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McCullough J. History. Transfus Med 2021. [DOI: 10.1002/9781119599586.ch1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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2
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Koepsell S. Complications of Transfusion. Transfus Med 2021. [DOI: 10.1002/9781119599586.ch16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Laroche V, Blais‐Normandin I. Clinical Uses of Blood Components. Transfus Med 2021. [DOI: 10.1002/9781119599586.ch10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Heddle NM. From cytokines to pragmatic designs: changing paradigms. Transfusion 2017; 57:2298-2306. [PMID: 28871619 DOI: 10.1111/trf.14309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 07/25/2017] [Indexed: 11/29/2022]
Abstract
Emily Cooley was a well-respected medical technologist and morphologist with a remarkable skill set. She was highly regarded both professionally and personally. The "Emily Cooley Lectureship and Award" was established to honor her in particular and medical technologists in general. This article first reviews how a medical laboratory technologist was inspired to become a clinical researcher, then goes on to describe research that led to the discovery of cytokines as the cause of febrile nonhemolytic transfusion and the use of a pragmatic randomized controlled trial design to address evidence of harm when stored red blood cells were transfused. Important lessons for performing quality, meaningful research are highlighted.
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Affiliation(s)
- Nancy M Heddle
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Chen DP, Wen YH, Lu JJ, Tseng CP, Chen WL, Chang SW. Human platelet antigens are associated with febrile non-hemolytic transfusion reactions. Clin Chim Acta 2017; 474:120-123. [PMID: 28919492 DOI: 10.1016/j.cca.2017.09.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 09/09/2017] [Accepted: 09/13/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Febrile non-hemolytic transfusion reaction (FNHTR) is the most common type of transfusion reactions, and it could be reduced by transfusing patients with leukocyte-poor blood products. However, FNHTR still occur in certain patients transfused with leukocyte-poor red blood cell (LPR) products. It is examined whether human platelet antigen (HPA) could be a potential membrane antigen that plays a role in FNHTR. METHODS A total of 120 inpatient subjects who transfused with LPR (60 in FNHTR group, 60 in control group) were typed for HPA-2, HPA-3, and HPA-15 using sequence specific primer-polymerase chain reaction (SSP-PCR) and electrophoresis. RESULTS HPA-2 unmatched rate between donors and patients in FNHTR group was 18%, and only 3% unmatched rate was observed in control group (p=0.0082). FNHTR group was further classified according to the imputability. There was a significant difference (p=0.0041) between FNHTR (probable imputability, infection) group and control group, and more significant difference (p=0.0008) was seen between FNHTR (probable imputability, febrile neutropenia) group and control group. CONCLUSIONS Those results indicated that HPA-2 might play roles on inducing FNHTR in patients suffering from infectious diseases and febrile neutropenia. HPA-2 genotyping between donors and recipients might be worth integrating in pre-transfusion testing to increase transfusion safety.
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Affiliation(s)
- Ding-Ping Chen
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Medical Biotechnology and Laboratory Science, Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Biomedical Sciences, Chang Gung University, Taoyuan, Taiwan.
| | - Ying-Hao Wen
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Jang-Jih Lu
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Medical Biotechnology and Laboratory Science, Chang Gung University, Taoyuan, Taiwan
| | - Ching-Ping Tseng
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Medical Biotechnology and Laboratory Science, Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Biomedical Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Wan-Ling Chen
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Su-Wei Chang
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan; Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Clinical Uses of Blood Components. Transfus Med 2016. [DOI: 10.1002/9781119236504.ch11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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7
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Complications of Transfusion. Transfus Med 2016. [DOI: 10.1002/9781119236504.ch14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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8
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History. Transfus Med 2016. [DOI: 10.1002/9781119236504.ch1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Sonker A, Dubey A, Chaudhary R. Evaluation of a red cell leukofilter performance and effect of buffy coat removal on filtration efficiency and post filtration storage. Indian J Hematol Blood Transfus 2013; 30:321-7. [PMID: 25435736 DOI: 10.1007/s12288-013-0257-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 04/05/2013] [Indexed: 11/27/2022] Open
Abstract
Prestorage leukoreduction of red cells is effective in reducing the incidence of HLA alloimmunization and improving the quality of stored packed red blood cells (PRBC). This study was conducted to evaluate the effectiveness of Imugard III-RC 4P in removing the leukocyte from packed red cells and the storage effects thereafter. The effects of buffy coat removal on the efficiency of leukofiltration, storage parameters of leukofiltered packed red blood cells and feasibility of prestorage leukofiltration were also assessed. Sixteen units each of buffy coat-depleted (LP) and nondepleted (NLP) PRBC were taken. Every unit was divided into two equal halves, one leukofiltered and other, non-leukofiltered. Cell counts, volume, hematocrit and hemoglobin were measured before and after filtration. Levels of K(+), lactate dehydrogenase (LDH) and hemolysis were assessed in all the units weekly, post leukofiltration. Post leukofiltration, red cell and volume loss was within the specified limit in all the units. Residual leukocytes were significantly lesser in LP- PRBC compared to NLPPRBC. K(+), LDH and hemolysis were significantly elevated in NLP- PRBC. Leukofiltered PRBC showed lesser elevation of K(+), LDH and hemolysis towards the end of the storage period as compared to their unfiltered counterparts. Leukofilter is capable of performing ~4 log reduction. Buffy coat removal prior to filtration improves the efficiency of leukofilter and aids in improving the storage of red cells in terms of hemolysis.
