polymorphisms of the proteins encoded by genes that lie within the major histocompatibility complex (MHC) have served as useful markers for organ transplantation and in genetic analysis of a large number of MHC-linked diseases. To extend the range of MHC polymorphic markers, we used a complementary-DNA probe specific for the fourth component of human complement (C4) to identify a new variant within the MHC. Polymorphic variants at the DNA level were detected among subjects with identical phenotypes of the corresponding protein. C4 genomic polymorphisms are inherited with the segment of the short arm of chromosome 6 that carries the HLA-DR and complement loci. The autosomal codominant mode of inheritance of this genetic marker and its utility for evaluation of 21-hydroxylase-deficiency congenital adrenal hyperplasia, one of the many MHC-linked diseases, were established.

Somatic mutation and recombination test in Drosophila melanogaster

A novel test system for the detection of mutagenic and recombinogenic activity of chemicals is described in detail. Drosophila melanogaster larvae trans-heterozygous for the mutations multiple wing hairs (mwh) and flare (flr) are exposed to the test compounds for various periods of time ranging from 96 hr to 1 hr. Induced mutations are detected as single mosaic spots on the wing blade of surviving adults that show either the multiple wing hairs or flare phenotype. Induced recombination leads to mwh and flr twin spots and also to a certain extent, to mwh single spots. Recording of the frequency and the size of the different spots allows for a quantitative determination of the mutagenic and recombinogenic effects. This and earlier studies with a small set of well-known mutagens indicate that the test detects monofunctional and polyfunctional alkylating agents (ethyl methanesulfonate, diepoxybutane, mitomycin C, Trenimon), mutagens forming large adducts (aflatoxin B1), DNA breaking agents (bleomycin), intercalating agents (5-aminoacridine, ICR-170), spindle poisons (vinblastine), and antimetabolites (methotrexate). In addition, the test detects mutagens unstable in aqueous solution (beta-propiolactone), gaseous mutagens (1,2-dibromoethane), as well as promutagens needing various pathways of metabolic activation (aflatoxin B1, diethylnitrosamine, dimethylnitrosamine, mitomycin C, and procarbazine). The rapidity and ease of performance as well as the low costs of the test necessitate a high priority for validation of this promising Drosophila short-term test.

Four crossmatch methods to select platelet donors

We employed four crossmatch techniques to select platelet donors for refractory patients. Forty-four donor-recipient pairs were studied in 32 patients. Analysis of effectiveness of platelet transfusions revealed that only 18 percent of transfusions gave a borderline response; the remainder were either effective or not effective at all. The corrected predictive values of three crossmatch tests were as follows: enzyme-linked immuno-specific assay, 81 percent; platelet immunofluorescence test, 73 percent; and lymphocytotoxicity, 70 percent (p greater than 0.05). The predictive value of these tests did not differ in HLA-matched versus unmatched platelet transfusions. Donor selection by lymphocytotoxicity compatibility did not appear to be useful if donors were selected by either of the other two methods. The fourth test, antiglobulin-modified lymphocytotoxicity, offered no advantage over lymphocytotoxicity. Our data suggest that platelet crossmatching assays are a useful adjunct to the selection process for the platelet donor in addition to ABO, Rh, and HLA matching.

Treatment of thrombotic thrombocytopenic purpura. Evaluation of plasma exchange and review of the literature

This report examines the results of treatment in 21 patients with thrombotic thrombocytopenic purpura (TTP) diagnosed over a 4-year time period (1976-1980) with a review of the possible role of each form of therapy in relationship to the various proposed pathogenic mechanisms. There was a 76.2% (16/21) overall survival with no significant difference in initial hematologic values in patients not surviving. Patients not surviving did not achieve a sustained platelet count greater than 150,000/microliters at any time during their clinical course. 16 patients received steroids, antiplatelet agents and plasma exchange, with a total volume exchanged ranging from 20.8 to 1,455 ml/kg, as part of their treatment protocol. In this group of patients there was an 81.2% (13/16) survival, with 4 patients receiving additional therapy including splenectomy and/or vincristine. There was no correlation between the intensity of plasma exchange and the time to hematologic recovery. It is apparent that controlled clinical trials are necessary to better define the effectiveness of the present forms of therapy.

Isolation and characterization of resident macrophages from guinea pig and human intestine

The evaluation of mucosal cellular immune function in the gastrointestinal tract has focused on properties of lymphocytes. We describe methods for use in guinea pig and human tissue that will now permit the maintenance and in vitro study of intestinal macrophages. This study characterizes the resident gastrointestinal macrophage population in the two species and shows that morphologic and ultra-structural characteristics are similar to macrophages from other tissues. Histochemically, the cells are esterase positive and peroxidase negative. They possess surface receptors for immunoglobulin G and complement, and are phagocytic via the Fc receptor.