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Affiliation(s)
- Atul Sonker
- Department of Transfusion Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, 226014 India
| | - Anju Dubey
- Department of Transfusion Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, 226014 India
| | - Rajendra Chaudhary
- Department of Transfusion Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, 226014 India
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10
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Complications of Transfusion. Transfus Med 2011. [DOI: 10.1002/9781444398748.ch14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Clinical Uses of Blood Components. Transfus Med 2011. [DOI: 10.1002/9781444398748.ch11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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12
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History. Transfus Med 2011. [DOI: 10.1002/9781444398748.ch1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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McCullough J. Innovation in transfusion medicine and blood banking: documenting the record in 50 years of TRANSFUSION. Transfusion 2010; 50:2542-6. [PMID: 20667041 DOI: 10.1111/j.1537-2995.2010.02787.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Jeffrey McCullough
- Department of Laboratory Medicine & Pathology, University of Minnesota, Minneapolis, Minnesota 55455, USA.
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Alter HJ, Klein HG. The hazards of blood transfusion in historical perspective. Blood 2008; 112:2617-26. [PMID: 18809775 PMCID: PMC2962447 DOI: 10.1182/blood-2008-07-077370] [Citation(s) in RCA: 225] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2008] [Accepted: 07/10/2008] [Indexed: 12/21/2022] Open
Abstract
The beginning of the modern era of blood transfusion coincided with World War II and the resultant need for massive blood replacement. Soon thereafter, the hazards of transfusion, particularly hepatitis and hemolytic transfusion reactions, became increasingly evident. The past half century has seen the near eradication of transfusion-associated hepatitis as well as the emergence of multiple new pathogens, most notably HIV. Specific donor screening assays and other interventions have minimized, but not eliminated, infectious disease transmission. Other transfusion hazards persist, including human error resulting in the inadvertent transfusion of incompatible blood, acute and delayed transfusion reactions, transfusion-related acute lung injury (TRALI), transfusion-associated graft-versus-host disease (TA-GVHD), and transfusion-induced immunomodulation. These infectious and noninfectious hazards are reviewed briefly in the context of their historical evolution.
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Affiliation(s)
- Harvey J Alter
- Department of Transfusion Medicine, National Institutes of Health, Bethesda, MD, USA.
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15
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Minchinton RM, Waters AH. THE OCCURRENCE AND SIGNIFICANCE OF NEUTROPHIL ANTIBODIES. Br J Haematol 2008. [DOI: 10.1111/j.1365-2141.1983.00657.x-i1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Treleaven JG, McGregor M, Blagdon J. An evaluation of some of the methods currently available for the production of leucocyte-poor blood. CLINICAL AND LABORATORY HAEMATOLOGY 2008; 6:45-9. [PMID: 6734099 DOI: 10.1111/j.1365-2257.1984.tb00525.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Four methods used for the production of leucocyte-poor blood were compared: liquid nitrogen recovery and washing, washing alone, the Imugard filter and the Leuko-Pak filter. Twenty units of blood were tested by each technique. Liquid nitrogen recovery and washing, and the Imugard filter removed over 95% of white cells, and 95% and 56% respectively of platelets. Washing alone was unreliable and removed on average 47% of white cells and 85% of platelets. The Leuko-Pak filter removed on average 42% of white cells and 79% of platelets.
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Kumar H, Gupta PK, Mishra DK, Sarkar RS, Jaiprakash M. Leucodepletion and Blood Products. Med J Armed Forces India 2006; 62:174-7. [PMID: 27407886 PMCID: PMC4921955 DOI: 10.1016/s0377-1237(06)80064-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2004] [Accepted: 09/26/2005] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Leucoreduction of blood products is increasingly being employed to produce blood products with residual WBCs < 5 × 10(6) per unit (99.9 percent or a log 3 leucoreduction). Clinical data suggests that non-haemolytic febrile transfusion reactions can be prevented by leucodepletion. The procedure also prevents alloimmunisation to HLA antigens in patients who will repeatedly require transfusion of blood/blood products. METHOD Of the methods available to reduce the number of WBC in blood products washing of red cells, freezing and deglycerolisation are effective and yield a product with only a 24 hour shelf life. Other methods such as leucodepletion filters are relatively inexpensive, simple and the final product has a normal shelf life. Modern generation of leucoreduction filters and apheresis machines can provide greater than 4 log reduction of WBC. RESULTS After the introduction of leucodepletion of blood for Thalassemics at our center in 2003, the incidence of non haemolytic febrile transfusion reactions (NHFTR) fell from 4% in 2002 to 1% in 2003. CONCLUSION In patients undergoing long-term blood transfusion therapy e.g. Thalassemics, alloimmunisation against the HLA antigens on donor white cells is prevented by leucodepletion and prevents NHFTRs.
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Affiliation(s)
- Harsh Kumar
- Prof and Head, Dept of Transfusion Medicine, AFMC, Pune
| | - P K Gupta
- Assoc Prof, Dept of Transfusion Medicine, AFMC, Pune
| | - D K Mishra
- Classified Specialist (Pathology and Haematology), AH (R&R), Delhi Cantt
| | - R S Sarkar
- Classified Specialist(Pathology), MH Roorkee
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Ortolano GA, Russell RL, Angelbeck JA, Schaffer J, Wenz B. Contamination control in nursing with filtration: part 2: emerging rationale for bedside (final) filtration of prestorage leukocyte-reduced blood products. JOURNAL OF INFUSION NURSING 2004; 27:157-65. [PMID: 15118453 DOI: 10.1097/00129804-200405000-00004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The first part of this 2-part series focused on the manufacture of filters and the application of filtration technology to intravenous fluids and point-of-care hospital water. This second part describes an apparent emerging potential for final filtration defined as bedside filtration of blood and component blood products leukocyte-reduced at the blood center prior to storage. Final filtration serves to further reduce the leukocyte burden in a previously leukocyte-reduced blood product. Another target for final filtration includes putative soluble mediators of morbidity.Selected patients may be at greater risk for alloimmunization and refractory to the benefits afforded by transfusion of blood leukocyte reduced to the current established standards. Multiparous patients who subsequently find themselves in need of a transplanted organ are alloimmunized by exposure to fetal proteins and may be further alloimmunized by transfusion. Such effects can put them at risk for increased latency for donor organ availability and organ rejection. Kidney transplant patients find themselves the recipients of transfused blood products particularly during end-stage renal disease and recent data suggest such patients are not benefited by the levels of leukoreduction prescribed by current standards and may need more dramatic leukocyte removal. The process of blood production is described and affords a greater appreciation for the levels of white cells found in component blood products. The development of alloimmunization is reviewed and fosters greater appreciation for a discussion of the potential for therapeutic value of more dramatic leukocyte reduction and blood conditioning accomplished through the removal of soluble mediators of morbidity.
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Hyllner M. Prestorage leucocyte filtration of blood: effects on cytokine generation and complement activation. ACTA ACUST UNITED AC 2004. [DOI: 10.1016/j.cacc.2004.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pruss A, Kalus U, Radtke H, Koscielny J, Baumann-Baretti B, Balzer D, Dörner T, Salama A, Kiesewetter H. Universal leukodepletion of blood components results in a significant reduction of febrile non-hemolytic but not allergic transfusion reactions. Transfus Apher Sci 2004; 30:41-6. [PMID: 14746820 DOI: 10.1016/j.transci.2003.08.013] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Universal leukodepletion of blood components to prevent acute non-hemolytic transfusion reactions (NHTRs) is still a subject of debate. PATIENTS AND METHODS Transfusion-associated NHTRs observed at our hospital in the last 6 years were retrospectively analyzed. Buffy-coat depleted red blood cells (bc-RBCs), and if indicated, leucodepleted post-storage (ld-RBCs) were initially used. In April 1997, universal leukodepletion was implemented at our hospital, and thereafter only prestorage ld-RBCs were used. All platelet concentrates transfused during this time were prestorage filtered single-donor apheresis platelets (SDAPs). RESULTS A total of 163,090 blood products were transfused from April 1995 to April 2001 (bc-RBC: n=34,040 units; ld-RBC: n=66,967; SDAP: n=14,516; FFP: n=47,567). The number of post-transfusion febrile NHTRs occurring with each blood product was 65 (0.19%) for bc-RBCs, 8 (0.16%) for post-storage ld-RBCs, 16 (0.03%) for prestorage ld-RBCs, 16 (0.11%) for SDAPs, and 10 (0.02%) for FFP. Allergic reactions (n=116) were most frequently observed after SDAP transfusion (0.32%) and occurred at a similarly low rate after transfusion of all other blood components (0.03-0.08%). CONCLUSION In conclusion, acute NHTRs rarely occur after the use of leukodepleted blood components. Prestorage appears to be more effective than post-storage leukodepletion in preventing febrile reactions following a blood transfusion.
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Affiliation(s)
- Axel Pruss
- Institute for Transfusion Medicine (Tissue Bank), University Hospital Charité, Campus Charité Mitte, Schumannstrasse 20/21, D-10117 Berlin, Germany.
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Kiefel V. Nichtinfektiöse unerwünschte Wirkungen. TRANSFUSIONSMEDIZIN 2004. [DOI: 10.1007/978-3-662-10597-9_35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
The use of various types of filters in anaesthesia and intensive care seems ubiquitous, yet authentication of the practice is scarce and controversies abound. This review examines evidence for the practice of using filters with blood and blood product transfusion (standard blood filter, microfilter, leucocyte depletion filter), infusion of fluids, breathing systems, epidural catheters, and at less common sites such as with Entonox inhalation in non-intubated patients, forced air convection warmers, and air-conditioning systems. For most filters, the literature failed to support routine usage, despite this seemingly being popular and innocuous. The controversies, as well as guidelines if available, for each type of filter, are discussed. The review aims to rationalize the place of various filters in the anaesthesia and intensive care environment.
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Affiliation(s)
- A Tyagi
- Department of Anaesthesiology and Intensive Care, University College of Medical Sciences, GTB Hospital, New Delhi, India
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Wortham ST, Ortolano GA, Wenz B. A brief history of blood filtration: clot screens, microaggregate removal, and leukocyte reduction. Transfus Med Rev 2003; 17:216-22. [PMID: 12881782 DOI: 10.1016/s0887-7963(03)00023-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A historical perspective of the evolution of blood filtration is presented. Topics addressed include recognition of aggregates in blood as mediators of morbidity, targeted for removal with gross clot screens, and evolution through the implementation of universal leukocyte reduction. Future directions for the development of blood filters are also described.
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Abstract
BACKGROUND Routine leukocyte-depletion (LD) of cellular blood products, and even plasma, is currently being implemented in most European countries, as a result of the fear that the variant Creutzfeldt-Jakob-disease (vCJD) might be transmissible by transfusion. However, not only is the scientific evidence supporting such a notion scarce, but the benefits of applying this procedure to all patients also remain unfounded. METHODS A MEDLINE-research for studies dealing with the indications for LD was performed. In addition, the guidelines and recommendations of national and international health authorities were scrutinized. RESULTS To date,the only proven benefit of LD that can be applied to all patients is the reduction of non-hemolytic febrile transfusion reactions. In addition, LD reduces HLA-immunization and platelet refractoriness in multi-transfused patients. In immunocompromized patients, LD reduces transfusion-transmitted CMV-disease. Furthermore, a minority of 5-10% of transfusion-related-acute-lung-injury cases can be prevented by LD. However, the potential of reducing the immunomodulating effects of transfusion such as postoperative infection, cancer-recurrence-related or overall mortality and of reducing septicemia due to bacterial contamination is still at issue. AIDS patients do not benefit from LD, at least. The suitability of LD for preventing the transmission of vCJD is at best hypothetical. Potential risks of LD like increased leakages have not been taken into account adequately to date. CONCLUSIONS At present, the scientific evidence does not justify the introduction of LD as a routine measure. In times of limited health care resources, this costly procedure might limit access to medical services with proven effectiveness and efficiency. In addition, the loss of 5-10% of the red cell pool is predicted to lead to more blood supply shortages than previously seen.