Intestinal malakoplakia in childhood: case report and review of literature

We report the clinical and pathologic features of primary intestinal malakoplakia in a 14-year-old boy. The transmural involvement of small bowel, chronicity of the disease, and development of fistulas simulated chronic inflammatory bowel disease, specifically Crohn's disease. The diagnosis of malakoplakia was only possible by tissue biopsy. The clinical and pathologic differential diagnosis is briefly reviewed.

Simulation analysis of platelet production and inventory management

To maximize the availability of platelet concentrates (PC) and minimize their outdate, competing criteria, a computer simulation model of platelet production and distribution was developed. Based on 2 years of actual platelet orders placed with a regional blood center, the simulation program generated daily platelet orders, and also calculated mean demand and standard deviation of demand for each day of the week. The number of PC to be produced on a given day was calculated from: PC to be produced = (mean demand for that day of the week) + Tx (standard deviation of demand for that day of the week)-(PC in inventory on the given day), where T is a selected multiple of the standard deviation. As T increases, availability is maximized, but outdating is expected to increase. Conversely, lower T is associated with less availability, but lower outdate. At the simulated platelet demand level (about 735 PC per week), with 3-day platelet storage life, 99% availability is associated with 1% outdate and distribution of PC of less than 1 day average age. 100% availability, with no outdate is predicted for a 5-day storage life, with no further improvement in logistics with 7-day storage life, at this level of demand. Although logistics of platelet production and distribution vary from center to center, the simulation analysis is generally applicable, and a formal plan has the great advantage of predictive, rather than reactive, platelet production.

Granulocyte yields using the Haemonetics 30. Effects of variations in corticosteroid regimen and donor selection

The factors of donor selection, corticosteroid drug choice, dose, timing and route of administration were studied to optimize granulocyte yield employing the Haemonetics Model 30 Blood Processor. Our data suggest that donors giving one excellent yield do not necessarily do so again. Donors with high initial granulocyte counts had only marginal increases in counts after taking corticosteroids. Selecting donors on the basis of high previous yield or granulocyte count is not a feasible strategy for improving granulocyte yields. Highest yields of granulocytes (16 X 10(9) total; 4 X 10(9)/liter processed) were obtained with any of four split-dose corticosteroid regimen. This increment is almost twice as large as the previously reported improvement using continuous-flow centrifugation. The choice of steroid, the route of administration and the timing of the split doses are not critical.

Analysis of two types of granulocyte transfusions in patients with acute leukemia and septicemia

In a study of 300 patient episodes where filtration granulocytes or centrifuged granulocytes were transfused to neutropenic patients with fever, 81 cases of culture proven septicemia in patients with acute leukemia were analyzed. Age, sex, organisms, interval between fever and transfusion, average number of transfusion, and antibiotics were similar in the two groups. Centrifuged granulocytes produced a statistically significantly better recovery rate when compared with filtration granulocytes.

Evaluation of individuals deferred from blood donation for medical reasons

Modern techniques of blood collection require health screening of donors by non-physicians using general guidelines. Health problems of concern to the donor and possible loss to future donation of actually individuals are inherent in this acceptance and deferral process. Of the 108,908 donors presenting at the bloodmobiles of regional blood center from September 1978 to February 1979, 9,542 were deferred. Of these, 1,203 with possible medical problems other than hepatitis, hypertension, or infectious disease were referred to their physician for further information concerning their suitability as donors. Over 80% had irregular pulses or histories suggestive of potential cardiovascular problems. The purpose of this study was to review the evaluation mechanism. Responses for evaluation were received from only 222 out of 1,203 (18%), and of these all but 29 (13%) were granted full permission to donate. Since only one evaluated individual with pulse or cardiovascular findings of possible significance was under the age of 35 years, this age is a reasonable cutoff for such deferrals. The minimum increase in collections with this change in deferral screening would be over 1,000 units per year in Connecticut, and perhaps 60,000 nationwide.

Mental health service priorities and the BSW

New Priorities in mental health service delivery call for the exploration of previously overlooked sources of mental health personnel whose preparation for practice is adapted to historically underserved populations and service delivery approaches geared to their special needs. One such source are baccalaureate level social workers. This exploratory study of 29 purposively selected baccalaureate social work education programs observes and describes their extensive mental health field instruction, in which the predominant student assignments include case management and related functions stressed in current mental health policy. Implications are drawn regarding the allocation of federal training funds and labor force issues.

Nature of platelet antibody in Evans syndrome: a case report

The association of autoimmune thrombocytopenia and autoimmune hemolytic anemia (Evans Syndrome) has been recognized previously. Recently the present authors investigated a patient with this disorder. Both IgG and C3d were found on the patient's red cells and the serum contained a polyspecific IgG red cell antibody demonstrable only by the antiglobulin test. IgG antiplatelet antibody was demonstrated on circulating platelets as well as in the serum from the patient by using 125I-staphylococcal Protein A (ISPA) assay. Absorption of serum with normal platelets resulted in removal of platelet antibody, but not the red cell antibody. Furthermore, eluate prepared from platelets sensitized with patient serum contained an IgG antibody directed specifically against platelets, since it did not cross react with red cells. Our data suggest the presence of two distinct antibodies, one directed against platelets and the other against red cells in our patient with Evans Syndrome. Both these antibodies are IgG in nature and belong to subclass other than IgG3 since staphylococcal Protein A (SPA) binds to all subclasses of human IgG except IgG3.