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Affiliation(s)
- Ralf Karger
- Institut für Transfusionsmedizin und Hämostaseologie, Klinikum der Philipps Universität Marburg, Germany
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Couban S, Carruthers J, Andreou P, Klama LN, Barr R, Kelton JG, Heddle NM. Platelet transfusions in children: results of a randomized, prospective, crossover trial of plasma removal and a prospective audit of WBC reduction. Transfusion 2002; 42:753-8. [PMID: 12147029 DOI: 10.1046/j.1537-2995.2002.00070.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Febrile nonhemolytic transfusion reactions (FNHTRs) complicate 2 to 37 percent of platelet transfusions in adults, but the incidence of such reactions in children is not known. The effectiveness of plasma reduction after storage and WBC reduction of platelet concentrates before storage was studied in pediatric recipients of platelet transfusions. STUDY DESIGN AND METHODS In the first study, a prospective randomized crossover design was used in which patients received either unmodified whole-blood-derived or apheresis platelets or platelets from which most of the plasma supernatant had been removed just before transfusion. The second study was a prospective audit of recipients of prestorage WBC-reduced platelets. Children between 3 months and 17 years of age were eligible for both studies. Patients were assessed for signs and symptoms that are characteristic of a reaction during, immediately after, and 2 hours following transfusion. RESULTS There were 226 platelet transfusions administered to 66 children. One hundred and sixty transfusions were given to 35 children enrolled in the randomized study, and 66 transfusions were given to 33 children during the audit. In the randomized study, nine of the 75 transfusions of unmodified platelets (12%) and six of 85 transfusions of poststorage plasma-removed platelets (7%) were associated with an FNHTR (p=0.42). In the audit, three of 66 transfusions of prestorage WBC-reduced platelets (5%) were associated with an FNHTR. Allergic reactions occurred with 5 percent (4 of 75), 6 percent (5 of 85), and 6 percent (4 of 66) of platelet transfusions, respectively. CONCLUSION FNHTRs appear to be less common among pediatric recipients of platelet transfusions than in adults. In our two studies, there was a trend toward a lower frequency of FNHTRs with poststorage plasma removal and prestorage WBC reduction than with standard platelets, but this was not significant.
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Affiliation(s)
- Stephen Couban
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
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Lin JS, Tzeng CH, Hao TC, Hu HY, Ho YT, Lyou JY, Liu JM, Ho CH, Yung CH. Cytokine release in febrile non-haemolytic red cell transfusion reactions. Vox Sang 2002; 82:156-60. [PMID: 11952991 DOI: 10.1046/j.1423-0410.2002.00159.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVES The aim of this study was to elucidate the role and identity of cytokines involved in febrile non-haemolytic red cell transfusion reactions (FNHTRs). MATERIALS AND METHODS Eighty-one patients experiencing transfusion reactions after receiving packed red blood cells (RBCs) were divided into three groups, as follows, based on the reaction experienced: FNHTRs (n = 60); chills without fever (n = 8); and allergic reaction with urticaria (n = 13). The concentrations of interleukin (IL)-1beta, IL-6, IL-8 and tumour necrosis factor (TNF)-alpha were measured in the packed transfused unit and patients' plasma by using enzyme immunoassays. Wilcoxon's matched-pairs signed test was used to compare the difference in cytokine levels in patients' plasma before and after transfusion. The Kruskal-Wallis test was used first, followed by the Mann-Whitney test, to compare the pretransfusion cytokine levels in patients' plasma between groups and to compare the cytokine levels in packed RBCs transfused to each group of patients. RESULTS The age of the implicated packed RBC was 11.5 +/- 5.7 days. Significant increases were observed in IL-6 (P < 0.001) and IL-8 (P < 0.001) patients' plasma levels, but not in IL-1beta or TNF-alpha levels, in those patients exhibiting FNHTR. No changes were observed in the patients' plasma samples of the other groups. Cytokine levels in the RBC concentrate supernatants were not appreciably elevated. CONCLUSIONS Transfusion of packed RBCs may significantly increase intravascular levels of IL-6 and IL-8 in patients with FNHTRs.
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Affiliation(s)
- J-S Lin
- Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taiwan, Republic of China.
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Wadhwa M, Seghatchian MJ, Dilger P, Sands D, Krailadisiri P, Contreras M, Thorpe R. Cytokines in WBC-reduced apheresis PCs during storage: a comparison of two WBC-reduction methods. Transfusion 2000; 40:1118-26. [PMID: 10988316 DOI: 10.1046/j.1537-2995.2000.40091118.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Several studies have suggested that cytokine accumulation during storage of platelet concentrates (PCs) may mediate nonhemolytic febrile transfusion reactions and that a reduction in WBC numbers prevents the generation of cytokines. Despite efforts to minimize WBC contamination in apheresis PCs, high numbers of WBCs and increased cytokine levels may still occur, depending on the quality of the apheresis device employed. STUDY DESIGN AND METHODS This study was undertaken to investigate whether PCs collected with WBC-reduction devices (Spectra LRS, COBE;or MCS+ LDP, Haemonetics) were sufficiently depleted of WBCs to limit cytokine accumulation during storage. The study evaluated 1) the levels of cytokines of WBC and platelet origin in two types of apheresis PCs during storage and 2) the effects of prestorage filtration on cytokine levels in the Spectra LRS PCs. RESULTS In the Spectra LRS PCs, low levels of IL-6, IL-8, and monotype chemoattractant protein 1 (MCP-1) were detected in Day 1 PCs, and they remained consistent during the shelf life. RANTES, platelet factor 4 (PF4), beta-thromboglobulin (beta-TG), and transforming growth factor (TGF)-beta1 were also detected in these PCs, and their levels increased significantly on storage. Prestorage filtration of Spectra LRS PCs did not further reduce the levels of IL-6, IL-8, MCP-1, PF4, beta-TG, and TGF-beta1 in the filtered component. In the MCS+ LDP PCs, IL-6 was detected on Day 1, and its level increased significantly on storage, whereas the levels in the Spectra PCs remained steady. IL-8 levels were lower in MCS+ LDP PCs than in Spectra LRS PCs of the same age. MCP-1 levels were similar in both products on Day 1 and marginally increased in stored MCS+ LDP PCs. Substantial amounts of RANTES, PF4, beta-TG, and TGF-beta1 occurred in Day 1 MCS+ LDP PCs, and, on storage, these levels rose significantly. CONCLUSION Despite a significant reduction in levels of WBC-derived cytokines, platelet-derived cytokines were present in different amounts in the two products.
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Affiliation(s)
- M Wadhwa
- Divisions of Immunobiology and Informatics, National Institute for Biological Standards and Control, Potters Bar, United Kingdom.
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28
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Abstract
For the past 30 years, platelet transfusions have been used in the treatment of thrombocytopenia caused by decreased production, inadequate function, or increased destruction of platelets. The number of platelet transfusions has increased more than transfusions of other blood components, shifting from whole blood use for the platelet source to plateletpheresis. Hematology/oncology patients are among the largest group receiving platelet transfusions, primarily because the more aggressive chemotherapies produce more acute and prolonged thrombocytopenia. While platelet transfusions often rescue patients with very low platelet levels, they are associated with the risk of viral and bacterial infections, as well as alloimmunization. Platelet donor recruitment can also be difficult, and platelet transfusion can be very expensive depending on the source of platelets. As a result, prophylactic transfusions are less likely to be administered at higher platelet counts, reducing platelet use and cost of platelet transfusions. However, cancer patients receiving intensive chemotherapy or myeloablative regimens require multiple platelet transfusions. For these patients, alternate strategies are needed so that platelet transfusions can be significantly reduced or eliminated.
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Affiliation(s)
- J McCullough
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis 55455-0374, USA
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29
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Waller C, Vicariot M, Gunzberger H. [Analysis of transfusion incident reports filed at 15 blood transfusion centers and health facilities during 17 months. Groupe Receveurs de laSFTS]. Transfus Clin Biol 1997; 4:541-8. [PMID: 9527419 DOI: 10.1016/s1246-7820(97)80079-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The principal result of the development of hemovigilance since 1994 has been the declaration of undesirable effects likely to be due to transfusions of labile blood products. Using the 1,694 cases of undesirable effects registered, it seemed worthwhile to us to analyze the distribution of the signs noticed, their frequency and the types of blood products responsible. This analysis allowed us to observe that the majority of reactions were shivery-feverish (47%) or allergic (24%). Most of them are linked to platelet concentrate transfusions especially simple donor platelets (with a frequency of ten reactions for thousand apheresis platelet concentrates transfused). In this study the frequency of undesirable effects reported is 2 per 1,000 apheresis platelet concentrate transfusions. Further investigations are necessary to determine the physiological mechanisms of these reactions and to estimate the degree to which transfusions are responsible for their occurrence.
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Affiliation(s)
- C Waller
- Etablissement de Transfusion Sanguine de Strasbourg, Strasbourg
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30
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Ahmed F, Elhag K. Bacterial contamination of platelet concentrate units: a study on 200 units. Qatar Med J 1997. [DOI: 10.5339/qmj.1997.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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31
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Wadhwa M, Seghatchian J, Thorpe R. Are cytokines in platelet concentrates responsible for febrile transfusion reactions? TRANSFUSION SCIENCE 1997; 18:367-71. [PMID: 10175148 DOI: 10.1016/s0955-3886(97)00033-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
In recent years, several studies have identified the leukocyte content and the age of the blood components as dominant factors in febrile transfusion reactions (FTRs). At present, extensive efforts are being made to reduce adverse effects by implementation and/or introduction of new methods for leuko-depletion of blood components and by studying the mechanisms responsible for these phenomena. A recent approach has been the evaluation of cytokines in platelet concentrates and this issue has been addressed with some detail in this review. Comparative data currently available on levels of cytokines in the different platelet concentrates is provided along with the functional role of the detected cytokines in including adverse reactions.
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Affiliation(s)
- M Wadhwa
- Division of Immunobiology, National Institute for Biological Standards and Control, Potters Bar, Herts., U.K
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32
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33
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Abstract
Intensification of therapeutic regimens, improved patient survival, and advances in cytokine and cellular therapies have led to increasingly complex requirements for transfusion and stem cell support in cancer treatment. This article focuses on current and evolving issues in red blood cell, platelet, and granulocyte transfusion support, as well as measures to avoid increasingly important complications of transfusion therapy, such as alloimmunization, graft-versus-host disease, cytomegalovirus infection, and immunomodulation. Issues concerning current applications of hematopoietic stem cell transplantation and future prospects also are discussed.
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Affiliation(s)
- D L Wuest
- Hematology Service, Memorial Sloan-Kettering Cancer Center, New York, USA
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34
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Abstract
Recent advance in the understanding of the mechanism of hemolytic transfusion reactions results from the investigation of cytokine generation in in vitro models of incompatible red blood cell transfusion. Cytokines with pyrogenic and pro-inflammatory activities as well as cytokines with activating properties for granulocytes, monocytes and endothelial cells are produced in both 'intravascular' and 'extravascular' types of hemolytic reactions. It has also been demonstrated that cytokines are generated and accumulated in blood components such as platelet concentrates, during storage. A large part of febrile transfusion reactions results from transfusion of stored platelet concentrates containing high cytokine levels and not from antigen-antibody reactions. Prestorage removal of white blood cells, which generate cytokines during storage, from platelet concentrates reduces strongly the reaction incidence and should be standard practice.