Occurrence of the release reaction during preparation and storage of platelet concentrates

To determine the degree of damage occurring during preparation and storage of platelet concentrates, the percent release of B-thromboglobulin (BTG) and percent leakage of the cytosolic protein lactic dehydrogenase was determined sequentially from phlebotomy to the end of storage for 72 h at 20-24 degrees C. The effect of storage temperature, pH, and radiation was also evaluated. The results showed that during preparation of platelet concentrate a large degree of release was found after resuspension of the platelet button formed after the high-speed centrifugation. During storage the percent BTG release increased from 18.1 to 40.2% (p less than 0.05). The percent release seen during storage at 4 degrees C (72 h) was 19.2%, while that seen for platelets subjected to temperature cycling at 4-37 degrees C was 24.9%. Both of these values were significantly less (p less than 0.05) than that seen for concentrates stored at room temperature. A negative correlation between pH and BTG release was found (r = -0.64). Irradiation to 10,000 rad did not induce the release reaction or lactic dehydrogenase leakage. We conclude that the degree of in vitro platelet release is dependent on the preparative manipulations, and gentler protocols for preparation and storage of platelets should be investigated.

Platelet collection and transfusion using the fenwal CS-3000 cell separator

A prototype model of the Fenwal CS-3000 Blood Cell Separator (Deerfield, IL) was studied for plateletpheresis in 63 donors and 5 transfusions in patients. Donor effects were consistent with platelet removal and mild hemodilution. The incidence of reactions (9 of 63) was low and all were mild "citrate" type. A two-hour collection yielded 4.0 +/- 0.72 x 10(11) platelets at an efficiency of 45 +/- 6.9 per cent. The product had little contamination with leukocytes (0.26 +/- 1.2 x 10(9) and red blood cells (hematocrit less than 1%). Morphology and pH were well preserved during 24 hours of storage. Four patients with uncomplicated aregenerative thrombocytopenia were transfused on five occasions, with a mean of 4.5 +/- 0.87 x 10(11) platelets resulting in a mean platelet count increment of 55,000/microliter and dramatic reduction in template bleeding times.

Clinical effectiveness of transfusion of granulocytes obtained by filtration or intermittent flow centrifugation

Clinical effectiveness of granulocyte transfusions collected by filtration or by intermittent flow centrifugation was compared in this study. In 251 patients receiving at least four daily transfusions of these products, there was no difference in response rate (67% in each group) as determined by defervescence. The most important factor in the recovery of patients appeared to be the underlying disease causing the agranulocytosis. Patients whose marrows were temporarily suppressed by chemotherapy showed the highest recovery rates (82% lymphoma and carcinoma), whereas those with intrinsic disease in the marrow showed the lowest recovery rates (47% aplastic anemia, 63% acute leukemia).

Horizontal nonparenteral spread of hepatitis B among children

Two families with an unusually high incidence of hepatitis B infection (15 of 21 persons) were investigated over an 18-month period. Serologic evidence of past or present infection--hepatitis B surface antigen (HBsAg), antibody to hepatitis B surface antigen (anti-HBs), or antibody to hepatitis B core antigen (anti-HBc)--was found in 11 of the 12 members of one family, four of whom were chronic HBsAg carriers, and in four of nine members of a contact family. Anti-HBc was the only serologic marker of infection in five persons. Histocompatibility leukocyte antigen (HLA) typing failed to show an association between carriage of HBsAg and specific HLA markers. Chewing gum was a potential vehicle as HBsAg was detected in gum samples from three of four children who were chronic HBsAg carriers. Horizontal, nonparenteral transmission of hepatitis B virus probably accounted for the clustering of infection in these families, especially via the exchange among children of objects contaminated with oral secretions.

Mutagenicity of municipal water obtained from an agricultural area

We have studied the mutagenicity of the water from Lake Bloomington and of the tap water that is made from the lake water. The lake, which is the source of drinking water for Bloomington, Illinois (pop. 44,000), is surrounded by land that is farmed intensively--being mainly in maize and soybeans. Samples were collected monthly from May through October 1979 and concentrated 3,000X with XAD-2 resin. Nearly all of the lake and tap water concentrates were mutagenic in Salmonella typhimurium TA98 and TA100 in the presence of S-9 mix, and the May tap water concentrate was highly mutagenic. In addition, many of the concentrates were toxic to the bacteria in the absence of S-9 mix. Chemical analysis of the highly mutagenic tap water concentrate from May revealed the presence of a number of organic contaminants that were absent from control concentrates prepared from deionized and distilled treated-well water. In addition, unconcentrated lake and tap water were tested in a reverse-mutation test in maize (Zea mays); no mutagenicity was detected. This study indicates that the contamination of drinking water with agricultural and/or industrial chemicals may result in a potential health hazard.