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Affiliation(s)
- L Muylle
- Blood Transfusion Center Antwerpen, Belgian Red Cross, Edegem
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35
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36
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Drew MJ, Hodges J. Research and development in the blood bank: efforts of a hospital donor center to improve efficiency of in-line leukocyte reduction filters for automated plateletpheresis. J Clin Apher 1995; 10:76-80. [PMID: 7592520 DOI: 10.1002/jca.2920100204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
In-line leukocyte reduction filters (LRF) are available for use with an automated plateletpheresis (PPH) system. Initially, 62% of PPH units produced with such a filter (LRF6, N = 29) had postfiltration (POF) white blood cell (WBC) counts < 5 x 10(6), with a mean POF WBC of 42 x 10(6). In an attempt to decrease POF WBCs, PPH were rested 30 to 60 minutes before filtration with LRF6. A new, larger-volume LRF (LRF10) was also assessed for its efficiency of leukodepletion. A total of 625 PPH, 490 filtered with LRF6 and 135 with LRF10, were evaluated using prefiltration (PRF) and POF samples. Mean prefiltration WBC loads averaged 80 x 10(6) (range, 60-88 x 10(6)) using seven combinations of filters, collection software, and PRF rest periods. Ninety-three percent of PPH units rested prior to filtration with LRF6 (N = 237) had < 5 x 10(6) WBC POF, with a mean of 5 x 10(6) WBC POF. All PPH units filtered with LRF10 (N = 135), whether rested or not, had < 5 x 10(6) WBC POF, with a mean WBC count of 0.2 x 10(6) POF. Mean platelet (PLT) yields POF ranged from 3.1 to 3.4 x 10(11). A PRF rest decreased mean POF WBC counts in products filtered with LRF6. The LRF10 consistently produced PPH with < 5 x 10(6) WBC POF. Blood centers must thoroughly validate equipment utilized in the production of blood components.
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Affiliation(s)
- M J Drew
- University Hospital of Arkansas Blood Bank, Little Rock 72205, USA
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37
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Heddle NM, Klama L, Singer J, Richards C, Fedak P, Walker I, Kelton JG. The role of the plasma from platelet concentrates in transfusion reactions. N Engl J Med 1994; 331:625-8. [PMID: 8052271 DOI: 10.1056/nejm199409083311001] [Citation(s) in RCA: 330] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Febrile, nonhemolytic transfusion reactions are the most frequent adverse reactions to platelets. A number of observations argue against the widely held view that these reactions result from the interaction between antileukocyte antibodies in the recipient and leukocytes in the platelet product. We sought to determine whether substances in the plasma or the cells in the product cause reactions to transfused platelets. METHODS We separated standard platelet concentrates into their plasma and cellular components and then transfused both portions in random order. Patients were monitored for reactions during all transfusions. Before each transfusion, the concentration of cytokines (interleukin-1 beta and interleukin-6) was measured in the platelet products. Studies were also performed on the platelet products to determine the effect of storage on the concentration of cytokines. RESULTS Sixty-four pairs of platelet-product components (the plasma supernatant and the cells) were administered to 12 patients. There were 20 reactions to the plasma supernatant and 6 reactions to the cells (chi-square = 6.50, P = 0.009). Eight transfusions were associated with reactions to both products. The plasma component was more likely to cause severe reactions than the cells (chi-square = 9.6, P < 0.01). A strong positive correlation was observed between the reactions and the concentration of interleukin-1 beta and interleukin-6 in the plasma supernatant (P < 0.001 and P = 0.034, respectively). In vitro studies demonstrated that interleukin-1 beta and interleukin-6 concentrations rise progressively in stored platelets and that these concentrations are related to the leukocyte count in the platelet product. CONCLUSIONS Bioreactive substances in the plasma supernatant of the platelet product cause most febrile reactions associated with platelet transfusions. Removing the plasma supernatant before transfusion can minimize or prevent these reactions.
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Affiliation(s)
- N M Heddle
- Department of Pathology, McMaster University, Hamilton, ON, Canada
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38
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Heaton WA, Holme S, Smith K, Brecher ME, Pineda A, AuBuchon JP, Nelson E. Effects of 3-5 log10 pre-storage leucocyte depletion on red cell storage and metabolism. Br J Haematol 1994; 87:363-8. [PMID: 7947280 DOI: 10.1111/j.1365-2141.1994.tb04923.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A new, in-line high-efficiency 3-5 log10 leucodepletion filter system (Leukotrap RC system) was used to investigate the effect of pre-storage white cell removal on the quality of AS-3 red cell concentrates stored for 42 d at 4 degrees C. Median residual white cell content was 4 x 10(5) when filtration was performed at 22 degrees C within 8 h of phlebotomy (n = 20) and 3.2 x 10(4) when filtration was performed at 4 degrees C 12-24 h after phlebotomy (n = 24). None exceeded 1 x 10(6) WBC per red cell product. Filtration was rapid (median 28 min), and red cell loss averaged (mean +/- 1 SD) 6.4 +/- 0.7%. In a paired study design, post-transfusion recoveries of 42 d stored red cells in the filtered units averaged 84 +/- 6% v 82 +/- 8% for unfiltered units (P < 0.05) and post-storage haemolysis. ATP, osmotic fragility, K+ and pH were significantly (P < 0.05) better in the filtered units. Reduced glycolytic activity was also observed in the filtered units, and there was a correlation between osmotic fragility, glucose consumption, and lactate produced in standard units that was not present in leucodepleted units. In conclusion, this study suggests that leucodepletion of AS-3 red cell concentrates prior to storage results in better maintenance of the integrity of the red cell membrane with reduced glycolytic activity. There was a modest improvement in post-infusion viability sufficient to offset the filtration-induced loss and to result in an equivalent red cell product.
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Affiliation(s)
- W A Heaton
- American Red Cross Blood Services, Mid-Atlantic Region/Eastern Virginia Medical School, Norfolk
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39
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Farrugia A, Tan Y, Romeo A, Martin L, Rolland JR, Kellner S, Piouronowski H. Relative efficiency of leucocyte removal procedures for the production of leucocyte-poor red cell concentrates assessed by flow cytometry. Vox Sang 1994; 66:153-60. [PMID: 8036782 DOI: 10.1111/j.1423-0410.1994.tb00302.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Flow cytometry was used to: (1) determine residual leucocyte numbers in red cell suspensions following the range of leucocyte depletion procedures used in our organisation, and (2) to characterize phenotypically the leucocytes using direct immunofluorescence with monoclonal antibodies to cell surface receptors. Under the conditions used, a lower limit of detection of 2.5 leucocytes per microliter (equivalent to 3.43 log10 or 99.96% removal) could be achieved. Filtration through polyester filters was found to remove up to > 99.96% of the initial leucocytes; however, a significant differential efficacy was observed between filters from different manufacturers even when filters with similar costs were compared. The order of filter brands with respect to leucocyte removal found was Pall BPF4 = Erypur Optima G-O > Sepacell R500 > Pall RC50. Phenotyping revealed that increasing filtration efficacy was associated with a preferential removal of lymphocytes; conversely, a second filtration over one brand of filter allowed proportionately more lymphocytes to pass through compared with the first filtration. A saline wash following filtration removed a further 0.5% of the initial leucocyte content, and was associated with a preferential loss of granulocytes. Freeze-thawing the red cell suspension removed fewer leucocytes (96.3%) than did filtration (98.74% to > 99.6%) or filtration followed by washing (99.22%), and also led to preferential loss of granulocytes. Flow cytometry provides a reliable tool for the quality control of leuco-depleted red cells, and allows a qualitative assessment of the residual leucocytes. This information is of value in choosing procedures aimed at decreasing the risk of alloimmunisation and post-transfusion reactions.
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Affiliation(s)
- A Farrugia
- Red Cross Blood Transfusion Service, South Melbourne, Australia
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40
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Goodnough LT, Riddell J, Lazarus H, Chafel TL, Prince G, Hendrix D, Yomtovian R. Prevalence of platelet transfusion reactions before and after implementation of leukocyte-depleted platelet concentrates by filtration. Vox Sang 1993; 65:103-7. [PMID: 8212663 DOI: 10.1111/j.1423-0410.1993.tb02124.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
To determine the impact of platelet leukodepletion by filtration on the overall prevalence of reported transfusion reactions associated with platelet concentrates, we audited platelet transfusion reactions after infusion of platelet concentrates reported at University Hospitals of Cleveland over 6 months before (interval 1, July 1, 1989 to December 31, 1989) and after (interval 2, July 1, 1990 to December 31, 1990) implementation of the Pall PL 50 filter on our adult Hematology-Oncology inpatient unit (Division 60). Thirty-two (1.7%) of 1,901 random, pooled platelet transfusion events resulted in blood bank transfusion reaction workups in interval 1, compared to 90 (5.3%) of 1,704 in interval 2 (p < 0.001). The Division 60 service accounted for more of our hospital-wide platelet reactions after implementation of the filter in interval 2 (84%) than before filtration in interval 1 (42%), p = 0.002. The prevalence of reaction workups for Division 60 was 0.6% for interval 1, compared to 4.3% for interval 2 (p < 0.001). No differences were found between interval 1 and interval 2 for the rate of discontinuation of platelet transfusion (36 vs. 32%, p = 0.14), rate of premedication for platelet transfusion (72 vs. 65%, p = 0.6), percentage of direct antiglobulin test-positive reactions (17 vs. 5.4%, p = 0.09), percentage showing icteric/hemolyzed serum (15 vs. 4.4%, p = 0.09), or reactions believed to be due to red blood cell incompatibility (8.8 vs. 1.1%, p = 0.1).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- L T Goodnough
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio
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41
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Hau F. [Leukocyte depletion of blood products and transfusion tolerance]. REVUE FRANCAISE DE TRANSFUSION ET D'HEMOBIOLOGIE : BULLETIN DE LA SOCIETE NATIONALE DE TRANSFUSION SANGUINE 1993; 36:293-6. [PMID: 8347252 DOI: 10.1016/s1140-4639(05)80188-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Leukodepletion of red blood cell or platelet concentrates decreases significantly the number of febrile non hemolytic transfusion reactions. Filtration appears to be very efficient on red blood cell transfusion reactions while its effect with platelet concentrates remains variable.
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42
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Mincheff MS, Meryman HT, Kapoor V, Alsop P, Wötzel M. Blood transfusion and immunomodulation: a possible mechanism. Vox Sang 1993; 65:18-24. [PMID: 8362511 DOI: 10.1111/j.1423-0410.1993.tb04519.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
To induce an immunogenic response in vivo, an antigen-presenting (stimulator) cell must present both antigen-specific (class II MHC) and an accessory signal to the CD4 T cell. Failure to express the accessory signal has been shown in vitro to induce a state of specific unresponsiveness (anergy) in the T cell. We have shown that although stimulator cells in blood continue to express class II MHC molecules during refrigerated storage, their ability to present the accessory signal diminishes, reaching zero in all units tested by about 13 days. This implies that blood in excess of 2 weeks old should not alloimmunize but could induce some degree of immunosuppression. UV-B irradiation and, to a lesser extent, gamma-irradiation, were also shown to inhibit expression of the accessory signal by stimulator cells in blood.
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Affiliation(s)
- M S Mincheff
- Holland Laboratory, American Red Cross, Rockville, MD 20855
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43
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Norol F, Bachir D, Bernaudin F, Beaujean F, Desforges L, Duedari N, Galacteros F. Frozen blood and transfusion-transmitted hepatitis C virus. Vox Sang 1993; 64:150-3. [PMID: 7683446 DOI: 10.1111/j.1423-0410.1993.tb05153.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The purpose of the present study was to evaluate the impact of frozen red cell transfusion on the transmission of hepatitis C virus (HCV) before the introduction of blood donor screening. Anti-HCV antibodies were detected in 59 patients with sickle-cell disease who required chronic transfusions and had exclusively received frozen red blood cells (RBC). The files were reviewed for clinical signs of chronic hepatitis C. Anti-HCV antibodies were detected in 2 adult patients; both also had clinical evidence of HCV infection. No other patient showed signs of acute or chronic HCV hepatitis. In a control group of 28 patients who had received nonfrozen RBC transfusions, the prevalence of anti-HCV antibodies was 25%. So, our study seems to indicate that the use of frozen RBC had reduced the risk of HCV contamination.
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Affiliation(s)
- F Norol
- Centre Départemental de Transfusion Sanguine du Val de Marne, Créteil, France
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44
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Choudhry VP, Desai N. Supportive therapy in management of leukemias. Indian J Pediatr 1993; 60:211-25. [PMID: 8244496 DOI: 10.1007/bf02822179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- V P Choudhry
- Department of Hematology, All India Institute of Medical Sciences, New Delhi
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45
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Pietersz RN, Steneker I, Reesink HW. Prestorage leukocyte depletion of blood products in a closed system. Transfus Med Rev 1993; 7:17-24. [PMID: 8431656 DOI: 10.1016/s0887-7963(93)70029-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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46
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Muylle L, Wouters E, De Bock R, Peetermans ME. Reactions to platelet transfusion: the effect of the storage time of the concentrate. Transfus Med 1992; 2:289-93. [PMID: 1339583 DOI: 10.1111/j.1365-3148.1992.tb00172.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Random platelet concentrates were pooled and depleted of leucocytes by centrifugation immediately prior to transfusion. The incidence and severity of reactions to 570 leucocyte-poor platelet transfusions in 74 patients were studied. An overall transfusion reaction rate of 13.7% was observed. The reaction rate to platelets stored for less than 3 days (8.7%) was significantly different from the reaction rate to platelets stored for 3 days or more (17.6%). Minor reactions as well as moderate and severe reactions were more frequent in the latter group. As most of the white blood cells were removed prior to transfusion, it is suggested that the reactions result from the transfusion of pyrogenic and/or vasoactive substances accumulated in the plasma of the concentrate during storage.
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Affiliation(s)
- L Muylle
- Blood Transfusion Center Antwerpen, Belgian Red Cross, Edegem
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47
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leukocyte-reduced blood components in transfusion medicine: Current Indications and Prospects for the Future. Clin Lab Med 1992. [DOI: 10.1016/s0272-2712(18)30483-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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48
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Crosby ET. Perioperative haemotherapy: II. Risks and complications of blood transfusion. Can J Anaesth 1992; 39:822-37. [PMID: 1288909 PMCID: PMC7100124 DOI: 10.1007/bf03008295] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/1992] [Indexed: 12/26/2022] Open
Abstract
Major life-threatening complications following blood transfusion are rare and human error remains an important aetiological factor in many. The infectious risk from blood transfusion is predominantly hepatitis, and non-A, non-B and hepatitis C (HCV) are the most common subtypes noted. The risk of post-transfusion hepatitis (PTH) appears to be decreasing and this is attributed to both deferral of high-risk donors and more aggressive screening of donated blood. Screening for HCV is expected to decrease this risk further. The risk of HIV transmission following blood transfusion is negligibly small. There are data to suggest that perioperative blood transfusion results in suppression of the recipient's immune system. Earlier recurrence of cancer and an increased incidence of postoperative infection have been associated with perioperative blood transfusion although the evidence is not persuasive. Microaggregate blood filters are not recommended for routine blood transfusion but do have a role in the prophylaxis of non-haemolytic febrile reactions caused by platelet and granulocyte debris in the donor blood. Patients should be advised when there is likely to be a requirement for perioperative blood transfusion and informed consent for transfusion should be obtained.
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Affiliation(s)
- E T Crosby
- Department of Anaesthesia, Ottawa General Hospital, University of Ottawa, Ontario, Canada
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49
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Häcker-Shahin B, Giannitsis DJ. Leucocyte depletion of neocyte-rich red blood cell concentrates by use of immunomagnetic beads. TRANSFUSION SCIENCE 1992; 13:261-4. [PMID: 10148129 DOI: 10.1016/0955-3886(92)90178-j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
In a series of pilot experiments we depleted neocyte-rich red blood cell concentrates of contaminating leucocytes by use of immunomagnetic beads. The beads were coated with monoclonal antibodies directed against the leucocyte common antigen CD 45. The number of cells isolated depended on the dose of beads which also corresponded to the decrease in leucocytes in the neocyte concentrates. The required ratio of beads to target cells was approximately 25:1, the depletion rate of leucocytes was about 96.0-99.8%.
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Affiliation(s)
- B Häcker-Shahin
- Blutspendezentrale des Städtischen Klinikums, Karlsruhe, Germany
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50
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Abstract
Blood filters have been available since the 1930s. In this review we evaluate the role of microaggregate filters (MF) in certain transfusion complications, namely non-haemolytic febrile transfusion reactions (NHFTR), pulmonary injury, thrombocytopenia, fibronectin depletion and histamine release. We review the latest generation of leucocyte depleting filters and discuss their role in preventing alloimmunisation, immunosuppression and CMV transmission. Finally, we provide a rationale for the role of blood microfiltration in the present day practice of intensive care medicine.
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Affiliation(s)
- F Kapadia
- Department of Anaesthetics, Queen Alexandra Hospital, Portsmouth, Hants, UK
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